On Trusting Experts

In 2019, I had a lot of friends who encouraged people to "trust the experts." A common criticism they made was to denigrate people who had "done their research," which was usually maligned to be something like watching three hours of ideologically motivated YouTube videos. The basic idea was that "Karen" and her having "done her research" was no match for an expert's years of study and advanced degree.

2020, of course, put an end to that sort of argument, at least as far as I've observed. No need to rehash the details here. The so-called "experts" gave befuddling and contradictory advice on managing the COVID-19 crisis, and then shut down the country for a year or more while the global economy ground to a halt. It was a disaster. Importantly, many of these same friends I had stopped criticizing people for "doing their research" and instead started criticizing people for "trusting the experts." 

These friends of mine were always on the side of what I would consider to be "the truth." That is, when the experts were largely correct, so were my friends; when the experts were largely incorrect, my friends were great sources of better information. But on the moral issue of advising people to trust experts, they flip-flopped.

As for me, I never criticized people for "doing their own research," because that's precisely what I believe everyone should do. No one should ever take for granted the idea that the experts probably know what they're doing. One should always verify information; and the more controversial or the more widespread the impact of that information, the more important it is to verify it. This kind of attitude comes easy to a type 1 diabetic, because we diabetics often know more about our condition than most of the doctors in our communities. We certainly know more about our own bodies than the "experts." We are used to "doing our own research" and arriving at life-saving conclusions to better manage our lives and our blood sugar.

Today, many people (say, about half the country) still insist on "trusting the experts" or "following the science" or whatever the canard happens to be. This morning, I thought about a hypothetical scenario that might help them understand the value and importance of skepticism.

Imagine you're a woman who has recently gone to her doctor to get a prescription for birth control, for the first time. You fill the prescription and start taking the pill. Very soon, you notice that your body feels very different. In fact, it feels awful. You're really uncomfortable all the time and you're struggling to just be normal. So, you go back to your doctor. He tells you that this is a common set of symptoms and that many women take time to adjust to the birth control pill. He advises you to stick with it. So, you do.

But months go by, and your discomfort doesn't let up even a little bit. Every time you think about going back to the doctor, you remember what he said. Some days you figure that you probably just need a little more time to adjust. Other days, you shrug and figure that even if there is some kind of underlying problem here, going back to the doctor is pointless, since he'll probably just tell you the same thing again, anyway.

One day, you come across a website or an internet forum of some kind, where many women describe symptoms a lot like yours, and many of them insist that the problem went away when they switched to a different kind of birth control pill. You know it's not real medical advice, but the women all seem very emphatic, so you figure, what will it hurt to try a different pill?

You make an appointment with a new doctor, you tell her that you want to try a new birth control pill. She shrugs and says sure, you can try it. She writes you a new prescription, which you fill. You make the switch and, sure enough, your symptoms let up a bit, and then a lot, and then after a few weeks, you feel completely normal again. You're back to your old self.

If you've ever been through something like this - or know someone who has - then chances are, you already understand the value of being skeptical of "the experts." You have gained some familiarity with internet research and you have an informed opinion of which other patients to listen to, and which to take with a grain of salt. You have developed a more nuanced understanding of which kinds of risks are worth taking, and which are not.

In doing so, you have equipped yourself with the tools required to verify the information that the nation's "experts" are giving you, and you have come to a point where you feel confident in the kind of research you are willing and able to do on your own time. There should be more people like you in the world, and fewer people out there who blindly trust "experts" just because they're "experts."

"Long Covid"

The news of the day is that so-called "long covid," persistent cases of COVID-19 that never seem to go away even after months, is possibly not real. Much of the data documenting "long covid" consists of self-reported survey data collected by an organization lead by "spiritualists," and many of the symptoms associated with it are identical to the scientifically debunked "chronic Lyme disease."

What could be going on here?

When I read about this, I'm struck by my own personal experiences. Diabetics like myself often take a long time to fight even simple things like the flu and the common cold. Such is life with a weakened immune system. A cold that other people get over in two or three days can sometimes persist in my body for two or three weeks. This is a fact: I can't "fake" or imagine three weeks of a runny nose. 

Coughs and chest congestion are somewhat easier to fake and/or imagine. One can truly believe that there's something in one's chest without there actually being something there. Headaches, fevers (especially mild ones), body pains, lethargy, fatigue, and so on, are all symptoms that can be imagined just as well as they can be experienced in reality. Put slightly differently, these symptoms are as real when they are psychosomatic as they are when they are the result of a viral infection.

When I was a young boy, I caught some stomach bug. My family and I were all downstairs watching MacGuyver when a sudden wave of nausea swept over me, and I threw up all over the carpet. I felt physically awful, but I was also mortified by the fact that I had just puked in front of everyone, that I hadn't had enough time to run to the bathroom. I can still see it in my memories as clear as day. Rightly or wrongly, the experience got into my head and stuck with me a long time. I developed a bit of a "complex" over it. For months - years? - I had to sleep on my stomach with a pan beside the bed. Every little twitch and gurgle in my stomach seemed like evidence that I was going to vomit. I'd wake up in the middle of the night with an imaginary stomach ache and sit with my bed pan, trembling, waiting to throw up. I'd run into the bathroom and just wait.

You could say that I was suffering from "long stomach flu." I had a little mental thing that I eventually out-grew. But were my stomach pains and gurgles real? Absolutely. One of the things that cured me was the realization that I could make myself feel nauseous just by thinking about it, and that before I knew it, things were really gurgling in there. 

The root cause of my "long stomach flu" was fear. I had had a real stomach bug which, when combined with a situation that seemed traumatic for a little kid, because a genuine and perhaps justified fear in my mind. Then the fear took over and manifested itself in physical symptoms that lasted a truly long time. To this day, I'm a bit scared to vomit, and I try to avoid it if at all possible - even when it would probably help me feel better. 

But the stomach flu is small potatoes compared to COVID-19. Today, society is confronted with an illness that, when serious, results in hospitalization, intubation, scarring of the lung and heart tissue, terrible fevers, and slow suffocation to death. Even when it's not a serious case, patients are forced to wonder if they will eventually develop deadly symptoms, and the timeframe between minor covid and terminal covid appears to be days. That is genuinely terrifying. As for those of us who have not been infected, COVID-19 has held us captive indoors, forced us to wear masks in public, stolen hugs and handshakes from us, paralyzed our economy, and created a kind of mass hysteria that many believe to be completely justified. 

