May 25 2018

ADHD Is Not a Fake Illness

The headline on this dubious health website reads: “ADHD is a FAKE Disease Invented by Big Pharma to Drug Children for Profit.” Every bit of that headline is made up, ironically – it’s fake. I have written about ADHD previously, and also about mental illness denial itself. This is a common theme among proponents of alternative medicine or snake oil treatments, because it is a rhetorically convenient way to attack mainstream medicine and bolster medical conspiracy theories.

Let me dispense with the easy parts first – the diagnosis of attention deficit hyperactivity disorder (ADHD) was not “invented by Big Pharma.” Unsurprisingly, the article provides exactly zero evidence to support this conspiracy claim. Right there the author of this article, and the hosting site, have lost all credibility. This is a specific and dramatic factual claim. Any responsible journalist, or author on a site that takes it upon itself to dispense medical advice, would have invested the five minutes it would take to discover that it is not true.

It literally took me 30 seconds to find this reference, a published article detailing the history of the ADHD diagnosis (so someone less Google savvy might take 5-10 minutes, but I just searched on “history of ADHD diagnosis”). The medical profession does have a tendency to write things down and publish their observations and musings about medicine. This leaves a nice paper trail for any medical historian to follow. The first descriptions of something similar to ADHD go back to the 18th century. Sir Alexander Crichton published an entire book “On Attention and its Diseases” in 1798.

It is also interesting to note that, right from the beginning, it was recognized that disorders of attention are multifactorial:

“A distraction of attention does not necessarily have to be pathological, e.g. mental stimuli, volition, or education can have a great impact on healthy attention.”

What a concept – a behavior as complex as attention is the result of a combination of inherent ability and environment. In the subsequent 200 plus years our concept and knowledge of ADHD evolved, documented in the DSM, the standard manual of mental disorders. There is also a vast published literature on ADHD. Searching PubMed on ADHD results in over 2000 references. The second of which is a helpful review of the genetics of ADHD, in which they estimate that the heritability of ADHD is 30-40%. Roughly that means that the disorder is 30-40% genetic and 60-70% developmental or environmental.

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May 24 2018

Elon Musk Attacks the Media

When you are a celebrity billionaire, your Twitter rants tend to garner media attention. Elon Musk recently unleashed his true feelings about the media in a Twitter fight with various people. You can read the whole exchange, but here is the money quote:

Thought you’d say that. Anytime anyone criticizes the media, the media shrieks “You’re just like Trump!” Why do you think he got elected in the first place? Because no ones believes you any more. You lost your credibility a long time ago.

Let me start by saying that overall I am a fan of Musk. I love SpaceX, the whole idea of private space flight, and got choked up the first time I saw a rocket landing vertically. Musk has a vision and he is getting it done. Sure, he has made mistakes and there is a lot you can criticize, but I love that he is trying.

But one of the side effects of the internet and social media is that public figures have become much more personal. Prior to Twitter, you probably wouldn’t have had an opportunity to trade barbs with a famous billionaire. They no longer necessarily live behind a carefully crafted public image. This often means we get to see the good, the bad, and the ugly of these public figures.  As a result there are many instances where people we might admire for one particular achievement reveal themselves to have unsavory characteristics, or just to be the flawed people that down deep we know everyone to be.

This is healthy, in my opinion. Valuing hard work, skill, talent, and virtuous qualities is a good thing, but hero worship isn’t. It’s just another way to lose objectivity.

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May 22 2018

Alien Cephalopods and Panspermia

A recent paper in Progress in Biophysics and Molecular Biology, Cause of Cambrian Explosion – Terrestrial or Cosmic?, has caused quite a stir. I think that was the intention, and the majority of journalists ate it up, either not caring if the science was good, or not able to tell.

