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Posts Tagged Psychological

Battle for the iPhone Might Make You Like it More Darcy Cowan Oct 01

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I happened to be browsing and saw a review of the newly released iPhone 5. On a whim I figured I’d have a look, turned out the most interesting part of the review for me was the misunderstanding of psychology in the opening paragraphs.

In setting up how “everyman” their acquisition of the new phone was the author provided a teaching moment on the ins and outs of investment bias and how we prefer things when they are hard to get.

Here’s the extract of relevance:

“Just to be clear, this isn’t some corporate review unit we’re talking about—we waited outside at the hellacious crack of dawn in a hell-pit shopping mall alongside people who were willing to actually hit each other for a new phone. We battled line-cutters and a shifty AT&T retail manager. I wasn’t due for a new contract, so I ponied up extra money for a semi-subsidized handset I was truthfully only buying because I shattered my last one.

I say this both because we got this phone like most people did, and because it was a gigantic pain in the ass. I had every reason to resent the iPhone 5. And yet…”

This might be intuitive but actually gets the psychology precisely backwards. We actually value things more highly if we are force to go through hardship to get them.

A similar effect is seen with the (now illegal) “hazing” rituals of American college fraternities. These groups would put new recruits through torturous initiation rites. You would think that any normal person would despise with a passion the person or group that did this to them but that’s not the case; these rituals inculcate a fierce loyalty to the group.

One theory to explain this is that of Cognitive Dissonance, the reasoning goes that people are justifying the effort by convincing themselves that they really like the group/item/task that they had to go through so much pain to join/get/complete because otherwise they are some sort of moron. Ok maybe not quite in those terms, but you get the idea.

To illustrate this from a slightly different perspective here’s the defining early experiment demonstrating the effect. Participants in the study had to complete an extremely boring task (adding and removing spools from a tray and turning pegs for about an hour). They were then paid to lie to a new participant about how enjoyable the task was, for this they were pain either 1$ or $20.

After this the participants rated honestly how enjoyable they found the task.

Those who were paid $20 predictably rated the task as boring, but those paid only $1 rated it as relatively more enjoyable.

These participants had done something relatively distasteful (lying) for very small reward ($1), as such they had two choices consider themselves liars or alter their attitudes about the task to seem like they hadn’t really lied at all. Being the heroes of their own story, as we all are, they “chose” the second option.

How does this relate to the hardship of getting an iPhone on release day? Well, if you go through all that effort you are either a schmuck, or the product really is that good. I know which one I’d rather believe.

That’s not to say the phone isn’t that good, could be. But it is one more thing to cement loyalty to the brand. Maybe other brands should take note.

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Filed under: Psychological, Sciblogs Tagged: Cognitive Dissonance, IPhone, Science and Society

Battle for the iPhone Might Make You Like it More Darcy Cowan Oct 01

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I happened to be browsing and saw a review of the newly released iPhone 5. On a whim I figured I’d have a look, turned out the most interesting part of the review for me was the misunderstanding of psychology in the opening paragraphs.

In setting up how “everyman” their acquisition of the new phone was the author provided a teaching moment on the ins and outs of investment bias and how we prefer things when they are hard to get.

Here’s the extract of relevance:

“Just to be clear, this isn’t some corporate review unit we’re talking about—we waited outside at the hellacious crack of dawn in a hell-pit shopping mall alongside people who were willing to actually hit each other for a new phone. We battled line-cutters and a shifty AT&T retail manager. I wasn’t due for a new contract, so I ponied up extra money for a semi-subsidized handset I was truthfully only buying because I shattered my last one.

I say this both because we got this phone like most people did, and because it was a gigantic pain in the ass. I had every reason to resent the iPhone 5. And yet…”

This might be intuitive but actually gets the psychology precisely backwards. We actually value things more highly if we are force to go through hardship to get them.

A similar effect is seen with the (now illegal) “hazing” rituals of American college fraternities. These groups would put new recruits through torturous initiation rites. You would think that any normal person would despise with a passion the person or group that did this to them but that’s not the case; these rituals inculcate a fierce loyalty to the group.

