How to not get cancer

In principle, there are few chronic diseases that are more easily preventable than cancer.

Cancer as a Metabolic Disease, Chapter 19.

At the beginning of 2014 I started to get involved in CrossFit after decades of not really doing any exercise but biking and snowboarding. I discovered quite quickly how unfit I was and made rapid improvements.

This led fairly quickly to thinking more about what I was eating. If I was spending a bunch of time to get fitter then I should probably spend some time figuring out where the energy was coming from. What I used to eat was essentially any crap that was available.

There’s a strong paleo bias in the CrossFit community. Paleo essentially means eating roughly what you were evolved to eat. The thinking is that it’s been a short time since pre-agrarian society existed and before farming we ate one set of things. After farming, we eat another set of things. Actually a radically different set of things from before farming.

The timeframe is evolutionarily very short. The theory is that we evolved to eat what we as a species ate before farming, and we haven’t evolved to eat the food we get in post-agrarian society. In fact, it takes about an order of magnitude longer for DNA to show some meaningful adaptation than the time we’ve had since someone invented farming.

Paleo led me to learning the three basic food groups: Carbs, protein and fats.

When I grew up, I was taught that fat was bad. It turns out that this isn’t really true. I was taught that carbs are good. Sadly that too doesn’t really have any truth to it.

Even more mind-blowing to me were the results of actually trying calories-in calories-out. This is the myth that if you balance the amount of calories you eat with the amount you burn you can gain or lose weight. It’s scary, but that’s not actually really true either.

You can read about all this in Why We Get Fat and many other books.

Reading that book led to some other interesting things. It turns out Japanese women don’t really get breast cancer. Japanese immigrants to the US do, but if they emigrate back it goes away again. That rules out genetics as the major factor.

Now I don’t know about you, but I was taught that cancer was caused by DNA mutation. A photon comes in from the sun and breaks some DNA, or a virus does the same thing, or some oxidant does it.  The broken DNA somehow causes a bunch of gene signaling that results in cells replicating out of control.

I was floored by the lack of actual evidence for this.

Now, what happens when you have some large metastatic cancer? The current technology is to give you a dose of radioactive glucose. Then you’re put in a large machine that detects that radiation (positrons as it turns out) and with a lot of computation will spit out three-dimensional images of where the radioactive glucose is.

Where is the glucose? It’s at the tumor sites. Think about that for a second.

The resolution of these machines is sub-centimeter (from memory I think it’s 7mm). So what happens if we do a biopsy and find a few cells but it’s not big enough to image or doesn’t have a clearly defined border so we can rip it out in surgery? Basically we irradiate you and kill everything. We hope that normal cells will rejuvenate back and that the cancer cells won’t survive. Unfortunately irradiating you has a lot of downsides which I won’t list, but are essentially horrific. Okay I’ll list one ironic side-effect, which is cancer.

This got me interested. Why was the glucose at the tumor sites?

It turns out someone was thinking about that and got a Nobel Prize for figuring out some of it in 1931. The theory is that cancer cells have broken respiration and are only able to ferment sugar for energy. This neatly (perhaps too neatly) ties a few things together.

First, that women in Japan aren’t eating bucket loads of sugar like we do in the US. If they aren’t eating all that sugar, and cancer requires sugar, then you’d expect cancer incident rates to be lower. Second, it explains why essentially no progress has been made treating cancer in the last 40+ years since going after DNA wouldn’t be the right thing to go after.

But wait. You saw Jurassic Park where they had a bunch of gene sequencing devices and Thinking Machines supercomputers. What if we took a group of people with the same type of tumor and sequenced the DNA in there. We should discover similar mutations – even the same mutations – in these different people. Then we could target those genetic malfunctions using some space age drugs and stop the cancer.

It turns out that people have been trying exactly this. The problem is they haven’t been finding any common genetic flaws and therefore, the entire working model we have of how cancer works might simply be wrong. That ties in nicely with making no progress in a few generations.

So if it isn’t DNA, what is it? Mitochondria. They supply energy to cells and even have their own DNA. It’s fascinating that mitochondria are inherited from your mother, which is interesting since it means a different set of evolutionary pressures will apply.

It’s worth taking a break from cancer for a second. If you go look at the data you’ll see an explosion of all kinds of other things in the world of chronic disease. Diabetes, Alzheimers, Parkinsons and lots more.

What about MS? Here’s something truly scary: It looks like MS is curable by essentially eating vegetables:

Dr. Wahl also has a few books out you can go find. So if thinking deeply about mitochondria can save someone from MS, what about those other things?

