Friday, July 24, 2009

Nothing Is Better than Something

Imagine you have gone to your physician and were told you needed a specific medicine to help you get better. Then your doctor told you that if the medication wasn’t working you could make it stronger by diluting in water. You were told to keep diluting it until there was only one molecule of the medicine left in the water. You were told this small amount of the medication would be extremely strong and would cure what ailed you. Would you have some misgivings about this advice? Most people would leave immediately, never go back and probably report the doctor to the medical board.

Yet, there are people who believe this kind of "medicine" really works. It’s hard to imagine this but millions of people swear this system has helped them with their medical problems. This treatment is called homeopathy. For many people homeopathy is a misunderstood concept. People often think homeopathy describes a remedy that uses natural herbs. This is not what homeopathy is. Regardless of this misconception, it is a popular treatment. If you Google "homeopathy" you will get over a million and a half hits most of which are favorable to homeopathic medicine.

Let me give you some background on what homeopathy real refers to. It was invented in the late eighteenth century by Samuel Hahnemann. He based homeopathy on a philosophy that believed all illness and disease was caused by "disturbances of the life force." Hahnemann lived during a time when the germ theory was just beginning to be understood. Humans had always wondered why people got sick and many ideas over the millennia had been advanced as to why people fell ill.

One of the more common theories on why people got sick was based on the idea that life could only be fully explained on the basis of a mysterious form of energy inherent to all living things. This strange force had nothing to do with the laws of physics and chemistry, however. People who held this view thought a healthy person was one in whom these forces were in balance. One became unhealthy when the forces were out of balance.

Hahnemann believed this vital force could be affected by internal events (like a person’s thoughts) or by circumstances outside an individual. He called this the "law of susceptibility." To cure this imbalance he devised a method based on the notion that "like cures like." In other words if you had a headache, the cure would be based on anything that would give you a headache. If Hahnemann could find a piece of bark or a root that would cause headaches he would then make a potion from it.

Hahnemann observed that if he swallowed a small amount of cinchona bark he would experience symptoms similar to malaria. Cinchona bark is used to produce quinine which in turn is an effective drug for the treatment of malaria. Aha! He thought he had found the miracle cure. Cinchona bark must have the vital force for curing malaria because in high enough doses it can cause malaria (it can’t).

To create the proper medicine for an illness he would find something that could cause symptoms similar to the illness. He would then dilute the chosen substance so much there was not enough toxicity left in the solution. He reasoned that the more he diluted a substance, the more powerful it became because the dilution would make the vital force even stronger. If this was true, then the more he diluted it, the stronger it became. Of course, he had no evidence this was true, it just seemed like a good idea to him.

This Principle of Similarities became the foundation for homeopathy. So, if rotten meat brings on nausea to the point of vomiting, then a solution with trace amounts of rotten meat, he declared, will cure nausea.

How much do homeopaths dilute their curing solutions? More than you can imagine. If you are really sick then serious dilution would be a lengthy process. A very small amount of the first dilution would be diluted again and again. This would be repeated until the initial substance barely existed. What remained would be equivalent to one drop of the cure diluted in all the water on earth.

Homeopathy proponents also believe that literally anything can be a potential remedy. Dr. Harriet Hall, a retired Air Force flight surgeon is convinced that homeopathy is absolute nonsense. When it comes to finding absurd things to act as a cure, her favorite is "eclipsed moonlight." She ponders as to how it is collected in order to prepare the remedy. Let me know if you find how out to harvest eclipsed moonlight.

What keeps this pseudoscience alive is that homeopathic practitioners and their patients swear these treatments work. Of course, swearing and belief do not a treatment make. There are many reasonable explanations why homeopathy "works." One of the strongest reasons is the power of the placebo. Since a placebo can be so effective, a treatment is not considered legitimate by the scientific community unless it can produce effects significantly greater than a placebo treatment would provide.

This is a very stringent standard because people can think a treatment is helping them when, in fact, it is the result of placebo. For example, a study was done where two groups of people were given either morphine for severe pain or an inactive placebo. Here’s the astonishing part. The people getting the "nothing" treatment were told they were getting a powerful new painkiller. The researchers were shocked to find out this group got just as much relief as the group who actually got morphine.

