Monday, November 25, 2013

Alternative Medicine: How much trust does it deserve?

Alternative medicine is a topic that many people are very passionate about because it has this connotation that it is the more natural or pure way of treating the body, bringing it back into balance. Some people feel that there is almost a spiritual nature to it. On the contrary, "evidence based medicine", or "western medicine", is sometimes seen in a very suspect way because of the huge amount of money that is involved and the synthetic nature of many of the pharmacological treatments. While alternative medical treatments have helped many people it can receive more trust than it deserves putting people at great risk of rejecting life saving and quality of life improving treatments. For this reason I would like to point out a few things about these two types of medicine.

Alternative medicine isn't shown to work while evidence based medicine is. 

By definition Alternative medicine is any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using the scientific method. This definition of alternative medicine doesn't necessarily mean that it never works, it just means that it hasn't been proven to work using the scientific method under reasonable experimental conditions. It also points out the fact that there are some alternative medications that are used which have been scientifically proven not to work, which is a problem.

Evidence based medicine on the other hand is medicine that has been proven to work using the scientific method. These studies have been peer reviewed and the results of the study accepted with high statistical confidence within the community of the medical specialty.

More simply stated by Tim Minchin:
"Alternative medicine, by definition, has either not been proven to work, or proven not to work. Do you know what they call alternative medicine that has been proven to work? Medicine."
-Tim Minchin
Using these definitions it means that once any substance or method has been proven to work under reasonable scientific experimental conditions it automatically becomes evidence based medicine and ceases to be alternative. Ideally whenever a new treatment is shown to work with a high level of confidence it would instantly be implemented into our health care system but this is not always the case for many different reasons good and bad.

Alternative medicine is not regulated while evidence based medicine is. 

The FDA (Food and Drug Administration) was initially set up in 1906 for the purpose of keeping people safe. One of their jobs is the regulation of medical drugs. In order for a drug  to claim it works as a treatment of a specific pathology it needs to have been shown to be safe and effective (benefits outweigh risks). Once approved the FDA monitors the manufacturing process of the substance, labeling and advertising. Each drug has a known toxic dose and effective dose based on studies to ensure it is safe. Even after the drug is released it is monitored to ensure there isn't any long term negative effects.

Dietary supplements, being a large bulk of alternative medicine, is not regulated because in 1994 they were mandated to be regulated as foods rather than drugs under the Dietary Supplement Health and Education Act. Therefore they are not subject to safety and efficacy testing and they have no approval requirements. They are not allowed to state on the label that they specifically treat, diagnose or cure any illness and must include a disclaimer on the label.  A 2013 study that looked at 44 different herbal products from 12 different companies showed that:
"Most (59%) of the products tested contained DNA barcodes from plant species not listed on the labels. Product substitution occurred in 30/44 of the products tested and only 2/12 companies had products without any substitution,contamination or fillers. Some of the contaminants we found to pose serious health risks to consumers". 
"Most of the herbal products tested were of poor quality, including considerable product substitution contamination and use of fillers"
So the majority of the time when you are taking dietary supplements what is stated on the bottle isn't necessarily what is in the bottle. Often times the labeling on dietary supplement adds and labels give the notion that they cure specific problems without specifically stating that they do, which is very confusing to consumers.

Alternative medicine usually isn't based on sound scientific principles.

Most forms of medicine that fall under the realm of alternative medicine are based on unsound principles. For example:

Homeopathic Medicine, developed in 1796, is based on the principle that "like cures like", meaning that the substance that caused the disease in a healthy person will cure similar symptoms in a sick person. These remedies are prepared by repeatedly diluting a substance in alcohol or distilled water to a point where none of the original substance remains. In essence you are only receiving water and any positive affect that you are receiving is due to the placebo affect.  A current example of the damaging affects of homeopathic medication include Nosodes, which are homeopathic (diluted down to only water) vaccines that claim to protect people against disease like a normal vaccine.

Traditional Chinese Medicine is not based on any internal anatomy. It was against the law to perform autopsies in China until 1912 and because of this the Chinese had no system of anatomy comparable to western medicine.

Use of alternative medications is often supported by logical errors. 

