Science-based medicine = Big Pharma? You hear it all the time from the peddlers of woo, but it’s rare that they disclose their own profit motives.

Take the fellow who used Greg’s recent post on the FDA and acetaminophen to complain about how the FDA conducts itself.

I think more people need to take a bigger picture approach to this latest FDA news. Who is the FDA ultimately protecting? How long do they wait, how many lives are affected before they take this kind of action on big pharma drugs? Too long. How long do they wait to come down hard on the natural health industry when a few people lose their sense of smell (for example)? Not that long. The makers of Zicam got dragged through the media a few weeks ago after 100 or so people lost their sense of smell temporarily over a ten year period, but it takes 20 years or so for the FDA to say anything about the drug that is the leading cause of liver failure in the U.S.

Set aside the fact that the post quotes an article talking about the years-long educational campaigns conducted by the government to help keep people from using acetaminophen dangerously. Set aside the fact that this is not the first FDA action on acetaminophen. Ben, the commenter, did, after all. Even after this was pointed out to him, he accused the FDA of “purposely staying silent” on the subject.

Ben wanted to “focus…on the priorities of the FDA.” Of course, contrarian that I am, that only makes me look at Ben’s priorities, particularly since I just looked at the FDA’s and he ignored what I said.

Ben was kind enough to provide a link to the blog for his company, Swanson Vitamins. So I took a look at the company, specifically in regard to things he didn’t think the FDA should be focusing on.

Zicam, of course, is the “homeopathic” cold/allergy/wealth remedy, at least one formulation of which actually contains an active ingredient (unlike most homeopathic remedies, which are just water). The FDA recently released a consumer warning that Zicam Cold nasal gels can temporarily or permanently impair users’ sense of smell. That may not sound so awful, but it’s an ugly condition.

Now, as Ben pointed out, his company’s site doesn’t carry the Cold products. Of course, those can’t currently be marketed without FDA approval, so that’s not evidence of care for their customers. They do, however, continue to carry other Zicam products, even after:

There have been 130 cases reported to the FDA of decreased sense of smell following the use of one of these Zicam products – sometimes after a single use, sometimes after repeated use. All of these cases were reported by patients or their doctors; none were reported by the company, Matrixx Initiatives. According to reports, the FDA has asked Matrixx to turn over 800 consumer complaints regarding to Zicam. There is a 2007 law that requires company to report such complaints to the FDA, although the FDA has not said whether Matrixx violated this law.

Swanson Vitamins could choose not to carry any of these Zicam products in order to protect their customers. They don’t. They are instead choosing to ignore a company history of unsafe formulations and failure to report problems with their own products in order to continue to promote a popular brand name of woo.

Ben points to the fact that the other Zicam products haven’t been dunned by the FDA. He links to an article on his own blog that says that the FTC and FDA have regulatory powers over “natural” medicines. What he doesn’t tell you:

While most homeopathic remedies are diluted to the point that they are indistinguishable from water, that is not a requirement. Lesser dilutions may contain small amounts of active ingredient. If a “homeopathic remedy” contains a biological active amount of a drug as an active ingredient, is it not a regular drug?

This is relevant to Zicam because these products are regulated as homeopathic drugs – which means they were allowed on the market without having to provide any evidence for safety or efficacy.The homeopathic exception allowed the manufacturer to simply bypass the usual requirements, even though Zicam is not really homeopathic but contains biologically active levels of zinc.

Why doesn’t he tell you that? Why doesn’t he tell you the the FTC has only the power to make sure he’s not making direct medical claims for his products? Well, you could ask Ben, or you could just read the title of this post again.

Update: Note that a profit motive can also encourage other unethical behavior. As Jason points out in the comments, the astroturfers from Swansons Vitamins have arrived.

This is not the post I intended to post today, but something happened that I could never anticipate would affect my blogging. Farrah Fawcett and Michael Jackson died. Even when it happened, I didn’t expect to blog about it. My reaction to both pieces of news was, “That’s a pity.” Then I moved on.

