Welcome to a blog I’d like to read

What started as a weekly email to a handful of friends grew into a substantially longer list of friends, then friends of friends, and quickly expanded to complete strangers. By late 2011, I decided to start putting my emails into long format and posting them as blogs. I mostly wrote about nutrition, but soon my interest in slightly more esoteric topics—such as lipidology—influenced what I wrote about.

Over the last few years competition for my time and energy have resulted in blogging being at the bottom of the priority list, somewhere just above watching reality TV (which I don’t watch) and just below rec league bocce ball (which I don’t play). But as my time for blogging has gone down, my reading and writing has actually gone up, just for a different reason.

In science, unlike politics, there is value in saying, “I don’t know,” or “We don’t really know, but it might be this,” or “Actually, what I believed last year is no longer likely correct.” Once you actually embrace this notion—that you can’t know everything, that facts have a half-life, and that humility is a blessing more than a curse when it comes to trying to understand the natural laws of our universe—you become obsessed with research. But there is an obstacle to consuming research (there are many obstacles, actually, but this one seems particularly troublesome): time. There are 168 hours in a week. Sleep, patient care (“work”), time with family, exercise, all chip away at this magic 168 number.

One of the great joys of practicing medicine is the frequency with which a patient asks you a question you don’t know the answer to. This is learning! Without it, the job could get boring. This happens to me about 5 or 6 times every week. Other times a patient asks a question to which I think I know the answer, but a day later I realize the answer I gave them was based on my last reading of the literature, which on that given topic was circa 2007. Maybe it’s no longer valid? Do PPIs really increase the risk of Alzheimer’s disease? Which fasting protocol is “better,” 5/25 or daily intermittent fasting? If one is only willing to exercise 3 times per week, what should the workouts look like?

The sheer volume of published work in the English language alone is staggering. At last check, every month 98,197 new papers make their way onto PubMed. Yes, every minute that goes by, more than 2 papers are indexed on PubMed.

David Hamilton, writing in Science (1990), noted the following statistics: an estimated 80% of papers that are published in academic journals were never cited more than once. (In addition, self-citation accounted for up to 20% of all citations. It may not be a stretch to think that some of those solo citations came from the eponymous author[s].) On top of that, 10% of the academic journals probably got 90% of the citations.

Let me re-state this: 80 percent of studies that are peer-reviewed and published are (or were), it seems, so utterly useless that no one ever cites them more than once. (In a follow-up study, estimates revealed that in the field of medicine, the percentage of papers without a single citation was about 46%; in the field of arts and humanities, an estimated 98% of papers go uncited.)

OK, so let’s pause for a moment and regroup. First, when I read/hear “thought leaders” (who shall remain nameless) claim to read all of the literature out there, I have to call BS. It’s simply not possible. Second, why would you want to? The above observations lead to the inevitable conclusion that most (by volume) of the published work on PubMed is barely fit to line the bottom of a bird cage.

(For the reader who gets all verklempt hearing that most published research is nonsense, it might be helpful to read this article on the chicanery in the modern scientific publishing world.)

It’s not lost on us that a heavily cited paper can be worse than useless and a thinly-cited one can be invaluable. A keen eye and good mental models can only get one so far. With more and more papers published by the minute, just how much noise is generated in the current landscape? Our conservative calculations show that, “these go to eleven.” To be sure, there’s still a formidable amount of information and knowledge waiting to be plucked from the literature. And a limited amount of time.

 

The best investment I’ve ever made

In 2015 I came to the realization that I was slipping. My “work” obligations, even with the huge reduction I deliberately made in exercise time, made it too difficult for me to keep up. The list of “To read” papers on my desktop was becoming an eyesore. I actually contemplated spending even more time on airplanes since that seemed to be best time for me to read. Yes, elective flights around the world just to read at 40,000 feet. The solution was obvious. I needed more brains. Literally more brains. So I hired them. Today, my practice employs a team of research analysts who are not just exceptionally bright and voracious consumers of literature, but also people who are so naturally curious (arguably the one skill I can’t really teach) that when you give them a problem, it’s just a matter of time until our collective knowledge on the topic will be increased.

