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For Lower Back Pain, You Can Skip the Tylenol

| Wed Jul. 23, 2014 8:24 PM EDT

Here's the latest from the frontiers of medical research:

About two-thirds of adults have lower back pain at some point in their lives, and most are told to take acetaminophen, sold under brand names like Tylenol, Anacin and Panadol. Medical guidelines around the world recommend acetaminophen as a first-line treatment.

But there has never been much research to support the recommendation, and now a large, rigorous trial has found that acetaminophen works no better than a placebo.

The good folks at Johnson & Johnson will no doubt disagree with extreme prejudice, but I'm not surprised. I suppose different people respond differently, but I've basically never responded other than minimally to Tylenol. It might dull a bit of headache pain slightly, but that's about it. However, there's more:

Dr. Williams said that acetaminophen had been shown to be effective for headache, toothache and pain after surgery, but the mechanism of back pain is different and poorly understood. Doctors should not initially recommend acetaminophen to patients with acute low back pain, he said.

Hey! That's right. I had some mild toothache recently thanks to a filling that involved a fair amount of work beneath the gum line. It acted up whenever I chewed food on that side of my mouth, and I found that Tylenol made it go away within 20 minutes. I was pretty amazed, since Tylenol had never really worked for anything else. But it was great for toothache.

Anyway, everyone is different, and Tylenol might work for you better than it does for me. It might even work for back pain. It doesn't on average, but that doesn't mean it's ineffective for everybody. In the meantime, maybe the medical research profession could hurry up a bit on that business of understanding what lower back pain is all about, OK? It so happens that I could use some answers on that score.

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Twitter Releases Its Diversity Stats. And Boy, Are They Embarrassing.

| Wed Jul. 23, 2014 7:37 PM EDT

Twitter today followed in the footsteps of Google, Yahoo, LinkedIn, and Facebook by releasing statistics on the race and gender of its workforce. The company certainly deserves credit for voluntarily making its diversity stats public, unlike, say, Apple. "Like our peers, we have a lot of work to do," Janet Van Huysse, its VP of diversity and inclusion, admits on the company blog. But perhaps that's an understatement; Twitter actually lags far behind its peers on some key measures. For instance, only 1 out of every 10 Twitter tech employees is a woman:

Twitter

In case you're wondering, other large tech companies have significantly better gender diversity (though it's still abysmal compared to professions such as law or medicine). At Facebook and Yahoo, 15 percent of tech workers are women. At Google and LinkedIn, it's 17 percent. In 2010, Mike Swift of the San Jose Mercury News found that women held 24 percent of computer and mathematics jobs in Silicon Valley and 27 percent of those jobs nationally (though those categories may be broader than how they're defined by leading tech companies, as Tasneem Raja explores in this great piece on America's growing gap in tech literacy).

Unlike its peers, Twitter can't entirely blame its dearth of female coders on the talent pipeline: About 18 percent of computer science graduates are women. Instead, Van Huysse points to a slew of efforts to "move the needle" at Twitter, such as supporting the groups Girls Who Code and sf.girls and hosting "Girl Geek Dinners." 

As other reporters have noted, major tech firms started releasing their workforce data shortly after I obtained a batch of Silicon Valley diversity figures from the Labor Department and began asking them for comment. But pressure to release the stats has also come from a campaign by Color of Change and Rev. Jesse Jackson's Rainbow Push Coalition, which have demanded the stats during a string of private meetings with Valley execs, and last week launched a Twitter-based campaign to urge Twitter to make its diversity numbers public. Strikingly, only 1 percent of Twitter's tech workforce and 2 percent of its overall workforce is African-American:

Jackson argues that improving Twitter's diversity isn't just the right thing to do; it's also a good business decision. It turns out that "Black Twitter" isn't just a meme. According to a recent Pew survey, 22 percent of African-American internet users are on Twitter, while only 16 percent of White internet users tweet. Meanwhile, usage of Facebook, LinkedIn, and Google+ is roughly the same between Blacks and Whites.

In short, Twitter might make more money by hiring more people who reflect its audience. "There is no talent deficit, there's an opportunity deficit," Jackson said in a press release responding to Twitter's data. "When everyone is 'in,' everyone wins."

The Great Third-Pound Burger Ripoff

| Wed Jul. 23, 2014 5:19 PM EDT

This is from a New York Times Magazine piece about America's innumeracy problem:

One of the most vivid arithmetic failings displayed by Americans occurred in the early 1980s, when the A&W restaurant chain released a new hamburger to rival the McDonald’s Quarter Pounder. With a third-pound of beef, the A&W burger had more meat than the Quarter Pounder; in taste tests, customers preferred A&W’s burger. And it was less expensive. A lavish A&W television and radio marketing campaign cited these benefits. Yet instead of leaping at the great value, customers snubbed it.