Eventually in my moving on, I got to Facebook, where I discovered that two celebrity deaths is not enough. One friend was “weirded out by the three celebrity icons that have passed away recently… Ed McMahon, Farrah Fawcett, and Michael Jackson.” Then there was ” Wow….I know these things seem to happen in threes, but wow.” and “Hopefully Ed McMahon was recent enough to fulfill the law of threes…” and “It happens in threes. It happens in threes.”

I gave in. I wrote about it. You can find the results at Quiche Moraine.

We already know we shouldn’t rely on Oprah or her guests for general medical advice or for medical advice for women, her main audience. Turns out, somewhat unsurprisingly, that one shouldn’t listen to her on matters of sexual health either. From Carnal Nation:

Take sexual orientation, for example—a subject that’s been in the news once or twice lately. As recently as 10 weeks ago, Oprah was asking psychologist Lisa Diamond if women turn to other women sexually “because of a shortage of men.” Oprah also wondered why, when women turn away from men, so many seem to choose women who don’t, um, look so feminine. […]

Oprah is so focused on female victimization, in fact, that she even tells the astounding untruth that doctors pay more attention to the sexual aspects of prostate surgery than to hysterectomy. She also forgets to mention that more men die from prostate cancer than from breast or uterine cancer.

While I admire what Oprah did to make it okay for people to talk about being the victims of sexual assault, perhaps someone who is still so traumatized by her assault that she can’t name her own body parts is not the person women should turn to for advice on how to nurture their own sexual and reproductive health.

Well, you may call it the vagina, but poor Oprah just can’t stand that ugly word. “Don’t you think vi-jay-jay sounds better than vagina?” she asked with a pained expression. And the urethral opening? That’s “where you pee-pee,” said the 55-year-old Oprah on national TV.

Thanks to Lou for the link.

I’m always fascinated by how “common sense” works. All too often, the first part (“common”) is presumed to imply the second (“sense”) when it does no such thing. I came across a great example today.

I was having brunch with Greg and Ben after today’s radio show, when Greg mentioned someone he’d recently heard go off on an anti-open source rant. “If I have a problem, I want the person helping me to be someone I’m paying, not some bunch of teen-aged geeks–“

“What?!?” I cut Greg off. I don’t do that to people often. Really. I did not actually put my face in my hands, but I was tempted.

Okay, here’s the problem. This guy, I’ll call him ClueBoy, was assuming that he’d get better service from the paid person than from the enthusiast because money would be a reward. That puts us in the realm of operant conditioning, a field about which most people know just enough to make psychologists cringe:

Behavior + Reward = Increased Behavior

Well, kind of. It is, like most things, a bit more complex than that. Some of those complications involve the kinds of behavior it’s possible to shape through operant conditioning. Others involve the effects of reinforcement on behavior that isn’t being reinforced. That’s where this guy’s “common sense” failed him.

Money as a reward is interesting. First–and least relevant to this discussion–it’s not rewarding in itself, but is a proxy for other rewards. Second, it’s incredibly difficult to structure pay schedules in such a way that they correspond with effective reward schedules for desired behavior. In fact, in the case of piece work, it’s illegal under a lot of circumstances (think minimum wage laws). There are big careers and consultancies built out of trying to solve this problem.

So, in the case of your average tech support geek, let’s look at how money really functions as a reward. In fact, let’s take two geeks, both of whom are good at and really enjoy solving tech problems. GeekA gets himself a job for, say, Dell and starts getting paid for tech support. GeekB goes to work managing a server farm in corporate obscurity, but she checks in on the forums while she waits for processes to run at work. Neither one is all that challenged by the job.

GeekA, at the beginning of his new job, gets an extra reward, in the form of a paycheck, for this task he already loves to do. W00t! He gets more helpful. If ClueBoy calls him for help right now, he gets everything he thinks he should from the transaction–money-motivated super service. It takes a little time, but ClueBoy’s truly obscure problem gets tracked down and eradicated. Stomped flat.

Then GeekA has a little talk with his supervisor. That extra time it took to help ClueBoy? Yeah, that didn’t help GeekA’s productivity. It turns out that GeekA isn’t really being paid to help people like ClueBoy. His incentives are all structured to reward volume of work tickets closed. The money rewards ending transactions, not fixing difficult problems. GeekA’s helpful behavior drops.

But it gets better.

