July 29, 2007 8:16

Scientific Truth

In response to my post about the amazing new addiction theory Ben Bonsens writes:

M.L. its usually not the eloquence of a thoughtful argument that proves a theory. Instead it is the repeatability by an outside second and third lab/study that proves a theory.

Further, science is basically the questioning of a system (hypothesis), determining a controlled environment to study the system (experiment), and reviewing the results as they pertain to the original question. Every one does this every day without even thinking. Otherwise we would still be in trees flinging our feces at each other.

As a researcher I read articles every day of experiments that compete with mine. Sometimes there are valid lessons to be learned and sometimes they don't know what they are talking about. But I can never discount someones work until I hear it out in its entirety.

True enough. But I'll bet you don't stop what you're doing and investigate every new theory that comes along. If you did, you probabably couldn't get any work done. I'm betting you only investigate new ideas that seem to you likely to be worth spending the time on, and with others, you make a judgment that they could conceivably be right but that it's too much of a long shot to worry about. That's what most scientists do, anyway.

As to the comment about eloquence vs. repeatability, of course, and if I gave the impression that I thought otherwise, then I wasn't clear. In psychology and psychiatry, though, the experimental system is very complex and messy, and controlled trials aren't always so easy.

Still, you and I agree that a valid idea will be proven over time, one way or another. I bet you also agree, though, that trying to convince journalists to do the evaluating is a pretty bogus proposition.

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July 29, 2007 12:57

A Radical New Theory of Addiction?

Dan Umanoff, MD thinks he has one, and writes in a comment:

Say what you want about me. It's not about me. It's about the science. You say that the validity of my argument is dependent upon its acceptance by the mental health community. Please. Science doesn't work that way. Scientific validity is boss, not the results of some poll.....So, if you really are interested in improving the field of addictions and helping addicts you will read and study my work and let the people know about it so they can chose to use it. Only then will we know if it works. Absent this, we are stuck with the same old nonsense which we know doesn't work.

To which I answer: no, I won't read and study your work. I am a journalist, not a scientist, and certainly not a specialist. That being the case, it would be absurd for me to judge your theory, and highly irresponsible to send addicts to you for treatment. You won't like hearing this, but when evaluating radical new theories, of which I receive at least two per week (most of them proving Einstein or the Big Bang wrong), I have to rely on the judgments of scientists, not on my own reading of scientific papers.

I didn't say that the validity of your work depends on the opinions of others. But I do say that if you expect anyone to pay attention to you, you'd better convince a significant number of others in the field that you're right. Ultimately, a majority vote of your peers is essential to your credibility, like it or not.

If you can't convince them, it's either because, despite your certainty, your work isn't valid after all. Too bad, but it happens all the time. Or it's because the vested interests of the Establishment are conspiring against you. That happens too, unfortunately, but my reading your papers isn't going to change it. If you're right, you'll be vindicated, eventually.

Alas, if you're looking for publicity, you're stuck with the unfortunate fact that while they laughed at Wegener (who proposed continental drift) and they laughed at Barry Marshall (who claimed, correctly, that ulcers are caused by bacteria), they also laughed at Bozo the Clown.

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July 29, 2007 12:08

Sally Satel Responds on the Addiction-Disease Question

A couple of days ago I ranted a bit on this article in Slate that argues addiction isn't a disease.

Many readers have commented, but now one of the authors of the original Slate article has weighed in. Here's her comment, in full:

Sally Satel responds: Below are the links to the SLATE article (note that the controversy is over the term "brain disease") and one to a expanded article on the same topic. http://www.slate.com/id/2171131/fr/flyout http://www.american.com/archive/2007/july-august-magazine-contents/the-human-factor-2 --Sally Satel MD

Not exactly a response, but quite useful. As she points out, the controversy is over the term "brain disease," and in both her Slate piece and the expanded version, it's clear that she doesn't oppose the term so much because it's wrong as because it's not useful.

Fair enough; since any mental behavior is by definition biological activity, you could arguably call any thought that deviated from the norm "pathological," and thus evidence of disease. Which we do, in fact, with schizophrenia or depression. But you have to draw a line somewhere, given that norms are somewhat arbitrary. Is a negative personality a disease state, or just a variant of normal personality? The Diagnostic and Statistical Manual, which psychiatrists use to answer those questions, is hardly a perfect guide: at one point, if I recall properly, homosexuality was considered a form of mental illness.

Satel argues that addiction isn't a disease because it involves a behavior that is at some level voluntary. I argue that it is a disease because the underlying brain state of an addict is different enough from that of a non-addict that the voluntary nature of the behavior is significantly compromised. Thus, when Satel argues that addicts have a choice about whether or not to use, I respond "yeah, that's easy for you to say."