In short, COVID-19 is terrifying enough to make manifest any number of psychosomatic symptoms, even in people who have never been infected by it. Rather than dismiss their suffering, we should compassionately acknowledge it; but, we should acknowledge it for what it is.

Those patients who must recover from pulmonary and myocardial scarring will probably take a long time to return to noromal. This is to be expected, since wounds take time to heal. During that time, such people will probably feel weak and sometimes lightheaded from lack of oxygen and/or low blood pressure, and/or any other predictable symptoms that come from such a significant cardiovascular ordeal. COVID-19 is certainly not unique in its ability to cause this kind of lengthy recovery. Pneumonia of various causes will produce a similar long recovery in patients who experience severe cases.

As for those patients who have few remaining physical signs of a COVID-19 infection, and still report spooky-but-vague "long covid" symptoms like aches and head "fog" and fatigue, it seems more likely to me that they are struggling with fear and psychosomatic problems. That's okay! We've all been through quite an ordeal with COVID-19, even those who never contracted it. 

We should not, however, sink over a billion dollars of public funds into chasing a phantom. Treat people with compassion and listen to their stories. Hug them and give them emotional support. But encourage them to rise above their fears, or at least to be aware of them. The last thing anyone needs is a false excuse to be coddled.

I'll say one final thing in closing. Early in the pandemic, I noticed that the number of people claiming in casual conversation to be "high risk for covid" seemed to exceed expectations based on disease prevalence. That is, a lot of people seemed to be adopting an "out of my way, I'm high-risk!" attitude. This attitude was not without its rewards. Remember that early in the pandemic, grocery stores had reserved shopping hours for high-risk populations. High-risk people were first to be admitted to the hospital, first to receive medical treatment, first to receive the covid vaccine. They also received extra lenience from their employers, and extra patience from friends and family. There were, and are, many incentives for people to claim high-risk status with respect to COVID-19.

Thus, it is not out of the question that many people who make these claims, and who make claims about "long covid" are, in fact, manifesting some form of Munchausen Syndrome, feigning illness for attention, sympathy, or personal benefit.

Life In A Global Pandemic, Part 12

I received the Moderrna COVID-19 vaccine.

Instead of selling it on the open market, the world's largest capitalist economy has decided to use central planning to distribute the vaccines. I wish I could say I didn't see that coming, but the global response to this virus has been a disaster of central planning from the very beginning. It stands to reason that the "end" (?) of the pandemic should unfold the same way.

Tarrant County provided a website, distributed mainly by word-of-mouth as far as I can tell, through which residents could register to receive the vaccine. It is not first come, first served. Instead, patients were linked to an electronic form, in which we disclosed our age, race, sex, and so on, along with any "preexisting conditions" we might have. This is to ensure that the vaccine goes first to the sick and the weak, rather than to the young, strong, socially active people who are probably responsible for transmitting the virus so widely. That said, I do think the old and the at-risk ought to have first crack at the vaccine.

"Luckily" for me, I acquired type 1 diabetes more than a decade ago. (Tempus fugit!) The county's electronic form doesn't differentiate between type 1 and type 2 diabetes, and of course it is only type 2 diabetes that is listed as the kind of "preexisting condition" that puts one at risk of death from COVID-19. Since I can't go on the open market and buy myself a shot, though, I didn't feel too badly about answering truthfully that I have "diabetes" and letting the health department sort out the details. Within a week, I had my appointment for receiving the vaccine scheduled.

The health department called me three times on Friday. I didn't recognize the number, so I let it go to voicemail. In any case, it was an automated call all three times. They also sent me three identical emails the text of which was verbatim to the phone calls I received. The emails contained a link to confirm my appointment, and so I did. The appointment was scheduled for the following day "between 9 AM and 11 AM."

I showed up at about 8:45 AM, and there was already a long lineup of cars waiting to park. Police split traffic up into four separate queues, which eventually merged back into two separate lines. Once we found a parking space, we lined up again inside the building - two separate lines this time. I waited in line for perhaps 40 minutes, during which time volunteers checked my paperwork no less than five times. Finally, I arrived at a registration table, where my paperwork was checked again, my driver's license and insurance information were taken down, and then I was directed into an all-new queue. This queue happened to split into two lines for about 20 yards, before merging back into one queue again. Central planning is wonderful, isn't it?

At last, I was allowed inside a conference room, where I sat at a table and someone administered the vaccine. I was then directed to a second person who gave me my "vaccine card," along with a memorized set of instructions that I will never be able to remember. The gist of it was that I needed my "vaccine card" to get my second vaccine dose, which I will be able to receive in four weeks' time. She also told me, despite CDC information to the contrary, that I cannot mix vaccines, meaning that since I received the Moderna vaccine, I should only get the Moderna vaccine for my second dose, otherwise it won't work. Finally, she gave me a sticky-note with a time written on it: 10:14 AM, the time when I would be allowed to leave the building. Apparently they make people wait in the conference room for 20 minutes to ensure that nobody has an adverse reaction to the vaccine.

Then I went home.

My sister had received the Moderna vaccine a few weeks before I did. By her account, the vaccine causes muscle cramps, tiredness, feverishness, and so on. I expected to have a similar experience, so I quickly went for a nice, hard run when I got home. I figured that if I was going to be out of commission for a day or two, I should get a good workout in before I started feeling down.

None of those adverse reactions happened for me. The injection site became about as sore as it would be for a tetanus or DTAP vaccine. I did not experience tiredness, pain, fever, or anything else. I feel perfectly fine.

I would recommend the vaccine to others. Hopefully, most everyone will eventually receive an effective vaccine, and the spread of this disease can be minimized as much as possible. I understand that this is one of the first widely used mRNA vaccines ever made. I was curious about it for that reason. This is a new mechanism of action, one that has not previously received widespread federal approval. (According to a handout I received when I was given my vaccine, the Moderna vaccine is "not FDA-approved." They want everyone to know that they are getting an unapproved vaccine, presumably so that no one will ever think to blame the FDA if something goes wrong. Nothing says "accountability" quite like government.) I think now that the concept has essentially been proven, we can expect to see more mRNA vaccines in the future. This could mean a cure for the common cold, to say nothing about all the other, more serious, diseases we might be able to cure with new vaccine technology. 

