Just because one doctor failed to follow the rules doesn't invalidate the entire field of psychiatry.
Scientology seems to be having a rough go of it lately, what with high-profile defections that include its leader's father and its founder's granddaughter. The organization also appears to be on the verge of losing Suri Cruise just as she's getting old enough to join in some of its special rituals. Even media titan Rupert Murdoch, well-acquainted with the attentions of conspiracy theorists and parliamentary inquiries alike, is on the record labeling Scientologists as "creepy, maybe even evil."
But Scientology is still heartily charging forth in its epic battle against the dark forces of psychiatry, sometimes scoring undeniable battlefield wins. Unfortunately, aided by unwitting state regulators and media, the Scientologists are slaying creaky old windmills, not the dragons they imagine. Founder L. Ron Hubbard considered the medical study and treatment of disordered thought, abnormal mood and bad behavior as something of a threat to the pseudo-scientific religion he devised to clear up all these matters. L. Ron baked in so much suspicion towards psychiatrists, I wonder if the group's founder wasn't concerned with what diagnosis shrinks might hand him if they ever got him on the couch.
Little wonder then that the Church of Scientology operates a subsidiary whose sole aim is to discredit and dismantle the field of psychiatry. The subsidiary flies by the benign moniker "Citizens Commission on Human Rights," which sounds like it might be a UN-affiliated NGO. The group incessantly employs classic propaganda techniques like trumpeting each instant of an errant psychiatrist as emblematic of the entire field. A favorite strategy is zeroing in on poorly funded government mental health facilities and blaming the clinicians who toil there for their lack of proper resources, rather than acknowledging the dearth of societal support for funding mental health care and the full array of community supports needed to deinstitutionalize the sickest patients. If anything, CCHR's campaigns undermine public support for mental health treatment, especially in countries with more unsophisticated representatives and gullible media.
When you watch self-congratulating CCHR videos cataloging shoddy conditions in the world's most underfunded and poorly managed mental health facilities over the years, Scientologists hope you'll accept their slippery logic that these events say something about the validity of psychiatry as a whole. Of course they do not, no more so than any case of medical malpractice in any field, in any country, brings down validity of medicine as a whole. Mental illnesses are disease processes rooted in biology still under research by medical scientists that require intervention by mental health clinicians who stay abreast of an evolving body of scientific knowledge. The auditing sessions and e-meters L. Ron prescribed bear no resemblance to this reality.
So you can see why any critically minded reader will want to know when Scientology is the driving force behind any given brouhaha. But readers of a recent four-article investigative series in the Austin American Statesman were instead informed that an enviably safe physical treatment was controversial as evidenced by the concerns of the humanitarians at CCHR, which was described only as "a mental health watchdog group." As the Statesman reported, CCHR succeeded in getting the Texas Department of State Health Services to investigate psychiatrist Allen Childs for conducting research without proper certification from his hospital's review board. Consumers of the newspaper series like the author of this article at the Austinist can be forgiven for getting the impression that a state hospital psychiatrist had actively experimented with a dangerous form of electrotherapy called Cranial Electrotherapy Stimulation (CES). Yet all public evidence suggests nothing of the sort occurred.
I do not believe that the Statesman or Texas officials knew they were also serving as functionaries in a Scientology campaign. If so I think that Scientology's role would have made its way into at least one of the four Statesman articles:
The articles report how CCHR complained to state officials about Dr. Childs publishing two studies (2005 and 2007) including patients from North Texas State Hospital without institutional review board (IRB) approval. Dr. Childs was working with a population of intellectually disabled adults prone towards violence that other state facilities couldn't treat, referring them to the North Texas facility because of its high-security behavior management unit. Dr. Childs realized that the CES treatment reduced the number of violent outbursts without any significant side effects, something medication couldn't do for these patients. He made CES part of his routine medical practice so as to use as little medication as possible. When he decided to report his experience to others, he should have gone to an IRB for the OK -- a panel of medical and community representatives who evaluate research designs for any potential risk to the participants. IRBs have the power to entirely veto projects or demand modifications to research protocols. Texas officials quickly found that no IRB approvals existed for Dr. Child's two papers, and their investigation snowballed from there. As reported in the final article, Dr. Childs resigned. He'd already wound down his practice at the hospital before this episode. He did not respond to the Statesman for comment (nor to the state inquiry, it appears).
