Finally, Hard Evidence Against The "Autism Epidemic"?

The idea of an 'autism epidemic' has a lot of people very worried.

No-one disputes that diagnosed rates of autism have increased enormously over the past 15 years or so, around the world. However, other people write it off as essentially a cultural phenomenon: we're getting better at detecting the disorder and more willing to label kids as having it.

I subscribe to the latter view, but there's very little hard evidence for it. To prove that diagnostic changes have occurred, rather than a true increase in autism, you'd have to know what would have happened to today's kids, say, 20 years ago. Would they have been diagnosed? We have no way of knowing. At least not until someone invents a time machine.

However, a new study just out offers a valuable new perspective on the debate: Spatial clusters of autism births and diagnoses point to contextual drivers of increased prevalence.

According to authors Soumya Mazumdar and colleagues, there's a zone of high autism prevalence in California, areas where kids aged 0-4 years old are more likely to be diagnosed with the condition. The epicentre is L.A.; there's actually three overlapping hotspots centred on Santa Monica, Alhambra and North Hollywood.

In these clusters, autism rates are between 2 and 6 times higher than the rest of the state.

Now an interesting thing about these areas was that they're rich in paediatricians, autism advocacy organizations, and money. In other words, there's better access to health services and probably more awareness of autism. This is suggestive evidence that the reason lots of kids get diagnosed here is about diagnosis, not autism per se.

But the blockbuster result is that children born outside the cluster, who later moved home into one, had a higher chance of getting a diagnosis than those who stayed out. The effect was smaller than for kids born inside the hot zone, but it was significant.

That's also consistent with the idea that the clusters are clusters of diagnosis, not autism.

It's not proof. You could argue that there's some toxic chemical, say, present in the rich parts of L.A. that causes autism, even if you move into the toxic area only at age 3 or 4, and that's been getting worse recently, leading to rising rates.

But it seems a stretch. What's the chemical? And why hypothesize one, when the diagnostic services hypothesis nicely accounts for these findings? As the authors say:

The findings reported in this article do not fully reject the possibility that environmental toxicants drive some of the risk of autism ... since there are a plethora of possible toxicants, it is impossible to falsify all hypotheses that researchers have started to explore.

 Mazumdar S, Winter A, Liu KY, and Bearman P (2012). Spatial clusters of autism births and diagnoses point to contextual drivers of increased prevalence. Social Science And Medicine PMID: 23267775

Mental Illness and Crime, Yet Again

As if on cue, a major study about the relationship (if any) between mental disorder and crime has appeared just when everyone's talking about that.

Although having said that, people seem to be interested in that issue most of the time nowadays, in the UK at any rate, with schizophrenia topping the list of supposedly scary syndromes.

So - should we be worried?

The new research, from Australian team Morgan et al, surveyed everyone born in the state of Western Australia between 1955 and 1969. About 1.6 million people lived there over the course of the study so this was a big project.

By linking local records of arrests over the period 1985 to 1996 to the database of psychiatric diagnosis, the researchers were able to examine disorder-crime correlations in the entire population - meaning that there was no possibility of bias.

So what happened? Here's some highlights:

• 32% of psychiatric patients had been arrested at least once. Unfortunately, it's not clear what the rate was in the general population, but that falls into the range of overall arrest rates in most countries.
• 11% of those arrested had a psychiatric diagnosis. This rose to 20% of arrests for violent offences.
• 0.8% of suspects had schizophrenia, rising to 1.7% for violent offences.
• The number of arrests in people without a disorder fell over the period 1985-1996, reflecting the well-known fact that people commit fewer crimes as they get older. However, in psychiatric patients, there was no change over time.
• For murder, 30% of suspects had a psychiatric history while 3% had a diagnosis of schizophrenia.
• Both substance abuse and personality disorders were associated with higher arrest rates than schizophrenia, but schizophrenia in turn was higher than depression, anxiety, and other miscellaneous disorders.
• Although only 1.7% of violent offenders had schizophrenia, those with the disorder were somewhat more likely to involve strangers, and to take place in public places, and less likely to target family and partners.

Overall this confirms that the great majority of crimes, including violent ones, are not committed by people with mental illness, and that your chance of getting 'murdered by a lunatic' is incredibly low. This strikes me as the only statistic that matters to most people.

There's a long-standing debate over whether people with various disorders are more likely to commit crimes than they would be if they didn't have one, the relative risk. While interesting, this is a purely academic question. What the rest of us need to know is the absolute risk, and this is low.

Morgan VA, Morgan F, Valuri G, Ferrante A, Castle D, and Jablensky A (2012). A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness. Psychological medicine, 1-12 PMID: 23234722

Religion Rises After Disaster Strikes

People turn to religion after natural disasters - but it doesn't actually provide much solace.

So say researchers Sibley and Bulbulia, who examined the population of Christchurch, New Zealand, before and after the 2011 earthquake. 185 died and many city landmarks were damaged in the disaster.

The paper, Faith after an Earthquake, opens with a Biblical quote.

Sibley and Bulbulia took advantage of the fact that a longitudinal study of the 'health and values' of the New Zealanders was already underway when the quake struck, and the survey included questionnaires about religious beliefs.

They found that, compared to before the event, residents of the affected Canterbury region were more likely to report becoming religious (8.6%) than of losing their faith (5.3%); in the rest of the country religion declined from 2009 to 2011, so the earthquake-hit area was exceptional.

The authors say:

Philosophers have plausibly argued that natural disasters such as the Christchurch earthquake are rationally incompatible with the existence of an all-powerful, all-loving God, because natural disasters cause pointless suffering to innocents... though faith eroded elsewhere in New Zealand, there was a significant upturn in religious faith among those who experienced the misery of New Zealand's most lethal natural disaster in eighty years.