If there is anything positive about any of this, that's it. It's exciting to be a part of medical history. I'll let you know if I grow a demonic hand or something, but at this point I am expecting it to be smooth-sailing from here.

Stationary Waves And Coronavirus

The concept of temperance has been a feature of this blog for many years. When I talk about temperance, I'm not talking about eschewing alcohol, but the two ideas do have commonalities. Temperance, broadly construed, means having enough restraint to not just do, you know, whatever the hell you want to do, whenever the hell you want to do it. Temperance means keeping your hedonic urges in check long enough to make sensible decisions in accordance with your longer cognitive time-horizon. See this old post on the issue for a brief primer.

There are many articles and blog posts out there discussing the matter of what is the correct policy response to the coronavirus epi/pan-demic. There is plenty of criticism to go around. Who did what, and did they do it how soon? What aspect of testing or messaging did the CDC botch, what can be learned from the mass quarantines in other countries?

In one sense, I think it's natural that people want to look at it from those angles. I can sympathize with that inclination. It's much easier to have a debate about public policy and to get worked up about all the wrong things someone else did than it is to simply acknowledge that pandemics occur approximately once every one hundred years, and that using political machinery to stop the spread of viruses is ultimately a futile endeavor. We'd have better luck stopping an incoming asteroid.

The fact of the matter is that there is nothing that the government can do to protect you from communicable viruses. They will spread, because that's what viruses do. It's the circle of life.

On a personal note, most readers will probably have nothing to worry about with respect to COVID-19, anyway; the death rate for most people appears to be somewhere between 0.1% and 1.0%. Those are very good odds for a virus like this. But for me, it's different. I'm "immuno-compromised." I'm a type 1 diabetic. For me, the death rate might be something more like 9%, and the rate of hospitalization independent of death is much higher for me than it is for the population at large.

This thing can kill me.

On the one hand, we could say that coronavirus is a public health emergency. On the other hand, we should probably say that the public health emergency already exists. I see just how much other human beings spread their germs around on a daily basis. You people are absolutely filthy. I see multiple people per day walk out of public restrooms without washing their hands. I see people playing with their noses, mouths, eyes, and then putting their hands all over public surfaces. I see people cough without covering their mouths, I see people spit out of their car windows, I see people blow their noses by plugging one nostril, leaning to the side, and blasting debris onto the sidewalk. It's disgusting. And these aren't low-brow "others" in some "other" part of town. These are the middle and upper class people in "nice" neighborhoods. These are the normies. And they're filthy, filthy people.

Earlier this morning, I saw a Facebook advertisement for a bidet. The comments under the ad were everything I've come to expect from filthy Americans. They expressed incredulity and skepticism, they laughed, they mocked, they teased... This is happening during a global pandemic. Here we have a centuries-old device that can vastly improve American hygiene and reduce the spread of communicable illness, and even during a global pandemic Americans' response is one of mockery and skepticism.

That mockery and skepticism, combined with Americans' refusal to wash their hands, cover their mouths, and avoid blowing their noses on the sidewalk, is what will ultimately be to blame for the spread of coronavirus and diseases like it. It's easy to point fingers at the CDC for botching "testing," but the demand for "testing" would be decidedly low if Americans knew how to wash their hands, backsides, and faces, and knew how to keep public surfaces clean and disease-free.

Naturally, there's nothing I can do from my perch above my keyboard, writing on an unread blog about how Americans are a travesty of public filth. But maybe things could get a little bit better on the margins if we all thought a little bit more about temperance.

If you find it tempting to blow your nose on the sidewalk, exercise a little temperance. Find your way to the nearest tissue, and use that instead. If you find it somewhat of a hassle to wash your hands every time you use the bathroom, exercise a little temperance. The expedient thing is to skip the hand-washing step, but the right thing to do is to wash your hands. You might not see the point of covering your mouth when you cough or sneeze in the privacy of your own work cubicle, but I urge you to exercise a little temperance on the margins. Cover your mouth, then go wash your hands. And, for god's sake, get a bidet. They are $15 and install in seconds. Jesus.

Practically speaking, it's unlikely that you'll be able to prevent every cough, sneeze, and itch that needs scratching. You won't always be able to find your way to a bathroom in time to wash your hands or do whatever else you need to do. But if you can exercise a little temperance on the margins, then there's a slightly better chance that people like me won't die.

Please, I beg you, exercise a little temperance. Be a little bit more hygienic. This disease does not really need to spread widely in an environment in which people practice good hygiene.

Cleaning Your Room

For many years, I was the sort of man who believed that the path to success and the solution to every problem was to simply work harder and become the best at whatever it is he happened to be doing. While a strategy like that bears sweet fruit in the teenage years, the so-called real world has a way of making mincemeat of it.

So it was one morning, when I found myself sinking into the earth-toned cushions of an old, uncomfortably squishy sofa at the far end of a psychiatrist's office. He was an incomprehensibly thin man with a patch of white hair bursting from the top of his head like water from a lawn sprinkler; his shirts were always plaid, and always of the same earth tones as his sofa; he spoke with earnestness, but I could always tell that he left too much unsaid, usually in response to something I had said -- a terrible quality in a psychiatrist. He also kept two small dogs on the premises with them; they, at least, were a soothing presence in the office.

I found my way into his office by route of my career: No matter how hard I worked, and no matter how good I became at my work, the assignments got worse, the company struggled, and the attitude in the office got darker and darker. A level-headed man could take such things in stride, but this was my first venture into the world of not being able to turn the beat around when the song started to drag, as it were. And this song, to be sure, had become a funeral dirge.

I hadn't much experience in therapy, so like most folks, I went into it with preconceived notions. We would talk about my feelings, I thought. The good doctor would identify some problems with my way of thinking, and help me correct course. Before long, my attitude would be adjusted, and I could go back to doing my work with the kind of pep and ambition I longed for.

