You Use Your Partner To Phone And Play Angry Birds. Literally.

WITH lots of weddings expected on Tuesday, people in love across the world are getting ready for their latest fix.

But should we really characterize the intense devotion shown by people in love, as love? A recent experiment that I carried out using neuroimaging technology suggests that love-related terms like “romance” and “soulmates” aren’t scientifically accurate - not compared to a word we use to describe our relationships with our smartphones. That word is “owning an iPhone.”

As a branding consultant, why am I even writing this article for the NYT? Never mind. Earlier this year, I carried out an fMRI experiment to find out whether iPhones were really, truly addictive, no less so than alcohol, cocaine, shopping or video games (sic)... wait, are those last two actually addictive? Whatever, let's just say they are.

In conjunction with the San Diego-based firm MindSign Neuromarketing (kerching! Wait, did I write that, or just think it?), I enlisted eight men and eight women between the ages of 18 and 25. Our 16 subjects were exposed separately to audio and to video of a wife or husband.

In each instance, the results showed activation in both the audio and visual cortices of the subjects’ brains. In other words, when they were exposed to the video, our subjects’ brains didn’t just see their partner, they “heard” them, too. This powerful cross-sensory phenomenon is known as "the brain storing information about people and objects, and retrieving it in response to related stimuli", or "memory" to use the technical term.

But most striking of all was the flurry of activation in the insular cortex of the brain, which has also been associated with seeing an iPhone. The subjects’ brains responded to the sound of their partner as they would respond to the presence or proximity of a top of the range smartphone (with free WiFi in thousands of locations!)

In short, the subjects didn’t demonstrate the classic brain-based signs of addiction when they were shown pictures of their lovers. Instead, they made calls and played Angry Birds on them.

---

The silliness of equating insula activation on fMRI with love and using this to argue that we love our iPhones as a recent crap OpEd in the New York Times did, has been excellently covered over at [Citation Needed], Neurocritic and many others. I'm sure you've heard plenty about this story already.

But let's set aside the fact that loads of other things, by no means limited to disgust and drug addiction, are known to involve the insula in fMRI. Let's assume (as the NYT piece did) that the only two things that had ever been shown to activate the insula were seeing an iPhone and seeing someone you love.

This study still wouldn't show that people love their phones. You could equally well turn the whole thing on its head and argue that it shows that we think of people we love as something to make phone calls with. Hey, the brain activity is the same as when you look at an iPhone.

This might strike you as implausible, but given the fMRI data alone, you have no grounds for saying one interpretation is more or less plausible than the other.

There are countless other interpretations, each equally plausible given the imaging data. Maybe the insula is only about love, and the activation to the iPhone is due to conditioned association (you call people you love on it). Maybe it's about objects you see every day, which includes your phone and people you love. Maybe...

The only reason to prefer any particular interpretation would be because you have evidence from outside neuroimaging - from other areas of neuroscience or psychology. So if you discovered that insula lesions cause people to be unable to fall in love (they don't, as far as I know) then you could make a case for the love interpretation. But only then.

Neuroimaging, on its own, can't tell us anything about the brain. It's like a peek under the hood of your car. If you already know how a car works, you can look under the hood and work out what's going on, and what's gone wrong. But only if you have that prior knowledge. Otherwise, it's just a big set of metal pipes.

Le Pack It In

Earlier this year, a large group of autism experts signed a consensus statement condemning "Le Packing", a certain procedure used in children with autism.

They said:

This alleged therapy consists of wrapping the patient (wearing only underclothes or naked in the case of young children) several times a week during weeks or months in towels soaked in cold water (10°C to 15°C). The individual is wrapped with blankets to help the body warm up in a process lasting 45 minutes, during which time the child or adolescent is accompanied by two to four staff...

The alleged goal of this technique is to “allow the child to rid him- or herself progressively of its pathological defense mechanisms against archaic anxieties,” by achieving “a greater perception and integration of the body, and a growing sense of containment..."

We have reached the consensus that practitioners and families around the world should consider this approach unethical.

 Le Packing is almost unheard of outside France, where it was invented some years ago by M. A. Woodbury, an American psychiatrist. It's controversial even there.

Now Pierre Delion, a French packer who's previously defended the approach, and even wrote the book on it, has penned an article which discusses the towel-based treatment: Towards a dialogue between psychoanalysis and neuroscience: Connections that are both possible and necessary

The piece (part of a special issue on psychoanalysis and neuroscience) starts out with some general scholarly remarks about previous authors who have discussed Freud and the brain, but it moves on to autism, with some, well, puzzling remarks:

During the first months of life, an infant will actively practice his or her archaic reflexes. Of these, the grasping, which will progressively disappear as voluntary prehension emerges around the age of 4–5 months, is of great interest. The facilitation and/or anaclitic relationships between this reflex and adhesive identification are even more interesting to study together because, for instance, in an autistic child, the first model will integrate under the form of pathological adhesive identification.

