Formula 1 and Iraqi psychiatry on AITM new series

A new series of BBC Radio 4’s All in the Mind has just kicked off with the first programme investigating the psychology of Formula 1 drivers and including an interview with an Iraqi psychiatrist involved in rebuilding the country’s mental health services.

The programme talks to Jenson Button, Honda’s top driver, Tony Lycholat, Head of Human Performance at Honda, and Dr Kerry Spackman a neuroscientist who is consultant to the Maclaren team.

In relation to mental health in Iraq, Dr Sabah Sadik is interviewed about his role as National Advisor for Mental Health to the Iraqi Ministry of Health.

The Iraqi mental health system has virtually collapsed since the invasion in 2003, and as recently reported by the Washington Post, the conflict has left intense psychological scars on many of the country’s children.

Link to first in the new series of BBC All in the Mind.

Psychiatrists top list of drug maker gift recipients

The New York Times continues its theme of investigating psychiatry and mental health with an article noting that US psychiatrists receive drug company ‘gifts’ worth the largest amount among all the medical specialities.

The data is only from two states, because they are the only ones which have gone public with their records of payments to doctors.

The practice is widespread and usually doesn’t take the form of direct cash payments, but instead funds everything from trips to conferences (which are often little more than marketing presentations in luxurious holiday destinations), to expensive meals and outings, to footing the bill for medical school events and symposiums.

The extent of the funding is quite eye-opening: the article reports that the average payment to each psychiatrist in Vermont last year was over $45,000 dollars.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

The state of psychiatric drug marketing is shocking. It’s gone beyond the point of promotion to what seems to be little more than outright bribery.

As you might expect, this practice has a strong and significant effect of the prescribing behaviour and attitudes of doctors when medical decisions should be taken on the best empirical evidence rather than on marketing information provided by commercial vendors.

UPDATE: An important clarification from Doctor X, taken from the comments:

While I am concerned about the influence of big pharma on psychiatry, I was taken aback by the figures presented in the Times story. I did a little checking and found that the Times article grossly misrepresented the facts as presented in the original Vermont report. The $45,000 per year figure is for the top 11 psychiatrists who are recipients of pharma money. The report does not indicate the average or median for psychiatrists across the state, but extrapolating from the report figures it looks like $1000.00 per year is probably more typical and closer to the median figure for all psychiatrists. The mean is probably in the neighborhood of $4,000 per psychiatrist, a figure that is probably skewed upward by a heavily lopsided distribution of money and fees paid to top recipients.

Further explanation here.

Link to NYT article ‘Psychiatrists Top List in Drug Maker Gifts’.

Enough about you doctor, what about me?

The New York Times reports on a new study that examined how doctors disclose information about themselves during patient consultations. The study found that disclosures are usually for the benefit of the doctor and rarely help the patient.

The study recorded 113 doctor-patient interactions and analysed the conversation for themes, timing, effect and number of self-disclosures.

Self-disclosure is usually specifically covered in clinical training and, if done carefully, is thought to enhance the relationship with the patient and make them feel more at ease.

In this case, the research team found that none of the self-disclosures were primarily focused on patient concerns and only 4% were useful, providing education, support, explanation, or acknowledgment, or prompting some indication from the patient that it had been helpful.

The study also contains a few transcripts, including this gem:

Physician: No partners recently?

Patient: I was dating for a while and that one just didn’t work out. . . . about a year ago.

Physician: So you’re single now.

Patient: Yeah. It’s all right.

Physician: [laughing] It gets tough. I‚Äôm single as well. I don’t know. We’re not at the right age to be dating, I guess. So, let’s see. No trouble urinating or anything like that?

As was found in a previous study, it was also found that the longer the doctor talked about themselves, the less likely it was to be useful.

We tend to think of medical diagnosis as a scientific process, but so much of it relies on conversation, with patients – to get their experience of symptoms, and colleagues – to get their opinions and advice. In other words, it relies as much on negotiation as diagnostic tests.

Another key element is how the doctor transforms the patient’s personal problem into a medical one, so he or she can apply medical knowledge and problem-solving techniques to it.

As found by a key study in medical sociology, doctors use various non-scientific strategies to interpret the objective medical symptoms while making a diagnosis.

When medicine is discussed as ‘part art, part science’, the art seems to be in how doctors interact with their patients and interpret their concerns, which seems to be equally as important as medical tests.

Link to NYT article ‘Study Says Chatty Doctors Forget Patients’.
Link to abstract of study.

Harnessing humans for subconscious computing

Technology Review has an article on using humans as part of a digital face recognition system. Uniquely, you don’t have to take part in any deliberate recognition, the system uses electrical readings to automatically measure the response of the brain – even if you’re not aware of it.

The system, developed by Microsoft Research, takes advantage of the fact that when we see something we recognise as a face, a specific electrical signal is generated by face-perception brain activity that can be picked up by electrodes.

Crucially, this brain activity happens automatically, we don’t have to make a special effort.

Last year, I wrote an article entitled ‘Hijacking Intelligence‘, noting that software is increasingly being designed to use humans as ‘biological subroutines’ for the things computers find most difficult.

Labelling pictures is one such task – it’s something humans find trivial, computers find difficult, and it’s needed in large numbers to create an index for image searches.

