vaughanbell

A disorder of marketing

The New York Times has an important article on how Attention Deficit Disorder, often known as ADHD, has been ‘marketed’ alongside sales of stimulant medication to the point where leading ADHD researchers are becoming alarmed at the scale of diagnosis and drug treatment.

It’s worth noting that although the article focuses on ADHD, it is really a case study in how psychiatric drug marketing often works.

This is the typical pattern: a disorder is defined and a reliable diagnosis is created. A medication is tested and found to be effective – although studies which show negative effects might never be published.

It is worth highlighting that the ‘gold standard’ diagnosis usually describes a set of symptoms that are genuinely linked to significant distress or disability.

Then, marketing money aims to ‘raise awareness’ of the condition to both doctors and the public. This may be through explicit drug company adverts, by sponsoring medical training that promotes a particular drug, or by heavily funding select patient advocacy groups that campaign for wider diagnosis and drug treatment.

This implicitly encourages diagnosis to be made away from the ‘gold standard’ assessment – which often involves an expensive and time-consuming structured assessment by specialists.

This means that much of the diagnosis and prescribing happens by local doctors and is often prompted by patients turning up with newspaper articles, adverts, or the results of supposedly non-diagnostic diagnostic quizzes in their hands. There are many more marketing tricks of the trade which the article goes through in detail.

As the initial market begins to become saturated, drug companies will often aim to ‘expand’ into other areas by sponsoring studies into the same condition in another age group and treating the condition as an ‘add on’ to another disorder – each of which allows them to officially market the drug for these conditions.

However, fines for illegally marketing drugs for non-approved conditions are now commonplace are many think that these are just considered as calculated financial risks by pharmaceutical companies.

The New York Times is particularly important because it tracks the entire web of marketing activity – that aside from the traditional medical slant – also includes pop stars, material for kids, TV presenters, websites and bloggers.

It is a eye-opening guide to the burgeoning world of ADHD promotion but is really just a case study of how psychiatric drug marketing works. By the way, don’t miss the video that analyses the marketing material.

Essential stuff.

Link to NYT article ‘The Selling of Attention Deficit Disorder’

2013-12-13 Spike activity

Quick links from the past week in mind and brain news:

Beware the enthusiasm for ‘neuroeducation’ says Steven Rose in Times Higher Education.

Lots of studies use oxytocin nasal sprays. You can buy it from websites. Neuroskeptic asks does it even reach the brain?

Time magazine finds a fascinating AI telemarketer bot that denies it’s a robot when questioned – with some great audio samples of the conversations.

The Tragedy of Common-Sense Morality. Interesting interview with psychologist of moral thinking Joshua Green in Slate.

Brain Watch takes a calm look at the most hyped concept in neuroscience: mirror neurons.

As is traditional the Christmas British Medical Journal has some wonderfully light-hearted science – including a medical review on the beneficial and harmful effects of laughter.

How much do we really know about sleep? asks The Telegraph.

Chemical adventurers: a potent laboratory neurotoxin is being sold as a legal high online. The Dose Makes The Poison has the news.

Not really into kickstarters but this looks cool: open-source Arduino-compatible 8-channel EEG platform.

Did Brain Scans Just Save a Convicted Murderer From the Death Penalty? Wired on a curious neurolaw development.

How the US military used lobotomies on World War II veterans – an excellent multimedia expose from the Wall Street Journal.

New Scientist takes a critical look at the ‘genetics more important than experience in school exam performance’ study that’s been making the headlines.

The Manifestation of Migraine in Wagner’s Ring Cycle. Neurocritic on migraine and opera.

Where data meets the people

Ben Goldacre might be quite surprised to hear he’s written a sociology book, but for the second in our series on books about how the science of mind, brain and mental health meet society, Bad Pharma is an exemplary example.

The book could essentially be read as a compelling textbook on clinical trial methodology with better jokes, but the crux of the book is not really the methods of testing medical interventions, but how these methods are used and abused for financial ends and what impact this has on professional medicine and, ultimately, our health.

