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Is Acupuncture Worth a Punctured Lung? or Does the Risk Out Weigh the Benefit? Darcy Cowan Aug 16

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Friday’s issue of The New Zealand Medical Journal includes a case report of pneumothrorax in a recipient of acupuncture. For the interested layperson out there a pneumothorax in the collection of air in the space between the lung and chest wall leading in extreme cases to cardiac arrest. Acupuncture can result in pneumothorax when the needle is inserted into the lung tissue while the patient is breathing leading to the laceration of the lung and air being forced out of the lung and into the pleural cavity1. Mmm-mmm, gimmie some of that lung collapsing goodness.

Now lest I give the impression that complications from acupuncture use are common I will hasten to add that they are not. One paper estimates the rate of serious adverse events at approximately 1 per 20,ooo patients2. Though if we look at the rates of acupuncture use in the United States as an example, as of about 2007 approximately 1% of the population reported using acupuncture in the previous 12 months3. This translates to about 155 serious adverse effects per year. Another study found over 2% of patients reported adverse reactions that required treatment4, commonly for bleeding or pain. Multiply these figures by the likely worldwide numbers of people receiving acupuncture.

Lets compare this with the conventional medical field, the drug Terfenadine marketed under the trade name Seldane (Teldane here in NZ) was removed from the market in the US due to increased risk of cardiac arrhythmia when used in conjunction with certain other drugs. This expressed itself as a risk of 0.04 – 0.08 per million “defined daily doses”5. Once a replacement drug came on the market Terfenadine was taken off.

Pneumothorax as a complication from acupuncture is  rare even in this subgroup. More common is infection. As I’ve noted before6, the underlying theory of acupuncture is the manipulation of life energies (Qi or Chi), blockages or imbalances in which are the cause of disease. If such is the case then why should the treating physician7 bother with proper antiseptic technique? I suspect that most modern practitioners are however not so far down the rabbit-hole that they have thrown away germ theory completely, at least the outward practical side involved in cleaning and sterilising implements. Which is why even infections are still relatively infrequent.

I would like to point out however that given the implausibility of the treatment basis, coupled with the fact that most large well designed studies find no benefit beyond placebo does make the existence of any complications ethically troubling. If your treament is no more than an elaborate placebo, are you willing to suffer adverse effects because of it? As reported by Dr Novella of Science Based Medicine8, a recent review of acupuncture admitted that sham (placebo) acupuncture was as good a “real” acupuncture.

Lets delve into the definition of “sham” acupuncture a little more to give the proper context to this revelation. Whereas “real” acupuncture depends on the proper insertion of the needles in specific meridian points on the body sham acupuncture can be considered to be either the placement of needles into non-meridian points, or the use of implements that feel like needles to the patients but do not pierce the skin like toothpicks9. This indicates that it doesn’t matter where you stick the needles and it doesn’t even matter if you stick the needles. How then can we conclude that acupuncture works if you don’t need to perform the two defining characteristics of acupuncture?

Given this background I find it difficult to imagine why acupuncture continues to be recommended despite convincing evidence of efficacy and indisputable evidence of harm. All medical interventions carry some element of risk, this is then weighed against the potential for benefit. However when there is no benefit any amount of risk must make that equation lopsided with regard to harm. With that in mind, if you are attracted to acupuncture as a therapy let me recommend sham acupuncture as the way to go. All the placebo-y goodness of real acupuncture without the potential for the nasty drawbacks of infection, bleeding, pain or even pneumothorax.

Further reading:

Type “Acupuncture” and “Infection” or “Pneumothorax” into Pubmed as key words and you will find a variety of papers, a selection of which are below:

Acupuncture induced pneumothorax:a case report (not the report mentioned in the post)

Editorial:Acupuncture transmitted infections

Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment.

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Footnotes:

1. Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection

2. A cumulative review of the range and incidence of significant adverse events associated with acupuncture

3. http://nccam.nih.gov/health/acupuncture/introduction.htm

4. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.

5. Detection and reporting of drug-induced proarrhythmias: room for improvement

6. Scepticon: Acupuncture

7. And here I use the term loosely.

8.Acupuncture Pseudoscience in the New England Journal of Medicine

9. I kid you not, here are a couple of the studies:
Description and Validation of a Noninvasive Placebo Acupuncture Procedure
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

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Filed under: Alternative medicine, Medicine, Questionable Techniques, Sciblogs, skepticism Tagged: Acupuncture, Acupuncture and Chinese Medicine, alternative, Alternative medicine, altmed, collapsed lung, complementary and alternative medicine, health, Health and Medicine, Medicine, New England Journal of Medicine, pneumothorax, Science

Pharmacy Customers Perception of Complementary and Alternative Medicine in Pharmacies Darcy Cowan Aug 05

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Going through the papers cluttering my inbox I found this survey of Australian pharmacy customers relating to their use of CAM and their impressions of how pharmacists should approach the subject.

Regular readers of Sciblogs may remember a kerfuffle earlier in the year regarding the sale of homeopathic remedies in pharmacies, I and others were uncomfortable with these items being sold in pharmacies to begin with. Fortunately, when surveyed homeopathy didn’t make it into the top ten modalities used in the last 12 months, though 3% noted that they had seen a homeopath.