One theory to explain this is that of Cognitive Dissonance, the reasoning goes that people are justifying the effort by convincing themselves that they really like the group/item/task that they had to go through so much pain to join/get/complete because otherwise they are some sort of moron. Ok maybe not quite in those terms, but you get the idea.

To illustrate this from a slightly different perspective here’s the defining early experiment demonstrating the effect. Participants in the study had to complete an extremely boring task (adding and removing spools from a tray and turning pegs for about an hour). They were then paid to lie to a new participant about how enjoyable the task was, for this they were pain either 1$ or $20.

After this the participants rated honestly how enjoyable they found the task.

Those who were paid $20 predictably rated the task as boring, but those paid only $1 rated it as relatively more enjoyable.

These participants had done something relatively distasteful (lying) for very small reward ($1), as such they had two choices consider themselves liars or alter their attitudes about the task to seem like they hadn’t really lied at all. Being the heroes of their own story, as we all are, they “chose” the second option.

How does this relate to the hardship of getting an iPhone on release day? Well, if you go through all that effort you are either a schmuck, or the product really is that good. I know which one I’d rather believe.

That’s not to say the phone isn’t that good, could be. But it is one more thing to cement loyalty to the brand. Maybe other brands should take note.

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Filed under: Psychological, Sciblogs Tagged: Cognitive Dissonance, IPhone, Science and Society

Guess what Percentage of the World Thinks it Will End In Their lifetime? Darcy Cowan May 07

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The optimist in me (no sniggers please it’s not polite) would liked to have thought that this percentage is quite low. You know, in the barely worth mentioning category. Alas, according to a poll conducted by Ipsos the world average is about 14%.

One in seven.

Think about that for a second.

One seventh of the world thinks they will see the end of civilisation as we know it.

One prediction has only a few weeks to go before hitting the cold light of reality, it won’t be the last. Why? I don’t know – You tell me.

I’ve given up, people are crazy.

Filed under: Hoaxes, Psychological, Sciblogs, skepticism Tagged: end-of-the-world, Science and Society

Guess what Percentage of the World Thinks it Will End In Their lifetime? Darcy Cowan May 07

No Comments

The optimist in me (no sniggers please it’s not polite) would liked to have thought that this percentage is quite low. You know, in the barely worth mentioning category. Alas, according to a poll conducted by Ipsos the world average is about 14%.

One in seven.

Think about that for a second.

One seventh of the world thinks they will see the end of civilisation as we know it.

One prediction has only a few weeks to go before hitting the cold light of reality, it won’t be the last. Why? I don’t know – You tell me.

I’ve given up, people are crazy.

Filed under: Hoaxes, Psychological, Sciblogs, skepticism Tagged: end-of-the-world, Science and Society

Future History: Apocalypse Then Darcy Cowan Mar 29

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End of the world predictions and scenarios abound, we have always been fascinated with our own demise it seems. Last year I covered the predictions of Harold Camping and the relatively small following he had in his advertising the apocalypse campaign.

This year we have the Mayans to blame and it’s rather more wide spread than a few eccentric Camping followers. In my previous post I essentially put together and End of the World retrospective, surveying a small number of past predictions that failed. This time showcase the many predictions that still lie in our future.

Behold the Future History of the Apocalypse!

[Edit] I tested the Vodpod code on the Sciblogs platform and it didn’t work but the syndicated version does. If you still have trouble viewing then go Here  or Here to see the timeline.

NB. Where I couldn’t find or couldn’t be bothered looking for exact dates 1-January was substituted. Click the individual events to find the person who predicted it, move the sliders at the bottom to zoom in and out of timeframes.

Timeline Key:

Sources are given by letters, links below or can be copied from the timeline with a right click.

ABHOTA , AV  , MB , CoB , RT , L , WZ

Sources are of varying veracity and humour.

What I found interesting was the fact that the dates are mostly clustered in the period covering the next 40 years or so. Further, about 40% (9 events) occur within the next 10 years. This matches with data showing that a significant number of Christians (in America at least) believe that the second coming will occur in their own lifetime.

