Max Planck and the Immutable Laws of Physics

Charlie Munger discusses Max Planck a number of times in the book, Poor Charlie's Almanack(1).
Max Planck was a physicist who developed Planck's constant, earned a doctorate at the age of 21, worked on energy emissions which lead to the "Quantum Theory," and received the Nobel Prize in 1918. He tried once to do economics and gave it up. So why would one of the smartest people to have ever lived give up economics? "It's to hard. The best solution you can get is messy and uncertain." It didn't have enough order to it so he gave it up.
What does this have to do with Health Matters? It made me think about the fact that medicine is a messy science too. Though our models are those of the hard sciences, physics, biochemisty, cellular biology, anatomy, results in medicine are not orderly. Outcomes are multifactorial. In my own career, I've gone from perhaps the only branch of medicine that has the most reliable outcomes, Anesthesiology, to one that has the least, Acupuncture (though I would say Psychiatry is on a par with Acupuncture.) But in contrast to Economics, where we're only talking about money (cough), the stakes in Medicine are so much higher. We need to convince people of Max Plancks' exceptional ability to wrestle with difficult, multifactorial, untidy outcomes because the need is so great. We need new and better models and methods.
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(1)Poor Charlie's Almanack: The Wit and Wisdom of Charles T. Munger, Peter Kaufman 2006

Precautionary Principle and Genetically Modified Food

Over the last few days, I've been discussing Munger's model of avoiding that which is bad for healthier or more successful outcomes. I've made the point that in Medicine, also, that is part of the way to be healthy, to avoid the unhealthy. Simplistic, but in a way profound.
When it comes to cancer, the Emperor of All Maladies, how do we avoid what is negative? We know the obvious, tobacco and asbestos, nuclear fall out, maybe full body scans at the airport. But what else? What else to we avoid? I was bedside a few times a week with a friend in her final months of battling thyroid cancer, and it inspired me to become a vegan, since there is some data to suggest a plant based diet can improve your immunity and help your own system to fight cancer. But what else can we avoid?
Cue this Op-Ed by Eric Schlosser and Gary Hirshberg. You might want to read the whole thing, but I'll feature a few highlights.
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The right to know what you are eating

Gary Hirshberg,Eric Schlosser

An unprecedented agricultural experiment is being conducted at America's dinner tables. While none of the processed food we ate 20 years ago contained genetically engineered ingredients, now 75 percent of it does - even though the long-term human health and environmental impacts are unknown. The Food and Drug Administration doesn't require labeling of genetically engineered foods. But as the current drive to get labeling on the ballot in California confirms, consumers want to know whether our food contains these revolutionary new things...

Biotech companies have fought labeling, claiming genetically engineered crops are "substantially the same" and produce larger yields - both unproven claims. But genetically engineered crops have led to the increased use of pesticides, often sold by the same companies that make genetically engineered seeds...Almost all the research on the safety of genetically engineered foods has been conducted by the companies that sell them. ..A study of pregnant women found genetically engineered corn toxins in 93 percent of the women and 80 percent of their unborn children. All of their umbilical cords had glyphosate residues. Biotech companies say genetically engineered crops aren't different - but defend their patent rights by arguing they're unique and that anybody who grows them without permission should be prosecuted. These companies want it both ways...

A recent poll found 93 percent of Americans think genetically engineered foods should be labeled. This month, 384,000 people signed a Just Label It ( www.justlabelit.org) petition urging the FDA to mandate genetically engineered food labeling nationally. ..
The FDA doesn't let pharmaceutical companies test new drugs on people without their informed consent...

So, in a nutshell, the companies that produce the Genetically Modified Food, run their own studies, tell us not to worry, all is well and they're exactly the same as all the other foods, but no, you can't know if you're eating them or not. What if they turn out to be implicated in cancer rates? Those of us who are not so trusting of these big conglomerates and their in-house studies ought to have the right to know what we're eating, so we can at least "first do no harm."