One main point of the paper is that the Cambrian Explosion – the geologically rapid event about 550 million years ago in which multicellular life appears in the fossil record – was so rapid because it may have been the result of alien genetic information. The authors further argue cephalopods, especially the octopus, are so amazing because they either incorporated alien genes into their makeup, or they are completely alien, coming to earth as cryopreserved eggs inside comets. The third leg of their alleged evidence for panspermia is microfossils found in meteorites.

All three arguments are utter crap. The underlying claim of panspermia – that life has seeded the galaxy from one or a limited number of initial sources – is highly problematic but perhaps not 100% nonsense.

The Three Lines of Evidence

Many science bloggers have trashed this article, doing damage control for the irresponsible journalists who probably should not be covering science stories. I will only quickly summarize here.

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May 21 2018

Solar and Wind Power and Energy Balance

My latest post sparked a bit of conversation, which is typically the case when the topic has a politically controversial angle. The question, an important one that we are currently facing as a society, is how to chart the best path forward in terms of our energy infrastructure. There is legitimate debate among experts on this question because of the various trade-offs and the uncertainty of projecting technology even a little bit into the future. There are many complex variables, and how you account for all of those variables can affect the bottom line.

As is also often the case, the more political a topic the more propaganda and nonsense seeps into the conversation. In such cases not only do we have to contend with a lack of information, but there is actual misinformation to address first. And that misinformation is not random or due to error – it is manufactured with a purpose, motivated misinformation, if you will.

Usually I (and others) will address such issues in the comments themselves, but occasionally correcting important misinformation requires a blog-length response. One comment in particular was a string of error representing common propaganda, that I thought worth addressing at length:

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May 18 2018

Renewable Energy Debate

Do we currently have the technology to create an energy infrastructure that is based 100% on renewable energy? That is a legitimate and very useful debate to have, and one that is playing out in the published literature.

Two recent systematic reviews in particular take opposite sides of this question. In one Heard et al argue that the burden of proof for feasibility and viability have not been met. In the same journal, Brown et al respond, saying that 100% renewable is both feasible and viable.

Both articles get fairly wonky, but they are reasonably easy to follow for the main points.

Heard argues that studies looking at plans for total renewable energy fail to consider critical factors, such as the feasibility of grid storage, of load balancing, and the necessary ancillary services required to maintain such a grid. They conclude that we would have to reinvent the electrical grid and infrastructure if we wish to go to 100% renewable.


Brown responds by arguing that only incremental advances to evolve our energy infrastructure are needed, and that 100% renewable are feasible with current technology, and economically viable.

From reading both papers, which if you are interested in this topic I suggest you do, I came down somewhere in the middle. I give the edge to Brown, but I think he and his coauthors made a bit of a biased case for renewables. Meanwhile Heard, I think, overemphasized current limitations. I got the sense that both were making a lawyer’s case for their side.

Here is what I get from these articles: First, it seems clear that we are capable of making sufficient energy from renewable sources to meet world demand. Further, renewable energy is cost effective, and the price is continuing to drop. So energy production is simply not the problem.

Further, renewables (mostly wind and solar) have some strong advantages. The first is that they are renewable – they do not depend on a limited resource that will eventually run out. The second is that they do not directly release carbon into the environment. There is a carbon footprint associated with the production of solar panels and wind turbines, but this is a small fraction of other energy sources.

Also, if you consider the externalized costs of the environmental and health effects of fossil fuels, non-polluting energy sources are massively cost effective.

So where are the problems? Renewable energy’s main downside is that they are intermittent, not on-demand. This creates challenges for grid stability, balancing supply and demand, grid storage, and reserve capacity for occasional dry spells (sustained periods of low light or low wind).

Both authors agree that right now we do not have the infrastructure to deal with significant renewable penetration. They differ about how radically and quickly we would have to change or infrastructure – but we have to change it.

Grid storage is clearly needed, and this is the main area where I disagree with Brown. He suggested that existing grid storage options are adequate, and even gave a positive nod to lithium ion batteries.