It’s a point I made in the previous post, but it is not a little disturbing that many people who ridicule putting a date on the “End Times” don’t do so because they think it’s not going to happen but because they think it’s a “mystery”. An interesting research project might be whether this propensity to feel the end of the world is nigh is a general human condition or a feature of religious individuals in particular. Presumably there is some innate propensity there that religious traditions use.

Anyway, plenty of opportunities for End of the World parties ahead! YAY!

[EDIT 3/05/12: I have just learned of another End of the World Event (a EWE if you will), this will be a combo of nuclear war and second coming of Jesus. Quite economical really. If I may indulge myself, a quote from the page:

"When I began writing posts for this site, I initially envisioned the possible need of writing more often, primarily due to our preparing for the possibility of “great tribulation” beginning at the very start of this final three and one-half year period. However, great physical tribulation did not begin at that time, and it thankfully has not yet begun. So the need to write more often in order to help people deal with tribulation that could have begun early on has not been needed. But rather, in the midst of horrifying prophecies for this end-time, God has revealed in a most powerful manner one of His greatest attributes toward His creation—toward mankind. It is the awesome quality of “mercy”!"

I'm not sure why this guy has put mercy in scare quotes but it is coincidental that God's "mercy" looks exactly like nothing happening at all. Looks to me like a built in excuse when the end of the world fizzles. More economy, handy that. Via UnreasonableFaith]

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Filed under: Psychological, Religion, Sciblogs, skepticism Tagged: Apocalypse, end-of-the-world, Eschatology, Harold Camping, Prediction, Science and Society

Why Do People Use Alternative Medicine? Darcy Cowan Mar 26

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ResearchBlogging.orgI often read that the reason people are turning to complementary/alternative/integrative(take your pick) medicine is because they are dissatisfied with the care received from mainstream/conventional/”western”* medicine. This may be true for a small segment of the population, those with a chronic illness or with terminal cancer spring to mind. But is this generally true of altmed users? Those who pick up a bottle of homeopathic remedy from the pharmacy or occasionally visit a naturopath?

I don’t think it’s quite as simple as that. A study “Why Patients Use Alternative Medicine” published in 1998 in the JAMA looked at this question using a survey sent to randomly selected participants. 1500 participants were sent the survey and 1035 completed it. Not too bad for a survey response rate.

The survey was geared to look at the use of altmed based on three paradigms:

“1. Dissatisfaction: Patients are dissatisfied with conventional treatment because it has been ineffective,5-6 has produced adverse effects, or is seen as impersonal, too technologically oriented, and/or too costly.

2. Need for personal control: Patients seek alternative therapies because they see them as less authoritarian16 and more empowering and as offering them more personal autonomy and control over their health care decisions.

3. Philosophical congruence: Alternative therapies are attractive because they are seen as more compatible with patients’ values, worldview, spiritual/religious philosophy, or beliefs regarding the nature and meaning of health and illness.”

According to the survey results satisfaction, or lack thereof,  with conventional medicine did not correlate well with altmed use. 54% of respondents reported being “highly satisfied” with conventional medicine providers, of these 39% use alternative therapies. Of those who were highly dissatisfied (40%) only 9% were users of altmed.

It seemed as if those who were fans of medicine overall were more likely to participate in both camps. A sort of “the more the merrier” approach to health care.

What was predictive of alternative medicine use was personal philosophy. Those who considered there to be a strong mind/body/spirit connection as well as those who had had a “transformational experience” were more likely to use alt med than those who did not.

Education and health status also correlated with altmed use. Those with higher educations were more likely to use it, as were those who described themselves as having a lower health status.

The situation was slightly different for those who shunned conventional medicine altogether in order to embrace altmed. These folks tended to be distrustful of and dissatisfied with conventional practitioners, as well they desired a high degree of control over their health and believed in the importance and value of “inner experiences”.

This proportion of the population was quite small however – only 4.4% of the survey respondents fell into this group. Even so somehow the reasons for this group’s embrace of altmed has been generalised to the wider population.

