Author: Seth Roberts

Progress in Psychiatry and Psychotherapy: The Half-Full Glass

Seth Roberts3 Comments

Here is an excellent introduction to cognitive-behavioral therapy (CBT) for depression, centering on a Stanford psychiatrist named David Burns. I was especially interested in this:

[Burns] currently draws from at least 15 schools of therapy, calling his methodology TEAM—for testing, empathy, agenda setting and methods. . . . Testing means requiring that patients complete a short mood survey before and after each therapy session. In Chicago, Burns asks how many of the therapists [in the audience] do this. Only three [out of 100] raise their hands. Then how can they know if their patients are making progress? Burns asks. How would they feel if their own doctors didn’t take their blood pressure during each check-up?

Burns says that in the 1970s at Penn [where he learned about CBT], “They didn’t measure because there was no expectation that there would be a significant change in a single session or even over a course of months.” Forty years later, it’s shocking that so little attention is paid to measuring whether therapy makes a difference. . . ”Therapists falsely believe that their impression or gut instinct about what the patient is feeling is accurate,” says May [a Stanford-educated Bay Area psychiatrist], when in fact their accuracy is very low.

When I was a graduate student, I started measuring my acne. One day I told my dermatologist what I’d found. “Why did you do that?” he asked. He really didn’t know. Many years later, an influential psychiatrist — Burns, whose Feeling Good book, a popularization of CBT, has sold millions of copies — tells therapists to give patients a mood survey. That’s progress.

But it is also a testament to the backward thinking of doctors and therapists that Burns didn’t tell his audience:

–have patients fill out a mood survey every day
–graph the results

Even more advanced:

–use the mood scores to measure the effects of different treatments

Three cheap safe things. It is obvious they would help patients. Apparently Burns doesn’t do these things with his own patients, even though his own therapy (TEAM) stresses “testing” and “methods”. It’s 2013. Not only do psychiatrists and therapists not do these things, they don’t even think of doing them. I seem to be the first to suggest them.

Thanks to Alex Chernavsky.

Assorted Links

Seth Roberts8 Comments
  • How little is known about tinnitus
  • Michael Lewis on Greg Smith’s book. Published months ago. “The dystopia often imagined in the world of artificial intelligence—in which computers somehow take on a life of their own and come to rule mankind—has actually happened in the world of finance. The giant Wall Street firms have taken on lives of their own, beyond human control. The people flow into and out of them but have only incidental effect on their direction and behavior.”
  • The price of admission to the Chinese Academy of Sciences. “Businessmen seeking ministry contracts learned of Zhang’s nomination and offered to help. . . . Zhang, using a slush fund provided by the businessmen, cloistered 30 experts from mostly ministry-affiliated universities and research institutes in a hotel for 2 months, during which time they churned out three books on high-speed rail technology that were credited to Zhang.”
  • Why was Matthew Shepard killed? I have not yet read this book (I will) but it sounds so good I am happy to publicize it before that. It is being ignored. It supports a theme of Ron Unz and this blog, that lots of what we are told is wrong.
  • Someone leaving graduate school at École polytechnique fédérale de Lausanne explains why he is leaving only a few months before finishing his Ph.d. His complaints about professional (academic) science resemble mine — for example, the dominant role of will this help my career? in all decisions.

Thanks to Joyce Cohen and Allan Jackson.

Queen Late

Seth Roberts5 Comments

When a Chinese friend of mine was in first grade, she was habitually late for school. Usually about ten minutes. Her mom took her to school on a bike. One day she was 20 minutes late. The door was closed. My friend opened the door. “May I come in?” she asked the teacher. The teacher came to the door. She took my friend to the front of the class. “Here is Queen Late (迟到大王),” she said.

Everyone laughed, including my friend. She thought it was a funny thing to say, not mean. The name stuck. Many years later, she was called Queen Late by those who knew her in primary school. Her teacher was not a great wit. Other students at other schools were called the same thing. It was/is a standard joke.

