Monthly Archives: September 2012

what health care + unlimited profit cannot help but create

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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?

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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

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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 brew, and I got into continental beers there also — primarily Belgian Trappist Ales. 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

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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

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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.”

Tirez sur le pianiste

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Rewatched it recently and it was like seeing it for the first time. So fresh. They must’ve had some fun back then making movies, the nouvelle vague folk. It shines out of so many scenes in Shoot the Piano Player, a playful, open-ended, we-can-do-anything quality. This one had a lot of improvisation in it, apparently. They didn’t even know what the ending would be until it was time to shoot it.

One of my favorite scenes is near the very beginning. Charlie Kohler (Charles Aznavour), the eponymous piano player, has a brother, Chico, who is being chased by two men (we have no idea why yet). Chico runs into the bar where Charlie plays, to hide. They have a brief exchange but it is time for Charlie to start a new set. Suddenly we are thrown into a hilarious tune (suggestive and somewhat surreal) sung and I think written also by Boby Lapointe (who by that point was fairly well-known in France). The three musicians have fixed and completely contrasting facial expressions throughout the entire sequence–Charlie in hang-dog (Charlie’s in hang-dog the entire film…), Boby Lapointe intense, super-serious, bouncing from foot to foot, and the drummer grinning from ear to ear. For part of the scene you get the faces together in triptych. Brilliant.


I believe the budget for this movie was virtually nothing, but that meant Truffaut and Co. could do whatever they wanted, and it also meant location shooting on the streets in Paris, trusting in intuition, spontaneity. There is farce followed by real pathos and back to farce again, fun from the opening chase scene to that final, unforgettable shot of … (don’t want to give anything away) … rolling down the snow-covered slope.

And then there’s the single most famous image (and justly so). But I won’t try to explain it–you’ll just have to see the movie…

small hours with John Martyn…

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It’s nearly 4, reminding me of the John Martyn song “Small Hours”… Over the summer I discovered piles and piles of live videos of him on YouTube going all the way back to the 70s.  And a couple of nice full-length documentaries. A man barely known in the States but nobody else had a voice like him or ever will. No slouch on guitar either but for me it was that tender, growling, roaring, aching, endlessly expressive voice… Simply one of the greatest singers we have had.

I got to see him once. He could give spine-chilling performances live, every one unique, and then he could get on stage totally wrecked and sound a complete mess. I caught one of those gigs, in a small club. He came on swigging scotch the first half, came back for the second chain-smoking spliffs, which he would smoke 3/4 of the way down then toss into the audience. (One of which landed at my feet, then disintegrated…)

He started out as a folkie in the late 60s then incorporated jazz / rock / blues elements in a way all his own, until eventually there was just nobody who sounded like him. Ended up with a burst cyst in his right leg, requiring amputation, after which he also put on a ton of weight. He lived such a wild life a lot of people, including he himself, were surprised he made it as far as he did (we lost him in 2009, to pneumonia). Not a consistent songwriter–there are chunks of his career I don’t connect with, but then there are these moments…

Like the song he wrote for his friend Nick Drake in 1973, the year before Drake died, age 26.

But then, can you believe this is the same guy, only a few years later? A 10,000 volt version of “Lookin’ On” :

Then for something completely different again … I was watching the movie “The Talented Mr. Ripley” one day, shell-shocked by the ending, the film score music going on over the credits, then a pause halfway through and suddenly … that voice again. It was John Martyn of all people doing a cover of the jazz standard “You Don’t Know What Love Is,” but doing it like it’s never been done before, in this sinuous, intimate, world-lost way. Such a brilliant choice by the director Anthony Minghella also (a movie full of brilliant choices and breathtaking ensemble acting by every lead) — the song gives a sort of ambiguous, subversive little twist I think on the movie. Martyn himself said that often a singer has to be satisfied with getting to 7 or 8 out of 10 of what they were after, but that with this recording he felt he hit a 10.

And finally a performance of “One World” from 1990. He doesn’t start singing until almost 3 minutes in but … don’t touch that dial!

