Speculation is tasty and rampant, but not real knowledge

July 24, 2007

Several summers ago I spent six weeks in another country, doing research in collaboration with autism researchers there.  We traveled around by subway, train, and cab, visiting multiple schools with autistic children.  Some were regular schools that had an autism unit; others were boarding schools for special-needs children or for children with autism specifically.  We worked with the higher-functioning kids with autism (who had at least some language) and with younger mental-age-matched kids without autism (because mental retardation is very common in autistic kids – up to 74% although I read something non-peer-reviewed on the Internet that claims as low as 50% – to compare autistic and non-autistic kids on cognitive stuff you need to equate them on mental age, not chronological age).

We did a variety of tasks with the kids, involving stuff like sorting cards, or hearing stories and answering questions, or pushing buttons in response to pictures of faces on a computer screen.  One of the weirder tasks, which was something for our collaborators, not for me and my prof, involved measuring kids’ heads with a measuring tape.  I thought it seemed kind of an odd approach at the time – most of what I was involved in was heavily cognitive.  And so I’ve been surprised to see that line of research actually panning out.

Here’s a recent instance of it (citation below).  Researchers found that, very clearly, children with autism had larger head circumferences.  What I thought was interesting was that head circumference above the 75th percentile was  “associated with more impaired adaptive behaviors and with less impairment in IQ measures and motor and verbal language development.”

So something strongly associated with autism was also associated with less mental retardation (but mental retardation is strongly associated with autism).  There’s some interesting stuff in there…  I’m tempted to hypothesize beyond the data, but I’m not going to.

Larger head circumference was also associated with allergy/immune disorders in the kids and their first-degree relatives.  The researchers speculate that this relates to immune dysfunctions that themselves cause or are associated with increased cell cycle progression (cannot dredge what that means up out of my brain) and/or decreased apoptosis (deliberate, clean cell death).

At the time of my first couple years in grad school, it was being speculated that for the quarter or so of autistic kids who have a noticeable period of skill loss (coincidentally around the time of the MMR shot, which has led to a whole lot of bad crap) lose their skills around the time that the brain undergoes a major reorganization in which unnecessarily neuronal connections are “pruned” or cut back.

So: Maybe immune dysfunction leads to lack of cell death in pruning and maybe outside of it too, and thus autism and larger head circumference?

That and a dollar will get you one-quarter of a latte, or almost a small iced tea, or a tiny little bit of the funding necessary to gain actual knowledge, or a fair bit of annoyance from someone more educated who already knows why you’re wrong.   Speculation is tasty and rampant, but actual knowledge comes from eliminating the untrue theories with evidence, and hammering on the true ones until we decide there’s not much point in continuing to do so.

Sacco, R., et al. (2007) Clinical, Morphological, and Biochemical Correlates of Head Circumference in Autism. Biol Psychiatry.


treating mental disorders to lower medical costs: I like the conclusion

July 9, 2007

The APA has argued that when you treat mental disorders, you don’t need to spend as much on physical healthcare, for a variety of reasons.

The linked article contains references to a bunch of studies, but is remarkably not like an APA paper in that it doesn’t mention and address any studies that were not favorable to its conclusion (something you have to do in science). It’s not possible to tell from reading it what the obstacles are to implementing better psych treatment, and it doesn’t seem targeted – i.e., it doesn’t mention and probably doesn’t address the concerns of the people it’s aimed at.

I really wish it did. I would much rather be writing a blog entry about how APA was carefully attempting to address the issues involved in convincing insurance companies (hospitals? other healthcare providers? the government?) to offer cheaper/better mental health treatment.

It’s so easy to do advocacy focused on showing you’re right, and so hard to do advocacy focused on removing the obstacles preventing your target audience from doing what you want them to do. But you don’t have to go all out to acknowledge why they aren’t taking your position, and to address those reasons.

I do think APA is probably right – and even if they’re not, I believe that appropriate mental health care (and physical health care) should be available to everyone, everywhere.

schizophrenia, creativity, and evolution

July 7, 2007

I’m updating early because I’m moving apartments this weekend, but my general plan is to post every evening by nine-o-clock meds time (EST).

Nash Suggests Schizophrenia May Serve Adaptive Function

On the mental illness side: schizophrenia is not associated with genius or creativity.  None of our evidence says it’s anything but severely impairing.  Bipolar is associated with creativity despite fucking everyone over, but schizophrenia mostly just fucks people over, although there are people who do well at times.  John Nash is a genius, but that’s not necesarily due to schizophrenia.  People who are geniuses can also be crazy without a causal link.  People who have bipolar are more likely to be creative, and not necessarily actually more creative.  Inability to think clearly or concentrate, or being depressed or manic, can really do a number on your creativity.

On the evolutionary side:  the detrimental effects of adaptations sometimes get undermentioned.  An “successful” adaptation can severely impair most of the people who have it if, on average, there’s enough benefit for at least some people to “balance that out”.  It doesn’t have to benefit an individual person.  It doesn’t even have to benefit any of the people who actually have it!  It might benefit copies of their genes that reside in their kin, instead.  This is where schizophrenia may come into play – family members of people with schizophrenia display increased creativity (can provide cite later, seriously supposed to be packing my remaining crap right now).

