Category Archives: Articles

House Calls for the 21st Century: Carrying a Doctor in Your Pocket

impatientHome diagnosis kits will soon let you give yourself a checkup whenever and wherever you want.

From my Impatient Futurist column in the September issue of Discover Magazine

I don’t know why people complain about going to the doctor for checkups. I’d go every week if I could. It’s not just for the sociability of exchanging interesting new microbes in the waiting room, or the pride in hearing my doctor mutter with approval when I hand her the 58-page printout of all the illnesses I’ve self-diagnosed based on what I’ve read on the Internet. Rather, it’s because I know that a lot of creepy things can happen in my body in a whole year.

Since my health insurance plan inexplicably won’t pay for weekly checkups, I’m faced with long, distressing gaps between visits. As with so many annoyances, this one got me wondering…read more.


ImageIn the coming decade, 
online primaries and elections might loosen 
America’s gridlock politics.

From my Impatient Futurist column in the September issue of Discover Magazine

Feuding between Democratic and Republican leaders has rendered the U.S. government nearly dysfunctional, with the summer 2011 deficit standoff only the most egregious recent example of gridlock run amok. As growing numbers of Americans say they are fed up with both parties, the door would seem open for an alternative. Historically, third parties have failed miserably: Ross Perot, the most successful independent presidential candidate in modern times, did not win a single state 
in 1992. Technology is changing the electoral rules, though, inspiring reformers to envision a new and more open brand of politics, one built around online voting and Facebook-style campaigns.

For a brief, shining moment last spring, it seemed as if that revolutionary concept might take hold in the United States. Americans Elect, founded and initially bankrolled by billionaire venture capitalist Peter Ackerman, launched plans to create a virtual third party via…read more.



The worst industrial spills call for something stronger than the old-fashioned bar sitting in your soap dish.

From my Impatient Futurist column in the June issue of Discover Magazine

Between freak arctic melting, Japanese nuclear melting, and antibiotic resistance popping up everywhere, I can’t help but see the world as tiptoeing into pre-apocalypse. If there is some sort of crapstorm coming and I’m lucky enough to survive it, there’s one thing I know for sure: I’m going to need a really good hand-cleaner for the aftermath. When I come in from a hard day of zombie hunting, it won’t be just dirt that I’ll need to get out from under my fingernails.

Actually, I could use that doomsday soap now—or rather, we all could. That’s because most of the human race has no intention of patiently waiting for an unspecified apocalypse and has already gotten a head start on mass despoiling. So far the tides of toxic waste and exploded-oil-rig crude haven’t made it as far as my sleepy burb. But right now somebody somewhere is facing a mess that Softsoap…read more.



All you need is $400,000 and the patience of Job.

From my Impatient Futurist column in the May issue of Discover Magazine

Like many people with limited social skills, I’ve always wanted a robot. And I’ve never been the least put off by the strict movie rule that having a robot can only result in its owner being pushed down the stairs, sucked into the vacuum of outer space, or enslaved with what’s left of humanity. I’m well aware that movie rules are hardly ever wrong, but it hasn’t been fear of betrayal that’s kept me from having a robot helper. It’s been the lack of their existence, in spite of a century of big talk. And this has left me not only without the sort of non–emotion-experiencing companion who could really understand me but also with a lot more laundry, cooking, dirty dishes, and child care than a technophilic citizen of the 21st century should have to put up with.

Useful home robots have always been about 20 years in the future, according to experts—a discouraging estimate, since the same experts assure me every other exciting technology under development is only 5 years away. Yes, I know, you can drive over to Walmart and pick up a carpet-vacuuming “robot” to keep your lawn-mowing “robot” company. While you’re there, why don’t you also grab a “house” in the camping department? I’ve got no interest in keeping company with hundreds of dumb, whirring little things. Scampering scrubbers and pot-stirrers are way too small and stupid to push me down the stairs when I’m not looking. read more.

Warped Sense of Time Heightens Temptations

ImageImpulsivity arises from a tendency to want small imminent rewards more than big future benefits. How can we correct our skewed values to care for our future selves?

From my article in Scientific American

(Preview only, full article requires subscription or payment) 

Walk into any fast-food restaurant, and you can watch a small crowd of ordinary people doing something that is utterly irrational: eating junky, excess-weight-inviting food likely to leave them feeling bad about their bodies and open to a host of serious ills. We literally line up to trade our health and self-image for a few minutes of pleasant mouth feel and belly comfort—because the latter is right here, right now, whereas the former is months, years and decades away…read more.

