Month: June 2010

Assorted Links

Seth Roberts8 Comments
  • “ant tribes” near Beijing
  • What exactly is umami?
  • Is omega-3 an antidepressant? “Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder.” Are they fooling themselves? Maybe not. My research suggests that morning faces can reduce only depression but also anxiety disorders. So if you have depression without an anxiety disorder it may indeed have a different cause.

Thanks to Anne Weiss.

What Antidepressants Do

Seth Roberts28 Comments

After I complained about lack of outrage in Daniel Carlat’s Unhinged, Bruce Charlton pointed me to this essay (registration required) by Simon Sobo, a psychiatrist. Sobo says something I may end up repeating every time the subject of antidepressants comes up:

Rat pups that are isolated from their mother and littermates produce ultrasonic sounds that are indicative of stress. SSRIs [the most popular type of antidepressants] reduce these sounds (Oliver, 1994). Is a chemical imbalance being corrected? I doubt it.

That’s a nice summing-up. Prozac (an SSRI) really does something, but the notion that it returns to normal something broken is absurd. Sobo also gives an example of how the anti-anxiety effect of such drugs works in practice:

Mrs. L. had originally required 40 mg of Paxil (paroxetine) per day to recover from a postpartum depression. After 12 months on the medication, an incident happened that disturbed her. During her lunchtime, she was visiting her 1-year-old son at his day care center when one of the workers began screaming at another infant instead of picking her up. The next day Mrs. L. went shopping during her lunch break. Later that week a co-worker became tearful during the course of a conversation with Mrs. L. regarding her own child’s day care center. Only then did Mrs. L. wonder about her decision to go shopping the day after she had witnessed the day care worker’s inappropriate reaction. She wondered if her Paxil had made her indifferent when ordinarily she would have reacted and worried about such a thing.

My research about mood suggests that depression is due to defective entrainment of a mood oscillator. It’s caused by something missing from the environment. “Chemical imbalance” has nothing to do with it.


Fermented Food in Japan

Seth Roberts11 Comments

If you know anything about heart disease epidemiology, you know that Japan has the lowest rate of heart disease in the world. The usual explanation is high fish consumption. But other countries, such as Norway, also eat a lot of fish but don’t have low heart disease rates.

My visits to Japan suggest to me that Japanese eat far more fermented foods than people in other countries, including Norwegians. If heart disease is due to infection, then it’s clear that the immune stimulation provided by fermented foods helps fight infection. My umami hypothesis — that we like umami, sour, and complex flavors to encourage bacteria consumption, which we need to be healthy — began with a trip to Japan in 2008, when I noticed, in a food court, many types of miso for sale. Back in Berkeley, I started making miso soup. I was stunned how well it worked. All you needed was miso. No other flavorings. It was so easy and good I ate it every day. It was my first bit of evidence that fermented foods are different and better than other foods.

Here are some fermented foods that are easy to get in Japan:

1. Miso soup. Most Japanese eat this daily. In a few countries, such as France, many people eat yogurt daily. Koreans eat kimchi daily. In most countries, as far as I know, it’s hard to find a fermented food (apart from cheese and alcoholic drinks) that’s eaten daily by most people. Miso is also used to flavor fish.

2. Japanese pickles. The best pickles in the world. Some are pickled as long as as two years, developing noticeable alcohol. Other countries have pickles, of course, but as far as I know the only pickle restaurants are in Japan. Moreover there are pickle shops in big Japanese cities. The only other pickle shops I’ve seen are in New York City.

3. Pickled apricots (umeboshi). At a food court you have a choice of acidity, anywhere from 5% (slightly sour) to 25% (extremely sour).

4. Vinegar drinks. Tokyo 7-Elevens sell a black vinegar drink. Vinegar and water. In food courts you can buy special vinegars for this purpose. I’ve never seen vinegar drinks for sale anywhere else.

5. Natto.

6. Yogurt. The Japanese yogurts I’ve tried were sweetened but weren’t as sweet as the yogurts sold in Beijing.

7. Yakult. The fermented milk drink. It’s sold in such small packages it’s pretty clear it must appeal to people who think it improves their health. It doesn’t boost energy, quench thirst, or taste especially good. The manufacturer says it is good for health and that one bottle per day is all you need.