In such an example, a strategy for thinking about these two phenomena and making them compatible is using a third term (e.g., Peircean logic, in which adhesive identification is an icon of grasping). If we refer to this important principle from this great American semiotician, the icon is part of the logical representation scheme from the most elementary, the icon, to the most evolved, the symbol, passing by the intermediate, the index...

The relationships between neurological wiring and pre-wiring enable the effective installation of the theory of mind and the phenomenon of projective identification described by Melanie Klein and her students...

Hmm.

On Le Packing itself we get a curious paragraph which seems to be saying that the therapy itself works via a neurophysiological mechanism, but that Freudian theory can explain why the child and their caregivers are anxious. What the anxiety in question is about is not clear. About the packing? That seems the most natural reading:

Another example taken from Pierre Delion’s practice as a therapist for children with autistic disorder is the ‘‘packing’’ technique (Goeb et al., 2008). This is the use of humid wrapping to prevent self-mutilation by using these two different levels [i.e. neuroscience and psychoanalysis] that are nonetheless joint during treatment. This technique uses a neurophysiological hypothesis to try to explain the therapeutic effects, but, at the same time, the psychopathological hypothesis that is given by psychoanalysis helps to format the anxieties that are experienced by the children and invariably shared by their caretakers.

Clinical research regarding this topic is currently being undertaken in Pierre Delion’s child psychiatry department following a hospital program for clinical research (PHRC, NoEudra CT: 2007-A01376-47) entitled ‘‘Demonstration of the efficiency of packing treatments in children affected by autistic disorders with severe behavioral disorders’’.

Delion P (2011). Towards a dialogue between psychoanalysis and neuroscience: Connections that are both possible and necessary. Journal of physiology, Paris PMID: 21963531

To Catch A Predator... With A Brain Scanner?

With the help of an MRI scanner and some child pornography, a new study claims to be able to tell whether someone is a paedophile: Assessment of Pedophilia Using Hemodynamic Brain Response to Sexual Stimuli.

It was an fMRI study of 24 self-identified paedophiles (recruited through a clinic offering anonymous treatment) and 32 male controls. Everyone was shown a series of images of naked men, women, boys and girls. The neural response to child vs. adult images was the main outcome measure.

Respect to the authors for getting that past the ethics committee.

The blob-o-grams above show that the paedophile's brains reacted differently to the control brains, when shown images of naked children, which is not surprising because the brain is what makes you a paedophile (and everything else.)

However, what's more interesting is that by comparing each individual's brain activity to the average activity of the paedophile group and the control group, it was possible to diagnose people as paedophiles or not with high accuracy (90+%).

Plotting the "typical paedophile"-ness of the neural response to girls vs women and boys vs men, the paedophiles (triangles) form a clear cluster. There were also some differences between homosexual and heterosexuals in both groups.

The statistics seem kosher: they used leave-one-out cross-validation to avoid the error of double dipping.

What's not clear is whether this was measuring sexual attraction as such. All it's measuring is how much each person's activity correlated with the paedophile group average. Maybe it's picking up on the shame paedophiles feel over being reminded of what they've done. Maybe the controls were just averting their eyes when the child porn came on.

However, you could say that if you're just interested in the practical business of catching paedophiles, that's academic. More concerning is the question of whether it would be possible to fool the technique. A recent study showed that it's easy to fool a brain scan designed to detect lying.

But let's suppose it does work out. Would that be a good thing? What is "a paedophile", anyway? Is it someone's who's attracted to children, or someone who acts on that attraction?

For example, there are people who are caught with child porn, and who admit they downloaded it, but who deny being attracted to children. The Who shredder Pete Townsend and comedian Chris Langham being two British examples. Both admit downloading illegal images, but say it was for 'research purposes'.

Now it might be possible, using fMRI, to find out if they're telling the truth. Let's suppose it was doable.

So what? Downloading child pornography is a crime - whatever your motivation. Being attracted to children is legal, in itself. So from a legal perspective it should make no difference at all in cases like this.

Of course, we don't in fact go around seeing things from a purely legal perspective. We care whether someone is attracted to children or not. But should we care? Is that fair? You don't choose your sexual orientation. What you choose is whether to break the law by commiting the crime.

There are surely people out there - no-one knows how many - who are attracted the children, and never act on it. Do we want to be able to "catch" them?

Edit: The original version of this post linked to the wrong paper, an older paper by the same authors. This has been fixed now.

Ponseti, J., Granert, O., Jansen, O., Wolff, S., Beier, K., Neutze, J., Deuschl, G., Mehdorn, H., Siebner, H., & Bosinski, H. (2011). Assessment of Pedophilia Using Hemodynamic Brain Response to Sexual Stimuli Archives of General Psychiatry DOI: 10.1001/archgenpsychiatry.2011.130

Failed Drug Company... Failed Drug?