However, while he gave us calculations on the finite amount of uranium in the world, there was no mention of the finite amount of lithium and rare earths. We may find more reserves of lithium, but we may also find more reserves of uranium. We may find substitutes for lithium and the rare earths, but we also may develop thorium reactors (thorium is much more abundant than uranium).

In any case, I simply don’t think we are there yet with battery technology. We are making steady incremental advances, and I think we will get there, but we may be 10-20 years away from a viable widely distributed system of grid storage based on battery technology.

There are other options, which I review here, but none of them great. Pumped hydro is the best, but is limited by terrain. We may need to develop hydrogen fuel cells, use renewables to make hydrogen, and use the hydrogen to store the energy. But this will require a massive change to our energy infrastructure.

This is where I think Brown skirted some real issues. He essentially argued that there are options that do not require any new technology or massive upgrade to the system, and there are options that can meet all our demands. But these are not the same options – there are no options that meet all the criteria he detailed at the same time.

Another alternative to grid storage to level off supply and demand is simply demand capacity – creating electricity on demand as needed. Brown acknowledges that worst case we may need to keep some fossil fuel plants on hand to meet demand needs.

He also points out that nuclear is not a good option for demand power generation. Nuclear plants operate most effectively when they are always on a peak production. But there is a recent analysis that indicates that nuclear power plants can produce variable power to meet demand, and that this would improve the economics of nuclear power.

I also think he does not consistently apply his criterion of viability of not requiring any new technology. I agree that we should not count on any technological breakthroughs, like fusion reactors. But I do think we can count of incremental advances that are already in the pipeline. This should apply equally to nuclear as to battery and solar technology.

I do agree with the bottom line conclusion of all the authors that we need to have a healthy evidence-based debate about how to move forward. We cannot make plans without a detailed analysis of technological feasibility and economic and political viability.

We need to chart a course forward that will get us to a sustainable minimal carbon energy infrastructure as soon as possible and in the most cost-effective way.

But at this time I do not think there is on clear option, because every options has serious limitations that will require some technological advances and significant upgrades to our infrastructure.

I think we still need to explore all our options. Clearly we will benefit from continued incremental advances in solar, wind, and battery technology. But I also think there is tremendous potential for advances in nuclear technology, and that we should not ignore this option.

We need to explore all our grid storage options, and will likely need a system that uses many components, optimized to location and other considerations.

The good news is that I think we will get there. The economics is on the side of renewables, and that will ultimately drive the development. The big  variable right now is time – how much carbon will we release and with what consequences before we move to mostly low-carbon energy?

This is where political will comes into play. And here, I think all we may need is to properly consider the externalized costs of fossil fuel. If fossil fuel use has to pay for the health and environmental effects, all other forms of energy become a no-brainer.

 

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May 17 2018

California Rules Coffee a Carcinogen

California Superior Court Judge Elihu Berle ruled, in accordance with Proposition 65 law, that coffee is a carcinogen and requires a warning label in the state of California. This ruling, however, is not in accord with science and rational medicine.

What went wrong are all the things that can go wrong when trying to assess health risk.

The ruling is based on the presence of acrylamide in coffee. There is evidence that acrylamide is a potential risk factor for certain cancers. This is based mostly on animal and in vitro studies.

How scientists determine that a substance is potentially a cancer risk is a little complex, since we cannot do direct clinical studies. It is unethical to expose a subject to a potential carcinogen to see if they get cancer. So we start with studies on cells and animals.


These types of pre-clinical studies, however, can only tell us about hazard, not risk. A hazardous substance is something which can theoretically cause harm depending on exposure, while risk is actual harm caused by exposure in a certain population to a certain dose over a certain period of time.

Think of it this way – sharks are hazardous, but a shark in a tank poses very little risk. Swimming with sharks in that tank, however, poses a high risk.

