tag:blogger.com,1999:blog-68865751373754517692024-03-12T13:40:01.354-07:00Garth Kroekera discussion about psychiatry, mental illness, emotional problems, and things that helpGKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.comBlogger373125tag:blogger.com,1999:blog-6886575137375451769.post-78718350356797072522023-08-04T22:23:00.005-07:002023-08-05T15:29:54.141-07:00"The Power of Us" by Jay Van Bavel & Dominic Packer: a recommendation, review, and applications in psychiatry<p> Jay Van Bavel and Dominic Packer are social psychologists whose recent book, <i>The Power of Us, </i>is a nice review of basic social psychology with a unique emphasis on the impact of identity and group affiliation on human behaviour and cognitive biases. </p><p>This book would be an excellent accompaniment to <i>The Righteous Mind, </i>by Jonathan Haidt, and <i>Blueprint, </i>by Nicholas Christakis. Haidt looks at individual differences in values as a factor affecting group behaviour. For example, people who value loyalty and "purity" (as opposed to "compassion" or "fairness") as cardinal values may be more likely to have strong group adherence, and may be more accepting of hierarchical or paternalistic systems; such traits could lead in particular to involvement with conservative groups. Haidt argues (and I strongly agree) that such values and traits have a strong hereditary basis (though are also partly influenced by environment & cultural milieu) and have evolved in humans due to selective advantages for those who have a strong inclination towards group affiliation. But of course, too much loyalty can be a bad thing, if it causes people to adhere loyally to groups which are engaging in harmful behaviour--we see this problem in the news every day. Christakis looks at group dynamics in an interesting mathematical way, with successful or unsuccessful group behaviour influenced by the structure of connectedness, which in turn is influenced by leadership styles, external factors, and individual personality traits. </p><p>The subject of group affiliation, identity, with associated biases, polarization, and conflict, is an incredibly important subject in the world today. Group-based divisions arguably are a primary cause of political problems and war across the world, and lead to delays and inefficiencies in solving world problems such as poverty, environmental degradation, and war. On the positive side, strong group allegiance has led to most of humanity's great achievements through history. Most great accomplishments in the sciences, the arts, in politics, and in the law, involve large-scale collaboration. </p><p>Group affiliation is a powerful source of identity for all of us. If we have a strong attachment to a group, we are likely to favour ingroup members. This is normal and ubiquitous, but it can lead in an extreme case to hating or persecuting outgroup members. To prevent this, it can be helpful to have a culture of interacting respectfully or collaboratively, or recreationally, with outgroup members (Jonathan Haidt made this point years ago, in <i>The Righteous Mind). </i> It could be especially effective if any such recreational activity could blend members from different groups. The authors cite some very successful examples of these ideas, such as having a soccer league in Iraq where each team was required to have players assigned equally from different conflicted religious groups. The resulting games allowed each player, and each team, to like, respect, and enjoy outgroup members, since they became teammates, leading to reduced conflict in their communities afterwards. A famous example from classic social psychology research is the "Robbers Cave" experiment from the 1950s, in which antagonistic groups of teenage boys later worked together in friendship and harmony if they had to collaborate together to solve a problem external to them both. </p><p>The chapter on "fostering dissent" is especially insightful. The authors make the point that voicing a dissenting opinion within a group is socially costly. Even if the dissent is about an important logical or moral issue, the risk of dissenting can be to make other group members angry, and therefore threaten one's position as a group member. You risk being seen as disloyal or disrespectful. They argue that you have to really care about your group to be willing to voice dissent. I see this could often be true, but sometimes particular individuals are more oppositional or defiant, due to character traits, leading to frequent dissent even if they don't particularly care about their group status. Another problem with dissent