Satel further argues that calling addiction a disease somehow relieves an addict of the responsibility to take action. In some cases, maybe so. But as Satel clearly knows, people in 12-step programs like AA manage to accept both concepts at once. Yes, it's a disease, and yes, you have to take some responsibility for your own recovery.

Is there a danger that some addicts use the disease label to avoid responsiblity? Sure, maybe. But active addicts are adept at using anything they can think of to keep from dealing with their addictions. Satel is sadly mistaken, in my opinion, if she thinks calling addiction a habit will make any difference at all. Conversely if calling it a disease leads to medications that can help addicts a little with their decision-making, I'm all for it.

Besides, addiction was stigmatized as simple bad behavior for about 10,000 years; it's been labeled a disease for the past half-century or so. Does Satel really think the treatment of addiction was better in the good old days?

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July 26, 2007 2:50

Comments on my addiction rant

We've had a bunch already, some thoughtful, some not so much. Here's a thoughtful one. Tom writes:

To call addiction a disease only validates the feelings of powerlessness that addicts feel. It undermines the fact that behavioral change is the only solution to their condition, and allows them to deny responsibility for their condition. Beating addiction is incredibly hard as it is, and the last thing drug counselors need is people coming to them with the belief that they have a disease which is beyond their control. If you believe your addiction is beyond your control to change, then you might as well be dead already because you're never going to do what you have to do to beat it.

A reasonable argument, but I don't agree. Diabetes is a disease, but people who have it can and do change their behavior to keep the symptoms of the disease at bay. For addiction, twelve-step groups like AA take the position that "we are powerless over alcohol"—i.e. that they have no responsibility for the underlying condition—and then provide practical steps to help them deal with that powerlessness by staying away from alcohol. I strongly believe that the underlying addiction itself is beyond personal control. But the behavior that will help you beat it is quite the opposite.

Now here's a "not so much." LJM writes:

Wow, that was kind of a bitter, petty response to a sober and professional disagreement with your article....How is this shallow sarcasm supposed to convince people that your point of view is correct?

We disagree on the basic premise. The Slate piece was not, in my opinion, either sober or professional. The nature of my response follows naturally. I take it you're not convinced, but I can live with that.

Jason James Morgan writes:

Maybe going to AA is just replacing one habit for another. Maybe there are other ways. Maybe there is valid research out there showing it is not a disease. Maybe being open minded is better than being close minded. Maybe I should stop being condesending and sarcastic.

Nah, why should I be the only one having fun here. Anyway, maybe going to AA is just replacing one habit with another. This is a bad thing...why? Don't you think going to AA meetings is a tiny bit better than the habit of pouring booze down your throat and then getting into fights or abusing your spouse or driving drunk or vomiting on your shoes or ending up with a rotten liver? I kind of do.

As for "other ways," you'll be surprised to learn that the central book in the AA literature says that the organization doesn't consider AA necessarily to be the only way—only that it worked for those who wrote the book, and might for others. You also mention valid research showing it isn't a disease. To which I respond: show me. The folks over at Slate sure haven't.

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July 26, 2007 7:41

Addiction is NOT a Disease???

A couple of weeks ago, Alice Park and I wrote a cover story about addiction. In it, we kept talking about the fact that addiction is a disease of the brain.

Silly us. While that's admittedly the view of the National Institute on Drug Abuse and the vast majority of addiction specialists, we forgot to talk to Sally Satel and Scott Lilienfeld. If we had, we would just have said "never mind." Yesterday, this dynamic duo published this essay at Slate.com, in which they set the record straight.

Satel and Lilienfeld, a psychiatrist and a psychologist, respectively, explain that addiction is no disease. It's a habit. "But like other bad habits," they write, "it can be broken." Which is to say, it's kind of like picking your nose in public, evidently, except that it's more expensive.

This clueless pair doesn't argue that the neurochemistry of an addict's brain is no different from that of a non-addict. They can't, because it demonstrably is. Instead, they offer gems of wisdom like this:

Characterizing addiction as a brain disease misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well.

This presumes that there's no underlying neurological basis that predisposes someone to addiction. Those who actually know something about it know this is a false presumption. Addiction, as Satel and Lilienfeld have somehow failed to learn, is not simply the behavior of abusing drugs—if it were, then all of the college students who drink too much would be alcoholics. Most aren't; they grow out of it.

Addiction is actually a disorder in which the brain's reward system is conditioned to value the reward of getting high over pretty much anything else. It's a disorder, in other words, in which the brain is malfunctioning. And it malfunctions even when the addict isn't actively using the drug. Satel and Lilienfeld would have you believe that the decision to use a drug when the addict knows full well it will lead to disaster, as it has every other time--a behavior every addict is all too familiar with—is just a habit. Like throwing your socks on the floor instead of into the laundry hamper, maybe.

