Denialism Blog

Psychiatry

What to say about psychiatry that isn’t already completely covered by television and movies? It’s unique among the specialties for its coverage in the media. Maybe because we’re such social animals, or maybe because such shows about psychiatry or therapy appeal to a voyeuristic impulse in us to peer into people’s most private thoughts and feelings.

Our exposure to psychiatry in medical school, however, is primarily with inpatient psychiatry – people who for whatever reason require hospitalization to deal with their mental illnesses. Reasons may range from soul-crushing anxiety attacks, to addiction, to suicidal ideation, to frank psychosis from schizophrenia, depression or bipolar disorder. I’ll also say it’s very upsetting at first to treat the subset of patients who are being held against their will due to court orders. One of the most basic tenets of medicine is that a physician must respect the autonomy of their patients, and psychiatric patients have often had a court take this autonomy away from them because of their actions or behavior. Not surprisingly, many patients are not happy about this. They may not be willing to accept they have a problem, or be very reasonably upset about the financial, social, or legal consequences of a hospital stay, or occasionally they don’t necessarily feel that their delusions regarding their absolute dictatorial control of the US government and their need to evade agents of foreign nations by breaking into a pet store are actually a problem. However, others necessarily are disturbed by such things, often resulting in a temporary detention order, or TDO, to assess their need for psychiatric treatment. I’m not making light of mental illness, but psychotic states result in behaviors that are frankly bizarre, and the self-reinforcing nature of delusions often put patients into a state that makes them feel you are part of a plot designed to persecute them. Worse, there are times when a TDO can be devastating to a patient’s life. An inpatient admission for psychiatric, alcohol or drug treatment is not a benign intervention and often has pretty major accompanying legal and social consequences. Patients are often facing criminal charges for DUIs, violence, or other behavior that has finally come to a head, and cost of treatments is often a huge burden.

The two major things I learned as a part of this process are that (1) the state of Virginia drastically underfunds the treatment of mental illness relative to other medical illnesses (and this is a very bad thing) and (2) anti-psychotic medications are amazing drugs. Let’s start with a case – details, of necessity, are highly altered due to the sensitivity of psychiatric treatment but the fundamentals are real.

A 22 year-old-male is admitted to the inpatient psychiatric unit at a private hospital after his family brings him to the ER for bizarre and uncontrollable behavior…
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February 19, 2009
Should IQ and Race be studied and what is Lysenkoism anyway?

Dan MacArthur has started a big discussion on whether or not the relationship between IQ and race should be studied. Inspired by a pair of essays for and against the idea it has created a pretty healthy debate among the sciencebloggers including Razib with whom I will likely never agree on this issue. For the record, I’m on the side of those like Richard Nisbett (for a good review of his analysis of race and the black white divide see here PDF) that genetics are a poor explanation for the divide.

But this issue aside, why do I believe this is a still a bad idea to expend resources to evaluate the role of race and IQ? After all, that’s just what Nisbett has done in the paper cited above.
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February 18, 2009
Scientologists blame psychiatry for 9/11

We’ll have to add Scientology to Pal’s list of disease-promoting groups. Via Screw Loose Change I learn that as part of their bizarre hatred of psychiatry, they’ve now taken to saying that 9/11 was caused by psychiatrists in addition to the holocaust. Apparently, Osama was just a regular guy until al-Zawahiri, a psychiatrist, got to him. Strange considering al Zawahiri was not a psychiatrist at all.

Scientologists Try to Explain how Psychiatrists caused 9/11 and the Holocaust from Chris Doyle on Vimeo.

Anyway, watch the crazy!

I’ll have a post up on my experience on my psych clerkship soon.

February 16, 2009
The Global Warming Cranks – George Will officially in their ranks

One would think given recent findings that antarctic warming is robust for instance, that the canard of antarctic cooling would go away. Or, that based on the round dismissal of the myth of 1970s global cooling warnings we’d stop hearing about that in the media too. But instead I’m watching TV last night and there’s all these unbelievable crank ads sponsored by the anti-regulation ideologues the Americans for Prosperity featuring fake expert John Coleman. His senseless rant against the stimulus and the evils of regulation is accompanied by text on the bottom of the screen declaring “global warming it is the hoax” and “it is the greatest scam in history”. It is amazing in this day and age that this shameless conspiracy theory is being broadcast on national television. There is no way that one can on the one hand describe anti-AGW denialism as skepticism, and at the same time be a proponent of such an absurd conspiracy that thousands of scientists around the world, and journals, and editors, and politicians are all in cahoots to falsify data about climate.

But if there is a truism about crankery that I can come up with to explain the persistence of debunked arguments, it is that good ideas may come and go, but we’re stuck with the bad ones forever. For instance, we saw this weekend that George will still thinks there were predictions of global cooling in the 1970s. Scibling James decries George Will’s inability to read what he cites, but this is nothing new. George’s Willful Ignorance on this topic has persisted for years this isn’t the first time he’s misquoted that exact same article, or the second time either despite being corrected by others. His incompetence at judging sources, and his inability to stop citing false information shows he’s simply unwilling or unable to differentiate between legitimate and false information, or even read for comprehension for that matter.