In the long run, it didn't quite happen that way. After making weeks of appointments, I eventually figured out the solution to my own ennui. I told the doctor at my final visit that I wouldn't be making another appointment, since it didn't seem necessary. He asked me then, "Would you mind telling me what worked for you?" I told him was something he said -- focus on the things you can control -- that made all the difference. I did that, and life got better. He seemed puzzled.

What brought the old doctor to mind this morning was the sad story of Jordan Peterson, and the memory I had of my first visit to a clinical psychologist.

Sitting in that earth-toned tar pit of a sofa with a small dog rubbing its wet nose against my dangling fingertip, my doctor asked me whether I'd considered antidepressant medication. I told him no, and that I would like to avoid doing so. He accepted my wishes, but first went on a brief soliloquy about the virtues of psychoactive medication. He told me that when he first started his practice, he, too, was skeptical of medication, but eventually came to see it much the same as taking an aspirin. We take an aspirin when we have a headache, and we think nothing of it; the doctor's position was that we ought to think similarly of antidepressants. He delivered his monologue in a pleasant and reasonable way, with calm and academic vocality. I did not come away with the impression that he was either arguing with me or trying to push medication on me. Instead, it seemed as though he wanted his office to be a safe place to discuss the therapeutic benefits of short-term psychoactive medication. But I did not pursue the matter any further, and so neither did he.

Yet, I can't help but wonder what a less thoughtful -- or more deeply troubled -- patient would have done in the face of such a calmly put suggestion by a qualified mental health practitioner in a time of need. It's not difficult for me to imagine that the marginal patient could be persuaded to fill a new prescription for psychoactive medication. In some cases, this might be entirely justified; in others, it might indeed be the wrong course of action. We trust our doctors to make that determination for us, but maybe we shouldn't.

The psychiatrist I saw that day was both an academic working at a university and a practicing clinical psychologist. Jordan Peterson can also make that claim. I point this out to venture a guess that perhaps these two men, similarly aged and of similar pedigree and professional background, held similar views on medication.

The National Post reports that Peterson began taking his medication "to treat anxiety after what [his daughter] described as an autoimmune reaction to food." This is a familiar issue to me: I once suffered anaphylaxis in response to eating a Brazil nut, and for years dealt with the fear of accidentally eating a nut and dying. Such fear is a very real and very palpable thing, and I would never minimize it. Still, it would never occur to me to address a problem like that with anti-anxiety medication, much less with hefty compounds like benzodiazepine tranquilizers.

But perhaps a man like Jordan Peterson, educated in accordance with modern of psychiatric medicine, would think almost nothing of it, just as we don't think twice about taking aspirin for a headache. If so, it would be a terrible lesson to have to learn the hard way.

I'm fond of Jordan Peterson's philosophy of life. I think it's a difficult road to follow, but a very worthwhile one for those capable of doing so. It saddens me to see such a strong advocate of living a deliberately moral life come face-to-face with his own moral failings in such a painful way, a way that risks such terrible long-term neurological damage, and in so public a fashion. The weaker thinkers among us, and those with a taste for schadenfreude, will (and have) pounce on this opportunity to denigrate a man who simply advocated that we live life according to our own moral compasses.

As hard as it will be for the critics to understand, Jordan Peterson's moral compass didn't actually fail him. He most likely took tranquilizers because he genuinely believed that they were the correct way to treat his anxiety. He most likely arrived at that belief through his own scientific expertise in psychology. When his addiction became obvious, he submitted himself to treatment. These are, simply stated, correct moral decisions. Unfortunately for Peterson -- and for all of us -- the world of psychology has not yet caught up with what the rest of the world already knows about tranquilizers.

Jordan Peterson nearly got himself killed. On the wrong day, for the wrong person, at the wrong doctor's office, it could have plausibly happened to me, or to you. Let us remember this episode, then, and learn another important thing from Dr. Peterson. Psychoactive medications are no mere aspirin, to be taken as for when we have headaches. They are powerful, dangerous substances that can leave a lasting and negative impact on your life, even on your legacy.

Be careful out there.

A Word Of Caution

Incredibly, it is now 2019. I've been blogging for over a decade, and my life has undergone many changes since I started. I've now reached middle age, and so I suppose there's no shame in blogging about middle-aged things. Perhaps you can benefit from reading this.

For most of my life, my blood pressure has been on the low side of the normal range. Regular readers will understand why that is: I'm an enthusiastic and borderline-obsessive fitness nut and distance runner. Imagine my surprise, then, when a routine medical checkup resulted in a reading of "State 2 hypertension," 140/90. That's high blood pressure.

Well, I thought, it's just one reading. Besides that, my blood sugar was high that day; it stands to reason that my blood pressure may have temporarily spiked. I wrote it off. Then, a couple of weeks back, I was at the pharmacy and got curious, so I strapped myself into one of those blood pressure kiosks and took another test. The result was the same. I took a few deep breaths, relaxed, and tried again. The result was confirmed again.

For a moment I started to worry. When otherwise-healthy people get hypertension, it's usually indicative of very serious health problems. When otherwise-healthy diabetics get hypertension, it usually means kidney failure. I admit it, I was scared.

My mind raced back to events from the past few months. What could cause sudden hypertension? What would have indicated kidney failure? The thing was, I felt perfectly fine. Still, there were some very odd things that had happened recently. The most jarring of those was this: One day my urine was an absolutely bizarre dark brown color. Upon seeing it, I frantically googled every conceivable health and medical website and deemed that I was either severely dehydrated, or indeed, I had kidney failure. I spent the next twenty-four hours drinking as much of every possible fluid as I could. I downed two cans of chicken broth, a pot of coffee, a liter of sparkling water, multiple cups of tea, and who knows -- possibly a gallon of water.

The next time I went to the bathroom, everything had returned to normal. I breathed a deep sigh of relief. I was fine. But, was I? Suddenly, a few weeks later, I had hypertension.

I decided to approach this new situation the same way as the other one. Rather than accept that I had kidney failure, I decided to make incremental changes to see what impact that would have. So I went from drinking about four cups of coffee per day (two with breakfast, and one or two during the workday at the office) to drinking a cup of tea for breakfast, and perhaps another in the evening. Basically, I eliminated caffeine from my diet almost entirely. I also reduced my alcohol intake.