There’s a lovely little paradox that’s been demonstrated in operant conditioning, called a negative contrast effect. In short, adding an extrinsic reward for a behavior that a subject already finds intrinsically rewarding lessens the effect of the intrinsic reward. In terms of our scenario, this means that when it is made clear to GeekA that he’s not being paid to solve problems, his problem-solving behavior doesn’t just drop to pre-job levels. He actually gets less helpful than he was before he got paid.

If ClueBoy comes along now, what does he get? Let’s just say it’s not what he thinks he’s paying for.

GeekB, on the other hand, never gets money for her problem-solving. The currency of a forum is recognition and appreciation. Considering that she gets very little of that at work, much less the opportunity to indulge in problem-solving in the company’s conservative setup, that’s extremely rewarding. Assuming that ClueBoy doesn’t patronize her for her unpaid status, she’s going to be very motivated to find him a fix.

ClueBoy and his “common sense” had this one exactly backward. Then again, what do you expect from someone who really believes that cost equals value?

This flu thing–it frightens me. I live in a major population center. I’m already at war with my immune system. I have reason to be scared, a little.

But I won’t let people manipulate and exploit that fear, mine or anyone else’s. (No, not even you and your prosciutto monopoly, Rick.) This is too important and the consequences too great, both the consequences of panic and the consequences of feeling safe when we’re not.

So I read a little news and explanation, from reliable sources. I avoid speculation, my own and other people’s. I’m ruthless, perhaps even vicious, with rumors and misinformation. And when I’m threatening to think about it all too much, I sing a little Squirrel Nut Zippers to cut through the tension, albeit not as well as these folks.

La Grippe

There’s a full moon howling at the night….

Yesterday, I talked a bit about the broader implications of amazonfail for censorship on demand. If you read (or reread) the post, you’ll find it’s full of “I suspect” and “I think.” Some of that is me trying not to sound as though I think I’m an anointed prophet, but more of it was a reaction to the pronouncements about amazonfail that I was seeing around me.

I realize I’m surrounded by writers who’ve had the passive voice beaten out of them, but statements like “Google removed the sales rankings of GLBT books and authors” are somewhat presumptuous in our hacking age. So is a petition that asks for “the rationalisation for allowing sales ratings for explicit books with a heterosexual focus.” Even worse are the statements that Amazon was targeting gay writers and readers.

All of these statements were made before Amazon had said anything about what happened, and all of them show the dangers of zero tolerance. Not that zero tolerance is bad in itself, but before we apply it, we should at least know what we’re refusing to tolerate:

It has been misreported that the issue was limited to Gay & Lesbian themed titles – in fact, it impacted 57,310 books in a number of broad categories such as Health, Mind & Body, Reproductive & Sexual Medicine, and Erotica. This problem impacted books not just in the United States but globally. It affected not just sales rank but also had the effect of removing the books from Amazon’s main product search.

For more insight into the glitch/programming error that turned an effort to “protect” us from explicit sex into an inability to search large categories of books, see this post with comments from a former Amazon employee. Then see the other comments in that thread and just about any other thread on the subject, or look at the Twitter amazonfail hash tag, and see all the people still insisting Amazon had this planned all along.

See people saying Amazon previously claimed to have been hacked, despite the links to some person on LiveJournal claiming to have hacked them. See people still claim this is Amazon trying to get rid of GLBTQ content, despite reporting in every forum I’ve seen that make it clear that other categories of books were known to have been affected before Amazon made any statement. See the sweeping away of facts that contradict the “Amazon is evil” narrative.

Ugh.

Look, I was wrong yesterday. As much as I enjoyed my little fantasy about some moralists getting results that were exactly the opposite of those they desired, I’m not going to cling to my ideas about what happened in the face of a contrary explanation that covers all the events that happened, even if I think the solution to either problem is the same.

Why? Because my righteousness and indignation, no matter how good they feel (and they do feel so terribly good) don’t actually get anything done on their own. At best, they can serve as a fuel to effective action–if I know enough to be effective. That was a problem in this case, with lots of speculation coming across as information and very few people putting it to the test.

