Do antidepressants work?

Jacob Stegenga

aeon.co

Originally published 5 Mar 19

Here is an excerpt:

To see this, consider an analogy. Imagine we are testing a drug for weight loss. For every 100 subjects in the drug group, three subjects lose one kilogramme and 97 subjects gain five kilos. For every 100 subjects in the placebo group, two lose four kilos and 98 subjects do not gain or lose any weight. How effective is the drug for weight loss? The odds ratio of weight loss is 1.5, and yet this number tells us nothing about how much weight people on average gain or lose – indeed, the number entirely conceals the real effects of the drug. Though this is an extreme analogy, it shows how cautious we must be when interpreting this celebrated meta-analysis. Unfortunately, however, in response to this work, many leading psychiatrists celebrated, and news headlines misleadingly claimed ‘The drugs do work.’ On the winding route from the hard work of these researchers to the news reports where you were most likely to hear about that study, a simple number became a lie.

When analysed properly, the best evidence indicates that antidepressants are not clinically beneficial. The meta-analyses worth considering, such as the one above, involve attempts to gather evidence from all trials on antidepressants, including those that remain unpublished. Of course it is impossible to know that a meta-analysis includes all unpublished evidence, because publication bias is characterised by deception, either inadvertent or wilful. Nevertheless, these meta-analyses are serious attempts to address publication bias by finding as much data as possible. What, then, do they show?

In meta-analyses that include as much of the evidence as possible, the severity of depression among subjects who receive antidepressants goes down by approximately two points compared with subjects who receive a placebo. Two points. Remember, a depression score can go down by double that amount simply if a subject stops fidgeting. This result, found by both champions and critics of antidepressants, has been replicated year after year for more than a decade (see, for example, the meta-analyses led by Irving Kirsch in 2008, by J C Fournier in 2010, and by Janus Christian Jakobsen in 2017). The phenomena of blind-breaking, the placebo effect and unresolved publication bias could easily account for this trivial two-point reduction in severity scores.

The info is here.

Using Machine Learning to Generate Novel Hypotheses: Increasing Optimism About COVID-19 Makes People Less Willing to Justify Unethical Behaviors

Sheetal A, Feng Z, Savani K. 

Psychological Science. 2020;31(10):

1222-1235. 

doi:10.1177/0956797620959594

Abstract

How can we nudge people to not engage in unethical behaviors, such as hoarding and violating social-distancing guidelines, during the COVID-19 pandemic? Because past research on antecedents of unethical behavior has not provided a clear answer, we turned to machine learning to generate novel hypotheses. We trained a deep-learning model to predict whether or not World Values Survey respondents perceived unethical behaviors as justifiable, on the basis of their responses to 708 other items. The model identified optimism about the future of humanity as one of the top predictors of unethicality. A preregistered correlational study (N = 218 U.S. residents) conceptually replicated this finding. A preregistered experiment (N = 294 U.S. residents) provided causal support: Participants who read a scenario conveying optimism about the COVID-19 pandemic were less willing to justify hoarding and violating social-distancing guidelines than participants who read a scenario conveying pessimism. The findings suggest that optimism can help reduce unethicality, and they document the utility of machine-learning methods for generating novel hypotheses.

Here is how the research article begins:

Unethical behaviors can have substantial consequences in times of crisis. For example, in the midst of the COVID-19 pandemic, many people hoarded face masks and hand sanitizers; this hoarding deprived those who needed protective supplies most (e.g., medical workers and the elderly) and, therefore, put them at risk. Despite escalating deaths, more than 50,000 people were caught violating quarantine orders in Italy, putting themselves and others at risk. Governments covered up the scale of the pandemic in that country, thereby allowing the infection to spread in an uncontrolled manner. Thus, understanding antecedents of unethical behavior and identifying nudges to reduce unethical behaviors are particularly important in times of crisis.