Only when the company held customer focus groups did it become clear why. The Third Pounder presented the American public with a test in fractions. And we failed. Misunderstanding the value of one-third, customers believed they were being overcharged. Why, they asked the researchers, should they pay the same amount for a third of a pound of meat as they did for a quarter-pound of meat at McDonald’s. The “4” in “¼,” larger than the “3” in “⅓,” led them astray.

Are Americans really innumerate compared to other countries? Perhaps: Author Elizabeth Green says that American adults did pretty poorly in a 2012 international test of numeracy. The rest of her piece is all about how we could teach math better if we really put our minds to it, but unfortunately, after inventing all the best methods for teaching math we gave up, leaving it to the Japanese to perfect them. I don't know whether or not this is a fair summary of the current state of play in math ed.

Still, the A&W anecdote was too good to check, and too good not to pass along. If it's not true, it should be.

UPDATE: Elizabeth Green tweets that her source for this anecdote is Threshold Resistance by Alfred Taubman, who owned A&W in the 80s. Here's the relevant passage, after Taubman has called in Yankelovich, Skelly and White to figure out what was wrong with their burger:

Well, it turned out that customers preferred the taste of our fresh beef over traditional fast-food hockey pucks. Hands down, we had a better product. But there was a serious problem. More than half of the participants in the Yankelovich focus groups questioned the price of our burger. "Why," they asked, "should we pay the same amount for a third of a pound of meat as we do for a quarter-pound of meat at McDonald's? You're overcharging us." Honestly. People thought a third of a pound was less than a quarter of a pound. After all, three is less than four!

So there you go.

Chart of the Day: Oil Is Getting Harder and Harder to Find

| Wed Jul. 23, 2014 12:46 PM EDT

Oil expert James Hamilton has an interesting summary of the current world oil market up today, and it's worth a read. His bottom line, however, is that $100-per-barrel oil is here to stay:

The run-up of oil prices over the last decade resulted from strong growth of demand from emerging economies confronting limited physical potential to increase production from conventional sources. Certainly a change in those fundamentals could shift the equation dramatically. If China were to face a financial crisis, or if peace and stability were suddenly to break out in the Middle East and North Africa, a sharp drop in oil prices would be expected. But even if such events were to occur, the emerging economies would surely subsequently resume their growth, in which case any gains in production from Libya or Iraq would only buy a few more years.

The chart on the right shows the situation dramatically. In just the past ten years, capital spending by major oil companies on exploration and extraction has tripled. And the result? Those same companies are producing less oil than they were in 2004. There's still new oil out there, but it's increasingly both expensive to get and expensive to refine.

(And all the hype to the contrary, the fracking revolution hasn't changed that. There's oil in those formations in Texas and North Dakota, but the wells only produce for a few years each and production costs are sky high compared to conventional oil.)

In a hypertechnical sense, the peak oil optimists were right: New technology has been able to keep global oil production growing longer than the pessimists thought. But, it turns out, not by much. Global oil production is growing very slowly; the cost of new oil is skyrocketing; the quality of new oil is mostly lousy; and we continue to bump up right against the edge of global demand, which means that even a small disruption in supply can send the world into an economic tailspin. So details aside, the pessimists continue to be right in practice even if they didn't predict the exact date we'd hit peak oil. It's long past time to get dead serious about finding renewable replacements on a very large scale.

Lots of Americans Think Obamacare Has Benefited Nobody

| Wed Jul. 23, 2014 12:00 PM EDT

Greg Sargent points us to an interesting new CNN poll about Obamacare. It asks the usual question about favoring or opposing the law, with the usual results. The basic question shows that Obamacare is unpopular by 40-59 percent, but when you add in the folks who "oppose" it only because they wish it were more liberal, it flips to 57-38 percent. In other words, if you confine yourself to garden variety conservative opposition to Obamacare, there's not nearly as much as most polls suggest.

But then there's another question: Has Obamacare helped you or your family personally? About 18 percent say yes. How about other families? Do you think Obamacare has helped anyone at all?

And guess what: A huge majority of Republicans and conservatives don’t think the law has helped anybody in this country.

Among all Americans, the poll finds that 18 percent say the law has made them and their families better off....Meanwhile, 44 percent say the law hasn’t helped anybody — a lot, but still a minority.

