Sunday, January 29, 2006

Never trust a scientist. Or an alcoholic.

Foxy: "Whatcha reading there?"
Cali: "Its an essay in PLoS Medicine explaining why most published research findings are false."
Foxy: "Wow. What's it called?"
Cali: "'Why most published research findings are false.'"
Foxy: "And why are they?"
Cali: "Well, the guy reduces it down to a pretty simple relationship between positive predictive value, error rate and bias; PPV = ([1 − β] R+uβR )/( R+ α − β R+u−uα +uβR )"
Foxy: "What?"
Cali: "PPV = ([1 − β] R+uβR )/( R+ α − β R+u−uα +uβR )"
Foxy: "And, umm, what does that mean?"
Cali: "I've got no fucking idea. But, still, are you surprised?"
Foxy: "That more than half of all published science is wrong? Not really. Most scientists use blind faith as a benchmark, arrogance as their guide and follow trends with all the awareness of a fourteen year old girl walking into Abercrombie and Fitch. No, not really surprised."
Cali: "Of course publication, or numbers of publications, are the currency of scientific careers, so its not likely to change. Maybe if those who regularly publish results later proven to be false were to face some kind of consequence?"
Foxy: "Yeah, make em appear on Oprah; 'I feel duped'. Did you see Frey last week? Looked like someone had sprinkled coke on his cornflakes."
Cali: "But she didn't ask the question that really needed answering - if he told a million little lies about his past life and relationships, did he also lie about the road to his recovery? Did he really travel it alone, without the twelve steps and a serenity prayer to his higher power? Inquiring alcoholic minds need to know."
Foxy: "A few persuasive words from the associates of his friend Leonard might be a more effective way to the truth. Another trip to the dentist's chair maybe?"
Cali: "Couldn't be much more painful than Oprah's couch. Who can you trust these days though?"
Tom: "Me! Me! Trust me!"
Foxy: "Oh for fucksake. Did you let him in?"
Cali: "No, he must have been hiding in the closet. So you're here to tell us the Truth, Tom?"
Tom: "You can't handle the truth!"
Foxy: "That wasn't you Tom, that was Jack shouting at you. And, no offence Tom, but you're no Jack."
Tom: "I'm no Jack, I'm Tom! I'm Tom!"
Cali: "Jesus. Can you get him off the couch and back into the closet? I'm off for a drink."
Foxy: "You quit drinking, remember?"
Cali: "Whatever. Maybe I was lying ....."

Friday, January 13, 2006

So, Santa's Really Imaginary?

We returned from the hols spent in the UK. Being my first sober Xmas/New Year for quite a while (!) it was actually more fun than I'd anticipated. Yup, still sober.

While we were there, there was some discussion as to whether the time had come to disabuse my ten year old niece of the notion that Santa Claus (Father Christmas as they call him over there) exists. I think she'll wake up to cruel reality soon enough without anyone forcing it on her. Besides, I merely traded in Santa's sleigh for Tanqueray, so who am I to do the waking. Of course, addiction is not the only sleigh ride from reality that some of us embark on. For instance;

A famous hollywood starlet ranted "There's no such thing as a chemical imbalance!"on morning TV not so long ago. Of course, Tom Cruise also believes that humanity's problems stem from the implantation of negative memories into the souls of our forefathers by extraterrestrial detainees visiting Earth on intergalactic DC-8's. But still, could there be at least a grain of truth in what poor deluded, sexually insecure, couch jumping Tom has to say?

zoloft blob

Not according to the Zoloft TV commercial in which a very unhappy blob creature is transformed into a happy one with the aid of this SSRI anti-depressant, a class of drugs pioneered by Prozac, market led by Zoloft and diversified by Paxil. In the Zoloft commercial we're told, with the aid of a diagram of a nerve synapse captioned with the disclaimer that its only a representation (lest we believe its the real thing), that depression may result from a chemical imbalance in the brain and that Zoloft works to correct this imbalance. The commercial confidantly states that "scientists believe that it could be linked with an imbalance of a chemical in the brain called serotonin", a belief founded on a theory proposed about forty years ago.

The fact is, though, there is no actual direct evidence for serotonin imbalance in depression. Scientists can't yet directly measure serotonin levels in the brains of depressed people. Of course they can measure serotonin levels in the brains of dead people, but I'd guess that most people get a bit down just before dying. In fact, the supposed success of SSRI anti-depressants, which boost serotonin by blocking its reuptake at synapses, is itself most often cited as proof of the hypothesis. This is a little like explaining headaches as being the result of aspirin deficiency and is about as good a piece of evidence as finding the cookies and milk eaten on Christmas morning. In fact, one could argue that the additional presence of the carrot, half eaten by reindeers, provides stronger support for Santa's existence.

But, if the drugs work, why should we care whether the pharmaceutical industry markets SSRI's by misrepresenting scientific findings. Well, leaving aside the question of whether or not they do indeed work (in case you're wondering, I've been taking Lexapro for years now), claiming a collective scientific belief legitimizes prescription not only for depression, but apparently for a whole host of other ailments including anxiety, panic, obsessive-compulsive and pre-menstrual dysphoric disorders. Just how such a variety of disorders with widely different behavioral symptoms could all be due to serotonin imbalance is beyond me, though not the FDA's guidelines apparently. Curiously the pharmaceutical companies also market new anti-depressants which don't act via serotonin - Wellbutrin and Edronax, for instance - which perform just as well as SSRI's in trials. To my knowledge their commercials don't claim "scientists don't believe that it could be linked with an imbalance of a chemical in the brain called serotonin".

Ultimately, it seems to me the only difference between the belief systems of kids at Xmas, the pharmaceutical industry and Tom Cruise is that the kids don't ram it down our throats on TV (though they may occasionally jump on the couch).

Still, at least Pfizer doesn't care if we've been naughty or nice.