The idea that just because it is natural it is good is incorrect. While it may appear that pharmaceutical drugs are more of a risk because they are required to list all of the known side effects, natural herbs and other substances have side effects  as well (click the link, I dare ya). These side effects are less understood because they haven't been as thoroughly tested. The consumer is less aware of these side effects because they are not required to release or obtain this information. All substances are toxic to the body at some level, even water. The problem with herbal supplements is that this toxic dose is not always known while with regulated drugs it is required knowledge.

Anecdotal studies and case studies are not adequate scientific proof. There are some very compelling documentaries out there that give the story of only a single person or a few people who benefit from a specific treatment. This is not adequate. There are many types of studies and each type provides a certain level of evidence and until an out come is statistically significant under scientific conditions it isn't proven. Case studies and anecdotal treatments are the starting point of investigation.

Just because something has been used for a long time doesn't mean it works. A common rational for supporting alternative medicine, such as eastern type medicine, is the fact that many methods have been used for thousands of years. This is not always true and could be attributed to a correlation vs causation fallacy. How many years did the native Americans perform rain dances?  The average life expectancy in China in 1960 was only 36.3 yrs while in the United States it was 69.8 yrs. Sam Harris put it well when he stated:
"But the mere endurance of a belief system or custom does not suggest that it is adaptive, much less wise. It merely suggests that it hasn't led directly to the society's collapse or killed its practitioners outright."
-Sam Harris, The Moral Landscape

  1. I do not consider healthy eating or a healthy life style to be alternative medicine. All people should do their best to eat healthy and stay active in an attempt to prevent problems down the road.
  2. Also, I am in no way claiming that evidence based medicine is perfect or that it has all the answers. There are still a lot of unanswered questions that need to be looked at. With time and the use of the scientific method, evidence based medicine will continue to improve. 
  3. Evidence based medicine is not biased towards where it obtains its treatments, specific health care systems maybe but that is different. As long as something can be shown to work under reasonable scientific experimental conditions beyond that of current treatments available, whatever the source of the information, be it China or fresh vegetables, it is then considered evidence based. 
  4. Testing any hypothesis, takes time and money and I do agree that pharmaceutical companies have a lot of money which allows them to actually test their products.  Numbers probably have been fudged by dishonest companies on rare instances but I personally trust this process of medicine being shown to work over the alternative. 
  5. The burden of proof is on these alternative medicines to do high level studies that show with high confidence that their treatments repeatedly work. Until then they will remain under the umbrella of Alternative Medicines. 
A few words from Michael Specter on the matter:

Tuesday, October 29, 2013

Yosemite: The Grack and Running El Capitan

View of the valley and Half Dome from Eagle Peak

Kimber and I got invited to go to Yosemite for the weekend with four of her girlfriends. We headed out Friday evening around 5:30pm and didn't get to the Upper Pines Campground until around 10pm. It was great just hanging out around the fire with friends.

Moriah, Audrey, Leslea, Nate, Kimber (L to R)

Saturday morning I got up and was on the Yosemite Falls Trailhead by 7:50am. I would have got up earlier but didn't end up going to bed until around 1am. The first 3.2miles were straight up, consisting of slippery rock steps and loose sand. Once I was on the rim the climb became more gradual and I took a little off chute trail to summit out on Eagle Peak (7779ft) which provided some awesome views of the valley.

Area surrounding Yosemite Falls trail. 

Yosemite Falls trail.

I trucked on another 2 miles and eventually made it to the top of El Capitan (7569ft). The summit didn't have a sheer ledge as I had hoped and sloped down through some gnar before getting to the edge. I opted not to swack down as I was short on time. My run out was uneventful and I felt great except I rolled my ankle while running along the road at the bottom right in front of a car. No injury but why is it always right in front of people?

El Capitan from the Valley. 