What can be our response to this consistent dishonesty from Will? A repeat of a cherry-pick not once, or twice, but three times despite this being clearly false? I think the only thing you can say about someone like this, a man who can’t be turned, is that they’re a crank.

February 16, 2009
Create Evolution-themed Art, get a grant from Burning Man!

For those artistic evilutionists out there, Burning Man, the yearly festival celebrating freedom, expression, and self-reliance, is sponsoring art based on this year’s theme of Evolution. The details for getting a grant to support your artwork are here.

So, come up with some ideas for interactive, creative expressions of what evolution means, where humans have come from or where are we going, and submit them for entry into the festival!

February 14, 2009
The DC Circuit Gets Privacy, and So Do Your Phone Records

I’m very pleased with today’s decision from the DC Circuit Court of Appeals on recently-strengthened privacy protections for phone records. The short history goes something like this: the FCC created strong opt-in (affirmative consent) provisions for the sharing of phone records (who calls whom, for how long, etc). In 1996, the 10th Circuit held that the restrictions violated the First Amendment rights of companies that wanted to sell this data to marketers. Thus, the FCC relaxed the standard to opt-out, meaning that you had to take affirmative action to stop your phone records from being sold.

Did you know that the burden was upon you? Probably not! That’s why in 2005, I petitioned the FCC to reestablish stronger privacy protections, because all sorts of investigation companies were pretexting and obtaining phone records for perverts, stalkers, etc. The FCC opened a rulemaking and reestablished opt-in protections for phone records again. The industry sued, arguing that the First Amendment barred opt-in protections. Today the DC Circuit rejected the industry’s argument, holding that the FCC had sufficient justification for the heightened protections.

But what’s more important is that the DC Circuit’s opinion “gets” privacy. Many courts conceive of privacy as a way to shield oneself from embarrassment. The DC Circuit disagreed, writing, “There is a good deal more to privacy than that. It is widely accepted that privacy deals with determining for oneself when, how and to whom personal information will be disclosed to others. See Daniel J. Solove, Conceptualizing Privacy, 90 CAL. L. REV. 1087, 1109-10 (2002).”

Further, “…the carrier’s sharing of customer information with a joint venturer or an independent contractor without the customer’s consent is itself an invasion of the customer’s privacy – the very harm the regulation targets. In addition, common sense supports the Commission’s determination that the risk of unauthorized disclosure of customer information increases with the number of entities possessing it. The Commission therefore reasonably concluded that an opt-in consent requirement directly and materially advanced the interests in protecting customer privacy and in ensuring customer control over the information.”

Wow! In privacy law, courts are often wedded to waiting for some type of harm to arise, such as unwanted telemarketing calls. They rarely get the idea that it is the data sharing itself that is the problem, and that privacy is about how personal data is controlled. Good job, Judge Randolph. Now the burden won’t be upon you to shield your phone records from sale to marketers!

February 13, 2009
The Autism/Vaccines Fraud

I have to admit I’m somewhat surprised (even if Orac isn’t). We all knew that Andrew Wakefield’s research was bogus and the link between vaccines and autism was engineered by ideologues who fear vaccines irrationally. But fabrication of data? Sloppy research is one thing, but the need for cranks to be correct, no matter what reality reflects, has resulted in yet another example of egregious dishonesty.

This is in line, however, with what we know about cranks. Mark Crislip recently wrote an interesting piece on mathematics crankery which bears upon just this phenomenon. Mathematics is a wonderful area to study crankery because as Crislip points out, mathematics is a field in which it is possible to distinguish between the possible and the impossible.

In mathematics there are things that are impossible. Absolutely impossible. No ifs, ands, or buts. Impossible. Can’t be done no how no way. In the world of mathematics, things are not only impossible, they are proven truly impossible within the boundaries of the mathematical discipline.

An example of mathematical impossibility is the quadrature of the circle, also called squaring the circle.

It is impossible, using only a straight edge ruler and a compass, to construct a square with the same area as a given circle. It was proved to be impossible in 1882 by Lindeman. Not improbable or unlikely or very, very, very difficult. With in mathematical reality, it is impossible.

But in his review of Mathematical Cranks he hits upon many of the commonalities between cranks we discussed in the Crank HOWTO.

Here is Crislip’s description of the mathematical crank:

1) They are convinced that their opinion is superior to the accumulated opinion of 2000 years of mathematics and mathematicians. That hundreds of mathematicians have worked for hundreds of years on these problems and found no errors in the proof that it is impossible to square a circle is of no consequence. Despite the accumulated mathematical knowledge of uncounted mathematicians, they are convinced that their solution is the right solution. Everyone else for all of history has been wrong. There is a tinge of megalomania in all the correspondence, and some appear to me to be clinically insane.

