Social Placebos

The theoretical psychologist Nicholas Humphrey argues that humans are genetically programmed for caution. As an example of this, he cites the curious effectiveness of placebos.

Consider what happens when the human immune system fights a disease. Suppose you have a disease that causes you to function at 90% of your usual capacity. You could struggle on for weeks at this level, feeling slightly run-down. Or your immune system could mobilize a full attack on the disease, during which you will feel terrible, you may have a raised temperature and other unpleasant symptoms, and you may be unable to carry out your normal activity for a few days. Most of the symptoms of disease are actually caused by the immune system trying to eliminate something or other.

In some situations, a full immune system response might be dangerous, as it makes you vulnerable to all sorts of environmental threats that you would be unable to protect yourself against. So instead of responding instantly to the first signs of a disease, it makes sense for the immune system to wait until the person is in a safe place to undergo this phase. For example, shelter, warmth, supply of food and water, someone else to keep the fire burning and watch out for wolves.

So what kind of signal triggers the immune system to start fighting? We can identify three possible signals. Firstly, when the person stops working hard and enters a period of relaxation. (This is why so many people get ill on holiday and at Christmas.) Secondly, when the person anticipates some future period of stressful hard work. (This is why so many people get ill before exams.) And thirdly, when the weather changes. (Which is why people get ill in the Autumn and Spring.)

According to Humphrey, the placebo acts as another signal of this kind. Especially when provided by a healthcare practitioner with the appropriate bedside manner, it indicates to the immune system that it is safe to mobilize a full response. It is as if the witch doctor is providing some level of "reassurance" to the body.


In a recent article, Humphrey extends this idea to social placebos, or what he calls Placebos at Large (New Scientist, August 2013, subscription required). He suggests that social symbols and rituals perform a similar reassuring function, allowing people (individually and collectively) to take bold action.

People love mocking "health-and-safety" regulations, promoted by the much-derided "nanny state", as if these regulations hold us back from being the enterprising, rebellious souls we would otherwise be. Humphrey quotes the sociologist Frank Furedi, who says, "in a world where safety has become an end in itself, society constantly promotes symbols and rituals to transmit the need for caution".

Humphrey offers a contrarian interpretation. He believes that in many areas of our lives we humans are, by nature, cowards. Left to follow our instincts we tend to be much more cautious than we need be – indeed, more cautious than is good for us.

So we are often presented with warnings that don't tell us anything - such as packets of peanuts that solemnly announce that they "may contain nuts". By laughing at these unnecessary warnings, we are able to project our real fears of alien food onto some bureaucratic Other, and feel (irrationally) reassured in the illusion that packaged food is safe for everyone except those with weird and antisocial food allergies.

Thus the implicit message of these warnings is a paradoxical one - no need to worry, nanny will do all that nasty worrying for us. Nanny as witch-doctor.

And in the corporate world, there is a wealth of corporate signals and rituals that are used to enable corporate change, including the appeal to corporate witch-doctors, also known as consultants. People often complain that corporate placebos and platitudes don't work - but the point is that they actually do work, but in a mysterious way. Isn't this an example of what Margaret Heffernan calls Willful Blindness?

Understanding pain

Many of us have a compulsion to look away during a painful event such as an injection. But scientists have found that looking at your body can reduce the amount of pain you experience.


Source: Flavia Mancini, Matthew R. Longo, Marjolein P.M. Kammers and Patrick Haggard, "Visual Distortion of Body Size Modulates Pain Perception" Psychological Science February 8, 2011 doi: 10.1177/0956797611398496 via Rebecca Morelle "Pain reduced by changing what you look at" BBC News 10 February 2011.

One way to understand this phenomenon is to understand the purpose of pain - as a signal. If you are looking at your arm, your brain is getting visual information about what is happening to your arm, so it doesn't need to pay so much attention to other sensory information. Therefore you feel less pain.

The researchers also found that this effect could be increased if the hand was magnified to make it appear larger, thus cutting pain levels further still.

To the extent that pain has a natural purpose, there is something problematic about conventional attempts to suppress pain, such as pain-killing drugs. We may note that the drugs often get less effective over time, as if the body is reasserting its need for information. The POSIWID principle explains why it's difficult to permanently suppress those symptoms that reflect an inherent purpose. (Some might argue that all symptoms reflect some purpose.) However, if we offer the system an alternative way of fulfilling the purpose - an alternative information channel - then the symptom can be attenuated without frustrating its purpose.

The Message of Packaging

Should cigarette packets be more boring? Three predictably contrasting views in today's news [Source: BBC News 21 November 2010].