In other words, the book looks at how clinical science is used socially and how social influences affect clinical science.

For example, this is question I often give students: If a trial is badly designed, are the results more likely to suggest the treatment is effective or more likely to suggest the treatment is ineffective?

Most students, naive to the ways of the scientific world, tend to say that badly designed trials would be less likely to show the treatment works but in the real world, badly designed trials are much more likely to give positive results.

There is nothing in the science that makes this happen. This is an entirely social effect. It’s worth saying that that this is rarely due to outright fraud but it’s those little decisions that add up over time, each of which seems completely justifiable to the researcher, that sway the results.

It’s like if your dad was school football coach. You’d probably get picked for the team more often not because your father was making a conscious decision to include you no matter what, but because he would genuinely believe he had recognised talent where others probably wouldn’t.

For scientists, the treatment they are testing is often their ‘baby’, and the same sort of soft biases creep in between the cracks. And the more cracks there are, the more creep occurs.

On the other hand, pharmaceutical companies are often deliberately trying to promote their product by distorting the evidence for its effectiveness. This often happens within the accepted regulations – the unethical but legal realm – but happens surprisingly often outside the law.

Bad Pharma is not specifically about psychiatry but as one of the medical specialities which is most corrupted by the influence of large pharmaceutical companies, it turns up a lot.

It is both an essential guide to understanding how treatments for mental health conditions are tested and has plenty of examples of how psychiatric drugs have been the subject of spin, over-selling and fraud.

Perhaps the only part where I think Goldacre is being too strong is in his criticism of ‘me too drugs’ which are new drugs which are often molecularly similar but no more effective for the target symptoms than the old ones.

At least in psychiatry, one of the big problems is not so much the effectiveness of the drugs, but their side-effects. Having other compounds which although no more effective may be more agreeable or less risky is a genuine benefit.

Goldacre is clear about this being a benefit, but I think he under-values it at times, especially since a lot of mind and brain medicine involves iterating through medications until the patient is happy with the balance between effectiveness and side-effects.

But this is a small point in an excellent book. It is essential if you want to know how medicine works and doubly essential if you have an interest in the mind, brain and mental health where these issues are both a significant battle ground and often under-appreciated.

I suspect Goldacre would prefer to call the book political rather than sociological, but if you are studying psychology, neuroscience or mental health it is a must read to understand how clinical science meets society.

Next and finally in this three-part Mind Hacks series on science and society – Didier Fassin and Richard Rechtman’s The Empire of Trauma.

Link to more details of Bad Pharma.

2013-12-06 Spike activity

Quick links from the past week in mind and brain news:

C-List celebrity is photographed with a psychology book in her hand and New York Magazine is all over it like Glenn Greenwald with an encrypted harddrive.

The New York Times covers a Dutch scheme to get alcoholics working by paying them in beer. Scheme to get stoners working by paying them in weed probably not as effective.

The British Medical Journal has an entertaining interview with psychiatrist Simon Wessely.

Soaring dementia rates prompt call for global action, reports New Scientist.

Bloomberg reports that the rate of US teens on psychiatric drugs remains steady at 6%. Hey, it could be worse.

Research on illicit drugs is being hampered by daft drug laws says David Nutt in Scientific America. Clearly not the worst scientific censorship “since the banning of the telescope” but the point remains.

Brain Watch has a good round up of discussions surrounding the ‘men and women’s brains are wired differently therefore stereotypes’ study that has been getting everyone’s unisex underwear in a twist.

Electric brain stimulation triggers eye-of-the-tiger effect. Not Exactly Rocket Science has the power-chords (and maybe the power cords – hard to see from this angle).

NPR has one of the few left-brain / right-brain articles you’ll ever want to read. Neuroscientist Tania Lombroso takes a detailed look at the science behind the concept.

The science of hatred. The Chronicle of Higher Education has an excellent piece on the psychology of genocide and racism.