Placebos have been studied so extensively that we now know there is a pecking order of effectiveness. Some placebos work better than others. Here is a list of which placebos work better than others. It looks something like this (This list is taken from "The Placebo Effect" by Harriet Hall in the Skeptic magazine, Volume 15, Number 1, 2009):
  1. Placebo surgery works better than placebo injections.
  2. Placebo injections work better than a placebo pill.
  3. Fake acupuncture also works better than a placebo pill.
  4. Pills as capsules work better than pills as tablets.
  5. Big pills work better than small pills.
  6. The more doses a day, the better.
  7. The more expensive the pill, the better it works.
  8. The color of the pill makes a difference.

This doesn’t make any rational sense and we only partially understand how a placebo works. So far we know it works and it can work very well. When studies of homeopathic treatment take into account the results of the placebo, homeopathy is left standing naked.

What about "all the studies" supporters of homeopathy quote that show how legitimate homeopathy is? We must realize there are studies and there are studies. It is very easy to do sloppy science. This kind of science can verify all sorts of crazy notions. Consequently, only well-designed studies are acceptable.

To illustrate this point, we can observe the career of Edzard Ernst who is a physician and the world's first professor of complementary medicine. He used to be a passionate support of homeopathy. Then he began to do research. He and his team of researchers have published over 700 papers in scientific journals on alternative medicine. After fifteen years of studying homeopathy, he has concluded that "the evidence points towards a bogus industry that offers patients nothing more than a fantasy." Strong language from someone who used to be inside the camp.

If you are interested in what logic is used by supporters of homeopathy to maintain that it is an effective treatment, you only need to browse the writings of Louise McLean who is the Executive Director of the Alliance for Natural Health. You can find her writings here. You will find an article called, "Homeopathy Facts List – 54 Facts." As you read through this article of "facts" you may quickly realize the "intellectual bankruptcy of the homeopathic belief system." Here are some examples (my comments are in parentheses):

  • FACT 10: Outcomes of homeopathic treatment are measured by the LONG TERM curative effects of prescribing and complete eradication of the disease state. (Like scientific medicine is only concerned with short term effects? All measurements of long term effects from homeopathy have found no significant effects.)

  • FACT 20: In 200 years, there has never been a single homeopathic medicine recalled, unlike pharmaceutical medicines. (That’s because homeopathic "medicines" are not regulated by any government body. Therefore, they cannot be recalled. The FDA doesn’t regulate treatments that don’t work.)

  • FACT 30: The Homeopathic Hospitals are clean, with friendly, well informed staff. The patients are generally pleased with their treatment unlike many orthodox National Health Service hospitals. (She is obviously comparing the best Homeopathic Hospitals with the worst British Hospitals. Even if this were true, I’m not sure how this proves that homeopathy works.)

  • FACT 40: Homeopathy can never be properly tested through double blind randomised trials because each prescription is individualised as every patient is unique. Therefore 10 people with arthritis, for example, may all need a different homeopathic medicine. (This is merely an excuse for why all double blind tests of homeopathy have failed. It would be easy to design a test for each of the 10 people who needed 10 different homeopathic medicines. Supporters of homeopathy need to do this if they really want to be accepted as legitimate. I wonder why they have not done so?)

  • FACT 50: Hundreds of famous people throughout the past 200 years have enjoyed the benefits of homeopathic medicine. (Hundreds of famous people in the past 200 years have believed in witchcraft, psychics, or other foolishness. The belief of intelligent people is hardly a reliable standard to finding truth. Some of the most gullible alive are members of MENSA.)
What really keeps homeopathy alive is that it is supported by nice people; humans respond to what nice people say. If you were to visit a homeopath you would probably find it to be a very pleasant experience. He would sit and patiently listen to you as you tell your personal story. You might not get this much attention from your MD. The homeopath would make you feel special because he would pick out a "special" treatment designed just for you which would make you feel special. The remedy would be inexpensive and would most likely have little or no side effects (how could there be side effects when there is nothing to cause it?). You would tell your friends that you were very reassured because the homeopath had been interested in you as a person.

Who wouldn’t want to experience this atmosphere along with medical treatment? Scientific medicine could use more of this relational aspect in their treatment. Many of my clients tell me they will change physicians if their physician treats them poorly. Excellent.