• UK Health Secretary Andrew Lansley said "glitzy designs on packets" attracted children to smoking and it made sense to look at "less attractive packaging".

• Martin Dockrell, director of policy and research at Action on Smoking and Health (Ash), suggested that cigarette packets are designed to fulfil certain purposes. "They use it to seduce our kids and mislead smokers into the false belief that a cigarette in a blue pack is somehow less deadly than a cigarette in a red one." Mr Dockrell claims that the tobacco industry calls packaging "the silent salesman".

• Simon Clark, director of Forest, a lobbying group that opposes smoking bans, said: "There is no evidence that plain packaging will have any influence whatsoever on smoking rates." Mr Clark described the Health Secretary's move as a "cheap publicity stunt". 

I'm wondering whether there is some kind of moral equivalence implied here between "glitzy packaging" and "cheap publicity stunts".

I'm also wondering about the nature of evidence. The tobacco industry is clearly willing to spend considerable amounts of money on certain things, including attractive packaging, and maybe this willingness constitutes indirect evidence that these things are indeed effective in producing outcomes beneficial to the tobacco industry. This is akin to a kind of existential POSIWID - "here's some mechanism, we can't demonstrate exactly what it does or how it works, but it would be unlikely to exist if it didn't do something useful for the entity that is responsible for its existence".

People attempt to use similar arguments in the biological sciences, to explain certain biological or psychological characteristics, as if these existed solely because of some supposed evolutionary advantage, but this class of argument is methodologically flawed because it grossly over-simplifies the way evolution works.

However, existential arguments may be a little more plausible where human agency is involved. If people and organizations are willing to invest in some costly or controversial mechanism, we may at least infer the existence of a belief that this mechanism will do something useful, even if this belief turns out to be unfounded. (After all, mediaeval Christians were willing to invest in all sorts of ways of getting into Heaven, which most modern Christians no longer credit. And George Bush jr was willing to sanction various mechanisms for obtaining information about terrorist threats, even though many experts regard information obtained by such mechanisms as highly unreliable.)


But existential arguments alone can't tell us what the purpose actually is. The tobacco industry presumably has the objective of selling more cigarettes, but it may also have the objective of reducing regulation by influencing public opinion. Sponsoring sports and culture may once have contributed significantly to the second objective, and perhaps respectable and responsible packaging will help here as well.

Perhaps the Health Secretary genuinely believes (or has been advised) that changing the packaging would reduce the lure of smoking to young people. Or perhaps he merely feels the need to make some kind of anti-smoking gesture, even if he doesn't really think it will make much difference. Because his action is consistent with both sincere belief and political cynicism, we cannot infer either belief or cynicism from his action alone.

Similarly, the fact that Forest objects to the Health Secretary's move might indicate a belief (fear) that it might work, or merely a cynical seizing of a publicity opportunity. Actually, if I were a spokesman for Forest, I should probably want to argue that the Health Secretary's move was irrelevant, because smokers were all sensible grown-ups who weren't influenced by glitzy packaging in the first place. I should also take the opportunity to mildly reprove the tobacco industry for wasting its money on vulgar advertising, just to emphasize in the public mind that I wasn't merely a paid spokesman for the tobacco industry. Forest's defence of glitzy packaging looks suspiciously like protecting the interests of the tobacco industry rather than the official purpose of Forest, speaking up for the freedoms of smokers.

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Meanwhile, the people who design cigarette packaging clearly understand that the meaning is not as simple as the politicians and lobbyists (on both sides) pretend to believe. See for example Catherine R Langan, Intertextuality in Advertisements for Silk Cut Cigarettes April 1998.

Why does a salad cost more than a Big Mac?

Because the US Federal Government doesn't subsidize healthy foods ...

... thanks to a political phenomenon known as Pork. Because a small number of farmers care greatly about farming subsidies while the rest of the American population care very little, and because a small number of politicians care greatly about being reelected, it turns out that the distribution of subsidies to farmers cannot be permitted to be influenced by vulgar considerations of healthy diet. You don't win votes with salad (see Lisa the Vegetarian).

source: Physicians Committee for Responsible Medicine, Autumn 2007

via Consumerist, Farnam Street and the New York Times.

See also Pork Scratchings

John Rock's Error

What the inventor of the birth control pill didn't know about women's health

Two or three of my Christmas presents this year were recommended to my friends and family by our local bookseller (who probably knows my taste in books better than most) including Malcolm Gladwell's latest book "What the Dog Saw, and Other Adventures".

I expect several of the chapters of this book will inspire blogposts, but I wanted to start with the chapter on the Birth Control Pill, because it echoes some of the themes I've been talking about recently.