Sometimes I think Chinese have, on average, a better sense of humor than Americans, but who really knows? A more interesting contrast is how lateness is handled. At UC Berkeley, about 20 years ago, I attended a large lecture class (Poli Sci 3, Comparative Politics) taught by Ken Jowitt, a political science professor. Jowitt was considered an excellent lecturer, which was why I was there, but he was also famous for being hard on students who came in late. When I was there, a student came in late. Jowitt interrupted what he was saying to point out the offender and said something derogatory. I don’t remember what Jowitt said but I do remember thinking — as someone who also taught large lecture classes where students came in late — that he was making a mountain, an unattractive mountain, out of a molehill. It didn’t occur to me to wonder how he could have dealt with the problem in a way that made everyone laugh.

 

 

“Trying to Confuse You”: Pluses and Minuses of the Professorial Value System

Seth Roberts5 Comments

A Chinese friend of mine is a chemistry major. In one of her classes, the textbook was so hard to understand she said the authors are “trying to confuse you.” They use difficult words, for example. A Berkeley art history major told me much the same thing. In her reading assignments, she said, the writers couldn’t write a sentence without a few big words. They were trying to impress readers, she believed.

Yes, professors write badly — in these two cases, the writing seemed actively bad. Thorstein Veblen wrote a whole book about showing off (The Theory of the Leisure Class). One chapter was about professors. They show off, said Veblen, by doing research with no practical application and by writing obscurely. Obscure writing is showing off because, like useless research, it shows you don’t have to care what other people think (“it carries a pointed suggestion of the industrial exemption of the speaker”).

Veblen said little about the costs and benefits of the behavior he described, beyond calling it wasteful. I say the opposite — not wasteful at all. When, long ago, people bought “useless” (“deadweight loss”) gifts or “useless” hood ornaments or decorated buildings with “useless” ornamentation or performed “useless” rituals and ceremonies that require special products (e.g., special clothes), they subsidized skilled artisans. For a long time, that was incredibly important. Research by skilled artisans led to better tools, the creation of metals, and so on. Helping those artisans make a living supported (increased) research in material science. Pushing people toward “useless” research was valuable because it diversified the research being done — there are many ways to be useless, just as you can misspell a word more ways than you can spell it correctly. The most important discoveries, such as electricity, would not have been made if everyone tried to do research with obvious application. Allowing professors to use big words and write badly is a small price to pay for the valuable “useless” research they perform.

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I use Grammarly for proofreading because . . . well, just because.

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There is an unrecognized problem with this, however. If you get one group of people to do “useless” research by turning things upside down so that useless is seen as better than useful (professors value “pure” research over “applied” research), it becomes very hard for them to do useful research. For a long time, practically all important research was material science research — how to control the material world. When something useful was discovered via “useless” research, the knowledge could be transferred to everyone else, who had normal values (useful is better than useless). Everyone else went on to use the knowledge in profitable ways — to make better knives, for example. This system (the results of “useless” research are used by other people to make a profit) gave us the world we live in, a world of wonderful products. The products on offer are staggering in their diversity, low cost, and general excellence. The hard drive on my laptop, the clothes I wear, for example.

Against this brilliant control of materials we can put our amazing lack of control of our bodies. A large fraction of Americans sleep poorly. Nothing (such as street noise) is making them sleep badly; they just don’t know how to sleep well. Depression is a huge problem, obesity is a huge problem (in America), and so on. It isn’t just ordinary people. Sleep experts don’t know how to improve sleep, weight control experts don’t know how to lose weight, psychiatrists don’t know how to prevent depression, and so on. Closely related to this is our health care system. It is dominated by doctors, who often use a peculiar and self-serving reasoning I call doctor logic. When I was a graduate student, my dermatologist was surprised when I measured my acne to see if the treatments he prescribed actually worked. It was a new idea to him. An influential Stanford psychiatrist named David Burns, whose famous book has sold millions of copies, has not yet figured out it would be a good idea to measure daily the mood of his patients. (Other psychiatrists are even worse.)

