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Deep Thoughts: Sabermetrics and my annual checkup

Feb 13, 2013, 12:56 PM EDT

LDL

I went for my annual physical this morning. I’m OK and stuff, but I am NOT in the Best Shape of My Life. And the entire conversation I had with my doctor about it made me realize how silly and stupid old school, anti-sabermetric arguments are.

Note: I warn the medical professionals among you that I am going to refer to some things in a very hamfisted way. Please feel free to correct my mistakes and misleading statements in the comments.

Most of us know that you really don’t want to have a high cholesterol number. We probably had it ingrained in our heads since the 1980s at least that if your “cholesterol” — the term usually used generically, but also known as “bad cholesterol” or LDL-C — is pushing 200 or more that you’re in a bad place and at risk of heart attacks and all of that.  So, dude, lower that cholesterol!

Except it’s not that simple anymore. In the past few years general practitioners have increasingly moved away from talking to their patients about that old bad cholesterol scale to more sophisticated and refined measures. Measures which have a much greater correlation with heart health than the old numbers. I’m sure it’s way more complicated than this (really, talk to your doctor), but for our purposes, LDL-P is a WAY better measure than the bad cholesterol/LDL-C measure. Indeed, you may very well have a low LDL-C number but still be at serious risk of a heart attack because your LDL-P number is too high.

This is where I am. I get a physical every year. After a not great one in 2010 I bought a treadmill, cut out sweets, cut back on beer and lost weight. I lost about 25 pounds or so, in fact. I went for a physical in December 2011. My “bad cholesterol” number was much improved. In the healthy range. As far as I knew, I was in the BSOML.

Since last year, however, my doctor began, as a matter of course, testing LDL-P levels. I am way, way too high in my LDL-P levels. This is true even though I’m still down in weight from where I was back in 2010 and despite the fact that my bad cholesterol numbers are still in good shape. The old metrics are misleading! They were failing me because they were not telling me and my doctor about my heart attack risks nearly as well as the newer, more sophisticated metrics.

After getting lectured by my doctor about how I need to change my diet, I began to laugh. I began to imagine myself as an old school baseball writer listening to this. I began to formulate a rebuttal to my doctor that could have easily shown up in Jon Heyman’s Hall of Fame column or something, switching out WAR for LDL-P:

“LDL-P. What is it good for? Absolutely nothing.  Look, doc, you can bury your head in your spreadsheets and clinical studies which purport to show correlation between dying of heart attacks and your fancy acronyms, but bad cholesterol numbers are widely accepted and understood by people who aren’t doctors. If they were good enough for the doctor I had in 1984 they’re good enough for me. I prefer the eye test anyway. I look in the mirror and I see a much thinner me than I saw two years ago. I see that my 34 jeans are actually loose. I see my breakfast each morning and note that I’m eating way more cereal now than eggs, and my 1984 doctor told me that’s what I should do.  I don’t need some abstract number to tell me something which goes against all intuitive sense. You’re using LDL-P as an argument-ender, and frankly, the tone of you LDL-P people has gotten extreme.”

Science and math is science and math no matter what you apply it to. If people in any other field besides baseball treated scientific and mathematical metrics with the sort of willfully ignorant disdain that many baseball writers treat advanced baseball metrics, they’d be laughingstocks. And while, yes, it is an extreme example, if doctors did so in the medical field more people would die.  Baseball isn’t life and death of course, but I’m glad my doctor doesn’t approach his field of study like Jon Heyman and guys like him approach theirs.

Anyway, end of deep thought. I’m off to chuck all of the cereal, bread, crackers and pasta I have into the garbage and begin steeling myself for egg-white omelets, fish and a lot more lentils and things. If that makes me a dietary stathead who needs to get his head out of his laptop and eat some damn bagels once in a while, well, so be it.

  1. stlouis1baseball - Feb 13, 2013 at 1:00 PM

    Glad to hear you are going to live C.C.
    One thing I am curious about though…
    When he told to bend over did it make you nervous to learn that he had both hands on your shoulders?

    • Stiller43 - Feb 13, 2013 at 3:55 PM

      Wait, how does this comment have so many thumbs down? Is this crowd that mature that they cant take a little craig getting sodomized humor?

      • stlouis1baseball - Feb 13, 2013 at 4:08 PM

        Yeah…you take it with a grain of salt Stiller.
        I know it was funny…you know it was funny.
        And that’s good enough for me.

      • bla bla bla - Feb 13, 2013 at 5:03 PM

        Change it to Florio getting sodomized and you might end up with an HBO special.