Partly for religious reasons (he was a devout Catholic), John Rock designed the birth control pill to be a "natural" method of contraception. He believed that the pill was merely reinforcing the established rhythm method, and he was bitterly disappointed when Pope Paul VI banned the Pill along with all other "artificial" contraceptives.

Rock and his colleagues had designed a pill with a twenty-eight day cycle, because they thought that this was the proper menstrual cycle for women, and they wanted to replicate and regulate this cycle in order to make the rhythm method (which only worked effectively for women with a regular menstrual cycle) more effective.

As Gladwell puts it, the Pill was

"shaped by the dictates of the Catholic Church - - by John Rock's desire to make this new method of birth control seem as natural as possible. ... But what he thought was natural wasn't so natural after all, and the Pill he ushered into the world turned out to be something other than what he thought it was".

For when female scientists look at patterns of menstruation, they typically find that the twenty-eight day cycle is not "natural" at all - it is a product of urban modern life. Furthermore, the artificially induced cycle has both short-term side-effects (period pains) and longer-term health risks (cancer).

So here is how Gladwell describes the consequences of John Rock's desire to please his Church.

"In the past forty years, millions of women around the world have been given the Pill in such a way as to maximize their pain and suffering. And to what end? To pretend that the Pill was no more than a pharmaceutical version of the rhythm method."

---

I've been exploring different kinds of problem-solving recently, including a common preference for solutions that seem to preserve the structure of the problem. But such structure-preservation often turns out to rely on hidden assumptions - in this case, assumptions as to what counts as "natural".

Describing a solution as "natural" implies that it is safe and unobjectionable and somehow innocent. But when we unpack what counts as "natural", we may find a hidden agenda buried within the allegedly "natural". The Pope refused to see the Pill as an innocent technology, and perceived it as a source of disruption to traditional family values.

So what is interesting here is that Rock and the Pope, two men with very similar religious beliefs and values, both Catholics, should interpret the POSIWID of the Pill in such completely different ways. Meanwhile, Gladwell's interpretation is different again. The purpose of the Pill depends who is telling the story.

Purpose of Labour Pains

In my post on Back Pain, in response to Scott Adam's complaint that back-pain was evil, I asserted that pain has a perfectly valid function, and it is painkillers that are evil.

Pain has a perfectly valid function - it is the body's way of communicating something important to the mind. If you ignore a small child, it will misbehave louder until it gets your attention. And pain works the same way. If you completely ignore your back until it seizes up, then you shouldn't be surprised if it seizes up from time to time. That's how systems work.

In my view, it is painkillers that are evil - or rather the casual use of painkillers - because they interfere with the natural communication between the mind and the body, and the natural balance of work, rest and play.

However, although this is the general function of pain, it sometimes doesn't seem to work properly. For example, in some chronic situations such as cancer, the body sends excessive pain signals to which the only possible response appears to be some kind of signal blocking mechanism such as drugs or TENS. Alternative therapies in this category might include acupuncture and hypnosis.

Childbirth is another situation where pain-killing drugs and TENS machines are commonly used. Why should mothers suffer labour pains?

Childbirth is a natural and, if all goes well, perfectly healthy procedure; many people therefore think it is inappropriate to treat childbirth as a medical condition. And there is a common ideology of "natural" childbirth: many women adopt birth plans that aim to avoid excessive medical intervention, not just out of bravado or authenticity, but also for fear of unnecessary side-effects.

But it is one thing to oppose or refuse excessive medical intervention; quite another to assert that labour pain has a positive function, as does Dr Denis Walsh.

"Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby." [Observer, 12 July 2009]

Dr Denis Walsh is an associate professor of midwifery at the University of Nottingham; he is described by the Observer as "one of the UK's leading midwives". The basis for his claim is apparently set out in an article Dr Walsh has written for the Royal College of Midwives journal Evidence-Based Midwifery. (See note below)

Evidence-based midwifery, huh? I wonder what kind of evidence can Dr Walsh produce for the purpose of labour pains? Is this perhaps the kind of hypothesis that can only be evaluated by evolutionary biologists? Labour pains have doubtless co-evolved with maternal care, many other species lacking both, but can we really conclude that labour pains are an adaptation that help to promote maternal care? I think it is more plausible to say that labour pains are a side-effect of a much more important adaptation, namely large brains.

In any case, evolutionary biology offers one possible meaning of the word "purpose" - some functional trait that has evolved or co-evolved for a reason. If that's not what Dr Walsh means, what else could he possibly mean?