Why are we so smart about materials and so stupid about health — which is far more important? I think it is because the whole system evolved to push our economy forward via advances in material science. For hundreds of thousands of years, that is where improvement was possible: better stuff, such as better tools. The same “habits of mind” (as Veblen would say) and research system has managed to produce plenty of “useless” knowledge outside of material science. This knowledge can be translated into useful discoveries, as I have done (new ways to sleep better, lose weight, be in a better mood, and so on), but these discoveries don’t lead to products, at least not in obvious ways. Control of our bodies is quite different than making something physical. My first interesting self-experimental discovery was that eating breakfast made my sleep worse. That’s very useful, but not at all profitable — there is no obvious associated product. For professors, a problem with my discovery is that it’s useful. (Another problem is that it’s small.) For everyone else, a problem is that it isn’t profitable. The system that worked so well for material science breaks down when it comes to health science.

Yet the fact that you are reading this suggests, at least to me, that a big change is coming.

 

Chinese versus American Math Education

Seth Roberts28 Comments

When she was in eighth grade, a Chinese friend of mine moved from Shanghai to upstate New York. (Her dad worked for General Electric.) In New York, she discovered she’d already learned eighth-grade math — in fourth grade. Her new school moved her to tenth grade math. It was still material she’d already had, but less absurdly easy.

If 80% of American parents knew this, would they abide it? Or would they decide that something is terribly wrong? Now, of course, almost no American parent knows this.

Does Intermittent Fasting Improve Repair Processes?

Seth Roberts8 Comments

After I blogged about benefits of alternate-day fasting, a software engineer named Brandon Berg commented:

I had had plantar warts for a couple of years prior to starting IF (eating in a four-hour window each night). They cleared up almost immediately.

I had never heard about this effect of fasting. And the Wikipedia entry on plantar warts said nothing about this. I asked Brandon for details.

When and where did this happen?

I was working full time while also attending college with a 12-hour schedule or so. That may or may not be relevant; I was under a lot of stress, both in terms of the pressure to serve both masters, and the sleep I sacrificed to make it happen. So that may have contributed to my development of the warts. I actually don’t remember whether I developed them before or after I went back to school, but I was definitely in school when they went away. I was 23 when they disappeared, and I lived in Seattle at the time. This was back in 2004, so I’m a bit fuzzy on the details.

Did you have any idea what had caused the warts?

Presumably a viral infection, since that’s what causes warts, isn’t it? I did a lot of walking around barefoot when I lived with my parents before going off to college in 1998; maybe I was infected then, and carried the virus asymptomatically until the stress triggered the development of the warts? But again, I don’t remember whether they were there when I went back to school.
Had you tried other ways of getting rid of the plantar warts?
I might have tried apple cider vinegar on a select few. I distinctly remember that working for a wart on my thumb, but the ones on my feet were too numerous to treat them all that way. I never saw a doctor about them, since I always figured they’d just go away sooner or later, and they didn’t bother me that much.
Why did you do the intermittent fasting?
This was back when the studies about IF extending lifespan in mice first started hitting the media. Or the first time I was aware of them, anyway. Living longer sounded good to me.
Did you expect it to affect your plantar warts?
I had no particular expectation that it would affect the warts.
How did others react to the fact that the IF got rid of the plantar warts?
I lived alone, so I never really told anyone else about them. I’ve mentioned this to a couple of people in passing, but don’t recall any notable reaction, other than “Oh, that’s interesting,” or something similar.
How fast did they clear up? (= what does “almost immediately” mean?)
I don’t remember, exactly. It was definitely within a month. I checked my email archives and see that in 2008 I said that it took less than a week. I remember mentioning this to a friend on ICQ back when it happened, and I *may* still have the logs from that on a hard drive in my closet, but I currently have no way to access it since I just moved to Tokyo and only have a notebook with no eSATA port, and I’m not planning on getting a desktop until I find a permanent apartment. Sorry I can’t be more precise here. Obviously the probability that it was a coincidence is much lower if they cleared up in a week than if they cleared up in a month.
How do you explain their disappearance?
I’m not sure. It’s entirely possible that they’d run their course and it was just their time to go. My pet theory is autophagy: Starved for protein, my body started scavenging for expendable tissue and resorbed the warts. There were two small wart-like growths–one on my thumbprint and one on my nose–that persisted for years afterwards, so it’s definitely not a surefire cure.
On a related note–and this also may be purely coincidental–the last two times I’ve felt a cold coming on, I tried to combat it with a full-day fast, on the theory that this would ramp up my cellular resistance to oxidative stress and reduce the severity of my symptoms. In both cases, I did have a much less severe cold than I usually do, with symptoms reduced to a more or less negligible level by the next day, where I usually get 3-5 days of moderately severe symptoms.

