Smooth Pebbles

Roundup of notables: The Certainty Epidemic, Dog Head Poetry, et alia

Some great stuff I've come across, lack time to blog on, but would hate for you to miss:

In On being certain, neurologist and novelist Robert Burton, who writes a column at Slate Salon, looks at the science of what makes us feel certain about things -- even when we're dead wrong about them. His book on the subject, which I read in advance copy a while back, is fascinating fun reading. The most startling (and disorienting) finding he describes is that, from a neurocognitive point of view, our feeling of certainty about things we're wrong about is pretty much indistinguishable from our certainty about things we're right about. Not something to think about when you're in the middle of an argument -- or maybe it is, because maybe it's the other guy who's certain but wrong. Hard to know!

Why are drug costs are going up?"Because they can," say the folks at Managed Care Matters

From Cognitive Daily, When we see a brain "light up," [most of] our brains shut off. How we are suckers for brain-scan pictures.

Mind Hacks drew attention to the wonderful poem below by Wislawa Szymborska, which is a reaction to a not-so-wonderful film, from 40s Soviet science, of a decapitated dog head that (supplied with blood) still reacts to many stimuli. Grim film, beautiful poem. Excellent commentary and links at Mind Hacks.

The Experiment
by Wisława Szymborska

As a short subject before the main feature -
in which the actors did their best
to make me cry and even laugh -
we were shown an interesting experiment
involving a head.

The head
a minute earlier was still attached to...
but now it was cut off.
Everyone could see that it didn't have a body.
The tubes dangling from the neck hooked it up to a machine
that kept its blood circulating.
The head
was doing just fine.

Without showing pain or even surprise,
it followed a moving flashlight with its eyes.
It pricked up its ears at the sound of a bell.
Its moist nose could tell
the smell of bacon from odorless oblivion,
and licking its chops with evident relish
it salivated its salute to physiology.

A dog's faithful head,
a dog's friendly head
squinted its eyes when stroked,
convinced that it was still part of a whole
that crooks its back if patted
and wags its tail.

I thought about happiness and was frightened.
For if that's all life is about,
the head
was happy.

We all seem convinced we're right about politics, religion or science these days. What makes us so sure of ourselves?

News

Feb. 29, 2008 | Certainty is everywhere. Fundamentalism is in full bloom. Legions of authorities cloaked in total conviction tell us why we should invade country X, ban "The Adventures of Huckleberry Finn" in schools, eat stewed tomatoes, how much brain damage is necessary to justify a plea of diminished capacity, the precise moment when a sperm and an egg must be treated as a human being, and why the stock market will revert to historical returns. A public change of mind is national news.

My Eating Well Story on Wild Salmon -- and the Times' Story on Lost Wild Salmon

Suddenly it's salmon everywhere -- or in some cases, nowhere.

My story on "The Wild Salmon Debate: A Fresh Look at Whether Eating Farmed Salmon is ... Well ... OK," was published a couple weeks ago in Eating Well. You can see the Eating Well web version here or download a pdf here. The story describes why I came to swear off eating farmed Atlantic salmon because of their impact on wild salmon fisheries, which have enough troubles as it is.

I’m increasingly convinced that the larger issue of farmed versus wild salmon poses a similar choice. The withering array of injuries that salmon farms inflict on wild salmon forces a sort of long-range consumer decision. This is not like deciding whether you want free-range versus conventional chicken for tonight’s dinner; that’s a decision with limited echo. To decide that you may as well eat farmed Atlantic tonight, however, is to decide, in a very real sense, that you may as well eat farmed salmon, and farmed salmon only, forever. That just doesn’t sit well with me. For now, anyway, I’ve eaten my last farmed salmon.

Accompanying the story are some great recipes Eating Well gathered or put together -- delishy dishes like salmon panzanella, grilled salmon tacos, and something highly photogenic called New World Graviax.

This story was, among other things, an attempt to describe not just the salmon's status but a sort of metric -- the "Is it Okay" Algorithm -- by which to sort though the frequently confusing question of what fish are okay to eat. I can't say I came up with a universal metric, but with luck this offers a bit of guidance. The feedback so far has been quite good.

Quite a few readers have written me asking for guidance to the confusing world of salmon - as in, what kind to eat. As I note in the Eating Well article, the answer to that question depends on a formula whose variables will get weighed differently by different people. But for me it sugars to a decision to eat only wild Pacific salmon from Alaskan fisheries. If you want to keep it simple, that works. More, of course, in the article in the links above.

No sooner was that published than came the news that an important run of Chinook salmon -- the Sacramento River run -- seems to have vanished. The Times has an excellent story on that.