The Gold Standard (double blind studies) for deciding what works and what doesn’t is the Gold Standard for a good reason. It minimizes human error and bias that is built into all human researchers, practitioners, and those of us who use treatment services. Hopefully, homeopathy will eventually go the way of bloodletting and purging. Philosopher Daniel Dennett at Tufts University has said that treatments based on "mysterious stuff" need to be relegated "to the trash heap of history." Amen.

Friday, July 17, 2009

Nobody Can Explain Love

Years ago when I became interested in science and would attempt to explain all the exciting things we can learn through science, it was not uncommon to get the rejoinder that "science cannot explain everything" (no scientist ever said it could).

The example that was often given to explain this belief was love. "Science will never be able to explain love." Of course, the human race has made this blunder ever since the dawn of science. Every time some says "Science will never be able to . . ." the prediction inevitably fails.

During my early years, grownups tried to convince me that a car could not be built to exceed sixty miles an hour. Even if the technology could pull this stunt off, I was told the human body would not be able to stand the force of such speeds. At the beginning of the twentieth century the idea of putting someone on the moon was laughable. There is a very long list of common bonehead statements like this and they are the result of our limited imagination. Science fiction writers and other novelists, like Ursala Le Guin, have been able to envision future human achievements that seem incredibly far fetched.

"Nobody can explain love." Like so many statements that have put constraints on scientific endeavors, this one is about to be thrown into the historical dustbin. Love is so powerful, so universal, so . . . unexplainable. Its mystery is probed in poetry, novels, movies, daily conversation and now by science.

You are probably already aware of the fancy tools scientists are using to peer into our brains. The human brain may be the most complicated thing in the universe and we are just barely beginning to understand how it works.

A recent study was conducted at State University of New York, Stony Brook. The researchers studied college students who had recently fallen in love (maybe we should call universities and colleges "love factories.") and the effect it was having on their brains. They watched the brain's reaction when these people were shown pictures of their beloved.

Sure enough, as soon as they glanced at the picture, a specific part of their brain lit up like fireworks. The interesting part is that this part of the brain is the same one that gets lit up for cocaine and nicotine users. It gets flooded with the brain chemical dopamine. We know that dopamine flooding is so rewarding that humans will do almost anything to make it happen.

Another love chemical in the brain goes by the tongue twisting name of isphenylethylamine. It is easier to call it PEA which scientists do. PEA is produced by the brain and is a naturally occurring amphetamine. These chemicals work in tandem. Amphetamines cause brain synapses to release this little, tiny spray of dopamine into the brain. There's the buzz — the same high after someone snorts a line of cocaine.

Using cocaine is illegal, smoking cigarettes should be illegal, but love will never be illegal. Many of my clients have told me that they have kicked highly destructive habits after they have fallen in love. A female client was relieved of her depression when she fell in love; a male client stopped having panic attacks when he fell head over heels for the "most beautiful woman" he had ever seen; a teenage client "cured" her bulimia when she met the perfect boy. And so on.

Guess what happened when these relationships ended? The dopamine no longer overrode the other chemicals that were making these people's lives miserable. This may be why some people have so many relationships. After one fails, they need a fix, another love fix. Some people who are not so intensely caught up in the cycle may still complain they just can't live by themselves and are continually on the prowl for someone to fill that emotional/chemical void.

This is not to say that we should have to enjoy being alone. After all, we are social creatures and find comfort and meaning within relationships. However, the people I have known who enjoy their relationships the most are the ones who are comfortable being by themselves.

Dr. Helen Fisher is a researcher in this field who did a similar experiment with a simple revision. She also showed her subjects a picture of another person who was neutral. You can probably guess the first picture released all the chemicals and the second picture did not get the same response. That is what happened.

Another research project wanted to find out what the brain chemistry was like for couples who had been together for many years. They chose couples who had been married for at least twenty years and said they were still deeply in love. Not surprisingly, their brains also showed increased levels of dopamine. However, something else was discovered.

Have you ever heard older couples talk about how love is even better after the initial burst of chemistry begins to subside? When I was younger, my friends and I thought this was laughable. All we knew was the dopamine high. Well, these scientists found that older love birds had another chemical in their brains called oxytocin. This brain chemical is often called the "cuddling chemical" because it helps new mothers make milk and be more capable of bonding with their babies.