Well T2 diabetes is your inability to control blood sugar. It turns out that by not eating sugar you can essentially cure T2 diabetes. What about Alzheimers and Parkinsons?

There’s another great book there: Grain Brain. It turns out, again, that not eating sugar helps a lot. This idea that we end up old and get all these conditions, somehow left up to fate, just isn’t really true. What you eat and how you exercise will essentially preclude you from getting any of these things.

And none of this is particularly new. There was a book in the 80’s that’s been rereleased called Pure, White and Deadly. 50 years before that, Warburg was getting his Nobel.

So this made me think, is it too late for me? Growing up I had cereal with sugar for breakfast and an all-round cheap low-fat… Oh let’s also mention eating fat doesn’t make you fat, in fact it’s incredibly good for you… and high-carb diet.

After much more reading I got to Cancer as a Metabolic Disease. This guy decided to give a bunch of mice brain tumors and then deny them sugar to see what happened, and the result is a $130 cancer textbook examining everything from Warburg onward, up to and including treatment propositions.

We can skip back to diet again, where we left off on paleo. Paleo is essentially a low-carb diet which means no sugar. If you go look, it’s kind of interesting to see what health problems paleo people had (think: polio) and how we’ve solved most of them. Since they didn’t have sugar they didn’t get tooth decay, people have dug up their bones and figured that out.

What happens with very low carb diets? You go in to ketosis. The reddit keto community have a great FAQ all about it. It turns out you have this other way of fueling your body when you don’t have any sugars or things to metabolize in to sugars.

This again is interesting since if you were on planet earth ten thousand years ago then periods without food were a normal occurrence. Dr. Seyfried, and others, proposition is that without sugar cancer cells are put under a lot of stress and they die. How do you deny that? Well don’t eat sugar, or simply don’t eat. There’s a third way to simulate not eating, which is to put yourself in to ketosis. You should spend some time on /r/keto and see how people do on the ketogenic diet. It’s insane.

ketosis-stress

This is a graph (from Seyfried’s book) of the glucose and ketones in someones blood over 30 days while they eat a ketogeneic diet. Essentially the glucose goes down and the ketones go up in a compensatory manor so you don’t keel over and die.

By extrapolating out from mice models, Seyfried suggests that fasting for a week per year or a few 2-3 day fasts should kill the dysplastic cells you have. Your blood should look like the above graph but with the time axis shortened down from 30 to 7 days. And as it turns out, there’s already a lot of evidence that fasting is good for you.

So I tried it. I managed to get 3.5 days in. The problem was my timing. Let me say upfront I felt fine, actually great for the whole 3.5 days. But I chose to do it just before going on vacation for my birthday with a bunch of stressful driving and screaming kids. That was sub-optimal. At the 3.5 day mark I had some slight heartburn, got pissed off, and had a cookie.

The fascinating thing is how food craving feels. Having a ham sandwich in front of me felt just the same as having a chocolate cake or a beer sitting there. I expected some major difference there since surely chocolate is a treat and a beer is alcohol (and sugar). It was really strange to have the same episodic emotions over plain food.

During the period I recorded my blood sugar and ketone levels with one of these meters. Diabetics will be familiar with them. You lance your fingertip and squeeze to get some blood. Then dip a test strip to the blood and the machine magically spits some numbers out. You can see the numbers in this spreadsheet.

The problem is that the meters are pretty crappy. The readings are only roughly 20% accurate and the ketone strips (which are ten times as expensive as the glucose strips) have a relatively narrow reading band. The error on them is good enough for diabetics but not really for what I wanted. I also recorded blood pressure with one of these things.

You can see the glucose stay about the same and the ketones jump up on day 3. I think the glucose is problematic for two reasons. One, the accuracy of the device is roughly the same as the drop I should see, so it’s easy to hide it in the noise. Two, Seyfried warns about having anything but water. He talks about subjects having decaf tea and I was drinking gallons of decaf coffee.

If you look, I lose 2+lbs per day too.

The main barrier to fasting is simply self-discipline in the face of food everywhere. That’s why lots of people go on retreats to do it. You’re perfectly capable of fasting and obese people can fast for months on just water. Go look it up.

So I’m starting another fast again today without decaf coffee this time.

Here’s another video, longer and with more technical detail:

Postscript

I don’t have a medical degree and I’ve glossed over a lot of detail in all this. I can’t summarize all these great books but hopefully just enough to get you interested. What can you do?

