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Category Archives: Sci/Tech

The Placebo Effect – Once More With Feeling

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PlacebosPlacebo is not what you think (MindHacks) is a great article on one of my favourite medical subjects; the placebo effect. It offers a great round-up of the current research into this phenomenon and discusses some possible future changes to its use in a professional capacity.

Given the pervasiveness of placebo success in medical trials, it always surprises me that the use of placebos by medical professionals is explicitly banned (even taking into account the fact that a person in a position of trust would be deceiving you). However, the above article links to an interesting paper written by Adam Kolber – a Bioethics and Law professor, and author of the Neuroethics and Law blog – on the possible ethical use of placebos by medical professionals. Here is its abstract:

Placebo treatments, like sugar pills and saline injections, are effective in treating pain and perhaps a host of other conditions. To use placebos most effectively, however, doctors must mislead patients into believing that they are receiving active medications. While placebo deception is surprisingly common, its legality has rarely been tested. In November 2006, the American Medical Association (AMA) adopted a new ethics provision categorically prohibiting doctors from using placebos deceptively. In so doing, the AMA shifted the legal landscape, making it almost certain that courts will decide that placebo deception violates informed consent requirements.

I argue that the AMA’s new policy is overbroad, insensitive to patient preferences, and likely to have unforeseen consequences. While deception is often exploitative, placebo deception can genuinely benefit patients. Absent stronger evidence to justify a ban than we currently have, deceptive placebos should be treated as scarce medical resources–used sparingly but not categorically prohibited.

One glaring problem with this – no matter how valid the conclusions – is that to use placebos safely and correctly we would need physicians who have the time (and inclination) to thoroughly peruse patient histories – something the overstretched NHS is severely lacking.

On a lighter note, it always amazes me that I learn something new and fascinating every time I read more about the use of placebos. This time my education came from the following paragraphs:

Furthermore, studies done in the 1970s showed that when heroin users inject water (sometimes done deliberately to alleviate cravings when drugs are in short supply), they can experience drug-like euphoria and have been observed to show opiate-like physiological signs such as pupil constriction.

This last point also demonstrates that placebo is not solely about expectancy, belief or ‘being fooled’, as the heroin users knew they were injecting themselves with water. Conditioned responses play a role.

Of course, as with most cases of classical conditioning, this response eventually becomes extinct as the initial stimulus (real heroin) is repeatedly withheld. Still fascinating, though!

(Bonus points if you know why I gave this post its title.)

Life Without a Memory – The Man Who Mistook His Wife for a Hat

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I have recently finished reading The Man Who Mistook His Wife for a Hat, a book by eminent neurologist Oliver Sacks taking the form of ‘clinical anecdotes’ – or, informal case-histories – on some of the more interesting patients he has encountered throughout his long and distinguished career.

You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all… Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing… (I can only wait for the final amnesia, the one that can erase and entire life.) – Luis Buñuel

The above quote is from The Lost Mariner, a chapter discussing one of Sacks’ patients, Jimmy G, who – due to Korsakoff’s syndrome – lost both his memories from the previous 35 years, and the ability to create new ones. It’s a touching and sad story where you feel that the only redeeming quality is the fact that this man cannot create new memories; at least then he doesn’t know that he has this problem.
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Six months ago my family-life was ticking along as normal; everything was fine. Then, during a routine operation, my grandmother passed away, leaving my grandfather – a very self-sufficient man approaching 90 – alone in their home of 30 years. While interim accommodation arrangements were being made, my grandfather was found unconscious after suffering a stroke and was admitted to hospital – not even two weeks after his wife’s funeral.

Three months in hospital saw him recover well, and he was eventually placed in a geriatric recovery ward in preparation for release. Whenever I visited him he would get angry at the sports results and moan about the “boring sods” with whom he was sharing a ward with and who refused to go outside for a walk around the hospital’s rather beautiful grounds. This was perfectly normal behaviour.

However I was fearing the worst, and it appears that these fears were well-founded. A month ago he started to develop severe dementia, leading me to make the obvious comparisons between him and Sacks’ patient, Jimmie G, whom I was reading about at the time.

The retrograde loss of memory – and losing the ability to create new memories – is a horrible thing to witness; nothing can really prepare you for it. At the same time it’s difficult to become truly sad at this fact: how can we, when the ‘patient’ themselves is oblivious to the fact – and is seemingly content – due to the fact that the condition itself causes them to lack the ability to comprehend what’s going on?

But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being – matter of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him… Neuropsychologicaly, there is little or nothing you can do; but in the realm of the Individual, there may be much you can do. – Alexander Luria in a letter to Sacks regarding Jimmie G.

These sort of medical conditions always raise interesting issues, but when combined with the general (and severe) decline of physical health in an older patient, some more interesting – and controversial – philosophical, moral, and political subjects are brought up. An important one of which is the topic of non-eugenics euthanasia.

Highly regulated, I believe that euthanasia would be a crucial addition to our public health system for a few exceptional and well-defined situations and circumstances. However, as this is unlikely to happen, I believe strongly that the topic of euthanasia is so important that it is at least worth serious consideration and debate – not just by medical professionals, but by both politicians and the public.

