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Bloggingheads 11-26-2011 12:57 AM

Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 

SkepticDoc 11-26-2011 06:43 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Very entertaining! Plenty of seeds for discussion...

"The Believing Brain": Science writers have the truth, their experience is not anecdotal? Ocean had quoted population research in other threads, that showed that the use of SSRIs reduced suicide rate in the population, she quoted a different one. It seems to me that our esteemed "Science Saturday" "founding fathers" are an example of bias, they don't like SSRIs, so they don't work??!! Getting a divorce or losing a loved person are examples of external depression, nobody will argue that any chemical will undo the grief and stress of a specific event, over time that event can negatively change the individual and chemical manipulation of neurotransmitters can be an effective treatment, not all the time, not for everyone, and certainly not with the same chemical for everybody.

We all can be lawyers arguing for the points that conform to our beliefs, but reality is a demanding mistress...

BNH 11-26-2011 12:51 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
I love these two guys! Whenever I see their faces on your homepage it makes my day. Thankyou!

bkjazfan 11-26-2011 01:24 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
A dichotomy here: talking about a movie where the main character suffers from an extreme form of depression followed up by a discussion that semi trashes the medications used to treat such a malady.

Perhaps, there could be a diavlog where at least one participant would be a defender of pyschopharmacology.

sapeye 11-26-2011 05:37 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
This is wonderful.

Ocean 11-26-2011 05:38 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Pardon me!

Ocean 11-26-2011 05:59 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by SkepticDoc (Post 232704)
Very entertaining! Plenty of seeds for discussion...

"The Believing Brain": Science writers have the truth, their experience is not anecdotal? Ocean had quoted population research in other threads, that showed that the use of SSRIs reduced suicide rate in the population, she quoted a different one. It seems to me that our esteemed "Science Saturday" "founding fathers" are an example of bias, they don't like SSRIs, so they don't work??!! Getting a divorce or losing a loved person are examples of external depression, nobody will argue that any chemical will undo the grief and stress of a specific event, over time that event can negatively change the individual and chemical manipulation of neurotransmitters can be an effective treatment, not all the time, not for everyone, and certainly not with the same chemical for everybody.

We all can be lawyers arguing for the points that conform to our beliefs, but reality is a demanding mistress...

Thank you, skepticdoc. I agree with the essence of your comment.

Antidepressants aren't powerful enough to cancel out reality. If someone is going through an extremely unpleasant, stressful, saddening experience, they will continue to experience the appropriate emotional response with or without antidepressants.

What happens is that if the person, in addition to the stressful situation has developed clinical depression, stress will become more unbearable, and the person's ability to cope and respond in ways that are going to lead to solving problems or improving one's circumstances will be impaired. In those circumstances treatment for depression (medications, psychotherapy or both) will be helpful.

Not everybody responds to the same antidepressant. That's why different trials are necessary sometimes. One of the arguments against dismissing the whole antidepressant effect as being purely placebo, is the fact that often people are tried on one antidepressant and they don't respond. Then another is tried and they come back with an unequivocal response. Why would one have placebo effect and not the other? I'm oversimplifying the argument here, but it is common in clinical practice to see this kind of selective response.

The whole discussion towards the end about the risk/benefits of different screening procedures has merit. But we need to have an unbiased view in order to assess each one separately. I have the impression that John comes to the discussion with his mind made up about not wanting routine check ups or screenings, for whatever reasons. He wants to prove that health screenings aren't helpful. I would prefer to have someone discussing the topic who has a more neutral position.

Having said that, I may agree that there's probably a number of costly or unnecessary, or plainly not cost-effective procedures that we accept as common practice. These are the kinds of decisions that the public will have to make when the cost of health care is discussed. Something will have to give. I tend to prefer a review of end of life measures, such as heroic treatments for people with terminal illnesses (cancer, or others).

Preventive procedures or screenings may still have a preferred place in health care if the benefits are sensible.

Funny stories about the outsiders to science. And it's always interesting to hear about some recognition to those who are true divergent thinkers. Not crackpots, but serious scientists who know when to remain within the boundaries of their discipline and accepted procedures, and when to make room for some creativity and paradigm challenge. That's the way science progresses, isn't it?

DavidIowa 11-26-2011 07:04 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
My cure for depression: thoughts come and go but I don't take them personally.

SkepticDoc 11-26-2011 07:07 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
The reality is that Public Health measures and science based medical care have extended life expectancy. Human biology experimentation is limited by ethics(humanity?), our senior diavlogers come from the Physical Sciences, they love to smash matter to elucidate the building blocks of space/time/energy. We can't do that with living "things"...