This survey was published in BioMed Central‘s journal of Complementary and Alternative Medicine. I might point out that I disagree with the authors views of Complementary Medicine (CM) but I agree with many of the conclusions of the survey, though I suspect for different reasons.

The survey included data from 1,221 respondents from 54 pharmacies that cover both rural and urban areas. Beyond that the methods aren’t particularly interesting, people filled out forms.

Findings of the survey showed that a significant number of pharmacy customers think that it is important for pharmacists to be knowledgeable about CM and to know about their customer’s CM use. I would agree with this, pharmacists should be aware of how CM is marketed and of the claims made on order to give customers appropriate advice on effectiveness. Another result of the survey that helps with this point is that almost 70% of respondents agreed that they trust their pharmacist’s advice regarding CM. This reveals an excellent opportunity for education of the public regarding these modalities.

In addition many of the respondent felt comfortable telling pharmacist about their CM use whereas previous research has shown this not to be the case for patients of other medical practitioners. Again this is an opportunity for pharmacists to assess the safety of CM modalities their patients are using, especial in conjunction with other treatments (this was also a conclusion of the survey).

That said, the survey also revealed that many customers rely on family and friends as information sources. This accords with with existing research on the importance of personal anecdote in making decisions. Next most popular were medical doctors (not bad) and in third place (disturbingly) was the media. Pharmacists were in 6th place after naturopaths and pharmacy assistants. While far down on the list pharmacists still rank and one of the important sources of information and should not be under estimated.

One of the questions that I disagree with the majority of respondents on is regarding the inclusion of natural medicine practitioners in pharmacy practices. To me this is inviting abuse of the pharmacist’s position of authority, it might even undermine some customers trust of the institution (I’d certainly think twice about any pharmacy that did this). At the very least it may allow pharmacists to divest themselves of the responsibility to actually learn about the alternative products they may be selling.

In conclusion, I consider the results of this survey important to keep in mind when considering the role of pharmacists in the field of CM. Pharmacists are in a somewhat unique position to educate the public regarding CM as a consequence of the level of trust afforded to them by customers. It also reveals that pharmacies are vulnerable to particular abuse for exactly the same reason, products sold in pharmacies are lent an aura of respectability by association.

It behoves pharmacists to take seriously the responsibility to be current on the debate around the safety and efficacy of CM modalities and be able to confidently relay this information to customers. No longer should pharmacists sit on the sidelines while irrationality invades their practice, hiding behind public demand as an excuse for not taking a stand for science based therapies.

–
Braun, L., Tiralongo, E., Wilkinson, J., Spitzer, O., Bailey, M., Poole, S., & Dooley, M. (2010). Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice BMC Complementary and Alternative Medicine, 10 (1) DOI: 10.1186/1472-6882-10-38

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Filed under: Alternative medicine, Medicine, Psychological, Sciblogs, skepticism Tagged: Alternative medicine, BioMed Central, health, Health and Medicine, Homeopathy, Medicine, naturopathy, Pharmacy, Physician

Randomness and Clustering: Is the Number of Twins in Timaru a Mystery? Darcy Cowan Aug 04

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If you saw 3 News last night you might have caught the story about the bumper crop of twins born this year. The prologue to the story gave the impression of a mystery with words to the effect of  “Experts are at a loss to explain it”, I personally think this was a sloppy attempt to generate some “Experts are baffled” buzz around an essential pointless story that just filled up a slow news day.

Stuff also covered the story but without the mystery aspect, good thing because the stats given at the end of the piece kind of belie that approach.

“The previous year was another big year for twins with ten sets born out of 620 babies. In 2005 and 2006 there were 542 babies born, including six sets of twins. In 2004 and 2005 only two sets of twins were found among the 571 babies born and in the 2003 and 2004 year, there were sevens sets of twins and one set of triplets in the 557 babies born.”

So in other words the number goes up and down every year and this year just happened to be a cluster of births higher than average. Boring.

What’s the deal with randomness though and why are we so poor at recognising it? We tend to think of random events or locations as those that are approximately evenly distributed in time or space. This view of randomness however gives a false impression of what it means to be truly random.

Randomness is more a measure of unpredictability than it is of aesthetic impression. There are different ways of defining this property but one approach is to apply the criteria of an algorithm. An algorithm is essentially a series of instructions, the more instructions, the more complicated the algorithm. One such might be “1. from an initial number add 5, 2. repeat step 1.”. This would be an algorithmic representation of a sequence of numbers at regular increments of 5 eg 1,6,11,16,21.

Nothing random about that, the key here though would be that a sequence of really random numbers wouldn’t be able to be represented by an algorithm that was less complicated than the sequence itself, ie it would be it’s own algorithm and would not be able to be compressed any further.

What has this got to do with groups of twins? Well, if events such as the birth of twins are actually random (simplifying the world somewhat) then we would expect to see variations in the number of births in any one place. Based on this assumption we can look back at previous numbers to see whether this year is within the range we would expect.

Using the figures from the story and removing this year’s number and the year that only 2 twins were born as a possible outlier I get a range of between 0.5% and 2% of births being twins, with a high probability that normal variation will fall in this range. The percentage of twin births this year is 1.8%, high but apparently normal.