The observation that users of altmed tend to be greater consumers of health services overall is also supported by the paper “Association Between Use of Unconventional Therapies and Conventional Medical Services“. This survey had a base of 16,068 individuals from which to pull data representing a 77% response rate from the 24,676 pool that was originally sampled.

According to this survey only 6.5% of the population use both altmed and conventional medicine** (and 1.8% using only altmed), with this group making more visits to their physician than those who used conventional medicine only. One possible reason for this is the so-called “worried well”, a portion of the population that focuses on their health to a degree higher than would be expected given their health status. Support for this is given within the paper:

“Compared with those with only conventional visits, those who used both types of care had significantly more outpatient physician visits (7.9 vs 5.4; P<.001), and used more of all types of preventive services except mammography. These groups did not differ significantly in inpatient care, prescription drug use, or number of emergency department visits.”

This on it’s own does not show a “worried well” connection but in the comments section of the paper it was noted:

“…there was no difference in any of the 4 self-reported health measures between respondents who had physician visits only, and those who had those visits in conjunction with unconventional therapy. Poor health status appeared to drive use of health services in general, that is, those using no services reported better health than those using either conventional medical services or unconventional therapies. However, poor health was not associated with increased use of unconventional therapies over and above conventional medical care.” [emphasis added]

So it would seem, at least in this sample, that dissatisfaction with conventional care cannot be the driving force for the majority of altmed users. More plausible is that altmed users seek to make the most of every perceived avenue for health.

Another survey published in 2001 also supported the general conclusion that dissatisfaction with conventional medicine does not lead to altmed use for most consumers. “Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey” surveyed 831 respondents who used both regular and alternative medicine.

Of these 70% would visit a conventional medicine practitioner as their first port of call. Only 15% went to a altmed provider first. There was also no significant difference in the level of confidence in altmed providers and regular medical professionals.

To quote the conclusion:

“National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care.”

From a paper presented at the Proceedings of the 1997 Conference of
the Australian Association for Social Research and published in the Journal of Sociology; “Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies“[PDF File download]:

“Those individuals who value natural remedies, are against chemical drugs, do not favour technological progress, and welcome variety in choice of therapy are more likely to have a positive attitude towards alternative medicine.”

These attitudes were enveloped under the “postmodern” rubric and were found to be a better predictor of altmed use than satisfaction levels with regard the conventional medicine.

To elaborate on that point, a further finding was that dissatisfaction with interactions with physicians rather than health outcomes was associated altmed use. This is a subtle point and worth dwelling on as it seems to be a valid criticism of the way in which conventional medicine is practised. It was not that altmed users were unhappy with the actual results of the care received via conventional medicines but the way in which they feel they are treated by doctors.

It seems that those turning to altmed may feel that conventional doctors do not give enough respect, time, don’t listen and are too authoritative. I don’t want to put too much emphasis on this perspective as it isn’t entirely consistent with the picture built up so far and the sample size of this survey was relatively small compared with the ones above (only 209 respondents), but it is worth considering.

In conclusion, while it might be true that some dissatisfaction does lead to an increase in the use of alternative medicine it seems unlikely to me that this is the main reason. I’m not sure why it has become the go-to reason trotted out by participants on both sides of the debate, ease I suppose. I could of course be wrong, perhaps there is a mountain of research out there that I’ve missed pointing in the complete opposite direction. I’m willing to grant that possibility, in the absence of such though I’ll have to go with personal philosophy being the largest contributing reason people use altmed.

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*I hate with a passion the label “Western Medicine”, what? – people from other cultures can’t use science? Nonsense.