But did faith help people cope with the disaster?

No - believers reported no better subjective well-being compared to the non-religious, either before or after the earthquake, although those who both lost their faith (apostates) during the period and were personally affected suffered a decline.

What's rather odd about this, however, is that other results showed that apart from the apostates, well-being wasn't affected by the earthquake at all. So it's no surprise that the religious coped no better: the irreligious already coped very well, so there was no room for improvement.

Sibley, C., and Bulbulia, J. (2012).Faith after an Earthquake: A Longitudinal Study of Religion and Perceived Health before and after the 2011 Christchurch New Zealand Earthquake PLoS ONE, 7 (12) DOI: 10.1371/journal.pone.0049648

How Intelligent is IQ?

"If your IQ is somewhere around 60 then you are probably a carrot'', according to a British spokesman for high-IQ club Mensa.

IQ's in the news at the moment thanks to a paper called Fractionating Human Intelligence from Canadian psychologists Adam Hampshire and colleagues. Some say it 'debunks the IQ myth' - but does it?

The study started out with a huge online IQ test...

Behavioral data were collected via the Internet between September and December 2010. The experiment URL was originally advertised in a New Scientist feature, on the Discovery Channel web site, in the Daily Telegraph, and on social networking web sites including Facebook and Twitter.

The test involved 12 different cognitive tasks, based on the usual IQ test kind of things, and they got a huge 45,000 usable responses.

However, the main part of the study used functional MRI (fMRI) to measure brain activity caused by each of the 12 tasks. There were only 16 volunteers in the brain scan study, which is pretty small.

The key finding was that although each of the 12 tasks made a different pattern of brain regions light up, there were two main components of this: one lit up mostly in response to tasks requiring short-term memory, and the other was associated with reasoning and logic: (EDIT: Picture corrected, oops.)

They did various other analyses that confirmed this, and they also found evidence for a third network responsible for language (verbal) skill.

Finally, the killer conclusion was that there was no reason to introduce the imfamous  'g factor' - a number representing general intelligence affecting performance on all tasks. Although there was a 'g factor' statistically, it was explained by the fact that tasks required both the memory and the logic networks (although to different degrees).

g is the most controversial aspect of IQ testing, because if it exists, that means that some people are just smarter than others across the board - not just better at a particular kind of thing. So has this study killed g?

Well, not by itself. There's a huge literature on IQ and g, going back almost 100 years. This stuff is not based on brain imaging, but just on IQ test scores, and it's a complex topic. I don't think one brain study with 16 people can really overturn that, although it does lend weight to the anti-g camp who have been arguing against g for decades.

There's a sense, though, in which it doesn't matter. If all tasks require both memory and reasoning (and all did in this study), then the sum of someone's memory and reasoning ability is in effect a g score, because it will affect performance in all tasks.

If so, it's academic whether this g score is 'really' monolithic or not. Imagine that in order to be good at basketball, you need to be both tall, and agile. In that case you could measure someone's basketball aptitude, even though it's not really one single 'thing'...

Hampshire, A., Highfield, R., Parkin, B., and Owen, A. (2012). Fractionating Human Intelligence Neuron, 76 (6), 1225-1237 DOI: 10.1016/j.neuron.2012.06.022

Why (And How) To Write Less

I said a couple of times during my recent trip to UPenn that "Most writing is too long". People seemed to nod appreciatively at this, so here's some more on that topic...

Most writing is too long and the most common reason is that it's not written for the reader's benefit. Readers want the important stuff, as clearly as possible, in the shortest possible space. If you remember that and let it guide your writing, you won't go far wrong. The reader's favourite bits are the ones you don't write.

The problem is that it's tempting to write for your own benefit, not the reader's, and this almost always ends up making things too long. This can take many forms:

Some write to help themselves understand the material, such that the end product is a record of their learning process. Others will insert details that the reader doesn't need, because it's a topic the writer's fond of. Other fear making tough decisions about what to include, so they say everything and hope some of it's good: "Write it all and let God sort them out."

This is common because formal education teaches you to write poorly. Specifically, it encourages people to overwrite. Teachers and professors give assignments and they set a minimum word count. This sends the message that where writing's concerned, more is better.

Teachers have their reasons. They want a brain-dump to show that the student's done the homework, pretty much the opposite of good writing. That's fair enough for school, but if you internalize that philosophy, you will end up writing to show off rather than for the reader's benefit.

Once you put the reader's interests first, you'll naturally start to find your own ways to achieve that. Everyone's style is different, but here's a few I've learned:

• If it starts "On that note...", "Also...", or "Furthermore...", you should probably cut it.
• Join Twitter - writing to a 140 character limit is a great form of discipline. Then imagine that every paragraph you write must become a tweet. You may find you can compress that paragraph into one sentence.
• Just as Twitter is good, other artificial constraints are good. Set yourself a word limit; if you're blogging, make it 500 words.
• Unless the article's about you, sentences that include the word "I" or "we" can usually be cut.
• Think of your piece as a nuclear missile: it has a payload, the message you want the reader to grasp, and a rocket motor, the introduction and other stuff you need to ensure it reaches the reader. Every missile needs a motor, but designers try to make the payload as big as possible, given the size of the motor. Identify what your payload is, and what your motor is. Then think, is my motor too big? (It probably is.) In this paragraph the missile analogy is the motor.
• As a rule of thumb, by writing it better, you can cut it down by half.

When "Mental" Illness Isn't

 

There's a theory that 'psychiatric diseases' like depression and schizophrenia aren't diseases because they're not diagnosed on the basis of any kind of biological abnormality, but purely on symptoms - unlike 'real' diseases like cancer and AIDS.