  1. Stop eating sugar. You’ll be amazed at the grocery store trying to find things that don’t have added sugar. Practically everything you pick up will have added sugar, under some name like “evaporated beet juice” or “dextrose” or whatever. Really, go see.
  2. Read. Get the books I’ve mentioned from the library or amazon, and here’s a recent good documentary to watch. It’s more than not eating sugar, but that appears to be a good start. It will be maybe 50 hours of time invested, but it’s a lot cheaper than getting cancer or some neurological malfunction. If you’re anything like me, educated by the government and charities, what you learn will blow your mind.
  3. Find a community. I highly recommend /r/keto as a starting point. It’s a place to ask questions and learn from others experience.
  4. Try to find some contradictory evidence. I’ve been trying, there doesn’t seem to be a lot out there that’s very defensible. Remember, people don’t change their minds, they just die and get replaced by new minds.

The Book of OpenStreetMap Kickstarter

book

I’ve launched a kickstarter for The Book of OSM. From the kickstarter:

I’ve been noodling a long time about how to structure and write a book about OSM. I never wanted to write a book about how to use the project, there are many now available of those in any case. I’m more interested in the stories and the people. How the project got going, the twists and turns, the ‘ah-ha’ moments and so on.

The blocker for me was figuring out how to give a voice to the community. I may have started the project but without thousands of other people it wouldn’t be where it is today. A friend showed me a book of interviews with designers and that solved the problem. So to give that voice, why not interview a number of key people?

What will be in the book

The book will be split roughly as 25% history (which may be in interview form) and 75% interviews with key people through the projects history, with those numbers subject to some change.

  • Your name, as a type of producer (see rewards)
  • The story of the project, from the early days to today
  • Discussion of why some technical decisions were made (usually for a non-technical reason)
  • What things that worked, what things that didn’t
  • Interviews with 15-25 key project members, including a favorite map for each of them and where possible, a picture of them

What won’t be in the book

Anything that will easily obsolete or get out of date won’t be in the book. That means:

  • How to map things and use the software today
  • How to use the website today
  • Deep technical, licensing or tagging discussions (as much fun as those things are)

Sadly it also isn’t physically possible to list every single project contributor.

What might be in the book

A number of companies have been involved in OSM over the years, and their contributions have been both interesting and extremely interesting. I need feedback to figure out how to tell those stories in an unbiased and open way, which just might not be possible.

Zero to One

It’s not the zippiest of titles but Zero to One, the Peter Thiel & Blake Masters duet about how to build the future is a short, fun and incisive read.

Perhaps Quantum Leap would have been better descriptively. Masters was a student at somewhere or other (Stanford at a guess) when Thiel gave an excellent sounding set of lectures on basically how he sees the world. You can read them over here. From the notes came a book.

Frankly you should read the notes. They’re more blunt, free and gives you a feel of being there. If you need it toned down and some sort of narrative structure to hold on to then get the book. Example. In the notes Thiel references the theory that eating carbohydrates is somehow healthy for you as just made up and let us say, influenced, by Kellogg’s marketing department – this isn’t to be found in the book. At least, as far as I could find.

What’s the central idea? It’s that it’s hard to make things the first time. Really hard. But it’s also really profitable. Alternatively it’s easier to take something that exists and iterate on it a little. Or to take something and divide it up.

Building OpenStreetMap was hard. Iterating it and copying it was easy. Comparatively if not in the absolute.

It looks like it was hard to build the United Kingdom but it’s pretty easy to try to divide it up. It’s the mentality that we’ve reached a plateau, things won’t get better and we need to divide up what’s left. Perhaps some sort of socialist paradise will save us – the ultimate division of wealth.

Thiel makes the argument repeatedly that the path to real wealth is to create new things (which as we noted, is hard).

It’s interesting to note little anger in the book or his comments. The outrage in San Francisco over prices of housing are a simple example. Thiel makes the entirely logical and evidence-based argument that house prices are high because it’s illegal to build houses and there’s therefore a shortage. Thomas Sowell does exactly the same thing in more detail in Basic Economics but with a strong hint of frustration and anger.

Should you read this book? If you want to build the future then yes you should, but that’s a demonstrably tiny number of the ~7 billion people on the planet and you’ve probably got it on your list already. If you want to understand how people who build things think then it’s useful too. Sadly the targeted audience and the inspiration it seeks to engender is outside the scope of this or any other book like it save maybe Atlas Shrugged.

And there lies the key question, how to get large groups of people building again instead of dividing and iterating?

Self-driving cars

I suspect that in a while we’ll just call self-driving cars by their name today; cars.

There’s an idea out there that The American Family will buy a self-driving car to replace their old boring human-driven car. I don’t think it will happen that way.