Hallucinated voices and the community inside us

I’ve long been fascinated by the experience of ‘hearing voices’ and long been baffled by the typical scientific approach to the experience.

As a result, I’ve just had a paper published in PLOS Biology that focus on one of the most striking but ignored aspects of hallucinated voices.

Here’s how I describe the central paradox in the paper:

Auditory verbal hallucinations, the experience of “hearing voices”, present us with an interesting paradox: the experiences are generated from within a single individual but are typically experienced as a social phenomenon—that is, a form of communication from another speaker.

Current theories attempt to explain auditory verbal hallucinations as alterations to individualistic information processing—namely, misattributions of internal thoughts as external phenomena due to biases in cognitive monitoring.

The fact that voices stem from an internal source is, of course, clear, but the typical experience of “hearing voices” is not that thoughts seem to be “spoken aloud” but that hallucinated voices have a social identity with clear interpersonal relevance. In other words, voices are as much hallucinated social identities as they are hallucinated words or sounds.

The article discusses the psychology and neuroscience of social processing in the experience of hearing voices and suggests how we can begin to consider this as a central component of the experience in terms of scientific research.

It’s an academic article but should hopefully be fairly accessible to most people with an interest in the science of hallucinations.

Enjoy!

Link to article ‘A Community of One’ on social cognition and hearing voices.

London’s Shuffle Festival is back

London’s film, food and science festival in an abandoned psychiatric hospital is back as the Shuffle Festival kicks off its Winter run.

Hosted in the old buildings of St Clement’s Hospital the festival has an impressive programme including everything from Jarvis Cocker to Brian Cox.

There are also regular talks from working scientists including a couple of standout-looking ones on the neuroscience of religious experience and circadian rhythms.

There’s also a full film programme, DJs, a restaurant, music, theatre and an art gallery with a commissioned show.

As with the summer Shuffle Festival, the profits go to the East London Community Land Trust that will ensure that when the hospital gets redeveloped, affordable housing will be available to the local community. A welcome change from the usual practice of converting London’s old asylums into exorbitant luxury flats.

If it’s anything like last time, it should be awesome. And if you didn’t go in August, this may be your last chance to say you’ve experienced a festival in an abandoned Victorian-era asylum.

The full programme is at the link below. See you there!

Link to the Shuffle Festival.

A life in the day of a medical morphine addict

AddictionBlog has an amazing article by a doctor and recovering morphine addict that describes the experience of injection, rush and withdrawal.

It’s wonderfully written to the point of being painful and if you’re not good with needles, you’ll probably feel a bit queasy when reading it.

Heroin, by the way, is just the prodrug of morphine. In other words, the heroin molecule just gets broken down into morphine in the body and this is the form in which it arrives in the brain.

But because each heroin molecule gets transformed into two morphine molecules (hence the medical name for heroin – diamorphine) the feeling can be a little different because the increased concentration can apparently make the high more intense.

Neurochemically, however, the action in each opioid receptor is the same.

As morphine is used more widely in medicine than diamorphine, it is more likely to be abused by doctors and turn up in cases of addiction.

As we’ve discussed previously, addiction and abuse of medical drugs by doctors is linked to clinical speciality – likely due to both knowledge of and access to particular compounds.

The AddictionBlog article is a strikingly written, honest, detailed and psychologically insightful piece if you want a look into this curious corner of medical drug abuse.

Link to ‘What it’s like to take and withdraw from morphine’

A quarter century of All in the Mind

A new series of BBC Radio 4’s All in the Mind has just kicked off and to celebrate 25 years of broadcasting they’ve just had three great episodes looking back on the last quarter century of psychology, neuroscience and mental health.

Each make for a interesting discussion of how science and attitudes have changed.

As per BBC usual, you can access the streamed versions at the links above, but you have to go to an entirely separate page for the podcasts.

