Look, part of the whole problem with the deinstitutionalisation of the mentally ill, which goes all the way back to the early seventies at least, and as far as theory is concerned probably a lot further, is that health professionals started, DELIBERATELY blurring the lines between mental illness and mental health.
Part of this was – I think – a genuine effort to make it possible for some people classified as “mentally ill” to be able to make a go of it in the community. A lot of new psychiatric drugs had been discovered which, while they didn’t heal, masked the symptoms of mental illness and therefore made it possible for these people to integrate in normal society – provided they would take their meds (more on that later.)
The other part – I know, my SIL took the mental-health portion of her MD in the late seventies – was the insane “equivalence brigade” which tried very hard to convince themselves that the US too did EXACTLY the same things the USSR did. Since the USSR put political dissenters in mental hospitals, then the people in US hospitals MUST be also political dissenters. This was hard to prove, since the Soviet system provided ideological support for mental treatment of dissenters: i.e. the Marxist system was perfect, so anyone disagreeing must be mad, while the American system mostly tried to get people off the streets who would do harm to themselves and/or others. However the medical profession found their justification in an upside-down of the Marxist system. Since Capitalism was bad for humans and other living things, then everyone who went mad under capitalism were, ipso facto, political dissenters. So, if you happened to be a woman who liked to throw rocks at strangers and go into bizarre monologues on the subject of cabbage, you weren’t mad, you were a feminist protesting male aggression.
Now I have no proof this was intentional or a coordinated AGITPROP operation. It’s entirely possible it was (merely) the predictable mix of ill-intentioned agents and well-intentioned idiot fellow travelers.
However the end result was making people too crazy to live alone into political victims and incidentally to give the USSR room to claim the capitalist system created homelessness.
Sarah A. Hoyt, “I’m Not Crazy, I’m Just A Little Unwell – A blast from the past post 10/12”, According to Hoyt, 2015-10-12.
January 6, 2016
QotD: De-institutionalization and mental health
January 4, 2016
QotD: The Science Czar
I have noticed a tendency of mine to reply to arguments with “Well yeah, that would work for the X Czar, but there’s no such thing.”
For example, take the problems with the scientific community, which my friends in Berkeley often discuss. There’s lots of publication bias, statistics are done in a confusing and misleading way out of sheer inertia, and replications often happen very late or not at all. And sometimes someone will say something like “I can’t believe people are too dumb to fix Science. All we would have to do is require early registration of studies to avoid publication bias, turn this new and powerful statistical technique into the new standard, and accord higher status to scientists who do replication experiments. It would be really simple and it would vastly increase scientific progress. I must just be smarter than all existing scientists, since I’m able to think of this and they aren’t.”
And I answer “Well, yeah, that would work for the Science Czar. He could just make a Science Decree that everyone has to use the right statistics, and make another Science Decree that everyone must accord replications higher status. And since we all follow the Science Czar’s Science Decrees, it would all work perfectly!”
Why exactly am I being so sarcastic? Because things that work from a czar’s-eye view don’t work from within the system. No individual scientist has an incentive to unilaterally switch to the new statistical technique for her own research, since it would make her research less likely to produce earth-shattering results and since it would just confuse all the other scientists. They just have an incentive to want everybody else to do it, at which point they would follow along.
Likewise, no journal has the incentive to unilaterally demand early registration, since that just means everyone who forgot to early register their studies would switch to their competitors’ journals.
And since the system is only made of individual scientists and individual journals, no one is ever going to switch and science will stay exactly as it is.
Scott Alexander, “Reactionary Philosophy In An Enormous, Planet-Sized Nutshell”, Slate Star Codex, 2013-03-03.
December 31, 2015
Blogging will continue to be light
I’m sharing this post from my iPhone while reclining in my bed in the Intensive Care Unit at Lakeridge Health in Oshawa. I’ve suffered a totally unexpected health setback on Tuesday evening and I don’t know when I’ll be able to resume blogging. There are still several postings in the queue, but once they’re posted, the blog may go quiet for some time.
My best wishes to all of you in 2016. I hope to be back to a relatively normal life as soon as medicine and rest will allow.
QotD: Some women really do dig jerks
Many of the “battered women” we are encouraged to sympathize with have a remarkable tendency to suffer from abuse at the hands of every man with whom they become involved. Tammy Wynette, the Country singer who gained fame with the song “Stand By Your Man,” was married to five men and left four of them (managing to die with her fifth marriage still intact). Most of her husbands are said to have abused her in some way, and teary-eyed retellings of her “tragic” life have been offered to the public.