Totals Distance: approx. 18 miles
Total Elevation Gain: approx. 4900ft
Total Time: approx. 4hrs 50min

Later that evening after a nice nap on our huge air mattress with Kimber (when we car camp we go all out) we hiked up and climbed a famous route called "The Grack". Luckily there wasn't much of a line and we were able to get on it right away. It is supposed to be done in 3 pitches but we sort of did it in two. I lead the first pitch up some really easy low 5th class and belayed Kimber up, maxing out our 70m rope. The second pitch consisted of a thin hands to fingers low angle crack the petered out at the top. I tried to pitch it out to the top but we ran short by about 15ft and was forced to climb across a slabby face to a left facing 4th class ledge where I belayed Kimber up a few pieces on a half hip/half crappy nut. I finished it out and hooked into the chains to finish belaying Kimber. She did great, except her shoes were really tight, having not brought he looser fitting ones that she uses for multipitch. We both and fun and the setting was fabulous!

Me leading the 2nd pitch of "The Grack". 

Kimber following 2nd pitch. 

Kimber wondering why she hasn't been wearing stretchy pants to climb since the beginning. 

Sunday morning we almost got onto another famous climb, Bishop's Terrace at the Chruch Bowl, but it took longer to find and we didn't have time to wait in line. Maybe next time. We had a nice drive back and stopped in Walnut Creek so Kimber could do a family holiday photo shoot. Then we rushed home to show an apartment in an open house. Busy. Kimber brought home some kind of a stomach bug which had her over the toilet all night and Tuesday morning it hit me. Not fun.

Upper Pines campground. 

Liz and Kimber at the base of "Bishop's Terrace", before we bailed. 

Yosemite: Nutcracker

With the park being closed for the previous 2 weeks due to the government shutdown, I wasn't sure if I was going to be able to get back to Yosemite before leaving for 3 months of externships.  Luckily the park opened a few days before we had planned to go. With school, rotations, managing the apartment and whatnot our only option was to make a day trip. Binh picked me up around 7am Saturday morning and we were in the park by 11 and racking up to climb Nutcracker. The park was much quieter than we had imagined. I sort of thought it would be extra busy due to the closure. The weather was beautiful, clear skies and temperatures in the high 50's.

The Nutcracker is a 5 pitch, 500' climb in Yosemite Valley that is named such because it was one of the first climbs to be climbed protected with nuts, which was done by Royal Robbins in 1967. Binh and I took 3 sets of nuts (and a bunch of cams) with and thought that we might try to do the whole thing with only nuts. This thought was scrapped on the first pitch.

I gave Binh the first pitch which included him jumping over a wide off-width section which he had climbed above and a horizontal greasy under-cling. I took the second pitch which was a walk up ramp which traversed to a platform where we caught up to a couple from Los Angeles. They were having a hard time and we waited around, allowing a team of four Polish climbers to catch up. After the LA couple had finished the pitch I lead up a few various small finger to thin hand cracks and ended up continuing off route setting a belay and then leading another off route pitch up some vegetative features to the crux of the route.

The crux was a semi-good protected corner that required a committing reach up to a huge ledge and then a mantle move to get up on top of the ledge. Luckily you can just watch me do it on this awesome video that the girl from LA took of me climbing it. The rest of the climb was some easier linking crack systems that took me to top out. It was a great climb and the views of the valley were phenomenal! At the top we met a dude from Texas who soloed up an adjacent route and had been living in the valley for 6 months. Nice guy.

Friday, October 25, 2013

NorCal Trinity Alps: 4 Lakes Loop

Even though I recently learned that Christopher Columbus did many not so awesome things ( and that his story has been whitewashed to the max like too many stories I have been taught in my life (others of which I have not based my knowledge on blog posts like I did here, but on credible primary sources), Kimber and I decided to celebrate Columbus Day by exploring the mountains of northern California.

We decided to hit the road Sunday morning early as Kimber had spent Saturday shooting a wedding in San Francisco and didn't get home until around 11pm. We headed to the Trinity Alps, 5 hours north of the Bay Area. The Trinity Alps are a beautiful mountain range to the northwest of Redding, CA and are a bit of a hidden gem. We needed a trip to get away from the busy city and enjoy nature and some time alone....and I planned the trip around a sweet run!

Kimber started shaking her head when we were driving into what appeared to be a deserted wilderness because I have this tendency of over planning adventures and she is well aware of it. We made it to the trail head where we luckily found a random camping spot about a half mile up the dirt road and pitched camp, car camping style (huge air mattress, camp chairs, firewood, table, cabin tent...etc). We spent the afternoon just basking in the woods wrapped in sleeping bags, drinking hot cocoa, reading thought stimulating books and discussing life. It was nice. We even wrapped up the night with a freaking old (like black and white old) Halloween movie on the laptop while sitting next to the campfire.