The result of eliminating caffeine was that my blood pressure returned to normal within three days. Three days.

I never would have guessed that a coffee habit -- something that I've been maintaining for twenty years or more -- would cause high blood pressure suddenly. I figured if it ever happened, it would happen gradually if at all. So the first thing I'd like my readers to know is that caffeine can cause high blood pressure "all of a sudden," even if you've been drinking it for years. The second thing I'd like my readers to know is that your blood pressure will become completely normal again if you stop drinking caffeine.

Now a word on withdrawal. I've never been someone who was highly stimulated by caffeine. It never kept me up at night, and never gave me the jitters. I could drink one cup or eight cups and feel pretty much the same in all cases. In light of this, I was not expecting to experience withdrawal symptoms from quitting coffee. I was wrong. While I didn't get the headaches that other people report, I was overwhelmed by fatigue, which lasted about three days. I was falling asleep in the early afternoon while hard at work. I had to take two days off from exercising because my body wouldn't physically move. It was bearable, but unpleasant. I was so tired that I almost felt drunk.

I hate to admit it, but my body feels a lot better now. I do miss the taste of a great cup of coffee, but I'm tolerant of the decaf they give us at the office, and there is no way that I would trade the way I feel now for a cup of coffee. After years of believing that coffee was just a great-tasting way to enhance life, I've suddenly discovered that being uncaffeinated actually feels better. So, I'd like my readers to know that if you ever have the chance to stop drinking coffee, go for it. I think you might discover, like I did, that it feels good to be caffeine free.

I did drink a diet Coke yesterday. It didn't give me jitters, nor did it elevate my blood pressure. I think it's probably okay to drink one caffeinated beverage per day and still enjoy the benefits of being caffeine-free. As for me, I'll try to avoid it from now on.

Creatine Update

A short while back, I posted briefly on creatine. Just to recap, my thinking was that most of the benefits that can be gained from creatine supplementation can be gained merely by increasing one's water consumption without taking creatine.

I had posted that I intended to stop taking creatine and just drink more water instead. So I did. For the past few weeks, I've been drinking no less than a liter of water between 7:00 AM and 11:00 AM, every day. (That's roughly between the time I arrive at work in the morning until the time I go to lunch.) In addition to that, I drink approximately 16 ounces of water at breakfast, along with another 16 ounces of water + milk in the form of two homemade cafe lattes. At lunch, I drink about 30 more ounces of water (just shy of another liter). I'll drink perhaps 12-24 ounces of water at dinner, and then throughout the evening, I'll have a cup of tea and another glass of water.

As you consider the above, please keep in mind that I live in a very hot and humid climate, and I work out 1-2 times per day. If a sedentary person in a more temperate climate were drinking this much water, I think it would make them sick. But for an active person living in Texas during the summertime, I believe this represents heightened, but reasonable, water intake.

Another thing I should mention is that I have significantly reduced the amount of alcohol I drink. Until recently, I've been having wine with dinner, and beer occasionally. Recently, I've eschewed alcohol unless I'm out socializing with friends. Reducing the amount of alcohol I drink also reduces the dehydrating effects of alcohol, therefore improving my body's overall hydration.

The result of all this additional hydration cannot be measured by "increased muscle mass," as is typically advertised on the label of a bottle of creatine, because I'm not a bodybuilder, and I'm not trying to increase my muscle mass. As a distance runner, however, my experience with creatine was that it helped my muscles feel fresh when it came time to do fast runs and speed workouts. (They felt fresh before any workout, really, but it was most noticeable during the most strenuous workouts.)

With that in mind, I'm pleased to report that my subjective experience with hydration in lieu of creatine supplementation is that, so long as I drink enough water, I can enjoy all the benefits of creatine without the actual creatine.

So, drink up, folks. All that additional water will likely help you feel every bit as good as you feel after a couple of weeks of creatine supplementation.

Is It Unfair To Be Born Faster Than Everyone Else?

NBC news reports:

The IAAF wants Semenya, Niyonsaba and other female athletes with high levels of natural testosterone to lower them — either through medication or surgery — to be eligible to compete in events from 400m to the mile at top track meets like the Olympics. The IAAF argues that female runners with abnormally high testosterone levels have an unfair advantage.

When is an advantage unfair?

Steroids are made from synthetic testosterone, which is why they call them ster-oids. The issue in this case seems to be that athletes who are born with naturally elevated testosterone levels are capable of building larger, stronger, more powerful muscles than other athletes.

It's true that steroids give athletes an unfair advantage. Steroids create the kind of athletic advantage that cannot be overcome by training alone. They're also hazardous substances that cause major health problems for users over time. The reason steroids are banned substances is because, if they weren't, all athletes would be required to permanently jeopardize their health just in order to be able to compete, let alone win. Officials don't want to foster a sports atmosphere in which medical intervention is the major determinant of elite competitiveness. That all makes sense.

But, in this case, we're not talking about any of that. We're talking about women who have naturally elevated testosterone levels. They didn't ask for elevated testosterone levels. They didn't aggravate their levels. They were simply born on the upper tail of the bell curve and found a way to make use of their natural hormonal profile: Train hard, and win races.

At the elite level, every advantage counts. It is probably true that an athlete with abnormally low testosterone levels will always lose to an athlete with abnormally high levels. In a cosmic sense, that might not be fair. It certainly comes down to pure, dumb luck. But in the sense of starting from a blank slate and rising to the upper echelons of competitive sports through hard work, isn't it impossible to call this "unfair?"

There are a few problems here. First, "normal" testosterone levels are not a static thing. We don't have testosterone records that go back 500 years, but I'm willing to bet that, just as humans have grown taller over time, so human testosterone levels have changed. So who's to say that the line drawn today is worthy of setting a competition policy on?

Second, elevated testosterone is something experienced by multiple athletes in the same competition. There is no evidence that these races have come down to "whoever has the highest testosterone levels on race day wins." Instead, there has simply been a trend showing that those who test high also tend to perform well. The correlation is clear enough, and perhaps also the causation, but there's still a lot more to it than hormones.

