what health care + unlimited profit cannot help but create

There has been a flurry of good books recently on the state of psychiatry, more specifically on the proliferation of “syndromes” over the past several decades, and the vast increases in people being prescribed drugs for these – including ever larger numbers of children. Marcia Angell had two excellent pieces in The New York Review of Books a year or so ago: “The Epidemic of Mental Illness: Why?” and “The Illusions of Psychiatry”. These reviewed the following: Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, by Daniel Carlat; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker; and The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch.

Now comes one of the single best summations of what is terribly wrong with our current system of health: an article in The Guardian by psychiatrist Ben Goldacre called “The Drugs Don’t Work: A Modern Medical Scandal.” It’s long but very worth reading in full.

What Goldacre’s piece is so good at is making clear just how corrupt the process is by which new drugs become approved for sale. For example, most people are not aware that negative test results simply don’t need to be published, and rarely are. Goldacre begins with an experience he’d had prescribing the antidepressant Reboxetine. He’d read the published studies (the results of the trials were “overwhelmingly positive”), talked it over with his patient, and they went ahead. However, two years ago a much bigger picture emerged when researchers were able to locate and collect all the data on this particular drug. It turns out that out of seven trials comparing it to a placebo, only one of these showed a positive result. And this, of course, was published. The other six trials, making use of nearly 10 times the number of patients, showed the drug worked no better than a sugar pill.

These were never published.

The story is the same with studies comparing Reboxetine to other antidepressants. And it’s the same with studies on side effects.

Here is Goldacre’s summary of the current state of affairs:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.

In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.

Goldacre includes a disturbing example of a dangerous drug (Rosiglitazone) remaining on the market for years because the system is so flawed. The trouble is: nothing changes in this regard. There has been a record number of fines imposed upon the pharmaceuticals in recent years but even though the amounts seem high to us, they represent a non-constraining fraction of annual profits. So there is simply no incentive to be safer; every incentive to cut corners, spin results, and find new “markets”…

are the Japanese really forgetting how to write kanji correctly?

I found this post on Language Log yesterday rather sad:

According to a recent survey of more than 2,000 people, 66.5 percent of Japanese think they are losing the ability to correctly handwrite kanji. Moreover, the level is above 50% for every age group except for the youngest (16-19), who are of course still actively studying characters and thus must be prepared for tests; and even there the figure is still very close to the 50% mark.

And these figures are much higher than 10 years ago.

The significance of this isn’t completely clear to me as the article (and perhaps the recent survey as well) doesn’t specify the relative number of kanji which are becoming difficult for those that replied in the affirmative. I’d guess all the more frequent characters remain easily writeable. But the long-term trend of writing less and less by hand seems assured, so… I assume there is an increased use of hiragana for less frequent characters. Which, on top of the ever more frequent non-native borrowings into katakana, will make the writing system a stranger hybrid over time.

There’s an interesting post near the bottom of the comments section about the history of Chinese character use within Korean, and the stages by which, over the course of the past century or so, the former has ceded most of its ground to the Hanguel (the native Korean syllabary). Still very hard for me to imagine the same thing happening within Japanese, for several different reasons, but it’s an unusual situation.

hops and grapefruit

At The Farmhouse just now, sampled an especially nice double IPA called Hill Farmstead Society and Solitude #5 (for the name alone…) The first linked review there does it justice I think. There’s no actual grapefruit in it, but it does smell remarkably like. The hops are from New Zealand.

And brewed in Greensboro, home of Caspian Lake, Willey’s Store, and the very special Greensboro Garage. (Strange to contemplate, but the late Chief Justice Rehnquist owned a summer home in the town also.)

It’s only been recently that I started drinking beer again. One of the treats of travel in England when I lived there was sampling the local bitter, and I got into continental beers there also–Belgian Trappist Ales, Pilsner etc. But on returning to the States, for some reason it took awhile to realize just how good and extensive the local beer scene has become in Vermont.

The Farmhouse carries around 20 rotating draught beers, many of them local, and then quite a few dozen more in bottles. It’s an amazingly successful place, always packed, as is the other new(ish) restaurant opened by the same owners, El Cortijo (“The Farmhouse” en español). The latter I’ve come to appreciate since a) it serves genuinely out-of-the-ordinary Mexican-inspired food, with mostly locally sourced ingredients, and four different vegetarian options, all nice and creatively thought-out; b) the menu is flexible, with individual tacos about $4, so you can have as many or as few as you like; and c) it’s open late–till 12 or 1–which is welcome in a town that largely goes to sleep mid-evening.