When there is a unified theory of Life, then further advances may be possible. Of course, there is the inevitable "woo" (in my mind it is more the "wow"!) factor, is there an immeasurable dimension that is necessary for Life? In Physics there are unknown entities, they are lumped together as "Dark Matter".

By definition, it is impossible for the Materialists to accept that Life may involve more than just the measurable matter/energy. Electrical processes have been going on forever, before the understanding of electricity, was that "woo" before ? Can we extrapolate the concept to Life? What if the essence of Life is just another building block in the Universe but it deals with beauty, love, compassion and other undefinables?

Ocean 11-26-2011 08:07 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by SkepticDoc (Post 232736)
By definition, it is impossible for the Materialists to accept that Life may involve more than just the measurable matter/energy.

Some people may think that even if more is involved, since we can't measure it or understand it or observe it, it is impractical to get too busy thinking about it.
Quote:

Electrical processes have been going on forever, before the understanding of electricity, was that "woo" before ?
Most surely.
Quote:

Can we extrapolate the concept to Life? What if the essence of Life is just another building block in the Universe but it deals with beauty, love, compassion and other undefinables?
I have the impression that it is up to us to decide what the essence of life is.

Parallax 11-26-2011 08:33 PM

Misunderstandings about antidepressants is depressing
 
George, just b/c you are having a rough time and the pills did not work does not mean that antidepressants are a scam.

1. Antidepressants show remarkable results (that is vastly different than placebo) in severely depressed patients. All the things you hear about SSRIs being the same as placebos is for mild and moderate cases of depression. For the severe cases there are no question about the efficacy of current antidepressants in the market.

2. Like I said last time in the comments when these two were talking about antidepressants. The current scientific view is that depression is a reversible neurodegenerative disease. Antidepressants basically stop the degeneration that is why beside Selective Serotonin Reuptake Inhibitors (SSRIs) you also Selective Serotonin Reuptake Enhancers (SSREs) prescribed for depression.

3. There is also a body of work on the nootropic effects of various antidepressants. For example Escitalopram (Lexapro, Cipralex) seems to improve cognitive function in patients after a stroke.

4. Switching to the effective stereoisomer has one obvious benefit: the dose gets cut in half and that means less side effects. It is good to have even only slightly better drugs, whether the drug manufacturer should be able to milk this to the extent they are doing right now is an entirely different question.

Wonderment 11-26-2011 08:37 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Having said that, I may agree that there's probably a number of costly or unnecessary, or plainly not cost-effective procedures that we accept as common practice. These are the kinds of decisions that the public will have to make when the cost of health care is discussed. Something will have to give. I tend to prefer a review of end of life measures, such as heroic treatments for people with terminal illnesses (cancer, or others).
Yes, something will have to give. The healthcare system is unsustainable, on life support, so to speak.

End of life, in particular, is a huge issue that everyone wants to turn their eyes away from until it happens to their loved ones. It is politicized by the least informed demagogues (Schiavo case, Sarah Palin's "death panels," etc.) and complicated by other vested interests within the healthcare community who, though well-intentioned, seem to advocate for immortality rather than reality.

But how do you get the public involved in rational policy? It's a political non-starter to underscore the perfectly obvious: death affects all Americans.

Certainly there are some basics: EVERYONE should have advanced directives and general end-of-life education and awareness. End-of-life decision making should not be done at the end of life, and planning for decline and death should be taken as seriously as retirement planning. Healthy living is also related to healthy dying. Creating communities (it takes a village) that keep the elderly at home and out of long-term care facilities would also reduce costs and increase happiness.

Saying no to some treatments that are too expensive has to happen. When quality of life is minimal, it is reasonable to ask who is paying for the skilled nursing care, the hospitalizations, the ventilator and the feeding tube. When survival is unlikely, Hail-Mary treatments (the $100K experimental cancer drug that will prolong life for 30 days) and surgeries are not appropriate.

I know that medical ethics professionals contemplate these issues all the time and come up with compassionate best practices, but a lot depends on patient (consumer) education and ordinary citizens making good decisions before they are incapacitated.

Parallax 11-26-2011 08:48 PM

People Protesting FDA? In a Democracy?
 
Welcome to the future. Protests for Avastin is why IPAB won't work. The first time it refuses to pay for an expensive drug with limited benefits for a common cancer it will come under heavy political pressure. See the history of Herceptin in New Zealand as a blueprint for what will come.

