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Do You Believe in Magic? - by Paul Offit MD

mercredi 26 septembre 2018

One of my pet peeves is homeopathy. I have nothing against natural medicine - many of the pharmaceuticals out there come from plants or are related to chemicals that come from plants - but homeopathic medicine just pisses me off. The reason is that it is based on two ridiculous assumptions: 1) that like cures like - this is based on the fact that quinine taken in large enough doses causes fever like symptoms which are similar to the malaria is also cures, 2) that diluting something until it is not even there still leaves energy traces or something in the water it once touched. This is the basis for homeopathy - that quinine, which cures malaria, causes symptoms somewhat similar to malaria in large doses. To me this is like saying that since I once had a headache and had a glass of water before the headache went away that water cures headaches.

I was expecting this book to be a debunking of "alternative" medicine and it largely was. But it also made some points in favor of alternative medicine which I had never really considered.

As a science-minded person I know that research shows that vitamin C does not cure colds, cancer or most illnesses besides scurvey. But still when I get a sore throat I want to take vitamin C. Even knowing that the myth that it boosts your immune system was largely created and promoted by one man, Linus Pauling, and is mostly an invention of the media, I still believe it. Even knowing better I still feel like it helps me when I get a cold. This is because of the placebo effect which is very real. This is why in clinical studies they test medications against placebos - because just believing that something will help tends to make it actually help.

While the benefits of most alternative medicine are not supported by science (if they were they would be regular medicine instead of alternative), the placebo effect makes this a somewhat murky area. When people go to the doctor for a cold there is generally not much the doctor can do. Antibiotics won't help with a cold (which is a virus) and will just promote antibiotic-resistant bacteria, but most patients expect the doctor to prescribe something. My father is a doctor and when I was a child he would tell me about some of his older patients who he would give a vitamin B12 shot to every time he saw them. He said they expected some kind of medication and they seemed to like the brightly colored vitamin B12 injections so he would give them one. Now with pharmaceuticals advertised on TV he doesn't have that option - the patients come in requesting a specific medication and he can either give it to them regardless of whether they need it or not or let them go away angry and dissatisfied. Of course this is why big pharma loves advertising direct to consumers, but it results in a lot of people taking a lot of medication they don't need, that probably won't help them, and that which may have negative side effects.

This is where alternative medicine comes in. There is a story at the end of the book about a doctor from England who moves to Africa in the 1800s. A visitor mentions about how backwards and primitive the witch doctors were, so the doctor takes him to see a witch doctor. The witch doctor at times chants, at times waves smoke around, at times gives the patients powder and sometimes points over to the English doctor. The doctor explains to his guest that when the witch doctor is chanting the patient has a psychological problem and the witch doctor is helping just by listening and doing something. The people who were given powder had minor ailments which would resolve on their own. For the people with serious medical problems which he could not treat, the witch doctor was sending them to the medical doctor. 

In this story the witch doctor is providing a valuable service - the people who don't need medical attention get to feel better because they talked to someone who listened and gave them something. Whether what they were given actually helps is irrelevant since their problems will resolve on their own. The people who actually need medical attention are referred to the medical doctor. The difference between this story and the reality of today is that the witch doctor knew what his limits were and when to refer patients to a level of care they need. Today most alternative healers do not believe in scientific western medicine and warn their patients away from it.

There is an entire field of medical research devoted to placebo medicine so placebos definitely have a place in medicine. However for them to work requires that the patient believe it will work and the patient is unlikely to believe that if the healer does not. There is a fine line between the need for alternative healers to believe in their remedies and also be aware of when their patients need actual scientific medical care. If they can manage this I think alternative medicine has a valuable place in medicine. Unfortunately it seems that most healers are not aware of their limits.

Libellés: books, science, medicine
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I had already read and enjoyed "The Way We Never Were" so when I saw another book by Ms Coontz I was excited to read it, and I was not disappointed. Like "Debt: The First 5,000 Years", this book takes on a subject which most people think they are knowledgeable about and with extensive research proceeds to dismantle what you thought you knew. 

The book goes through the history of marriage throughout the ages and in different cultures and examines how the institution has evolved and changed. Spoiler alert - what Americans tend to think of as "traditional marriage" really only existed in the 1950s and 1960s, and even then wasn't as "Leave it to Beaver" as people tend to think. The subject of nostalgia for the "good old days" that never really existed was very thoroughly covered in "The Way We Never Were" and, while some overlapping material is covered in this book, this one really focuses on the history of marriage, from ancient Greece through to modern times. 