Now the sample size here is very small so I wouldn’t put too much trust in it but it is indicative that there is nothing really out of the ordinary going on here. According to the NZ Multiple Birth Association there were 900 multiple births last year in NZ (incl. triplets) this is about 1.4% of the 63,000 live births in NZ last year. So rough and ready these numbers may be but they aren’t too far off the mark, some places will be higher than average and others lower.

So when several rare(ish) events happen at the same time or place, consider; is this really unusual? What would we expect if it was just random?

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Filed under: Psychological, Sciblogs, Science, skepticism, Uncategorized Tagged: Multiple birth, New Zealand, Probability, randomness, Science

The Risky Business of Hunger Darcy Cowan Jul 16

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ResearchBlogging.org

We like to think of ourselves as rational actors when it comes to making decisions, we take in information, process it and choose the path that we think will lead to a desirable outcome (if we aren’t deep-seated masochists I suppose). Regular readers of this blog and others that espouse a sceptical viewpoint will know that this isn’t really the case. We are influenced by a large number of factors from implicit biases, to environmental factors, and errors of thinking. The hope is that if we are aware of these factors we can go some way toward mitigating their effects and making choices that are both rational and lead to improving our lives.

Well, here’s another one for you. You may have guessed by the title of this post that it involves food and risk taking behaviour. A paper published last month in PLoS ONE out of the University College London looked at how hunger and food intake affected choices that had a monetary reward. The actual experimental design ran something like this, subjects fasted for 14 hours they then performed tasks that in effect were an idealised lottery, the tasks were performed before, directly after and an hour after a standardised meal. Over this time the subjects also had blood samples taken to measure hormones that correlate with hunger and energy reserves.

The task subjects had to perform consisted of choosing one of a pair of “lotteries” where there was a 25% chance of receiving one of four monetary amounts. Each pairing was designed so that there was always a difference in risk between the two  (see the picture it’s hard to explain).

Paired Lottery doi:10.1371/journal.pone.0011090.g002

How the subjects performed on the tasks was measured to determine the amount of risk aversion. In other words, humans have a tendency to normally prefer less risky choices. The effect of of hunger and especially immediate satiation (right after eating the meal) is to decrease this risk aversion and to make the subjects more risk neutral.

This way of referring to the subject matter is a little counter intuitive and can take a bit of getting used to, the bottom line is that the researchers looked for the point at which the subjects were equally likely to choose the “safe” bet which promised an certain average reward, and a “risky” bet that may lead to a higher average pay off but a lower chance of receiving it. Thus risk aversion has been reduced. By varying the reward amounts the researchers can measure the degree of risk aversion in each subject as the trial proceeds.

Actually the correlation is more complex than I would have thought, not only is the fact that calories are received taken into account but also the amount of calories. It seems that the size of the meal (in terms of calorific intake) is assessed to determine if it meets the rate of food intake required to meet baseline energy requirements. If it does risk aversion is increased (less risky behaviour) if not the risk aversion is decreased.

In hormonal terms this meant that a greater drop in the hormone associated with hunger was correlated with greater risk aversion but a smaller drop meant an increase in risk taking behaviour. The study authors also note that the adiposity of an individual (eg higher BMI) correlated with the size of the hormonal decrease after eating with higher BMI subjects experiencing a smaller drop and a corresponding greater increase in risk taking behaviour.

In effect we not only look at the reward in terms of the gain we will receive compared to our external resources (cash in the bank, say) but also in relation to our internal resources (metabolic requirements for example). This makes sense if we consider that for most of our history true advantage was not measured in abstract accumulation of “wealth” which we would recognise today but in available energy, including that within our bodies. That’s just a speculation of course, I’m no expert in this area.

What is the take home message of this research then? Well first off we should be careful to realise that risk taking behaviour is not limited to single domains in our lives. If you take away from this that only financial decisions are affected then that is too narrow an interpretation. In the final analysis though, no matter our eating habits or body size, we should endeavour to think over important decisions carefully and be aware of the changeable nature of our biology and it’s effects on our thinking.

–

Symmonds M, Emmanuel JJ, Drew ME, Batterham RL, & Dolan RJ (2010). Metabolic state alters economic decision making under risk in humans. PloS one, 5 (6) PMID: 20585383

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Filed under: Psychological, Sciblogs, Science, skepticism Tagged: Biology, Business, Decision making, Eating, Research, Risk, Risk Management, Science, Science and Society, University College London

Miracles: What Do We Mean? Darcy Cowan Jul 14

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Have you ever described an event as miraculous? Perhaps it was a near-miss accident, recovery from an illness or some other fortuitous moment in your life. Did you stop to consider what you meant by that description or did or roll off your tongue like so many other cultural conventions, without a second thought?

One of the reasons I write this blog1 is to allow people the opportunity to examine the world and themselves in more detail and more reflectively than they might ordinarily be inclined to do. In this I have largely attempted to do so using science directly, by showing research that reveals facts about ourselves and the world around us that are not necessarily intuitively obvious (such as biases in our reasoning).

I thought I would deviate from the strictly scientific today to discuss miracles, especially the depiction of miracles in the media and what is really meant when we resort to the designation of “miracle” in describing events.

Recently I have started reading popular philosophy books, trying to be a well rounded person or something, or possibly just so I sound intelligent at parties2. I may delve a little bit into philosophy here but hopefully can keep it light enough that you won’t even notice.