First, we already have self-driving cars available to most people. They’re called taxis. Government restrictions aside, a taxi costs roughly what a self-driving car does. You need to buy an old Crown Victoria and pay someone $50k a year. Let’s say you buy one every three years, that’s $160k ($10k for the old cop car). That’s roughly what a self-driving car will cost soon and it too will last about three years.

We’re not all excited about running out and buying Crown Vics. Instead we rent them for short periods. And the rent is going to come down one or two orders of magnitude with car sharing services and their new ride-along sharing services.

Second there’s a nice reduction argument for how many self-driving cars there will be. Since everyone will have one, I won’t need one. If I want to visit my friend then they can just send their self-driving car to pick me up. Maybe I buy beers along the way as a thank-you. Therefore you won’t need one either, and neither will most people. The number of cars will drop off a cliff.

You’re not going to buy a self-driving car.

Instead every service that you use will offer them. Want to go to Pizza Hut? They’ll send a pizza car to pick you up, so long as you buy a couple of all-you-can-eat tickets. Want to go drink at Hooters? The free car will pick you up and take you home. Need some groceries? Safeway will have a car at your door in 10 minutes.

If the number of cars on the road drops off a cliff then the utilization has to rise. And that’s a good thing. Your car today spends 90% of its life doing nothing sitting in a garage or rusting in the rain. Self-driving cars will be the other way around and spend most of their time being used. And that means it’s ok if they’re dramatically more expensive. Like, $200,000 or $2M a pop.

When you push the sunk cost in to that range then suddenly electric cars with huge batteries are not an issue. And that’s useful since electric cars have fewer moving parts to break down, and all the pollution happens far away instead of being emitted by the vehicle.

The conundrum is the commute. The daily mass migration from home to office. Or rather it’s the inverse. It’s the down time in between commutes. Today we just park our cars for that down time but it would be nice if we didn’t commute, staggered the commute across the day or some other nice solution. Trains are horrifically inefficient, especially when the government runs them. But perhaps privatized trains with last-mile self-driving car solutions would work out.

Auth0 and the new pay to play

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I’m pleased to announce I’m on the advisory board of Auth0, a company making authentication trivial. I’m going to get to Auth0 specifically in a minute but let’s talk about how companies place bets.

VC firms, book publishers and movie studios all do approximately the same thing but with different media in different cities. VCs try to find tech companies, publishers find books and movie studios try to find blockbuster movies. Silicon Valley, New York and LA. The problem is, we don’t yet know how to predict the future. Therefore they try to come up with nice stories about how something will succeed or fail and put money in to the things that they think will succeed. Of course, they’re largely wrong on those bets.

Luckily the rewards for being right are disproportionate. Because of the long tail distribution, being right will make you very right, and rich. That win will pay for all the failures. In fact it’s an interesting exercise to think that maybe the long tail distribution of returns is the only way it could work and maybe it’s a long tail precisely because it has to be.

In any case, these firms place a number of bets. Let’s say they invest in ten companies, book authors or movies at $10MM each. Then we hope one of them becomes a billion dollar exit (Google, Harry Potter or Lord of the Rings). That will pay for the other 7 that blow up and the 2 that do ok. Things blow up all the time, like Solyndra or Waterworld.

In this model the firms have to raise the capital to make these bets, either from past lottery winnings or from investors. But when you think about todays service businesses the model is very much inverted.

Instead of you paying to place the bets, the customer is paying you. You have a large number of companies paying you $5/month for some minimal service level and then some of them will randomly take off and start paying you $1,000/month or whatever it happens to be. Thus by providing a very visible self-service model you can expose yourself to some large upside almost automatically. This optionality is interesting; in that your customers are paying you to take the option.

Of course, they can always jump off your service too. But if you’re doing your job they won’t do that; you just have to create different incentives and value models as you go up the stack. You need more features as the price increases, better customer service and so on.

Compare and contrast this to you having to pay to take the bet. Under that model you have to go find the customers where here they find you. You have to build narratives about why they will succeed instead of them doing so. All in all, it’s a lot nicer when they come to you.

Also notice that we’re smoothing the price function. Instead of not funding your movie or funding it as a binary, $0 or $10MM bet, you pay whatever you want. Maybe it’s $5/month, maybe it’s $100/month but we’re still exposed to the upside while covering costs for the low end of the market instead of just turning those options away.

