Atlas Shrugged: The Mocking

Wednesday, January 11, 2012

Expert Opinion

Sometimes being a knee-jerk contrarian, always eager to assume that the little people who serve you are inept, is not a good idea.

Megan McArdle is once again telling us far more than we need to know about her personal life. This time she is discussing her medical condition, one of her favorite subjects.

Medical Advice for the New Year: Don't Get Sick

By Megan McArdle

I have a family history of high blood pressure, so naturally when I saw that the Wall Street Journal had a piece up on "starting early for cardiovascular health", I clicked through.
The article said that "[b]ringing high blood pressure under control at any time reduces risk of disease. But not letting it creep up in the first place can be even better." McArdle is verklempt, because nobody knows anything ever and nobody can do anything ever in her philosophy.

[Y]ou'd really be surprised to learn how little control hypertension patients have over their condition. Yes, there are risk factors. But without medication, my blood pressure routinely spikes over 155 even though I have a perfectly normal BMI. It began creeping up in my mid-thirties for no obvious reason.

Actually, there is one obvious possibility.

That did not stop my doctor from offering ridiculous suggestions as to how I might control it. In her defense, she was a resident in internal medicine, and was presumably required to give me ludicrous advice by whatever shadowy figure was supervising her and actually making the decisions. First she came back and told me that a glass of wine with dinner more nights than not was "really a lot" of drinking, in a tone that would have been more appropriate had I confessed that I frequently woke up on the floor of our living room, surrounded by empty scotch bottles that I couldn't remember having purchased.

If McArdle drinks more than 9 drinks a week (5 oz of wine is one drink), she is considered a higher risk drinker. (A standard wineglass is a little over half full when it holds 5 oz of liquid.) Someone whose criteria for buying a house included bars within walking distance and who says she drinks at least four times a week could easily exceed a safe drinking level, and McArdle's response is quippy but unwise. You don't have to drink until you pass out to drink too much and these guidelines are for healthy people, which McArdle is not. She has Hashimoto's Thyroiditis and asthma, as she has mentioned several times.

McArdle's doctor told her to cut back on salt, which she decided was stupid advice.

 It made more sense just to ignore her advice, as I'm sure that everyone else she gave it to did. (And with good reason: the evidence that reducing your salt intake has a big impact on your blood pressure is pretty mixed.)

McArdle links to fellow professional contrarian John Tierney, whose article is far from convincing but who is as against government intervention as McArdle.

I am sure that it would, in theory, have been better for me to not have developed high blood pressure in the first place. It might also have been better for me to be 5'10 instead of 6'2--and unfortunately, I have no idea how I could have achieved either stunt.

Nor did most of the people in the study cited by the WSJ; according to the authors: "The prevalence of hypertension treatment in this study is low because of the time period during which these cohorts were initiated". The Journal compresses this to "patients who curbed their levels in the Circulation study did so only with lifestyle changes " but that is not actually what the authors said. Rather, they said that they don't know why people's blood pressure fell. People whose blood pressure fell did see smaller increases in body mass index and cholesterol than those whose blood pressure rose. But those things were still increasing, not decreasing. So:

Decreases in BP may have been due to lifestyle changes, as suggested by the changes in body mass index and total cholesterol, although it is possible that differences were due to random variation or regression to the mean.

So what we really know is that if your blood pressure is high, and then falls, it is better than if it just stays high--and it's even better if it doesn't get high in the first place. Except we knew that before. Having high blood pressure is bad for you. So is getting Lou Gehrig's disease. But it is not very useful to tell people that they will be better off not contracting these conditions.

The article that McArdle read discussed rising blood pressure in aging men. The advice would be appropriate for them, if not her.

You can treat the condition, of course--but to my chagrin, even well-controlled hypertension is not the same thing as having normal blood pressure. Whatever underlying process is causing my blood pressure to rise is also probably damaging my cardiovascular system, even when the blood-pressure itself reads normal. Moreover, at least as far as I know, doctors don't give you blood pressure meds when your BP hits 121. They wait until you're, well, hypertensive, or close to it. That's because there's substantial error in blood pressure readings (you're having a bad day, you were late and ran up the stairs, you're scared of hospitals). They don't want to put you on diuretics for years to treat that rumor you heard that your company might be having layoffs.

Of course, you should exercise--but research seems to indicate that it's good for a few points, not a drop from "Stage 2 hypertension" to "normal". And you should quit smoking--but much to my surprise, smoking apparently doesn't cause high blood pressure. Maybe you should eat less salt, too, but the evidence that this will improve your hypertension is not all that convincing. Even losing weight, the most plausible intervention, seems to generate modest improvement, not radical reduction. All of these things together, at the most generous estimates, would not have reduced my blood pressure below 120/80.