Sure, recovery from addiction requires some change in behavior. So does Type 2 diabetes, which requires the sufferer to avoid sugar and simple carbohydrates, but who nevertheless (unless Satel and Lilienfeld beg do differ) has a disease. An addict has to choose not to use, which is overwhelmingly difficult. It's overwhelmingly difficult but not impossible for someone with depression to get out of bed and put on a good face. But Satel and Lilienfeld don't harangue people with depression to change their "bad habits." Or..maybe they do, come to think of it. It wouldn't surprise me. If medications can help an addict resist the urge to use, why, precisely, is this something to avoid?

The funniest part of the essay, if you have a perverted sense of humor, is where they say "we believe that the brain disease concept is bad for the public's mental health literacy." I haven't seen something so mental-health-illiterate in quite a while.

It's pretty clear that the authors long for the days of Nancy Reagan's "Just Say No" campaign. After all, that approach—good old fashioned will power—pretty much eradicated drug abuse back in the 80's.

Oh, wait...no it didn't.

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July 11, 2007 1:52

Saving American Science

I may have had a transformative experience last week. In fact, I'm prettu sure I did.

What I'm talking about is the growing drumbeat of amply justified fear that America is fast losing its edge over the rest of the world in science and technology—something I wrote about in this TIME cover story.

Figuring out why, and what to do about it, has become a cottage industry. So when I was asked to come to a two-day meeting sponsored by the Aspen Science Center, I was kind of dubious. Even though the organizers had put together a guest list so prestigious that I felt like an important-person impersonator, I was pretty sure the result would be a list of platitudes and noble-sounding but impotent suggestions—some sort of feel-good document that wouldn't accomplish much.

I think I was wrong. On the second day of the conference, the proceedings were basically hijacked by two participants: Esther Dyson, former journalist and current high-tech venture capitalist, and Adam Bly, founder of Seed Magazine, the associated (and terrific) ScienceBlogs website and plenty of other science-communications ventures you're likely to hear about.

We'd already come to the conclusion that while it would be great to reform the entire educational system, and to pump the media up with even more exciting and engaging science stories than the exciting and engaging stories we already produce (no false modesty in this group), we realized that the real problem is that Americans just don't care a lot about science. Think about it: if you bring up Shakespeare at a party, or Picasso, or the Beatles, you'd be astonished if anyone said "what's that?" But if you bring up science, people are almost proud of the fact that they haven't a clue.

This is pretty bizarre, considering that science underlies all of the technology we depend on, and many of the serious policy issues (global warming, stem cells, space exploration, resource depletion, alternative energy) we're struggling with. Yet Americans generally don't have a clue; it's just not a part of the culture. If a network news broadcast, or the PBS News Hour went an entire show without discussing politics or world affairs, we'd be astonished. If it doesn't have a science story--who even things about it.

So our two insurgents herded this high-powered group of cats into what we're calling the Aspen Science Working Group (write that down, it may be important). The idea is that we'll use our contacts in government, philanthropy and business (and some of these folks, who include two former directors of the National Science Foundation, have some pretty impressive contacts) to get science into the national conversation, not as an optional item but as a factor necessary for America's national health.

If we can do it, we might not have to worry so much about bright young people with science degrees becoming investment bankers, or about politicians skewing science to fit their political ends, or about industry ignoring basic research that might not pay off for a decade in favor of pumping up the next quarter's profits.

I agree it sounds Quixotic. But having spent two days in a room with these folks, I think it has a chance of working. What do you think?

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July 2, 2007 9:16

Big Bang, Again

The questions keep coming....

Jim Hill asks:

Almost all cosmologists now posit that the universe began in a big bang 13.7 billion years ago, and they recreate the timeline of its existence in a far amount of detail -- look at the infamous Wikipedia. The question that occurs to me is, what or who existed before the start of the big bang? Is the whole process of the start of the universe an argument for the existence of God? You already know that I have a religious nature, so you can guess what I think easily enough.

You may not be surprised to learn that you're not the first to wonder, nor the first to think the Big Bang is an argument for the existence of God. And sure, it's an argument. But I don't think it's a very convincing one. Sure, it's possible. But as I've often said, lightning was once an argument for the existence of God(s), until we figured out the real cause. It may be that THIS time we've come to the final impasse, and will have to invoke God as the cause. But I prefer to wait and see what the smartest theoretical physicists in the world can do with the problem first. They're on the case.

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July 1, 2007 9:26

More on the Big Bang

Chris asks:

Hi, I was reading the questions and answers about the big bang and I noticed one sentence: "The actual universe is much bigger, and may even be infinite in extent".That does mean the universe is still in extension. So if it is, something else exists outside the universe. What is it? Extension does mean space to move. Move in what? What is the "container"?

But it doesn't mean that at all. There's no need for a container. Go to the tutorial, and look for Frequently Asked Questions. Yours is one of them—understandably, since it's a logical assumption. Just a wrong one.

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