 

 

Assorted Links

Seth Roberts8 Comments

Thanks to Jeff Winkler and Tom George.

“Sitting is the New Smoking”

Seth Roberts8 Comments

I learned this phrase (“sitting is the new smoking”) from Galen Cranz, with whom I taught a class called Office of the Future in 2001. We agreed that sitting was bad. I believed that sitting was bad because I discovered that if I stood a great deal, I slept better. A recent review:

A study published in the journal Diabetologia in November 2012 analyzed the results of 18 studies with a total of nearly 800,000 participants. When comparing people who spent the most time sitting with those who spent the least time, researchers found increases in the risks of diabetes (112%), cardiovascular events (147%), death from cardiovascular causes (90%) and death from all causes (49%).

I wonder whether any effect of sitting would remain after adjustment for quality of sleep. Maybe those who sat less slept better, as I did. Epidemiologists haven’t yet grasped the importance of sleep — part of an overall failure to realize that the immune system matters. Whether or not you sleep well is surely as important as whether or not you smoke. Here is a study that connects poor sleep and heart disease.

At a recent conference, I foolishly sat a lot more than usual. Maybe I sat for 7 hours two days in a row. After the first day I woke up with a minor muscle spasm in my lower back that went away. After the second day, I woke up with a really bad muscle spasm in my lower back and could barely move most of the day. Maybe my sitting muscles are weaker than other people’s. Maybe eating more sugar than usual (sugar is inflammatory) and less flaxseed than usual (flaxseed is anti-inflammatory) also contributed to the problem.

 

Teeth Clenching Can Release Too Much Mercury

Seth Roberts13 Comments

Recently the Berkeley City Council heard testimony about a proposed ban on mercury amalgam dental fillings. A young man named D— M—, shown in the video, told the Council that he had grown up in Berkeley and had gotten mercury amalgam fillings from local dentists. They did not tell him the fillings were dangerous. He attended Berkeley High, Harvard, and finally the clinical psychology program at UC Berkeley — which I know is extremely hard to get into, as he says. They accept about 1 in 500 applicants.

In 2007, three years into the program, he started clenching his teeth. He began to have problems resembling mercury poisoning, such as fatigue and poor concentration. He had to leave the psychology program. Hair tests showed large amounts of mercury. He did not eat unusual amounts of fish, so it’s likely that his fillings were the source of the mercury. By 2012, he could no longer work and pay rent.

I had no idea that teeth clenching and mercury fillings were so dangerous together. A few years ago, I found, to my surprise, that removal of mercury fillings improved my score on the reaction time test I use to measure brain function. At first, I had thought the improvement had other causes. Only when I tested these causes and found no supporting evidence did I look further and discover the improvement had started exactly when I got my fillings removed. After I discovered this, I looked around for other evidence that mercury fillings were dangerous. To my surprise (again), my evidence seemed more persuasive than anything I found. M—’s story is much scarier than mine and supports my conclusion that mercury fillings are dangerous.