Over the past year the volume of reports we’ve created—both in response to patient questions and our more elaborate proactive research agenda—has been impressive, though largely underused. In many cases, a particular report may only be shared with the one patient who asked for it. In other cases, maybe a dozen patients read it. But this work has largely remained internal. We’ve even created an internal helpdesk to moderate, organize, prioritize, and keep track of our work. (I love sending my requests to an email address that begins with Support@…)

Earlier this year one of my patients expressed his gratitude for the reports we had prepared for him. He suggested we make our work public as part of a subscription service. While we may indeed do this in the future, the other takeaway from his comment was that it was time to re-organize the blog, create a few different types of posts, and most of all, get back to some regularity.

 

Nerd Safari

Bob Kaplan, our head analyst, is a really amazing guy, and not just because he’s done more pullups than pretty much any one on earth, though that helps. (At a bodyweight of 185 pounds, Bob did a weighted pullup of 195 pounds [i.e., 195 pounds hanging from a chained waist-belt] … just 35 pounds shy of the world record.) Bob immediately had three great ideas when we kicked this idea around:

  1. Don’t worry about trying to figure out what everyone wants to read, write the blog I would want to read and let like-minded people find it.
  2. We should create three different types of posts and regularly put them out:
    1. A personal blog, which is basically what I do now; we’ll aim to put out one new post per month; and one blast from the past (previous post with updates).
    2. Reviews, specifically one “Bob’s book club” per month and one review of a scientific paper (i.e., journal club) we deem illustrative for the purpose of interpreting research papers.
    3. Nerd Safari, a weekly blog that focuses on, well, some of the more nuanced and detailed stuff that people like me (and you, if you’re reading this) have come to love. Bob also gets credit for this name, which I find pure gold. Some of the cognoscenti may have noticed I’m starting to hashtag this… #nerdsafari on Twitter.
  3. At some frequency, and ideally weekly, do a live video session on Facebook, to add commentary and address questions to that week’s Nerd Safari article.

As I get closer to the publication of the book (if I had to guess, Q4 2019), we’ll also start to release some other content related to the book, such as our on-camera interviews with some of the top scientists in the fields related to longevity. Once the book is out, we’ll also publish the “outtakes” (i.e., the stuff the publisher felt was too dense for the book).

And—eventually—what I really hope will come of all this is something that so many of you have been asking of me for years: an online forum where patients and doctors can find each other. Every week I get asked, at least a dozen times, some variant of the following question: “Peter, I live in So-and-so and I really wish I could find a doctor who understands X, Y, Z. Can you point me in the right direction?”1X, Y, Z can be anything from ketosis to HRT to nutritional approaches to cancer care to lipidology. I usually don’t have an answer for them but I’m convinced there is a way to play match.com for like-minded doctors and patients to find each other.

 

The Upshot

When over 3,000 articles are published daily on PubMed, and when the vast majority of the subsequent reporting on those articles appears dubious (at best), it pains me to even think of computing the signal-to-noise ratio people face when they want the straight dope on any given subject relating to their health.

I want to visit a site that publishes meaningful information that makes me wiser for having read it. This almost always requires me to do some of the lifting. Many of the topics I love so much cannot be summarized in a listicle. If the title of an article starts with “8 Essential Foods for…,” or the like, chances are it’s not worth reading. To really learn something requires contemplation and thinking—even as the reader—and over time this leads to new insights, which is one of the most rewarding experiences I have come to know. It’s the reason why I get so excited when a patient asks me a question I don’t know the answer to. I want to learn more each day, ask better questions, create and connect more dots, and engage my curiosity.

This site is my attempt to create this environment for you. Buckle up.

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