A heartbreaking version of “Never Let Me Go” from the same concert is also up on YouTube but cut off a minute or so from the end unfortunately. So you also miss the stunned silence afterwards and some guy in the audience then whispering “beautiful” …

The guy even does … “Over the Rainbow” … like you never heard …

or, as once was said long ago…

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The living are soft and yielding;
the dead are rigid and stiff.
Living plants are flexible and tender;
the dead are brittle and dry.

Those who are stiff and rigid
are the disciples of death.
Those who are soft and yielding
are the disciples of life.

The rigid and stiff will be broken.
The soft and yielding will overcome.

Tao Te Ching 76 (J.H. McDonald translation)

Michael Chabon nails it

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From an interview published yesterday (my emphases).:

“The men in Chabon’s books all come in pairs … in every possible permutation: fathers and sons, business partners, collaborators, lovers…. These permutations interest him mostly because, in real life, men have so few options for how to relate to one another. ‘It’s your buddy or your business partner or your romantic partner,’ Chabon says. ‘Or your enemy. That’s it. That’s all we’ve got.’

“Chabon envies women’s relatively greater emotional freedom, he says. And he believes that ‘a lot of the things men feel in terms of confusion and frustration and lack of emotional connection and fulfillment is because the accepted possibilities are so paltry.’ With his books, he says, ‘ultimately the question I’m asking is: What does it mean for two men to love each other? Do male friends love each other? And if they do love each other, what kind of love is it? Do they say they love each other? Do they even know they love each other?’

“Chabon does love men. He has written, in his nonfiction, about sleeping with one man and falling in love with another, and although he’s close to many women, he says his mental category of ‘best friend’ is, by default, male. (‘If I were casting the part, I’d call in men.’) But he is profoundly frustrated by how men behave, or rather by how they misbehave, a problem he sums up as ‘dickishness.'”

scientism

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Awhile back Philip Kitcher, philosopher at Columbia, published a piece on scientism in The New Republic, leading to a lengthy exchange with Jerry Coyne. I want to reply to this exchange at some point as it’s a question I’ve been contemplating for quite awhile. Though there were good things said in the original article I would have preferred an even more robust defense of the humanities. So when I get the chance I will make an attempt at one.

Along with this, I’m troubled by the basic response Kitcher received. Coyne says: “I’d prefer to see the word ‘scientism’ quietly shelved, replaced by more specific charges like ‘scientists sometimes overreach themselves’ or ‘scientists denigrate the value of literature.’ Those, at least, are charges that can be documented and discussed using evidence. The general charge of ‘scientism,’ slippery of definition, can’t be.”

No no no! I hasten to disagree, strongly. The concept is so very necessary, crucial even. But more on this another time.

“your heart is the big box of paints”

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“…and others, the canvas we’re dealt.” (XTC – “Wrapped in Grey”)

Earlier today overheard the tail end of a sentence: “… they’re just so uncomfortable with shades of gray.” But, really, this isn’t right. Shades of gray are still only combinations of black and white. The third category merely buttresses the overarching sovereignty of the Two. Of “This or That.” So now we have “sort of This, or sort of That.”

But I think what we really fear is the profundity and brilliance of living colour. Irreducible to anything else, to any grid or agenda, any … This or That. The redness of red, the blueness of blue, the greenness of green. As the Buddhists say, “suchness” beyond concept. That which is, in itself.

I guess this is why I’ve always liked the term “person of colour.” And, in part, it’s why I’ve always disliked the term “bisexuality,” for instance. Because the latter keeps us imprisoned in one-dimensional calculus: there’s a dot over here, and a dot over there, and you can have one dot, or you can have two dots, but that’s “who you are,” that’s what your longing is, your full exquisitely sensitive aesthetic. It’s a dot — or two.

But our “sexuality” or libidinal universe, the realm of all that we find beautiful as a body among bodies, down to the last unmappable particular — this remains unique to us, vast and uncontainable. Not black, not white, not black-and-white, but our own personal world of brilliant colours.

And so with our pure longings, in our natural radiance, we go out into the worlds which are given to us, and we create our communities of love.  

“your heart is the big box of paints
and others, the canvas we’re dealt
your heart is the big box of paints
just think how the old masters felt, they call:
awaken you dreamers…”