The  next morning I got up and ran the 4 Lakes Loop. It is a loop in the heart of the alpine wilderness that goes around Siligo Peak (8162ft) and in the process passes by 4 beautiful lakes. The loop is accessed by 6 mile, 4,100ft climb up Long's Canyon, making the round trip approximately 18 miles.

Up Long's Canyon.

Looking down Long's Canyon

The Long's Canyon climb consisted of dispersed forest that opened up into multiple meadows surrounded by towering red and granite peaks. The start of the loop is at Deer Creek Pass which gives you an awesome view before you drop down toward Deer Lake followed by steep switch backs up the NE face of Mt. Siligo.  At the saddle I had the option of climbing another 350ft to the top of Silgo but decided to pass because I had slept in a bit longer than I had planned and needed to get back. From the saddle I traversed around the back side of Siligo able to view Diamond Lake and then up another saddle and down into Luello Lake. Somewhere around there is where my GPS watch died. I think I slept with it running because it was only at 22% when I awoke. Bummer! The climb back up from Luello to Deer Creek pass was significant and I took it at a quick hike. I then  ran down Long's and eventually met up with Kimber who had started up the canyon much later and we finished running back down to the trail-head together. It was a gorgeous run.

Looking down at Deer Lake from Deer Creek Pass.
I always debate to myself if trips like this are worth it because we drive for so long and only get about 24hrs there. I never regret them when they are over so I think I am making the right decision to go.

Mt. Siligo from Deer Lake

Total distance: approx 18 miles
Total elevation gain: approx 5,800ft
Total time: approx 5hrs.

Sunday, September 29, 2013

Aloha Lake Circumnavigation and Ridge Traverse: Desolation Wilderness

I finished up my month in Denver with the Presbyterian/St. Luke's podiatric residency program. I had a great month. The attendings were very well read and talented, the residents worked hard and seemed to be well trained and Denver has its perks. I had my final presentation in front of the attending and residents on Thursday night, a 7am surgery on Friday and I hit the road. My presentation was on a small ligament in the foot that is considered by some to be a major contributor to flatfoot when it fails. Standing up in front of a bunch of residents and seasoned doctors presenting is very intimidating but I feel it went well and I was easily able to answer all of their questions in an intelligent manner. Glad to have that one behind me.

Leaving Denver on the I-70. 
As per the norm I hoped to get some type of an adventure in to break up my 20hr trip back to Oakland and make the most of my cross country travels. I had a few things in mind but Friday morning in Denver was overcast and there was rain in the forecast for the entire range meaning that running up on a 14,000ft peak probably wasn't a great idea. As I drove across the I-70 through the Rockies there was low visibility, snow and rain. I made the right call.

Sunset over the Great Salt Lake.
I made it to Utah around 5pm and plan B was to try to run up either Nebo or aross the Timpanogos ridge-line. This plan also was scrapped because there appeared to be a considerable amount of snow on the top 1/3 of the range.  I spent the next hour in McDonalds on the internet working out my options.

I ended up stumbling across a guy's trip report entitled Desolation Seven Summits which inspired plan C. I pushed on through Nevada and ended up meeting with my longtime buddy and fellow podiatry student Garrett Child at a Nevada truck-stop around midnight. It was great to catch up. I continued on and ended up throwing down at some random pull off and sleeping under the stars. I was glad to have my down coat and an extra sleeping bag.

The Desolation Wilderness is just south of Lake Tahoe and is a place that I have been wanting to check out. I was at the Ralston Peak trail-head around 11:00am. After getting some beta from a nice ranger lady who thought I was a bit nuts from the route I was suggesting I was on my way. The first mile and a half I ran along Highway 50 until I bailed off on an unofficial trail up Rock Canyon that went straight up for about 4 miles and 4,100ft to the top of Pyramid Peak (9,985ft), the highest point in the Desolation Wilderness. I reached the summit in about 1:45. The view was magnificent. I could see the entirety of Aloha Lake which is a discontinuous body of water with granite islands scattered throughout  surrounded by stunning peaks.