Of course, views on this vary wildly by culture, religion, and even within each individual (agreeing in some cases and not in others, even when the actual medical circumstances are the same), and for one moment please don’t think my family and I are planning any mercy killings – it just raised a debate between us and I wanted to spread the love and ignite your internal debating chamber.

In my family, many of us have made it clear that if we were in such an awful physical and psychological state that life were no longer enjoyable and was a chore, that we wouldn’t want to be kept alive. One member has even gone so far as to say (in all seriousness), that if this were the case they would be eternally grateful if we were to assist them in dying. Of course, current legislation makes entertaining this thought pointless.

EMI Embracing the Future?

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I have just read that EMI – one of the ‘big four’ record labels – has appointed Douglas Merrill as the president of its ‘digital strategy’; a post covering “all of the company’s digital strategy, innovation, business development, supply chain and technology activities“.

This in itself is not that impressive. What makes this newsworthy, however, is Merrill’s past… as CIO and vice president of engineering at Google.

Google’s corporate information site says of Merrill (for now, at least):

Douglas Merrill joined Google late in 2003 as Senior Director of Information Systems. In this capacity he led multiple strategic efforts including Google’s 2004 IPO and its related regulatory activities. He holds direct line accountability for all internal engineering and support worldwide.

Previously, Douglas was senior vice president at Charles Schwab and Co., Inc, a multinational financial services company. At Schwab, he was responsible for such functions as information security, common infrastructure, and human resources strategy and operations. Prior to his tenure there, Douglas worked at Price Waterhouse as a senior manager, ultimately becoming a leader in security implementation practices. Before that, he was an information scientist at the RAND Corporation, where he studied topics such as computer simulation in education, team dynamics and organizational effectiveness.

Douglas holds a BA from the University of Tulsa in Social and Political Organization, and an MA and Ph.D. in Psychology from Princeton University.

I for one think this is great news. With the music industry in deep trouble and constantly being crushed by new technologies, they need new ideas… and fast. Litigation is only going to go so far in helping a struggling company to increase its profits.

As I’ve said before; “we can’t hold back technological advancement and especially the evolution of music and its distribution“. With that said, what the big labels need to do is not sue, but evolve. A ‘digital business model‘ is what is required to revive the industry and with this move it seems that EMI have realised this glaringly obvious fact.

Simplicity, Marmite, and ‘Getting Real’ with Don Norman

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Marmite’s high zinc content could be the catalyst that helps solve the Arab-Israeli conflict, or so Edward de Bono suggested to the UK’s Foreign Office back in 2000. The so-called reasoning behind this is that on both sides of the conflict unleavened bread is a staple foodstuff – a staple foodstuff that’s considerably lacking in zinc; a deficiency of which can cause aggression.

This was my most recent introduction to Edward de Bono; the father of ‘thinking outside the box’, and the pioneer of ‘lateral thinking‘: a creative problem-solving technique that involves looking at a given situation from unexpected – and often unusual – angles.

I was first introduced to de Bono in university when his theory of ‘thinking hats‘ was introduced to us as a way to acquaint us with parallel thinking to expand the way we look at information systems. It was an interesting 10 minutes, but after that I had completely forgotten about these techniques ’til now, when I happened upon de Bono’s Six Thinking Hats when brainstorming for books to add to my 2008 reading list.

Reading more about de Bono I find that in another of his books – Simplicityhe argues that the subject of simplicity should be taught in schools as a defining characteristic of quality, something I wholeheartedly agree with. Look at the themes running through the design of most of the successful Web 2.0 (and 1.0) companies and you’ll see that simplicity and usability are at the forefront of every design decision. Look at the design of really great ‘real-world’ objects – simple, right?

Of course, simplicity isn’t everything, and it depends somewhat on your definition of the term. To me simplicity is about delivering more from less by focusing on what’s important to the end-user: a simple – yet effective – strategy which appears to be midway between ‘Getting Real‘ and Don Norman‘s idea of user-centered design.

So, Six Thinking Hats and The Design/Psychology of Everyday Things are on my to-read list (I’ve only read extensive excerpts of the latter) – if I hadn’t already read all of it, Getting Real would be too. I guess all that’s left to ask now is; what does Simplicity/Usability mean to you, and could Marmite bring peace to the Middle Yeast? It’s definitely food for though. (Puns – unfortunately – intended. Sorry.)

A Month Without E-Mail

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In April I’m going to be kicking it old-school; 30 days and 30 nights without sending a single personal* email. I’ve primed my pen and paper and I’m ready to be “sooo 2oth Century!

Why am I doing this? I feel the proliferation of e-mail and instant messaging in my life has disconnected me from the close relationships I had with people who I once lived with and was close to. I hope that this romanticist approach to my communication can help me reconnect with, and mend, these relationships.

It may not be easy, but it’s going to be an interesting experiment nonetheless. I’m not just replacing e-mails with letters – I’m planning on sending letters to people who I haven’t spoken to in a while – if you want a letter, send me your address!

*In our paperless office it would be impossible for me to go an entire workday without sending an e-mail – I’m not going to even attempt it for ‘official’ work e-mails… and emergencies, if one should unfortunately arise.