While marriage has existed since the beginning of recorded history, it has constantly been in flux and has been regarded very differently in different cultures. While the changes since the 1950s are most memorable to me, writing here in 2018, all of the book was very interesting and I had to stop reading to tell my wife something interesting I had just read at least once per chapter. I highly recommend this book to anyone interested in history or sociology.

Libellés: books, history
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My wife has been watching a TV show from the UK called "Can't Pay We'll Take It Away" which is about people who go to collect debts from people, and if they can't pay they take their stuff. They are similar to repo men, but they work for the court rather than the lender and they won't just repossess the item the debt is against - they'll take anything at all to sell for pennies on the dollar and use the money against the debt.

My first reaction to hearing about this was that this didn't really make sense. I thought that interest was supposed to be compensation for the risk of not being re-paid, and that this did not make sense. If you can go and take any possessions of a debtor and sell them to repay yourself there is no reason to not loan money to anybody and everybody. Then I thought about how the current debt system reinforces the inequality inherent in capitalism in that people who have to borrow money often end up re-paying it forever, making the lender or credit cards or whoever a huge amount of interest.

My next reaction was to go out and get this book, which had been lingering in my "To Read" list for quite a long time. The book, written by an anthropologist, examines human societies in terms of debt and, more broadly, the concept of money in general. The book presents exactly the type of arguments I like - it takes common assumptions of the type we are taught in school as unquestionable facts, dissects them, applies facts to them, and finds the assumptions lacking. The first such assumption is the origin of money. In business school I was taught that before money people had to barter. Say I have a chicken and I need new shoes - I would have to find someone who has shoes and needs a chicken. If the people who have shoes don't need chickens I am out of luck. Money was the solution to this problem - by acting as a common denominator for everything I can sell my chicken to someone who needs a chicken and use the money to buy shoes from someone who has shoes. Graeber says that this is not supported by any facts - the evidence indicates that people dealt with such situations with a crude system of IOUs. At the time communities were much smaller and people probably knew everyone in their village, so someone who had shoes would give them to me, and then later I might give them a chicken when they needed it. 

Imagine that your neighbor comes over to ask to borrow an egg. Do you ask for money for it, do you ask for something of equal value in return? You will probably give him the egg and expect that if you ever need an egg in the future he will do the same for you. Now imagine that you know everyone in your town as well as you know your neighbor, and that your town is largely self-contained. According to Graeber this is how commerce worked for a large portion of history - he refers to it as "everyday communism." 

While neoliberal capitalism is based on the assumption that everyone is out for themselves, specifically to get as much money as possible, everyday communism is based on the assumption that people will help each other without being forced to. While this would never work in today's world, according to Graeber it was the dominant system of commerce for most of history.

Most economics textbooks assert that the first system was barter, which led to money, which led to the creation of debt and credit. Graeber claims that this is not supported by any evidence and believes that debt and credit of type described above variety predated money and barter. While his theory seems more likely to me than the standard economic theory, it seems there is no conclusive evidence supporting either version, so who can say? 

The book also covers a variety of other topics such as the origins of coinage and paper money, the origins of credit, the role of precious metals and slavery, and the effect of warfare and government on all of these things. Graeber's theories are a bit more complicated than the standard assumptions, but at least to me they ring truer than the accepted wisdom. Especially interesting to me where the explorations of "human economies," in which the common denominator was people rather than money, viz the thing in which everything else was measured was human lives, not dollars. 

The big takeaway from this book is that civilizations have struggled with debt for thousands of years, with the pattern being that the poorer people have to borrow money from the wealthy to live, when they can't pay it back they have to work or become slaves for the wealthy, and this continues until something major happens - either a revolt, a crisis, the cancellation of the debts or some other cataclysmic event. I believe that today we are nearing the end of such a cycle. As inequality grows we are starting to see some unrest on the part of those who do not have capital, where this leads only time will tell.


Libellés: books, economics
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In my opinion, the work of Kahneman and Tversky is probably the most important work in psychology and economics in the last century. I mention cognitive biases in conversation on a daily basis. Many years ago I was considering doing a PhD in economics, but I gave up the idea when I realized that economic theory is based on a completely invalid assumption - that people are rational and make rational decisions based on self-interest. If this was true the entire advertising industry would not exist. The concepts of brands, corporate image, basically everything that goes into modern advertising is direct proof that humans are not rational.