Summit of Pyramid Peak.
After taking a quick photo and slamming half a PB&J I continued on down the ridge-line. There was some traces of snow from a previous storm but I was able to avoid it and stay on the rocks to avoid getting ice on my shoes which could be devastating while jumping from rock to rock down the steep ridge. I continued on the ridge scrambling up and down for the next 1.5hrs. It was gorgeous. I topped out on Mt. Agassiz (9,967ft) and Mt. Price (9,975ft) before dropping down Mosquito Pass to catch the trail which I reached at about mile 11. My legs and feet were hurting a bit but I fell into the rhythm of a slow jog. The single track was beautiful and I only saw a few people backpacking along with their huge multi-day packs. Over the next 9 miles I took a few turns which required me to bushwack around a bit looking for the correct trail. Not being on a trail when you think you should be is one of the most demoralizing occurrences that can happen when you are fatigued and are ready to be done with your adventure. Even though I was exhausted the views were still breathtaking coming up Ralston Peak. From there I could see the entire valley containing Aloha Lake under the afternoon sun. As I made the decent down Ralston back to my car I tried to maintain a jog but it was more like a quick stumble down the steep trail. I found the adventure that I was looking for and reached the car sufficiently exhausted and fulfilled.

Looking down from Pyramid at the ridge-line yet to be traveled. 
View back up at Pyramid Peak at the ridge I came down. 
The ridge-line towards Mt. Agassiz and Mt. Price. 
Looking down at Mosquito Pass from Mt. Price.

The banks of Aloha Lake looking at the previously traveled ridge, Pyramid on the left. 

Alpine single track.

View back at Lake Aloha from Mt. Ralston with Lake of the Woods in the foreground. 
I took a few minutes to rest before I started my 3.5hr drive back to Oakland to spend the next month with Kimber. Being away from your wife is not awesome but is all for the greater good.

Elevation graph from my GPS watch.

Total Distance: 19.3miles
Total Time: 7hrs 36min
Total Elevation Gain: 6713ft

Tuesday, September 10, 2013

A Walk in the Park: Glacier Gorge Ridge Traverse, RMNP

Me heading up the north ridge of Powell. Notice McHenrys Notch in the center. 
In looking for a bigger adventure while here in Colorado I stumbled upon a route called “A Walk in the Park” on The route description was fairly vague and included summiting the 8 huge peaks surrounding the Glacier Gorge in Rocky Mountain National Park, one of the peaks being Longs Peak which is 14,259ft high. The best time that I could find online for completing it was 10hrs, 14min. Under the section entitled “Protection” (which usually gives recommendations on what size of cams and gear to bring) was stated, “Free solo. If you need a rope and a partner you can forget about it. You don’t have time to eat let alone belay”. This was perfect, as I was way overdue for a major epic and I had to do something that might impress my friends that were participating in the Wasatch 100 mile race the same weekend in Utah.
Disregard the white boxes. We took this map from somewhere else. We did the loop. 

Crappy panorama of Glacier Gorge from Storm Peak.

I talked Brody Hatch, who was preparing for his first trail marathon and is a stellar climber, into giving it a shot and we started to do a bit of online beta searching. We found a few trip reports and some decent topographical maps. We just planned to figure it out as we went beyond that.
After spending much of Saturday in my horrible Denver extended stay hotel studying Foot & Ankle International, an academic journal, I took off to meet Brody up near RMNP. We cooked dinner and slept in our cars to try and get some rest before our 3:30am alarms went off.

Getting ready to hit the trail at 4:30am. 
We hit the trail at 4:30am running at the Glacier Gorge TH. The first 2.5miles up to Mills Lake is on a well-marked and traveled trail. Arriving at Mills around 5:05am we bailed off into the woods in the dark scrambling up the base of our first peak, Thatchtop (12,668ft). The lower half of the climb provided interesting 4th and low 5th class climbing intermingled with ramps with trees and vegetation. We got lucky and pulled a semi direct route up to the never ending boulder field that took us to the top. I reached the top in 2:02 and watched the sunrise. 