The head of the University of Texas College of Pharmacy took a particular interest in the Statesman articles. Dean Lynn Crismon provided statistical and research design assistance for some of Dr. Child's CES research in the late 1980's and was shocked to read how his old associate had gone off the rails. His research back then included IRB approvals. But when I explained to Dr. Crismon that Scientology had successfully targeted his old research partner, their involvement instantly tempered his interpretation of the newspaper articles. A full time administrator now long after his brief association with Dr. Childs, Dr. Crismon went on to spend a significant portion of his research career evaluating methodologies for improving care in public mental health systems. He and his team were the sometime target of CCHR press releases that he believes distorted his record.
What provoked the ire of state hospital officials, the lack of IRB approval, was a bit of a moving target, Dr. Crismon pointed out. For most of Dr. Childs' career, IRB approval would not have been the standard for the type of research he was conducting. Dr. Childs was using a technology that had been FDA approved for over 30 years to treat depression, anxiety and insomnia and whose only known side effects (like headaches and tingling) are so rare, benign and self-limited they would be the envy of most pharmaceuticals. CES passed its most recent FDA safety review just this past March. Dr. Childs secured approval to use the device (marketed as Alpha Stim) from his hospital's therapeutics committee and by its ethics panel, then obtained proper consent from each patient before use. He went on to make this stimulator a part of his routine practice, finding that it helped lower aggression. So he started using it for that problem more and more. Other doctors followed suit.
This is a very common evolution in routine medical practice seen with any number of devices, procedures and medications. All doctors use treatments "off label." This isn't an experiment. Dr. Childs then decided to collect his cases and report about his success so other doctors could consider trying it themselves. There is no question that an IRB would have approved the study, in fact they most likely would have issued a "waiver." When a doctor is using his own clinical data and masking any information that could identify the individual patients involved, there is essentially no risk to the patients. A pro-active "experiment" is not occurring, only a review and synthesis of clinical records. The relevant federal regulation specifically excludes this type of work:
Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.
It didn't become the norm for clinicians to ask IRBs to vet this kind of publication until around the year 2000, according to Dr. Crismon, who has served on IRB's for 19 years including a period as chairman of the Texas Behavioral Health IRB. Today the University of Florida tells its staff that case studies with three or fewer patients need not go before its IRB. That number appears to be an internally developed rule of thumb; federal statutes don't include any such guidance. Dr. Childs's 2005 paper involved nine patients.
CES raised red flags for Scientologists because of the "electrical" aspect. Scientology considers electroconvulsive therapy (aka "electroshock") to be torture, and has a penchant conflating other electrical treatments with that therapy. ECT can send an entire amp of current through the brain. By contrast CES operates on the level of hundreds of microamps, over a thousand times smaller. Worn on each earlobe, you can walk about and do your business while having a CES treatment for thirty minutes or an hour. Users have full control to take it off at any time. I tried it on my back once a few years ago and didn't feel anything (it is no longer "cranial" stimulation when applied to the back, of course). It's powered by a 9-volt battery.
Cranial electrotherapy stimulation has not entered the medical mainstream despite its many decades on medical supply store shelves. Its second-class status becomes obvious on the principle manufacturer's website which features heavy direct-to-consumer appeals. CES isn't important enough to be discussed in medical schools, and seems to be embraced only quite spottily in psychiatry, neurology and related fields. Its unpopularity doesn't stem from any concerns about safety, however; the general impression is that there are other, more effective and well-studied treatments available (including full-bore electroconvulsive therapy). Ironically, considering Scientology's concerns, many clinicians have trouble believing a few microamps can do anything. By all accounts, Dr. Childs is one of the true believers, speaking at conferences across the country. I spoke with a neurologist who recalled one of his talks in the 1990s. Dr. Childs came off overly enthusiastic but sincere, I am told.