Now, in my view there's quite a bit of truth in that - but there's also a serious flaw in the argument. Sometimes, disorders diagnosed on the basis of psychiatric symptoms do turn out to have had a clear biological cause. So the original diagnosis of a psychiatric disease was correct: there was indeed a disease.

This is happening more and more often now because of biomedical advances.

A group of German neurologists and psychiatrists recently wrote about a case of a man diagnosed with bipolar disorder:

In February 2009, a 28-year-old presented to our clinic with a first episode of depression. He reported depressed mood, anhedonia, decreased drive, reduced alertness and concentration. The symptoms responded well to quetiapine 100 mg.

Fourteen months later, a first manic episode with logorrhea [excessive speech], aggressive and disinhibited behavior occurred... it completely remitted after treatment with quetiapine 1000mg. A diagnosis of bipolar I disorder was made.

Two months later, the patient presented with another depressive episode... Despite treatment with quetiapine, aripiprazole, lithium, valproate and escitalopram, the patient did not improve...

So far, seems like a fairly typical case of bipolar. However, it turned out that...

Neurological examination was remarkable for extrapyramidal symptoms with left-sided rigor and bradykinesia [slowed movements]. On initial and concurrent magnetic resonance imaging (MRI), numerous subcortical lesions in the frontal lobes were detected... Screening for autoimmune antibodies detected NMDAR antibodies.

It turned out the guy had autoimmune encephalitis: his body was generating antibodies that blocked the brain's key NMDA receptors; the drug ketamine does that too. Treatment with immunosuppressant drugs was started and he recovered fairly quickly. For a first-hand account of the disease, in which it was also diagnosed as a psychiatric disorder initially, see the recent book Brain On Fire.

Now, let's imagine that this had happened in 1960. What would the guy's story have been then?

He'd have been seen by a psychiatrist and diagnosed with bipolar, just as he was today. Depending on how severe the depression was, and whether or not he had any more episodes, he might well have ended up in a psychiatric hospital.

But he probably wouldn't have been diagnosed with a neurological disorder. He'd have tested negative for all the neurological diseases known at the time. No-one tested for NMDA antibodies back then, because NMDA receptors weren't even discovered until 1981.

It's true that his neurological exam showed a movement disorder (left-sided rigor and bradykinesia)  but this might well have been written off as a side effect of the high dose antipsychotics he was taking, which cause similar movement disorders.

50 years ago this guy, and many others like him, could well have ended up committed to an asylum. 100 years ago, I think it would have been almost certain he'd have been deemed 'insane' and locked up at some point.

If so, some of the people in psychiatric hospitals 50 or 100 years ago will have had this disease - or others. And if we didn't know about anti-NMDA encephalitis until recently, who's to say what we'll discover next?

Choe CU, Karamatskos E, Schattling B, Leypoldt F, Liuzzi G, Gerloff C, Friese MA, and Mulert C (2012). A clinical and neurobiological case of IgM NMDA receptor antibody associated encephalitis mimicking bipolar disorder. Psychiatry research PMID: 23246244

Ketamine: Magic Antidepressant Or Illusion? Revisited

There's a lot of interest in the idea that ketamine provides unparalleled rapid, powerful antidepressant effects, even in people who haven't responded to conventional antidepressants.

Earlier this year, I asked:

Ketamine - Magic Antidepressant, or Expensive Illusion?
There have now been several studies finding dramatic antidepressant effects of ketamine, the "club drug" aka "horse-tranquilizer". Great news? If you believe it. But hold your, er, horses... there's a problem.

My concern was that although depressed patients certainly do report feeling better after an injection of ketamine, compared to people given placebo, that doesn't prove that the drug is actually an antidepressant.

Rather, patients might be experiencing an enhanced, 'active' placebo effect, because ketamine causes subjectively powerful hallucinogenic experiences. So the placebo-controlled trials weren't really blinded.

To settle the question, I suggested a three-way trial comparing it both to an inert placebo, and to some other hallucinogen; if ketamine has a specific antidepressant effect, it should produce more improvement than the comparison drug.

This has never been done.

Given this background, a new trial from NIMH's Ketamine King, Carlos Zarate, makes interesting reading: A Randomized Trial of a Low-Trapping Nonselective N-Methyl-D-Aspartate Channel Blocker in Major Depression.

Zarate et al tried a novel drug, AZD6765 in depressed people. AZD6765 works much like ketamine in that it blocks brain NMDA receptors. But it is a less powerful trapping blocker than ketamine, meaning that AZD6765 causes less dramatic effects on the target receptors, in some respects.

In practice, this makes AZD6765, much less hallucinogenic than ketamine.

So it's interesting that, compared to placebo, the new drug only produced small benefits. On the MADRS depression symptom scale, patients felt a little better on AZD6765, but the boost only lasted a few hours.

The effect was far smaller than in an earlier ketamine trial as my crudely-mashed-up graph shows (although note that the patient populations were somewhat different, one bipolar and one unipolar depression, although their baseline severity was the same.)

While on ketamine people experienced significant subjective effects, with AZD6765 they didn't, and couldn't tell whether they got drug or placebo. Is that why they got a smaller benefit?

This is what we'd see if NMDA blockers do have a modest antidepressant effect but the dramatic improvements seen on ketamine are largely active placebo phenomena. Then again, it's also consistent with ketamine being a powerful antidepressant and AZD6765 just being less effective because it's a milder blocker of NMDA - effectively, a low dose of ketamine.

To tell the difference, we need... an active placebo controlled trial, like I've been banging on about for ages. But I wasn't the first one to suggest it - that was none other than Carlos Zarate et al in 2006.