is that other group members may have quietly agreed with the dissenter's position, but it could be costly for them to endorse the dissent, since it could make them look bad or immoral for not having brought it up first. So a default position in groups would be to maintain the status quo, and for dissent to be risky, even if the group is engaging in harmful behaviours or beliefs. Unfortunately, this can cause harmful behaviour to be perpetuated in some groups, and for dissenters to be punished or ostracized. Recent examples of this include U.S. politician Liz Cheney, who has spoken out against the deeply immoral behaviour in the leadership of her political party. Unfortunately, she was defeated in the subsequent election. While she should be seen as someone defending the honour, integrity, and values of her group, therefore protecting the group's long-term interests, she instead has been seen by her own ingroup members as disloyal, and punished for it. I hope her own story is not over, and that her principled behaviour may prevail in the end. </p><p>An approach to solving the dissent problem is to have a leadership structure or ethos in groups which encourages respectful disagreement, without fear of punishment or other consequences. Also it is vitally important, as a persuasive factor, to frame dissent or challenge with the group's long-term well-being in mind--to remind others of the group's core values, of the group's long-term interests, with a dissenting view intended to be a service to the group rather than merely a criticism. </p><p>On a larger scale, I think it is always helpful to expand the circle of our groups. Instead of focusing on local or national or religious or political allegiances, why not focus on a shared humanity. Some of the guiding insights of many of the world's religions, such as Christianity, were to expand a circle of love, respect, and inclusion to outgroup members, and not to shrink into insular, bitter enclaves judgmental of others outside of their own ranks. </p><p>Psychiatric issues always exist in a social context. Patients will always have group allegiances or identities. These could involve religion, politics, gender, race, family, occupation, etc. It is important to understand these group allegiances, empathize with them, and communicate therapeutic ideas with the group allegiances in mind. Encouragement or advice for change carries a high risk of failing if it is expressed in such a way as to challenge a person's individual or group-based values. A survey of group affiliation and identity factors should be an essential part of a psychiatric history, and an ongoing theme in a therapeutic dialogue. </p><p><br /></p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-13246772770559614752023-05-26T15:53:00.003-07:002023-05-26T16:02:31.652-07:00Foolproof, by Sander van der Linden: a recommendation, review, and analogy with psychotherapyI strongly recommend a new book by Cambridge psychologist Sander van der Linden, entitled <i>Foolproof: why misinformation infects our minds and how to build immunity.</i><div><i><br /></i></div><div>I have followed van der Linden's research for several years, alongside other experts who are studying the psychology of persuasion, misinformation, and propaganda. This area has been an interest of mine for many years, after discovering psychologists such as Cialdini and Kahneman. </div><div><br /></div><div>This is a subject that everyone needs to learn about! Persuasive techniques (for good and for bad) have always been with us through history; the power and influence of these techniques will only continue to escalate, thanks to the internet era, and now the era of artificial intelligence (AI). </div><div><br /></div><div>I have discussed these issues in other posts, such as:</div><div><br /></div><div> <a href="http://garthkroeker.blogspot.com/2022/07/how-minds-change-by-david-mcraney-book.html">Garth Kroeker: How Minds Change by David McRaney: a book review and discussion</a> (August 18, 2022)</div><div><br /></div><div>and </div><div><br /></div><div><a href="http://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html">Garth Kroeker: Political polarization, propaganda, conspiracy theories, misinformation, and vaccine hesitancy: a psychiatric approach to understanding and management</a>). (September 1, 2021) </div><div><br /></div><div>and </div><div><br /></div><div><a href="https://garthkroeker.blogspot.com/2016/10/groupthink.html">Garth Kroeker: "GroupThink"</a> (October 6, 2016) </div><div><br /></div><div><div>Van der Linden reviews the history and scope of misinformation. Among