Had M— been using my reaction-time test day after day, he might have discovered deterioration on that test before he noticed other problems. The test might have provided early warning. I hadn’t noticed problems with concentration or fatigue, yet when my fillings were removed I got better on my test. Had M— noticed the problem earlier, he might have figured out the cause earlier.

If you don’t monitor yourself as I do — and almost no one does — you are trusting your dentist, your doctor, your food providers, and so on, to be well-informed and truthful about the safety of their products. If the problems aren’t obvious, there is plenty of reason for them to put their hands over their eyes and say “I don’t want to know” about problems with their products. Drug companies have often hidden the dangers of their products and surgeons have hidden the dangers of their procedures. Few people grasp that “evidence-based medicine”, with its disregard of bad side effects, is biased in favor of doctors. (Ben “Bad Science” Goldacre is a prominent example of someone who fails to understand this.) If you monitor yourself you are less at the mercy of other people’s poor science, lies, and motivations that conflict with finding and telling the truth.

What Goes Unsaid: Self-Serving Health Research

Seth Roberts13 Comments

“The realization that the world is often quite different from what is presented in our leading newspapers and magazines is not an easy conclusion for most educated Americans to accept,” writes Ron Unz. He’s right. He provides several examples of the difference between reality and what we are told. In finance, there are Bernie Madoff and Enron. Huge frauds are supposed to be detected. In geopolitics, there is the Iraq War. Saddam Hussein’s Baathists and al-Quada were enemies. Invading Iraq because of 9/11 made as much sense as attacking “China in retaliation for Pearl Harbor” — a point rarely made before the war. In these cases, the national media wasn’t factually wrong. No one said Madoff wasn’t running a Ponzi scheme. The problem is that something important wasn’t said. No one said Madoff was running a Ponzi scheme.

This is how the best journalists (e.g., at The New Yorker and the New York Times) get it wrong — so wrong that “best” may be the wrong word. In the case of health, what is omitted from the usual coverage has great consequences. Health journalists fail to point out the self-serving nature of health research, the way it helps researchers at the expense of the rest of us.

The recent Health issue of the New York Times Magazine has an example. An article by Peggy Orenstein about breast cancer, meant to be critical of current practice, goes on and on about how screening has not had the promised payoff. As has been widely noted. What Orenstein fails to understand is that the total emphasis on screening was a terrible mistake to begin with. Before screening was tried, it was hard to know whether it would fail or succeed; it was worth trying, absolutely. But it was always entirely possible that it would fail — as it has. A better research program would have split the funds 50/50 between screening and lifestyle-focused prevention research.

The United States has the highest breast cancer incidence (age-adjusted) rates in the world — about 120 per 100,000 women, in contrast to 20-30 per 100,000 women in poor countries. This implies that lifestyle changes can produce big improvements. Orenstein doesn’t say this. She fails to ask why the Komen Foundation has totally emphasized cure (“race for the cure”) over prevention due to lifestyle change. In a long piece, here is all she says about lifestyle-focused prevention:

Many [scientists and advocates] brought up the meager funding for work on prevention. In February, for instance, a Congressional panel made up of advocates, scientists and government officials called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities.

Nothing about how the “meager funding” was and is a huge mistake. Xeni Jardin of Boing Boing called Orenstein’s article “ a hell of a piece“. Fran Visco, the president of the National Breast Cancer Coalition, praised Orenstein’s piece and wrote about preventing breast research via a vaccine. Jardin and Visco, like Orenstein, failed to see the elephant in the room.

Almost all breast-cancer research money has gone to medical school professors (most of whom are men). They don’t do lifestyle research, which is low-tech. They do high-tech cure research. Breast cancer screening, which is high-tech, agrees with their overall focus. High-tech research wins Nobel Prizes, low-tech research does not. For example, those who discovered that smoking causes lung cancer never got a Nobel Prize. Health journalists, most of whom are women, apparently fail to see and definitely fail to write how they (and all women) are harmed by this allocation of research effort. The allocation helps the careers of the researchers (medical school professors); it hurts anyone who might get breast cancer.