I remind the reader of the central principle of male-female relations: women choose. They represent the supply; men represent the demand. If Tammy Wynette never took up with a man who failed to abuse her, there can be only one explanation: Tammy had a thing for nasty boys.
If you put a woman like this in a room with a dozen men, within five minutes she would be exclusively focused on the meanest, most domineering and brutal fellow in the room. Some women who had alcoholic fathers have a similar uncanny ability to detect the alcoholic in a room full of men, even if he is sober at the moment. “Women’s intuition” is a reality: it is an ability to pick up on tiny signals, slight nuances of facial expression that would go unnoticed by a man.
We are attracted to qualities in the opposite sex which our own sex lacks. For many women, this means an attraction to male brutality. Such women may claim to want a sensitive fellow who is in touch with his feelings, but this bears no relation to their behavior. What women say about men comes from their cerebral cortex; how they choose men depends upon their evolutionary more primitive limbic system. Even campus feminists choose arrogant jocks to “hook up” with, not male feminists in touch with their emotions. I have heard it suggested that the best reason not to strike a woman today is that you will never be able to get rid of her afterwards.
F. Roger Devlin, “The Question of Female Masochism”, Counter-Currents Publishing, 2014-09-17.
December 30, 2015
Elon Musk, Jeff Bezos and the future of spaceflight
Colby Cosh on the real significance of the private space companies’ successes:
The science fiction authors who originally imagined spaceflight thought it would be classically capitalistic in nature — a Wild West of chancers, gold-diggers, outlaws, and even slave-traders transposed to the skies. It ended up, in its first incarnation, being a government program. This had the merit of showing that some impossible technical problems could be solved if you threw near-infinite resources and human lives at them. But the money and will ran out before NASA got around to figuring out how to make orbital spaceflight truly routine. Reusable rockets are the important first step that NASA didn’t have time to try in the Golden Age, under the pressure of a “space race” between governments.
Musk and Bezos are trying, I think very consciously, to revive the public interest and inspiration that this race narrative once brought. When SpaceX stuck its landing this week, having previously had a couple of flops, Bezos tweeted “Welcome to the club!” Musk will not mind the cheap shot too much. Bezos is doing him a favour by making a game of it.
It is hard for us to feel passion about accounting, even when “accounting” translates to cheaper satellite technology that means subtle advances in science and cost cuts in earthbound communications tech. Anything you can turn into a mere clash of personalities will get the attention of journalists and readers more readily. Musk and Bezos are exploiting their position as two of the great stage characters of our day.
The benefit they’re really going for is to bring a slightly larger margin of the human neighbourhood within reach for spaceships assembled on orbital platforms — the only practical kind of spaceship, as it seems to have turned out. Routine orbital access means affordable space tourism; it means possible Mars missions predicated on traditional exploration/adventure motives; it means deeper scientific scrutiny and even commercial study of the Moon, the asteroids, perhaps the inner planets. It means space stations that aren’t just for handpicked careerist supermen.
It means — well, we don’t know, from this side of the future, what it means. Some grade-three kid out there may already have a “killer app” for reusable rockets that nobody has considered yet. (If the cost comes down far enough, are we certain rockets won’t re-emerge as a possibility for long-haul terrestrial travel? That’s another assumption of early SF we have discarded, perhaps carelessly!) But it is probably a good guess that the balletic SpaceX triumph will turn out, after the fact, to have been one of the biggest stories of 2015.
QotD: Medicine before antibiotics
Explanation was the real business of medicine. What the ill patient and his family wanted most was to know the name of the illness, and then, if possible, what had caused it, and finally, most important of all, how it was likely to turn out
[…]
During the third and fourth years of [medical] school it gradually dawned on us that we didn’t know much that was really useful, that we could do nothing to change the course of the great majority of the diseases we were so busy analyzing, that medicine, for all its façade as a learned profession, was in real life a profoundly ignorant occupation
[…]
Once you were admitted [to hospital] … it became a matter of waiting for the illness to finish itself one way or the other … Medicine made little or no difference.
Lewis Thomas, The Youngest Science, 1983, quoted by John Derbyshire in “The Scariest Science”, Taki’s Magazine, 2014-11-13.
December 29, 2015
QotD: The health benefits of moderate drinking
Should we consider mandatory graphic warning labels on bottles of booze? Our science reporter Tom Blackwell reviewed various Canadian discussions of the idea in these pages yesterday, suggesting that it is being looked at behind the scenes by addiction researchers. Labels with colour images of diseased esophagi on liquor labels would, of course, mimic the approach Canada has already taken toward cigarettes. So, well, why not? They say if you have a hammer, everything looks like a nail: by a similar token, if your field is addiction, no doubt everything that has addictive qualities looks like an unsolved problem.