One of the books on my reading list brought up the concept of miracles and attempted to outline the different definitions that are attached to this word3. This sparked in me a thought about how the word is used by those around me, in the general population these multiple versions of the meaning get seem to get merged into an amorphous description that verges on meaninglessness.

Many of the definitions of the word that I could find invoked some sort of supernatural component, in particular the assertion that such an event contravenes the laws of nature. By this criteria I have never witnessed, nor seen credible reports of a single miracle, yet I hear the word used all the time4. How can we reconcile how the word is defined and how it is used?

Let us note one instance of the (over)use of this word, last year when an aeroplane crash landed in the Hudson river after hitting a flock of birds soon after take off the event was labelled a miracle. Currently no fewer than ten news stories with the word “miracle” in the title are listed in the Wikipedia article about this event and I suspect there are many more not mentioned. This seems to be the type of event that attracts exclamations of “Miracle” yet if we delve into the details there is no point at which we can reliably determine that the laws of nature have been suspended or otherwise altered to allow the final outcome.

If we are committed to the definition that for a miracle to have occurred the laws of nature must be violated then this event does not qualify.

Of the multiple meanings that I mentioned above it would appear the most frequently used makes the word “miracle” synonymous with “unlikely coincidence”. This though is insufficient to describe what most people would consider to be miracles as it ignores whether or not an event has any beneficial consequences, so lets add that requirement into our ad hoc definition.

The trouble with this definition is that it leaves us unable to determine what we might term “True Miracles” from merely random (beneficial) occurrences. Especially in as much as, like the Hudson river crash above, said miracles have no religious significance5. This pre-supposes however that we would wish to make such a distinction, if (as I suspect) our use of the word actually no-longer assumes the intervention of supernatural forces then our definition of “True Miracles” becomes superfluous, no different than what we might consider a regular miracle.

In this case the word simply becomes short hand for an amazing6 coincidence that is of benefit to a person or persons7. It would then seem that our definition of miracle actually stems from our own inability to sufficiently appreciate how probability acts in our lives. How many of us are in a position to calculate how probable any particular event is? Our normal day-to-day experience is a poor guide regarding this but if we cannot perform the calculation then by what basis do we conclude that an event is likely or unlikely?

I will readily admit that musings like this are have little practical significance but I think are still worth considering in order to develop for ourselves a more consistent and precise outlook. I hope that there are others beside myself that also see value in this.

footnotes

1. In general not this particular entry.

2. Who am I kidding? I don’t go to parties.

3. The definitions were broken down into 4: a) Violation miracles where the laws of nature are violated; b) Willed miracles where miracles occur via an act of a supreme being’s will; c) Inexplicable miracles where the event is unexplainable via the laws of nature though does not necessarily violate them; and finally d) Coincidence miracles, as discussed in this article.
See Nicholas Everitt’s “The Non-Existence of God” p112-ish.

4. Okay, that’s an exaggeration, but certainly more often than my experience tells me it should be used.

5. Try putting the word “miracle” into google news and see how many look explicitly religious.

6. Or not so amazing, depending on your point of view.

7. Miracle is definitely easier to say, though it does leave us open to misinterpretation by those who apply a more strict definition of the word than we do.

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Filed under: Psychological, Religion, Sciblogs, Science, skepticism Tagged: Christianity, Existence of God, God, Miracle, Opposing Views, Philosophy, Physical law, Religion and Spirituality, Wikipedia

Is there Something Fishy about Psychosis? Darcy Cowan Jul 02

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ResearchBlogging.org

Psychosis is a scary word, conjuring images of people who have so lost touch with reality that they are unable to integrate with society. As with most everything else this condition exists on a continuum, mild symptoms may pose no problem for the sufferer1 nor be outwardly visible. Previous studies have seen correlations between the intake of polyunsaturated fatty acids (with the cute acronym PUFA2) and increased severity of psychotic symptoms, with this in mind a study was performed in Sweden looking at the dietary intake of fish and the incidence of psychosis symptoms in the general population.

In total 33,623 women completed the study which covered the period between 1991/92 to 2002/03 (with questionnaires at the beginning and end of this period). This group was then classified based on their answers to the questionnaires into 3 groups: Low, middle and high frequency of symptoms, where the low group included women with no symptoms. This gave a split of 18,411, 14,395 and 817 women in the groups respectively. The first question I had reading this study is how do you classify someone with psychotic symptoms? The women in the study completed two questionnaires to provide the information for this part.

The first was the Community Assessment of Psychic Experiences (CAPE, another cool acronym), this contained questions ranging from those looking at emotional states such as “Do you ever feel sad?”, to those that address personal perception like “Do you ever feel pessimistic about everything?”. Also included are the questions that we would more easily recognise as relating to psychosis such as “Do you ever feel as if a double has taken the place of a family member, friend or acquaintance?” or “Do you ever see objects, people or animals that other people cannot see?”.

There are also questions that might seem to generate positive answers from a wide range of the population that we would not consider psychotic such as “Do you ever think that people can communicate telepathically?”, a belief that if I can take what I see in the media seriously is becoming more widespread. And “Do you believe in the power of witchcraft, voodoo or the occult?” which thinking back to the furore that arose around the Harry Potter books is a view that is held by a disturbing number of people3.

