Category Archives: Navigating Healthcare

Is Quantified Self Worth It? (Post #1)

I’m inclined to be a huge fan of Quantified Self. Taking entrepreneurial initiative, using numbers, even Meetup groups – it’s right up my alley! I’ve been doing it for years, including many months of daily 30 second recording, a few months of tracking every meal, and some self-designed Randomized Double Blind Controlled Trials (No, that’s not a typo. Yes, double blinding by yourself is tough). I’ve also seen several people try personal things at various stages of complexity, talked to people at the meetup groups, and watched many of the highlighted QS videos.

What I’ve taken away from it is that the human body is complex. Moreover, a human life is complex. So you can try to say “I ate carrots from days 1 to 10 and felt terrible, then avoided them from days 11 to 20 and felt great”, and infer that you’re allergic to carrots. But think about all of the things that could go wrong in this minimal example:

  • Maybe some nutrient that’s relatively high in carrots was accumulating in those first 10 days, and was actually the only reason you felt so good in the last 10
  • Maybe you ate celery instead of carrots in the last 10 days, and that’s actually the only factor that matters
  • 10 day cycles means that one of your samples probably had two weekends in it, while the other had just one. Maybe the difference in averages is simply because you feel different on weekends
  • Maybe there was a party at work, and you ate something you don’t usually, which contained the actual allergen
  • Maybe it has nothing to do with allergies, and responds to the weather
  • Maybe it has nothing to do with anything external, and relates to hormonal cycles (which also happen in men)
  • Maybe your definition of “felt terrible” shifted as you acclimated, or relative to other events in your life during the experiment

There’s also the issue that we often can’t directly measure the thing we’re interested in. Energy levels, focus, even “pain” are hard to put a consistent number on. If the true effect is small, it can easily be swamped in the difference between your definition of a 6 and 7 on whatever scale over time.

Finally, there are a near infinite number of interventions you can try, and just randomly guess-and-checking them is going to make for slow progress. There are some where your priors can be high enough to make them worthwhile (lactose intolerance is a good example), but once you get down into cutting out trace ingredients, or unconventional sleep routines, or anything like that, you’re looking for a needle in a haystack. Also: https://www.xkcd.com/882/

Also, very few doctors know what to do with your data. It makes sense, since few of their patients are arriving with anything like it, and those who are probably bring totally different formats to address different problems.

Still, you’re going to live your life today anyway, you might as well take some quick notes about how it went. At the very least, it might form the baseline if you decide to try a more significant intervention down the road.

Should I go to a Nutritionist? (Post #1)

One way to narrow down the list of medical professionals that I could go to is by looking at what my insurance will cover. This is pretty compelling, since it offers a chance that my out of pocket expenses will be lower. It’s a perverse indication about the healthcare system that this is just a chance, between random denials of coverage, and things like 10% co-insurance on services that cost 15x as much as they should.

But, when I look at “Find Care” under my Aetna website (which is quite a bit better designed than I would have expected, so check it out if you happen to have Aetna), there are 5 categories under “Alternative”:

  1. Acupuncture: Not relevant
  2. Chiropractor: Not relevant
  3. Massage Therapist: Wish I’d checked here before paying for one last year!
  4. Naturopathy: I’m surprised that Aetna is covering this. For all the (often justified) flak that insurance companies get, there’s something to be said for having a voice in the system that says “I really need to see some statistical proof of effectiveness before subsidizing this treatment”. My feelings about naturopathy are here.
  5. Dietician: That’s what we’ll be digging into today

The problem is that the list gives me dozens of choices, but no relevant information to select on. They’re all listed simply as ‘registered dietician’, with no indication of whether they specialize in weight loss (which is not my goal) or something else. And there’s even less information about what I’m really looking for, whether they would work with me over time as an active partner. That’s the sort of thing that would come out in patient reviews, but less than 10% of providers have any, and they’re incredibly focused on the patient experience, not the clinical approach or outcomes. Some examples:

  • Not only do they never postpone my appointment, they always try go get me in as fast as possible.
  • They had plenty of staff members to help me whenever I needed assistance
  • They’ve never used foul language, which bothered me at some other places I’ve been to

This isn’t going to help me find the relatively rare approach that I’m looking for. The next step is going to see if any of them have blogs or other outlets where they discuss their philosophy and see if they think about things besides weight loss, regularly consider the medical literature, and generally appear to think critically and flexibly.