Did Antidepressants Depress Japan?

The Kirsch study published a few weeks ago has stirred much discussion of the placebo power of antidepressants (or is it the antidepressant power of placebos?); it's clear that the act of taking a pill that you expect to help you often does help you.

But can the availability of a pill meant for depression make you feel (or think of yourself as) depressed? That's the question behind another part of the drug debate, regarding whether the drug industry encourages us to medicalize ordinary experience.

In pondering these things I ran across this fascinating New York Times >article from 2004, "Did Antidepressants Depress Japan," about the introduction of the concept of depression in Japan beginning in the late 1990s. Before then, the article asserts, Japanese culture concerned itself little with depression outside of professional psychiatry and medicine. But when drug companies started pushing antidepressants beginning in 1999, a cultural awareness of depression grew -- and with it, the number of people who considered themselves depressed.

All arguments about the reality of severe depression aside, this says remarkable things about how cultures define -- and individuals experience (or not) -- a state of ill-being. The story is excerpted below the break, or read the whole thing here.

Drugs in Your Drinking Water

This one's getting a lot of play: There are traceable levels of prescription drugs in many public water supplies.

The Times includes the AP story, which is both long and good. I bumped into it first on the Wall Street Journal Health Blog:

Health Blog : Big Pharma is in the Water Big Pharma is in the Water Posted by Sarah Rubenstein

It's not so expensive to get pharmaceuticals after all: Just drink water.

An investigation by the Associated Press found trace amounts of scads of drugs in drinking-water supplies around the country. For a list of what was found in the watersheds of 28 metro areas, click here. Among the water's offerings were antibiotics, anti-convulsants, mood stabilizers and sex hormones. There were traces of sedatives in water serving the city that never sleeps.

The drugs get in the water via our own waste.

Clive Thompson looked at the ability to trace drugs in water supplies -- a "community urinalysis," as he called it -- in a brief item in the NY Times Magazine's "Ideas" issue.

Do these drugs have any effects? The drug content is pretty low, but as one scientist points out in the Times story, these drugs are meant to have effects at low doses. As the Times story notes in signing off:

''We know we are being exposed to other people's drugs through our drinking water, and that can't be good,'' says Dr. David Carpenter, who directs the Institute for Health and the Environment of the State University of New York at Albany.

From Wall St Journal: "Employers Pick Workers’ Pockets on Health Insurance"

Why aren't your wages going up? Maybe because you're the one paying for the health insurance your boss is supposedly paying for.

That's the gist of a new commentary in JAMA, which I'd missed till the Health Blog at the Wall Street Journal brought it to my attention: "Who Really Pays for Health Care?," the recent commentary by bioethicist Ezekiel Emanuel and economist Victor Fuchs,  argues that employer-provided health care is not as valuable a benefit as it is cracked up to be because employers basically pull it from pay raises employees would get otherwise. The result, the article says, is that you get flat or declining real wages, which is exactly what many workers have received the last decade or two. Thus along with management taking an increasing share of company income, rising health premiums are a main reason wages have been flat.

"Why does this myth matter?" ask the WSJ Health Blog --

Emanuel says that people’s belief that they’re getting a free benefit is a big reason why they are resistant to a major overhaul of the health care system. But employer-based health care is economically inefficient, Emanuel tells the Health Blog. A substantial chunk of the money goes to pay for things that have nothing to do with health care, such as underwriting, sales and marketing.

Uwe Reinhardt, a Princeton health economist, likens the employer-based health insurance to a garden party where a very slick pickpocket steals your wallet and then buys you roses and chocolates. “You’d be very grateful,” Reinhardt tells the Health Blog. Employers “are pickpockets who very skillfully take it out of your paycheck. Then they say, ‘Now genuflect.’ ”

The JAMA article is here, behind a paywall; the WSJ blog piece is here.

Tags: heath_insurance, health_care

NPR: Radio Lab: Into the Brain of a Liar

There's been a lot of attention the last couple years to the possibility of brain-based lie detector tests -- most of it premature. That coverage, I see now, has overlooked (as did I!) a 2005 study that showed compulsive liars are wired differently -- in an unexpected way -- than the rest of us. NPR's Radio Lab covered it this morning. You can get both the text and the audio at NPR: Radio Lab: Into the Brain of a Liar.