But there is one very obvious way in which liquor is not like cigarettes: scientists are reasonably sure that light drinking has positive public-health consequences. If you don’t believe me, you can look up articles like the one I have in front of me here from a 2013 issue of Annals of Oncology: its title is “Light Drinking Has Positive Public Health Consequences.” As a layman I obviously can’t be certain I have summarized this editorial correctly, but you’ll have to trust me.
Colby Cosh, “The real problem with liquor warning labels — there’s such a thing as good drinking”, National Post, 2015-12-17.
December 26, 2015
Moderate drinking and statistical health outcomes
Aaron Carroll debunks some myths about booze and health:
Over the past year, I’ve tried to clear up a lot of the misconceptions on food and drink: about salt, artificial sweeteners, among others, even water.
Now let me take on alcohol: wine, beer and cocktails. Although I have written about the dangerous effects of alcohol abuse and misuse, that doesn’t mean it’s always bad. A part of many complex and delicious adult beverages, alcohol is linked to a number of health benefits in medical studies.
That doesn’t mean the studies provide only good news, either, or that the evidence in its favor is a slam dunk. You won’t be surprised to hear that, once again, my watchword — moderation — applies.
Research into how alcohol consumption affects health has been going on for a long time. A 1990 prospective cohort study included results of more than 275,000 men followed since 1959. Compared with those who never drank alcohol, those who consumed one to two drinks a day had a significantly reduced mortality rate from both coronary heart disease and “all causes.” Those who consumed three or more drinks a day still had a lower risk of death from coronary heart disease, but had a higher mortality rate over all.
A 2004 study came to similar conclusions. It followed about 6,600 men and 8,000 women for five years and found that compared with those who drank about one drink a day on average, those who didn’t drink at all and those who drank more than two drinks a day had higher rates of death. Results like these have been consistent across a number of studies in different populations. Even studies published in the journal Alcoholism: Clinical and Experimental Research agree that moderate drinking seems to be associated with a decreased risk of death over all.
However, alcohol seems to have different effects on different diseases. Almost all of the major benefits of drinking are seen in cardiovascular illnesses. In fact, with men, even consumption of a surprisingly large amount can seem protective.
December 23, 2015
SpaceX Falcon 9 performs successful launch and controlled landing
William Harwood reports for CBS News:
Making its first flight since a catastrophic launch failure last June, an upgraded, more powerful SpaceX Falcon 9 rocket roared to life and shot into space Monday, boosting 11 small Orbcomm data relay satellites into orbit in a major milestone for the California rocket builder.
In a significant space “first,” the Falcon 9’s first stage fell back into the atmosphere and pulled off a powered landing at the Cape Canaveral Air Force Station, settling to a smooth tail-first touchdown in a convincing demonstration of reusability, a key requirement for lowering commercial launch costs.
In a scene resembling a launch video running in reverse, the booster quickly dropped out of a cloudy sky atop a jet of flame from one of its Merlin 1D engines, heralded by twin sonic booms that rumbled across Florida’s Space Coast. Cheers erupted in company headquarters in Hawthorne, California, as the stage settled to a smooth touchdown.
In another first, the Falcon 9 used colder, denser-than-usual liquid oxygen and kerosene propellants, a significant upgrade allowing the booster’s nine first-stage engines to generate more power, increasing their combined liftoff thrust from 1.3 million pounds to 1.5 million, or 170,000 pounds of thrust per engine.
The launch, first-stage landing and satellite deployments all appeared to proceed without a hitch, a welcome success for a company returning to flight after a disheartening failure.
“Everything we’ve seen thus far in the mission appears to be perfect,” SpaceX founder Elon Musk said in a conference call with journalists. “The satellites were deployed right on target and the Falcon 9 booster came back and landed. Looks like almost dead center on the landing pad. … As far as we can see right now, it was absolutely perfect. We could not have asked for a better mission.”
There and back again pic.twitter.com/Ll7wg2hL1G
— Elon Musk (@elonmusk) December 22, 2015
December 21, 2015
QotD: Witches
It turns out that witchcraft beliefs arise in surprisingly similar forms in many parts of the world, which suggests either that there really are witches or (more likely) that there’s something about human minds that often generates this cultural institution. The Azande believed that witches were just as likely to be men as women, and the fear of being called a witch made the Azande careful not to make their neighbors angry or envious. That was my first hint that groups create supernatural beings not to explain the universe but to order their societies.