Take-home point: If serious mental illnesses are adaptations (I’m not convinced they are, but I’m open to the possibility), they’re not beneficial for most affected people.  If they were, we wouldn’t call them mental illnesses – a major requirement in the DSM is that a mental disorder cause marked impairment in functioning.   It’s nice to think we’re all geniuses, but that stereotype covers up the crappy reality of just trying to make it day to day, let alone hold down a job or have good relationships.

media and anecdotes vs. science and critical thinking

June 24, 2007

Yesterday I went to the Chattanooga aquarium almost all day, and it was awesome. When I got home I was too tired to think straight, and briefly posted something on psych meds and creativity that was inaccurate – oops. It may make another appearance later on. In the meantime, here’s something more off-the-cuff.

First, the media and anecdotes:

People with serious mental illness have problems using glucose efficiently in the brain

Okay, I find this completely fascinating and intuitively plausible. When I was around twelve – the first time I remember having mood problems, although probably not the first time I started having them – I started eating sugar excessively. Not just at dessert, but during the day. I’d take powdered sugar from the cabinet and put it in a tupperware and hide it in a drawer in my room and eat it straight. Among other things. I felt awful about it, but just stopping never seemed to work, even though I tried frequently. (If you can get addicted to video games, why not a substance that has immediate lifting effects on mood and energy, followed by a crash?)

When I was seventeen and working in a bookstore, I ran into a book with the badly-chosen title “Potatoes Not Prozac” which argued that sugar could be addictive, that it was related to alcoholism (I have alcoholism running on both sides of my extended family, and there’s a plausible evolutionary argument related to this I’ll share some other time), and that you could go off of it and get a drastic improvement in mental and physical health through a diet that can be summed up as sufficient protein and whole grains (similar to what later became very popular as the South Beach diet). This worked very well for me; it was like suddenly getting a stable personality, and was very similar to the first time I went on an antidepressant. Neither of those effects lasted, but they were amazing and gave me hope that life didn’t have to be the way it was most of the time.

Interestingly enough, when I’m stable on medication I can have a relationship with sugar that’s about what regular people have – it’s nice sometimes but I can drop it without a problem (unless I start eating dessert more than occasionally; I still have to watch for that).

Further anecdotal information: When I mention to psychiatrists that sugar affects my mood, they’re never surprised, although I don’t think any psychiatrist has ever suggested this as a factor up front. It’s pretty common in the patient literature, though.

So that’s the media and the anecdotes. Here’s some stuff to notice about the article (and the anecdotes):

1. There’s no mention of a published article. If it had been published, that would have almost certainly have been mentioned. That strongly suggests that this research has not been peer reviewed. (The list of articles on the lab’s website does not appear to refer to the research mentioned in the article. There’s something about glutamatergic dysfunction in schizophrenia that may be a precursor to this work.)

2. This is the only reference to that research I can find on google news or on google. I don’t have a way to cross-check the accuracy of the reporter’s take on what’s going on (I’ve seen enough errors in science reporting that I don’t want to trust an individual article, and this one appears to confuse “inefficient glucose processing” with “not enough glucose” and “lack of sugar” with “not enough glucose in the brain”).

3. I’m telling this anecdote where I’m linking my own personal screwed-up relationship with sugar to this brain glutamate thing, but I’m not sure they’re even related. I’m not sure what the relationship between ingested sugar and glucose in the brain is, but I doubt it’s all that straightforward, and anyway the article is suggesting it’s lack of sugar that’s the problem, right? And I actually felt better when I stopped, even though there was probably a reason I was eating it to begin with. (I’m pretty sure the “lack of sugar” thing doesn’t actually mean “go eat more sugar, it’ll make you feel better”, though, even if it’s possible to take that away from the article.)

4. Anecdotes aren’t data. Lots of anecdotes collected in a careful, systematic way using random sampling are data, but my telling you this stuff off the cuff isn’t data. I could be wrong about a connection between my craving sugar and my mood problems. I’ve been flat-out wrong about myself before – I thought some major issues I have following lectures and other extended verbal information would turn out to be due to an auditory processing problem, but they turned out to be due to ADD and disappeared with stimulants. (This is what we have highly trained medical professionals for – to save us from some of our best guesses.)

So what does this mean? Well, it doesn’t mean the researcher’s conclusions are incorrect. The article has some problems, like the “lack of sugar” bit giving the false impression that not getting enough sugar in diet = lack of glucose in brain, and that in turn giving the impression that the problem is lack of glucose in the brain when the research appears to implicate inefficient glucose processing.
But it doesn’t mean they’ve hit the status of widely accepted fact. It’s more of a back pocket kind of finding – very interesting, tuck it away, pull it out again later when you hear more – like another article mentioning a publication (or a publication itself), or another researcher’s work.