8. Beer and wine.

Because soy sauce is used in small amounts, it doesn’t count. At a Tokyo restaurant I met a nurse who said she thought you should eat fermented foods every day to be healthy. She said perhaps a third of Japanese believe this.

I’ve never seen high Japanese consumption of fermented foods noticed by epidemiologists. Individual fermented foods (such as miso), yes; the whole category, no. You can see how hard it would be to combine across foods: how much miso equals how much Yakult? Yet I’m sure fermented food consumption is extremely healthy.

Unhinged by Daniel Carlat

Seth Roberts7 Comments

Daniel Carlat, a Massachusetts psychiatrist, is the author of the excellent blog The Carlat Psychiatry Blog. He also wrote an excellent article in the New York Times Magazine about working on the side as a drug rep: He told other psychiatrists about new drugs. He quit (or was fired) because telling the truth wasn’t compatible with the job.

Unhinged, his new book (sent to me by the publisher after I asked for it twice — that’s how much I wanted to read it), covers the same ground. Its subtitle (or two subtitles) is/are The Trouble With Psychiatry — A Doctor’s Revelations about a Profession in Crisis. The contents were well-written, but none of it was new to me: the “chemical imbalance” theory of depression is a convenient myth, how drug reps work, how drug companies influence doctors, diagnosis difficulties, the cases of Charles Nemeroff and the like. (I did learn that Nemeroff was called “the boss of bosses” because of his prominence and power.) If any of his criticisms are new to you, this book is a great introduction. He uses many stories of patients to make his points.

Overall, I found the book too calm. What Nemeroff and others like him did I find outrageous but Carlat doesn’t sound outraged. Maybe he is, I have no idea, but his book is more reasonable-sounding than scornful and I would have preferred scornful. At one point he says he wrote an “angry” op-ed for the New York Times about something and I thought: good, some emotion!Â

The crisis of the subtitle (“A profession in crisis”) is enticing but is not borne out by the contents. Carlat dislikes aspects X, Y, and Z of his profession, but one person’s dissatisfaction does not equal crisis. I saw no signs he is part of a growing movement. My take on the trouble with psychiatry is that psychiatrists don’t understand what is wrong in almost every case they see and, due to lack of understanding, do a poor job of fixing the problem. Lack of understanding by doctors is nothing new and, until someone has a better understanding, doesn’t pose a professional problem. This basic truth goes unmentioned in Unhinged.

The David Healy Affair

Seth Roberts3 Comments

Bruce Charlton pointed me to this website full of information about how the University of Toronto rescinded a job offer to David Healy, a British psychiatrist, after he made negative comments about Prozac. Psychiatrists at the University of Toronto got a lot of money from Lilly, the maker of Prozac. Here’s something from a CBC documentary about it:

Although he refuses to interviewed, Dr. Nemeroff said through his lawyer that the [University of Toronto psychiatry] center asked for his opinion of Dr. Healy that day and he gave it. . . . Later that day he flew to New York where we do know he told a meeting of the American Foundation for Suicide Prevention exactly what he thought about Healy. One scientist who was there said Nemeroff’s attack was furious, angry, exercised, that the thrust was Healy was a nut.

If Charles Nemeroff calls you a nut . . .

Prenatal Ultrasound and Autism: Multiple Voices

Seth Roberts3 Comments

I previously blogged (also here) about Carolyn Rodgers’s idea that prenatal ultrasound may cause autism. It turns out that she isn’t the only person with this idea; researchers at the University of Louisville recently published the same idea.

I learned about the Louisville study from Anne Weiss, who said the connection has been plausible for a long time.

Ultrasound was introduced into obstetrics in the 1970′s and was generally restricted to high-risk pregnancies. By the 1980′s policy statements were issued by ACOG, the NIH and equivalent bodies in Europe and Canada stating that its use should remain limited to high-risk cases. Despite these recommendations, ultrasound technology became common in hospitals and doctors’ offices and routinely applied to low-risk populations. Within a short time the majority of pregnant woman were being exposed at prenatal visits, during multiple scans in hospitals, and during continuous monitoring during labour (which could mean 12 to 14 hours during childbirth alone). Skills and techniques used to monitor the fetus prior to the introduction of ultrasound (in utero and during the birth process) were slowly undermined by the technology and often underutilized. Iatrogenic effects from false positive readings, – unnecessary C- sections, inductions, instrumental deliveries etc. caused harm to moms and babies, especially in the early 1980′s.