To make it even better, Twitter was the main vector of communication about the Amazon stuff. Twitter is lousy for any communication which takes more than 140 characters; it strips logic leaving us only with reputation capital. The #amazonfail tag got a lot of reputation capital, initially from upset people and later from sheer volume…

But you can’t tell from a Twitter post whether or not something’s authentic. You gotta do your own research and thinking. Some people do; lots of people don’t. No matter what Amazon did or didn’t do, intentionally or not, there is absolutely not enough evidence right now to draw any conclusions other than “it’s bad that this happened.”

[…]

At some point we’re going to have to figure out how to overcome a thousand years of conditioning: for a very long time, saying something loudly required a great deal of effort, so at least you knew someone really believed what they were saying. These days, no effort at all, but we still have that kneejerk reaction.

No effort required and no information. Today’s technology makes it all too easy for the broadcast of righteous anger to become an end in itself, which makes for great peer-bonding and catharsis. Change is harder.

Well, that’s not exactly true. It isn’t difficult to channel righteous anger into change. Any number of riots have been the direct result of righteous anger applied directly, as have tarrings, featherings, rides on rails and lynchings. It’s achieving effective change and justice that are difficult, and the hardest part is waiting for all the information to come in and be sorted through.

Don’t underestimate how difficult waiting is, particularly for people who have been waiting for justice all their lives. They have every reason to be upset, even paranoid, if paranoia can be based on experience. I’m upset, and I’m not affected directly. But justice is worth the work and the wait, and the alternatives are not always pleasant, as Jacob Davies noted at Making Light.

Before we rush to decide that Amazon Is Evil and head over their headquarter with pitchforks and burning torches, faces flush with the pleasure of our own righteousness, we had better remember that that same pleasure in presumed righteousness is what brought down all the democracies of the past.

Of course, this is only Amazon. This is only a test. But we had better start learning some lessons about how to handle online democracy, because it’s coming down the pike at us fast – in the form of rapid opinion polling, Twitter, blogs, instant messaging, text messaging, email, and ubiquitous mobile phones – and in our rush of enthusiasm for this wonderful opportunity to build a new democracy – and it is a glorious opportunity, believe me when I say that I think that – we had better look at the lessons of the past before we repeat them.

This was just a test. The next one will be real, and people will die as a result of a mob sentiment building on Twitter before an investigation of the facts can take place. Don’t laugh. It is coming, faster than you think possible. As I say: this was just a test. The next one will be real.

I want Amazon to fix this yesterday. I want them to create public policies on how they treat what I’m tempted to start calling, “politically sensitive material,” so I can determine whether they’re a company I want to deal with. I want Amazon to state, very publicly, that they’ll treat my friends who are GLBTQ or who write GLBTQ characters or who write erotica with the same respect they’ll give to any other reader or writer. Ideally, I want them to recognize that they don’t want to be in the business of determining what is or is not offensive.

However, I’ll give them a few days to get it all done, particularly with a holiday weekend in there. I’ll give them time to investigate and to think about what the find. I’ll listen to what they do have to say about the situation and take enough care not to confuse it with things that other people have said. I won’t call them evil on the basis of processes and decisions I don’t understand unless they continue to make sure I don’t have enough information to understand. I hope others will do the same.

I’ll also suggest that authors and publishers should take a good, hard look at what they’re trading for the ease of working with one big, online retailer and ask that they understand that the pr
oblem isn’t that Heather Has Two Mommies wouldn’t come up in a search. The problem is that any time we set up a situation in which some content is filtered, even if it’s just a tiny amount, something will be screened out that shouldn’t be. The only way to keep their own work safe from the nannies is to make sure all work is accessible.

Now, do you think that will all fit on Twitter?

Sheril at The Intersection is asking where the women with big, world-changing ideas are. JLK at Pieces of Me wants to know where the psychologists are who made a difference in the world. I can answer them both in one person, Elizabeth Loftus.

Even if you’re not in psychology, there’s a fair chance you’ve heard of Loftus. She’s known as a skeptic, and her work has enough real-world implications that she makes the news fairly frequently.

If you are in psychology and you don’t know who she is…well, I don’t know what to do with you.

Loftus has been researching memory for somewhere around forty years. She started out by doing what everyone around that time was doing, studying storage and retrieval, classification and chunking–the nuts and bolts of memory of items. Then she started asking the kind of questions JLK is now.