More on Munger's Mental Models and Acupuncture

My post yesterday was a riff on Charlie Munger and his use of mental models. Why is this of interest? I am searching for workable models to use for acupuncture and thereby improve its efficacy. I also think that the models for Western Medicine are breaking down in various ways and to varying degrees. They are still the best we have, but they are inadequate and have been corrupted by moneyed interests to boot.
Example:
At the ISAMS conference, I presented a poster on Heart Rate Variability and its correlation with clinical outcomes in my private practice clinic. Professor Longhurst was interested in the poster in so much as he came over a number of times to argue with me. He has done yeoman's work on hypertension and cardiac health and acupuncture. His argument was that since I used manual and not electroacupuncture, I was not getting a sustained stimulation so I couldn't draw any conclusions. His argument makes sense according to his mental model; i.e that acupuncture works by stimulating nerves under the meridian. My models say that that's part of it, but after reading a textbook on Immunology and the Skin describing what happens when one gets a sunburn, I would posit that there are cascades of immunological healing effects that happen with the tiny injury of placing of a needle. (This is the model that could account for the non-specific needling effects seen with acupuncture.) Also, as I've written about repeatedly on this blog and in my research I think that the decrease in the stress response can account for the variety of conditions treated by acupuncture from panic attacks to allergy to sciatica.
Models are extremely important, because without them how can we improve outcomes? When it comes to Longhurst's model it worked in this study on hypertension, but to use electroacupuncture routinely in the clinic, especially for musculoskeletal pain can lead to severe aggravation of symptoms, which, naturally enrages the patients. Not good clinically nor for business... Electroacupuncture is used on lab animals all the time and they don't seem to be enraged, but maybe they have a stronger placebo effect?? I kid.
The mental models used in Traditional Chinese Medicine, also do their best to make sense of health and healing in their own ingenious way and have structured their models completely differently than the models of Western Medicine. It is a struggle to use models that don't fit with our models, but on the other hand there is a constraint of thinking in only using the traditional models again and again if they are failing. For failing models you need look no further than Avastin, temporal artery surgery for stroke prevention, or stents to name a few.
More on my practice here.

Longevity, Jing, Dr. Mao, and Munger's Models

This is another quote from Dr. Mao Shing Ni's book "Secrets of Longevity." It concerns one of the key concepts in Chinese Medicine, jing. The topic of jing is a Chinese Medicine mental model that, in part, echoes the Munger model of "inverting" or avoiding what you don't want to get what you want.

Ancient Formula Strengthens Your Essence
According to Chinese longevity philosophy, jing, or essence is the basic substance of life. Innate essence is inherited from parentage and can be refined through practices such as tai chi, qigong, and meditation, while a second kind of jing acquired during your life can be replenished through diet, nutrition and longevity herbs. A formula for enduring youth passed down in our family medical tradition contains such essence-building herbs as Chinese wild yam, ligustri fruit, schizandra berry, sesame seed, eucommia bark, he shou wu root and cistanches root. Studies of all these plants confirm their positive effects on the hormonal, immune and metabolic systems.

What he doesn't mention are the things that can harm your jing, childbirth without sufficient rest, drugs, excessive alcohol, illness. So avoiding these are over half the battle against aging. The crucial aspect of jing is that it can be supported throughout life with wise and balanced living, but once destroyed is extremely difficult to replace. This fits nicely with the Munger model, that in avoiding destructive habits or avoiding "where you are going to die so you don't go there" is a key concept in Chinese Medicine.
The formula I recommend for longevity and an overall health tonic is Astra Essence from Health Concerns. The "Astra" in "Astra Essence" is for astragalus an herb that nourishes the lung function and, indeed, can keep you from getting ill, especially with respiratory illnesses, colds, flu etc... It has been studied in conjunction with telomeres and has been shown to decrease cellular aging also.
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Monday Morning Philosophizing: Charlie Munger

This may seem off the topic of medicine, but I think if you stay with me, you'll see the relevance. Over the weekend I was reading a book about and by Charlie Munger[i], a famous and successful investor and partner of Warren Buffett. I was interested in the various "mental models"he's derived from multiple disciplines (mathematics, physics, psychology, engineering) and wanted to read more about them.
One quip that he uses over and over again is the quote from an old "rustic" who says "I wish I knew where I was going to die, and then I'd never go there." Which is funny, of course, but it echoes the great algebraist Jacobi, who said "Invert, always invert." Munger's point in investing and in life, is that in avoiding what is negative, you are much more likely to be successful. Avoid losing, spend less than you make, and save.

So what does this have to do with acupuncture and alternative medicine? I realized that the "First Do No Harm" part of acupuncture and alternative medicine, though hardly a ringing call to action is an important part of the mission. In keeping people off medications whenever possible is not a small thing. Some studies show that the side effects of pharmaceutical drugs kill some 140,000 people in the U.S. a year and cost the country over $136 billion annually. As always, it's hard to prove a negative, but the wisdom of billionaires, Chinese ancients, genius mathematicians, and "rustics" concur that by avoiding the negative, you're much more likely to flourish. Once back pain, IBS, or migraines occur if the standard was to use acupuncture first who knows how much medication, cost and work would be saved. I've discussed these issues frequently in this blog, for eg here, here, and here.

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[i] “Poor Charlie’s Almanac: Wit and Wisdom of Charlie Munger” Kaufman 2006