Once Brody caught up we headed down the saddle and up the north ridge of Powell Peak (13,208ft). The ridge was absolutely stunning, having a knife edge with a vertical drop down into the gorge to the east and an uncomfortably sloping slab to the west. Climbing this during the morning “golden hour” provided some amazing photographs.

North ridge of Powell Peak.
Summit of Thatchtop.

North ridge of Powell Peak, Brody.

North ridge of Powell Peak, Brody.
Summit of Powell Peak.

The next objective was McHenry Peak (13327ft). The difficulty of this was getting past McHenry’s Notch which is a couple hundred foot notch in the ridgeline. To get down into the notch we had to make the decision to climb down the north or south side blindly, because we didn’t have any beta on which was better. We picked north and ended up on multiple thin dead-end wet moss covered ramps. Because there was moisture and vegetation occasional rocks were loose making it a bit too spicy for comfort. We both ended up climbing up different routes of 5th class to a ledge where we could access the south side and made it down into the notch safely. Climbing up the east side was much more straightforward 4th/5th class climbing and we made it out and along to the summit of McHenry.
Chiefs Head Peak (13579ft) followed which required us to drop down about 1,000ft into Storm Pass.  This consisted of mainly uneventful boulder hopping and we eventually topped out. Here we were able to rehydrate some by sucking water from small puddles that accumulated on the larger boulders from recent storms.
Brody lapping up water on top of McHenry Peak, not praying.

The crux section (most difficult) came next up to Pagoda Mountain (13497ft). Pagoda’s west ridge was extremely narrow with areas that we deemed unclimbable for free soloing. This forced us to work our way up the north side of the mountain where we encountered multiple lower 5th class sections and were eventually forced to drop down a wide ramp and ascend up a climbable gully. While headed up the gully I was on the lookout for bivy spots, having seen the looming storm clouds coming from the south before dropping off the ridge putting them out of view. It started to lightly rain as we regained the ridge and eventually the summit.

Me heading up Pagoda's west ridge.
Free solo Pagoda. 
Longs Peak (14,259ft) was next in line and required us to pass through the Keyboard of the Winds (some cool towers) and up to link into the south section of The Keyhole Route (most popular route) of Longs. Just below the route the weather turned bad and we found ourselves caught in a hail/rain storm. We found a large rock to sit under and waited it out for about 15 minutes. Travel after this storm was slow going due to everything being wet making it uber slippery. Our original plan had been to summit Longs and descend down the 5.4 Cable Route on the north side but we bailed on that idea due to conditions, fatigue and time. It was getting rather late and we had a long way to go still.  We headed down the Keyhole route following the red and yellow dots on the rocks marking the trail. It was slow going and frustrating because every step was slippery.

Sitting out the hail storm on Longs Peak.

From the actual Keyhole section on the northwest side of Longs we only had a small climb up a boulder field to Storm Mountain (13,326ft) and then a huge seemingly never ending decent down a boulder field to Half Mountain (11,482ft). Once on top of Half Mountain some beta that we had in our heads told us to descend a talus filled gully on the northwest side, easy enough. It was getting dark as we descended. The decent had some somewhat sketchy down climbing due to the moisture and loose rock but we continued until it was completely dark and we realized that we were surrounded on three sides by cliffs. Our only logical option was to turn around and climb back up the same section that had just taken us about an hour to cautiously descend. After multiple angry words were released we trudged on worked our way back up to the top and ended up descending down the north side through a fawna filled boulder field that took forever to work through. We eventually made it down to a trail and made the trek back to the car. My GPS watch had died at around 16hrs and we ended up reaching the car 18hrs and 48 minutes after leaving. The drive home was BRUTAL because I was so tired but I had to be in surgery the next morning to observe and had to make it home.

Brody coming out of the Keyhole of Longs.
Never-ending boulder field of Storm Mountain and Half Mountain.

 This was an awesome achievement! Brody did awesome. Multiple times we had to just keep it cool and focused to make it through. Looking back at it I might try it again someday, being a little bit more prepared in an attempt to beat the 10hr 14min record. Only time will tell.

Final Statistics
  • 7 Summits (we were only a few hundred feet away from getting Longs Peak which would have been 8)
  •  Distance Traveled: Approx. 18 miles
  • Vertical Climbed: Approx. 9,000ft
  •  C2C Time: 18:48