---

Note 1: Dr Walsh has an article in the current issue of Evidence-Based Midwifery (Volume 7, Issue 2, June 2009), but this seems to be about something else and I couldn't find the word "purpose"; he had an article on the Role of the Midwife in a previous issue, but this is for subscribers only. However, I did find an interesting editorial in the current issue by one Professor Marlene Sinclair, Practice: a battlefield where the natural versus the technological, citing Elul, Habermas and Ihde.)

Note 2: I didn't know whether evolutionary biologists had ever studied labour pains as a separate phenomenon, so I tried Google and found an abstract of an article by Wulf Schiefenhövel called Perception, Expression, and Social Function of Pain: A Human Ethological View (Science in Context, 1995). I have sent an email to Professor Schiefenhövel asking for his opinion on Dr Walsh's claim.

Note 3: When I previously blogged on pain, I got a lot of comments from people trying to sell dodgy pain relief. Any such comments will be quickly deleted, so please don't bother. I am only interested in retaining comments that discuss the points in this blog.

Sarcasm causes Cancer

( for @bengoldacre )

Practically anything you can think of has been named either as a possible cause of cancer or as a possible preventative or cure.

January 2008 marked the launch of an ambitious project, the Daily Mail Oncological Ontology Project, which was going to follow the Daily Mail’s ongoing mission to divide all the inanimate objects in the world into those that cause or cure cancer. After only four days, the project was abandoned in despair. (Like a typical New Year Resolution, perhaps.)

But why pick on the Daily Mail? Even the BBC is constantly running stories like these.

• How spicy foods can kill cancers
• Lack of exercise linked to colon cancer
• A chemical used to manufacture rubber ...
• Shark blood offers cancer hope
• Limit mobile phone use, cancer expert tells staff
• Popping bubbles to treat cancer
• Aspirin prevents bowel cancer
• Doctors' call to regulate sunbeds

How to respond to this endless array of pseudo-oncology without sarcasm?

• Facebook causes cancer
• You are hereby sentenced eternally to wander the newspapers, fruitlessly mocking nutriwoo

But all is not lost. A New Daily Mail Oncological Ontology Project rises from the ashes. So that's all right then.

Food Dye

What the purpose of food dye?

• Sometimes it is used to make food look more attractive, like bright colours on confectionery.

• Sometimes it is used to make food look more like people imagine it ought to look. For example, butter is coloured differently for different markets - people in some countries expect butter to be nearly white, while in other countries people expect butter to be nearly yellow. Farmed salmon is coloured pink (usually by feeding colour to the fish) to make it resemble wild salmon.

How does this affect people's choices?

• They might select an artificially coloured product over a naturally coloured or uncoloured product, because the artificially coloured product deceptively looks more "natural"

• They might even prefer factory-processed food to naturally prepared home-cooked food, because the former appears more attractive. For example, many children would prefer a shop-bought birthday cake to a home-cooked cake, not just because it contains even more sugar, but also because it looks better.

What other effects do food dyes have?

• There is some evidence (the FDA believes there is no "scientific" evidence, but the UK Food Standards Agency disagrees) that some food dyes cause hyperactivity in some children.

• Manufacturers of processed foods prefer artificial food colour whenever this is permitted by local regulations, which suggests that it is either cheaper or more well-behaved in the manufacturing process. As an example, Nutrigrain Cereal Bars (Kellogg) contain artificial food colour in the USA but contain natural food colour in the UK.
  

• The food industry also funds organizations such as the Institute of Food Technologists, which dismisses the validity or relevance of the studies linking artificial food colour and hyperactivity. See for example Food Allergies and Other Food Sensitivities (pdf - search for "Feingold" or "hyperkinesis").
  

What is the effect of labelling?

• In Europe, all food additives have E-numbers. Many consumers don't distinguish between different additives and are averse to any E-numbers whatsoever.

• The food industry therefore resists any extension to food labelling regulations, because manufacturers fear this will prompt consumer rejection.

So let's come back to the question of purpose. Are these additives a secret weapon by the food industry against the consumer, as some consumer groups appear to imagine? And does the power of this weapon disappear if the secrecy is exposed, as some manufacturers appear to imagine?

---

Source: Do food dyes affect kids' behavior?

Statins and Supplements

Why do some people take vitamin and mineral supplements? Why do some people (usually on the advice of their doctor) take statins?

Both are thought to improve health. Supplements such as Vitamins A, C and E, together with beta-carotene and selenium, are thought to have an antioxidant effect, attacking so-called free radicals; meanwhile statins are supposed to reduce levels of cholesterol. Both free radicals and cholesterol are commonly blamed for various causes of ill-health and premature death.