Zarate CA Jr, Mathews D, Ibrahim L, Chaves JF, Marquardt C, Ukoh I, Jolkovsky L, Brutsche NE, Smith MA, and Luckenbaugh DA (2012). A Randomized Trial of a Low-Trapping Nonselective N-Methyl-D-Aspartate Channel Blocker in Major Depression. Biological psychiatry PMID: 23206319

My Breakfast With "Scientism"

One morning, I awoke convinced that science was the only source of knowledge. I had developed a case of spontaneous scientism.

The first challenge I faced was deciding what to eat for breakfast. Muesli, or cornflakes? Which would be the more scientific choice? I decided to go on the internet to look up the nutritional value of the different cereals, to see which one would be healthiest.

My computer was off. So first I'd need to turn it on - but how? From past experience, I suspected that pressing the big green power button on the front would do it - but then I remembered, that's merely anecdotal evidence. I needed scientific proof.

So I made a mental note to run a double-blind, randomized controlled trial of "turning my computer on" tomorrow.

Lacking nutritional data, I decided to pick a cereal by taste. I like muesli more than cornflakes. At last, a choice! Muesli it is, I thought - until I realized that I didn't actually know which one I preferred more. I had a gut feeling I liked muesli, but that's not science. What if, in fact, I hated muesli? Science couldn't tell me, at least not yet.

Another mental note: conduct cereal taste preference study, day after tomorrow. No breakfast for me, today.

By now, I was hungry, confused and annoyed. "This is getting ridiculous!", I tried to exclaim to no-one in particular - but then I realized - I could not even speak because I knew next to nothing scientific about the English language.

Sure, I had vague intuitions about how to put words together to express meaning, but that's just unscientific hearsay that I'd picked up as a child (no better than a religion, really!) In order to communicate, I'd need to study some proper science about semantics and grammar... but, oh no, how could I even read that literature?

Faced with the impossibility of doing anything whatsoever purely guided by science, I decided to go back to bed... yet with no scientific basis for controlling my own muscles, I collapsed where I stood, bashing my head on the breakfast table as I fell. 

Luckily, the bump on the noggin cured me of my strange obsession, and I lived to tell the tale.

---

Many people will tell you that "scientism", the belief that science is the only way to know anything, is a serious problem, a misunderstanding that threatens all kinds of nasty consequences.

It's not, because it doesn't exist - no-one believes that. If they did, they would end up like the unfortunate narrator in my story.

Everyday, we make use of many sources of information, from personal experience and learning to simply looking at things, whether they be right in front of your eyes or on TV. This is knowledge, and no-one thinks that we ought to replace it with "science", if that were even possible.

"Scientism" is a fundamentally unhelpful concept. Scientists are often wrong, and sometimes they're wrong about things that other non-scientists are right about. But each such case is different and must be judged on its own merits.

Neither Drugs Nor Therapy Prevent Psychosis

Neither medication nor psychotherapy is effective in improving the prognosis for youngsters considered to be at high risk of developing psychosis, according to a major study just published.

The idea of identifying and treating young people at risk of becoming psychotic - because of a family history of schizophrenia, or because they're showing some mild symptoms - has become very fashionable lately. But can we really do anything to pre-empt the disorder?

In this trial, 115 "ultra-high risk" Australian subjects were randomized to three different treatment conditions, or if they didn't agree to treatment, they were just followed up to see what happened.

The treatments didn't work. Here's the smoking gun, showing the proportion who didn't go psychotic over time:

This shows all four of the subject groups did pretty much the same in terms of their likelihood of becoming psychotic. Neither cognitive therapy, nor the antipsychotic drug risperidone (at a low dose) had any effect: those given 'supportive therapy' (basically: sympathetic chats) and a placebo pill did just as well.

There probably wasn't even a placebo effect: none of the three treatment groups did better than people who got no treatment at all (monitoring group), although people weren't randomly assigned to that group, so that's a little less clear.

Is this a surprise? Yes, if you believed the early studies to examine this question which claimed great things for drugs and therapy. But the current findings are no shock if you've been following the (much larger) recent trials - for example the British one from earlier in the year, which found zero benefit of cognitive therapy.

Early small trials have a nasty habit of not working out in the long run.

The other lesson here is that even "ultra-high risk" folks usually don't get psychotic: only about 10-20% of them, in fact, became ill in the first two years of this study; the British results I mentioned are very similar.

So is this really "ultra high"? Relatively, yes it is; even a 10% risk is far higher than the chance that a random person on the street would have. But in absolute terms, perhaps not.

A concern here is that rounding these folks up, labelling and 'treating' them might make their lives worse, or even increase the risk of psychosis. That's not just my opinion: that's what the very cognitive therapists who eagerly run these trials believe (or ought to, if they're being consistent with their own theories).

One of the key ideas in cognitive accounts of psychosis is that the belief and fear that one is 'going crazy', or that you're otherwise abnormal, is itself a major source of stress that actually leads to worsening of symptoms.

What could be scarier than being told you're at "ultra high risk"?

Preventing psychosis is a great idea in theory. But most bad ideas are.

McGorry, P., Nelson, B., Phillips, L., Yuen, H., Francey, S., Thampi, A., Berger, G., Amminger, G., Simmons, M., Kelly, D., Thompson, A., and Yung, A. (2012). Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis The Journal of Clinical Psychiatry DOI: 10.4088/JCP.12m07785

Search Trends Reveal The Most Suicidal States

US states with more Google searches for suicide-related things actually have a higher suicide rate, according to a study just out.

Researchers Gunn and Lester write that, across the 50 US states,

The association between suicide rates and the search volume for ‘‘commit suicide’’ was significant and positive[r=0.31, p=0.01]... ‘‘how to suicide’’ was marginally significant and positive [r=0.21, p=0.07]... Finally, ‘‘suicide prevention’’ was significant and positive [r=0.61, p=0.001].