Third, if the IAAF can make a determination about how much is too much testosterone among women, does that mean they also plan on doing so for men? Or is "too much testosterone" only something that matters among women? If this rule applies to both sexes then the IAAF will have a lot to account for when they start demanding medical intervention for qualification. And if the rule only applies to one sex and not the other, despite the fact that both sexes make testosterone, it's impossible to see this as anything other than sex discrimination, even beyond the medical discrimination issue already being discussed.

And finally, what does it mean to become a great athlete if the very biological differences that give us an advantage over our competitors are outlawed from competition? Will the IAAF eventually decide that only people of average height be able to compete? Only those with average-sized hearts or average hemoglobin levels? Should people of above-average intelligence be banned under the argument that they can train smarter than all other athletes?

If the body an athlete was born with - naturally - disqualifies them from competition, then what if anything is fair?

Supplementing My Life Away

For a while now, I’ve been adding supplements to my diet, and I’d like to dedicate some space here to the supplements I’m taking and why.

I started taking a multivitamin some years ago. While I recognize that there is little evidence that these vitamins are actually absorbed, they don’t cost very much money, and I am a diabetic. Diabetic people don’t absorb vitamins very well. There are two ways to think about this: The first is that we diabetics have even less of a reason to take a multivitamin; after all, if “normal people” can’t absorb the vitamins in a vitamin pill, diabetics are even less likely to be able to do so. The other way to think about it is that, since I’m getting fewer vitamins from my food than “normal people do,” I should throw more vitamins at the problem in hopes that it does some kind of something for me. I chose the latter way of thinking about it, although I concede that the former is probably more logical.

For a long time, that daily multivitamin was all the supplement I took. Then, one day, a colleague of mine at work mentioned that he was taking milk thistle. He didn’t strike me as being the voodoo-hippie-supplement type, so I asked him about it. He said that milk thistle was good for your liver, and from this I gathered that my colleague started taking milk thistle as an insurance policy against his appetite for weekend partying. No judgement here, he was a virile twenty-something guy doing what virile twenty-something guys do. But it was enough to cause me to do some research on milk thistle. As it turns out, milk thistle is genuinely excellent for the liver. The data is pretty clear on that, it successfully lowers the primary marker for liver disease. I’m not a hard-partying twenty-something, but we diabetics, in addition to poor vitamin absorption, often suffer from liver failure. So, I started taking a half-dose of milk thistle daily as a preventative measure.

That brought me up to two daily supplements, but after a short while, that wasn’t enough for me. I started to wonder, if there are legitimate supplements out there, like milk thistle, what else might I be missing? I started to do some more research, ruling out all the useless supplements and getting curious about the ones that had data to back them up.

One supplement I discovered was called “phosphatidyl serine.” According to some research, there is some weak but not terrible evidence that phosphatidyl serine reduces the cortisol response in the body after exercise. If true, this would prevent my blood sugar from spiking after a hard workout. I bought a bottle and started taking it daily, but eventually looked at the ingredients list. There was only one ingredient: soy lecithin. After some additional research, I realized that the reduction in post-exercise cortisol was something that could be achieved by eating some protein; so the main benefit of phosphatidyl serine is that it’s a miniscule amount of protein.

So, I struck out there. But no big deal. It was a harmless health experiment.

Next on my list was glucosamine. Glucosamine is often prescribed to arthritic dogs, and since it’s over-the-counter, arthritic humans also sometimes take it. It’s not a cure for arthritis, not by a long shot, but it has strong evidence in its favor. That is, the evidence suggests that it very definitely does some good, but only a little bit of good. It’s also cheap and has no side-effects, so I bought a bottle and started taking one daily. This time, the experiment worked like a charm: I have literally not had tendinitis since I started taking glucosamine, despite increasing my exercise frequency and running perhaps more than I have in the previous ten years. To be fair, I don’t know for sure that glucosamine is what made the difference here. Maybe I somehow managed to improve my running form after 30 years of great form. Maybe. But my family is prone to arthritis, and my anecdotal experience suggests that the glucosamine is doing some good. So I’ll keep taking it.

The next one I thought I’d try was coenzyme Q10. Coenzyme Q10 is a coenzyme that the body naturally produces and that helps the heart do what the heart does. Some people have a medical issue wherein their bodies are deficient in coenzyme Q10, and for those people the CoQ10 supplement is actually a total solution. The supplement restores their CoQ10 levels and they return to living normal lives. For most other people, there is no harm in CoQ10 supplementation, but it’s not clear that anyone really benefits from it. I did some research and discovered that, at least epidemiologically, diabetics tend to have lower than average CoQ10 levels. So, when it went on sale at Costco, I bought some. I figured, there are no side-effects, the price is right, and it might do me some good. I’ve never had my CoQ10 levels checked, but I am diabetic, so why not.

Here's where things get interesting. After several weeks of daily CoQ10 supplementation, I observed a very small improvement in my blood glucose control. In addition, I simply felt better. Was this a placebo effect? Possibly. But when I go on vacation, I don’t take my CoQ10 supplements with me, and I always feel a little worse. Then I get back home to my supplements, and I start to feel better again. I repeat: this might be a placebo effect. But it’s working for me, so I’ve been keeping up with my CoQ10. It seems to give me a little more energy and… I don’t know… spry-ness, maybe? Virility? (Not like that, perv.)

Two days ago I started taking Niagen. Niagen is nicotinamide riboside, i.e. a form of vitamin B3. The thing about nicotinamide riboside is that, as it gets absorbed in the cell, it “activates” some genes associated with anti-aging. Every form of B3 activates genes in order to absorb the B3, but only nicotinamide riboside activates these specific genes. This much is factual. The speculative theory is that, by activating these genes, nicotinamide riboside actually gets the body to do “anti-aging stuff.” If true, it would prevent some cell aging, notably in the brain, but also in the body, thereby preventing cognitive decline, and also physical decline. People self-report that nicotinamide riboside supplements make them feel younger, look younger, perform at a higher level of athleticism, get better sleep, and many other things. I have no idea whether these claims are true. But I decided to try a bottle and see what happens.

Finally, today, I started adding creatine to my post-run protein shake. The benefits of creatine are thoroughly described elsewhere. The short story is that creatine really does cause muscles to retain more water, and thus improves their ability to absorb nutrients and create ATP during exercise. In the end, this causes people who exercise to get a little bit more out of their training sessions. The reason I had previously avoided creatine was that it was supposedly contraindicated for diabetics. According to more recent research, however, that’s not true.