Huge amounts of money are spent on both supplements and statins. In Britain, the NHS apparently sees statins as some kind of wonder-drug; Professor Roger Boyle, National Director for Heart Disease in England, hopes to increase the number of people on statins from roughly 3 million at the moment to around 6 or 7 million people. [BBC News, 2 April 2008]

Howeve, there seems to be no evidence that either supplements or statins actually increase life expectancy for the general population, although statins do appear to improve life expectancy for a small number of men (generally those who have already had heart attacks). Some research suggests that vitamins 'may shorten your life' [BBC News, 16 April 2008].

Advocates of both supplements and statins tend to shift their ground at this point. Even if it doesn't increase the length of life, which of course they don't necessarily concede, then it certainly improves the quality of life. (This is of course a much more difficult claim to disprove, since quality of life is more difficult to measure objectively, and the data are harder to come by.)

For my part, I can't see much difference between the supplement debate and the statin debate. I don't understand how people can be strongly in favour of one kind of pill, and strongly against another kind of pill, when they are produced in the same kind of factories and sold on the same kind of logic.

Perhaps we shouldn't be surprised if the benefits of supplements and statins aren't easy to prove. After all, free radicals and cholesterol occur naturally in the human body, and are necessary for life. The idea that you can improve health by simply taking some pill that will reduce the level of a naturally occurring substance seems to conflict with the idea of the human body as a complex, interconnected, largely self-regulating system. I am particularly astonished that many people who think of themselves as "holistic" either don't seem to appreciate the consequences of meddling with this complexity, or they imagine that popping pills can establish a better all-round balance than the body can achieve on its own.

Sources

Wikipedia on Cholesterol: Cholesterol is a lipid found in the cell membranes of all animal tissues. ... Most of the cholesterol in the body is synthesized by the body and some has dietary origin. ... Biosynthesis of cholesterol is directly regulated by the cholesterol levels present, though the homeostatic mechanisms involved are only partly understood.

Wikipedia on Free Radicals: Free radicals play an important role in a number of biological processes, some of which are necessary for life. ... The body has a number of mechanisms to minimize free radical induced damage and to repair damage which does occur.

Wikipedia on the Statin Controversy: Some scientists take a skeptical view of the need for many people to require statin treatment. Given the wide indications for which statins are prescribed, and the declining benefit in groups at lower baseline risk of cardiovascular events, the evidence base for expanded statin use has been questioned by some researchers. A much smaller minority ... question the "lipid hypothesis" itself and argue that elevated cholesterol has not been adequately linked to heart disease. These groups claim that statins are not as beneficial or safe as suggested.

Wikipedia on Antioxidants: Despite the clear role of oxidative stress in cardiovascular disease, controlled studies using antioxidant vitamins have observed no reduction in either the risk of developing heart disease, or the rate of progression of existing disease. This suggests that other substances in fruit and vegetables (possibly flavonoids), or a complex mix of substances, may contribute to the better cardiovascular health of those who consume more fruit and vegetables.

[all articles accessed 16 April 2008]

Update

Antioxidants prevent health-promoting effects of physical exercise in humans (May 2009). hahahahahaaa says Ben Goldacre

Purpose of Hormones

Lots of stories on the BBC News website about hormones and their effects. Is this because it is a popular subject for research, or a popular subject for science journalism?

Effects on sexual attraction

• Feminine males 'more attractive'
• 'Hormonal' women most attractive
• Women's choice of men goes in cycles
• Asymmetrical men 'are a turn-off'
  

Effects on parenting

• Sex hormone 'higher in single men'
• Becoming a father 'civilises' men
• Secret of paternal bond
  

Effects on health

• Masculine men 'are healthier'
• Sex hormone could help mental health
  
• Sex hormone blamed for forgetfulness (misleading headline - actually it's a lack of the hormone that is said to cause forgetfulness)
  

Effects on business

• Hormones 'may fuel market crises'
• Sex hormone 'controls fear and desire'
  

Other effects

• Bad driving linked to hormones
• Hormones make women safer drivers
  

Most of these stories are related to testosterone, oestrogen and/or progesterone. The stories come from a range of sources, and sometimes contradict one another. The explanations overlap and sometimes conflict. See my previous post on Face Values Applied to Love Game.

It would seem (not surprisingly) that hormones have some effect (albeit confusingly), at least on reproduction. So it might make sense to infer the purpose of these hormones from these effects. For expertise in these matters, the BBC generally turns to one Dr Nick Neave.