So how do we determine the risk to humans of a substance which is potentially hazardous based on pre-clinical studies? For that we rely on epidemiology and observational studies. If we, for example, ask people about their coffee drinking habits, and then track them over time for the development of cancer, we can then make comparisons and see if drinking coffee correlates with increased cancer risk.

There are many shortcomings from this type of data, however, specifically the potential for confounding factors. Drinking more coffee may correlate with more smoking, or consumption of other hazardous products, for example. You can try to control for possible confounding factors, but not the ones you are not aware of. So this limits the utility of such data.

Even still, it is possible to build a robust base of evidence clearly showing risk. If the observational studies all triangulate to only one plausible cause, then we can be highly confident of that interpretation of the correlations. Smoking, for example, correlates with risk of lung cancer every possible way you can look at the data. This is a solid causal link.

The same solid link does not exist for acrylamide in coffee. Therefore coffee is deemed only a probable cause of cancer by the IARC, which is a notoriously cautious body that errs on the side of calling substances “probable” carcinogens. Essentially, if some hazard shows up in pre-clinical studies, but there is no clinical evidence of actual risk, they still call it “probable.”

California law then takes the IARC “probable” and turns that into “coffee causes cancer.” In each step the precautionary principle ratchets up the warning, until we go from no clinical evidence of actual risk, to a required warning label that it does cause cancer.

This approach, however, is not without its own risk, turning the precautionary principle on its head.

As I reported previously on SBM, a 2013 study found that 72% of random ingredients from a cookbook had published data showing that they increased the risk of some cancer. What is the public supposed to do with this information?

There are two real risks here, the first of which is what is called alarm fatigue. If you set your threshold for warning alarms too low, then the alarms will always be going off, and people will learn to ignore them.

Do you think many people will stop drinking coffee because of the warning? I wonder what percentage will give up their daily coffee habit based on this decision. Most people will likely (and correctly) file this away as a manifestation of the overly cautious CYA nanny state and ignore the warnings. But this makes it more likely they will ignore more meaningful warnings about actual risk that they should be listening to.

If everything causes cancer, then perhaps nothing really does, and you should ignore all such warnings. The warnings themselves become useless.

There is also the opposite risk, that some people, in the sincere desire to be healthy or out of anxiety, will try to heed all such warnings. This can lead to what some are calling “orthorexia” (not currently a recognized clinical term), in which people excessively restrict their diet in the hopes of avoiding risky food.

If 72% or so of foods or ingredients can be linked to cancer, and you try to avoid them all, then what will you eat? What are the risks of such a highly restrictive diet? I strongly suspect that if you followed all the warnings about potential risks of foods, there would be net harm from poor nutrition.

There is also an opportunity cost to spending so much time and effort carefully vetting everything you eat for any possible risk. That time could be better spend on more fruitful healthy activities.

There is also an industry of self-help advice turning these public warning into marketable fearmongering. They have essentially been “weaponized” for either marketing or to promote various ideological agendas. The anti-GMO campaign is perhaps the best example.

The state should be trying to mitigate these counterproductive forces, not aid them. If anything they should be a mediating force, putting together panels of experts to create sober and useful bottom-line advice for the public, advice that people can plausibly used, and designed to minimize unintended consequences.

California’s approach, I think, is harmful. In an endeavor to protect the health of their citizens I think they are harming health. They are also potentially undercutting faith in experts an expertise itself, which has further downstream negative consequences.

This is the precautionary principle out of all control.

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May 15 2018

Homeopathic Nosodes

Homeopathy is bunk. Most people I encounter who disagree with this statement do not actually know what homeopathy is. They think it is some kind of herbalism or natural medicine. No – it is a prescientific superstition-based system of magic potions.

The basic idea is that you start with a fanciful treatment based on notions like sympathetic magic and incidental characteristics (like hair color). Then you dilute that fanciful treatment out of existence – so it doesn’t really matter anyway. Homeopathy is literally nothing, but homeopaths believe that the magical “essence” of the substance remains.