The other thing that’s evolved is the sales process. Instead of me having my bizdev guy talk to your bizdev guy to get business, your developer just happens upon my service and starts playing with it. Instead of exchanging press releases, our developers talk about how awesome everything is. It’s much more efficient that way, especially when getting started. You don’t have to pay for your developer to talk to their PM to talk to their bizdev guy to talk to my bizdev guy to talk to our sales rep. Your developer just talks to my developer. That’s cheaper and quicker for you and for me. We’re reversing the causality here too; my bizdev guy doesn’t contact 100 companies to find 10 that might use the service. The 100 companies just find me instead.

Back to Auth0. I like Auth0 for a number of reasons:

  • Making Enterprise Easy. You might not be aware, but everyone uses ActiveDirectory or AD. It’s great for a number of things like making Office and Lync and various DRM things all work together when you’re a real company. But it sucks if you want to expose your users externally. For example you want your employees to be able to use their username and password (credentials) to log in to your healthcare provider. Auth0 makes that magically (and securely!) work.
  • Making Hacking Easy. Doing away with the “user” table. I see the primary advantage of Ruby on Rails as doing away with having to learn SQL. Thus I now “only” need to know HTML, JS and ruby. Parenthetically, you see things like meteor making this an even shorter list of just HTML and JS. What Auth0 does for me as a developer is remove all the user pain. I don’t need to start building my app with an email authentication loop, an email server and SQL table or whatever, now instead I just insert a couple of lines of JS and let Auth0 handle that. Gradually we are chipping away at all the things you need to do to get a web app up and working.
  • Auth0 hides complexity. It’s a real pain to go set up authentication with the 1,001 providers like Google, Microsoft, Twitter, Facebook and so on. What Auth0 does is magically hide all that pain via their very cute dashboard.
  • Openness. Auth0 is all over github.
  • New things. Auth0 just shipped a wordpress plugin to let you login to your wordpress instance using, basically, anything you can think of. This is great; no more authentication loops dropping users at the first hurdle!
  • People. It’s easy to turn money in to smart people working for you. But it’s really hard to get the quality, depth and breadth Auth0 has without doing something truly meaningful. Auth0 is great people doing great things.

And of course, Auth0 is exposed to the kind of optionality I described above as many others are too. So, if you have any interesting authentication go play with Auth0.

Cardboard economics

cardboard

Google shipped an interesting product and pretty website for cardboard. Basically a cheap way to turn your cheap cellphone in to a AR display unit a-la Oculus Rift. Only very crappy with low resolution and high latency; good enough to prototype & play with which is great. You put a phone in it and it pretends to be a VR display.

Someone on Hacker News posited that “Somebody should do a Kickstarter to make and ship copies of this kit for $5 or $10.” So I dug in to it a little. Here’s what my rough bill of materials looks like:

  • cardboard 1.59
  • lenses 9.00
  • ring magnet 3.98
  • disk magnet 1.98
  • velcro 2.98
  • rubber band 0.01
  • nfc tag 1.50
  • postage 5.00
  • sub total 26.04
  • labor 5
  • margin 5
  • unit cost 36.04

So let’s call it $35. This is roughly half the cost of a Dive unit. And the dive unit actually ships, is made out of plastic and you don’t have to think about building it.

A laser cutter big enough to cut the cardboard is about $11k and at $5 margin per unit you’re looking at needing to ship $80k of these cardboard units to recoup the cost, which I’m assuming would be a reasonable goal. I don’t think anyone will raise $80k of cardboard kits but as ever I could be wrong.

dodocase are flying a kite to sell a unit for $20 which is clearly too cheap without massive volume, unless you can somehow turn it in to a loss leader for something else.

So, in sum, cardboard VR headset cases are kind of irrelevant. The cost isn’t the cardboard vs. plastic housing material: It looks like it’s everything else like the lens units, the postage, the risk, the labor and so on. The PR value is of course very high. There’s clearly tens/hundreds of millions of dollars of PR value out of cardboard for roughly half that in fully loaded headcount and other costs – it all depends how you account for it. The narrative that “Google did something cool” (e.g. cardboard) out of the I/O event is worth a significant sum of money and they deserve all the credit for executing on that.

OSM PLUS: Two weeks to go!

OSM PLUS logo

Get your ticket
OSM PLUS is in two weeks at the Marriott Union Square in San Francisco. You can get your tickets here and if you use the discount code OSMPLUS25 you’ll get 25% off!

Provisional program

The provisional program is now live here. Similar to last year, OSM PLUS is an exciting mix of talks and panels from a variety of businesses using OSM every day.

Why people like you are attending

Come and hear from FactualMapZenESRICartoDB and many more on the shared opportunities and challenges of using OSM data in the real world: Data quality, community engagement and how open licensing works.

Questions? Comments?

Please do reach out.

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