Crucially, an astonishing 72 percent of Republicans, and 64 percent of conservatives, say the law hasn’t helped anyone. (Only one percent of Republicans say the law has helped them!) By contrast, 57 percent of moderates say the law has helped them or others. Independents are evenly divided.

Perhaps these numbers among Republicans and conservatives only capture generalized antipathy towards the law. Or perhaps they reflect the belief that Obamacare can’t be helping anyone, even its beneficiaries, since dependency on Big Gummint can only be self-destructive. Either way, the findings again underscore the degree to which Republicans and conservatives inhabit a separate intellectual universe about it.

Maybe I shouldn't be, but I'm a little more dismayed by the news that even a large number of moderates and independents don't think Obamacare has helped anyone. In a way, that's more disturbing than the dumb—but predictable—knee-jerk Republican view that automatically produces a "no" whenever the question relates to something positive about Obamacare.

I guess the lesson is that liberals still haven't done a very good job of promoting the benefits of Obamacare. Maybe that's an impossible task since, after all, it's not as if you can expect the media to run endless identical stories about local folks who finally got health insurance. Still, it's a funny thing. If you passed a law that gave cars to 10 million poor Americans, pretty much everyone would agree that some people benefited from the program. But if you pass a law that gives health insurance to 10 million poor Americans, lots of people think it's just a gigantic illusion that's helped no one. What's more, the number of people who believe this has increased since last year's rollout.

Why? Certainly not because they think health insurance is worthless. Just try taking away theirs and you'll find out exactly how non-worthless they consider it. Is it because they don't think Obamacare policies are "real" health insurance? Or that all these people had health insurance before and the whole thing is just a scam? Or what? It's a peculiar view that deserves a follow-up.

Nobody Knows What Makes a Good CEO

| Wed Jul. 23, 2014 10:51 AM EDT

Bloomberg has done a bit of charting of CEO pay vs. performance, and their results are on the right. Bottom line: there's essentially no link whatsoever between how well CEOs perform and how well they're paid:

An analysis of compensation data publicly released by Equilar shows little correlation between CEO pay and company performance. Equilar ranked the salaries of 200 highly paid CEOs. When compared to metrics such as revenue, profitability, and stock return, the scattering of data looks pretty random, as though performance doesn’t matter. The comparison makes it look as if there is zero relationship between pay and performance.

There are plenty of conclusions you can draw from this, but one of the key ones is that it demonstrates that corporate boards are almost completely unable to predict how well CEO candidates will do on the job. They insist endlessly that they're looking for only the very top candidates—with pay packages to match—and I don't doubt that they sincerely think this is what they're doing. In fact, though, they don't have a clue who will do better. They could be hiring much cheaper leaders and would probably get about the same performance.

One reason that CEO pay has skyrocketed is that boards compete with each other for candidates who seem to be the best, but don't realize that it's all a chimera. They have no idea.

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We're Still at War: Photo of the Day for July 23, 2014

Wed Jul. 23, 2014 9:51 AM EDT

US Navy sailors honor Pearl Harbor survivor Motor Machinist's Mate 3rd Class Wesley E. Ford at a memorial service at Pearl Harbor. (US Navy photo by Mass Communication Specialist 2nd Class Diana Quinlan.)
 

That Antioxidant You're Taking Is Snake Oil

| Wed Jul. 23, 2014 6:00 AM EDT

Plants can't move. They're sitting targets for every insect, two- and four-legged creature, and air-borne fungus and bacteria that swirls around them. But they're not defenseless, we've learned. Under pressure from millions of years of attacks, they've evolved to produce compounds that repel these predators. Known as phyotochemicals, these substances can be quite toxic to humans. You probably wouldn't enjoy the jolt of urushiol you'd get from a salad of toxicodendron radicans (poison ivy) leaves.

Pills loaded with vitamin E and beta-carotene are at best useless and at worst harmful—that is, they may trigger lung cancer in some people.

But other phytochemicals have emerged as crucial elements of a healthful human diet. Indeed, they're the source of several essential vitamins, including A, C, and E. But according to an eye-opening Nautilus article by the excellent science journalist Moises Velasquez-Manoff (author of a recent Mother Jones piece on the gut microbiome), our view of how these defensive compounds benefit us might be wildly wrong.

The accepted dietary dogma goes like this: The phytochemicals we ingest from plants act as antioxidants—that is, they protect us from the oxidative molecules, known as "free radicals," that our own cells produce as a waste product, and that have become associated with a range of degenerative diseases including cancer and heart trouble.