UPDATE: I’ve done that for everyone within a 3mi radius. People are pretty non-specific, saying things like “helping others develop a healthy relationship with food and reach their health and wellness goals” (LinkedIn) While I’d love to find someone who’s tweeting an in-depth literature review around a relevant set of symptoms, the realistic signal that I’m looking for is that they self identify as focusing on scientific and quantitative approaches. Barring that, just some specificity would be great. Here’s a good example: “My expertise & passion is in the prevention and treatment of diabetes.” (LinkedIn) Not a fit for me, but I much prefer to come to a crisp ‘yes/no’ than the endless ‘meh’ that the previous example provokes!

One of them had a website full website, though it was last updated in 2015. She referenced going to a conference at Harvard, which is the best that I’ve found so far. I wish that I had something better to go on, but that puts her well ahead of the pack, so I’ve reached out.

UPDATE 02: I went to her and it was pretty good. No breakthroughs, but I will try out a few of the things she suggested and go back in a month or two.

Should you go to a Naturopath?

This ended up being shorter than originally envisioned. My answer is: No, unless a specific course of treatment has proven effective for someone whose judgement you really trust, is extremely low cost/risk, and is not replacing more widely accepted treatment.

What is a naturopath?

Broadly, anyone who defines themselves as one. 17 US states also have a licensing system, and there are a handful of schools that are accredited to teach it.

What’s worrisome?

These schools teach some things which I am willing to have an open mind about, like massage therapy and dietary advice, but it also teaches things which are widely discredited like homeopathy. Worse, they are linked to the anti-vaccine movement (more here). The schools and professional bodies have also reportedly behaved in ways that suggest less of a “Let’s rationally investigate and debate these alternative approaches which could have value” and more of a “Let’s squash the non-believers” mentality. I came in willing to give them benefit of the doubt about being honest, if sometimes credulous, truth-seekers. More details here.

Choosing a Medical Provider – Overview (Post #1)

I’ve decided that I need to find a new doctor.

The problem isn’t with my current doctor, who I like quite a bit, but with the entire system around her. All of the ancillary stuff, like getting a referral, moving my records, getting significant time from specialists, has been disastrous. Because moving medical records is so difficult, I figure that I need to switch sooner rather than later, because every visit with her is further investment into a system that I don’t want to be at long term.

My first option is finding another MD in another medical system. That’s absolutely on the table, but there are significant drawbacks: 1) It will probably take me months to get the first appointment, and then weeks to a follow up. It’s like getting my medical advice by snail mail from England. 2) It costs at least $400 per basic appointment. Sometimes I pay, sometimes my insurance pays, but it’s certainly insane. 3) It takes at least 2 hours of my time for 15 minutes of actual doctor time.

To be clear, I believe in medical science, in the sense that I don’t think there’s any other process that reliably produces better understanding and advice on human ailments. On the other hand, doctors are not doing a complete literature review before each diagnosis. They’re listening to me for about 7 minutes, glancing through my medical record, and coming up with their best guess on the spot. They don’t submit a case study document with citations for peer review, and they don’t necessarily follow up after a week for detailed feedback on their treatment’s impact. While medical school was absolutely based on science, but the actual clinical process simply doesn’t allow time for an hypothesis-experimentation-analysis cycle.

So I have the highest respect for doctors and medical researchers. The problem is in the business. With the exception of some specific chronic diseases like diabetes, the model is designed for point diagnosis, not to work with patients over time (especially not with their active participation). That is why I started considering (emphasis on considering) other options. For what it’s worth, I’m hardly alone: about 1/3 of American adults were actively using a Complementary/Alternative Medicine technique according to the NIH (though it’s worth noting that they’re grouping together things like “Deep Breathing” and “Meditation” with “Chiropractics”).

One of the attractions of CAM is that many of the interventions are extremely low risk, and low cost. I already meditate, which almost certainly isn’t hurting anything, and has cost less than $50 for books and an app. In the last year, I’ve twice gotten therapeutic massages in response to acute muscle pain. The first time, it led to an immediate and lasting improvement. The second time, it didn’t work, but felt nice. ¯\_(ツ)_/¯ The benefit of the first absolutely justified the second. (1hr/$90 each)

So I’m doing some research into nutritionists, naturopaths (UPDATE: no), and anything else that people might find valuable. Email me if you’ve got ideas or personal experiences in this space!

UPDATE: I’m getting particularly interested in finding people who are more like guides than experts. A loose example would be a fitness guide, who might give their client some suggestions, some things to read, and check back in on a weekly basis. At the outset, they can’t know what will work, but by pairing objective research with the client’s ongoing results, they help iterate towards the right solution. Most of these people are focused on weight loss, though, not sure how to find anyone who helps with anything else!

UPDATE 2: I’ve looked into dieticians, with mixed results. But I’ve scheduled an appointment with the one who seemed most scientifically grounded.