the many current examples are conspiracy theorists impacting public opinion and policy, political influencers attempting to sway elections, propagandists from other countries defending violent or oppressive policies or sowing discord among their opponents, and of course the anti-vaccine community. </div><div><br /></div><div>There are a couple of acronyms he introduces: the word CONSPIRE can help us to recognize some of the common features of conspiracy theories: </div><div><br /></div><div>C = contradictory. Most conspiracy theories feature contradictions. For example, there could be a belief that some awful event is a hoax, but then also a belief that the awful event is real but was caused by evil conspirators. </div><div><br /></div><div>O = over-riding suspicion. A sense of general distrust that goes beyond the topic of the conspiracy theory, particularly a distrust of official or mainstream explanations. </div><div><br /></div><div>N = nefarious plot. A belief that there is a shadowy group of evildoers, such as government officials, corporations, or (at worst) a particular racial or ethnic group, who behind the scenes have caused some bad thing, perhaps with a motive to advance themselves. </div><div><br /></div><div>S = "something's wrong." The belief that regardless of any acknowledged or corrected fact about an event, there's something going on that isn't right. </div><div><br /></div><div>P = persecuted individual. The belief that someone is being deliberately harmed (most commonly, the believers in the conspiracy theory). </div><div><br /></div><div>I = immune to evidence. Presentations of evidence often have little or no effect to change the opinion of people having conspiracy theory beliefs, in fact evidence could even "backfire" and cause the conspiracy theorist to become even more entrenched, or to believe that you or your sources of evidence are all biased or part of the conspiracy. Such immunity to evidence is common among people who have limited expertise or knowledge about science, but could also be present in some highly educated people. A conspiracy theorist who does have more scholarly expertise may understandably deploy statistical or psychological terminology to defend their beliefs; for example, by accusing other scholars of having psychological biases (such as confirmation bias).</div><div><br /></div><div>Re = reinterpreting randomness. This is creating a false causal story about random, unrelated events. Humans in general are prone to doing this. </div><div><br /></div><div>It's interesting as a psychiatrist to reflect on the "CONSPIRE" factors above. They are very often present in frank psychotic states, or in milder variants such as paranoid personality. The tendency to have paranoid thoughts exists as a trait on a continuum in the population. This trait has various environmental causes, but also has a high heritability. It is a typical psychotic symptom to believe that there is a special, often ominous explanation behind pseudorandom events. </div><div><br /></div><div>Of course, sometimes there are explanations for events which differ from the mainstream understanding. Through history there have always been maverick scientists, who demonstrated something new and important, despite the objections or condemnation of their peers. One example that has always bothered me was Alfred Wegener, who in 1912 was the first to propose the theory of continental drift; he was ridiculed and dismissed by his peers, who couldn't believe that entire continents could move across the face of the earth; Wegener tragically died before his theory was proved correct. We have to be open to consider alternative theories. However, maverick scientists, unlike conspiracy theorists, have clear evidence to support their claims; their reasoning does not contain contradictions; they are not immune to evidence, do not reinterpret randomness, and do not have ominous, over-riding suspicious beliefs about persecution. </div><div><br /></div><div>Van der Linden's next acronym is "DEPICT", to help remember features of manipulative communication:</div><div> </div><div>D - discrediting. The manipulative communicator will portray experts who disagree with them (such as scientific leaders, or even entire communities such as leading scientific journals), as biased, poorly qualified, incompetent, or having some nefarious agenda. It is frustrating to have a scientific debate with someone who is engaging in such discrediting, since any sound evidence you raise with them will be dismissed as invalid. </div><div><br /></div><div>E - emotional. Using strong emotional language