Here is part of the Discussion

We formulated a novel hypothesis—that optimism reduces unethicality—on the basis of the deep-learning model’s finding that whether people think that the future of humanity is bleak or bright is a strong predictor of unethicality. This variable was not flagged as a top predictor either by the correlational analysis or by the lasso regression. Consistent with this idea, the results of a correlational study showed that people higher on dispositional optimism were less willing to engage in unethical behaviors. A following experiment found that increasing participants’ optimism about the COVID-19 epidemic reduced the extent to which they justified unethical behaviors related to the epidemic. The behavioral studies were conducted with U.S. American participants; thus, the cultural generalizability of the present findings is unclear. Future research needs to test whether optimism reduces unethical behavior in other cultural contexts.

In Japan, more people died from suicide last month than from Covid in all of 2020

S. Wang, R. Wright, & Y. Wakatsuki

CNN.com

Originally posted 29 Nov 20

Here is an excerpt:

In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry said.

Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

(cut)

Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

The info is here.

Freerolls and binds: making policy when information is missing

Duke, A. & Sunstein, C.

(2020). Behavioural Public Policy, 1-22. 

doi:10.1017/bpp.2020.51

Abstract

When policymakers focus on costs and benefits, they often find that hard questions become easy – as, for example, when the benefits clearly exceed the costs, or when the costs clearly exceed the benefits. In some cases, however, benefits or costs are difficult to quantify, perhaps because of limitations in scientific knowledge. In extreme cases, policymakers are proceeding in circumstances of uncertainty rather than risk, in the sense that they cannot assign probabilities to various outcomes. We suggest that in difficult cases in which important information is absent, it is useful for policymakers to consider a concept from poker: ‘freerolls.’ A freeroll exists when choosers can lose nothing from selecting an option but stand to gain something (whose magnitude may itself be unknown). In some cases, people display ‘freeroll neglect.’ In terms of social justice, John Rawls’ defense of the difference principle is grounded in the idea that, behind the veil of ignorance, choosers have a freeroll. In terms of regulatory policy, one of the most promising defenses of the Precautionary Principle sees it as a kind of freeroll. Some responses to climate change, pandemics and financial crises can be seen as near-freerolls. Freerolls and near-freerolls must be distinguished from cases involving cumulatively high costs and also from faux freerolls, which can be found when the costs of an option are real and significant, but not visible. ‘Binds’ are the mirror-image of freerolls; they involve options from which people are guaranteed to lose something (of uncertain magnitude). Some regulatory options are binds, and there are faux binds as well.

From the Conclusion

In ordinary life, people may be asked whether they want a freeroll, in the form of a good or opportunity from which they will lose nothing, but from which they gain something of value, when the magnitude of the gain cannot be specified. The gain might take the form of the elimination of a risk. More commonly, people are given near-freerolls, because they have to pay something for the option. Often what they have to pay is very low, which makes the deal a good one. The central point here is an asymmetry in what people know. They know the costs, while they have large epistemic gaps with respect to the potential gains. People often fall prey to ‘freeroll neglect.’ When this is so, they do not see pure or near-freerolls; they seek missing information before choosing among options, even though they have no need to do so.

Freerolls are mirrored by binds, in which people are given an option from which they can only lose, even though they do not know how much they might lose. To know that binds are undesirable, the chooser need not have full knowledge about the range of possible downside outcomes. Nor need the chooser know anything about the shape of the distribution of those outcomes.

Toward a Hierarchical Model of Social Cognition: A Neuroimaging Meta-Analysis and Integrative Review of Empathy and Theory of Mind

Schurz, M. et al.

Psychological Bulletin. 

Advance online publication. 

