NoahSD's Awesome Poker Blog

(Seriously.. No poker content at all.)

The human body is unquestionably the most complicated machine that any person has ever encountered, and it’s likely to hold that title. Each of the about 6.8 billion people on Earth is composed of a unique set of roughly 100 trillion cells (Whenever you hear the word trillion, be amazed) of a huge variety of types. Each of these cells is way more complicated and elegant than your high school bio textbook said. The organelles in your cell exist in this terrifyingly confusing and surreal world in which incredibly weird objects of a huge variety of scales interact according to the bizarre laws of organic chemistry, three-dimensional geometry, and quantum mechanics. This is explained way better than I ever could by this insanely awesome video created for Harvard students:

(For more about this video, see this awesome TED talk.)

Everything you see happening in that video (except for the stuff at the beginning and the end that is clearly extracellular in a blood vessel) is a mundane occurrence from your cells’ perspective, and each is happening at least hundreds of billions of times over in your body at this moment. (Some are happening over ten sextillion times at once, like the walking thing, called a kinesin.) And, somehow, arising through all of this madness, is some lazy poker player who’s considering going to Chipotle, but he can’t quite sum up the energy, so he’s writing a blog post instead. My typing fingers, my beating heart, my hunger, my laziness, my terrible ideas for blog posts–All of these things are somehow wonderfully nuanced properties of one giant machine built out of an incomprehensible number of these weird tiny machines.

So how the hell do we study this thing? That video only shows a tiny fraction of the mundane activities that we’ve thoroughly researched, and we likely know only about one percent of what actually goes on in your cells. The organs in your body, weird and busy in their own right, are each composed of trillions of these trippy, poorly-understood, active worlds. Worse still, this machine wasn’t designed by anybody (sorry creationists…). Your laptop was designed in layers by humans for human use with the explicit goal of being easily understood by humans. It’s actually not that hard to understand how something gets written to RAM or how to write in assembly language or how to program in C, and you can understand all of these things individually without any knowledge of the others. There might even be a guy somewhere who understands how your computer works from the ground up.

In horrifying contrast, your body was designed by a bootstrap evolutionary process that didn’t partition it into such neat layers. In order to understand one aspect of the human body, it is often necessary to understand everything underlying it–from the interactions of molecules composed only of a few atoms to the mechanics of a large and complex organ. Your thoughts, for example, are influenced to a huge degree by the tiny details of the process by which billions of individual neurons release trace amounts of chemicals to interact with those around them. Indeed, it’s unlikely that any person will ever understand all of the workings of a single red blood cell, let alone the entire human body. So, to say that the human body is difficult to understand is an understatement of epic proportions.

But, we have to understand it. Our bodies are machines that were built to live miserable and short lives, and we would strongly prefer them to live much longer, happier lives with significantly less pain and significantly more happiness and pleasure along the way. So, for as long as man has been conscious, he has been attempting to rig the most complicated and intricate machine on Earth to do entirely new things. (And we’ve certainly made some serious progress. Most of us would not have made it past the age of five had it not been for modern medicine.)

The correct way to do this is to identify potential fixes that are plausible based on our (extremely limited) knowledge of how this machine works and try them out to see what happens. For extremely simple things, this process isn’t too hard at all. Broke a bone? Don’t move it for a while, and it’ll probably heal itself–If it’s really bad, we’ll line it up so it heals properly or mabe put some metal in there to help out. Cut yourself really bad? We’ll clean the wound and maybe sew it up if necessary. Baby not coming out right? We’ll cut you open and take her out ourselves (ewwwwwwww). All of these things are pretty obvious solutions, and they work so often in practice with so few consequences that it really doesn’t take much to establish their plausibility, test them, refine them, and conclude that they’re smart procedures.

For even slightly more complicated things, stuff gets really messy really quickly because, again, the human body is a very complicated machine. Some stuff is just hard to figure out, even if the solution is simple and easily testable. For example, how the hell were we supposed to figure out that a tiny amount of iodine can prevent goiters and cretinism? And it only gets worse. For considering truly complex topics like heart disease, cancer, obesity, mental illness, etc., we have to drop the language of simple cause and effect and instead use the language of statistics–from causes and cures to risk factors and preventative therapies. This move brings with it all of the dangers of statistics that poker players are (or should be) quite familiar with–questions of sample size, variance, and correlation without causation. Are heart attacks actually made more likely because of high cholesterol or did random noise or a bias in our sample incorrectly suggest that? It also lends itself to misunderstanding. “My friend had cancer and survived when she changed her diet” is not sufficient evidence to suggest that a new diet cures cancer just like “My friend played 55/40 at 6-max and won five buy-ins” isn’t sufficient evidence that playing 55/40 at 6-max is a good idea. Your friend may be one of the few who happened to survive life-threatening cancer without treatment just like she may be one of the few who happened to win playing like a maniac. (Sorry for the poker analogy…)