And because there are no separate podcast pages for specific episodes, I’ve linked them directly below. Here’s hoping that in the next 25 years, the BBC can fix their website.

mp3 of ’25 years of understanding the brain’
mp3 of ‘What has psychology research taught us in the last 25 years?’
mp3 of ‘How have attitudes to mental health changed in the last 25 years?’

Neuroscience and its place in the social world

This is the first of three posts that will cover three important books about how the science of mind, brain and mental health, interfaces with society at large.

First off, I want to discuss an excellent book called Neuro: The New Brain Sciences and the Management of the Mind published this year by sociologists of neuroscience Nikolas Rose and Joelle M. Abi-Rached.

You may be wondering why we need a social study of neuroscience but it becomes clear when we think of how neuroscience has become important.

It is not just due to what has been discovered. Neuroscience research itself, is only driven in part by scientific discovery.

In the main part, it is driven by a complex mix of politics, business, health care needs and public popularity. That’s what provides the funds and makes the scientific discovery possible and this only moderately, some would say weakly, relates to how far we ‘advance’ in terms of learning.

There is also a common idea that discoveries from psychology and neuroscience form the basis of interventions or changes to society, but much of the time, discoveries from psychology and neuroscience are co-opted to justify changes based on social values.

Here’s a really good example from p196 from the chapter on ‘The Antisocial Brain’ that discusses how the neuroscience of plasticity, the adolescent brain and child psychopathology has been used to justify family interventions.

By way of the brain, then, we reach a conclusion that does not differ greatly from arguments reaching back to the late nineteenth century about the effects of the early years on later propensities to problematic conduct.

From Mary Carpenter’s campaigns for colonies for dangerous and perishing children, through the social problem group and “the submerged ten percent” in the early twentieth century, via the mental hygiene movement in the 1930s, and arguments for setting up child welfare services in the years after the Second World War, to the contentious concept of the “cycle of deprivation” in the 1970s, and the interventions of the Head Start program to the Sure Start program – we find repeated arguments that one should minimize a host of social ills, including criminal and antisocial conduct, by governing the child through the family.

In each generation, unsurprisingly, these arguments are made on the basis of whatever happens to be the current mode of objectivity about the development of children – habits, the will, instinct theory, psychoanalysis, and today the brain.

Each time, the scientific programme is received as if it is a new approach to the problem of child deprivation and delinquency, when the success of these programmes lies precisely in the fact that they are largely the same. In this case, based on the idea that the family is the primary point of responsibility and intervention for poor adolescent behaviour.

Similarly, the success of neuroscientific approaches to problems often depends on how acceptable the implications would seem to potential funders because the money has usually to be agreed before significant lines of inquiry can be started.

This is why non-medical behavioural genetics research gets such a hard time. It’s not that it’s necessarily worse science in terms of its empirical methods but it reminds people of unsavoury practices like eugenics that run counter to prevailing values.

Neuro tracks exactly these sorts of interactions through history and between prevailing current interests. It is also brilliant technically, however, and you will actually learn a great deal about neuroscience methods from the book.

From the history and development of brain scanning techniques, to psychiatric drugs, to the rhetorical role of animal models in understanding mental illness, to how our notion of ourselves is changing in light of advances in brain sciences – it’s remarkably wide in scope.

Sociology is famous for its gobbledebook jargon, and this book has none of this, but its only drawback is that it is, in the end, an academic book and is sometimes written without much thought for the general reader.

But if you can tolerate the academic language, it is essential reading. If you want to understand neuroscience – rather than just facts about neuroscience – Neuro is probably one of the most important books you could read.

And the same goes if you are a neuroscientist or just interested in how we, as a society, are integrating the study of the brain into how we live.

Next in this three-part Mind Hacks series on science and society – Ben Goldacre’s Bad Pharma.

Link to more details about Neuro.

2013-11-29 Spike activity

Quick links from the past week in mind and brain news:

Science News reports on a ‘brain training’ app that actually seems to be a data gathering tool for big data neuropsychology research. Interesting if not a bit ethically dubious.