  2. unclemosesgreen - Feb 13, 2013 at 1:01 PM

    Oatmeal. That’s my breakfast suggestion – sticks to the ribs, fiber, actually eats cholesterol.

    Jon Heyman and all the other guys specifically got into sportswriting because there was no math. They were absolutely sure there would be no math. How about some sympathy for these schnooks, you SABR guys changed the game, right in the middle of the game.

    • kirkvanhouten - Feb 13, 2013 at 1:48 PM

      Oatmeal? I’d rather be dead by 40.

      …also, I ate a Philly Cheesesteak Hotpocket for breakfast this morning…so 40 is probably pushing it.

      • indaburg - Feb 13, 2013 at 1:58 PM

        I’d rather be dead than eat a Hot Pocket.

      • kirkvanhouten - Feb 13, 2013 at 2:02 PM

        I’m pretty sure everyone who has ever eaten a Hot Pocket is already dead on the inside….

      • chacochicken - Feb 13, 2013 at 2:03 PM

        Rock bottom

      • stlouis1baseball - Feb 13, 2013 at 2:13 PM

        Oatmeal is wonderful Kirk. An added bonus? It makes your poop float.
        Noone wants their poop to sink.
        High Fiber = Floating Poop

      • kirkvanhouten - Feb 13, 2013 at 2:25 PM

        stlouis1baseball

        I’m confused. I thought floating poop was a bad thing, but refuse to actually google to find the correct answer because..well…gross. I’m sure a few too many very upsetting results would come up before I found the actual scienfitic answer. So if you could enlighten me as to the reasons behind floating/sinking poop, I would thank you.

        And, personally speaking only of course, I have never had strong opinions on the buoyancy of my feces.

      • unclemosesgreen - Feb 13, 2013 at 2:48 PM

        I bought a box of ham and cheese hotpockets once a long long time ago. I was extremely … red eyed at the time – and smelt of whiskey and burnt trees. The first bite burned my tongue – the next turned my stomach – the third bite nearly destroyed my will to live. The memory of that one half of one hot pocket has fueled 15 years of unbridled rage, insult and profanity.

      • stlouis1baseball - Feb 13, 2013 at 3:02 PM

        I can appreciate your apprehension Kirk. I mean that sincerely.
        But it is really pretty simple.
        A high fiber diet is a good thing.
        Fiber makes your poop float.
        So if your poop doesn’t float…I suggest you eat more fiber.

      • indaburg - Feb 13, 2013 at 3:57 PM

        Lots of scatology on HBT these days. First, Lawrie and his plane farts, and now this.

        Normal stools usually sink. Floaters are typically harmless but can sometimes be related to nutritional malabsorption or gassiness. Whoever farted on the Jays’ flight probably has floaters. A sudden increase of fiber into the diet can also cause gassiness, so there could be a correlation there between fiber, farts, and floaters.

        The more you know…

      • cur68 - Feb 13, 2013 at 6:27 PM

        I was away all day learning about cluster infections and case control studies (among other things). I can see I missed NOTHING important on HBT.

  3. IdahoMariner - Feb 13, 2013 at 1:03 PM

    excellent analogy.

  4. b453841l - Feb 13, 2013 at 1:03 PM

    With all this snow we got, I’m pretty sure the planet is getting colder.

  5. chacochicken - Feb 13, 2013 at 1:16 PM

    Try some primal (not paleo mind you).

    http://www.marksdailyapple.com

  6. illcomm - Feb 13, 2013 at 1:20 PM

    good luck with your health. I had a high cholesterol level once and since have changed my diet for better. one thing that is still hard for me to cut out is the red meat. I’m down to once a week n am still trying to reduce that number. good luck n stick with it Craig.

    • stlouis1baseball - Feb 13, 2013 at 2:19 PM

      Great to hear illcomm. How much weight have you lost? I could stand to lose about 30 lbs myself.
      Taking Met Formin, Simvastatin, Nexium (among a few others). And I am only 40!
      The red meat and beer is my downfall.

  7. Chris Fiorentino - Feb 13, 2013 at 1:30 PM

    There’s of course a HUGE difference between WAR and LDL-P Craig….

    LDL-P is calculated using a 100% scientific method that measures the exact amount of LDL particles.

    WAR has ten different methods on how it is calculated and it changes just about every year. Half of the stat is completely subjective as it pertains to a player’s defensive abilities.

    Nice try…but it’s an apples to oranges comparison.