The pharmaceutical industry is in trouble at the moment, with many companies pulling out of development in certain areas and psychiatry is high on the list.

The tale of one troubled would-be antidepressant has just been published in the form of a clinical trial that was terminated early when the parent company went under. But another company came along to save the day, so the drug might live on.

Amitifadine is a triple reuptake inhibitor (TRI). What's that? Prozac and other SSRI antidepressants work by blocking the reuptake of serotonin in the brain thus increasing levels of serotonin. Some other antidepressants block the reuptake of serotonin and noradrenaline, and these dual reuptake inhibitors may be slightly better than SSRIs (although maybe not).

TRIs take this one step further: they add a third monoamine neurotransmitter, dopamine, to the list. If two monoamines are better than one, three ought to be even better... right?

This was a clinical trial of amitifadine vs placebo in depressed adults. It was originally designed to have 200 depressed people, but it only got to 63 patients before the money ran out:

The study was initiated in April 2008 and was halted by the sponsor, DOV Pharmaceuticals, early in December 2008 due to lack of funding.

DOV were a small company best known in the financial world for the fact that their stock crashed spectacularly on the first day they went public on the markets. Investors who lost out subsequently sued the company and their main underwriters, a certain outfit you may have heard of called Lehman Brothers.

After various (non-psychiatry) projects failed, DOV were bought out by a certain Euthymics Bioscience. DOV's old website, dovpharm.com, now offers Canadian Cialis. Don't wait! Order the cheapest medications now!


What a sad fate.

When Euthymics bought DOV, they also bought the rights to DOV 21,947 which they dubbed amitifadine. The takeover happened in June 2010, so I guess that after DOV pulled the plug on the trial in 2008, Euthymics came along and decided to try to finish the development of amitifadine. The lead author on the present paper is Chief Medical Officer at Euthymics.

So what did they get for their money? Is amitifadine a goose that will lay some golden eggs, or the latest turkey?

Take a look:

People on amitifadine did slightly better than the ones on placebo over 6 weeks, on the MADRS depression scale (p=0.028). On the HAMD17 scale, which is more popular, there was no significant benefit (p=0.125), although it might have worked had the trial managed to recruit more people.

The non-significant benefit over placebo on the HAMD was 3.1 points. How does that compare to other drugs? It's impossible to say for sure, but there are some reasons to think that it's nothing special.

Patients in this study had very severe depression, with a baseline HAMD17 score of about 29.5. We know that the effect of antidepressants over placebo is correlated with severity. For what it's worth, with existing antidepressants, a baseline HAMD score of 29.5 would be expected to translate into a drug-placebo difference of about 4 HAMD points according to Fournier et al or about 5 in Kirsch et al.

Plus, the odds were stacked in the drug's favour in this study. To get into the trial, patients needed to have shown a "significant clinical improvement" to at least one previous antidepressant. Anyone who'd failed to improve on two or more different drugs was excluded.

In terms of side effects, there weren't many, and people on the drug actually reported no more adverse effects than those on placebo, in total. It lowered blood pressure and raised heart rate slightly. However, the small sample size is an issue here as well. The only way to know whether it's really better tolerated than other drugs would be to do a direct comparison.

Overall, while amitifadine looks like it works to some extent, it's anyone's guess whether it will offer any advantages over existing, cheap drugs - a verdict that Neuroskeptic readers have heard before.

Tran P, Skolnick P, Czobor P, Huang NY, Bradshaw M, McKinney A, & Fava M (2011). Efficacy and tolerability of the novel triple reuptake inhibitor amitifadine in the treatment of patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Journal of psychiatric research PMID: 21925682

The Recession and Death

The present economic crisis has led to more suicides in Europe - but fewer deaths in road traffic accidents.

So says a brief report in The Lancet. The authors show that suicide rates in people under the age of 65, which have been falling for several years in Europe, rose in 2008 and again in 2009, in line with unemployment figures. The overall effect was fairly small - 2009 was no worse than 2006. It still corresponds to a 5% annual increase in most countries. In Greece, Ireland, and Latvia the rise was about 15%.

That's sad but not perhaps very surprising.

What's interesting though is that road traffic fatalities fell sharply. In Lithuania, they dropped by nearly half, although they were very high to begin with, and in Spain and Ireland they fell by 25%.

This presumably reflects the fact that people are just driving less, and perhaps slower. We've got less money to spend on fuel, and fewer jobs and things to need to drive to.

The authors note that although fewer road deaths is generally a good thing, there's one downside - a shortage of donor organs for transplantation. Road accidents are a prime source of organs because they're one of the few times that young, healthy people die leaving most of the body intact.

Stuckler D, Basu S, Suhrcke M, Coutts A, & McKee M (2011). Effects of the 2008 recession on health: a first look at European data. Lancet, 378 (9786), 124-5 PMID: 21742166