The US Military’s science wing DARPA wants to fix broken brains and restore lost memories. Interview with deputy director in Science.

Wired Science launches a new neuroscience blog called Brain Watch written by Mind Hacks alumnus Christian Jarrett.

Important piece in Nature about the Many Labs Project which did a mass replication of psychology studies find 10 out of 13 held up.

Slate has an excellent, explicit discussion of the results from the UK’s National Survey of Sexual Attitudes and Lifestyles.

Neurobonkers has an excellent piece reviewing the psychological biases that affect forensic science analyses.

Robots, the ‘uncanny valley’ and identity. Interesting piece in The Telegraph.

The Las Vegas Sun reports on a couple being released from prison after 21 years as evidence for ‘ritual satanic abuse’ based on ‘recovered memories’ and un-validated physical examinations is deemed to be flawed.

A new NeuroPod podcast has hit the wires – this one being a special from the 2013 Society for Neuroscience conference.

Discover magazine reports on a study finding that surprisingly, the more two negotiators match each other’s language styles, the worse things are likely to go.

Extending new senses through implanted magnets

In 2006, journalist Quinn Norton had a magnet implanted in her finger so she could ‘sense’ magnetic fields.

An article on the ABC Radio National website shows how this simple concept has been taken to its next level by the body modification community to find new ways of integrating magnetic fields into our senses.

Before I was prepped to have a magnet inserted in my fingertip, I had a conversation with my piercer, Kyla Fae, about placement…

I had thought that the only possibility was the finger, but apparently there are many fleshy parts of the body that are viable placement options.

‘I haven’t performed any in genitals, but I’m well aware of people with them,’ said Ms Fae.

‘If you’ve got a magnet in your lady garden or whatever, it will vibrate away near big speakers.’..

Some enthusiasts are also starting to get magnets that act as mini speakers implanted next to their ear. All it takes is a magnetic coil disguised as a necklace, an amplifier and MP3 player to have music piped straight to your brain.

Now imagine that in an MRI scanner. Fast Spin Echo sequence for the win.

Link to ‘Taking body modification to the extreme’.

You are a data series in a profit-making algorithm

If you only read one psychology article in the next few months, make it the startling and unsettling Atlantic piece on how ‘people analytics’ is being applied to managing, selecting, and promoting employees.

The idea behind people analytics is that job performance can be measured and predicted by analysing the huge amount of behavioural data generated by the digital tools we use or from specifically designed online tests.

The prediction part comes from analysing data across employees to find out, for example, what characteristics best predict a good team leader, or a poor performer, or someone who needs a specific sort of support or intervention to develop.

The potential power of this data-rich approach is obvious. What begins with an online screening test for entry-level workers ends with the transformation of nearly every aspect of hiring, performance assessment, and management. In theory, this approach enables companies to fast-track workers for promotion based on their statistical profiles; to assess managers more scientifically; even to match workers and supervisors who are likely to perform well together, based on the mix of their competencies and personalities. Transcom plans to do all these things, as its data set grows ever richer. This is the real promise—or perhaps the hubris—of the new people analytics. Making better hires turns out to be not an end but just a beginning. Once all the data are in place, new vistas open up.

In other words, the idea is to develop software that can identify predictors of specific behaviours and use them as the basis of management decisions.

Essentially, you have become a data series in a profit-making algorithm.

It is an important and fascinating article that is worth reading in full as it heralds a future of human resources that will be driven by ultra-personal data.

Link to Atlantic article ‘They’re Watching You at Work’.

2013-11-23 Spike activity

Quick links from the past week in mind and brain news:

Prosthetics to replace amputated hands can fall into the uncanny valley reports Science News.

The New York Times covers the nascent science of female aggression.

Can gambling machines prevent addiction? asks Scientific American Mind. Answer: of course. Will they? No.

NPR has an excellent piece by neuroscientist Tania Lombroso on whether pictures of brain scans have persuasive power. Only sometimes, it turns out.