The Perfected Self

B. F. Skinner’s notorious theory of behavior modification was denounced by critics 50 years ago as a fascist, manipulative vehicle for government control. But Skinner’s ideas are making an unlikely comeback today, powered by smartphone apps that are transforming us into thinner, richer, all-around-better versions of ourselves. The only thing we have to give up? Free will.

From my cover story in the June 2012 issue of The Atlantic


My younger brother Dan gradually put on weight over a decade, reaching 230 pounds two years ago, at the age of 50. Given his 5-foot-6 frame, that put him 45 pounds above the U.S. National Institutes of Health’s threshold of obesity. Accompanying this dubious milestone were a diagnosis of type 2 diabetes and multiple indicators of creeping heart disease, all of which left him on a regimen of drugs aimed at lowering his newly significant risks of becoming seriously ill and of dying at an unnecessarily early age

He’d be in good company: a 2007 study by TheJournal of the American Medical Association found that each year, 160,000 Americans die early for reasons related to obesity, accounting for more than one in 20 deaths. The costs are not just bodily. Other studies have found that a person 70 or more pounds overweight racks up extra lifetime medical costs of as much as $30,000, a figure that varies with race and gender. And we seem to be just warming up: cardiologists who have looked at current childhood obesity rates…read more

Disruption Comes (Finally!) to Commercial Real Estate

How Jason Freedman (no relation) and 42Floors cooked up a killer business idea that could turn commercial real estate on its head.

From my article in the May issue of  Inc. Magazine

Jason Freedman hunches his shoulders against New York City’s December chill and walks faster, nudged both by the cold and by being late. He and David Woodworth, co-founders of an Internet company called 42Floors, both stand out a bit with their buoyant, vulnerable Californianess as they swim against the trudging, elbowing crowds.

Focused on the iPhone he clutches a foot in front of his face for navigational purposes, oblivious to how dorky and unsafe this seems on these streets, Freedman races on to the next stop in a two-day string of meetings, Woodworth trailing a few feet behind.

Freedman and Woodworth are several months into the creation of 42Floors, which aims to… read more

The Kitchen of the Future

An introduction to the visionaries planning tomorrow’s high-tech, ultra-efficient, green, and even mood-altering spaces designed for much more than cooking.

From my article in the April 2012 issue of Gourmet Live

The kitchen of the future has a long past. At world fairs and trade shows going back more than a century, crowds have been tantalized with slick visions of the extraordinary ways we’d be preparing foods in the coming decades. In particular, notes Ruth Oldenziel, a professor of American and European history at the Eindhoven University of Technology in the Netherlands, and coeditor of the book Cold War Kitchen, futuristic kitchens have long been used by marketers to excite us about new technologies. In the 1900s, it was the magic of natural-gas stoves, then in the 1920s and 1930s, the spread of electric and telephone utilities, then refrigeration in the 1940s, on through microwave ovens in the 1950s and even nuclear power in the Atomic Age kitchen (to say nothing of today’s quesadilla presses and single-serving coffeemakers). “In every generation, the kitchen of the future is a sort of passport photo for innovation,” says Oldenziel.

But lost in all the fuss over electromechanical, thermal, and radiative marvels, according to Oldenziel, was much discussion about changes…read more

Coupon Deals and the Search for New Customers

From my article in the Small Business Blog of The New York Times

A few weeks ago I wrote a post about two small businesses that were taking different approaches to employing Groupon-style social-network marketing as a way of drumming up business.

One of them, a restaurant called Acropolis in Needham, Mass., went with Living Social, whose service closely follows the Groupon model — meaning the coupon company sends the offer out to its large database of local consumers, takes a big chunk of the revenue that comes from selling the discount vouchers, and doesn’t share much customer information with the small business that buys the deal.

The other, the Urban Escape Day Spa in Golden, Colo., tried a new service called SaveLocal, which is offered by Constant Contact, a company best known for its e-mail marketing tools. With SaveLocal, there are some important differences…read more

Your Personal Automated Mass Transit Vehicle Is on Its Way

Get out of your car and into your flying train, 
superclean superbus, and most impressive of all, your personal subway.

From my Impatient Futurist column in the the April issue of Discover

Despite my mania for all manner of irresponsible personal vehicles, I’m actually a public-transportation nut. A few of the reasons:
• I can read, check email, send text messages, or catch a few winks while I’m zipping to my destination
• I have built-in motivation for walking, given that I have to get to and from the bus or train stop
• I feel good that my ride isn’t fueled by the conversion of fossilized sea life into impending climate catastrophe
• I get to trade small talk and occasional newspaper sections with fellow transit riders.