This seems pretty convincing although it's hard to know whether this represents suicidal people making the searches, as opposed to people searching in response to local suicides that already happened.

The fact that "suicide prevention" was the closest correlated with suicides while "how to suicide" was weakest makes the latter seem more plausible to me.

Previous suicide-search research has given mixed findings:

Sueki (2011) looked at variations in the volume of Google searches about suicide and depression in Japan by month from 2004–2012 and found that the monthly search volume for‘‘suicide’’and‘‘suicide method’’was not significantly correlated with the monthly suicide rate. However, searches for‘‘depression’’ were positively associated with the monthly suicide rate especially with a time lag of 1–3 months.

Over the past couple of years there's been a flurry of studies based on analyzing Google and Twitter trends. What's interesting to me is that we're really in the early days of this, when you think about likely future technologies. What will happen when everyone's wearing a computer 24/7 that records their every word and move, and even what they see?

Eventually, psychology and sociology might evolve (or degenerate) into no more than the analysis of such data...

Gunn III, J., & Lester, D. (2012). Using google searches on the internet to monitor suicidal behavior Journal of Affective Disorders DOI: 10.1016/j.jad.2012.11.004

The Case Of The Missing Parasites

Collembola or "Springtails" are a common group of bugs - they're technically not insects although much like them - found all over the world.

There's no evidence that these critters are parasites for humans - except for one strange scientific report claiming to have found Collembola body parts in skin scrapings from people diagnosed with delusional parasitosis - a psychiatric disorder characterised by the belief that one is infested with parasites.

According to said 2004 paper by Altschuler et al, these patients are not delusional after all. This paper has been popular in the delusional parasitosis community.

However, insect expert Matan Shelomi says that Altschuler et al's best photo of the so-called Springtails was probably Photoshopped. He explains that in the only pic to clearly show anything resembling a 'bug' (there were many others, but none look convincing), the raw microscope image shows nothing but a blurry blob.

Altschuler et al claimed to have enhanced the contrast, but when Matan did that, there was still no visible critter. However, in the published image, a rather sinister bug is clearly seen. How did it get there?

Either the image contrast was somehow selectively enhanced just for the 'bug' part - which, of course, presumes that the bug was there, and is quite invalid - or more likely,

The level of detail present in Altschuler et al.’s enhanced image, particularly in the areas of the legs and a very odd pair of stripes along the abdomen, does not appear when contrast is applied equally. Such detail, however, can easily be created using functions such as Burn, Dodge, and Colorize on Photoshop®,when applied to select portions of the image manually as if via paintbrush.

However, Shelomi says, even if such fraud is proven, there may be nothing anyone can do: the journal the original paper was published in has since folded, so it would be impossible to retract it, and the author runs an independent non-profit and is hence not subject to scientific misconduct regulations.

Thanks very much to @benmeg for sending me a copy of this paper.

Shelomi M (2012). Evidence of Photo Manipulation in a Delusional Parasitosis Paper. The Journal of parasitology PMID: 23198757

The Onion Makes Mental Illness Ridiculous

Despite being entirely fictional, The Onion offer some of the most perceptive political analysis anywhere.

Less well known, but likewise brilliant, is its coverage of mental health. The Onion's approach is to satirize the beliefs and perceptions that characterize psychiatric illness. The result is hilarious, but also insightful and, in a weird way, empathetic:

Local Anorexic Still Way Too Fat

Despite years of intense dieting and vigorous exercise, local anorexic Lisa Kimmel is still way too fat, it was reported Monday... Though Kimmel could stand to lose a few pounds in nearly every area of her body, worst of all are her arms. "I've got this totally disgusting flab on the back of my arms that swings back and forth when I move," said Kimmel, wearing an oversized Champion sweatshirt to conceal her obesity. "My arms totally look like my grandmother's."

Making matters worse is the fact that Kimmel's mother wants her to be overweight, constantly trying to get her to eat fatty foods like ravioli, mashed potatoes and broiled chicken with the skin still on. Other family members, as well as Kimmel's friends and doctors, also entreat her to eat because they want her to be fat, repulsive and unliked.

Pharmaceutical Company Says Its New Anti-Depressant Is 'Worthless And Dumb'

At a press conference Monday, Peter Cafazzo, CEO of Brunley-Hunt Pharmaceuticals (BHP), introduced his company's latest anti-depressant, Cyntrex, a product he described as "a totally stupid waste of time that probably nobody will ever want ever." ...

According to reports, top BHP researchers began having doubts about the drug during the early development stages, when they realized they couldn't do anything right ever ever ever, and that none of the pharmaceutical-industry leaders cared whether they lived or died. But work on the project continued, despite BHP's growing conviction that Cyntrex would be the worst product in pharmaceutical history.

Is The Government Spying On Paranoid Schizophrenics Enough?

Panelists discuss ways to care for the nation's paranoid schizophrenics, such as hiding cameras in their homes or audio transmitters in their ears. e.g. "We need to hide cameras everywhere they go, in the street, in their homes, in the eyes of people at the stores where they shop."

Some people might see this as making fun of the mentally ill, but I don't: it's making fun of the illness.

Suffering from a psychiatric disorder is a tragedy, but the disorder itself, and the distorted cognitions associated with it are, well, ridiculous. It's ridiculous to see yourself as fat when you're dangerously underweight. It's laughable to think you're worthless when you're successful and respected.

Coming to realize the absurdity of such beliefs is an important part of recovery, and an explicit goal of cognitive behavioural therapy although therapists don't tend to emphasize the funny side, it is certainly there.

Did Boys Use To Wear Pink?

There's a belief that the colours we associate with the genders - pink for girls and blue for boys - used to be the other way around.

About 100 years ago, we're told, boys wore pink clothes, but then during the early 20th century, it flipped over. This is often used as an example of how arbitrary gender stereotypes are.