Don't get me wrong: hypertension is a serious condition; it's imperative to treat it, and it would be even better if we could avoid it entirely. But I only know one sure-fire way to keep your blood pressure from rising, and that's to avoid reading articles telling you that you really shouldn't have become hypertensive in the first place.
McArdle does not believe fat people can lose weight, poor people can have discipline, or rich people can be greedy and make bad decisions. Things just happen for no reason and there's nothing we can do about it. Experts don't know anything, governments can't help people, the poor we will have with us always. This casual disregard for logic and reason and hand-waving dismissal of expertise can have very detrimental effects.

For instance, evidently McArdle was so busy dismissing everything her doctor told her that she did not ask about a connection between her autoimmune disease and high blood pressure. According to the American Heart Association, the two are associated.


Dillon said...

MM: What can I do to lower my blood pressure?

Doctor: Consume less alcohol and less salt.

MM: Let me rephrase the question. What drug can you prescribe for me to lower my blood pressure, so that I don't have to alter my lifestyle in any way?

Lurking Canadian said...

Shorter every article Megan has ever written:

Nobody can know anything, ever, except me, and I don't need to study to learn things because my gut feelings are JUST THAT GOOD.

Susan of Texas said...

I think she's going to need a bigger pillbox.

fish said...

Maybe you should eat less salt, too, but the evidence that this will improve your hypertension is not all that convincing.

This assertion really pisses me off, because there is actually EXCELLENT evidence that controlling sodium and changing your diet will substantially improve your blood pressure (and the underlying damaging physiology). In fact it is some of the best nutrition/lifestyle research out there.

I know Megan outright lies frequently to "prove" her point, but often the actual source of the facts for both sides can be debated in such a way that you can muddy the waters a bit. This cannot be muddied, the data is the data.
DASH research was sponsored from the National Heart, Lung and Blood Institute, came out of multiple studies from some of the best research hospitals in the country, and the effects are rapid (less than 2 weeks) and effective. Pivotal to the discovery was the largest factor affecting BP was sodium intake. If you don't do anything else to change your habits, if you reduce sodium, you sharply reduce BP. Even cursory exploration of the internets would reveal this close kept secret (i.e. free gov brochure).
ARGH! It just makes me see red!

fish said...

No one is smart enough to know:

The DASH studies were sponsored by the NHLBI and conducted at four medical centers. There was also a central coordinating center at Kaiser Permanente Center for Health Research in Portland, OR. The four medical centers were: Brigham and Women's Hospital, Boston, MA; Duke Hypertension Center and the Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC; Johns Hopkins Medical Institutions, Baltimore, MD; and Pennington Biomedical Research Center, Baton Rouge, LA.

Lurking Canadian said...

Who you gonna believe? Megan's impressions, gleaned from a random web page, or the lying collected wisdom of the scientific community?

Ken Houghton said...

But, Dillon, Himalyan Pink Sea Salt must be better for you than Commoner Morton's.

Ken Houghton said...

More seriously, one of the things about salt intake is that it generally goes UP with age. All the research indicates that, by the time you reach around my age, people's taste buds have begun "losing their power," as it were—salt gets added because food "loses flavor."

So if you're young (or, as in Megan's case, relatively young) and you're already eating Too Much Salt, your doctor knows that your salt intake is only going to get more extreme in ten or so years.

We know she doesn't take her antibiotics correctly. Now we know it's general neglect of doctors's advice and training.

It's a good thing David Bradley can afford to subsidize her poor lifestyle choices. (Whether this makes him a Rational Actor is another question.)

BillCinSD said...

In addition to lowering sodium, raising your potassium intake is helpful for most people. Finland made a law where processed foods needed to use a high potassium salt rather than NaCl and deaths from heart disease and stroke dropped 60% and diastolic blood pressure dropped 10 points.

Kathy said...

Isn't smoking rather hard on the BP?

And smokers I know seem to always want to add salt to their food- always asking for the salt shaker at the dinner table. The only one I have is kept next to the stove, and its usually close to full. I seldom use salt- I have a box of Morton's from the 90's. (Well- I tossed it when we moved in Sept. Does salt "go bad"?) I used to quarrel with my (smoking) Mom every Thanksgiving. I made the turkey dinner, but she'd sneak into the kitchen and add so much salt to everything, one couldn't taste the actual food. Might as well eat dry dog food. grrr.

ifthethunderdontgetya™³²®© said...

Finland made a law...


Anonymous said...