Dr Nick Neave, a psychologist at Northumbria University, told the BBC News website that a fall in testosterone was nature's way of ensuring men behaved in a "civilised" and non-aggressive way around newborn offspring. [BBC News 9 November 2005]

The purpose of a system is what it does (POSIWID).

Childhood Diseases

Should children be protected against minor diseases? Or are childhood diseases a normal (and perhaps even necessary) part of growing up? 

Some doctors are now recommending routine vaccination against chicken pox (varicella) - there is a suggestion that it might be combined with the (already controversial) MMR vaccine to produce MMRV [BBC News November 8th 2007]. 

Chicken pox killed six children in the UK and Irish Republic last year, and there were 112 cases involving severe complications. So there is certainly a risk. But is this risk high enough to warrant action? Each mass vaccination campaign has

• financial costs - could the same resources deployed elsewhere have delivered greater medical benefits to a greater number of people?

• medical side-effects - possible negative reactions to the vaccination itself in some children, reduced protection against related diseases such as shingles

• social costs - fear of side-effects (whether founded or unfounded) reducing the take-up of all vaccines, not just this one

But I have a more general concern. If this proposal makes sense, then it would make sense for every other infectious disease that kills a small number of people every year. Medical researchers think they understand the effect of a single vaccine on the human immune system, or even a compound vaccine such as MMR. But how would it be if a child never got ill, because every possible disease was preempted by vaccination? Would the immune system develop normally, or would it be weak from lack of exercise? Would new diseases emerge to fill the gap? Will medical research tell us the answers to these questions before it is too late? 

Childhood disease involves some suffering, and a tiny risk of complications and even death, and most parents accept that. If I wanted to protect my children totally from any suffering or risk, then they wouldn't learn to cross the road or ride a bicycle or climb trees; they wouldn't be allowed to use the kettle or the toaster, or bathe in more than 3cm of water; and they certainly wouldn't have any contact with the opposite sex until they were at least 25 years old. This is of course ridiculous - I would be condemning them to a life-without-life. 

While my heart goes out to those parents who have lost their children to childhood disease, I don't think the answer is to eliminate childhood disease altogether. It is a normal part of growing up: it develops the immune system, and equally importantly it develops confidence in the immune system. A child can feel poorly one week, with spots all over her face, and then be back at school the following week: this experience engenders a deep belief in your ability to recover, a belief that however bad you feel right now, you should feel better tomorrow. 

What doesn't kill you makes you stronger.

Update

The Chief Executive of RoSPA (Royal Society for the Prevention of Accidents) made a similar point in his 2007 Annual Report.

"Rather than adopt the extremist protectionism of ‘cotton wool kids’ our argument is that a skinned knee or a twisted ankle in a challenging and exciting play environment is not just acceptable, it is a positive necessity in order to educate our children and to prepare them for a complex, dangerous world, in which healthy, robust activity is more a national need than ever before."

Of course this is not an argument dismissing safety precautions altogether, and my blogpost should not be read as an argument against all vaccinations - merely an argument against the extreme idea that we need to vaccinate against every possible condition.

See also

Gever Tulley: 5 dangerous things you should let your kids do (Ted Talks, March 2007)

Life on Mars 2

What is the purpose of chocolate? What is the purpose of desire for chocolate? And what is the purpose of habit? Following my earlier post Life on Mars, which questioned the enthusiasm of vegetarians for Mars Bars, someone called Adam asked:

"Why shouldn't vegetarians want to be able to continue to eat the chocolates they're used to?"

I am not sure whether this is a question about desire or about habit. What's wrong with trying new brands of chocolate, rather than feeling your life is ruined because The Men From Mars are messing around with the recipe of your favourite brand? And I think there is sometimes a temptation for people to think a product is good for you, just because it is "organic" or "vegetarian" or "GM-free". It is perfectly possible for a product to comply with all of these labels and still contain disgustingly unhealthy amounts of refined sugar, fat and salt. So I'm interested in the social and psychological and symbolic effect of these apparently positivc labels - the fact that many vegetarians think these labels are not only worth reading but worth campaigning for. Meanwhile, a quick internet search for "health" and chocolate" led me to several webpages about the health-giving properties of chocolate - dark chocolate in particular - posted by chocolate companies and independent news organizations, all apparently based on the same set of scientific studies. I especially liked the look of Yachana Gourmet, which appears to be a socially progressive supplier of FairTrade RainForest chocolate. Suitable for vegans.

Smoking

As a non-smoker, I've never really understood the purpose of smoking. It's a waste of money, and it makes your breath, hair and clothes stink.