However according to psychologist Marco Del Giudice, the whole "pink-blue reversal" is an 'urban legend'. He argues that there's really only anecdotal evidence for the existence of the previous blue-girls pink-boys association.

The exceptions are four magazine articles - quoted in the paper that started the whole debate - which seem to provide documentary evidence. These associate girls with blue, but Giudice says that two of these might have been accidental typos, that swapped 'pink' with 'blue', while the other two may have represented a sneaky campaign by early feminists to subvert the blue-pink patriarchy.

Hmm. I don't really buy that. However Giudice has a stronger argument, which is that according to Google NGram, a searchable database of over 5 million books, there are lots of instances of the terms "blue for boys" and "pink for girls" going back to 1890, but none for the reverse at any time point:

Fair enough. However it's a big step from that to the idea that

the pink-blue convention may ultimately depend on innate perceptual biases toward different regions of the color spectrum in the two sexes (Hurlbert & Ling, 2007)

Del Giudice, M. (2012). The Twentieth Century Reversal of Pink-Blue Gender Coding: A Scientific Urban Legend? Archives of Sexual Behavior, 41 (6), 1321-1323 DOI: 10.1007/s10508-012-0002-z

Ritalin, The Ultimate Crimefighter?

There's been lots of interest in the idea that ADHD meds reduce crime rates.

No doubt that, even as we speak, worried pundits are writing of how this is a worrying Orwellian scenario and yadda yadda. But what's really going on?

The research is from Sweden and published in the New England Journal of Medicine: Medication for Attention Deficit–Hyperactivity Disorder and Criminality. The first thing to note is that the study is not about giving medication in order to prevent crime; it was purely looking at what happened to people given ADHD treatment for their ADHD.

In a nutshell, the authors found that people diagnosed with ADHD were about 10% less likely to be convicted of a crime during periods when they were on medication for the disorder. This was true of both men and women, and the effect was greater for the more serious offences.

It was a huge study with over 25,000 ADHD patients and the data comprise pretty much everyone in Sweden over the relevant period so in that respect it's a very good study - although speaking of Orwellian, these studies are only possible because of the Scandinavian tendency to make national registers of everything.

Now the big criticism here is that it's just a correlation, it doesn't prove that the meds were what prevented crime. It might be that ADHD meds have no effect on crime, but that people are less likely to commit crimes at periods when they have their lives sorted out (when they're 'on the rails'), one marker of which is that they're seeking treatment for their ADHD.

However, the authors found that periods of use of SSRI antidepressants were not associated with changes in conviction rates. This is quite good evidence against the 'on the rails' critique, assuming that being prescribed SSRIs is as much a marker of being on the rails as being prescribed Ritalin is.

So, in my view, this is pretty good work, as good as any observational non-randomized study. However, remember: this is just about treating ADHD. Not drugging criminals to stop crime.

Lichtenstein P, Halldner L, Zetterqvist J, Sjölander A, Serlachius E, Fazel S, Långström N, and Larsson H (2012). Medication for attention deficit-hyperactivity disorder and criminality. The New England journal of medicine, 367 (21), 2006-14 PMID: 23171097

Best. Experiment. Ever.

Studies have shown that men's testosterone levels increase after sexual stimulation. However, other research shows that merely briefly chatting to a woman also causes testosterone release, making it unclear whether sex, per se, is associated with testosterone changes.

So an intrepid band of researchers decided to find out using a unique methodology. Their paper's called Salivary Testosterone Levels in Men at a U.S. Sex Club and it's about... that.

They first set the scene:

Subjects were recruited from an internationally known "adult social club" in Las Vegas, Nevada, also referred to as a "sex club"... patrons pay a membership fee (akin to an entrance fee) to enter the 18,000 square foot, 2-story club. The first floor is open to all paying customers. The second VIP floor is available for an additional fee and includes a variety of rooms, including fetish rooms...

All are not created equal in this Garden of Eden, however:

Personal observation and communication with staff and members revealed to the investigators that there is a semi-structured hierarchy of patrons in the club. Single men (also referred to as ‘‘sharks’’) are easily identified by an orange wristband. Single women also wear an orange wrist band. Couples are identified by a green colored wristband. Single men are often considered to be a nuisance, as reported by many patrons, and are avoided in certain circumstances. Single women, moderately rare, do not share the stigma.

Anyway, the authors went there and recruited 44 men, of whom 18 ended up having sex, while 26 only looked at other patrons doing so. Saliva samples were taken before and afterwards, and levels of testosterone were measured. The results showed that testosterone increases were much larger in the do-ers than the watchers (see above).

This is an important result, the authors say, because

it runs against the grain of previous human testosterone and sexual stimuli studies in which testosterone increases in response to erotic videos and "courtship"’ behavioral interactions appeared more reliably induced than those related to active sexual behavior... We suggest that the reason for our findings, in contrast to the overarching pattern of previous work, is that lab-based paradigms may quell men’s testosterone responses... engaging in sexual behavior while wired up to machines in a sterile lab may put a damper on men’s arousal and physiological responses.

A good point.

In general, lab studies can be misleading when the behaviors under investigation are the kind of thing you can't really do in a lab. For research on fairly 'basic' memory, perception and cognitive tasks, a lab is probably as good an environment as any but for more complex behaviours it may be systematically misleading. And if a lab is bad, an MRI scanner is even less realistic.

Now, I thought the neuroscientists who threw a cocktail party on their grant money had it good, but these authors really hit a home run by using theirs to get into a sex club. It would be hard to top that but I note that surprisingly little is known about the, er, physiological correlates of lying on a beach in the Bahamas atop a pile of gold bars and bottles of Dom Pérignon. Someone needs to find out and I for one would be willing to undertake this challenge.