Hmm, Hashimoto's Thyroiditis, I did not know this. Incidentally, one of the symptoms of this condition is "difficulty thinking and concentrating". Who would have thought? There might be a medical explanation for McMegan that has nothing to do with Down syndrome. However, the condition description does not mention dishonesty. I think she owns that in full.

Anonymous said...

Doesn't the Libertarian Personal Responsibility that Ms. Megan so espouses require one to take responsibility for one's own lifestyle choices?

If that is the case, then Ms. Megan has declined to do so in this instance and expects her employer, her Koch Brothers-employed spouse, and her well-connected parents to finance her absence of personal responsibility.

fish said...

Heh, got into a little tiff with her, with moving goalposts and everything.

Anonymous said...

You all don't understand. Megs doesn't have plain ol' ordinary high blood pressure that can be substantially controlled with diet and exercise. She has some sort of special snowflake super-contrarian HBP that common doctors are incapable of understanding. There's no way her HBP is caused by too much booze and shitty food, like some damned commoner. Meg's HBP can only be comprehended by searching the farthest corners of the internet and talking to people who have no medical credentials.

Daddy fed her a continuous stream of "you're my little magic special princess" from ages 0 to 18 in lieu of actually raising her, didn't he?


Anonymous said...

Everything about that column is hysterical.

1) Megan bragging about her BMI, even though BMI really has nothing to do with your health outcomes compared to your level of activity and fitness. If you're skinny and out-of-shape, you're at a much higher risk of HBP/heart attacks/diabetes/etc than if you're overweight but in shape. Megs has never mentioned her exercise routine, her gym membership, her outdoorsy hobbies, her personal trainer, or her opinions on pilates and the right kind of elliptical machines, has she? My guess: she gets winded and gasps for air after climbing a flight and a half of stairs.

2) It's a complete goddamn mystery how someone who consumes enough hollandaise and bernaise sauces to brag about buy a $1500 robot to make them is having circulatory problems as they enter the second half of their life.

3) I love, love, love how her defense about maybe dialing down her drinking a notch or two for health reasons is transformed into the doctor treating her as if she guzzles scotch all day long. Isn't that a big warning sign that you have a problem, when you get hyperdefensive and attack your critic and point out that you're not as bad as some extreme case? I never figured McMegs for a drunk (she's certainly can't hold a candle to the current holder of UMich's Franzia Chair of Law) but it does explain a lot of things.

4) Her throwing away her doctor's specific advice is hilarious. She was told point blank BY HER DOCTOR that she needed to cut down on the salt and the booze because she has HIGH BLOOD PRESSURE and a FAMILY HISTORY OF HBP and an AUTOIMMUNE DISEASE THAT CONTRIBUTES TO HBP, and her response is to complain that the doctor doesn't know nothin'. Astonishing, hilarious.


atat said...

Shorter: "I already cook most of my food from scratch. Telling me to make everything from scratch is ridiculous."

Batocchio said...

Uh-oh, I sense another McArdle-Althouse alliance forming. Let them drink Franzia!

Isn't it funny how, in McMegan's world, "shadowy figures" lurk in doctor's offices but not on Wall Street? And that we must defer to the "experts" on Wall Street, but not medical professionals?

Bravo to fish for hanging in there as she doubled-down.

Anonymous said...

Did anyone notice her bald assertion that smoking does not affect hypertension/HBP greatly or did that just slide by everyone in that santorum salad? (now available in iowa)

I mean this is a woman who "quit" smoking after all, photo evidence be damned. Asthma so she probably can't do much cardio, and eats cheese and white rice (great HBP combo here!) despite owning a Thermomix. All doctors are dumb! Some people need more synthroid and I know! I will quote Paul Campos! lawyer! about obesity!

In her case, going low carb and increasing potassium intake probably would help her immensely.

I also recall her pushing coupons for a scotch tasting or something at some point or another. I could use one about now.

Anonymous said...

Also forgot to mention her constant railing against exercise as a weight loss tool because she ignores its relation to long term weight loss. Instead she goes off on how exercise can make you healthy, but not lose weight because...exercise makes you hungrier...and you can't control your impulses. Impossible!
Pointing out that what you eat affects your appetite is not relevant.

Susan of Texas said...

Fish, you were a model of deportment. And I am sure she will not notice that you said she probably has another reson for her high bp besides salt.

fish said...

I was unwilling to let her get away with BS she probably heard at some cocktail party and used to confirm her world view. It took a lot to keep my cool.

If she really does have a relatively low sodium diet, I bet if she switched to more processed foods her BP would go through the roof. Her having high BP on a low sodium diet is not proof it isn't working. But as we know, her analytical skills are a bit lacking.

Anonymous said...