2) To accommodate their solutions, they are willing to alter reality to fit their proofs. There are solutions to squaring the circle, but they require a value of pi that is different that 3.14159265… Pi, for those that have forgotten, is the ratio of the circumference to the diameter of a circle and is a constant of the universe. For some circle squarers, Pi has a different value and all the mathematics that has confirmed the current value of pi is wrong. Others deny that pi exists or that the definition is meaningless, since they can construct a squared circle with pencil and paper, and send in the (flawed) construction.

3) When errors of math or logic are pointed out, they respond not with understanding, but a redoubling of efforts to prove that their erroneous solution to the problem is actually correct. They are incapable of recognizing flaws in logic, or mathematics, or flaws that are in opposition to mathematical consistency. A crank cannot recognize their error because they cannot recognize that their reality differs from mathematical reality.

4) Cranks are impervious to arguments based on mathematical reality. They do not recognize or understand that their solutions are in error because the solution contradicts known mathematical reality. They do not base their solutions on known mathematics, but on their own flawed understanding of mathematics.

5) Cranks evidently send their ‘solutions’ to multiple mathematical departments and rarely receive a reply. This silence from academia is interpreted not that their solution is worthless, but that there is a conspiracy of Professors of Mathematics to keep their solution secret, to the detriment of human kind. Big Math, out to suppress the truth THEY don’t not want you to know.

It is obvious to me that no matter what the field, the problem is crankery – the defective thought processes that allow people to believe in nonsense, no matter what obstacles reality throws in their path. Every description of every crank in every field ultimately boils down to these same factors. Cranks believe in something contrary to observable reality. They will do anything to prove it. When reality gets in their way, they ignore, subvert, lie, cheat, or obfuscate to create confusion. And when it’s proven beyond all doubt they’re wrong? That’s when the conspiracies come out. The comments on the Huffington Post coverage of the most recent Wakefield dishonesty are an excellent example of this. Wakefield is a victim of Big Pharma, being persecuted by Brian Deer, it’s all a conspiracy against children by doctors and pharmaceutical companies etc.

The more time passes the more I’m convinced that our original thesis on cranks and denialism in general has been confirmed again and again. No matter what the foolish belief the problem the reality-based community is fighting is a defective pattern of thought, an incompetence in evaluating the quality of evidence that afflicts millions of individuals and ultimately is why so many people believe in such stupid things. Wakefield, ultimately, is just another in a long line of cranks. And while biology is never as concrete as mathematics, it is clear that accepting reality was never a part of the the anti-vaccine movement’s ideology. And what do cranks do when reality opposes your world view? They do what Wakefield did. Reject reality, and substitute their own.

Even after all this time I was surprised they would find outright fabrication in Wakefield’s work, but I shouldn’t have been.

February 10, 2009
The editors of PLoS should read PLoS

What do this cartoon and the latest edition of PLoS One have in common? Well, reading Bora’s blog this week I saw an article entitled, Risks for Central Nervous System Diseases among Mobile Phone Subscribers: A Danish Retrospective Cohort Study and my ears perked up. We have been mocking the idea that cell phones cause everything from brain cancer to colony collapse disorder and it’s always fun to see what cell phones are being blamed for based on weak associations and correlations.

In this article the authors identified more than four hundred thousand cell phone subscribers and linked their cell phone use to their medical records in the Danish Hospital Discharge Registry which has collected records of hospitalizations since 1977. They then tried to identify an association between cell phone use and various CNS disorders over the last few decades. These disorders include epilepsy, ALS, vertigo, migraines, MS, Parkinsons and dementia, a broad spectrum of diseases with a variety of pathologies and causes. Basically, they’re fishing. Well, what did they find?
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February 6, 2009
Let the Bread and Circuses Continue!

Obama has delayed am important political risk: he’s pushed back the DTV transition. If the televisions stopped working on February 17th, we would probably have an impeachment trial (as soon as the televisions were back on again).

February 4, 2009
Choosing a Medical Specialty IV — Interviews!

The process of choosing a medical specialty, and applying for residency programs is nearly complete as I have returned from my tour of the West Coast and am nearly done with interview season. This is when medical students travel the country at great (and unreimbursed) expense to find their future training program. When all is said and done, all your research into programs and time spent interviewing boils down to a simple question. Do you want to work with these people for the next 3-7 years of your life?

It’s also nice to see the cities where you may live and get a feel for the type of lifestyle you may enjoy. You also get to take pictures from helipads! Like this one from UNC:

And then there is the famous medical art like the Gross Clinic at Penn which also graces a common surgery text:

Or Ether Day (in the Ether Dome at MGH):

More pictures and some fun interview questions below the fold…
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February 4, 2009