http://dx.doi.org/10.1037/bul0000303

Abstract

Along with the increased interest in and volume of social cognition research, there has been higher awareness of a lack of agreement on the concepts and taxonomy used to study social processes. Two central concepts in the field, empathy and Theory of Mind (ToM), have been identified as overlapping umbrella terms for different processes of limited convergence. Here, we review and integrate evidence of brain activation, brain organization, and behavior into a coherent model of social-cognitive processes. We start with a meta-analytic clustering of neuroimaging data across different social-cognitive tasks. Results show that understanding others’ mental states can be described by a multilevel model of hierarchical structure, similar to models in intelligence and personality research. A higher level describes more broad and abstract classes of functioning, whereas a lower one explains how functions are applied to concrete contexts given by particular stimulus and task formats. Specifically, the higher level of our model suggests 3 groups of neurocognitive processes: (a) predominantly cognitive processes, which are engaged when mentalizing requires self-generated cognition decoupled from the physical world; (b) more affective processes, which are engaged when we witness emotions in others based on shared emotional, motor, and somatosensory representations; (c) combined processes, which engage cognitive and affective functions in parallel. We discuss how these processes are explained by an underlying principal gradient of structural brain organization. Finally, we validate the model by a review of empathy and ToM task interrelations found in behavioral studies.

Public Significance Statement

Empathy and Theory of Mind are important human capacities for understanding others. Here, we present a meta-analysis of neuroimaging data from 4,207 participants, which shows that these abilities can be deconstructed into specific and partially shared neurocognitive subprocesses. Our findings provide systematic, large-scale support for the hypothesis that understanding others’ mental states can be described by a multilevel model of hierarchical structure, similar to models in intelligence and personality research.

Where Are The Self-Correcting Mechanisms In Science?

Vazire, S., & Holcombe, A. O. 

(2020, August 13).

https://doi.org/10.31234/osf.io/kgqzt

Abstract

It is often said that science is self-correcting, but the replication crisis suggests that, at least in some fields, self-correction mechanisms have fallen short of what we might hope for. How can we know whether a particular scientific field has effective self-correction mechanisms, that is, whether its findings are credible? The usual processes that supposedly provide mechanisms for scientific self-correction – mainly peer review and disciplinary committees – have been inadequate. We argue for more verifiable indicators of a field’s commitment to self-correction. These include transparency, which is already a target of many reform efforts, and critical appraisal, which has received less attention. Only by obtaining Measurements of Observable Self-Correction (MOSCs) can we begin to evaluate the claim that “science is self-correcting.” We expect the validity of this claim to vary across fields and subfields, and suggest that some fields, such as psychology and biomedicine, fall far short of an appropriate level of transparency and, especially, critical appraisal. Fields without robust, verifiable mechanisms for transparency and critical appraisal cannot reasonably be said to be self-correcting, and thus do not warrant the credibility often imputed to science as a whole.

Oncologist Pays for Patient's Meds: A 'Boundary' Crossed?

Nic Mulcahy

medscape.com

Originally posted 4 Nov 20

It was an act of kindness: while overseeing a patient through a round of chemotherapy, an oncology fellow at Johns Hopkins University's Kimmel Comprehensive Cancer Center in Baltimore, Maryland, paid a modest amount of money (about $10) for that patient's antiemetic medication and retrieved it from the center's pharmacy.

Co-fellow Arjun Gupta, MD, witnessed the act and shared it with the world September 23 on Twitter.

"Just observed a co-fellow pay the co-pay for a patient's post-chemo nausea meds at the pharmacy, arrange them in a pill box, and deliver them to the patient in the infusion center. So that the patient could just leave after chemo."

Healthcare professionals applauded the generosity. "Phenomenal care," tweeted Carolyn Alexander, MD, a fertility physician in Los Angeles.

It's a common occurrence, said others. "Go ask a nurse how many times they've done it. I see it happen weekly," tweeted Chelsea Mitchell, PharmD, an intensive care unit pharmacist in Memphis, Tennessee.

Lack of universal healthcare brings about these moments, claimed multiple professionals who read Gupta's anecdote. "#ThisIsDoctoring. This is also a shameful indictment of our medical system," said Mary Landrigan-Ossar, MD, an anesthesiologist at Children's Hospital, Boston, Massachusetts.

However, one observer called out something no one else had ― that paying for a patient's medication is not allowed in some facilities.

The info is here.