Daniel Kahneman and Amos Tversky revolutionized psychology with their work on decision making under uncertainty. Kahneman describes the mind as consisting of two systems - System 2 is what people normally think of the mind - the part that thinks in words, analyzes things and makes logical decisions. System 1 is what most people refer to as the "unconscious" mind, the part that reacts and makes judgements without analysis. Their work reveals that System 1 is far more important than most people think.

Far from making logical, rational decisions based on evidence most decisions are made using heuristics and cognitive biases. A heuristic is a rule-of-thumb - an easy way to answer difficult questions, usually by substituting simpler questions which are similar. For example, if you are asked how worried you are about terrorist attacks your reply has nothing to do with the actual rate of attacks. Unconsciously you think of how many attacks you can think of and answer based on that. So if you see a lot of terrorist attacks on the news you probably think the chances of being affected by one are far greater than they actually are. This is called the availability heuristic - people judge how common something is by how easily they can remember instances of it.

Cognitive biases are exactly what they sound like - unconscious biases that effect how we process information. My favorite is the confirmation bias, which predisposes people to accept information that is consistent with their opinions and beliefs and reject information that is not. If you think about it it is really quite simple and obvious. Say, for example, I think that all immigrants are criminals. If I hear about a crime commited by an immigrant I think, "there's proof that I'm right." And if I hear statistics that say that immigrants are less likely to commit crimes I just ignore it or say that the source must be wrong. If you think about it, this is really obvious, but until Kahneman and Tversky wrote about it no one had ever thought of it.

Kahneman says that System 2, the thinking part of the brain, is lazy and does as little as possible, relying mostly on snap judgements made by System 1. Personally I would go even further than that. I think that System 2's primary purpose is communicating thoughts and ideas by putting them into language, and it's ability to think logically is just a side effect. I think that unless one makes purposeful effort to think through something logically, what System 2 will do is try to put what System 1 has already decided into words. In other words when we think we are thinking through a decision, we are really just rationalizing what System 1 wants. Of course there are exceptions to this and people can and do use System 2 to analyze data and make decisions, but in my opinion, most of what System 2 does is rationalizing.

Since Kahneman and Tversky released their paper on decision making under uncertainty, hundreds of other heuristics and cognitive biases have been discovered and named. While humans tend to think of ourselves as highly evolved and highly intelligent, all of this work tends to show that we make decisions in a much less thoughtful way than we think. When we make judgements under uncertainty, for the most part we do not analyze the evidence. Instead we use heuristics and biases to "estimate" the answer to the question by substituting answers to somewhat similar questions, or maybe we just rationalize whatever our subconscious mind has already decided.


Libellés: books, psychology
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I was familiar with the case of Edgardo Mortara from having read Henry Charles Lea's "History of the Inquisition of the Middle Ages" and I am very interested by the subject of the crazy things that are often done in the name of religion, so when I found out that this case had an entire book written about it I was anxious to read it.

For those who are not familiar with this affair here is a quick summary: In Italy in 1858 the pope was still the temporal leader of at least part of the territory, and church law said that a Christian child could not be raised in the Jewish faith. Jewish families frequently hired Christian servants because they could do things prohibited to the Jews on the Sabbath, such as light fires. The Mortara's had such a Christian servant, and when one of their young children was ill the servant thought he might die and secretly baptized him so that he would not go to hell. Years later, the Church found out about this and came to take the child away so he could be raised Catholic. 

If you are interested in the full details of this case, this book provides a very detailed and rich description of the kidnapping, the laws at the time, public response to the affair, and the eventual political consequences, which include the pope's temporal powers being dimished by the unification of Italy.

It was rather shocking to learn that at the same time as the Civil War was being fought in the United States the laws of the Papal States were still incredibly anachronistic and had not evolved all that much since the Middle Ages. Pope Pius IX, who initially had seemed to be a reformer who would bring the church into modernity, ended up becoming reactionary in response to the Italian unification movement and the threat of losing his temporal kindgom. While he had initiated some reforms regarding the Jews, such as tearing down the gates of their ghettos and relaxing the restrictions on them, in this matter he refused to budge and Edgardo never returned to his family and eventually became a priest who tried to convert other Jews.

I would say this book is a must read for anyone interested in this period of European history, Italian history, or the history of the Catholic church.

Libellés: books, politics, religion
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