** I suspect that the wildly differing definitions of what constitutes “Alternative” medicine are to be blamed for the fluctuating figures around the proportion of users.
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Astin, J. (1998). Why Patients Use Alternative Medicine: Results of a National Study JAMA: The Journal of the American Medical Association, 279 (19), 1548-1553 DOI: 10.1001/jama.279.19.1548

Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, & Davis RB (2001). Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of internal medicine, 135 (5), 344-51 PMID: 11529698

Druss, B. (1999). Association Between Use of Unconventional Therapies and Conventional Medical Services JAMA: The Journal of the American Medical Association, 282 (7), 651-656 DOI: 10.1001/jama.282.7.651

Siahpush, M. (1998). Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies Journal of Sociology, 34 (1), 58-70 DOI: 10.1177/144078339803400106

Aditional reading:

Joy, J.M. (2004). Complementary and Alternative Medicine (CAM): Do Barriers to and Dissatisfaction with Traditional Care Affect CAM Utilization Patterns, Masters Thesis, Texas Tech University Health Sciences Center

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Filed under: Alternative medicine, Medicine, Psychological, Sciblogs, Science Tagged: Alternative medicine, Health and Medicine, Health care, Medicine

First, Do No Harm Darcy Cowan Mar 21

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Primum non nocere

A while ago I was accused of advocating that doctors should break the Hippocratic oath. That the cardinal rule of “First, do no harm” should be ignored. Setting aside that this phrase does not appear in the Hippocratic oath, what do we mean by harm in the context of medicine?

I was reminded of this by a post on Science Based Medicine by David Gorski in which he muses over the measure of patient satisfaction as a proxy for how well hospitals meet their obligations with regard to patient care. To kick it off the good doctor notes that many interventions used by modern medicine cause harm, often direct harm.

Does this mean that doctors are throwing out their obligation not to harm patients? No, because we recognise that the concept of harm in this case includes those harms that would occur were we to withhold treatment as well as recognising that the total harm is reliant on the amount of benefit obtained by the patient.

The accusation against me was in the context of my arguing against the claims of anti-vaccinationists that vaccines do more harm than good. I don’t want to rehash that argument here but I do want to dwell a bit on our concept of harm and how it applies in the medical arena.

One of the themes that return to over and over again on this blog is that of risk vs benefit. The amount of harm or risk can only be appropriately assessed in light of the benefit accrued. As pointed out by doctor Gorski there are many procedures that hurt, they hurt a lot. Should a doctor refuse to perform them then? Even if they could save a patient’s life?

Of course not.

It is plainly ridiculous to assert that short term harm out weighs long term benefit, it might but that calculation has to be made in each case. In many cases the benefit will be clear, in others less so. If a patient undergoes a painful procedure that is relatively short lived and then makes a full recovery then the choice is fairly simple. If the recovery is likely to be only partial and the patient’s quality of life is ever after severely reduced then we may weigh up the benefits of that treatment differently.

What then of treatments that are good for most but may harm a few? These are the tricky cases and it depends on a few variables. One is can we identify the persons that will be harmed,  second, how much harm are they likely to suffer and what percentage of the treatment population do they make up? Finally what total benefit will accrue to the population if treatment is green lit?

I listed these variables in the order of importance I estimate they have. If we can identify prospectively harmed persons then they may be removed from the treatment group, harm avoided. If this information is unavailable then we may move to the next criterion: how much harm will they suffer? If this is likely to be relatively mild then all to the good. If the harm is considerably more serious then we may stop the treatment altogether in order to avoid these instances. The last two variables may switch in order depending on the situation or individual values.

Should a vital treatment be withheld from the general population if a very small percentage with be greatly harmed by it? Frankly I don’t know. Help – is there a Medical Ethicist in the house?

Often I’ll find that the people who oppose modern medicine will emphasise the risks of medicine while over-hyping the benefits of alternative medicine. The claims that iatrogenic (caused by medical treatment) harms are enormous abound. This point of view seems completely ignore the benefits received by individuals and society by medicine in it’s current form*.

This seems perverse to me, the idea appears to be that any risk is unacceptable – a completely untenable position to my mind – every action carries risk. I take my life in my hands every time I drive to work, but the risks a relatively low and the benefits are more important to me – and the majority of other drivers I suspect. To argue that we should abstain from automotive transport until it is completely safe misses the point entirely. As does decrying the risks of the majority of medical science in the face of the undoubted benefit received.