All this time, Loftus had been working seven days a week on yellow fruits: specifically, she was studying how the mind classifies and remembers information. In the early seventies, she began to reevaluate her direction. “I wanted my work to make a difference in people’s lives.” She asked herself, “What do I talk about when I have no other reason to be talking?” An impassioned conversation about a man who’d been convicted after killing someone in self-defense suggested the answer. Perhaps she could combine her interest in memory with her fascination with crime by looking at eyewitness accounts.

Loftus obtained a grant to show people films of accidents and crimes and test their memory of such events. Thus the study of eyewitness testimony was born, a field she can literally claim as her own. At that time the world believed that eyewitness testimony was as reliable as a video camera. Loftus found that just the questions interviewers asked, and even the specific words they used, significantly influenced memory. “How fast were the two cars going when they hit each other?” will elicit slower estimates than “…when they smashed each other?”

Merely by careful questioning, Loftus could cause subjects to remember stop signs as yield signs, or place nonexistent barns in empty fields. Subsequent research has shown that violent events decrease the accuracy of memory: in fact, memory is weakest at both low (boredom, sleepiness) and high (stress, trauma) levels of arousal. The bottom line? Memory is fragile, suggestible, and can easily decay over time.

In other words, she started studying how memory works in real life, with real complications. In the process, she completely changed how we think about memory. She also changed police procedures and how trials are conducted. She created a great deal of upheaval, for which she’s probably still not well liked, but she set us on the path to understanding the science behind at least one part of the law.

In the eighties, another kind of memory started hitting courtrooms–recovered memory of sexual abuse, sometimes of organized ritual abuse. Loftus paid attention.

We live in a strange and precarious time that resembles at its heart the hysteria and superstitious fervor of the witch trials of the sixteenth and seventeenth centuries. Men and women are being accused, tried, and convicted with no proof or evidence of guilt other than the word of the accuser. Even when the accusations involve numerous perpetrators, inflicting grievous wounds over many years, even decades, the accuser’s pointing finger of blame is enough to make believers of judges and juries. Individuals are being imprisoned on the “evidence” provided by memories that come back in dreams and flashbacks — memories that did not exist until a person wandered into therapy and was asked point-blank, “Were you ever sexually abused as a child?” And then begins the process of excavating the “repressed” memories through invasive therapeutic techniques, such as age regression, guided visualization, trance writing, dream work, body work, and hypnosis.

Loftus had already seen how easy it was to change the details of memory by asking the right questions. Now she turned her attention to creating memories of events that never happened. We may not be surprised now that this can happen, and fairly easily, but much of that understanding is due to her work.

This was, of course, controversial.

She has been called a whore by a prosecutor in a courthouse hallway, assaulted by a passenger on an airplane shouting, “You’re that woman!”, and has occasionally required surveillance by plainclothes security guards at lectures.

…

Perhaps her voluminous mail says it best. One anonymous letter from an incest survivor concludes, “Please consider your work to be on the same level as those who deny the existence of the extermination camps during WWII.” Another, from a jailed minister accused of mass child molestation, begins, “Your dedication and compassion for the innocent have earned my deepest admiration.” Yet another, from a confused therapy patient, reads: “For the past two years I have done little else but try to remember. I have been told that my unconscious will release the memories in its own time and in its own way…And I need to know if I am really remembering. The guessing has become unbearable.”

Loftus has been challenged on the basis that she doesn’t study traumatic memory formation in children. However, her work (and others‘) suggests that the use of leading questioning, hypnosis, descriptions of others’ abuse and statements that a patient matches the profile of an abuse victim are all problematic forms of therapy that could potentially lead to false memories being created. Her work, once again, has practical implications for how we help others and society.

Wherever one falls on the controversies surrounding Loftus, she has dramatically changed our understanding of memory. She’s done this in ways that have direct implications for achieving justice. In doing so, she’s changed our world.

Do I need to say anything more about my opinion of personality tests than to say that on this measure:

Agreeableness

Agreeableness is the tendency to be sympathetic and cooperative towards others. People who score high on agreeableness strive for social harmony and value getting along with others. Disagreeable people tend to be more suspicious and hostile towards others.