Another cool thing about creatine is that it is associated with higher levels of insulin-like growth factor, which has anti-aging properties, and which also (as the name suggests) lowers blood sugar levels. So, I’ve been keen to try creatine, and today I finally did.

We’ll see where all this gets me.

Every Food Is A Dead End

Most of us, when we imagine a very unhealthy person's diet, imagine that it consists of fast food, empty calories, excessive alcohol, excessive fat, chips, candy, and so on.

At the other end of the spectrum is the model of a healthy eater, but this is much more difficult to imagine. One reason is because there are competing theories as to what constitutes a healthy diet. Another, perhaps more important, reason is being "healthy" is a continuum, not a binary condition. Two men who eat lots of broccoli might be healthy, but the one who washes his broccoli three times is healthier than the one who washes hers only twice. The one who runs 5 miles a day before eating broccoli is healthier than the one who runs only 4.7 miles. One who neither runs nor eats broccoli would simply call them both healthy.

Recent reports indicate that drinking diet soda increases all sorts of health risks. While no one thinks diet soda is a health food, and while there have been previous warning about the impact of artificial sweeteners on health, I don't think anyone expected that drinking a can of Diet Coke for lunch every day could actually triple your chance of having a stroke. The punchline of the study seems to be, not to eliminate diet soda from your diet, but to simply consume less of it. But again, he who cuts down from 5 to 3 cans per week is less healthy than he who cuts down from 3 to 1.

Seafood, of course, is loaded with lean protein and healthy fats, but also brain-killing mercury and cholesterol. We're urged by our doctors to eat seafood over hamburger, but eating a tuna fish sandwich every day may actually harm you worse than eating ground beef for lunch every day. If so, what sense are we to make of healthy recommendations? Tuna is healthier than hamburger the first two times you eat it in a week, but after that, you're better off with hamburger.

Even if you're a vegetarian - indeed, even if you're a vegan - you're not out of the woods. Eating a green pepper is healthy, except for all the pesticides it carries. Eating an organic green pepper won't save you, either, since the pesticides are in the water supply and floating through the air.

And if you ever drink water, well, you're unfortunately consuming all the impurities in our water supplies, including pharmaceuticals and hormones ingested by people who have legitimate reasons to ingest them, but whose medicines may cause unpredictable negative consequences to you.

In a world like this, it's easy to grow cynical and to say, moments before biting deep into your bacon-topped pizza slice, "Well, everything is going to kill me, so I might as well eat whatever I want to!" But this, too, is the wrong conclusion, since eating without a care in the world will surely kill you more swiftly than meticulously managing your diet.

But seriously: How are we supposed to manage our diets? The question is especially tough for us diabetics: Too much meat will kill me with cancer, but too many carbs will kill me with organ failure. Do I have a preference? Should I have a preference? While the whole world treats themselves to an evening snack, the only thing I can reach for is a low-carb drink: spirits or light beer. This is a healthier option, really? It won't raise my blood sugar, but it will slowly chip away at my liver, or maybe just give me stomach cancer.

"Just eat the snack, but cover it with more insulin," says the diabetic who takes one trip per year to the emergency room for an insulin overdose.

What's a guy to do? I'm not sure it's possible to live on water, 30g of carbs per meal, and organic chicken breast. But I'm all out of ideas.

Some Links

• The alligators have finally reached Dallas, Texas. No one knows how.
• Neanderthals cooked their meat and conducted rituals as far back as 176,500 years ago, long before homo sapiens existed.
• Yet another drug that holds the potential to reverse Type 1 diabetes. That doesn't help those of us who don't have any beta cells left, but still very cool.
• Compression gear - tight, spandex workout clothing - is scientifically better for endurance and post-workout recovery.
• I Sweet Talked again.

Some Links

• Native Americans wish to purchase Cuban cutting-edge treatment for diabetic foot ulcers. Regulations stand athwart.
• US foreign policy in a nutshell: She swallowed the bird to catch the spider, she swallowed the spider to catch the fly, etc. etc.
• Time Magazine argues that Hillary should not put Bill in charge of the economy because Bill is too laissez-faire. I say an even better reason she shouldn't do it is because it seems to violate the 22nd Amendment of the US Constitution.
• Regular readers know I'm not one to cite Scott Sumner. So you can imagine just how awesome this post must be, in order to warrant my linking to it.
• Also, I'm sort of proud of myself because when I read this David R. Henderson post, I was able to anticipate all of his arguments before he made them. That means he is a good teacher, and I am learning from him.
• This is a genuinely interesting link because it shows what an "emergent," voluntary tax code would look like if we didn't have Gub ramming one down our throats all the time. H/T Marginal Revolution.
• An interesting allegory from Adam Gurri at Sweet Talk Conversation.

Some Links

Really exciting links in this round.

• People who DIY their own artificial pancreases - and they work. And Medtronic's artificial pancreas will get FDA approval as early as 2017.
• Speaking of which, David R. Henderson is excellent on the FDA.
• An economist/runner (no relation) developed a calculator that estimates your potential best running times, based on your previous PRs and the age at which you ran them. The calculator is based on this paper, and also includes separate calculators for swimming, high jump and chess.
• It's been a while, but I wrote a piece at Sweet Talk Conversation about how open borders is the same thing as free trade, and free trade is just plain good.
• More recently, I wrote a different piece about how Trump might be bad, but he's no worse than any of the others. My point: If you think he's bad, then you should be really worried about how everything he's talking about is already out there. David R. Henderson scooped me literally at the same time I was writing my piece.

Bad Samaritans

Tyler Cowen links to an article that essentially reduces to the finding that people experiencing medical emergencies cannot count on the kindness of strangers. In that spirit, I'd like to tell you a short story about single-payer health care.

I think people have the general impression that single payer health care is just like other health care, only the government foots the bill. Unfortunately, that's not quite right. Under such regimes, we routinely discover regulatory quirks that impose strict limits on the quantity and quality of care. This is the reality of government medicine. I don't make these stories up - believe me, I very much wish they had never happened to me in the first place. But facts are facts, and this is one such factual story.