The idea that in a democracy something like IPAB can survive for very long is nonsense. People won't care how much it costs or how little it extends the life. And internet has made things worse by making information available to public at large.

Ocean 11-26-2011 08:52 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Wonderment (Post 232740)
Yes, something will have to give. The healthcare system is unsustainable, on life support, so to speak.

End of life, in particular, is a huge issue that everyone wants to turn their eyes away from until it happens to their loved ones. It is politicized by the least informed demagogues (Schiavo case, Sarah Palin's "death panels," etc.) and complicated by other vested interests within the healthcare community who, though well-intentioned, seem to advocate for immortality rather than reality.

But how do you get the public involved in rational policy? It's a political non-starter to underscore the perfectly obvious: death affects all Americans.

Certainly there are some basics: EVERYONE should have advanced directives and general end-of-life education and awareness. End-of-life decision making should not be done at the end of life, and planning for decline and death should be taken as seriously as retirement planning. Healthy living is also related to healthy dying. Creating communities (it takes a village) that keep the elderly at home and out of long-term care facilities would also reduce costs and increase happiness.

Saying no to some treatments that are too expensive has to happen. When quality of life is minimal, it is reasonable to ask who is paying for the skilled nursing care, the hospitalizations, the ventilator and the feeding tube. When survival is unlikely, Hail-Mary treatments (the $100K experimental cancer drug that will prolong life for 30 days) and surgeries are not appropriate.

I know that medical ethics professionals contemplate these issues all the time and come up with compassionate best practices, but a lot depends on patient (consumer) education and ordinary citizens making good decisions before they are incapacitated.

I agree. People need to receive appropriate information about their choices and have the possibility of deciding well in advance.

It is likely that medical treatments have become more aggressive and in a certain way more effective in postponing death. In the past people didn't have so many choices (for example no intensive care units), and would probably die sooner. There weren't too many decisions to be made.

But now, with the multiple interventions, you can keep someone's body (with or without a mind) alive for extended periods even when there's no hope of recovery. I think that the first step is to point out to patients and families what's to be expected and to be clear that prolonging life sometimes means only prolonging suffering with no hope of improvement.

Wonderment 11-26-2011 09:23 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

It is likely that medical treatments have become more aggressive and in a certain way more effective in postponing death. In the past people didn't have so many choices (for example no intensive care units), and would probably die sooner. There weren't too many decisions to be made.
Yes, it's true that much of the "problem" is driven by advances in medical knowledge, practices and technology. Just simple things like replacing ambulance drivers with EMTs saves many lives. As you suggest, what ERs and ICUs do well is save and prolong lives. It's what happens post-ER, post-OR and post-ICU that's often questionable for quality of life.

Quote:

But now, with the multiple interventions, you can keep someone's body (with or without a mind) alive for extended periods even when there's no hope of recovery.
I visit an advanced dementia unit weekly. The patients do not have much mind left. Some are on DNR orders and/or hospice, but many are not. In the latter cases there is virtually no limit to medical interventions, which can include frequent trips to the hospital, cancer treatments, surgeries and so on. The hospice patients (palliative care only) have a much better deal. They're happier, more comfortable and less costly to society. It's all about advanced directives and good decision-making by patients and family members. The default position -- no decision-making -- leads to the worst outcomes.

Quote:

I think that the first step is to point out to patients and families what's to be expected and to be clear that prolonging life sometimes means only prolonging suffering with no hope of improvement.
That's why the Obama "Death Panels" were so important. The idea was to properly reimburse family physicians for having this conversation with patients at the right time and in the right place. I have seen it done at the wrong time and the wrong place (in the ER with a diminished capacity patient and a stressed-out, time-pressed doc). It gets done, but it ain't pretty.

badhatharry 11-26-2011 09:42 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Wonderment (Post 232745)
That's why the Obama "Death Panels" were so important. The idea was to properly reimburse family physicians for having this conversation with patients at the right time and in the right place. I have seen it done at the wrong time and the wrong place (in the ER with a diminished capacity patient and a stressed-out, time-pressed doc). It gets done, but it ain't pretty.

So doctors need to be reimbursed properly to have a fifteen minute (max) conversation with a patient? And will the death panels (your words) be advising these physicians who don't have the good sense to talk to severely ill patients about death, when the time is right???