Quite obviously simply answering affirmatively to these questions does not place you in the psychotic camp, it is the aggregate of these answers that matter as well as further variables that relate to these answers such as how these thoughts and experiences make you feel. The experience of seeing or hearing a loved one that has died is quite widespread but I don’t think general conclusions about the sanity of the general population can be reached using this information.

The second questionnaire was a variation on the Peters et al. Delusions Inventory (PDI, and the good acronyms come to an end). There is significant overlap between the questions asked in the PDI and the CAPE questionnaires, the main difference seems to be how each question is followed up. The CAPE approach simply asks how distressed the respondent feels if they answered affirmatively to a question (with a 4 point scale, Not distressed to Very distressed) while the PDI covers this aspect as well as asking how much the respondent thinks about it and how much they believe it is true.

Now how do the categories that I mentioned above (low, middle and high) relate to the results of the questionnaires? Rather than attempt to paraphrase the study I’ll just quote that bit:

“The “low level symptoms group” included women with no or few experiences of psychotic-like symptoms (≤3 “sometimes” and no “almost always” and “often” answers to any of the questions). The “high level symptoms group” included women with frequent experiences of psychotic-like symptoms (≥3 “almost always” or “often” answers). The “middle level symptoms group” was defined as participants not included in the low level or high level groups.”

Fairly simple, not as nuanced as I expect an in-depth psychological evaluation might be but that’s the limitation of performing a large scale study.

Finally, what were the results of the study regarding fish consumption and symptoms of psychosis? Interestingly the authors did not see a simple relationship between the two variables, there was no clear protective effect with increasing intake of fatty fish (those with high levels of PUFAs). Instead there was an optimal intake that was correlated with low (or no) symptoms, higher intake actually correlated with increased symptoms. The authors are unsure what could account for this effect stating:

“This puzzling finding may be due to unknown or known unhealthy constituents of fatty fish. For instance, environmental pollutants such as polychlorinated biphenyls (PCB) and dioxins are known to accumulate in fatty fish. Another possible explanation may be that the frequent intake of fish and PUFA may be advantageous in lower doses but disadvantageous in higher doses.”

The authors also caution that the study was not geared to determine a causal relationship between the variables merely how these were correlated4. Another interesting finding was that high levels of psychotic symptoms are also correlated with women who are both overweight and are smokers (and also for some reason migration to Sweden5).

Bottom line? Hard to say really, the results of this study are indicative but not definitive. The take home message in my book looks to be that it is a balanced diet which is most beneficial, including fish in your meals between 1 and 3 times a week or so. For those of us who aren’t keen on fish, supplements might be the answer but that’s really another question.

OpenLab2010 Submit To Open Laboratory 2010(What’s This?)

1. Indeed they may not even consider themselves to be suffering from anything untoward.

2. You might recognize Omega-3 as representative of this group.

3. For me that number is 5.

4. Remembering the adage: Correlation does not equal Causation.

5. So should the tourism board adopt the slogan “Sweden: You don’t have to be crazy to move here, but it helps”? Too insensitive?

–
Hedelin M, Lof M, Olsson M, Lewander T, Nilsson B, Hultman CM, & Weiderpass E (2010). Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33 000 women from the general population. BMC psychiatry, 10 (1) PMID: 20504323

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Filed under: Psychological, Sciblogs, Science, skepticism Tagged: Causality, Conditions and Diseases, Harry Potter, health, Health and Medicine, Mental health, Nutrition and Metabolism Disorders, Pollution, Psychosis, Religion and Spirituality, Schizophrenia, Science, Science and Society, Women’s Health

Is Your Boss A Better Liar Than You? Probably, Yes Darcy Cowan May 21

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How good a liar are you? It turns out the answer to that question may depend on how much power you wield. A study performed by Dana Carney at Columbia University (not to be confused with Dana Carvey) suggests that with power comes an ability to lie more effectively. Lets take a step back, when people lie there comes with the act a number of emotions and cognitive repercussions that reveal themselves via various physiological cues. If any one has seen the TV show “Lie to Me” (which is based on actual research) you will be aware that our emotions tend to play out on our faces and by the way we move our bodies, however much we may try to suppress them. This new paper suggests that observing these cues in powerful people is more difficult than we thought.

In an experiment performed to look at this effect 50 participants were randomly assigned to a leadership or subordinate role. Several steps were taken to reinforce these roles, Firstly the group was given a leadership questionnaire and told that roles were assigned based on the result, actually it was random. Second the leaders were given large offices compared to the subordinates and the leaders were given the ability to award the subordinates all or only a portion of a $20 “paycheck”. Once this was complete, half of the participants were instructed to “steal” $100 dollars that they would then be able to keep if they could convince the experimenter, in an interview, that they had not stolen the money (ie lie).

The researchers measured variables that correlate with lying, including: behaviour (8 behaviours altogether), the level of the stress hormone cortisol in their saliva, cognitive impairment, and emotional distress. Behavioral cues were gauged from video taken during the interviews, an independent observer (unaware of the nature of the experiment) reviewed the videos and assessed the behaviours present. The specific behaviours looked at where those that both positively and negatively correlated with lying. Behaviors such as cooperativeness, immediacy and length of time spent speaking are all negatively correlated with lying (ie associated with the truth), while nervousness, uncertainty, lip presses, one-sided shoulder shrugs and increased speech tempo are all positively correlated with lying.