Once, when I was attempting to use an insulin pump, I went for a four-mile run. As per the recommendation, I shut the insulin pump down to prevent a hypoglycemic event, but I didn't seem to have timed it correctly because at about the 2-mile mark, I felt myself going low. Unfotunately, I did not have any glucose tablets with me at the time, so I was in a bit of a pickle. No glucose, no phone, no money, and far from home.

Luckily, I was running through the University of Ottawa's campus. I reasoned that there must be a medical clinic nearby. I was right. In a few short minutes, I had managed to find a student medical clinic, and I walked right in.

I told the receptionist what the issue was. I explained that I'm not a student, but I happened to be running and noticed that I went hypoglycemic. I needed some glucose in order to bring my blood sugar back up so that I could walk back to my starting point, where my wife would be waiting to pick me up.

Keep in mind that in Canada, health care is supposedly "universal."

The first thing I was told was that they could not admit me into the clinic because I was not a student of the university. After some hypoglycemia-induced panic, I managed to explain that all I really needed was some sugar. I didn't need treatment, I just needed, you know, some glucose tablets. Four would do.

But the nurses, and later the doctor, explained that in order to give me something for my emergency medical condition, they would first have to admit me to the clinic. And they couldn't do that, because I wasn't a university student.

I don't remember exactly what happened next. Forgive me, I was hypoglycemic. At any rate, eventually one of the nurses or secretaries offered to give me a bottle of orange juice - not as a medical treatment, but just as, you know, a gift between friends. I profusely thanked her and sipped a measured portion of juice to treat my low. The crisis was averted.

Meanwhile, the medical staff looked on, "unable" to help, but unwilling to let me just go. I think someone loaned me their personal cell phone so that I could call my wife to pick me up from the clinic. It took some time, but eventually that's what happened.

Yes, You Have The Right To Complain, Even If You Don't Vote

This morning Jason Brennan linked me to a recent radio interview he did on the ethics of voting. The interview is informative, entertaining, and highly recommended to anyone with a taste for such things.

Toward the end of the interview, Brennan is asked for his take on the old canard, "If you don't vote, then you have no right to complain." He gives a fine enough answer, but the question got me thinking, and so I'd like to offer my own answer to the question.

I'll provide my answer in a series of arguments.

I.

First of all, this statement implies that people who do not have the right to vote do not have the right to complain. For example, a seventeen-year-old is not old enough to vote in the United States of America, therefore 17-year-old Americans do not have the right to complain about their government. This feels intuitively wrong. Taking this argument a step further, suppose a 17-year-old is wrongfully imprisoned by the government due to a specific point of policy. For example, suppose the 17-year-old is arrested for possession of medical marijuana in a state in which medical marijuana is illegal. The voting = right to complain argument seems to suggest that the 17-year-old, by virtue of not having the right to vote, has no right to complain that a perfectly legal activity in one state is not also perfectly legal in her home state (or the state in which the arrest took place).

That doesn't seem right, does it?

II.

Second, suppose someone wants very much to vote, but happens to be unable to do so for practical reasons. Say, for example, a pregnant voter goes into labor at the exact moment she could have voted. Then, she has no right to complain about the outcome of the election, or about the government more generally, because she was giving birth to her child at the time she would have been granted her right to complain. This, too, seems unreasonable.

III.

Third, suppose I voted in the 2008 election, but do not intend to vote in the 2016 election. The spirit of the vote = right to complain argument would suggest that I have a right to complain about things that occurred after the 2008 election, but my right to complain stops at the 2016 election. But suppose a piece of legislation is passed in the wake of the 2008 election (take ObamaCare, for example) that will likely not be repealed. The argument seems to suggest that if I don't vote in 2016, I have no right to complain about the Affordable Care Act, even if none of the candidates on the ballot intend to do anything about ObamaCare. Can it really be true that I have no right to complain about past legislation if I stop casting a vote in future elections?

IV.

Fourth, suppose I have a complaint about Congressman X, but I am not a part of Congressman X's constituency. Thus, I may or may not have voted, but in any case I have never voted for Congressman X. The vote = right to complain argument would seem to suggest that I do not have a right to complain about Congressman X, but how many people who actually make the argument withhold complaints about congressmen or other politicians for which they have no right to vote, because they do not live in the constituency of interest? So it seems likely that they do not actually believe their claim about the right to complain.

V.

Fifth, suppose my complaint about government involves real information that could affect the outcome of an election. Suppose I had inside information that somehow proved that Congressman X was a Russian spy or something. Do I have a right to complain about the fact that Congressman X is a Russian spy, or am I only allowed to voice this complaint if I vote? It seems rather obvious to me that such a complaint is so valuable that it ought to outweigh any argument that I should withhold my complaint.

But then the question is this: How serious must my complaint be before it outweighs the fact that I didn't vote? Surely if Congressman X is in possession of a Doomsday Device, I have a right to complain, even if I didn't vote. But, more realistically, what if I have real evidence that Congressman X is corrupt and taking bribes in exchange for votes; do I have a right to voice this complaint, even if I didn't vote? Most would say yes.

VI.

Here's one that comes up for me a lot, and one that many people are certainly feeling themselves in this latest US Presidential election cycle: What if none of the candidates' policy platforms is agreeable to me. That is, what if there is no good choice, even despite there being differences between the choices. Suppose there is an initiative on the ballot to spend $80 million on a new sporting arena, or $80 million on additional Congressional salaries, but no option to invest the $80 million in any other arena, and no option to not spend the $80 million at all. That is, suppose I can advance a reasonable complaint against all the available options, and that voting merely forces me to vote for something I do not actually want. 

Couldn't we say that in that case, I have a right to complain, even if I don't vote?

Couldn't we say that a citizen of North Korea has a right to complain about his political landscape, whether or not he votes?

Conclusion

In light of the above, it seems that we have many reasons to grant people the presumption of the right to complain. There may be isolated reasons when we might say that someone doesn't have the right to complain if that person didn't vote, but I imagine that this would be the exception rather than the rule. 

Perhaps the exception is this: If you are willing and able to vote, agree with the policies for which you are voting, and have a reasonable expectation that your vote can affect the outcome of the election, but you simply choose not to vote, then you do not have a fair moral claim to complain.

But then and only then.