But I know you have your very good reasons for being among the 98 percent of the population that shuns public transportation:
• You can read, check email, send text messages, or catch a few winks while you’re swerving into oncoming traffic and pedestrians
• You have built-in motivation for stopping at Wendy’s for celebration takeout, given that you haven’t had to walk more than nine consecutive steps the entire day
• You feel good about the copious burning of hydrocarbons, which is creating valuable new beachfront property
• You get to trade hand gestures and occasional gunfire with fellow traffic jammers.

Ok, go ahead and sneer at my bus through the windshield of your Range Rollover…read more

Good News, Spock—We’re Getting Closer to a Universal Translator

The rapid advancement of Google-style, statistical translation may help realize this long-time dream.

From my Impatient Futurist column in the the March issue of Discover

Those of us for whom Star Trek serves as a benchmark for technological progress can only bemoan the fact that hopes for faster-than-light travel to other galaxies seem to be receding at warp speed, given that we no longer even have faster-than-sound travel to France. But I would prefer to focus on the bright side: We’re rapidly closing in on the Universal Translator, which means that when I do finally arrive in France, I’ll be able to communicate as easily as if I were on Earth.

The Universal Translator, of course, was a handheld device that 
instantly converted Captain Kirk’s futuristically clipped English into the language of whichever vaguely humanoid alien was offering to buy him a blue drink. It is impossible to overemphasize…read more

Evernote: Company of the Year

Evernote is rejecting industry trends, getting customers to pay for something that’s free, and reinventing the way we remember

From my article in the December 2011 issue of Inc. magazine

Phil Libin remembers the moment he left childhood behind. It was nearly four years ago, when the funding for his Internet start-up fell through. He was 35.

   It had all been so much fun until then. But at 3 a.m., out of cash and having waited in vain for a venture capitalist or angel or CEO or anyone at all to return his increasingly desperate calls, Libin knew that he would have to pull the plug on Evernote, a software application that helps people remember things. “I realized I was going to have to wake up tomorrow and lay off everyone in the company,” he says….read more

Science Finds a Better Way to Teach Science

After doing some much-needed research, cognitive scienctists are suggesting a new way to boost students’ lagging scores: Get rid of the hallowed (and stultifying) classroom lecture

From my Impatient Futurist column in the the December 2011 issue of Discover

Teaching well is hard. I can cite my direct observations of the hundreds of victims of my occasional efforts over the years as a teacher of physics and writing. As I have stood lecturing brilliantly to a few dozen purportedly eager collegians, it has not escaped my attention that at any one time only three or four seem awake enough to keep up with their text messaging.
   Clearly the problem is not the content or presentation style of my lecturing, which, as I may have neglected to mention, is brilliant, or so I was once assured by a student who stayed after class to ask for a sixth extension on an assignment. Then again, from what I recall of my college days, I wasn’t exactly on the edge of my seat at my professors’ lectures, either. And most of my fellow lecturers don’t report much different. Could the problem be with the nature of lecturing itself?…read more

The Man Who Gave Us Less for More

Examining the crushing success of Steve Jobs

From my article in the January 2012 issue of Discover
(#8 of the top 100 science stories of 2011)

I was front row center when Steve Jobs unveiled the Apple Macintosh to the world in 1984 in 
Boston. While the crowd cheered and clapped 
and squealed, I was scratching my head. What did this pretty beige box offer that a hundred other computers didn’t already offer, besides a higher price, much less choice in software, and no 
compatibility with the rest of the world’s devices?…read more

Layer by Layer

With 3-D printing, manufacturers can make existing products more efficiently—and create ones that weren’t possible before

From my article in the January 2012 issue of Technology Review

GE thinks it has a better way to make jet-engine fuel injectors: by printing them. To do it, a laser traces out the shape of the injector’s cross-section on a bed of cobalt-chrome powder, fusing the powder into solid form to build up the injector one ultrathin layer at a time. This promises to be less expensive than traditional manufacturing methods, and it should lead to a lighter part—which is to say a better one.

The innovation is at the forefront of a radical change in manufacturing technology that is especially appealing in advanced applications like aerospace and cars. The 3-D printing techniques won’t just make it more efficient to produce existing parts. They will also make it possible to produce things that weren’t even conceivable before—like parts with complex, scooped-out shapes that minimize weight without sacrificing strength. And the technology could reduce the need to store parts in inventory, because it’s just as easy to print another part—or an improved version of it—10 years after the first one was made. An automobile manufacturer receiving reports of a failure in a seat belt mechanism could have a reconfigured version on its way to dealers within days…read more

In Memoriam: The Space Shuttle

With great ambivalence we note the passing of 
the first and only reusable spaceship, the space shuttle, 
on July 21, 2011. Our prayers are with NASA.