Three important names in the 1980s were (1) Robin Mole, who presented a paper “Possible Hazards of Imaging and Doppler Ultrasound in Obstetrics” to the Royal Society of Medicine Forum on Maternity and the Newborn: Ultrasonagraphy in Obstetrics, April 1985. She was former director of the Medical Research Council Radiobiology Unit, England. Also the work of (2) M.E. Stratmeyer – Research in ultrasound. A public health view. Birth and Family Journal 1980 and (3) Doreen Liebeskind – still at Albert Enstein and a prof of radiology- presented at a symposium at Columbia in 1983.  She was concerned that ultrasound may be producing subtle changes in the fetal brain perhaps affecting behavioral mechanisms, possible changes in reflexes, IQ, attention span or some of the more subtle psychological, psychiatric or neurological phenomena. Referred to animal and lab studies that showed ultrasound may cause chromosomal damage, breakdown of DNA, etc. There are others who sounded the warning that this was not a benign technology but these voices were crowded out for varied reasons like threats of litigation, loss of the traditions skills of birthing etc.

There were also Japanese studies that raised concerns about ultrasound. Weiss continued:

Unfortunately the use of ultrasound in obstetrics has not declined, despite safety concerns and the lack of research to rule out serious neurological effects. It’s so entrenched in modern obstetrical practice.  Doctors use the machines to protect themselves from litigation – in the case of fetal abnormalities, undetected multiples, placenta previa, neurological or physical damage to the fetus during childbirth, stillbirth etc. It has almost become a form of entertainment – you can get photos and videos of baby’s ultrasound. It’s disturbing how benign it appears.

Within the context of the work I do, ultrasound is just one of many concerns I have with the over-management and medicalization of childbirth. My clients come to me to find ways to subvert this within the hospital setting or to prepare for a home birth with a midwife.  I also get referrals from doctors whose patients are dealing with difficult issues while pregnant.

Chinese Mystery Explained: Humorous Names

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Describing my first day of teaching at Tsinghua, I wrote:

The students did brief introductions. Many students appeared to think that one student’s Chinese name was humorous. This was briefly explained to me but I still have trouble believing it.

I don’t remember the brief explanation. At the time I didn’t know that my Chinese name sounds exactly like the word for eggplant, which has different characters. As the Tsinghua story suggests, this isn’t rare. I met a girl whose name sounds the same as China’s ruler. (Different characters, of course.) Anyway, it seems a blessing that my name has a humorous side and perhaps that’s what the parents in this case were thinking.

Assorted Links

Seth Roberts2 Comments

Law Guardians and Self-Experimentation

Seth Roberts5 Comments

In my recent Medical Hypotheses paper, I argue that scientists care a lot about status display and this interferes with good science. Failure to self-experiment is an example. I think the main reason self-experimentation is unpopular is that it looks low-status. Here I explain how sleep researchers would benefit from the self-experimentation they don’t do.

In a May New Yorker article, Janet Malcolm gives another example of status display getting in the way of doing a good job:

Not speaking to their clients [children] is almost a badge of honor among law guardians [lawyers assigned to look after the interests of children in the legal system, such as the child of divorcing parents]. In a 1982 study by the New York State Bar Association, this practice was found to be ubiquitous. . . . Judges continue to turn a blind eye to what the Bar Association called the “phantom” attorney.

Lucky Charms Can Work

Seth Roberts2 Comments

Speaking of good-luck charms, a study at the University of Cologne found in four different experiments with four different tasks that people did better when they believed that they somehow had Lady Luck on their side. For example, they did better when they had their lucky charm with them than when they didn’t.

If lucky charms work then it’s reasonable to buy them. I explained why it’s helpful in an evolutionary (i.e., long-term) sense to buy them: long ago, the resources paid for them supported technological innovation.
Via Bad Science.