To conclude this ramble, harm or risk is part of the human condition. Arguably the complete removal of risk is not only impossible but not even desirable**. We have to live with risk and harm, the key is to ensure we balance these against the good that comes from acting in the world to oppose even greater harms.

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*This is quite an extreme view and I would hasten to add that I don’t think the majority of alternative medicine users (however you may break that group down) would subscribe to it, but it exists.

** Depending on how this might be achieved. Possibly we could make ourselves impervious to harm rather than removing everything that might harm us.

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Filed under: Alternative medicine, Medicine, Psychological, Sciblogs, skepticism Tagged: Alternative medicine, David Gorski, harm, Health and Medicine, Primum non nocere, Risk

God, UFOs, Life After Death: What do New Zealanders Believe? Darcy Cowan Dec 07

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Reading the paper today I learned that 1/3 of New Zealanders believe that we have been visited by extra terrestrials. I thought this was an interesting juxtaposition of stories given that a page or two later there was a report about a possibly habitable planet. Maybe aliens are visiting us from Kepler-22b.

Keplerites aside, I decided to look up the report from UMR Research about the beliefs of my fellow citizens.

The report makes for interesting reading (if somewhat disconcerting in places) and I’ll be looking for the follow-up reports around Maori culture and Herbal remedies. The first thing to note is that this was an on-line survey, so right off we should be wary about how representative these findings are of the general population. In that vein there was some attempt to make the results as representative as possible with quotas and weighting of responses. I couldn’t find details of how this was carried out so with that in mind do take the results with a grain of salt.

One of the first things that jumped out at me was how uncertain people were regarding their answers. The questions seems to have 4 possible answers for both the affirmative and negative, from Absolutely Certain through Fairly Certain, Not Too Certain and Not At All Certain.

So while 61% believe “That there is a God or some sort of universal spirit” only 28% are absolutely certain of this. If we lump in the fairly certains then it goes to 41% (from now on I’ll consider both groups to make up the “Certain” category). Compared to 38% who don’t believe (27% of who are certain-ish). 38% non-believers in NZ. It’s difficult to compare data sets but this appears to be up somewhat from ~34% (depending on how you count) religiously unaffiliated at the 2006 Census.

57% of us believe that there is life after death. 32% are certain. 31% are certain this isn’t the case. 55% of us believe in psychic powers, 27% are certain; 27% are certain that they don’t exist.

Now we get to the headline grabbing UFO question. 33% believe we have been or are being visited. How many are certain? 11%.

That’s a bit of a relief.

Then there’s Astrology. 24% think there is something to that malarkey. Only 6% are certain though. Whew…That’s lucky. Still, those horoscopes are everywhere.

It seems that the hardcore believers tend to only make up a minority of the population, even for the mainstream beliefs. With the more mainstream the belief the more evenly spilt the believers and non-believers. i call that interesting. As well as somewhat heartening.

The report breaks down the results further into gender and ethnic responses but I’m happy with looking at the top level stuff here. Check it out to see how women answered differently than men and how ethnicities are split between the different questions.

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Filed under: Psychic Phenomena, Psychological, Religion, Sciblogs, Science Tagged: belief, New Zealand, nz, Religion and Spirituality, sceptic, Science and Society, skeptic

Confounding Variables Darcy Cowan Nov 01

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Over at Psychology in Action there’s a decent post on confounding variables.

The focus is on conducting and reading research and determining good research study practice but I think there is value in everyone knowing what confounding variables are.  So what are they?

Well, read that post……

Ok, good.

Another example that I got in my stats class (many moons ago) was the correlation of matches with cancer. Those people who tend to carry boxes of matches in their pockets also have a higher risk of cancer.

As in the Murder vs Ice-cream example given at the link above, there is no direct link between matches and cancer (though it’s obviously related), the most probable explanation is that those who carry matches are more likely to be those who smoke and it is the smoking that relates to cancer.

Smoking can then be said to be the confounding variable – the variable that explains both of the explicitly stated variables and either ties them together with a causal mechanism (Matches -> Cancer) or shows that there is no direct relation (Ice-cream -/-> Murder).