From my article in the January 2012 issue of Discover
(#6 of the top 100 science stories of 2011)

The space shuttle, which long served NASA and humankind as a low-Earth-orbit 18-wheeler, died on July 21 at the NASA Kennedy Space Center in Florida, after gliding to an uneventful touchdown from a routine mission. It was 39 years old. The shuttle program had been suffering for several years from a wasting loss of enthusiasm for its high price tag and untamed risks. The final cause of death was failure to find any reason to keep pouring billions of dollars into an obsolete space ferry that lacked a stirring mission…read more

Why Economic Models Are Always Wrong

A fundamental problem with the mathematics of models ensures we’ll always get unreliable predictions

From my article on the Scientific American Website, posted Oct. 26, 2011 (A companion piece to my feature article on economic models in the Nov. 2011 print edition, posted just below

When it comes to assigning blame for the current economic doldrums, the quants who build the complicated financial risk models, and the traders who rely on them, deserve their share of the blame. But what if there were a way to come up with

simpler models that perfectly reflected reality? And what if we had perfect financial data to plug into them?

   Incredibly, even under those utterly unrealizable conditions, we’d still get bad predictions from models.
   The reason is that current methods used to “calibrate” models often render them inaccurate….read more

A Formula for Economic Calamity

Despite the lessons of the 2008 collapse, Wall Street is betting our future on flimsy science

From my article in the November 2011 issue of Scientific American

The market crash of 2008 that plunged the world into the economic recession from which it is still reeling had many causes. One of them was mathematics. Financial investment firms had developed such complex ways of investing their clients’ money that they came to rely on arcane formulas to judge the risks they were taking on. Yet as we learned so painfully three years ago, those formulas, or models, are only pale reflections of the real world, and sometimes they can be woefully misleading….read more

Doing Business in China

Michael Lee is on the verge of becoming the first American entrepreneur to build big in the world’s most populous country

From my article in the Oct. 2011 issue of Inc. magazine

Michael Lee is eerily quiet as his world comes down noisily around him. Packed into a cramped conference room in his company’s modest offices in Nanjing, China, Lee’s key managers are at one another’s throats. The more angrily they spit blame at one another for the disastrous, unsalvageable situation the company finds itself in, the more enervated Lee seems to become, until finally he is no more than a slumped statue following the action only with slight movements of his eyes….read more

Why US Green-Tech Firms Are Moving to China

Boston Power’s move reflects China’s willingness to provide incentives for companies in electric vehicles and other strategic industries

From my Sep. 9, 2011, article on the Technology Review Website

Many in the U.S. have an interest in getting clean-tech ventures off the ground. Among them are the government, capital markets, industry, and science labs. But China seems ready to do more on every front to make such projects happen, and to do it right now—without red tape or concern about economic turmoil.
     Leading-edge battery maker Boston Power appears to have come to that conclusion. The company is set to move to China, where the government is helping to cut the firm a $125-million deal that no one else is likely to match. The deal could leave the company poised to be a part of what could be a mushrooming market there in electric vehicles… more

The Triumph of New-Age Medicine

Carefully controlled studies have shown alternative medicine to work no better than a placebo. But now many doctors admit that alternative medicine often seems to do a better job of making patients well

From my story in the July/August 2011 issue of The Atlantic

…You might think the weight of the clinical evidence would close the case on alternative medicine, at least in the eyes of mainstream physicians and scientists who aren’t in a position to make a buck on it. Yet many extremely well-credentialed scientists and physicians with no skin in the game take issue with the black-and-white view espoused by Salzberg and other critics. And on balance, the medical community seems to be growing more open to alternative medicine’s possibilities, not less.
   That’s in large part because mainstream medicine itself is failing. “Modern medicine was formed around successes in fighting infectious disease,” says Elizabeth Blackburn, a biologist at the University of California at San Francisco and a Nobel laureate… read more

How to Fix the Obesity Crisis



Although science has revealed a lot about metabolic processes that influence our weight, the key to success may lie elsewhere

From my cover story in the February 2011 issue of Scientific American

Obesity is a national health crisis—that  much we know. If current trends continue, it will soon surpass smoking in the U.S. as the biggest single factor in early death, reduced quality of life and added health care costs.
Why are extra pounds so difficult to shed and keep off? It doesn’t seem as though it should be so hard. The basic formula for weight loss is simple and widely known: consume fewer calories than you expend. And yet….almost everybody who tries to diet seems to fail in the long run—a review in 2007 by the American Psychological Association of 31 diet studies found that as many as two thirds of dieters end up two years later

weighing more than they did before their diet.
   Maybe someday biology will provide us with a pill that readjusts our metabolism so we burn more calories or resets our built-in cravings so we prefer broccoli to burgers. But until then, the best approach may simply be to build on reliable behavioral psychology methods developed over 50 years and proved to work in hundreds of studies. These tried-and-true techniques, which are being refined with new research that should make them more effective with a wider range of individuals, are gaining new attention. As the NIH puts it in its proposed strategic plan for obesity research: “Research findings are yielding new and important insights about social and behavioral factors that influence diet, physical activity, and sedentary behavior….” read more (Subscription or payment to Scientific American needed to read full article at the site, but you can read a copy here)