Unsurprisingly, clinical trials of homeopathic potions have convincingly shown that homeopathy works for nothing. So it can’t work, and in fact it doesn’t work.

So why is homeopathy still a thing? That is a fascinating question dealing with culture, human psychology, and political failure.

There is also an aspect of homeopathy that dovetails with another pseudoscience – the anti-vaccine movement. Homeopathic nosodes, which are just as useless as all other homeopathic potions, are offered as a substitute for vaccines. This way you not only waste money on a worthless health scam, you also forgo safe and effective medicine – a nice double whammy.

Nosodes are prepared by taking body fluid from a diseased person or animal and then diluting it so that you have – water. This water is then given to prevent the disease that the person or animal from which the fluid was taken had.

In addition to giving fake medicine instead of effective medicine to prevent a serious and communicable disease, there is some risk to the preparation process itself. Homeopaths are making nosodes of HIV, ebola, Hepatitis, and other serious infectious diseases. That’s right – their answer to the HIV epidemic in Africa, or to ebola outbreaks, is to give their fake medicine.

Are there any clinical trials of homeopathic nosodes that show they work? No. Homeopaths largely rely upon what they call a “homeopathic pathogenetic trials.” This is a great example of pseudoscience, because it follows some of the forms of real science, but isn’t doing actual science.

Here is one of an HIV nosode – they basically give 15 volunteers water, I mean an HIV nosode, and 7 volunteers water, I mean placebo. The volunteers are trained to record every symptom they experience. Over four weeks the HIV nosode water group recorded 130 symptoms, while the placebo water group recorded 60 symptoms. Those ratio’s are remarkably similar to the number of people in each group – twice as many people reported twice as many random symptoms. Shocking.

This is what passes for science in homeopathy. What they rarely do are actual efficacy trials designed to answer the real question – do the potions work? When high quality efficacy trials of homeopathy are done, they usually turn out negative, and systematic reviews have all been negative. So they mostly don’t bother with such trials, instead doing their HPTs, and observational trials, or looking at markers, so that they can pretend they are doing science.

This nonsense isn’t limited to humans. Recently there was outrage over homeopathic nosodes given to pets. These cats and dogs might get serious and preventable diseases because their owners relied on homeopathic nosodes they purchased on Amazon instead of real vaccines.

Opting for homeopathic remedies in favour of vaccines can be the cause of fatal viral diseases including parvovirus and herpes virus, the RSPCA said.

The former kills nine in 10 dogs who contract it, the latter can prompt a pregnant dog to abort her puppies or kill an entire litter of young puppies to die over 24 hours.

The British Veterinary Association said that skipping vaccinations can also be the cause of zoonotic diseases, such as canine leptospirosis, which can be infectious to humans.

Allowing people to die from fake vaccines is one thing, but you cross a line when you allow cats and dogs to die from preventable infections.

What I don’t get is the unwillingness to properly deal with homeopathy from a regulatory standpoint. Why is the political will lacking? It seems that part of the problem is that many politicians are not scientists or even minimally scientifically literate. But odds are most still realize that homeopathy is snake oil, or at least would listen to the overwhelming scientific consensus that homeopathy is snake oil.

There just doesn’t seem to be any political incentive to do so. This is a manifestation of a broken political system, where there is insufficient motivation to do something so obviously beneficial and correct like banning 100% fake medicine. But I also think this is a failure of the scientific and academic communities. There is a paucity of outrage at the infiltration of pseudoscience into our culture and our medical system. That is our fault. And if we lack proper outrage, how can we expect others to have it?

The underlying problem is that many snake oils like homeopathy fly under the radar. Many doctors don’t know what it is, do not know how much it has insinuated itself into the system, and don’t know the regulations. They are happy to ignore it and assume it is a small and benign fringe. They are wrong. This situation is easily remedied through education. Once properly informed, most health care professionals are properly outraged. Let’s have more of that.