Cognitive impairment was measured using the Stroop task. If you are not familiar with this technique it involves flashing a word on screen and the subject must indicate the colour that the word is written in as quickly and as accurately as possible. Sometimes the colour and the word is the same (eg the word “blue” in blue) and sometimes it will be different (eg the word “Blue” in red), and sometimes the word will be neutral towards the colour (eg “Table” in blue). The subject’s reaction times are recorded and the difference in time between correct answers on the word/colour matches (“Blue” in blue) are compared to the word/colour mismatches (“Blue” in red). The differences between the times are indicative of cognitive impairment. Emotional distress was determined with a questionnaire, subjects rated themselves as bashful, guilty,
troubled or scornful on a 7 point scale. Higher scores indicated more emotional distress.

Those who were assigned to the subordinate role and who stole the money displayed the physiological correlates that predict lying, just as expected. However those that undertook the theft in the leadership group gave responses that were indistinguishable from the responses of truth tellers. In other words they were much better liars than the subordinates.

Lying is cognitively costly, the liar must actively suppress the truthful information as well as deal with the negative emotions evoked by the act of lying. Therefore ordinarily people cannot help but let their true feelings “leak” out in their behaviour.

In contrast it is suggested by the authors of this study that powerful people experience a buffering effect, this may be an inherent benefit that comes with the acknowledgement of power or it may come as a side benefit of knowing that the consequences of one’s actions may be mitigated by the power. In this scenario it is less cognitively costly to both lie and hide the effects of lying. Therefore powerful people are more able to lie more effectively.

Does this mean you should stop trusting your boss? I wouldn’t go that far. I would suggest that you can still gauge for yourself the trustworthiness of those in power over you by other means than direct observation. Still, if you really have trouble trusting your boss in this fashion, I think you might be in the wrong job.

Filed under: Psychological, Sciblogs, Science, skepticism Tagged: deception, lying, Science, Science and Society, truth

Dig-in Or Adapt: The Effect of Political Views on Changing One’s Mind Darcy Cowan May 07

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Are you the sort of person who will change their position on a subject conditional on further information gained? I personally think this is the behaviour we should all be striving for. If we do not we end up withdrawing further and further from reality, insulating ourselves from rational argument and retreating into our own self contained worlds of comforting fantasy. Not unlike a Pauly Shore fan.*

Seriously though, when confronted with information that contradicts previous knowledge there are a number of different reactions possible. One is to reject the previous knowledge in favour of the new information, there are good reasons why we shouldn’t do this uncritically. If we simply accepted every new thing we were exposed to we would become like motes in the wind, changing direction constantly. Long term decisions and actions would become impossible and our lives would be subject to the merest whim. A poor strategy.

A different approach is to consider the new information in context with previous knowledge, determine which is more likely to be correct and then determine our actions accordingly. This is the most favourable action in my view but may still result in a distressingly high chance of having to change your mind on a regular basis. Again, possibly making it difficult to forge and maintain long term alliances and life strategies. A variation on this theme might be strategically best.

Another option is to summarily reject any new fact or opinion that is counter to your own, while this may make life simpler it is also fraught with difficulties in that it can make us too rigid and resistant to change. This is a recipe for ultimate downfall. A variation on this is to not only discount opposing views but to actually reinforce your commitment to prior beliefs.

This last variation was investigated in the paper “When Corrections Fail: The Persistence of Political Misperceptions“. The primary experiment showing the effect involved subjecting 130 participants to fake news stories about the US invasion of Iraq. The news stories contained an  actual quote from then president Bush regarding the possible existence of WMDs and the risk that this capability would be passed to terrorist groups.

The stories were then split into two conditions, they either then included information from the Duelfer Report that stated there were no WMD stockpiles nor an active program to produce such directly prior to the US invasion or a version that omitted this information.

Subjects were then asked to rated how much they agreed (On a 5 point scale; “Strongly agree” to “Strongly Disagree”) with the following statement:

“Immediately before the U.S. invasion, Iraq had an active weapons of mass destruction program, the ability to produce these weapons, and large stockpiles of WMD, but Saddam Hussein was able to hide or destroy these weapons right before U.S. forces arrived.”

When the responses of the subjects who received the corrective information were plotted with regard to their political stance (Liberal or conservative) it was found that conservative subjects were more likely to agree with the statement, with more conservative subjects agreeing more strongly.

It would seem from this that new information which not only contradicts previous knowledge but clashes with deeply held ideological convictions will have what the researches termed a “Backfire” effect. In this case the information apparently strengthened the previously held belief.

Now the experimental conditions apparently favoured an especially strong effect on politically conservative individuals but I don’t think that those on the the opposite end of the political spectrum are immune to this phenomenon. A further experiment aimed at this group did not show a clear “Backfire” effect but it did show that increasingly liberal subjects were less likely to be affected by the corrective information, in this case regarding the incorrect notion of a stem cell ban in the US.

In conclusion I think that, as always, we should take care that we examine all of our beliefs critically and not only evaluate new information based on whether it conforms to those beliefs but also on how accurately it conforms to reality.

*I don’t really mean that.

Thanks to the Badscience blog for the topic. Read Ben Goldacre’s post here.