Jump-Starting the Orbital Economy

Why NASA’s plan to get out of the manned spaceflight business may (finally) make space travel routine

From my article in the December 2010 issue of Scientific American

Two years ago deceased Star Trek actor James “Scotty” Doohan was granted one last adventure, courtesy of Space Exploration Technologies Corporation. SpaceX, a privately funded company based in Hawthorne, Calif., had been formed in 2002 with the mission of going where no start-up had gone before: Earth orbit. In August 2008 SpaceX loaded Doohan’s cremated remains onto the third test flight of its Falcon 1, a liquid oxygen- and kerosene-fueled rocket bound for orbit. Yet about two minutes into the flight Doohan’s final voyage ended prematurely when the rocket’s first stage crashed into the second stage during separation. It was SpaceX’s third failure in three attempts….read more

What four new studies hint about fixing obesity

Four recent obesity-related studies have come out in the past few days that are worth taking a slightly closer look at. One reported that overweight people who have successfully taken and kept off weight tend to stick to structured exercise programs. Another found that male rats made obese and diabetic via high-fat diets tended to have diabetic female offspring, while male rats given normal diets did not–and since there was no general difference between the genes in the two groups, and because the mother rats in both groups were non-obese and non-diabetic and so couldn’t have passed along anything different in utero, the explanation lies somewhere in environmental differences relating to the dad rats’ different diets. (Yes, rodent studies usually don’t translate well to humans, and this might well fail to translate, too, but for what it’s worth it was an unusually simple and clean study, no genetic engineering or exotic behavioral manipulation or psychological interpretation involved.)

A third study found that people who live in areas where the Mediterranean diet (lots of “good” fat, lean protein, grains, vegetables and fruit, little saturated fat) is prevalent tend to keep weight off as they get older better than people in other areas–but (hallelujah!) the researchers and even (at least in this particular Reuters article) the reporter prominently note that it may well be behavioral and other environmental issues common to people who live on this diet that does the trick rather than the diet itself. The last study predicts US obesity rates have not peaked at about a third as other experts have claimed, and will continue to rise to hit 42 percent–and add that part of the problem is that hanging around with obese people tends to make it more likely that a person will herself become obese, so that the higher the obesity rate goes the more it increases the chance that it will rise further (up to a certain point).

I find all of these studies interesting in their own right, but the main reason I mention them is that all four highlight behavioral and environmental issues as being key to obesity rather than–or at least in addition to–the choice-of-food-types and the genetic issues that are often emphasized in studies. I hope I’m seeing a trend here. We can’t get rolling on solving the obesity problem until we stop fixating on poorly understood physiological processes and on molecular biological factors that we can’t do anything about, and start focusing on behavioral and environmental changes that we can start working on today. That’s what got us into this fix, and that’s what will get us out.

Is it all about the calories?

Does which foods you eat matter in weight loss?  I don’t think any aspect of obesity and weight loss is more confusing, or more responsible for people’s muddled thinking and poor choices in approaches to taking and keeping weight off.  Most of the answers we’re given to this question fall roughly into what seem like two sharply contrasting camps.  The “it’s all about the calories” camp (be warned, this link brings to you a nasty little article) suggests it doesn’t really matter what you eat, you just need to eat small-enough amounts of it to not exceed the calories you’re burning.  The “eat healthier foods” camp suggests that you will lose weight if you emphasize certain foods over others–some push fruits and vegetables, others “less-processed” foods, others less-calorie-dense foods, others low carbs, others low fat, and so forth.

Here’s my take on it. (I’ve been interviewing many, many respected experts in the obesity field and reading quite a lot of studies and articles, so I’m not entirely shooting from the hip here, or at least not more than anyone else. Consider this a synthesis of what I’ve been finding out.)  The bottom line is that both camps are sort of right, but they’re both a little misleading, too. It’s true, you can lose weight eating anything if you keep portions small enough, and you can gain wait eating only vegetables if you eat enough of them. But most people are indeed more likely to keep the weight off if they lose it by emphasizing certain types of foods. That’s because some foods more than others tend to push the various physiological and perhaps psychological buttons that will make it harder for you to keep control of your calorie intake. In the end, you’ll still have to take in fewer calories than you’re burning–but most people will find it easier to do that with some menus than with others.