 

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May 14 2018

AI Accurately Mimicking Humans

Recently Google pushed the envelope a bit further with its Duplex chat bots. This is an artificially intelligent (AI) system designed to mimic natural-sounding human speech and interaction. Take a listen to the conversations on the link above, they are pretty convincing.

I do think, knowing ahead of time that I was listening to a bot, I can sense the computer algorithm at work rather than a real person. However, I do wonder if I would have detected it if I were blinded to whether or not the conversation was with a bot, and especially if I wasn’t even alerted to the possibility.

It seems that every time there is an incremental advance toward more human looking or acting robots or software, it sparks a conversation about the implications of this technology. Google Duplex is no exception. Not long after they announced and demonstrated their software, they had to announce that they would always warn people when they are speaking with a bot. It’s interesting, because that may defeat the whole point.

Google says it developed the technology so that people will feel at ease when doing business with AI, because the conversation will feel natural. However, (at least some) people feel creeped out instead. People may feel somehow deceived and even violated if they find out they thought they were talking to a person when in fact they were talking to a machine.

That is an interesting psychological question in itself, one that will likely become increasingly relevant as our world fills with AI and robots.

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May 11 2018

The Evolution of Baleen Whales

A recent survey finds that knowledge of evolution correlates with acceptance of evolution. This was widely reported as suggesting that educating the public about evolution could lead to higher rates of acceptance. Sure, but to be clear the survey does not actually show this. We can also interpret the same data to suggest that acceptance of evolution leads to greater knowledge of it.

This latter interpretation makes sense in light of the fact that there is a tremendous amount of misinformation about evolution from creationist sources. If you are anti-evolution for ideological reasons, you are likely to be highly misinformed about the science because your rely on secondary hostile creationist sources for your information. If you accept the scientific consensus on evolution, you may be more likely to avail yourself of legitimate scientific sources of information.

But probably both factors are at play, and we certainly should strive to improve public education about evolutionary science. It is a complex and subtle science that is poorly understood by the public. The survey also found that 68% of those surveyed failed to demonstrate a basic knowledge of evolutionary theory. And it is certainly easier to spread misinformation about a science the public generally does not understand. In this case knowledge would be a good defense against propaganda.

It is also true that the evidence for the basic fact that life on Earth is the result of evolutionary processes is a scientific home run. It is a phenomenally well-established fact, with no viable competing theory. This often creates the naive belief among those with a solid understanding of evolution and the evidence for it that if they could only explain that evidence to a typical creationist, they will win them over with the massive force of that evidence. That does sometimes happen, but more often evidence is no match for motivated reasoning.

With all that said, I am still going to write about the evidence for evolution in the hopes of nudging public acceptance even a little.

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May 10 2018

False Dichotomy and Science Denial


Psychologist Jeremy Shapiro has an interesting article on RawStory in which he argues that one of the pillars of science denial is the false dichotomy. I agree, and this point is worth exploring further. He also points out that the same fallacy in thinking is common in several mental disorders he treats.

The latter point may be true, but I don’t see how that adds much to our understanding of science denial, and may be perceived as inflammatory. For example, he says that borderline personality disorder clients often split the people in their world into all bad or all good. If you do one thing wrong, then you are a bad person. Likewise, perfectionists often perceive that any outcome or performance that is less than perfect gets lumped into one category of unsatisfactory.

I do think these can be useful examples to show how dichotomous thinking can lead to or at least support a mental disorder. Part of the goal of therapy for people with these disorders is cognitive therapy, to help them break out of their pattern of approaching the world as a simple dichotomy. But we have to be careful not to imply that science denial itself is a mental illness or disorder.

Denialism and False Dichotomy

A false dichotomy is a common logical fallacy in which many possibilities, or a continuum of possibilities, is rhetorically collapsed into only two choices. People are either tall or short, there is no other option. There are just Democrats and Republicans.

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