To be fair, she never said it wasn't working. She just wanted to throw a tantrum against doctors who tell her she can't have what she wants because it's inconvenient, and then try to rationalize said bad behavior by cherry-picking data.

Batocchio said...

She just wanted to throw a tantrum against [actual experts] who tell her she can't have what she wants because it's inconvenient, and then try to rationalize said bad behavior by cherry-picking data.

In other words, classic McArdle!

Anonymous said...

I'm rooting for injuries.


Susan of Texas said...

Wasn't she self-medicating by taking iodine at one point? Injuries might be inevitable.

Dillon said...

MM: So, any further thoughts on what can I do to lower my blood pressure?

Doctor: Reduce stress. For example, is there anything you can do to get Susan of Texas to stop blogging about you?

MM: No.

Doctor: Oh. In that case, you're pretty much fucked.

aimai said...

Go Dillon!

I wanted to add that I think Megan's self love is so great that she gets some kind of pleasure in typing out phrases like "I have a family history of high blood pressure" because the very phrase "family history" gives her a tingle of aristocratic joy. She reminds me of the Austen Character--Susan will remember who I mean--the father in Persuasion. Here's a quote:

"Vanity was the beginning and the end of Sir Walter Elliot's character; vanity of person and of situation. He had been remarkably handsome in his youth; and, at fifty-four, was still a very fine man. Few women could think more of their personal appearance than he did, nor could the valet of any new made lord be more delighted with the place he held in society. He considered the blessing of beauty as inferior only to the blessing of a baronetcy; and the Sir Walter Elliott, who united these gifts, was the constant object of his warmest respect and devotion."

Anonymous said...

the very phrase "family history" gives her a tingle of aristocratic joy.

Yup. This goes along with her insistence that she must be suffering from some obscure and romantic medical syndrome, and not just the effects of too much booze and tobacco and junk food like some ordinary schmoe. Ever Meg's diseases are better than your common, ordinary, lumpen afflictions!

"I'm in to some really obscure metabolic disorders, you probably haven't heard of them." - Megan McArdle, disease hipster

I still love that her response to having her doctor tell her point blank to change her diet and drinking habits lest she hypertension her way to an early grave was to google around until she found a better, less demanding diagnosis. A nice example of objectivist super-rationality in action.


zuzu said...

She reminds me of the Austen Character--Susan will remember who I mean--the father in Persuasion.

She's reacting to her doctor's advice the way Sir Walter reacted to the suggestion that as a result of his spendthrift ways he must retrench.

By the way, if you haven't seen it, the film version of Persuasion is divine.

But back to McMegan: I thought she pushed fancy salt as a way of getting the taste of salt without the saltiness. You use these things as finishers, which means you get the most bang for your buck. One could eat a low-salt diet and still get that salty flavor by using good salt in small quantities on top of the food.

But something tells me that when she says she cooks, she uses a lot of salt and a lot of processed ingredients which bump up the sodium content.

Anything but having to retrench.

Susan of Texas said...

McArdle would be a great Austen character.

I think Jonah Goldberg would be Dickens. And for some reason whenever I think of K-Lo I think of Margaret Rutherford's performance in The Importance Of Being Ernest.

Susan of Texas said...

Someone who talked at great length about her salt usage, that she keeps it in an open container on her stove for easier access, now tells us that she uses very little salt. As aimai says it's all about the image she wants to project.

Anonymous said...

meg = poster girl for NPD.

Batocchio said...

Someone who talked at great length about her salt usage, that she keeps it in an open container on her stove for easier access, now tells us that she uses very little salt.

Susan, are you suggesting that McMegan might be - *gasp* - lying about her sodium consumption? (Or indignantly unaware?)

Also, Zuzu, are you a fan of the 2007 version of Persuasion (Sally Hawkins), the 1995 one (Amanda Root), or one of the earlier ones? I'm assuming the 2007 one...

zuzu said...

The 1995 BBC version with Amanda Root and Ciaran Hinds (and Corin Redgrave as the McMegan of his time).

Haven't seen the 2007 version; is it worth checking out?

Batocchio said...

I actually haven't seen the 2007 version yet (another one for my list), but Hawkins has been fantastic in everything I've seen her in (especially Happy-Go-Lucky, if you're a Mike Leigh fan).

DocAmazing said...

It does make one consider the term "salt pig", nicht wahr?

Anonymous said...

Interesting that, when it comes to herself, there's absolutely nothing you can do to mitigate one's blood pressure, but when the subject of single payer comes up, she's ready to blame the "old and sick" for their bad behavior: "as a class, the old and sick have some culpability in their ill health. They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports." (From her 2007 post on single payer, to which I could link but refuse to.)