to induce fear, anger, or disgust as a persuasive tool. </div><div><br /></div><div>P - polarization. Framing issues, and people who have positions on these issues, in a "black or white" fashion, rather than as shades of grey. This leads to a false sense of dichotomy, and encourages the formation of teams of opponents holding increasingly extreme positions, and increasing disrespect for those who disagree. </div><div><br /></div><div>I - impersonation. Using fake experts to bolster a claim. A variant of this is using an actual expert, but whose expertise has nothing to do with the issue at hand. </div><div><br /></div><div>C - conspiracy theories. Encouraging conspiracy theory beliefs. </div><div><br /></div><div>T - trolling. Attacking, insulting, or threatening opponents, usually in an online environment, such as on social media. Such harassment has at times been so intense that scientists or policy experts (including in public health) have been afraid to speak out, fearing for their safety. </div><div><br /></div><div>Van der Linden's work focuses on how we can best deal with misinformation. He concludes with an analogy: misinformation must be dealt with by "immunizing" ourselves against it. </div><div><br /></div><div>In order to build immunity against an infectious disease, it is necessary to be exposed to a weakened version of the pathogen, in order to train the immune system, such that future doses of pathogens would be dealt with quickly. </div><div><br /></div><div>Infectious diseases are much easier to manage, with much less risk of harm or spread, by building immunity, rather than by only relying on treatment after infection. </div><div><br /></div><div>Similarly, it is much harder to "treat" misinformation after the fact. Tactics to "treat" misinformation would be debate, education, and careful review of evidence. But many people who have fallen into a misinformation "rabbit hole" are difficult to reach or persuade using reasoned debate. Such debate may even cause the misinformed person to become even more angry or stubbornly adherent to their ideas. </div><div><i><br /></i></div><div>It is better to prevent people from falling into the rabbit hole in the first place--not by eliminating rabbit holes (which is impossible) but by teaching people how to identify and manage rabbit holes if they encounter them. </div><div><br /></div><div>The idea of "vaccination" is presented as an analogy throughout the book. But beliefs and persuasion are not exactly like the body's immune system. It's a very good analogy, but not perfect. Much of the phenomenon van der Linden is talking about is explainable through learning theory: we learn much better if we actually practice "hands on" with things, rather than just passively absorbing theory. If you want to learn mathematics, you actually have to work through a lot of problems, not just read about how to do them. If you want to learn how to ride a bike or drive a car, you have to practice cycling and driving, not just read about those things in a book! As part of the practice, it is best to face challenging situations, and learn through experience how to overcome them. </div><div><br /></div><div>Similarly, to deal with emergencies, it is imperative to do behavioural practice many times as a preparation. We have to do fire drills to prepare for a potential fire. Pilots need to practice many times in a simulator how to manage engine failure. If you only read about something, or learn about something, without practicing, you can't possibly become proficient, especially under pressure. </div><div><br /></div><div>To deal with misinformation, we have to practice, hands-on, dealing with misinformation, at first with "easy" examples, then more and more difficult ones. </div><div><br /></div><div>Applying these ideas to psychotherapy: CBT (cognitive-behavioural therapy) is very important and useful, but at worst it can be too passive. Many people engaging in CBT do a lot of passive learning, they do written exercises in a workbook, but do not really practice deliberate exposure to uncomfortable stimuli. The "vaccine" analogy could be useful to incorporate into CBT for treating depression or anxiety. This is something that I have advocated for many years, mainly an emphasis on the "B" part of CBT. To deal with panic attacks, it is most helpful to actually practice having panic attacks, in safe, controlled conditions! To deal with depressive thoughts, it could be a useful exercise to invent simulated depressive thoughts, at first mild ones, then more challenging ones, to understand the mechanism by which they are