It's true that many phytochemicals and the vitamins they carry have been proven in lab settings to have antioxidant properties—that is, they prevent oxidization. And so, Velasquez-Manoff shows, the idea gained currency that fruits and vegetables are good for us because their high antioxidant load protects us from free radicals. And from there, it was easy to leap to the conclusion that you could slow aging and stave off disease by isolating certain phytochemicals and ingesting them in pill form—everything from multivitamins to trendy antioxidants like resveratrol. "A supplement industry now worth $23 billion yearly in the U.S. took root," he notes.

Taking antioxidant supplements before exercise actually negates some of the well-documented benefits of physical exertion.

And yet, antioxidant pills have proven to be a bust. In February, a group of independent US medical researchers assessed 10 years of supplement research and found that pills loaded with vitamin E and beta-carotene (the stuff that gives color to carrots and other orange vegetables) pills are at best useless and at worst harmful—that is, they may trigger lung cancer in some people. Just this month, a meta-analysis published in the New England Journal of Medicine found that antioxidant supplements "do not prevent cancer and may accelerate it."

And a 2009 study found that taking antioxidant supplements before exercise actually negates most of the well-documented benefits of physical exertion: That is, taking an antioxidant pill before a run is little better than doing neither and just sitting on the couch.

So what gives? Velasquez-Manoff points to emerging science suggesting that phytochemicals' antioxidant properties may have thrown us off the trail of what really makes them good for us. He offers two key clues. The first is that plants produce them in response to stress—e.g., pathogenic bacteria, hungry insects. The second is that exercise itself is a form of self-imposed stress: You punish your body by exerting it, and it responds by getting stronger.  Leaning on the work of Mark Mattson, Chief of the Laboratory of Neurosciences at the National Institute on Aging, and other researchers, Velasquez-Manoff proposes that phytochemicals help us not by repelling oxidant stresses, but by triggering them.

Consider that exercise actually generates free radicals in our muscles—the very thing, according to current dogma, that makes us vulnerable to cancer and aging. But a while after a bout at the gym or on the running trail, these free radicals disappear, replaced by what Velasquez-Manoff calls "native antioxidants." That's because, he writes, "post-exercise, the muscle cells respond to the oxidative stress by boosting production of native antioxidants." And these home-grown chemicals, "amped up to protect against the oxidant threat of yesterday’s exercise, now also protect against other ambient oxidant dangers" like ones from air pollution and other environmental stressors, he writes. In the exercise study, the supplements may have interrupted the process, the study's main author, Swiss researcher Michael Ristow, tells Velasquez-Manoff—they prevent the body from producing its antioxidants, but what they deliver doesn't offset the loss.

Yet phytochemicals found in whole foods—"the hot flavors in spices, the mouth-puckering tannins in wines, or the stink of Brussels sprouts"—may work on our bodies much as exercise does. Velasquez-Manoff writes: "Our bodies recognize them as slightly toxic, and we respond with an ancient detoxification process aimed at breaking them down and flushing them out."

To bolster his case, Velasquez-Manoff cites the example of sulforaphane, the compound that gives broccoli and other members of the brassica family of vegetables—such as Brussels sprouts—their sulfurous smell when they cook. It's what's known as an "antifeedant"—i.e., it's pungency discourages grazing (and makes many people hate Brussels sprouts, etc). Unlike many phytochemicals, sulforaphane isn't an antioxidant at all, but rather a mild oxidant—that is, it mimics free radicals and thus under the old dietary dogma, we should avoid it. And yet...

When sulforaphane enters your blood stream, it triggers release in your cells of a protein called Nrf2. This protein, called by some the “master regulator” of aging, then activates over 200 genes. They include genes that produce antioxidants, enzymes to metabolize toxins, proteins to flush out heavy metals, and factors that enhance tumor suppression, among other important health-promoting functions. In theory, after encountering this humble antifeedant in your dinner, your body ends up better prepared for encounters with toxins, pro-oxidants from both outside and within your body, immune insults, and other challenges that might otherwise cause harm.

In this theory, what causes cancer and general aging isn't oxidative stress itself, but rather a poor response to oxidative stress—"a creeping inability to produce native antioxidants when needed, and a lack of cellular conditioning generally." And that's where the modern Western lifestyle, marked by highly processed food and a lack of physical exertion, comes in.

[The National Institute on Aging's] Mattson calls this the "couch potato" problem. Absent regular hormetic stresses, including exercise and stimulation by plant antifeedants, “cells become complacent,” he says. “Their intrinsic defenses are down-regulated.” Metabolism works less efficiently. Insulin resistance sets in. We become less able to manage pro-oxidant threats. Nothing works as well as it could. And this mounting dysfunction increases the risk for a degenerative disease.