Nyhan, B., & Reifler, J. (2010). When Corrections Fail: The Persistence of Political Misperceptions Political Behavior, 32 (2), 303-330 DOI: 10.1007/s11109-010-9112-2

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Filed under: Psychological, Sciblogs, Science, skepticism Tagged: Conservatism, Iraq, politics, Saddam Hussein, Science and Society, Scientific method, United States, Weapon of mass destruction

I’m Certain That I Can Certainly be Wrong or Confidence and Memory, Is one a Good Measure of the Other? Darcy Cowan Mar 05

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A man is the sum of his memories, you know, a Time Lord even more so.

The Doctor, in “The Five Doctors”

ResearchBlogging.org
We all know that our memories can’t always be trusted, time and life tends to erode the confidence we have in our memories. At least that is the case for normal memories. We also tend to have special memories that seem to be burned into our brains, events in our lives that hold such significance that it feels like we are in some sense still experiencing the moment the memory represents. Such memories are described as being “flashbulb memories” as if at that moment as sort of metaphysical flash went off and recorded every detail of an event vividly in our consciousness.

This “flashbulb” effect allows us to confidently recall these events days, weeks or even years later. Memories such as this may be unique to each individual but there are commonly cited examples of shared flashbulb memories such as where a person was and what they were doing when they heard about the events of 9/11. In fact this event was used in an experiment to test the accuracy of this type of memory. At Duke University on September 12th 2001, 54 students recorded their memories of hearing about the incident as well as a recent everyday event by answering a series of questions about the events. Then either 1, 6 or 32 weeks later they answered another questionnaire and this was used to evaluate the confidence and consistency of the memories.

Surprisingly there was no difference in the consistency of memory recall for the flashbulb memory compared to the everyday memory but the flashbulb memory continued to be reported with a high degree of confidence while confidence in the everyday memory decreased. This implies that while we can be very confident in the details of a memory this is no guarantee of their accuracy. In fact other studies between confidence and accuracy of recall (for example in eye witness reports of crimes) shows the same lack of correlation between how confident we are and how accurately our recall matches events.

With regard to confidence in memories hypnosis is often put forward as a means of increasing the reliability of recall (even featuring on Mythbusters). There is evidence however that what actually happens is the hypnosis increases the confidence of the recall but is not effective at increasing the accuracy of the information gained through this process.

Finally, as a little reward for getting this far that is modestly related to this subject, here’s an interesting little test that is meant to measure your risk IQ based on your confidence in the answers to certain questions rather than on the answers themselves. (as previously blogged on by Alison over on Bioblog). So go take the test and feel free to report back your score.

References:

Talarico, J., & Rubin, D. (2003). Confidence, Not Consistency, Characterizes Flashbulb Memories Psychological Science, 14 (5), 455-461 DOI: 10.1111/1467-9280.02453
Smith, V., Kassin, S., & Ellsworth, P. (1989). Eyewitness accuracy and confidence: Within- versus between-subjects correlations. Journal of Applied Psychology, 74 (2), 356-359 DOI: 10.1037/0021-9010.74.2.356
Green, J., & Lynn, S. (2005). Hypnosis versus relaxation: accuracy and confidence in dating international news events Applied Cognitive Psychology, 19 (6), 679-691 DOI: 10.1002/acp.1133

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Filed under: Psychological, Sciblogs, Science, skepticism Tagged: Cognitive science, Duke University, Five Doctors, Intelligence quotient, memory, psychology, Review, Science, Science and Society, Social Sciences, Time Lord, Witness

New Zealand Pharmacy Ethics in Relation to Homeopathy in the Wake of Homeopathy Report Darcy Cowan Feb 24

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Earlier this year I wrote a post (along with fellow Sciblogger Grant) concerning the sale of homeopathic remedies in pharmacies. Monday night saw the release of England’s Science and Technology Committee’s “Evidence Check 2″ report on Homeopathy (also ably covered by Grant). One of the issues covered by the report is that of pharmacy responsibilities regarding sale of these remedies. Essentially the report recommended that sales continue but with adequate disclaimers stating that there is no scientific evidence that homeopathic products work beyond the placebo effect.

I see this as a compromise between commercial freedom to sell safe, though not necessarily effective, products and patient informed consent. It’s reasonable even if I disagree that it is ideal. Regardless, I thought it was a good excuse to look once again at our own pharmacies and see how the selling of scientifically unsupported remedies aligns with their professional responsibilities.

Enquiring into this area I was directed to the Pharmacy Council Code of Ethics for pharmacists. The Pharmacy Council seems to fill the function of professional association and regulatory body for pharmacists their functions including:

prescribe the qualifications required for scopes of practice within the profession, and, for that purpose, to accredit and monitor educational institutions and degrees, courses of studies, or programmes

and

consider the cases of health practitioners who may be unable to perform the functions required for the practice of the profession

Perusing the Code of Ethics (which may be found Here) I found a number of sections that I feel should preclude pharmacists from selling homeopathic remedies in good conscience. In order to try and represent the spirit of the code as accurately as possible I have included here both the relevant over-arching Principles that pharmacists should strive for as well as the Specific Obligations that I feel make my point (any emphases are mine).