created, and to practice facing them without being negatively affected. This exposure therapy is like van der Linden's "vaccine." But most therapists don't emphasize this enough, they only try to teach people to relax or cope with symptoms after they have occurred. One of the purposes of talking about past emotional trauma is to recreate the painful events in the mind, but in a limited, controlled, "virtual" form, within the safe context of a therapy office. In this way talking therapy has a vaccine-like effect. </div><div><br /></div><div>Linden's book is a must-read, not only for those interested in propaganda or misinformation, but also for anyone wanting a better understanding of the mind itself, with ideas that touch upon managing almost any life adversity, including mental illnesses. </div><div><br /></div><div>References: </div><div><br /></div><div><i><br /></i></div><div><span style="text-indent: -2em;">Linden, S. V. D. (2023). </span><i style="text-indent: -2em;">Foolproof: Why Misinformation Infects Our Minds and How to Build Immunity</i><span style="text-indent: -2em;">. WW Norton.</span></div><div><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;"><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><br /></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=urn%3Aisbn%3A978-0-393-88144-8&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Foolproof%3A%20Why%20Misinformation%20Infects%20Our%20Minds%20and%20How%20to%20Build%20Immunity&rft.publisher=WW%20Norton&rft.aufirst=Sander%20Van%20Der&rft.aulast=Linden&rft.au=Sander%20Van%20Der%20Linden&rft.date=2023-03-21&rft.tpages=336&rft.isbn=978-0-393-88144-8&rft.language=English"></span></div></div></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-24876947619203594362023-02-01T11:36:00.010-08:002023-02-01T11:47:14.225-08:00Why to get your COVID bivalent booster<p>The COVID vaccines have saved millions of lives, and spared millions more a frightening hospital or intensive care admission. Many people may not realize that recovery from a COVID hospitalization will often not be complete; tissue damage from COVID pneumonia may not heal completely, also the psychological effect of respiratory failure should not be underestimated. Severe respiratory failure (a terrifying, suffocating experience) can often be a cause of PTSD that could affect you psychologically for years afterwards. The vaccines have caused a huge reduction in such episodes of respiratory failure. </p><p>COVID vaccinations are not perfect, and their protective effect does diminish gradually with time, though does not disappear entirely. There are indeed rare cases of serious adverse effects, much lower than the rate of similar or worse adverse effects from COVID itself. Also, vaccination reduces the probability of spreading to other people, thereby multiplying the beneficial effects in the whole community. Vaccination followed by a mild case of COVID a few months later likely adds robust protection compared to vaccination or infection alone. But the most effective and safe protection is to have an updated bivalent COVID booster, particularly if your last dose of vaccine and any episode of COVID infection has been more than 2-3 months before present. Unfortunately, fewer people have had their boosters compared to previous vaccine doses, resulting in thousands of needless hospitalizations and deaths. </p><p>Anti-vaccine misinformation is widespread, with testimonial accounts from people claiming that the vaccines are harmful. It is important to know that a bivalent booster will lead to a large reduction in risk of severe disease, hospitalization, ICU admission, and death. Evidence to support this is very, very robust, and unfortunately has not been emphasized strongly enough in current public health information campaigns. </p><p>I encourage perusing the references below. Aside from reading the studies and assessing the evidence for yourself, I encourage you to look up the authors and verify for yourself that these are incredibly experienced, well-educated researchers from major research centers, with no major biases or profit motives affecting their findings. The research findings are corroborated and consistent with the experience of ICU and infectious disease physicians, who on a daily basis in the past months have continued to see much more severe COVID disease and dangerously high hospital occupancy among those who are not up-to-date with their booster vaccinations. </p><p><br /></p><p>The references below are a preliminary list; I encourage you to continue checking out other references I've included in my previous