Of course, these conversations could never have occurred without the Affordable Care Act because never before in the history of the world have doctors had to deal with dying people.

badhatharry 11-26-2011 09:56 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Ocean (Post 232743)
I
But now, with the multiple interventions, you can keep someone's body (with or without a mind) alive for extended periods even when there's no hope of recovery. I think that the first step is to point out to patients and families what's to be expected and to be clear that prolonging life sometimes means only prolonging suffering with no hope of improvement.

You seem to be implying that this kind of information isn't being given or given properly. Don't you think most people understand when their loved one is severely ill and that repeated surgeries and procedures have limited chance of recovering any semblance of a worthwhile existence?

I've been through this three times now and in all three cases, the family (of which I am a member) knew what to do, knew the right questions to ask and decisions to make. It really isn't that mysterious, no matter how sophisticated treatments become. It just requires common sense.

sapeye 11-27-2011 01:49 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Wonderment (Post 232745)
I visit an advanced dementia unit weekly. The patients do not have much mind left. Some are on DNR orders and/or hospice, but many are not. In the latter cases there is virtually no limit to medical interventions, which can include frequent trips to the hospital, cancer treatments, surgeries and so on. The hospice patients (palliative care only) have a much better deal. They're happier, more comfortable and less costly to society. It's all about advanced directives and good decision-making by patients and family members. The default position -- no decision-making -- leads to the worst outcomes.

This is such a challenging issue. I agree that the costs of end of life care can be exorbitant and will need to be controlled. But still...

My mom was a fiercely independent woman. She was a member of the Hemlock Club for many years and insisted on her right to end her own life whenever she chose. She told me some years before she died that she didn't want to be a burden on us kids. I agreed that she did absolutely have the right to end her own life and that the idea that such an act is illegal is an outrageous example of government impingement on our freedom - as if they own our bodies. But she didn't have the right to decide for us kids whether she was a burden. That was our decision to make, not hers.

The years went by and her physical and cognitive functioning deteriorated until she could no longer live alone and my sister could no longer care for her. Mom went to live in a center for the elderly. The last time I took her out to lunch, I felt things had sort of reversed and I told her that when she was ready to die, she didn't need to stick around for us kids. That she should feel free to go.

She firmly said that she wasn't ready to die and that when she was ready she knew what to do about it. I didn't believe her. I was convinced that if she could see herself as she was now through the eyes of who she had been five years previously, she would not want to continue to live in such a diminished condition.

I thought the fundamental biological imperative to continue to exist no matter what had taken over. I was deeply troubled by this and my philosophy of life was seriously shaken. If even my mom, who had had an iron will and had spent years developing the spiritual aspects of her being, could be dominated by her biology, what did this mean for the power of consciousness/spirit?

Some months later Mom died of pneumonia. (Years before, Mom had decided that no extraordinary measures should be taken to prolong her life.) Shortly after her death, I was talking with a close friend of hers, and in passing the woman said, "You know, for the first time since I've known her, your mom told me two weeks ago that she was ready to die." I very much appreciated hearing it, and I again recognized the power of spirit in our lives.

We don't know what is going on deep within people, what work they might still be doing, what joy still feeling, even when it seems from the outside like there isn't much of anyone still there.

Wonderment 11-27-2011 02:52 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

We don't know what is going on deep within people, what work they might still be doing, what joy still feeling, even when it seems from the outside like there isn't much of anyone still there.
Yes, as you say, a very challenging dilemma and, for me at least, mysterious.

My (admittedly very limited and non-professional) experience in interacting with patients with extremely compromised cognitive function entirely supports what you've expressed above. The patients may not remember where they're from or who their children and spouse are. They may not have more than a dozen words of vocabulary. But they are still people with subjective experience and a significant emotional repertoire. Somebody is home.

Your mother's life, after her decline, seems very much worth living to me. It might not have been, though, if she hadn't made the good advanced directive decisions (DNR) that prevented the system from going on automatic pilot with all the "heroic" interventions.

Olavus 11-27-2011 02:58 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Thanksgiving and turkeys, hmmm...

The Green Butchers

http://en.wikipedia.org/wiki/The_Green_Butchers


The Green Butchers (2003) Trailer

http://www.youtube.com/watch?v=tUEvBM82DzI

badhatharry 11-27-2011 09:23 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by sapeye (Post 232760)
The last time I took her out to lunch, I felt things had sort of reversed and I told her that when she was ready to die, she didn't need to stick around for us kids. That she should feel free to go.