And those two problems pale in comparison to the last; even if you find a statistically significant effect of a treatment and you’ve ruled out sample bias, and you’ve shown conclusively that you are witnessing true causation (not that anyone could actually do that in practice), you still can’t be sure that your treatment works. This is because of the great confounder of medical science: The placebo effect. This is a way bigger deal than you probably think; there are actually two sort of distinct placebo effects:

1. “I think I feel better now.” This is what you probably think of when you think about the placebo effect. Some dude in some primitive tribe goes to his local witch doctor and tells him, “I feel funny.” The witch doctor kills a couple chickens and says a chant or two, maybe drinks some mescalin or whatever he’s got around for good measure, and goes, “Alright, I’ve cured you. That’ll be three goats.” The patient thinks about it for a while and decides “Hmmm.. I guess I do feel better. After all, you are a witch doctor…” He hands him four goats and goes home. (Tipping doctors is apparently standard in this culture.)
2. “Hey… Where’d my Parkinson’s Go?” There’s still an active debate in the medical community about whether or not the placebo effect can actually cure real physical diseases. The consensus is that it actually does. In other words, paying the witch doctor four goats to slaughter a few chickens and tell you that you’re cured might actually cure you. For example, Parkinson’s disease–a very serious physical illness caused by the death of brain cells–responds remarkably well to placebo (1 2). People actually go from being bedridden to walking around after being treated with fake medicine. There’s some less compelling evidence that the same might be true for ulcers. And, indeed, there’s similar evidence about a long list of diseases.

If this actually happens and if so why are both still an open question. There are lots of different theories that essentially boil down to this one, which I won’t bother to attempt to summarize (1 2). There’s also a pretty wide body of literature (1 2) arguing that the placebo effect actually doesn’t cure much except for pain, nausea, and psychological disorders, and the rest is just caused by poor studies and the difference between how healthy people think they are and how healthy they actually are. (Radiolab has a really really awesome discussion of the placebo effect that I highly suggest you check out.)

So stuff is really really hard for medical scientists. It’s pretty easy to think that you’ve found a cure for something and later learn that the effect was statistical noise or that your patient would’ve been equally well cured by watching a tripping witch doctor behead a few chickens. To combat this problem, modern medicine has turned to the holy grail of studies: the large sample size, randomized, double-blind, placebo-controlled trial. The use of large sample sizes should be self-explanatory to poker players; you need to try out your cure on a lot of people to get statistically significant results. Instead of simply seeing how treated patients do on their own or how they fare compared to untreated patients, placebo-controlled studies look at how treated patients do compared to patients who receive fake treatment. (I.e. if you are testing the effect of a pill, you give your control group pills filled with sugar. Patients always consent to the chance of placebo.) This should in theory account for the placebo effect. In order to make sure that the two groups are treated equally, good experiments are typically done double blind, which means that both the patient and the doctor don’t know whether the treatment is real or fake (otherwise the doctor might appear more confident to one group or take one group less seriously). And, in order to minimize errors due to sample bias, patients from the sample are randomly chosen to be in either the placebo group or the group receiving real medicine. Even extremely subtle effects like the color of a pill can taint a study, so good studies have to be done extremely carefully.

Needless to say, this leaves a ton of room for error, confusion, and misinformation. In fact, there is an entire industry called alternative “medicine” that thrives off of this confusion. It exists entirely to sell “medicine” to people that has not been properly tested, or even “treatments” that have been repeatedly shown not to work. This is a gigantic business, with about $34 billion per year in revenue. People’s fundamental misunderstandings of the above concepts and the huge prevalence of misinformation coming from this industry (both from people who think that they are helping and from people who are intentionally lying to make money) cause the vast majority of people to believe in pseudoscientific fake medicine. Tragically, even many real doctors who went to legitimate medical schools and practice western scientific medicine are misinformed about many topics. And, the internet is full of misinformation (ughhhhh). I’m not just talking about forums and web sites that look like they were made in the 90s by obvious quacks, I’m talking about sources that reasonable, smart people trust like WebMD, which is full of pseudoscience.