The subjective turn

Jon Stewart

aeon.co

Originally posted 2 Nov 20

What is the human being? Traditionally, it was thought that human nature was something fixed, given either by nature or by God, once and for all. Humans occupy a unique place in creation by virtue of a specific combination of faculties that they alone possess, and this is what makes us who we are. This view comes from the schools of ancient philosophy such as Platonism, Aristotelianism and Stoicism, as well as the Christian tradition. More recently, it has been argued that there is actually no such thing as human nature but merely a complex set of behaviours and attitudes that can be interpreted in different ways. For this view, all talk of a fixed human nature is merely a naive and convenient way of discussing the human experience, but doesn’t ultimately correspond to any external reality. This view can be found in the traditions of existentialism, deconstruction and different schools of modern philosophy of mind.

There is, however, a third approach that occupies a place between these two. This view, which might be called historicism, claims that there is a meaningful conception of human nature, but that it changes over time as human society develops. This approach is most commonly associated with the German philosopher G W F Hegel (1770-1831). He rejects the claim of the first view, that of the essentialists, since he doesn’t think that human nature is something given or created once and for all. But he also rejects the second view since he doesn’t believe that the notion of human nature is just an outdated fiction we’ve inherited from the tradition. Instead, Hegel claims that it’s meaningful and useful to talk about the reality of some kind of human nature, and that this can be understood by an analysis of human development in history. Unfortunately, Hegel wrote in a rather inaccessible fashion, which has led many people to dismiss his views as incomprehensible or confused. His theory of philosophical anthropology, which is closely connected to his theory of historical development, has thus remained the domain of specialists. It shouldn’t.

With his astonishing wealth of knowledge about history and culture, Hegel analyses the ways in which what we today call subjectivity and individuality first arose and developed through time. He holds that, at the beginning of human history, people didn’t conceive of themselves as individuals in the same way that we do today. There was no conception of a unique and special inward sphere that we value so much in our modern self-image. Instead, the ancients conceived of themselves primarily as belonging to a larger group: the family, the tribe, the state, etc. This meant that questions of individual freedom or self-determination didn’t arise in the way that we’re used to understanding them.

The information is here.

How to know who’s trustworthy

T. Ryan Byerly

psyche.co

Originally posted 4 Nov 2020

Here is an excerpt:

An interesting fact about the virtues of intellectual dependability is that they are both intellectual and moral virtues. They’re ‘intellectual’ in the sense that they’re concerned with intellectual goods such as knowledge and understanding; but they’re moral virtues too, because they’re concerned with the intellectual goods of others. Indeed, the moral, other-regarding features of these virtues are especially central in a way that’s different to other intellectual virtues, such as inquisitiveness or intellectual perseverance.

It is in part because of the centrality of their other-regarding dimensions that the virtues of intellectual dependability haven’t taken on a larger role in education. The reigning paradigm of what we should aim for in education is that of the critical thinker. But being a critical thinker doesn’t necessarily mean that you possess other-regarding qualities, such as the virtues of intellectual dependability.

While we might lament this fact when it comes to formal education, we can still make efforts to become more intellectually dependable on our own. And we arguably should try to do so. After all, it’s not just us who are in need of dependable guides in our networks – we need to be intellectually dependable for the sake others, too.

If we want to grow in these virtues of intellectual dependability – to become more benevolent, transparent and so on – what can we do? The following are four strategies that researchers tend to agree can help us grow in intellectual virtue.

A first strategy is direct instruction – learning about the nature of particular intellectual virtues that we hope to cultivate. Ideally, we’ll gain an account of what the virtue involves, and we might learn about the vices that oppose it. Part of the reason why direct instruction is important is that it helps to reduce our cognitive load. It gives us a framework to think through our intellectual life. It also helps us set a target to aim for.

A second strategy is to think how intellectual virtues apply in particular situations, considering what the intellectual virtue – and perhaps also its opposing vices – looks like in action. You might select some historical, contemporary or even fictional examples of people who appear to act in accordance with the virtue or its opposing vice. By encountering exemplars, you might gain a taste or sensibility for the virtue, and a person to emulate. More generally, this exercise can help you to practise evaluating scenarios in which intellectual virtues can influence behaviour. When done well, this can help you appreciate the variety of contexts in which intellectual virtues make a difference, and the different kinds of behaviour they lead to.

The info is here.