She firmly said that she wasn't ready to die and that when she was ready she knew what to do about it. I didn't believe her. I was convinced that if she could see herself as she was now through the eyes of who she had been five years previously, she would not want to continue to live in such a diminished condition.

I thought the fundamental biological imperative to continue to exist no matter what had taken over. I was deeply troubled by this and my philosophy of life was seriously shaken. If even my mom, who had had an iron will and had spent years developing the spiritual aspects of her being, could be dominated by her biology, what did this mean for the power of consciousness/spirit?

Sorry about your mom.

So you told a woman who was failing that she should feel free to commit suicide and you were disappointed at her reaction? Hopefully when we are talking about people giving in to death, we are not just talking about pre-emptive suicide.

Death comes and doesn't really need to be invited. The questions come when we feel compelled to prevent it. In a civilized society we feel that the decision should lie with the individual or the family if they have been given the permission.The mechanism of an advanced directive is a very effective tool. I think most people either have one or would be willing to sign one. As far as biological imperative, I don't think anyone relishes the idea of being kept alive by a machine.

All of this is nothing new or radical. But I must say that when a person is around a loved one's dying and death it is a remarkable event and teaches us about what we have in store for us.

Ocean 11-27-2011 10:41 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
This kind of personal experience leaves us with a sense of meaning beyond what can be expressed with words which is difficult to convey to others.

I see where your doubts about decision making in advance may be coming from. However, the story that you shared with us confirms that the issue is complex and deserves a lot of thinking, a lot of information and awareness of possible outcomes towards the end of life.

Indeed, people with advanced dementia may be physically healthy while their minds have regressed to early childhood status. Their capacity to make health care decisions at those times isn't intact, the same that you wouldn't expect a 5 year old to make such decisions. It is important that the person makes decisions while their intellectual capacity is intact. But such decisions have to make provisions for all kinds of possible outcomes.

It's relatively easy to decide not to go on life support if the person will require a respirator, feeding tubes and all sorts of artificial mechanisms. It's also easier to think of ending life when there's a terminal condition that causes intense pain and suffering.

But how about a condition which is progressively deteriorating but doesn't cause pain or suffering because the person is unable to appreciate his/her own deterioration? We should have an open discussion and think about all those possibilities. That's why careful information and education about options is so important.

In terms of your ending paragraph with your reflections about someone deciding when they're ready to die, I've seen that many times in the context of my professional life. I'm not sure how to interpret it, but it seems like the person's desire to live stops and somehow it contributes to their death. Perhaps in a tenuous balance between health and illness, life and death, that subtle difference in desire to live may tip the balance. We could get into speculating about possible physiological mechanisms, but it seems that's not what we're talking about anyway.

uncle ebeneezer 11-27-2011 11:19 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
First off, I just want to say that I'm sorry to hear that George is suffering from some form of depression. I hope he gets whatever will help him to feel better. He's always struck as one of the true "nice guys" of Bloggingheads so I wish him the best.

Skeptic/Ocean, it sounded to me that George was not being outright dismissive of SRRI's or writing them off entirely, but more cautious/skeptical about how much we can really judge their effectiveness based on the data (as far as he knows it.) John seemed more bull-headed against them but George didn't seem dismissive on the whole, just more skeptical than he had once been. And they both noted that they had known many people for whom they seemed to work.

Ocean, as to your hypothetical, is it possible that after a failure on the first SRRI, that increased frustration of the patient would make a placebo on the second, more likely? Just curious.

Great diavlog on the whole. I too loved the segment on fringe scientists. Sounds like a wonderful book. Happy Thanksgiving all!

Ocean 11-27-2011 11:46 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by uncle ebeneezer (Post 232768)
First off, I just want to say that I'm sorry to hear that George is suffering from some form of depression. I hope he gets whatever will help him to feel better. He's always struck as one of the true "nice guys" of Bloggingheads so I wish him the best.

About 1/3 of people suffer from some form of clinically significant depression at some time in their lives. Almost all recover from it sooner or later, with or without treatment, and with more or less impairment.

Quote:

Skeptic/Ocean, it sounded to me that George was not being outright dismissive of SRRI's or writing them off entirely, but more cautious/skeptical about how much we can really judge their effectiveness based on the data (as far as he knows it.) John seemed more bull-headed against them but George didn't seem dismissive on the whole, just more skeptical than he had once been. And they both noted that they had known many people for whom they seemed to work.
Yes, I think that George was somewhat disappointed and perhaps he was having some side effects to the antidepressants he tried. But the bottom line is that a divorce process is almost always painful, and there's no antidote for that.