Despite its place in the nightmares of Scientologists everywhere, electricity is reaching a new heyday in medicine thanks to more sophisticated and targeted technologies like transcranial magnetic stimulation and deep brain stimulation, both recent FDA-approved technologies that offer more anatomical localization than CES. As electrical stimulators continue to miniaturize and start recharging over the air, a great many medical applications lie ahead in the next few decades.
So Dr. Childs conducted a study that nobody questions would have met perfunctory approval, had he only bothered to submit it. He did his work in an era when norms for this type of research were evolving. I think these facts should attenuate our condemnation of his actions, which should not be viewed through the perverted lens of Scientology's hate for the psychiatric profession, but rather as the error of an overzealous clinician committed to doing anything he can do help some of the most helpless people in the state psychiatric population. There were other misdeeds uncovered in the course of the investigation: Dr. Childs is accused of filming some of his patients without their consent and speaking judgmentally about their behavior in a talk accompanied by the video; he did not disclose in his second paper that he had become a consultant for the device company after the first paper. These are serious charges and there are no available facts that mitigate them. I have not seen the video, so the excerpts as reported are out-of-context. Was video consent ever obtained? Was Dr. Childs consulting for Alpha Stim at the time of his 2007 paper? Dr. Childs is not cooperating with the state (it seems) or granting interviews, so we don't know.
This collection of errors is certainly enough for state officials to demand Dr. Child's resignation, particularly if he is unwilling to defend himself. But just as important in the whole affair is the fact that the state of Texas and the Austin American Statesman were made unwitting players in a staged production by the Church of Scientology, some of the greatest showmen on earth. They'd like Dr. Allen Childs's mistakes to go towards discrediting the entire field of psychiatry. The true lessons in this tale are wholly different. I've spoken with three people who knew Allen Childs and all describe a sincere and passionate and perhaps rather excitable man. He made no secret of the fact that he was submitting his cases for publication, and he appears to have been simply ignorant of the need for IRB approval; perhaps his ignorance extended to his use of video as well. Could the state hospital have done a better job of educating its staff and supporting their research? Did the journals prompt Dr. Childs for certification of his IRB approvals?
I will not give Dr. Childs the benefit of the doubt while he is able yet unwilling to speak for himself. However, I do not see any evidence that he harmed patients beyond using their images in the video (as described). In fact the results he reports warrant further randomized, controlled investigation. The resignation of this well-meaning psychiatrist means little for the safety of his former patients, but it means a lot to Scientology. If CCHR's new strategy is to comb the psychiatric literature for instances where an IRB is MIA, psychiatry had better prepare for battlefield earth.
“Somewhere at Google there is a database containing 25 million books and nobody is allowed to read them.”
You were going to get one-click access to the full text of nearly every book that’s ever been published. Books still in print you’d have to pay for, but everything else—a collection slated to grow larger than the holdings at the Library of Congress, Harvard, the University of Michigan, at any of the great national libraries of Europe—would have been available for free at terminals that were going to be placed in every local library that wanted one.
At the terminal you were going to be able to search tens of millions of books and read every page of any book you found. You’d be able to highlight passages and make annotations and share them; for the first time, you’d be able to pinpoint an idea somewhere inside the vastness of the printed record, and send somebody straight to it with a link. Books would become as instantly available, searchable, copy-pasteable—as alive in the digital world—as web pages.
An interview with the Associated Press shows President Trump slowly coming to terms with the size of the government he now runs, and the challenges he must tackle.
Every president faces a steep learning curve when he enters the presidency. There is, as John F. Kennedy, wrote, no school for commanders in chief. Yet even by that standard, recent interviews show a Donald Trump who is genuinely surprised by the size of his duties, the interests he must balance, and the methods required to get that done.
On Sunday, the Associated Press released a transcript of an interview with the president last week. It deserves to be read in full: It captures his constant evasiveness on facts, preferring hyperbole, for example, and his detachment from reality—when asked about a “contract with the American voter” on what he’d achieve in 100 days, Trump dismisses it, saying, “Somebody put out the concept of a hundred-day plan.”
Will you pay more for those shoes before 7 p.m.? Would the price tag be different if you lived in the suburbs? Standard prices and simple discounts are giving way to far more exotic strategies, designed to extract every last dollar from the consumer.