A similar effect may be seen with something like surveys, the manner in which a survey is carried out may introduce confounding variables (say a phone or internet survey which pre-selects participants by their access to said communication methods) or the questions asked may smuggle in assumptions that do not separate out confounding variables.

For example a survey may ask “Are you Religious” and “Are you Happy” (as many have). The Religious question smuggles in a number of extra factors that may contribute to a person’s level of happiness eg religions usually come with a feeling of belonging to a community, social interaction, social support networks or guilt over actions and feelings. Each of which may more directly impact happiness that religion per se.

Other areas may also suffer from the confounding variable problem, alternative medicine springs to mind. Say you suffer from a cold, you soldier through it until you can’t take it any more and start downing some homeopathic remedy. In a day or two your symptoms resolve and you feel better. Did the remedy work?

In this case the confounding variable could be the natural history of the disease. Colds don’t last for ever (it is “self limiting”), it could be that you took the remedy right before the cold would have resolved itself anyhow. If this is so the conclusion that the remedy “cured” your cold would be invalid, there would not be a causal connection between the remedy and the cold symptoms going away.

The natural history of the disease would explain the reason you took the remedy when you did (symptoms had reached a climax) and why the remedy appeared to work (the cold would have resolved anyway).

When we examine issues closely we can see that confounding variables crop up, and should be carefully considered, every time we try to determine a causal connection between two events or phenomena. This is the reason that skeptics chant “Correlation does not equal causation” like a mantra.

Just for fun, suggest some instances of confounding variables in the comments. The more obscure the better.

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Filed under: Psychological, Sciblogs, Science, skepticism Tagged: Causality, Confounding, Correlation and dependence, Science, Science and Society, skeptic

Defending The Term ’Anti-Vaccine’ Darcy Cowan Oct 17

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I have spent some time recently labelling the IAS as anti-vaccine. They themselves categorically state that they are not anti-vaccine. Who am I to say that I’m right and they are wrong?

Well, nobody really. I can’t read their minds, although if I could would that change anything? All anyone can do is examine their output, and that of others, and try to make a determination as to whether it is more consistent with an impartial, or simply safety concious, approach to vaccines and vaccination or an anti-vaccine stance.

I hope that my previous posts have demonstrated that the IAS in particular produces anti-vaccine rather than balanced vaccine safety material.  The mission of the IAS is to cast doubt on the safety and efficacy of vaccines not to educate responsibly about the real concerns and limitations of vaccine use. If this was their aim they could do a much better job. Look at the articles produced on their website and you will see many that promote the “dangers” of vaccinations, try to discredit health campaigns and generally aim to undermine public confidence in vaccines.

An organisation concerned about vaccine safety and promoting responsible use of vaccines might write about reducing wide-scale vaccination in favour of targeted vaccination of at risk populations. Perhaps They would also try to work with health authorities to examine ways in which vaccine production can be improved (better production techniques might avoid allergy issues mentioned below), or ways in which the distribution of vaccines can be made more effective and thereby reducing the need to preservatives that are thought by them to be harmful.

It is important to note that someone can be concerned about the safety of vaccines while not being anti-vaccine at the same time. I alluded to this above, but there are legitimate safety issues surrounding vaccine use and vaccines should indeed be closely scrutinised prior to mass roll-out via safety and efficacy trials and post roll-out via surveillance systems and doctors reports. It is a valid complaint that procedures are not always carried out effectively.

Sometimes though they are carried out quite effectively and in a follow-up post I will look at a couple of examples of this. The trouble is that often when a “danger” of vaccines is reported more coverage is given to the sensationalistic claims than the eventual explanation. Also (perhaps because of this) these claims have a tendency to hang around and affect public sentiment long after the coast is clear from a safety standpoint.