Quote:

Ocean, as to your hypothetical, is it possible that after a failure on the first SRRI, that increased frustration of the patient would make a placebo on the second, more likely? Just curious.
No, not really. There are people that have very clear and unequivocal response to antidepressants. I've had patients that responded initially very well to an antidepressant, but for some reason, perhaps changing or losing insurance coverage they need to change to another one. And let's say that they don't respond to the second one. It's very obvious clinically. Then, say you put them back on the initial one and voilą! They do well again.

The main problem with antidepressants is that many times it's a hit or miss, and it takes more than one trial to find the right one, and then there's the possible problem of "chronification" of depression.

What I find in clinical practice is that at times, physicians who prescribe the antidepressant forgets to taper off after a certain period of time according to guidelines. This is probably more frequent in primary care, just because they are the ones who prescribe the most antidepressants. In psychiatry we tend to get people who have a history of more severe or more recurrent or chronic depression. The guidelines for those are slightly different.

eeeeeeeli 11-27-2011 12:24 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Ocean (Post 232737)
Some people may think that even if more is involved, since we can't measure it or understand it or observe it, it is impractical to get too busy thinking about it.

I think this is right. But then we still have the problem of phenomenon that we can't really explain very well, and yet must start somewhere if we are to hypothesize - especially if there are real-world consequences of our assumptions either way. Critiques of materialism usually see people as assuming too much, relying too readily on a physical framework as a best guess. Critiques of the opposite - immaterialists? - see people as ignoring what seem to be perfectly reasonable logical conclusions drawn from our knowledge of the physical world.

I tend to fall into the latter camp. I'm reminded of the old creationist thought experiment, the clearly "designed" phenomenon in the natural world, such as Mt. Rushmore or a house in a desert, in which physical processes are assumed to be incapable of such complexity. This can be contrasted with a thought experiment designed to illustrate Occam's Razor, where a broken, blackened tree is found in a field - in the absence of clear evidence, one might assume any number of explanations, some more fantastic than others. Yet the most likely, the most reasonable explanation would be that lightening has probably struck it down.

Surely, many biological processes - certainly those involving the brain and/or consciousness - are lacking in a great deal of evidence. But there is also much that we *do* know, and would be remiss in not taking into full account, if not inferring even further material hypotheses.

sapeye 11-27-2011 12:49 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by uncle ebeneezer (Post 232768)
Skeptic/Ocean, it sounded to me that George was not being outright dismissive of SRRI's or writing them off entirely, but more cautious/skeptical about how much we can really judge their effectiveness based on the data (as far as he knows it.) John seemed more bull-headed against them but George didn't seem dismissive on the whole, just more skeptical than he had once been. And they both noted that they had known many people for whom they seemed to work.

Yes, neither of them seemed particularly closed minded about the efficacy of SSRIs.

sapeye 11-27-2011 12:58 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by badhatharry (Post 232763)
Sorry about your mom.

Thank you. It's been a long time ago now.

Quote:

So you told a woman who was failing that she should feel free to commit suicide and you were disappointed at her reaction? Hopefully when we are talking about people giving in to death, we are not just talking about pre-emptive suicide.
I didn't tell my mom she should be free to commit suicide. I told her that when she was ready to die, she didn't need to stick around for us kids. Why the snark?

stephanie 11-27-2011 02:35 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
I mostly agree with you and Ocean here, but am going to take issue with one small bit of the response:

Quote:

Originally Posted by SkepticDoc (Post 232736)
The reality is that Public Health measures and science based medical care have extended life expectancy.

As I understood the issue raised about screening tests, it dealt at least in part with when the screening tests should occur, who should be given them. The question asked by Horgan (I think) was if the risks of false positives and riskier follow-up tests are so high, why do people prefer having the tests, despite the tiny likelihood of a helpful result. For example, the outcry when it's discussed raising the recommended age for a test from what we've been accustomed to.

Presumably, when it's recommended that the test not be mandatory until a later age (and thus not paid for by insurance, generally), that is a result of public health measures, yet people don't like it. This is related to the general discussions of medical costs, of course. It's also related to the argument that we overtest due to fears about medical malpractice (which I note can't be addressed by any of the usual tort reform schemes).

I agree that John goes beyond this in questioning the benefits of screenings more broadly, and I'm not referring to this.