    • Ari Collins - Feb 13, 2013 at 3:56 PM

      WAR has, like, three different ways to measure it, and the only difference is whose defensive metrics they use. Which aren’t subjective, they’re just measuring different things. And I don’t think anyone’s changed their measurement ever, let alone just about every year.

      To go back to Craig’s analogy, it’s like you’re saying that since there are two different LDLs, and they measure different things, they must both be worthless. I mean, why can’t the medical establishment agree on one single measure of all health ever?!

    • paperlions - Feb 13, 2013 at 3:59 PM

      The point is that LDL-P is a far better indicator of heart health than LDL-C…..just like WAR (no matter which version you use) is a far better indicator of productivity than RBI, BA, ERA, or pitcher wins.

      Each version of WAR is calculated perfectly, just like LDL-P is calculated accurately for a given sample, but LDL-P is probably less correlated with heart health than WAR is to baseball productivity because WAR uses far more of the necessary variables to do the job than LDL-P does.

  8. frankenderek - Feb 13, 2013 at 1:31 PM

    Clap, clap, clap. Probably one of the best blog posts in a while from you. It’s a perfect analogy. Old stats aren’t bad, but they should be used in moderation, but you should think more in modern terms.

    Just like how cocaine was prescribed in the old days for pain….yeah about that….

  9. proudlycanadian - Feb 13, 2013 at 1:31 PM

    Have a donut, smile and relax. In a couple of years, doctors will be touting some new health metrics based on “new revised” scientific evidence.

    • proudlycanadian - Feb 13, 2013 at 1:32 PM

      P. S. Do not forget your daily input of Red Wine.

  10. kirkvanhouten - Feb 13, 2013 at 1:40 PM

    Pffft…Sabermetrics is just witchcraft with numbers. I don’t know why we don’t stick to the invented baseball math of the 1880s as our lone source of player evaluation. I mean, it’s not like society has improved anything else since the 1880s, why should we expect them to have come up with better ways to evaluate baseball players?

    Now, if you’ll excuse me, I gotta load up the family in an Ox-drawn cart for our four month journey to California*. I even got me a new musket to fight off any Apaches we may encounter en route.

    *yeah, yeah, I know there were trains then.

    • 18thstreet - Feb 13, 2013 at 2:18 PM

      I’m sure there were people in 1880 who refused to take the train because ox-drawn carts were good enough for their grandfathers. No need for the asterisk.

  11. JB (the original) - Feb 13, 2013 at 1:45 PM

    You do realize they keep coming up with new things to measure and call “bad” so they can justify putting you on drugs that Big Pharm pays them off for prescribing? I’m 48 and relatively good health. But when I go to the doctor and they ask me what all I’m on and I say “nothing”, they all go ‘what about cholesterol?’, ‘what about blood pressure?, etc. etc. When I repeat “nothing”, they look at me like I’m crazy. If you have noticed, the numbers for what is considered “high blood pressure” keep nudging down, and in addition to hypertension we now have pre-hypertension. Granted, they have learned new things, but modern medicine is all about the $$$ now.

  12. JB (the original) - Feb 13, 2013 at 1:48 PM

    In this analogy, Scott Boras is Big Pharm….

  13. indaburg - Feb 13, 2013 at 1:52 PM

    “If they were good enough for the doctor I had in 1984 they’re good enough for me.”

    Most of the patients I deal with do think that way. Or, they have PC’s point of view–in a few years, some new health metrics will come out, so why bother? First eggs where the devil. Egg whites only. Then newsflash: the egg yolk raises HDL, good cholesterol. HDL is good, right? Then, another study comes out. Eating a high number of egg yolks may thicken your artery walls as much as smoking. And whaddaya mean, HDL isn’t necessarily “good” cholesterol? Wtf, mate?

    It gets a little frustrating for us health professionals too. We learn one thing, then presented with evidence indicating the opposite. Part of the issue is that most of us like things simple and absolute. Black or white. Good or bad? A lot of times, the answer is “it depends” but we don’t want to hear that.

    Kudos to your doc, Craig, for keeping up with the latest and greatest.

    • unclemosesgreen - Feb 13, 2013 at 2:55 PM

      Most of the time when people use that kind of “logic” they are just making excuses to keep doing whatever they like. A lot of the answer is moderation. Some things are just bad even in small quantities, y’know, like crack, heroin, arsenic. Iocaine powder. Although evidently, over time, small enough servings of Iocaine powder help you build up a resistance to it. Never quite understood that. But I digress.

      Most of the “bad” things are o.k. in occasional and reasonable sized portions.