COVID-related posts. </p><p><br /></p><p>References</p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<div class="csl-entry">Watson, O. J., Barnsley, G., Toor, J., Hogan, A. B., Winskill, P., & Ghani, A. C. (2022). Global impact of the first year of COVID-19 vaccination: A mathematical modelling study. <i>The Lancet Infectious Diseases</i>, <i>22</i>(9), 1293–1302. <a href="https://doi.org/10.1016/S1473-3099(22)00320-6">https://doi.org/10.1016/S1473-3099(22)00320-6</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">CDC. </span><i style="text-indent: -2em;">COVID Data Tracker. </i><span style="text-indent: -2em;">Centers for Disease Control and Prevention. </span></div><div class="csl-entry"><a href="https://covid.cdc.gov/covid-data-tracker/#vaccine-effectiveness" style="text-indent: -2em;">https://covid.cdc.gov/covid-data-tracker/#vaccine-effectiveness</a></div><div class="csl-entry"><a href="https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status" style="text-indent: -2em;">https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Arbel, R., Peretz, A., Sergienko, R., Friger, M., Beckenstein, T., Yaron, S., Hammerman, A., Bilenko, N., & Netzer, D. (2023). </span><i style="text-indent: -2em;">Effectiveness of the Bivalent mRNA Vaccine in Preventing Severe COVID-19 Outcomes: An Observational Cohort Study</i><span style="text-indent: -2em;"> (SSRN Scholarly Paper No. 4314067). </span><a href="https://doi.org/10.2139/ssrn.4314067" style="text-indent: -2em;">https://doi.org/10.2139/ssrn.4314067</a></div><div class="csl-entry"><br /></div><div class="csl-entry"><a href="https://www.azdhs.gov/covid19/documents/data/rates-of-cov-19-by-vaccination.pdf?v=20230104">https://www.azdhs.gov/covid19/documents/data/rates-of-cov-19-by-vaccination.pdf?v=2023010</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Lin, D.-Y., Xu, Y., Gu, Y., Zeng, D., Wheeler, B., Young, H., Moore, Z., & Sunny, S. K. (2023). </span><i style="text-indent: -2em;">Effectiveness of Vaccination and Previous Infection Against Omicron Infection and Severe Outcomes in Children Under 12 Years of Age</i><span style="text-indent: -2em;"> (p. 2023.01.18.23284739). medRxiv. </span><a href="https://doi.org/10.1101/2023.01.18.23284739" style="text-indent: -2em;">https://doi.org/10.1101/2023.01.18.23284739</a></div><div class="csl-entry"><br /></div></div><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;"><div style="text-align: left;"><span style="text-indent: -2em;">Andersson, N. W., Thiesson, E. M., Baum, U., Pihlström, N., Starrfelt, J., Faksová, K., Poukka, E., Meijerink, H., Ljung, R., & Hviid, A. (2023). </span><i style="text-indent: -2em;">Comparative effectiveness of the bivalent BA.4-5 and BA.1 mRNA-booster vaccines in the Nordic countries</i><span style="text-indent: -2em;"> (p. 2023.01.19.23284764). medRxiv. </span><a href="https://doi.org/10.1101/2023.01.19.23284764" style="text-indent: -2em;">https://doi.org/10.1101/2023.01.19.23284764</a></div><div style="text-align: left;"><span style="text-indent: -2em;"><br /></span></div><div style="text-align: left;"><span style="text-indent: -2em;">Davydow, D. S., Gifford, J. M., Desai, S. V., Needham, D. M., & Bienvenu, O. J. (2008). Posttraumatic stress disorder in general intensive care unit survivors: A systematic review. </span><i style="text-indent: -2em;">General Hospital Psychiatry</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">30</i><span style="text-indent: -2em;">(5), 421–434. </span><a href="https://doi.org/10.1016/j.genhosppsych.2008.05.006" style="text-indent: -2em;">https://doi.org/10.1016/j.genhosppsych.2008.05.006</a></div><div style="text-align: left;"><br /></div><div style="text-align: left;">Tenforde, M.W. et al. (2022). Early estimates of bivalent mRNA vaccine effectiveness in preventing COVID-19-associated emergency department or urgent care encounters and hospitalizations among immunocompetent adults. VISION Network, nine states, Sep-Nov 2022. <i>Morbidity and Mortality Weekly Report, </i>71(5152), 1616-1624. </div><div style="text-align: left;"><span style="background-color: white;"><br /></span></div><div style="text-align: left;"><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-indent: -24pt;"><br /></p></div><div style="text-align: left;"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" style="font-family: inherit;" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1016%2Fj.genhosppsych.2008.05.006&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Posttraumatic%20stress%20disorder%20in%20general%20intensive%20care%20unit%20survivors%3A%20a%20systematic%20review&rft.jtitle=General%20Hospital%20Psychiatry&rft.stitle=General%20Hospital%20Psychiatry&rft.volume=30&rft.issue=5&rft.aufirst=Dimitry%20S.