As Christmas approached in 2015, the price of pumpkin-pie spice went wild. It didn’t soar, as an economics textbook might suggest. Nor did it crash. It just started vibrating between two quantum states. Amazon’s price for a one-ounce jar was either $4.49 or $8.99, depending on when you looked. Nearly a year later, as Thanksgiving 2016 approached, the price again began whipsawing between two different points, this time $3.36 and $4.69.
We live in the age of the variable airfare, the surge-priced ride, the pay-what-you-want Radiohead album, and other novel price developments. But what was this? Some weird computer glitch? More like a deliberate glitch, it seems. “It’s most likely a strategy to get more data and test the right price,” Guru Hariharan explained, after I had sketched the pattern on a whiteboard.
The early results out of a Boston nonprofit are positive.
You saw the pictures in science class—a profile view of the human brain, sectioned by function. The piece at the very front, right behind where a forehead would be if the brain were actually in someone’s head, is the pre-frontal cortex. It handles problem-solving, goal-setting, and task execution. And it works with the limbic system, which is connected and sits closer to the center of the brain. The limbic system processes emotions and triggers emotional responses, in part because of its storage of long-term memory.
When a person lives in poverty, a growing body of research suggests the limbic system is constantly sending fear and stress messages to the prefrontal cortex, which overloads its ability to solve problems, set goals, and complete tasks in the most efficient ways.
With Benoît Hamon’s defeat, his Socialist Party may be obsolete.
In the first round of a French presidential election, there will, naturally, always be more losers than winners. But until Sunday, the Socialist Party had lost in the initial round only once before: In 2002, when incumbent Prime Minister Lionel Jospin unexpectedly finished a close third, behind a surprise surge from the National Front’s leader (FN), Jean-Marie Le Pen.
This year, independent-centrist Emmanuel Macron and Jean-Marie’s daughter, Marine, now leader of the FN herself, will move on to the final round on May 7. The Socialist candidate, Benoît Hamon, finished an unprecedented fifth. His loss feels very different from Jospin’s of 15 years ago, and not only because his paltry share of the vote was so much lower—just over 6 percent compared to Jospin’s 16.
A machine mapped the most frequently used emotional trajectories in fiction, and compared them with the ones readers like best.
“My prettiest contribution to my culture,” the writer Kurt Vonnegut mused in his 1981 autobiography Palm Sunday, “was a master’s thesis in anthropology which was rejected by the University of Chicago a long time ago.”
By then, he said, the thesis had long since vanished. (“It was rejected because it was so simple and looked like too much fun,” Vonnegut explained.) But he continued to carry the idea with him for many years after that, and spoke publicly about it more than once. It was, essentially, this: “There is no reason why the simple shapes of stories can’t be fed into computers. They are beautiful shapes.”
That explanation comes from a lecture he gave, and which you can still watch on YouTube, that involves Vonnegut mapping the narrative arc of popular storylines along a simple graph. The X-axis represents the chronology of the story, from beginning to end, while the Y-axis represents the experience of the protagonist, on a spectrum of ill fortune to good fortune. “This is an exercise in relativity, really,” Vonnegut explains. “The shape of the curve is what matters.”
An exploration of syndromes that are unique to particular cultures.
You can’t get your genitals stolen in America.
At least, not while they’re attached to your body. But people can in Nigeria, Benin, China, Singapore, and Hong Kong. In all of these places, there have been cases of koro (also called suo yang in some places), “a cultural syndrome where people feel like their genitals are being sucked into their body,” says Frank Bures. “And there’s a fear of death.” It’s often thought to be caused by some kind of curse, or spell, or spirit—something otherworldly.
This is the condition that sparked Bures’s interest and led to his new book The Geography of Madness: Penis Thieves, Voodoo Death, and the Search for the Meaning of the World’s Strangest Syndromes.In it, he investigates mostly penis theft, but also other examples of what are called “cultural syndromes” or “culture-bound syndromes”—conditions that only exist in, and seem to stem from, particular cultures. Other examples include “frigophobia” in China, “a fear of cold which has its roots in traditional Chinese cosmology of balancing between hot and cold”; running “amok” in Malaysia, when people go on a killing spree they can’t remember later; and “hikikomori,” in Japan, when people socially withdraw to the point where they never leave home.