      • indaburg - Feb 13, 2013 at 3:21 PM

        Even those substances you mentioned (except for iocane, which is one of the dealiest substances known to man) aren’t just bad. In the ER, I’ve applied cocaine to patients’ nostrils for to stop extreme nose bleeds. It’s very effective since it’s a potent vasoconstrictor. Heroin, being an opioid, is a very effective analgesic. In the UK, it’s actually legal to administer under strict guidelines. Even good ol’ arsenic is being researched as a potential cancer treatment.

        You’re right though. Moderation is the key. It’s just so… boring. Moderation itself should also be practiced in moderation.

      • indaburg - Feb 13, 2013 at 3:28 PM

        Sigh… Deadliest, no dealiest.

    • stlouis1baseball - Feb 13, 2013 at 4:18 PM

      Darn it! Thanks for the clarification Inda.
      Not only am I wrong about Obama (the sun apparently does rise and set in his ass)…
      I am wrong about “floaties.” LOL! I am going to ease off the oatmeal for a while.

      • indaburg - Feb 13, 2013 at 4:51 PM

        No, no! Keep eating the oatmeal! It’s a wonderful food. Drizzle a little 100% pure maple syrup in it for variety. I saw that you take metformin (ouch). There’s been a lot of research the benefits of maple syrup for diabetics (but of course, check with your doc first). Use the real stuff, not that Aunt Jemima mixture of toxins.

      • cur68 - Feb 13, 2013 at 6:33 PM

        Use the Canadian stuff, man. Its full of Beavery-goodness.

    • stlouis1baseball - Feb 13, 2013 at 5:11 PM

      Thanks for the advice Inda. Very helpful. I do eat a lot of oatmeal. But the pre-packaged maple and brown sugar kind. I know it isn’t the greatest for you. Sometimes I go overboard and put honey on it as well. LOL! I am pre-diabetic. My two buddies who are Doc’s and my Mother-in-Law (the NP) do a great job of staying on my ass. As well as the Wife (she’s a nurse).
      I need to lose about 30 lbs. Blood pressure has always been great. But the red meat and beer is what the primary issue seems to be.
      From what I am told…
      Once you are on Met Formin…it’s a forgone conclusion that you typically stay on it and the actual diabetes ultimately follow’s suite. But I am gonna do my best to squelch that noise.
      My Wife and Mother-in-law tell me I am taking the medicine of an overweight geriatric.
      Yeah…fun stuff!

      • indaburg - Feb 13, 2013 at 7:28 PM

        I hear you, stlouis. Red meat and beer does a lot of us in. In unclemoses’s original post about oatmeal, the word that stood out to me in his first sentence was “ribs”… St. Louis style, Texas style, Carolina style, Oklahoma style (gotta shout out my girl, ‘philiac)… I don’t discriminate. I love me some bbq. What were we talking about again? Oh, yeah, oatmeal… it’s good for you…

    • jwbiii - Feb 13, 2013 at 7:36 PM

      Dammit, leeches have to eat too!

  14. chacochicken - Feb 13, 2013 at 2:09 PM

    Certainly for the better but science is cumulative. Complex organisms are complex…exponentially so. Eat what morphologically modern humans ate for the 150,000 years before the advent of that damnable agriculture.

    • bisonaudit - Feb 13, 2013 at 2:35 PM

      This might make some sense if your only goal was to live long enough to see your offspring to self sufficiency.

      • chacochicken - Feb 13, 2013 at 6:14 PM

        They lived long remarkably healthy lives compared to modern agriculturalists. Our big advantage is advanced medicine and antibiotics. The food has gotten worse.

  15. bisonaudit - Feb 13, 2013 at 2:36 PM

    How has climate change not come up yet?

  16. dawgpoundmember - Feb 13, 2013 at 3:08 PM

    whoa craig! so your doctor said your stats are not what they use to be, did he offer you some new pill or something that will help you recover from the treadmill runs and what nots?

  17. raysfan1 - Feb 13, 2013 at 3:13 PM

    @JB–
    Your assertions about there being some sort of medical provider and “Big Pharm” conspiracy is almost as laughable as it is insulting. I’ve practiced medicine for over 20 years and here is the total pay out I have received from drug companies: $0.00. Likewise, the only doctors I know who do receive money from drug companies happen to be directly employed by them. We take ethics very seriously.

    The reason hypertension and hyperlipidemia are defined more strictly than in the past is simple, namely that scientific studies have consistently shown that lowering levels further to the current definitions prevents heart attacks and strokes.