This information spreads so readily because it’s so easy to believe. It gives people hope, makes them feel unique, and feeds into our fears of science, technology, government, and corporations. People don’t want to hear that an expensive pill made by a giant corporation and regulated by the government might make them better, but it comes with side effects; they want to hear that some ancient civilization knew of some wonderful natural cure that always works for all diseases with no side effects, and that stupid and/or evil corporations and governments have failed to provide this knowledge for various reasons. This rhetoric, combined with a general fear of insulting people’s “beliefs” causes the better-informed to fear speaking out, so very reputable sources like the NIH and the Mayo Clinic treat alternative “medicine” with guarded respect. And as a result, it can be extremely difficult to find good information anywhere.

This extreme prevalence of poorly combatted misinformation kills people. In fact, my uncle (with whom I wasn’t very close.. not looking for sympathy) would probably not be dead right now were it not for a crank who convinced him that the best way to cure his cancer was to take large amounts of vitamins and other crank cures. Rather than suffer through radiation and chemo and live, he chose to fly to Germany, where he was treated with a variety of “cures” that did nothing. It wasn’t until his cancer paralyzed him that he realized the The people who did this to him, and many others, don’t only charge money to lie to their patients, they charge them money to keep them away from doctors and ultimately kill them.

So, when you consider medical advice, follow NoahSD’s Official Guide to Interpreting Medical Advice(TM):

• Always be skeptical. This is self-explanatory. Remember that your body is complicated and that it’s easy for people to be misinformed about it. Just because someone tells you something doesn’t mean it’s true. Even very smart people (and even doctors) are frequently wrong about the human body.
• Always assess plausibility. If someone tells you that sticking needles in your back will cure your asthma, you’re probably pretty safe ignoring their advice. If someone tells you that eating lots of spinach (or whatever) will cure your asthma, you should wonder how that could be true when so many people with access to spinach have asthma, and probably ignore the advice or maybe continue researching with a large dose of skepticism. If your pulmonary doctor tells you that a certain gas is FDA approved for asthma patients, and that inhaling it might help alleviate your symptoms, you’re probably okay taking it regardless, but you should still probably research it on your own to make sure.
• Remember that you’re not special, and the placebo effect affects you too. This is depressing as hell, but just because something “worked” for you, doesn’t mean it actually worked. My dad takes vitamin C every time he gets a cold, and every time he says that after taking it he feels better. This is in spite of the fact that the evidence shows that vitamin C actually doesn’t help with colds more than placebo. (Or, you might have experienced a sugar high at some point in your life, except for the fact that sugar highs don’t exist.) To some extent, this is fine. My dad takes his vitamin C, and he gets some placebo effect (either by convincing himself he feels better than he feels or by an actual physical placebo effect lessening his symptoms). He pays a few bucks to go to a witch doctor, and he comes out happier. That’s fine. The danger in stuff like this is when similar logic is applied to more important things, e.g. eating an extreme diet because it seemed to make you “feel better” or attempting to cure seriously illnesses with false cures.
• Two (or four) opinions are better than one. This stuff is complicated, and doctors get stuff wrong all the time. If you see a doctor for a serious medical condition, your next step should always be to see another one (and then another).
• Wikipedia is your friend–seriously. Believe it or not, Wikipedia is a wonderful wonderful resource for medical advice. It is far far better than WebMD or anything else that I’ve discovered. One way that you can tell that Wikipedia is so good is because of how non-committal its claims are. For example, there is no evidence that colds are caused by cold weather (in spite of what my pediatrician told me), nor is there any evidence that cold weather hurts your immune system. (These are myths created to explain why colds occur so much more often in colder climates and during the winter. The real reason is that cold weather makes people stay indoors, where they breathe each other’s germs.) Wikipedia knows this, but it is beautifully open-minded in it’s discussion of the topic: “The experimental evidence for this effect is uneven: many experiments have failed to produce evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection, implying that the seasonal variation is instead due to a change in behaviors such as increased time spent indoors at close proximity to others.^[10][23] However, other experiments do find such an effect for both body chilling and cold air exposure, and a number of mechanisms by which lower temperatures could compromise the immune system have been suggested,^[17] while other experiments have shown that exposure to cold temperatures may instead stimulate the immune system.^{[74][75]” Plus, it lists it’s sources, so you can check the information yourself.}
• Large sample size, double blind, placebo controlled, randomized. If something is proven by a study that has all of those characteristics, it’s probably true. Any other evidence should probably be ignored, or at most, considered with a very healthy dose of skepticism. Remember that witch doctors “cured” people for millenia with ridiculous rituals. Don’t fall for that stuff. In particular, completely ignore anecdotal evidence.
• Multiple studies are much better than one. Even if studies are double blind, placebo controlled, etc., it’s just so easy to make mistakes. This is why there’s a news story about once a week about how something causes or prevents cancer or heart disease or Alzheimer’s or whatever. (You often don’t hear about the follow-up studies that disagree with these findings.) Studies also have a natural selection bias in that negative studies often don’t get published; this is less true of larger studies (i.e. clinical trials) and follow-up studies to earlier-published positive results. So, lots and lots of bad treatments have one or two studies that were poorly designed or got lucky and showed positive results. Worse still, some people lie about results. (The autism vaccine controversy was a fraud that cost the world lives and money.)
• Be very wary of anything that’s “alternative”. Food supplements, “natural healing”, “eastern medicine”, anything that mentions “flow of energy” or “your body’s natural frequency”, etc etc. All of these things are “alternative” because nobody’s shown that they work rigorously enough to satisfy conventional medicine’s standards.
• Quackwatch is cool. http://quackwatch.org/ is a nice resource for researching fake medical claims. For example, if someone tells you that the acidity/alkalinity (i.e. pH level) of your blood influences your health, you can search “alkalinity” on Quackwatch and find a nice concise article explaining that that’s not true and debunking some related common misconceptions and tricks that cranks will use to sell you their products. (Compare that to searching google for alkaline diet.)
• Sometimes you have to gamble with your health, but gamble responsibly. In a perfect world, every medication, diet, therapy, etc. would be tested on a sample of 10,000 clones of you in a perfectly done study before you even considered it. Unfortunately this isn’t happening (yet). Many potential treatments are poorly studied or not studied at all, but still might be effective. When considering such things, weigh the plausibility, potential pros, and potential cons, and make an informed decision. Doctors do this all the time when they prescribe drugs for off-label treatments, for example.
• Remember that nobody knows what they’re talking about. I probably got some facts wrong in this article. (Sorry about that. Please call me out in the comments.) Doctors regularly misdiagnose patients. The FDA has approved many drugs that turned out to not do what they were supposed to do, sometimes in spite of clear evidence, and it will do so again. This is a complicated topic, and nobody understands it well. In fact, probably the single best way to judge someone’s medical advice is by how often they sound unsure. The more times someone says “maybe”, “the evidence is inconclusive”, or something similar, the more likely they are to be well-informed. (The fact that this post makes a lot of assertions without qualifiers is pretty good evidence that I am not a good medical researcher.)