As I mentioned there are real risks associated with vaccine use, there are known side effects that can have implications for the health of a small number of vaccine recipients. One of the more obvious being allergic reactions to the vaccine ingredients. Those with egg allergies are urged to use vaccines cultured via chicken embryos with caution and may be unable to receive the vaccine at all. There can be other serious and not so serious or transitory side effects for specific vaccines and effects that are general to vaccines (such as redness, soreness, syncope etc).

As such there are a variety of non-histrionic ways that vaccine safety can be discussed, without impugning the general safety of vaccines. Likewise reasonable conversations may be had regarding relative efficacy of vaccine preparations against the myriad of infectious agents that we are exposed to as well as discussions about cost effectiveness of mass vaccination for low incidence infections.

Serotype replacement (or replacement disease) is another issue that can be raised. As infectious strains are targeted by vaccines there is the possibility that other strains that were less important in the pathology of disease become more prominent once the “Top Dog” has been removed.

Encouraging the production and research into more effective vaccines that give better or more long lasting protection could also be a fruitful line of approach. Perhaps we could focus on immunogenicity, better adjuvants would give a vaccine the ability to provoke a stronger immune response, possibly with fewer antigens – as has already been achieved with modern vaccines. If vaccines are improved in this way then there will likely be more local reactions with the inclusion better adjuvants. This again is a reasonable discussion to have.

The lack of large RCTs on all vaccines and the challenges of working around this (for example ethics prohibit withdrawing a measles vaccines then trying a new one against a placebo). The types of studies required or currently used to give us the appropriate information to act upon is something that we can all try to resolve together.

All these things are such that reasonable people may disagree and we should be able to marshal evidence based (rather than emotive) arguments to discover the optimal us of vaccines in society. To my reading of the IAS, their output appears limited to vitriolic and divisive attacks on health authorities and other informational agencies, vilification of pharmaceutical companies, fearmongering over the alleged dangers of vaccination and downplaying the risks of infectious diseases.

Where we start treading into anti-vaccination territory is when we start to become entrenched in a view that sees vaccination as an evil unto itself, perpetrated in the name of profits by immoral pharmaceutical companies and carried out by unethical doctors who are either ignorant dups or willing accomplices. Those who take this stance may make all of the reasonable arguments that I outline above but also be resistant to evidence that contradicts their views and committed to a general non-vaccine outlook.

In discussing this it is very difficult to convey the range of views that may be represented. Obviously we all exist on a spectrum – from fully pro-vaccine to recalcitrant anti-vaccine. It can also be very difficult to determine the views of people in conversation. I prefer to err on the side of caution and assume people are generally well intentioned and open to evidence until proven otherwise.

One of the defining characteristics of the anti-vaccination crowd, it seems to me, is the hyping of dangers far beyond what the evidence supports. As can be seen in some of the attacks on vaccine ingredients, lists of ingredients are given and scary information accompanies them with the toxicological effects of these compounds on living organisms. In these cases  though the dose is often ignored. Dose response is one of the corner stones of medicine and the dose makes the poison. Drink large quantities of formaldehyde and you’re in trouble, but in the tiny doses found in vaccines your body can easily handle it. as noted in a previous post our bodies actually make formaldehyde as part of normal metabolism and the amount found in vaccines is far smaller than that made by the normal process of living.

When it comes down to the bottom line – Vaccines work, and they actually perform that holy grail of CAM, “boosting” the immune system and allowing the body to heal itself. Not in some vague, feel good alternative medicine way but in real objectively measurable and observable ways. Your immune system is primed to react to infectious agents in such a way as to reduce the amount of time that it takes for an effective immune response to be mounted against the pathogen.

With this priming your body can fight off infections much more efficiently and this translates into keeping us healthy, or reducing the severity of diseases. While we can debate the finer points of vaccine safety and efficacy in the end we have a system that works and has saved many lives. I see that as a win.

[for more on this topic see this post from David Gorski of Science-Based Medicine published last year]

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Filed under: Alternative medicine, Medicine, Psychological, Questionable Techniques, Sciblogs, Science, skepticism Tagged: anti-vaccine, antivax, health, IAS complaint, Immunization, Science, Science and Society, Vaccination, Vaccine

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