While this emerging view of phytochemcials is compelling, Velasquez-Manoff acknowledges that it isn't fully settled. For one thing, it's unclear why isolated phytochemicals in pills don't seem to work the same magic as they do in the form of whole foods. Here's Velasquez-Manoff:

Proper dosage may be one problem, and interaction between the isolates used and particular gene variants in test subjects another. Interventions usually test one molecule, but fresh fruits and vegetables present numerous compounds at once. We may benefit most from these simultaneous exposures. The science on the intestinal microbiota promises to further complicate the picture; our native microbes ferment phytonutrients, perhaps supplying some of the benefit of their consumption. All of which highlights the truism that Nature is hard to get in a pill.

But human nutrition is a deeply interesting topic precisely because it resists being settled. As Michael Pollan showed in his 2008 book In Defense of Food, humans have adapted to a wide variety of diets—from the Mediterranean and Mesoamerican ones based mostly on plants, to the Inuit ones focusing heavily on fish. The one diet that hasn't worked very well is the most calibrated, supplemented, and "fortified" of all: the Western one.

In Georgia, Perdue Win Ends One of the GOP's Craziest Senate Primaries

| Wed Jul. 23, 2014 4:11 AM EDT
Rep. Jack Kingston (R-Ga.)

In the run-up to last May's primary to replace retiring Sen. Saxby Chambliss, Georgia Republicans flirted with a large field of candidates that included Reps. Paul Broun (who once called evolution a lie "from the pit of hell") and Phil Gingrey (who once defended Todd Akin). But when the dust settled, it was former Dollar General CEO David Perdue and 11-term congressman Jack Kingston who went on to a top-two runoff—a decision framed at the time as a victory for the Chamber of Commerce Republican establishment over the tea party fringe. On Tuesday, after trailing in every poll, Perdue won a narrow victory to claim the GOP nomination. He will take on Democrat Michelle Nunn (the daughter of former Sen. Sam Nunn) in November.

But the real story may be the lack of influence wielded by Kingston's biggest supporter, the US Chamber of Commerce. The Chamber backed Kingston to the tune of $2.3 million in TV ads during the primary, only to see him use its most precious issues as mallets with which to bludgeon Perdue. Take the Common Core State Standards, a set of national math and language-arts benchmarks for public schools that have become a bogeyman for conservatives. The Chamber supports Common Core and recently poured $1.38 million into a PR campaign to promote it. But that didn't stop Kingston from characterizing Common Core as an abomination and attacking Perdue—who himself has been highly critical of the standards—for supporting "the Obamacare of education." In the final days of the race, Perdue fought back, running ads depicting Kingston as soft on immigration because of his support from the Chamber, which backs comprehensive immigration reform with a path to citizenship. "Kingston's pro-amnesty vote is bought and paid for," one ad warned. Kingston, in turn, had falsely accused Perdue of supporting amnesty during the runoff.

Kingston will likely land on his feet—11-term congressmen beloved by the Chamber of Commerce tend to do pretty well in Washington!—but his days in Congress are now numbered. At least we'll always have this video of him explaining why evolution is a myth—because Jack Kingston is not descended from an ape.

Will Republicans Finally Find a Tax Cut They Hate?

| Tue Jul. 22, 2014 9:38 PM EDT

Charles Gaba makes an interesting point about today's Halbig decision: if upheld, it would amount to a tax increase. Everyone who buys insurance through a federal exchange would lose the tax credits they're currently entitled to, and losing tax credits is the same as a tax increase. This in turn means that if Democrats introduce a bill to fix the language in Obamacare to keep the tax credits in place, it will basically be a tax cut.

This leaves Republicans in a tough spot, doesn't it? Taken as a whole, Obamacare represents a tax increase, which makes it easy for Republicans to oppose it. But if the Halbig challenge is upheld, all the major Obamacare taxes are unaffected. They stay in force no matter what. The only thing that's affected is the tax credits. Thus, an amendment to reinstate the credits is a net tax cut by the rules that Grover Norquist laid out long ago. And no Republican is allowed to vote against a net tax cut.

I'm curious what Norquist has to say about this. Not because I think he'd agree that Republicans have to vote to restore the tax credits. He wouldn't. He's a smart guy, and he'd invent some kind of loophole for everyone to shimmy through. Mainly, I just want to know what loophole he'd come up with. I'm always impressed with the kind of sophistries guys like him are able to spin. It's usually very educational.