To get round this problem, Google designed an online game that involved labelling pictures. Humans play for fun, while Google get the benefit of your intelligence for their database.

This new system takes it a step further, as you don’t have to be doing anything related for it to take advantage of your ‘mental work’.

For example, a picture could flash up every time you hit save on a word processor, or every time you look at a certain website.

Each time your brain signals that you’ve seen a face, the system reads your recognition activity and sends it back to the main database to classify the image.

This might be one way of sifting through security images to see which should be inspected in more detail.

As a substitute for advertising, maybe you’d be offered free internet access if you had the system installed. Your brain would pay the bills.

While the system has only been developed as a proof-of-concept, it’s interesting, if not a little scary, to speculate how technology will harness our mental skills, even when we’re not aware of it.

Link to Technology Review article ‘Human-Aided Computing’.

Tooth marks reveal childhood trauma

Childhood stress can interfere with the development of the teeth to the extent that a traumatic experience leaves a recognisable line in the tooth enamel that remains as a record of past traumas.

I discovered this when reading about a study published in the Annals of the New York Academy of Sciences [pdf] that used these lines to compare the number of childhood traumatic experiences that occured in people diagnosed with schizophrenia and healthy controls.

New approaches to the problem of estimating stress during early brain development are required. In this regard, human enamel has promise as accessible repositories of indelible information on stress between gestation and the age of 13. Stressful experiences induce long-term activation of the sympatho-adrenal system, slowing of tropic [growth-related] parasympathetic functions, and they then induce disrupted secretion of the enamel matrix.

During the brain development (in infancy, childhood and preadolescence), ameloblast activity in human enamel is slowed during 1 to 2 days of extreme stress, and the segment of enamel rods is smaller and often misshapen, making a particular dark line seen by the use of a microscope (we referred this line to Pathological Stress Line, PSL in short). Retzius reported that this line is incremental lines reflecting the layered apposition of enamel during amelogenesis (Retzius, 1937), and after that this line is termed the Retzius line. The line is conceptually akin to tree rings which are markers of environmental adversity in the tree’s life.

Schizophrenia was once thought to be largely caused by genetic factors, but in the last decade a number of studies have shown that childhood trauma contributes to the chance of developing the disorder.

One difficulty with this type of research is that it often relies on people remembering back to their childhood after the onset of psychosis, which could mean that the memories aren’t perfectly reliable in some cases.

Stress-induced lines in tooth enamel are one way of looking at the link between trauma and schizophrenia that doesn’t rely on potentially hazy memories of the past.

Link to abstract of study.
pdf of scientific paper.

Why don’t ethics professors behave better?

If you spent your whole life trying to work out how to be ethical, you would think you’d be more moral in everyday life. Philosopher Eric Schwitzgebel has found that this isn’t the case, and asks the question “Why don’t ethics professors behave better than they do?”.

Initially, this was based on a hunch, but Schwitzgebel, with colleague Joshua Rust, has begun to do research into the question. They’ve found some surprising results.

At a recent philosophy conference, he offered chocolate to anyone who filled in a questionnaire asking whether ethicists behaved better than other philosophers.

It wasn’t long before an ethics professor stole a chocolate without filling in a questionnaire. (This reminds me of a famous psychology study that found that trainee priests on their way to give a talk on ‘The Good Samaritan’ mostly ignored someone in need if they were in a hurry!).

When the results came in, ethicists rated other ethicists as behaving better, but other philosophers rated them as no more moral than everyone else.

In another study, Schwitzgebel investigated whether people interested in moral issues are more likely to steal books. By looking at library records, he’s found that books on ethics are more likely to be stolen than other philosophy books.

So why aren’t ethics professors more ethical than the rest of us? Schwitzgebel wonders whether it is because there is a difference between emotional engagement with moral issues and a more detached reasoning style that is necessary for careful analysis, but which may not make someone feel compelled to act more ethically.

Ominously, he notes that “More and more, I’m finding myself inclined to think that philosophical reflection about ethical issues is, on average, morally useless”.

It is interesting that there are similar problems in other professions. For example, doctors don’t follow health advice adequately and are much more likely to suffer from mental illness.

As an aside, Schwitzgebel has made all his papers and publications available online and has a fantastic blog that is well worth keeping tabs on.

Link to Schwitzgebel’s articles on ‘The problem with ethics professors’.
Link to Schwitzgebel’s homepage with publications and blog links.

Law, ethics, brain scans and mind reading

ABC Radio National’s All in the Mind has just broadcast the first of a two-part series on using neuroscience to read the mind.

The first programme investigates whether neuroscience can tell us anything about criminality and violence, and what role brain-based evidence will play in the court room.

The programme talks to many of the delegates from last April’s The Law and Ethics of Brain Scanning conference which was one of the first to consider the legal issues of brain scans in detail.

All of the conference talks have been put online as mp3 files so you can listen to the talks yourself if you want to hear more.

In the mean time, this edition of All in the Mind covers the key issues and next week’s will investigate some more (as yet undisclosed) aspects of so-called ‘mind-reading’ technology.

Link to AITM on ‘Mind Reading’.
Link to The Law and Ethics of Brain Scanning conference audio.