Another brain chemical is released when we start experiencing puberty. Do you remember your days of pre-teen infatuation? How could we forget. This state of mind is caused by still another drug called norepinephrine. Because this is the first experience of a love chemical, pre-teens get jolted by this strong drug and think it is The Real Thing. Not that it doesn't feel good. It is just the brain's way of getting young people together to learn the social skills needed for The Real, Real, Thing (dopamine and associates).

There is no question that love is the result a drug. Anyone who has been addicted to this drug and then done something incredibly stupid will not deny its power. Science and human experience know that love is such a powerful experience that it can completely override common sense and rational decision making. When hit with this emotional genie we can go hungry, avoid sleep and cause our friends to shake their heads in disgust and confusion.

So what does this all mean? Has love now been relegated to something so mundane as a drug? Has science taken away the mystery and excitement of falling in love? I don't think so. Knowledge is always better than ignorance. Do astronomers yawn and become bored when looking at a beautiful galaxy or nebula in their telescope? Most certainly not. They go back again and again to gaze at these heavenly wonders. Do English professors stop reading because they have the ability to dissect and discuss the fine points of an author's work? The opposite is true. They have a deeper appreciation of what they are reading. How about musicians? Does their knowledge of the link between music and neurology of the brain lessen their love of music? Not at all. This type of knowledge enhances the music. Even religious people who read the Bible can have a more profound experience of its contents when they begin to understand the insights of professional scholarship from the last two hundred years.

So in summary, this is what love is about: oxytocin makes you want to cuddle and touch; PEA gets your juices and energizes you to lose sleep; dopamine makes you crave more of what you have; and norepinephrine makes you have sweaty palms and a pounding heart when you are near to or even think of that really special person.

Although we have only mentioned a few brain chemicals, Dr. Mary Cochrane at the University of Buffalo says there are many more chemicals involved in romantic love. Her article, Psychologist Says Neurochemical Processes Explain Romantic Attraction explains what those other chemicals are.

Additional Reading:

Fisher, H. (2004). Why we love: The nature and chemistry of romantic love. (Holt Paperbacks)

Regan, P. (2008). The mating game: A primer on love, sex, and marriage. New York: Sage Publications.

Friday, July 10, 2009

Science, Food & All That Jazz

It seems like these summer blogs are becoming less about psychology than they are about my travels and hobbies. Last Saturday, Sharon and I left early in the morning and headed to San Francisco for my Birthday Boy Bash weekend (July 5). She wouldn’t tell me where we were going exactly but we had to get there by 9:00 in the morning.

Day 1: July 3, 2009
When we arrived at Golden Gate Park I followed her directions and found the destination was the new Academy of Sciences Museum. Even though we got there before the doors opened, the lines were so long it took us thirty minutes to enter the building. Once inside, we stayed there until closing at 5:00. A surprise benefit was the food available in the two cafes. Usually, food in these places is overpriced and underwhelming. We forgot we were in San Francisco, the Mecca of fine food. The meals were delicious.

The California Academy of Sciences is a world-class scientific and cultural institution based in San Francisco. The Academy recently opened a new facility in Golden Gate Park, a 400,000 square foot structure that houses an aquarium, a planetarium a natural history museum and a 4-story rainforest all under one roof.
The new facility is also home to the Academy's staff of world-class scientists, an education department that provides a wide range of student and teacher services, and an extensive science library with over 20 million specimens and artifacts.
This place is a stunning science museum. The building, itself, is a wonder to behold. It is the world’s greenest museum. The roof is called a "living roof" because it is composed of plants, soil and solar panels. You can see a picture of the roof here. Visitors can visit the roof and see why it is the largest public energy efficient building in the world. The website, itself, is quite educational and entertaining.

Inside we attended an amazing planetarium show with the latest digital effects. The aquarium consists of many different nooks and crannies for seeing a large selection of marine life. There is also a natural history museum and the one place we were not able to get to – the tropical rain forest.

After closing, we left the Academy and walked across the street to the De Young Museum. Since it was Friday night there was no admission charge. It was open to the public with entertainment by members of Stellamara. They presented live music and dance from the Middle East, North Africa, and the Roma "Gypsy" trail. You can hear a sampling of there music here. At 9:00 we drove to our hotel in the financial district for a good night’s sleep.