&rft.aulast=Davydow&rft.au=Dimitry%20S.%20Davydow&rft.au=Jeneen%20M.%20Gifford&rft.au=Sanjay%20V.%20Desai&rft.au=Dale%20M.%20Needham&rft.au=O.%20Joseph%20Bienvenu&rft.date=2008-09-01&rft.pages=421-434&rft.spage=421&rft.epage=434&rft.issn=0163-8343&rft.language=en"></span></div></div><div style="text-align: left;"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" style="font-family: inherit;" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1101%2F2023.01.19.23284764&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.type=preprint&rft.title=Comparative%20effectiveness%20of%20the%20bivalent%20BA.4-5%20and%20BA.1%20mRNA-booster%20vaccines%20in%20the%20Nordic%20countries&rft.rights=%C2%A9%202023%2C%20Posted%20by%20Cold%20Spring%20Harbor%20Laboratory.%20The%20copyright%20holder%20for%20this%20pre-print%20is%20the%20author.%20All%20rights%20reserved.%20The%20material%20may%20not%20be%20redistributed%2C%20re-used%20or%20adapted%20without%20the%20author's%20permission.&rft.description=Background%20Data%20on%20the%20comparative%20vaccine%20effectiveness%20(CVE)%20of%20the%20bivalent%20mRNA-booster%20vaccines%20containing%20the%20original%20SARS-CoV-2%20and%20omicron%20BA.4-5%20and%20BA.1%20subvariants%20are%20limited.%0AMethods%20In%20a%20period%20of%20BA.4-5%20subvariants%20predominance%2C%20we%20estimated%20the%20CVE%20of%20the%20bivalent%20Comirnaty%20(Pfizer-BioNTech)%20and%20Spikevax%20(Moderna)%20BA.4-5%20and%20BA.1%20mRNA-booster%20vaccines%20given%20as%20a%20fourth%20dose%20in%20Denmark%2C%20Finland%2C%20Norway%2C%20and%20Sweden.%20From%201%20July%202022%20to%2012%20December%202022%2C%20we%20conducted%20nationwide%20cohort%20analyses%20using%20target%20trial%20emulation%20to%20compare%20risks%20of%20Covid-19%20hospitalization%20and%20death%20in%20four-dose%20(second%20booster)%20with%20three-dose%20(first%20booster)%20vaccinated%20and%20between%20four-dose%20vaccinated%20individuals.%0AResults%20Compared%20with%20having%20received%20three%20vaccine%20doses%2C%20receipt%20of%20a%20bivalent%20BA.4-5%20booster%20as%20a%20fourth%20dose%20was%20associated%20with%20a%20country-combined%20CVE%20against%20Covid-19%20hospitalization%20of%2080.5%25%20(95%25%20confidence%20interval%2C%2069.5%25%20to%2091.5%25).%20The%20corresponding%20CVE%20for%20bivalent%20BA.1%20boosters%20was%2074.0%25%20(68.6%25%20to%2079.4%25).%20CVE%20against%20Covid-19%20death%20was%2077.8%25%20(48.3%25%20to%20100%25)%20and%2080.1%25%20(72.0%25%20to%2088.2%25)%20for%20bivalent%20BA.4-5%20and%20BA.1%20boosters%20as%20a%20fourth%20dose%2C%20respectively.%20The%20CVE%20of%20bivalent%20BA.4-5%20vs.%20BA.1%20boosters%20were%2032.3%25%20(10.6%25%20to%2053.9%25)%20for%20Covid-19%20hospitalization%20and%2012.3%25%20(%E2%88%9236.1%25%20to%2060.7%25)%20for%20death%20(the%20latter%20estimable%20in%20Denmark%20only).%0AConclusions%20Vaccination%20with%20bivalent%20BA.4-5%20or%20BA.1%20mRNA-booster%20vaccines%20as%20a%20fourth%20dose%20was%20associated%20with%20increased%20protection%20against%20Covid-19%20hospitalization%20and%20death%20during%20a%20period%20of%20BA.4-5%20predominance.%20Bivalent%20BA.4-5%20boosters%20conferred%20moderately%20greater%20vaccine%20effectiveness%20against%20Covid-19%20hospitalization%20compared%20with%20bivalent%20BA.1%20boosters.&rft.identifier=urn%3Adoi%3A10.1101%2F2023.01.19.23284764&rft.aufirst=Niklas%20Worm&rft.aulast=Andersson&rft.au=Niklas%20Worm%20Andersson&rft.au=Emilia%20Myrup%20Thiesson&rft.au=Ulrike%20Baum&rft.au=Nicklas%20Pihlstr%C3%B6m&rft.au=Jostein%20Starrfelt&rft.au=Krist%C3%BDna%20Faksov%C3%A1&rft.au=Eero%20Poukka&rft.au=Hinta%20Meijerink&rft.au=Rickard%20Ljung&rft.au=Anders%20Hviid&rft.date=2023-01-19&rft.language=en"></span></div></div></div><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;"><div class="csl-entry"><br /></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.type=webpage&rft.title=COVID%20Data%20Tracker&rft.description=CDC%E2%80%99s%20home%20for%20COVID-19%20data.%20Visualizations%2C%20graphs%2C%20and%20data%20in%20one%20easy-to-use%20website.&rft.identifier=https%3A%2F%2Fcovid.cdc.gov%2Fcovid-data-tracker&rft.aulast=CDC&rft.au=CDC&rft.date=2020-03-28&rft.language=en"></span></div></div>