Jonathan Haidt, quoted by Scott Alexander in “List Of The Passages I Highlighted In My Copy Of Jonathan Haidt’s The Righteous Mind“, Slate Star Codex, 2014-06-12.
December 16, 2015
To lower healthcare costs, increase the competition
At Mother Jones, Kevin Drum links to an article that explicitly shows the cost of having monopoly providers in healthcare:
Regular readers of this blog should know that when it comes to the price of hospital care, it’s competition that matters, not insurance companies. In areas with only a single hospital, insurance companies have no leverage and have to accept whatever price the hospital charges. If there are lots of hospitals, they have to compete with each other to earn the insurance company’s business.
But in case you’re still skeptical, a team of researchers has analyzed a huge database of health care claims in the US to check this out. They found enormous regional variation in hospital costs for the same procedure, and one of the biggest drivers of this variation was competition:
Hospital market structure stands out as one of the most important factors associated with higher prices, even after controlling for costs and clinical quality. We find that hospitals located in monopoly markets have prices that are about 15.3 percent higher than hospitals located in markets with four or more providers. This result is robust across multiple measures of market structure and is consistent in states where the HCCI data contributors (and/or Blue Cross Blue Shield insurers) have high and low coverage rates.
Chipotle gains “green cred PR opportunities” and worse health outcomes for customers
Henry Miller on the Faustian bargain Chipotle willingly made and is now paying for:
Chipotle, the once-popular Mexican restaurant chain, is experiencing a well-deserved downward spiral.
The company found it could pass off a fast-food menu stacked with high-calorie, sodium-rich options as higher quality and more nutritious because the meals were made with locally grown, genetic engineering-free ingredients. And to set the tone for the kind of New Age-y image the company wanted, Chipotle adopted slogans like, “We source from farms rather than factories” and, “With every burrito we roll or bowl we fill, we’re working to cultivate a better world.”
The rest of the company wasn’t as swift as the marketing department, however. Last week, about 140 people, all but a handful Boston College students, were recovering from a nasty bout of norovirus-caused gastroenteritis, a foodborne illness apparently contracted while eating Chipotle’s “responsibly raised” meats and largely organic produce.
And they’re not alone. The Centers for Disease Control and Prevention has been tracking another, unrelated Chipotle food poisoning outbreak in California, Illinois, Maryland, Minnesota, New York, Ohio, Oregon, Pennsylvania and Washington, in which victims have been as young as one year and as old as 94. Using whole genome sequencing, CDC investigators identified the DNA fingerprint of the bacterial culprit in that outbreak as E. coli strain STEC O26, which was found in all of the sickened customers tested.
Outbreaks of food poisoning have become something of a Chipotle trademark; the recent ones are the fourth and fifth this year, one of which was not disclosed to the public. A particularly worrisome aspect of the company’s serial deficiencies is that there have been at least three unrelated pathogens in the outbreaks – Salmonella and E. coli bacteria and norovirus. In other words, there has been more than a single glitch; suppliers and employees have found a variety of ways to contaminate what Chipotle cavalierly sells (at premium prices) to its customers.
QotD: The truth about beauty
There are certain practical realities of existence that most of us accept. If you want to catch a bear, you don’t load the trap with a copy of Catch-22 — not unless you rub it with a considerable quantity of raw hamburger. If you want to snag a fish, you can’t just slap the water with your hand and yell, “Jump on my hook, already!” Yet, if you’re a woman who wants to land a man, there’s this notion that you should be able to go around looking like Ernest Borgnine: If you’re “beautiful on the inside,” that’s all that should count. Right. And I should have a flying car and a mansion in Bel Air with servants and a moat.
Welcome to Uglytopia — the world reimagined as a place where it’s the content of a woman’s character, not her pushup bra, that puts her on the cover of Maxim. It just doesn’t seem fair to us that some people come into life with certain advantages — whether it’s a movie star chin or a multimillion-dollar shipbuilding inheritance. Maybe we need affirmative action for ugly people; make George Clooney rotate in some homely women between all his gorgeous girlfriends. While we wish things were different, we’d best accept the ugly reality: No man will turn his head to ogle a woman because she looks like the type to buy a turkey sandwich for a homeless man or read to the blind.
There is a vast body of evidence indicating that men and women are biologically and psychologically different, and that what heterosexual men and women want in partners directly corresponds to these differences. The features men evolved to go for in women — youth, clear skin, a symmetrical face and body, feminine facial features, an hourglass figure — are those indicating that a woman would be a healthy, fertile candidate to pass on a man’s genes.