Day 2: July 4, 2009
The Ferry Building by the Bay is an unusual building. Not only is it a ferry landing but it is also the site of one of the best Farmer’s Markets in California. The large Saturday market is found in front of, inside, and behind the building that overlooks the Bay. About ten to fifteen thousand people crowd into this place each Saturday. Being San Francisco, the food is exquisite.

We left the Ferry Building around noon and caught a bus to The Fillmore, land of jazz, to wander around the Fillmore Jazz Festival. It stretched up and down Fillmore Street for about seven long blocks and touts itself as the Largest Free Jazz Festival on the West Coast. We listened to Sam Reider, a local twenty-something who is making his musical mark in the New York jazz scene. Later in the day we listened to another local musician, Bobbie Webb and his Smooth Blues Band. Bobbie is a local legend. Although he has played with every great Blues musician in the world, he was never a full-time musician until recently. He realized early that he needed to take care of his wife and eight children which would have been difficult as a musician. He became a mechanic by day and a musician on weekends and during vacations. Now that he is retired and has a pension and social security he has devoted himself to playing non-stop.

In the late afternoon we drifted into Yoshi’s, one of the premium jazz locations in the Bay Area. We got good seats and were entertained by a Latin jazz group. Around dinner time we went to the Jazz Club (another jazz room in Yoshi’s) for a jam session. We were lucky to get one of the last tables. We had missed Marcus Shelby on the street but caught him at a jam session in Yoshi’s Jazz Club. He had just come back from Jazz Camp West. Marcus brought four people with him from the jazz camp and they improvised for an hour and a half. BTW, Yoshi’s has great ribs.

Around 8:30, as it was getting dark, we got on another bus and headed to Pier 39 to see the fireworks over the Bay. We thought it started at 9:00 but it didn’t get going until 9:30. Even so, there were a lot of people. Everyone had taken all the places for sitting so we, and hundreds of others, had to stand. It was a beautiful night and everyone was friendly and in a good mood. As we waited for the light and noise to begin, we watched about half a dozen cruise ships take their place out in the Bay for the paying customers on board. Along the waterfront, there were four different locations where the fireworks were being set off. We could just barely see another location at Pier 27 and noticed that their fireworks were perfectly synchronized with the fireworks we were watching.

It was a spectacular show and when it was over, we walked to Fisherman’s Wharf and had a snack. From there we walked a few more blocks and caught a free bus (have I mentioned that all the entertainment during this day was free — even the music at Yoshi’s?). The city provided free bus service back to the Ferry Building. From there we walked the mile or so back to our hotel.

Day 3: July 5, 2009
We were planning to get up early, drive to Muir Woods on the other side of the Golden Gate Bridge and do some hiking. Instead, we slept in and just goofed off for a time. At 10:00 we walked about a mile to the new Contemporary Jewish Museum. Quite a place! Although founded in 1984 it took over a historical landmark, the Jessie Street Pacific Gas & Electric (PG&E) Power Substation. They hired the renowned architect Daniel Libeskind to design their new home. The architecture is full of contrasts: historic and contemporary; subtle and boisterous. The blue cube in the picture on the right looks like it is falling down but is actually a part of the museum’s external structure. The inside is open and airy and is full of surprising angles. One of the exhibits we enjoyed highlighted the work of Marc Chagall and his work with the Russian Jewish Theater in the first half of the twentieth century. Other exhibits included "Being Jewish": A Bay Area Portrait, Jews on Vinyl, and Susan Hiller: The J Street Project. Fascinating.

It was finally time to head back to Sacramento except we took a side trip to the Stern Grove Festival. This is an annual summer event held in a beautiful setting among trees and hills. Roberta Flack appeared here in June. The San Francisco Ballet will be performing in August. We were privileged to listen to the San Francisco Symphony with an exciting and very young conductor James Gaffigan.

Prior to the symphony we were surprised with a half hour of jazz by the Inouye Jazz ensemble. The leader is the principal trumpet player of the SFS. The bass player is the principal bassist of SFS and the drummer is also a member of the SFS. They had added a non-SFS member, Jeff Massanari, to play guitar. Jeff is one of the most in-demand guitarists in San Francisco.

It was engaging to listen to musicians who are so talented they can be stars in both classical and jazz music. It reminds me of the young Andre Previn who is a virtuoso jazz pianist and a top-ranked orchestra conductor.

And then we had to go home.