So which foods should the would-be weight loser emphasize? There’s a certain amount of disagreement on this question, to be sure, but a rough consensus of evidence and expert opinion favors cutting down significantly on sugar and refined carbs (like non-whole-wheat bread and pasta), taking it easy on fats (especially saturated fat, for other health reasons), eating good amounts of relatively lean protein (especially fish, chicken, and soy, prepared without much oil or butter, but beans, wheat gluten, egg whites, whey and pork can be good sources of lean protein, too), and eating lots of vegetables and reasonable amounts of fruit and other foods high in fiber.  Most experts don’t advocate ultra-low-carb diets (or even counsel cutting down much on complex carbs like whole-wheat foods), and most don’t think an ultra-low-fat diet is worth the trouble.  There are three main weight-control benefits to these recommended foods: They tend to be less calorie-dense, so they feel more filling per calorie and it’s easier to meter how many calories you’re taking in compared to a small, dense calorie-bomb like a piece of candy or fried chicken; they’re less intensely stimulating to your pleasure systems, so you’ll be less likely to feel compelled to pig out on them; and they tend to enter the bloodstream at reasonable rates, avoiding the blood-sugar spike-and-plummet effect you get from eating simple carbs that can lead to intense appetite swings.

Now having said all this, I’d like to point out that while eating “healthier” foods is a helpful and for most people important element of keeping weight off, I don’t think it’s necessarily the most important element, and it’s absolutely not the only element, as is often implied by some weight-loss gurus.  Most people will not be able to keep much if any weight off just by trying to take in more healthy food, if everything else they do and everything else that’s going on around them otherwise remains the same. For most people keeping weight off requires a full-court press via a “behavioral” approach, something I’ll be talking a lot about here and elsewhere. Part of that approach also involves finding out which healthier foods work best for you in terms of being as satisfying as possible without pushing your appetite and cravings buttons. And it also involves being smart about the way you introduce these foods into your daily menu and make enjoyable habits out of eating them, and about how you regulate your intake of these healthier foods as well as of those less-healthy foods you may also want to take in in order to have a satisfying diet.

Does all this seem like a lot of work to figure out, put into action and maintain? Well, it can be, but if you get good guidance it shouldn’t be all that hard. Even if it is a lot of work, the benefits people get out of losing excess weight in terms of their health and how they feel almost always seem worth the trouble. And if you do the behavioral approach right, losing and keeping off weight–especially if you lose it slowly, and try don’t lose a large percentage of your body weight–need never be hugely demanding or uncomfortable, and in fact ought to be highly satisfying and in many ways enjoyable.

Brain Control

A scientist explores how to alter behavior by using light to turn neurons on and off

From my article in the December 2010 issue of Technology Review

The equipment in Ed Boyden’s lab at MIT is nothing if not eclectic. There are machines for analyzing and assembling genes; a 3-D printer; a laser cutter capable of carving an object out of a block of metal; apparatus for cultivating and studying bacteria, plants, and fungi; a machine for preparing ultrathin slices of the brain; tools for analyzing electronic circuits; a series of high-resolution imaging devices. But what Boyden is most eager to show off is a small, ugly thing that looks like a hairy plastic tooth. It’s actually the housing for about a dozen short optical fibers of different lengths, each fixed at one end to a light-emitting diode. When the tooth is implanted in, say, the brain of a mouse, each of those LEDs can deliver light to a different location. Using the device, Boyden can begin to control aspects of the mouse’s behavior…read more

Oh, behave!–and lose weight doing it, says JAMA study

The Journal of the American Medical Association just published a two-year diet study that I think is well worth looking at–and please remember it the next time you read about how the seriously overweight can’t lose weight and keep it off without bariatric surgery or drugs because they’re programmed by their genes to be obese. What I especially liked about this study was that rather than focusing on gimmicky diets that call for nearly altogether cutting out some food group (e.g. carbs or fat), or loading up on some type of food (e.g. dairy, as pushed in another recently published study getting some press), or pushing significant calorie deprivation, it instead focused on a “behavioral” approach–that is, in educating participants in how to establish healthier, sensible, sustainable eating and exercise habits, and in providing ongoing support to encourage them to stick with the program. It was also a randomized controlled trial–the obese women who participated were randomly assigned to a “normal care” group that got fairly minimal support, or one of two groups that got much higher levels of support as follows:

The diet component of the program consisted of a nutritionally adequate, low-fat (20%-30% of energy), reduced-energy diet (typically 1200-2000 kcal/d) that included prepackaged prepared food items with increased amounts of vegetables and fruits to reduce the energy density of the diet. The approach was tailored so that participants could choose regular foods when preferred. Participants were encouraged during the initial period to follow a menu plan with prepackaged foods, which would provide 42% to 68% of energy for those who choose not to deviate from the plan. Regular foods, such as vegetables, fruit, cereal or grain products, low-fat dairy products, lean meat or the equivalent, and unsaturated fat sources were recommended to achieve the total prescribed energy intake. Over time, participants were transitioned to a meal plan based mainly on food not provided by the commercial program, although participants could choose to include 1 prepackaged meal per day during weight loss maintenance. Prepared foods and counselors were provided by Jenny Craig Inc (Carlsbad, California).