Also, speaking as a potential patient and not a doctor, one reason people might prefer the tests is that they don't understand why there would be any negative side to having them vs. the preference that something be discovered early. Or even more broadly, they just trust their doctor's judgment on this. (I recently dealt with this, because my doctor told me that I could get a mammogram at 35, since my mother had breast cancer. I didn't have the test, but I probably would have if my doctor had pushed it more, despite being somewhat medical-procedure-adverse, maybe like John.)

Ocean 11-27-2011 02:58 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by stephanie (Post 232787)
As I understood the issue raised about screening tests, it dealt at least in part with when the screening tests should occur, who should be given them. The question asked by Horgan (I think) was if the risks of false positives and riskier follow-up tests are so high, why do people prefer having the tests, despite the tiny likelihood of a helpful result.
[...]

Also, speaking as a potential patient and not a doctor, one reason people might prefer the tests is that they don't understand why there would be any negative side to having them vs. the preference that something be discovered early. Or even more broadly, they just trust their doctor's judgment on this.

You basically laid out the main issues. But let's take into account that for each individual procedure, the risk/benefit ratio is very different and it also has to be applied to the patient's individual risk (like you pointed out regarding having a family history of a particular form of cancer). John mentioned one of the most controversial procedures, since prostate cancer can be so slow in its growth that it may outlive the individual who may end up dying from other causes, while the complications of treatment are quite significant. * It's an extreme example, but certainly a procedure that should be reviewed carefully.


*And let's not forget that such complications are related to sexual function which god forbid! it's worse than death. This last is an aside, but interestingly, men are willing to risk their lives for their sexual function (taking medications with high cardiovascular risk), so this particular procedure is extremely problematic for that reason.

Wonderment 11-27-2011 03:37 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
The problem in this diavlog and others is that John wants to mix apples and oranges: a PSA test is not a mammogram is not a colonoscopy is not a pap smear. John's prediction that colonoscopies would soon be discredited "just like" PSA testing is unwarranted.

John wants to have his "I told you so" moment on medical quackery and questionable studies supporting vast expenditures in testing, procedures and surgeries, but he's jumping to unwarranted conclusions here.

OTOH, it is disturbing how market forces push the science and practice of medicine in the other direction. It's hard to dispute that anti-depressants have been vastly over-hyped and over-prescribed by Pharma, as have psychotropics for kids, like Ritalin and Adderall.

Another problem is that medical culture at the level of practitioner is hard to change. I went for my annual checkup this year and inquired about the PSA test. The government has found "There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," but my doctor still thinks the test is the best thing since sliced bread and gave me a whole (unpersuasive) storyline that contradicted the latest data.

Worse than that, this month at the hospital where I volunteer there was a special workshop for the public on prostate cancer risks, treatments and cures. They were offering free PSA tests and middle-aged men were lining up to get them. Guess who was sponsoring the event.

So sometimes John is paranoid, and sometimes paranoics get things right.

sapeye 11-27-2011 04:39 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by SkepticDoc (Post 232736)
The reality is that Public Health measures and science based medical care have extended life expectancy. Human biology experimentation is limited by ethics(humanity?), our senior diavlogers come from the Physical Sciences, they love to smash matter to elucidate the building blocks of space/time/energy. We can't do that with living "things"...

A question: I've heard in various places that the longer life expectancy we enjoy is due in very large part to decreasing infant mortality and that if we start counting from 5 years of age, we don't live much longer today than people previously did. That the age at which people die is much the same today as it has been for several hundred years. Is this an urban myth?

Ocean 11-27-2011 04:45 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Wonderment (Post 232803)
The problem in this diavlog and others is that John wants to mix apples and oranges: a PSA test is not a mammogram is not a colonoscopy is not a pap smear. John's prediction that colonoscopies would soon be discredited "just like" PSA testing is unwarranted.

John wants to have his "I told you so" moment on medical quackery and questionable studies supporting vast expenditures in testing, procedures and surgeries, but he's jumping to unwarranted conclusions here.

Yes.

Quote:


OTOH, it is disturbing how market forces push the science and practice of medicine in the other direction. It's hard to dispute that anti-depressants have been vastly over-hyped and over-prescribed by Pharma, as have psychotropics for kids, like Ritalin and Adderall.

Another problem is that medical culture at the level of practitioner is hard to change. I went for my annual checkup this year and inquired about the PSA test. The government has found "There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," but my doctor still thinks the test is the best thing since sliced bread and gave me a whole (unpersuasive) storyline that contradicted the latest data.