 Escasa, M., Casey, J., and Gray, P. (2010). Salivary Testosterone Levels in Men at a U.S. Sex Club Archives of Sexual Behavior, 40 (5), 921-926 DOI: 10.1007/s10508-010-9711-3

The Small World of Words

I've been asked to encourage people to take part in an online psychology study called The Small World of Words

I get a lot of this, and I usually don't respond to such requests, but this one looks pretty interesting.

The project aims to collect the world's biggest word association database. You see a series of words and you just have to type in the first three words that pop into your head.

Here's some more about it:

On average, an adult knows about 40,000 words. Researchers in psychology and linguistics are interested in how these words are represented mentally. In this large-scale study we aim to build a network that captures this knowledge by playing the game of word associations. You can help us with this project by participating in this short and fun study.

The study consists of giving the first three words that come to mind for a list of 14 items.
All ages and nationalities are welcome, but please note that we do require all participants to be fluent English speakers.

It's the sheer scale of this that makes it cool. They've got some 60,000 participants, and over a million associations already, but they're aiming for almost 300,000 people - which would make it not just the biggest word association study ever, but the biggest psychology study of all time, as far as I know.

It only takes about 2 minutes to complete and it's actually quite revealing. Out of 14 words I managed to associate a full 3 of them with 'pain', which disturbed me somewhat.

So take a look and spread the word (associations)...

Am I Attacking Neuroscience?

A New York Times article just out says:

Neuroscience: Under Attack

Under attack by who?

Er... me. And the rest of the usual suspects:

A gaggle of energetic and amusing, mostly anonymous, neuroscience bloggers - including Neurocritic, Neuroskeptic, Neurobonkers and Mind Hacks - now regularly point out the lapses and folly contained in mainstream neuroscientific discourse. 

I had promised not to do any more self-referential posts, but this one wasn't my fault. Just when I thought I was out, they pull me back in.

Anyway, I'm pretty happy with how Neuroskeptic's presented in the article, but not entirely.

The headline is sensationalist - I don't see myself as attacking neuroscience and I don't think any of the others do either. We are trying to defend neuroscience against errors and misrepresentations. My ideal is The Sceptical Chymist, where skepticism helped, rather than undermined, chemistry.

But the job of a headline is to be sensationalist so that's OK. Most of the piece is very good. I'm all on board with this:

Meet the "neuro doubters". The neuro doubter may like neuroscience but does not like what he or she considers its bastardization by glib, sometimes ill-informed, popularizers.

Yet I can't quite go along with this:

A number of the neuro doubters are also humanities scholars who question the way that neuroscience has seeped into their disciplines, creating phenomena like neuro law, which, in part, uses the evidence of damaged brains as the basis for legal defense of people accused of heinous crimes, or neuroaesthetics, a trendy blend of art history and neuroscience.

Admittedly this wasn't directly aimed at me because I'm not a humanities scholar, but I believe that neuroaesthetics and neurolaw are absolutely valid - in theory.

I'm not defending any particular manifestation of those, and I've criticized quite a few. But in the abstract, I see nothing wrong with neuroscience helping to explain those things. It will be difficult in practice, but it's fine to try.

Are Porn Stars Happier?

Women who appear in porn are happier than other women, enjoy sex more - and have lots more of it.

So says a new paper with the pulls-no-punches title of Pornography Actresses: An Assessment of the Damaged Goods Hypothesis

Researchers James Griffith and colleagues sampled 177 American adult actresses, and an equal number of other women of the same age, gender and relationship status. The results were pretty clear: the actresses said they started having sex earlier; had far more partners with an average of 75 vs. 5 in their lifetime (and that's not including on camera).

They were a lot more likely to be bisexual (67% vs 7%!), enjoyed sex more, and reported slightly higher levels of sexual satisfaction, happiness and self-esteem.

On the other hand, they were more worried about STDs and took more drugs (50% had tried ecstasy, 40% cocaine and 27% methamphetamine.)

Finally - and the authors emphasize this - they were no more likely than other women to have suffered childhood sexual abuse. They're not 'damaged goods' as that horrible phrase has it.

So. Well. This study is clearly going to become a hot potato, or rather a political football in The Great Porn Debate, so let's take a calm look at it.

In any survey the fundamental question is - are the respondents representative examples? Or were the porn actresses who filled out the questionnaire atypically happy? Were the comparison women unusually miserable?

We really have no way of knowing. The controls were recruited from a university and an airport, which is pretty sensible although it might introduce some bias. The actresses came via adverts placed in an L.A. clinic specifically for the adult movie industry, the now-defunct AIMHF. That seems like a selective sample - but the clinic reportedly catered to most, if not all, stars in LA because all performers had to get monthly HIV tests there.

Ultimately, though, we don't know how representative they were.

Next up, it was all self-report. So the reports might have been wrong. However, that's a feature of all survey studies, especially those about such things as happiness. It's hard to see a way around this. It's also not clear what bias it would introduce into the results. It could be that the porn actresses were motivated to exaggerate their happiness in a bid to defend their industry, which I suspect will be a common criticism - but that assumes they're happy enough with it to want to defend it, so it's somewhat circular.

Finally, and most importantly in my view, L.A. porn stars are not your average pornstars. The American professional adult movie industry is the biggest, most regulated, and most 'mainstream' in the world. Sadly elsewhere the degree of exploitation, coercion, poverty and abuse among people who end up in porn is a lot higher.

Basically, I can't see anything obviously wrong with this study as far as it goes, but all it shows is that American porn actresses are in fairly good shape. Most women in porn, however, are not American.