The Dream Catcher. Matter has an in-depth piece about sadly over-hippied but genuinely fascinating subject of lucid dreaming.

io9 covers the psychology experiment that led to the phrase “thinking outside the box”.

Brain scans teach us nothing of morality says philosopher of mind Thomas Nagel in a street-fighting review of Joshua Greene’ new book.

NPR reports that your chance is being murdered is heavily to who you have in your social network.

Neuroscientist Kate Mills sets out a programme for understanding the interaction between networked culture and the adolescent brain in a talk from the Serpentine Gallery.

A ray directly from “Delhi University”

A series of ‘bizarre delusions’ from patients diagnosed with schizophrenia described in a new paper just published in the Indian Journal of Psychological Medicine:

“Some rays are there in me, which create magnetic field and I have the power to affect TV signals. Body is producing charge; whenever I touch anything I get electric current. Some heavenly body comes and makes me powerful and communicates with me.”

“My hands are changed into cat’s paws.”

“I have some special power, if I call the Sun then it will come to me, whenever I look at the Sun, it smiles back at me.”

“My rib-cage is left behind in the bathroom; while I was bathing it got washed away.”

“The heart is moving round the clock in different areas of the trunk.”

“A ray directly from “Delhi University (DU)” used to teach me the engineering course.”

Delusions are one of the central symptoms of psychosis and despite the fact that they can be both distressing and disabling, are often quite amazing in their complexity and content.

Link to article from Indian Journal of Psychological Medicine.

Listening for the voices of the dead

I’ve got an article in The Observer about our tendency to perceive meaning where there is none and how this inadvertently popped up in one of the strangest episodes in the history of psychology.

The article discuss the work of psychologist Konstantīns Raudive who began to believe that he could hear the voices of the dead amid the hiss of radio static – after, it must be said, much re-recording and amplification of the samples.

He wrote a 1971 book called Breakthrough where he explained his technique which was even accompanied by a flexidisc that has lots of not very convincing examples of the dead speaking through noise. You can listen to it on YouTube if you’re so inclined.

He gained widespread media attention but subsequent scientific studies found that everyone was hearing something different amid the static, making it one of the most well-know examples of illusory meaning or pareidolia of its time.

However, the experience of illusory meaning has become widely studied for its relationship to magical thinking and hallucination but was even recently deployed as a practical tool for the assessment of dementia.

More in the full article at the link below. It’s been given a somewhat odd title but hopefully, it should be fairly self-explanatory.

Link to Observer article on illusory meaning.

With every language, a personality?

The Medieval Emperor Charlemagne famously said that “to have another language is to possess a second soul” but the idea that we express different personality traits when we speak another language has usually been left as anecdote.

But The Economist takes this a step further and examines the science behind this idea – which may have more weight than we might first think.

It looks at the issue from lots of intriguing angles. Perhaps the most obvious is that bilingual speakers may have different associations with each language – for example, home and work – and so come to associate different sorts of social behaviours with each.

One of the most interesting is how different language structures might allow for different behaviours, although a grammatical explanation for why the Greeks having a tendency to interrupt during conversation is given short shrift

Is there something intrinsic to the Greek language that encourages Greeks to interrupt?…

In this case, Ms Chalari, a scholar, at least proposed a specific and plausible line of causation from grammar to personality: in Greek, the verb comes first, and it carries a lot of information, hence easy interrupting. The problem is that many unrelated languages all around the world put the verb at the beginning of sentences. Many languages all around the world are heavily inflected, encoding lots of information in verbs. It would be a striking finding if all of these unrelated languages had speakers more prone to interrupting each other. Welsh, for example, is also both verb-first and about as heavily inflected as Greek, but the Welsh are not known as pushy conversationalists.

There’s plenty more interesting analysis in the Economist article and it turns out the magazine’s language blog, called Johnson (relax Americans, it’s a reference to Samuel Johnson) is very good as a whole.

Link to ‘Do different languages confer different personalities?’