Increased physical activity was another program component; the goal was 30 minutes of physical activity on 5 or more days per week. Program material and counseling addressed attitudes about weight, food, and physical activity and included recipes and guidance for eating in restaurants, CDs and DVDs to increase physical activity, and online tools and support.

And what do you know, the participants who got the real treatments took off weight and by the end of the two years had kept it off.  

By study end, more than half in either intervention group….had a weight loss of at least 5% compared with 29%…of usual care participants….  More than twice the proportion of participants in the center-based and telephone-based intervention groups compared with participants in the usual care group…had a weight loss of 10% or more of baseline weight at 24 months….

As with all diet studies, there’s plenty to be wary of, too.  It was funded (but not run) by for-profit weight-loss-program company Jenny Craig, which also supplied pre-packaged meals for the studies, and bias toward the funders may well have crept in there somewhere. Two years is typically taken as a standard for proof that a diet intervention helps keep weight off, but obviously it doesn’t necessarily tell you how the participants will fare in the next two, or ten or forty years, and weight-losers, like smokers, need to be in it for the long haul in order to really raise their chances of having a long, healthy life, not just long enough to look good for their high-school reunion. The reliance on free pre-packaged food is a somewhat unrealistic model for the real world–though not completely unrealistic if we as a nation start getting more serious, as we should, about helping the obese get healthier. The treatment participants got $25 for showing up for clinic visits–getting paid to lose weight is a hot idea these days, but I don’t think smallish payments make a big difference over the long term and fear it just confuses the issue. As the study authors themselves point out, one always has to wonder if the people who participate in a diet study are representative of the population, for example in terms of level of motivation and commitment. But on the whole, I thought the diet interventions were smart, and doable on a large scale in the real world, and it was great to see them produce these impressive results in what seems a relatively careful study.

It also didn’t surprise me in the least–behavioral approaches to weight loss, including Weight Watchers, have been doing pretty well in studies on a fairly consistent basis for decades, unlike most other approaches.  So let’s support more people who need to lose weight to be healthy in eschewing gimmicky and unsustainable diets, and in ignoring the toxic claims that they’re genetically incapable of benefiting from any non-surgical, non-pharmaceutical intervention, and instead make it easier for them to get access to comprehensive behaviorally oriented weight-loss programs designed to take modest amounts of weight off gradually, comfortably and forever.

Doctors and dieting; and measuring calorie burn

Nicholas Bakalar has a good article about physicians’ efforts to encourage patient weight loss in the New York Times “Science Times” section. Bakalar is one of the most careful writers at the Times when it comes to avoiding flashy medical findings that aren’t likely to hold up, as well in making a point of looking for and clearly reporting on the limitations of the studies he covers. You wouldn’t think those would be unusual traits in science journalists, and especially in Times reporters, but they are. (I should also mention I’ve met Bakalar a few times and consider him a friend, but my admiration for his work pre-dates my knowing him.)

Bakalar’s piece makes two important points: physicians normally have little luck in getting patients to lose weight, and physicians tend to have more impact when instead of trying to push a patient into losing weight they instead work with the patient to try to figure out together what to do about the problem. I’ve been researching both of these issues for my ongoing obesity projects, and Bakalar’s article is spot on with regard to both of them. I’ve asked dozens of physicians how many patients they’ve managed to convince to lose weight, and the answer is pretty much always just about zero. And the idea of working with patients to come up with an appropriate plan that focuses in part on helping patients to recognize and deal with their lack of motivation, and in part in figuring out what actions can be taken that are realistic for whatever level of motivation they have, is a critical part of a behavioral approach to weight loss. Something I’ll be saying a lot more about in this blog and elsewhere is the fact that the behavioral approach, while backed by a lot of evidence, made famous by Weight Watchers and pushed by many highly credible experts and public health officials, is largely ignored by most of the overweight public as well as by most physicians and obesity researchers–and I think it’s a big reason we keep getting bigger.

Separately, here’s a piece, this one in Canada’s Globe and Mail, that hits on a another point I’ve become very interested in: the terrible job that people and devices do in measuring calories burned when exercising.  I’ll have more to say about this soon.