Glamorous? Now that hospitals don't allow smoking indoors, you can sometimes see patients in dressing gowns huddled in the street outside the hospital, or in the hospital car park. Looking at these desperately ill people, it is easy to see why cigarettes used to be called "gaspers".

I can see why smoking is attractive to certain groups of people in certain cultures. If the people around you cannot afford cigarettes, smoking is a sign of status.

I seem to remember seeing some statistics that suggested that smoking rates peaked as a country was developing economically, and then took several decades to fall. From memory it was something like this (if you've got better data, please add a comment and I'll correct):

• USA: prosperity starts 1940s, smoking declines 1970s
• UK: prosperity starts 1950s, smoking declines 1980s
• West Germany: prosperity starts 1960s, smoking declines 1990s

I think there may also be some gender issues, especially for women smoking in male-dominated societies. (I wonder which countries the cigarette manufacturers are targetting now?)

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But since this is the POSIWID blog, I'm going to look at the purpose of not smoking. The effects of smoking (active and passive) have been extensively reseached and debated, and are even summarized on the cigarette packets themselves. So it might seem obvious that the purpose of not smoking is to alter some set of health outcomes. But health campaigners (including governments) have been going on about this for decades, and lots of people are still smoking. Clearly there are many people for whom these supposed health outcomes provide insufficient motivation to give up smoking, for whom the purpose of smoking (whatever it is) outweighs the purpose of not smoking.

So we come to stage two - progressively reducing the number of places where smoking is permitted. This is also a badge of status and prosperity. Ireland was one of the first countries to introduce a smoking ban, signalling to the rest of the world that Ireland is now economically thriving, and its bars and restaurants are full of people who no longer need to smoke.

As a non-smoker, I'm happy that I can eat out without having smoke blown over my food and my children. (Many smokers have developed the unpleasant habit of holding the offending item away from the people at their own table, so that the smoke goes to the neighbouring table instead.)

But I wonder about the effects of these regulations. Will they really reduce smoking, or will they drive smokers into defiant little bands? Does smoking reemerge as a self-sacrificing act of rebellion against an over-regulated society? And does this establish a new purpose for smoking?

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Fish Oil

Schoolchildren in the North East of England are to be given fish oil supplements. The purpose of this trial is to improve exam results [source: BBC News].

Some people might think that improving health is more important than improving exam results. I think it says something interesting about our society that this trial is justified (to participants and their parents, as well as to the tax-payers who are presumably funding the scheme) in terms of the education benefit, rather than the health benefit.

Meanwhile, the Food Standards Agency (presumably aligned more to the health lobby than to the education lobby) has already cast doubt on the education benefits of fish oil [source BBC News]. If I didn't believe in the pure motives of public servants, I might think that the FSA objections were based more upon inter-agency rivalry than upon objective science.

There must surely be some degree of statistical correlation between health and exam results, so you might possibly use exam results as a very rough indicator of general health, but this would need careful interpretation by a trained statistician, as there are obviously many other factors involved. In any case there are much better (more direct) measures of general health.

One possible reason for the nature of the scheme is that the education agencies are able to use their budget to produce educational benefits, but not to produce health benefits. So they downplay the health benefits, in order to avoid having to collaborate with other agencies.

I said above that the purpose of the trial is to improve exam results. A scientist might argue that the purpose of any trial is to produce knowledge, and the knowledge can then be used to produce some benefit, such as improved exam results. But this is not how government agencies work. Trials like these are expected to deliver results, not just knowledge. (Note that there is no mention of double-blind testing - the supplements will be offered to all year-11 children in the region.)

So the purpose of a scheme depends on what benefits are seen as politically acceptable, as well as on the division of responsibilities between different agencies. And the visible effects of the scheme will be determined by what is measured. In situations like these, POSIWID must be seen as a political construction.

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Update: For Tim Harford's call for proper scientific trials, see Political Ideas Need Proper Testing (Financial Times, 18 March 2010)

Size Matters

Dean Johnson (via Seth Godin) has found an interesting correlation between people getting fatter and houses getting bigger.

Update: Dean's text is fine, but there seems to be a problem with the image on his website, so I'm linking to Seth's copy of the graph instead. Click on the image for the [big] version, and on Dean's link for the details.

Dean suggests one possible interpretation of the data - that Americans grow to fit their environment. We may also note the possibility that larger houses have larger refrigerators.

So all we have to do to reverse the obesity trend is to put people into smaller houses??

But before we implement such a drastic solution, we need to understand the system better. Who really benefits from houses being larger? Who really benefits from people being overweight? Who will support obese people in their valiant struggle against better health?