The first principle is one of patient autonomy:

Principle 1: Autonomy
The pharmacist shall promote patient
self-determination, respecting the
patient’s right to understandable
information, privacy, and confidentiality

1.4 Professional services
Where the patient is seeking or receiving, from the
pharmacist or from other personnel for whom he or
she has responsibility, any professional service or
intervention, the pharmacist must ensure that the
patient is provided with credible, understandable
information about reasonably expected results,
outcomes or effects of the service or intervention, any
risks of receiving the service or intervention, and any
insufficiency of evidence about the efficacy of the
service or intervention, to allow the patient to make
an informed choice.

This to my reading implies that should pharmacists sell homeopathic remedies they are obligated to inform the patient of the lack of scientific underpinnings for the use of the remedy. One of the objections I have run into regarding the sale of these remedies in pharmacies is that they are commercial enterprises and are within their rights to sell products regardless of their medicinal value. This is partially true but these remedies are specifically sold to treat symptoms, not as entertainment, confection or cosmetic. The Code has several entries covering this aspect the first of which is:

1.5 Independent information
The pharmacist must ensure that their advice is
independent of personal commercial considerations.

Does this not imply that the sale of unscientific medicines should not be undertaken simply because it make financial sense? We will return to this point later.

The next Principle covers patient needs:

Principle 2: Beneficence
The pharmacist shall optimise medicines
related health outcomes for the patient
according to their concerns, needs,
cultural values and beliefs

2.2 Quality use of medicines
The pharmacist must provide scientifically-based,
unbiased medicines information to healthcare
providers, patients and the community in order to
optimise medicines related health outcomes.

My reading of this point leads me to understand that any information provided regarding pharmacy products must have scientific backing and moreover must not be biased by the pharmacist’s own views. Any such information regarding homeopathy must therefore be negative.

But, what if the pharmacist is not asked for this information? After all, I do not usually go in asking for a lecture if I already think I know what I need. I think the next obligation covers this instance:

2.8 Involvement in sale of medicines and other
therapies
The pharmacist must be involved and intervene in the
sale of any medicine, complementary therapy, herbal
remedy or other healthcare product whenever this is
necessary to ensure a reasonable standard of
pharmaceutical care.

Scientifically speaking homeopathy should not be considered to encompass a “reasonable standard of pharmaceutical care”.

The next Principle of relevance concerns fairness:

Principle 4: Justice
The pharmacist shall practise fairly and
justly and promote family, whanau and
community health

4.4 Commercial interests not to override good
practice
The pharmacist must ensure that commercial interests
are not permitted either to override the independent
exercise of their own professional judgement on
behalf of a patient or to compromise the standard of
care provided by them or to affect their cooperation
with other healthcare providers.

Once again the issue of financial gain over patient care is addressed with commercial interests coming off second best when the standard of care is concerned.

The next Principle is one I feel is of especial importance when the reputation of pharmacists in the wider community is considered and their self representation in the media is a factor (remember, they’re the health professional you see most often). This is trustworthiness, pharmacists are seen as, and promote themselves as, first and foremost medical professionals not business interests. The sale of homeopathic medicines is antithetical to this position and undermines their credibility in this regard, in direct contraction to the Code of Ethics as follows:

Principle 7: Trustworthiness
The pharmacist shall act in a manner
that promotes public trust in the
knowledge and ability of pharmacists
and enhances the reputation of the
profession

7.7 Non-medical goods and services
The pharmacist must not purchase or sell from a
pharmacy any product or service which may be
detrimental to the good standing of the profession or bring the profession into disrepute.

If the sale of scientifically worthless remedies such as homeopthy does not do this I don’t know what would, perhaps offering Therapeutic Touch?

Finally the Principle of dignity undermines the pharmacist’s sale of unsupported medicines:

Principle 8: Dignity
The pharmacist shall provide
information about professional services,
medicines and healthcare products in a
dignified manner without making
exaggerated or unsubstantiated claims

8.4 Medicines not ordinary articles of
commerce
A pharmacist must only participate in promotional
methods that do not encourage the public to equate
medicines with ordinary articles of commerce.

If the previous examples of why remedies should not be sold with the sole purpose of earning money for the pharmacist this should put that argument to rest. The sale of medicines (which many people consider homeopathy to be) should not be equated with ordinary articles of commerce. This puts the lie to arguing that these remedies are simply another commodity to be bought and sold like chewing gum regardless of therapeutic value.

8.8 Evidence of efficacy
The pharmacist must only promote to a potential
purchaser that any medicine, complementary therapy,
herbal remedy or other healthcare product associated
with the maintenance of health is efficacious when
there is credible evidence of efficacy.

This last obligation explicitly refers to promotion of a therapy to a patient by the pharmacist which I don’t think any reputable pharmacist would do for homeopathy but arguably the presence of the product in the store constitutes an implicit promotion of it to potential customers. This point goes back to the principle of trustworthiness, the public trusts the pharmacist to stock efficacious products. To include unscientific therapies among their wares undermines and betrays this trust. Perhaps I am naive to think so but I think the Pharmacy Council’s own Code of Ethics backs me up when I say that we should hold pharmacists to a higher standard than your average shop owner.

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Filed under: Alternative medicine, Medicine, Sciblogs, Science, skepticism Tagged: health, Health and Medicine, Health care, Herbalism, Homeopathy, homoeopathy, Medicine, Pharmaceutical drug, Pharmacy, Placebo, Science and Society

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