Should the public be told about the trouble with medical research?

Among the reaction to my Atlantic article there has of course been a certain amount of skepticism and criticism.  Some of the criticism has been perfectly fair and insightful, pointing out the ways in which I or Ioannidis (the physician-researcher I profile in the article who has documented and analyzed the high wrongness rate in medical research) might ourselves be biased, and might be spinning some aspects of the story.  I touch on this problem in the article, and have a whole chapter on it in the book, and I have no interest in denying that my own bias and sloppiness (as well as those of the people I interview and those of my editors) may skew things.

I generally welcome criticism, and usually don’t respond to it–I figured I had my say–except as part of a formal response to comments submitted to the publication that ran the article. But I saw a blog post today that I think calls for a bit of a response.  The post, by the physician-researcher David Gorski (whom I actually briefly quote in the Atlantic article), echoes posts in other blogs from a few people in or close to the medical community in essentially suggesting that the problems with research that Ioannidis has uncovered and that I report on in the article aren’t really big problems; rather, they’re just an acceptable part of the nature of research.  I don’t think so.  Bias and sloppiness may be routine and perhaps inevitable even among top researchers, but that doesn’t mean we shouldn’t be made aware of the extent of the problems and the toll it takes on the credibility of medical findings–and the vast majority of researchers seem to agree, to judge by most of what has been posted in response to the article.  Gorski’s post also states that we should focus on the fact that (as I report in the article) 90 percent of large randomized controlled trials tend to hold up, and not pay much attention to the fact that other types of studies sink to levels as low 10 percent rightness and even lower.  This is to me a shocking argument, considering that large RCTs make up a tiny percentage of the studies that fill journals, make headlines and influence treatment and lifestyle decisions.

Finally, the post argues that everyone should put their energy not into looking into the problems with mainstream medical research, but rather into the poor or non-existent science behind alternative medicine–and that we should keep our mouths shut about whatever problems we do find with mainstream medicine because it only gives ammunition to the alternative medicine crowd.  Once again, I have to strongly disagree.  People who are drawn to alternative medicine have already proven themselves essentially either uninterested in or incapable of assessing scientific evidence, and when researchers like Gorski rant and rave about alternative medicine they’re really just preaching to the choir, as is clear from the comments that appear under his post.  In fact, compare the nearly unanimous point of view in these comments to those that appear almost anywhere else in response to the Atlantic article–Gorski’s fans clearly have their minds made up about people who criticize mainstream medical research, and they don’t even actually have to read the criticism themselves to feel comfortable commenting dismissively and authoritatively on it.  Some of the comments, following Gorski’s lead, include ad hominem attacks on me that are based entirely on sloppy and mostly incorrect assumptions about my background.

Unlike the well-known absence (with a few exceptions) of good science behind alternative medicine, the serious problems with mainstream medical research have largely been unknown outside of the medical community itself.  I believe the public has a right to hear about them, and to judge by the reaction the public seems quite interested in hearing about them.  I quote Ioannidis in the article as pointing out that if mainstream medical science tries to keep quiet about its problems and limitations, then it is doing what it accuses alternative medicine of doing–misleading the public.  I’m glad Gorski and his fans represent a small minority of the medical community in being unwilling to own up to and communicate these problems–see, for example, what the British Medical Journal had to say about my book–and in focusing instead on endlessly recycling the same old complaints about alternative medicine because it makes them look good in comparison.

And for the record: Along the way, Gorski belches out the sarcasm-and-bile-drenched claim that my earlier post on this blog relating to quack autism researcher Andrew Wakefield reflects my refusal to recognize that Wakefield was wrong.  That’s just plain silly.  The point of the post was that the outing of a rare, gross fraud like Wakefield distracts from the more widespread, routine problems in medical research trustworthiness.  I think I was pretty clear about that, but judge for yourself.  I happen to be a little sensitive to the suggestion that I support quack autism research, because two members of my immediate family work with children with autism, relying solely on the treatment that is the mainstream standard of care, applied behavior analysis.  I know quite a bit about autism quackery, actually.  I just didn’t think the intelligent readers of this blog needed me to rant and rave, Gorski-style, about an obvious and blatant charlatan who had long been making global headlines for his misdeeds. (And my Wakefield post linked to an article that described the misdeeds at length, though I just now changed the link to point to a similar article because the original is no longer online.) Considering that he passes himself off as the champion of objectivity, facts and reason, Gorski seems surprisingly comfortable distorting the facts to fit his nearly undisguised biases.  But maybe we should be grateful for undisguised biases–it’s really the well-disguised ones we need to watch out for.