By antagonizing the U.S.’s neighbor to the south, Donald Trump has made the classic bully’s error: He has underestimated his victim.
When Donald Trump first made sport of thumping Mexico—when he accused America’s neighbor of exporting rapists and “bad hombres,” when he deemed the country such a threat that it should be contained by a wall and so clueless that it could be suckered into paying for its own encasement—its president responded with strange equilibrium. Enrique Peña Nieto treated the humiliation like a meteorological disturbance. Relations with the United States would soon return to normal, if only he grinned his way through the painful episode.
In August, Peña Nieto invited Trump to Mexico City, based on the then-contrarian notion that Trump might actually become president. Instead of branding Trump a toxic threat to Mexico’s well-being, he lavished the Republican nominee with legitimacy. Peña Nieto paid a severe, perhaps mortal, reputational cost for his magnanimity. Before the meeting, former President Vicente Fox had warned Peña Nieto that if he went soft on Trump, history would remember him as a “traitor.” In the months following the meeting, his approval rating plummeted, falling as low as 12 percent in one poll—which put his popularity on par with Trump’s own popularity among Mexicans. The political lesson was clear enough: No Mexican leader could abide Trump’s imprecations and hope to thrive. Since then, the Mexican political elite has begun to ponder retaliatory measures that would reassert the country’s dignity, and perhaps even cause the Trump administration to reverse its hostile course. With a presidential election in just over a year—and Peña Nieto prevented by term limits from running again—vehement responses to Trump are considered an electoral necessity. Memos outlining policies that could wound the United States have begun flying around Mexico City. These show that Trump has committed the bully’s error of underestimating the target of his gibes. As it turns out, Mexico could hurt the United States very badly.
Plant proteins called lectins are an emerging source of confusion and fear.
Two weeks ago, a publicist sent me an early copy of a book that claimed it would change everything I thought I knew about food.
That happens a lot. This one caught my eye because it warned of the “hidden dangers lurking in my salad bowl,” and I was eating a salad.
The book, The Plant Paradox, has an image of an artfully smashed tomato on the cover, and it tells readers that eating tomatoes is “inciting a kind of chemical warfare in our bodies, causing inflammatory reactions that can lead to weight gain and serious health conditions.”
Tomatoes and ill-timed references to chemical warfare are, apparently, only a small part of the problem. The Plant Paradox urgently warns against eating wheat, beans, and peanuts, among other plants.
The organization has a flair for attracting media attention, but lacks a mass membership or scholarly expertise—and its connection to its famed namesake isn’t what it claims.
Sean Spicer was in trouble. In a press conference addressing Syrian President Bashar al-Assad’s use of chemical weapons against his own people, the White House press secretary had fallen into one of his signature slow-moving train-wrecks of an analogy: “You had someone as despicable as Hitler who didn’t even sink to using chemical weapons,” he said, later clarifying that he understood Hitler did use them in “the Holocaust centers” but didn’t use them “on his own people.” The claims were wrong in just about every way: Adolf Hitler used gas chambers to murder millions of Jews in concentration camps across Europe, including German citizens.
“BREAKING NEWS: SEAN SPICER DENIES HITLER GASSED JEWS DURING THE HOLOCAUST,” the Anne Frank Center for Mutual Respect wrote in all-caps on Facebook. “MR. PRESIDENT, FIRE SEAN SPICER NOW.” Weeks earlier, the center had slammed Donald Trump for being slow to condemn a recent wave of bomb threats against Jewish Community Centers—“a Band-Aid on the cancer of anti-Semitism that has infected his own administration,” it said—and the White House’s failure to mention Jews in its statement on Holocaust Remembrance Day. Dozens of news outlets picked up the statements, and the group’s executive director, Steven Goldstein, was all over television. After all, this was the American organization that speaks for Anne Frank, the teenaged author of the world-famous diary about her life in hiding in Amsterdam before she was murdered in a Nazi concentration camp.