Here's the opening:

Morning Edition, March 6, 2008 ·

We all lie — once a day or so, according to most studies. But usually we tell little lies, like "your new haircut looks great!" And most of us can control when we lie or what we lie about. But some people lie repeatedly and compulsively, about things both big and small.In 2005, a study published in The British Journal of Psychiatry provided the first evidence of structural differences in the brains of people with a history of persistent lying. The study was led by Yaling Yang, a doctoral student in psychology at the University of Southern California, and Adrian Raine, an expert on antisocial disorders who is now at University of Pennsylvania.They expected to see some kind of deficit in the brains of these liars, Yang says. But surprisingly, the liars in their study actually had a surplus — specifically, they had more connections in the part of their brains responsible for complex thinking.

The compulsive liars had, in fact, 22-26% more white matter in their prefrontal cortex than did normal controls. The study's author is quoted as saying that allows them (or responds to a need) to "jump from one idea to another and ... come up with more random stories and ideas." I would wonder if the extra-robust prefrontal cortex (the 'thinking' part of our brain, and also a part crucial to negotiating the social world) is needed to run the complex calculations about others' receptions of his lies that a liar needs to do in order to fib successfully.

Hat tip to Jonah Lehrer at Frontal Cortex for spotting this first.

Tags: neuroscience, fmri, lying, Adriane_Raine

Placebo effect stronger if you pay more

With so much written here lately about placebos and drug effectiveness, I would not want to leave out this remarkable study: Placebo effect is stronger, apparently, if you pay more for the placebo.

This is a fascinating study described in a letter to the Journal of the American Medical Association. A crudely shortened version: Some researchers at MIT (none of them Bill Murray, as far as I can tell) gave light shocks to volunteers, then gave them some placebos that were costly and some that were cheap. The costly ones worked better.

It sounds like a bit of a stunt, but as Respectful Insolence points out in a nice write-up, the finding is perfectly consistent with what we know about placebos. It would seem to have unsettling implications for lowering health-care costs.

An excerpt is below the break; study is here, but behind a pay firewall.

"No more scavenger hunts," says Nature of SSRI-placebo study

A quick heads-up: Nature weighs in on the flap over the Kirsch SSRI study that found antidepressants no more effective than placebo. I've given a lot of attention to the placebo issue. Nature stresses another point: That the Kirsch study underscores the need for clinical trial data to be public. At present it is not, as the drug companies have persuaded the FDA that releasing all trial data might reveal trade secrets. Nature argues -- as have many -- that what's being hidden is not proprietary trade secrets but information vital to public health:

No more scavenger hunts

The recent media flap over antidepressants highlights the need for data to be transparent %u2014 and for a mandatory database of all clinical trials.

It was not the media's finest hour. When a study was released last week challenging the effectiveness of several popular antidepressant drugs, some news outlets, particularly in the United Kingdom, responded with headlines blaring 'the drugs don't work' %u2014 even though the drugs often do work. Yes, the study showed that the drugs often performed no better than a placebo. But what many of the media missed was that the placebo effect can be remarkably strong in psychological and neurological disorders, especially in mild depression. Doctors scrambled to assure patients that they should not abandon treatment.

Almost buried in the hubbub, though, was a more important story. To access the data needed for this study %u2014 a meta-analysis of 35 clinical trials %u2014 the researchers had to file a Freedom of Information Act request with the US Food and Drug Administration. And the information they finally received was incomplete: crucial data were missing for several studies that failed to find a significant benefit of the drug compared with the placebo. The missing data limited the analysis, and forced the researchers to abandon their investigation of two drugs altogether.

Such data chaos has become all too familiar in the world of clinical trials. And that fact, combined with recent scandals about antidepressants, diabetes drugs and cholesterol medications, has spurred an outcry to make clinical-trial registries mandatory.

More at the Nature website.

Nicholson Baker on Wikipedia

Now here's a match-up: the fine-grained, highly particularized, unpredictable, and insatiably curious mind of Nicholson Baker and the many-grained field of knowledge expressed in Wikipedia. In a great reading pleasure, Baker reviews John Broughton's Wikipedia: The Missing Manual in the current issue of the New York Review of Books:

Wikipedia is just an incredible thing. It's fact-encirclingly huge, and it's idiosyncratic, careful, messy, funny, shocking, and full of simmering controversies—and it's free, and it's fast. In a few seconds you can look up, for instance, "Diogenes of Sinope," or "turnip," or "Crazy Eddie," or "Bagoas," or "quadratic formula," or "Bristol Beaufighter," or "squeegee," or "Sanford B. Dole," and you'll have knowledge you didn't have before. It's like some vast aerial city with people walking briskly to and fro on catwalks, carrying picnic baskets full of nutritious snacks.

This is just Baker's cup of tea.