These preferences span borders, cultures, and generations, meaning yes, there really are universal standards of beauty. And while Western women do struggle to be slim, the truth is, women in all cultures eat (or don’t) to appeal to “the male gaze.” The body size that’s idealized in a particular culture appears to correspond to the availability of food. In cultures like ours, where you can’t go five miles without passing a 7-Eleven and food is sold by the pallet-load at warehouse grocery stores, thin women are in. In cultures where food is scarce (like in Sahara-adjacent hoods), blubber is beautiful, and women appeal to men by stuffing themselves until they’re slim like Jabba the Hut.
Amy Alkon, “The Truth About Beauty”, Psychology Today, 2010-11-01.
December 15, 2015
Hillary Clinton’s well-intentioned plans will make the prescription medicine market even worse
Another older post from Megan McArdle on the nice-soundbites-but-terrible-economic-notions from the Hillary Clinton campaign to fix the prescription medicine marketplace:
Hillary Clinton thinks drug development should be riskier, and less profitable. Also, your health insurance premiums should be higher. And there should be fewer drugs available.
This is not, of course, how the Clinton campaign would put it. The official line is that Americans are just paying too darn much for drugs, and she has a plan to stop that:
- Regulate direct-to-consumer advertising more heavily, and strip its tax deductibility
- Require drug companies to spend a certain percentage of revenue on research and development, or face penalty payments and the loss of their R&D tax credit (I am inferring that this is what she is talking about, since the actual language of the proposal is long on paeans to the importance of federal research funding and short on details)
- Cap out-of-pocket costs for drugs
- Reduce the exclusivity period for biologic drugs
- Prohibit companies from making side payments to generic manufacturers to keep generic competition off the market
- Allow drug reimportation
- Require that new treatments be proved to be a substantial improvement over existing treatments — i.e., eliminate the dreaded “me too” drugs
- Allow Medicare to “negotiate” drug prices
Eliminating the side payments seems eminently sensible. (Yes, yes, you can strip my libertarian card, but market-rigging contracts shouldn’t be enforced.) It also seems reasonable to require some sort of comparative effectiveness research. Other provisions will certainly drive down drug prices, at the risk of also driving down innovation.
Still other provisions, however, are simply bad economics. In what other market do we worry about having a second product available that’s merely just as good as the first? Should we really only have one antidepressant, one statin, one blood pressure medication, and so forth? Might there be variation among patients so that drugs that are statistically about equally effective in large groups are nonetheless individually more or less effective for different people? Might one drug’s side effects be better tolerated by some patients than another’s? Might having two drugs in the category help keep prices down?
Then there is notion that we should force pharmaceutical companies to spend a set percentage of their revenues on R&D. This seems to me to be … what’s the word I am looking for? Ah, I’ve got it: “insane.”
[…]
Economically, large parts of this plan make little sense. Politically, many of these items would be very difficult to pass, not least because the Congressional Budget Office would assess the likely effects and would make it sound much less appealing than it does in a gauzy stump speech. But away from those harsh realities, purely as campaign rhetoric, it probably works very well.
Asthma and the “Hygiene Hypothesis”
An older report at the BBC News website discusses recent research into childhood asthma:
Being exposed to “good bacteria” early in life could prevent asthma developing, say Canadian scientists.
The team, reporting in Science Translational Medicine, were analysing the billions of bugs that naturally call the human body home.
Their analysis of 319 children showed they were at higher risk of asthma if four types of bacteria were missing.
Experts said the “right bugs at the right time” could be the best way of preventing allergies and asthma.
In the body, bacteria, fungi and viruses outnumber human cells 10 to one, and this “microbiome” is thought to have a huge impact on health.
The team, at the University of British Columbia and the Children’s Hospital in Vancouver, compared the microbiome at three months and at one year with asthma risk at the age of three.
Children lacking four types of bacteria – Faecalibacterium, Lachnospira, Veillonella, and Rothia (Flvr) – at three months were at high risk of developing asthma at the age of three, based on wheeze and skin allergy tests.
The same effect was not noticed in the microbiome of one-year-olds, suggesting that the first few months of life are crucial.
Further experiments showed that giving the bacterial cocktail to previously germ-free mice reduced inflammation in the airways of their pups.
One of the researchers, Dr Stuart Turvey, said: “Our longer-term vision would be that children in early life could be supplemented with Flvr to look to prevent the ultimate development of asthma
“I want to emphasise that we are not ready for that yet, we know very little about these bacteria, [but] our ultimate vision of the future would be to prevent this disease.”