Worse than that, this month at the hospital where I volunteer there was a special workshop for the public on prostate cancer risks, treatments and cures. They were offering free PSA tests and middle-aged men were lining up to get them. Guess who was sponsoring the event.

So sometimes John is paranoid, and sometimes paranoics get things right.
There's a difference between appropriate skepticism and inquiry, and paranoia and over generalizations. Knowing how to use one and avoid the other is the key to sound judgment.

I would like to see more moderation. But, that's just my taste.

Ocean 11-27-2011 04:56 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by sapeye (Post 232821)
A question: I've heard in various places that the longer life expectancy we enjoy is due in very large part to decreasing infant mortality and that if we start counting from 5 years of age, we don't live much longer today than people previously did. That the age at which people die is much the same today as it has been for several hundred years. Is this an urban myth?

This is the kind of data you're referring to. And, indeed, most of the increase in life expectancy at birth can be accounted for by improved rates of infant and childhood survival. As the age gets higher, the gains are less marked.

badhatharry 11-27-2011 06:13 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by sapeye (Post 232775)
Thank you. It's been a long time ago now.



I didn't tell my mom she should be free to commit suicide. I told her that when she was ready to die, she didn't need to stick around for us kids. Why the snark?

Well you did go on to say you were quite disillusioned by her apparent change of mind in comparison to her prior, more enlightened view and that it really shook your world. I'm sorry.

Suffice it to say death and dying are very dramatic events in people's lives and we experience all sorts of unexpected feelings. I think the recent event (in the last thirty years or so) of hospice care and families being together for the final illness and breath is very healthy. Prior to that in the last century, death was something unfamiliar that happened in white hospital rooms, at least for a lot of families in America. I think in the same sense birth has become a more familiar event.

miceelf 11-27-2011 06:33 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by sapeye (Post 232775)
I didn't tell my mom she should be free to commit suicide. I told her that when she was ready to die, she didn't need to stick around for us kids. Why the snark?

I wouldn't take the snark personally if I were you. It's really got nothing to do with you at all.

Diane1976 11-27-2011 07:37 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by BNH (Post 232717)
I love these two guys! Whenever I see their faces on your homepage it makes my day. Thankyou!

Me too. I always like to see them turn up. The discussion of depression was very informative and interesting.

Hope to see them again.

sapeye 11-27-2011 11:22 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by badhatharry (Post 232833)
Well you did go on to say you were quite disillusioned by her apparent change of mind in comparison to her prior, more enlightened view and that it really shook your world. I'm sorry.

Not disillusioned with mom, but deeply troubled by my sense that perhaps after all flesh is more powerful than spirit/consciousness. Of course, that dualistic view is not a very fruitful way to look at things, as though matter and spirit/consciousness are fundamentally separate.

Thank you for the apology.

sapeye 11-27-2011 11:47 PM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by miceelf (Post 232836)
I wouldn't take the snark personally if I were you. It's really got nothing to do with you at all.

Yes, thanks. Not taking things personally is pretty good advice for all situations.

sapeye 11-28-2011 02:41 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by Ocean (Post 232825)
This is the kind of data you're referring to. And, indeed, most of the increase in life expectancy at birth can be accounted for by improved rates of infant and childhood survival. As the age gets higher, the gains are less marked.

Thanks, Ocean. Yes infant mortality does account for a significant amount of the difference, but there is still a lot even from age 10 on. What's interesting is that for those that make it to 50, there's not a lot of difference in how many years they can expect to live whether living in the late 19th century or the early 21st. By the time people reach 80 it's a wash. So longevity for individuals hasn't changed much at all.

Ocean 11-28-2011 07:54 AM

Re: Science Saturday: Blowing Smoke Rings (John Horgan & George Johnson)
 
Quote:

Originally Posted by sapeye (Post 232866)
Thanks, Ocean. Yes infant mortality does account for a significant amount of the difference, but there is still a lot even from age 10 on. What's interesting is that for those that make it to 50, there's not a lot of difference in how many years they can expect to live whether living in the late 19th century or the early 21st. By the time people reach 80 it's a wash. So longevity for individuals hasn't changed much at all.

Well, I bet there are a whole lot more individuals who get to be 80 as compared to before. I think that's what we're talking about when we say that life expectancy has increased. Lifespan has not.

By the time you get to be 80 you'll start to hit illnesses (cancer, heart disease, degenerative disease) which probably reflect the effects of cumulative wear and tear of our bodies (and all the bad things that we do to them). Here's a nice summary by one of the Cryonics / life extension guys.


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