Not-So-Brief Explanation for This Post

First of all, let me know if you’d like more non-poker stuff here. I’d love to rant about lots of fun (or maybe really boring?) stuff like politics, science, economics, my weird social theories, etc., but I have no clue if people are interested. So please let me know if that sounds appealing or boring or repulsive or whatever. (More variance-related poker stuff coming soon. I promise.)

This post was motivated by the fact that the poker community (like almost all communities) seems to be infected with pseudoscience. I originally intended to discuss the Poker Road show Life Smart with Thuy Doan, in which Thuy, a pro poker player with cancer whose name is pronounced “Twee”, talks about medicine, health care, etc. with her health advisor Kevin Meehan, whose web site describes him as “the Owner [sic] and founder of the Teton Health Clinic, serving Teton County, and nearby Idaho and Wyoming communities with alternative healing therapies that foster the body’s inherent ability to heal.” I wanted to explain why I think Poker Road should not have this type of stuff on their site and why I strongly disapprove of Meehan. But, after making an ass out of myself in an e-mail conversation with her, I’ve realized that I’m no where near tactful enough to handle a delicate issue like that without offending Thuy–who I believe has nothing but the best of intentions, and just generally seems to be really sweet and much more of a mench than I am–and just generally coming off as an ass.

So, I scrapped the project. But, after the appearance of a bunch of tweets from various poker pros like Prahlad Friedman and Jen Harman discussing their incorrect views on health and the memory of that horrible “balance bracelet” thing that fooled a bunch of poker players (See here. Their web site is now down, probably for legal reasons…), I got to writing. I feel a pretty strong need to combat misinformation about science in general, and medicine in particular, because I know that this sort of misinformation kills people, and I’m hoping that the fact that some people in the poker community are actually willing to listen to me will allow me to change a mind or two. Hopefully this post doesn’t make me come off like a total ass like I probably would have had I devoted the entire thing to calling out people for their perfectly reasonable incorrect beliefs.