Sartre on anti-Semitism

Have been reading Sartre’s Anti-Semite and Jew: An Exploration of the Etiology of Hate. Quite brilliant, with a number of very insightful passages. Still digesting it, but appreciating having to think through the dimension of class that he brings in.

Another interesting contribution is the film The Believer, which really … packs a punch. The (Jewish) filmmakers held nothing back in trying to reach the deepest level of pathology that is going on, and a lot of viewers were offended by this. But I think it’s a necessary thing to try and do. One scene stands out for me in this regard: Ryan Gosling (who is amazing in this) in a café with the New York Times reporter, laying out his philosophy. (His character is based upon a real person, a Jewish anti-Semite who became something of a terrorist.) Where Sartre focuses (at least so far, I’m only halfway through) on psychological processes of resentment and scapegoating, that scene takes the film perhaps even deeper, into “blood” and the body and sexuality–the Jew as culturally “effeminizing” force par excellence.

I find contemporary anti-Semitism quite terrifying in its paranoia and hysteria. “Anti-Semitism” isn’t actually a good word for it both because, of course, the Arab people are also Semitic, and because “anti” is far too mild a term to describe the literally deranged rantings one comes across online too often. I don’t know of any phenomenon quite like it. All the more reason that we descend as far as we can, and dare, to try and understand the swamps of confusion and fear out of which it arises.

Seth Mnookin on the current troubling state of science reporting

Seth Mnookin over at PLOS has an excellent piece on the present state of science writing, worth reading in full. Here are some highlights:

Lest anyone think that the ENCODE case was sui generis, just this past Wednesday, a team of researchers based in France published a paper in PLOS ONE titled “Why Most Biomedical Findings Echoed by Newspapers Turn Out to be False: The Case of Attention Deficit Hyperactivity Disorder.” (The paper’s authors were intentionally evoking the title of John P. A. Ioannidis’s groundbreaking 2005 piece, “Why most published research findings are false,” which built off of his earlier JAMA paper, “Contradicted and Initially Stronger Effects in Highly Cited Clinical Research.”) After examining every newspaper report about the ten most covered research papers on ADHD from the 1990s, the authors were able to provide empirical evidence for a troubling phenomenon that seems to be all but baked in to the way our scientific culture operates: We pay lots of attention to things that are almost assuredly not true.

The first cited article above (by Gonon, Konsman, Cohen, and Boraud) examined 47 scientific publications on ADHD from the 1990s, “echoed by 347 newspaper articles.” The authors selected the 10 most echoed publications, tracked all subsequent research relating to them up to 2011, and also followed newspaper coverage of this research. Here were their results:

Seven of these ten publications were initial studies; three were not. Of the seven, “the conclusions in six of them were either refuted or strongly attenuated subsequently. The seventh was not confirmed or refuted, but its main conclusion appears unlikely.” Of the three, one of the findings has been attenuated. (In other words, eight out of ten of these studies, 80%, cannot be confirmed as originally stated, and 60% have already been either refuted or “strongly attenuated.”)

Now, how did newspapers report on all this? “The newspaper coverage of the “top 10” publications (223 articles) was much larger than that of the 67 related studies (57 articles). Moreover, only one of the latter newspaper articles reported that the corresponding “top 10” finding had been attenuated.”

Put another way, newspapers paid pretty much exactly FOUR times as much attention to the original studies–80% of which have either been subsequently refuted or unconfirmable as stated–than to the related studies. And a grand total of one out of 57 articles on the related studies even bothers to mention that the original finding cannot be confirmed as stated!

Why is this the case? Mnookin suggests:

Because it’s sexier to discover something than to show there’s nothing to be discovered, high-impact journals show a marked preference for “initial studies” as opposed to disconfirmations. Unfortunately, as anyone who has ever worked in a research lab knows, initial observations are almost inevitably refuted or heavily attenuated by future studies–and that data tends to get printed in less prestigious journals. Newspapers, meanwhile, give lots of attention to those first, eye-catching results while spilling very little (if any) ink on the ongoing research that shows why people shouldn’t have gotten all hot and bothered in the first place… The result? “[A]n almost complete amnesia in the newspaper coverage of biomedical findings.”

He goes on to summarize: “…publications that should be exemplars of nuanced, high-quality reporting are allowing confused speculation to clutter their pages; researchers and PIOs are nudging reporters towards overblown interpretations; and everything we write about will probably end up being wrong anyway — not that we’ll bother to let you know when the time comes.”