Update: Some other interpretations of the data are offered in Scribe's comments to this blog posting, as well as several comments to Dean's original post. I think this just reinforces my point - that we have to understand the system better before leaping in with ideas for system improvement.

Technorati Tag: POSIWID

Hospital Superbugs

According to the Independent, citing a study by Professor Mark Wilcox (Leeds University, and a member of the Hospital Infection Society), hundreds of hospital wards are being closed, and the UK National Health Service is losing £160m a year because of the lethal bug Clostridium Difficile. 

Clostridium Difficile benefits from two interacting forces:

Overuse of antibiotics This produces stronger bacteria and weaker patients. 

Complex targets Government targets on hospital infections have focused on MRSA, which has led to other hospital infections being neglected. Furthermore, patients are shuffled around the hospital to satisfy healthcare productivity targets, which increases the rate of infection. Meanwhile, hospital cleaning is driven by cost targets.

As with many complex ecosystems, there are some winners and losers. Does that mean the purpose of this complex system is to promote the interests of Clostridium Difficile? What does POSIWID tell us about the possibility of effective interventions into this complex system? 

 

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Update. My original post cited a news item from the Independent (June 8th, 2005), but this has now disappeared. Here is a later story from the same source. 

Jeremy Laurance, Hospital superbug threatening to spread through community (Independent, 21 December 2005)

My post also included a picture How Clostridium Difficile wins by default, but this has got lost.

Previous post on Innovation and MRSA: When Knowledge is Free (September 2004)

Viral Pandemic

Professor Maria Zambon, head of the Health Protection Agency's Influenza Laboratory, is quoted in the Guardian (April 14th, 2005) as follows:

It is not in the interests of a virus to kill all of its hosts, so a virus is unlikely to wipe out the human race.

I think this reasoning is unsound.

Firstly, the argument is based on the supposition that a virus mutation that destroyed the human race would destroy itself as well. But this would be true only if the virus only affected humans. But we already know that many of the viruses most dangerous to humans have jumped from other species, such as birds. So exterminating the human race would not necessarily represent a failure for such a virus, because there may be lots of other species to infect. (And some of these other species may thrive better in the absence of humans, such as rats or insects.)

Secondly, the argument is based on the supposition that a virus mutation is not going to destroy itself. Of course, successful mutations don't do this - but surely one lesson of evolution is that successful mutations are hugely outnumbered by unsuccessful mutations. A mutation can generally be regarded as an evolutionary experiment: the survival of the fit equates to the non-survival of the unfit. A virus mutation that destroyed the human race might be regarded as a pretty unsuccessful virus, but that doesn't give us any less reason to fear such a virus.

Of course, a virus that killed its hosts too quickly (such as SARS) might fail to spread effectively through the population. A slow-acting virus (such as AIDS) may be more dangerous in the long run. It is perfectly possible that the human race could be exterminated by AIDS within a century or so.

Many diseases have become less dangerous over time, and this can be explained by evolution. For example, scarlet fever (a bacterial disease) was already diminishing in force before the advent of the modern antibiotics. (Source: Guardian 21 March 2016). But this observation doesn't justify the belief that all diseases will follow this evolutionary path.

Professor Zambon is offering what appears to be a teleological argument for the survival of the human race. The purpose of a virus is to infect humans - therefore there will always be a fresh supply of humans to infect.

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On The Interests of a Virus

While it may be in the interests of a virus to take up residence in my lungs it would be stretching the notion of value to allege that the virus “values” that location. If the term “value” is to be useful, we must restrict its range to the category of such goals as may be pursued by conscious agents. (Thomas W Platt, Global Values: Actual, Unlikely and Necessary, doc). Paper given at the Fourth International Society for Value Inquiry Conference held in Florence Italy, Aug 2003.

It is not in the best interests of a virus to cause lethal tumors in its natural host. ... However, unexpected but important discoveries that HHV8 encodes a series of novel genes give credence to the tumorigenic properties of HHV8. (Gary Heywood, JNCI Cancer Spectrum, 1999).

Compare the following remark about the gambling industry.

It is far more profitable to have long-term customers who only spend what they can afford to lose, than to have a handful of customers overspending massively and burning out in a couple of months. (Raf Keustermans, Why studios need to think about the ethics of social gaming, The Guardian Feb 2012)

See also

Threat of drug-resistant viruses (BBC News July 2005)

Hugh Pennington, Ebola in the UK? (LRB July 2014)

Florence Williams, How Animals May Cause the Next Big One (New York Review, April 2013)

Related post: Explaining Natural Selection (January 2021)

Updated  21 March 2016