Griffith JD, Mitchell S, Hart CL, Adams LT, and Gu LL (2012). Pornography Actresses: An Assessment of the Damaged Goods Hypothesis. Journal of sex research PMID: 23167939

The Perils of Sharing Brain Scans

A fascinating paper by neuroscientists Van Horn and Gazzaniga chronicles their pioneering, but not entirely successful, attempt to get researchers sharing their brain scans: Why share data? Lessons learned from the fMRIDC.

It all started in 1999 when, along with some colleagues, they decided that the time was right for data sharing in neuroimaging. They got some public funding, and tried to get various major neuroscience journals to require that anyone publishing an fMRI study should make their data available to the fMRI Data Consortium (fMRIDC).

By making it mandatory, they'd ensure that there was no selection bias. Requirements to post raw data were already common in other fields of science like genetics and crystallography. So, they thought, why can't it happen here?

However, it didn't go down very well:

Upon becoming aware of our efforts and goals, fMRI researchers angered by journal requirements to provide copies of the fMRI data from their published articles began a letter writing campaign seeking to muster opposition  an effort which was featured in the news and editorial sections of several influential journals.

Editorials and commentaries over fMRI data sharing were aired in the pages of Science, Nature Neuroscience etc. expressing concern over the data sharing requirement, over what possession of the data implied, human subject concerns, and, if databasing was to be conducted at all, how it should be conducted “properly”.

This was all before my time, sadly. It sounds like a grand old academic street-fight. No doubt those on the other side remember it differently from how it's presented here, though.

The reactions of our colleagues caught us somewhat off guard. We were honestly surprised by the  negative and hostile response when we had believed that creation of a data archive would be of benefit to the neuroimaging community. Perhaps, they had a point.

Maybe the field wasn't ready for fMRI data sharing? Perhaps, it was too early to start such a project? We struggled with how best to move forward or whether to move forward at all.

Anyway, they decided they would continue, on a more modest scale. fMRIDC ended up with data from about 100 fMRI studies by the time the funders pulled the plug in 2006, only a fraction (and perhaps an unrepresentative one) of the papers published, but still, it's something.

As I said, I missed out on this debate, but if I had been in the field 10 years ago, I suspect I'd have been on the extreme wing of the pro-sharing faction, the Montagnard to the founders' Girondism. My view is that no researcher owns their data. The only person who owns the results of a brain scan is the person whose brain it is.

If I could wave a magic wand, I'd put a chip in every MRI scanner that automatically uploaded all scans to a public database as soon as they appeared (with the subject's consent, and/or with personal information about the subject stripped out). I'd fix all the software such that every time someone ran an analysis, it was publicly logged. Total transparency is best for science, I believe, and it would also make scientists lives  easier, once they got over the initial shock.

Sadly that's not possible... yet... but data sharing is a noble cause and, as Van Horn and Gazzaniga point out, even if fMRIDC is dead, the idea lives on with many new initiatives emerging, hydra-like, in its place.

Van Horn JD, and Gazzaniga MS (2012). Why share data? Lessons learned from the fMRIDC. NeuroImage PMID: 23160115

Should You Judge A Book (Woman) By The Cover?

"Do physically attractive women possess particularly attractive inner attributes?"

So ask the authors of a study just out in Psychological Science: Don't Judge a Book by Its Cover, Revisited. Their answer? People do tend to judge (female) books by their covers, but we shouldn't.

Psychologists Segal-Caspi and colleagues took 118 female Israeli students and videotaped them walking into a room and reading a weather forecast. Then other students - male and female - judged the 'targets' on attractiveness, but also tried to work out their personality, purely based on 60 seconds of video.

So what happened?

The judges judged prettier women as having stereotypically 'better' personality traits e.g. less neurotic and more friendly. Interestingly, both male and female judges did this, and there were no significant differences between the genders.

So there's a tendency to think that those we find attractive are also beautiful on the inside - but, that's all an illusion, say the authors. The targets were also rated themselves on personality, and these self ratings told a different story - there was no correlation between personality and average ratings of attractiveness.

There were however some small differences in self-reported values, with attractiveness being associated with valuing tradition and conformity, but not 'self-direction'.

So there we have it. Books, covers, don't judge 'em by 'em. It would have been better if this study had included both male and female 'targets', though, and the whole thing does rely on the validity of self-report, though no more than any other psychology paper.

The journal Psychological Science has been criticized recently, accused of publishing findings that probably aren't true and wouldn't be interesting even if they were. I don't think that applies to this, though.

On the contrary, this is the kind of study that psychologists should do more of.

The subject may seem crude, unsophisticated and not very 'scientific' but like it or not, it's one that people care about. Many people have strong views on issues like this (one way or the other), ones based essentially on hearsay, and personal recollections, i.e. on not much to speak of.

By addressing issues such as these, psychologists could really help to clear up some messy debates and damaging misconceptions.

Segal-Caspi, L., Roccas, S., and Sagiv, L. (2012). Don't Judge a Book by Its Cover, Revisited: Perceived and Reported Traits and Values of Attractive Women Psychological Science, 23 (10), 1112-1116 DOI: 10.1177/0956797612446349

Upcoming Appearances (And A Funny Picture)

Just a quick reminder - or perhaps a new announcement for those of you who aren't on Twitter - that I've been short-listed for the UK Science Blogging Prize. I'll be giving a very brief talk at the awards night next Sunday 25th November which is in the Penderel's Oak, London.

Speaking of Twitter, I'm on Twitter here: https://twitter.com/Neuro_Skeptic

I'll also be speaking in Philadelphia on December 6th at UPenn on the topic of Brain Rumors: Public (MIs)understanding of Neuroscience and Why It Matters

Finally, to save this from being a completely boring post, here is the cover of the latest British Medical Journal, which in my opinion is the funniest image ever to grace the front of an academic publication. Even if it is, literally, potty humour.