    • stlouis1baseball - Feb 13, 2013 at 3:36 PM

      Absolutely Raysfan. I have a couple of friends who are family practitioners and they bemoan this sort of thinking as well. They also bemoan the impending costs that Obamacare is going to have on family Doc’s.

      • El Bravo - Feb 13, 2013 at 3:57 PM

        way to sneak in obamacare haterism in there. the short answer is the system will cost less than not having the affordable care act in place once it takes full effect, despite what the family doc says. it will has already insured millions more people as well. not sure you can hate on that.

      • paperlions - Feb 13, 2013 at 4:53 PM

        Yeah, the cost of health care in the US has absolutely nothing to do with any current proposed health care system….it is all about a few companies reaming everyone else via unjustified health care costs. In the US, nearly 20% of the GNP is spend on health care….there is no way that is reasonable. Somebody is making out like a bandit, and I doubt it is anyone that has been to med school.

      • raysfan1 - Feb 13, 2013 at 7:42 PM

        I like money, therefore I support a true universal healthcare system. Obamacare is not a true universal healthcare system as there will still be millions of uninsured Americans. Our healthcare expenditures are roughly 17% of our GDP. Great Britain, which has a private healthcare option, spends about 11% of its GDP on healthcare.

    • JB (the original) - Feb 13, 2013 at 4:26 PM

      Things have changed in recent years inasmuch as Big Pharm cannot provide the niceties they once did (ever wonder why all the conferences were in Hawaii or Phoenix in the winter time?). Personal observation and from others I’ve talked to that go in and have poor numbers (mine are fine) typically see “the doctor” for less than 5 minutes and the scrips are written up as fast as they can sign them with no talk of “diet” and “exercise”. But I guess that’s what happens when you triple book patients to make up for the reduced insurance payouts…

      • stlouis1baseball - Feb 13, 2013 at 4:35 PM

        “But I guess that’s what happens when you triple book patients to make up for the reduced insurance payouts…”

        On point! This is also part of what I was referring to previously.
        But…shhhhh! If we don’t discuss it people might forget about it.

      • raysfan1 - Feb 13, 2013 at 7:33 PM

        Can’t speak for others on how much time they spend with patients. I see 20-25 a day on average, about 1 every 15 minutes. Regardless, I start with an open-ended question, let the person talk without interrupting and at the end make sure they have no questions.

        Recently, the number of doctors who are employees rather than in private practice surpassed 50%. I am one of those, meaning I get paid a salary–how many patients I see does not change that.

        Most conferences are still in nice places in nice hotels. Attendance is much better that way. Pharmaceutical reps do show up too, as do medical textbook publishers and equipment manufacturers. However, every scholarly paper or research presentation has mandatory disclosure of any connection to them. My hotel bill and travel costs and food are my own.

      • JB (the original) - Feb 14, 2013 at 8:41 AM

        There are good and bad guys in every walk of life. In medicine some are in it for the love of helping people, others are in it for the money–just like baseball, some just want to play, some just want to be paid.. I wasn’t trying to disparage any one person/doctor, more an indictment of the system at large.

  18. El Bravo - Feb 13, 2013 at 3:54 PM

    “Science and math is science and math no matter what you apply it to. If people in any other field besides baseball treated scientific and mathematical metrics with the sort of willfully ignorant disdain that many baseball writers treat advanced baseball metrics, they’d be laughingstocks.”

    Ummmmmmmmmmmmmmmmmm, have you ever heard arguments against climate change? How about evolution? They SHOULD be laughingstocks, but alas, dumb f@cks get to rail against facts and science all the time in the mainstream media.

    • stlouis1baseball - Feb 13, 2013 at 4:15 PM

      Easy Bravo. I have two very good friends who are family Doc’s and we discuss it all the time.
      My Mother-in-Law is a Nurse Practioner and we also discuss it frequently.
      My buddies are conservative…my Mother-in-Law is a liberal. And they all agree it is going to have a terrible affect on their bottom lines.
      In a nutshell…they have been getting reimbursed less and less over the last 10 – 15 years as it is.
      It’s only going to get much worse.
      But I understand where you are coming from.
      Any type of negative comment(s) whatsoever against our feerless leader is blasphemy.
      You just can NOT disagree with anything. You simply must conform
      While we are at it…we must kneel down as well.
      Amiclose?

      • El Bravo - Feb 13, 2013 at 4:25 PM

        Close enough not to argue…hahahaha. I’m trollin’. Haven’t been posting in awhile. Busy 2013.

    • stlouis1baseball - Feb 13, 2013 at 4:36 PM

      Fair enough Brah’. I wondered where you went. Busy thus far huh?

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