<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1016%2FS1473-3099(22)00320-6&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Global%20impact%20of%20the%20first%20year%20of%20COVID-19%20vaccination%3A%20a%20mathematical%20modelling%20study&rft.jtitle=The%20Lancet%20Infectious%20Diseases&rft.stitle=The%20Lancet%20Infectious%20Diseases&rft.volume=22&rft.issue=9&rft.aufirst=Oliver%20J&rft.aulast=Watson&rft.au=Oliver%20J%20Watson&rft.au=Gregory%20Barnsley&rft.au=Jaspreet%20Toor&rft.au=Alexandra%20B%20Hogan&rft.au=Peter%20Winskill&rft.au=Azra%20C%20Ghani&rft.date=2022-09-01&rft.pages=1293-1302&rft.spage=1293&rft.epage=1302&rft.issn=1473-3099&rft.language=en"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-89378645797915936172023-01-29T14:08:00.005-08:002023-01-29T23:46:03.074-08:00Heavy Metals in Chocolate<p> Chocolate is one of my favourite foods, and may even have health benefits. But of course, we have to be wary of bias about health claims that we would really, really love to be true! </p><p> A few studies suggest possible positive mood effects from chocolate consumption, but this research looks a little bit preliminary or questionable (Shin et al). </p><p>Other studies suggest that dark chocolate could help reduce blood pressure (see Amoah et al for a meta-analysis). </p><p>But a recent simple RCT showed that 8 weeks of dark chocolate intake (100 mg per day) did not affect cognition (Suominen et al). </p><p>In any case, I think chocolate, like other delicious foods, has a role in a healthy, happy lifestyle, provided of course that we stick to moderation, and that we choose products which are high quality and lower in sugar. </p><p>The big issue in the past few weeks has been concern that chocolate contains high levels of lead and cadmium. This was alarming to read about. The December 2022 <i>Consumer Reports </i>article on this showed that many brands of dark chocolate (including my own personal favourite) contain up to 7 micrograms of cadmium and 1 microgram of lead in a typical 1-ounce serving. They compare these numbers to California's maximum allowable dose levels, which are 4 micrograms of cadmium per day, and 0.5 micrograms of lead. </p><p>But whenever we see a report like this, it would be important always to find out what the baseline levels are in the population, otherwise we may be much more alarmed than we need to be. Various studies have looked at average lead and cadmium intake in the diet. In summary, average cadmium intake in the diet ranges from 5 micrograms per day in the U.S., to 10-15 micrograms per day in Europe, to 30 micrograms per day in Asia, from sources such as grains, nuts, vegetables, and shellfish. Average lead intake ranges from 2-5 micrograms per day in the U.S., to 10-30 micrograms per day in Europe and other parts of the world, from sources such as cereals, meat, and fish. Recommendations from various sources, such as the FDA, conclude a conservative safe limit of about 58 micrograms a day for cadmium and 12.5 micrograms a day for lead, for a typical 70 kg adult, which are numbers much lower than previous recommendations. </p><p>So the 7 micrograms of cadmium and 1 microgram of lead in a serving of chocolate is still way below most recommended safe limits, and in a ballpark comparable to existing average dietary intakes across the world. </p><p>Of course, any amount of lead and cadmium should be reduced or eliminated in the diet. And I hope that chocolate makers will take steps to bring down these levels. But in the meantime, moderate daily chocolate intake is very unlikely to push your lead or cadmium levels up very much higher than they would have been otherwise; the enjoyment and possible health benefits very likely exceed the small risks. </p><p>It will continue to be a longer-term global issue to minimize heavy metal contamination and other contaminants in food and water. While some of this contamination is "natural," other examples are made worse by industrial pollution. In any case, there is more work to be done to improve food safety in the coming decades. </p><p>References:</p><p><br /></p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<div class="csl-entry">Suominen, M. H., Laaksonen, M. M. L., Salmenius-Suominen, H., Kautiainen, H., Hongisto, S.-M., Tuukkanen, K., Jyväkorpi, S. K., & Pitkälä, K. H. (2020). The short-term effect of dark chocolate flavanols on cognition in older adults: A randomized controlled trial (FlaSeCo). <i>Experimental Gerontology</i>, <i>136</i>, 110933. <a href="https://doi.org/10.1016/j.exger.2020.110933">https://doi.org/10.1016/j.exger.2020.110933</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Amoah, I., Lim, J. J., Osei, E. O., Arthur, M., Tawiah, P., Oduro, I. N., Aduama-Larbi, M. S., Lowor, S. T., & Rush, E. (2022). Effect of Cocoa Beverage and Dark Chocolate Consumption on Blood Pressure in Those with Normal and Elevated Blood Pressure: A Systematic Review and Meta-Analysis. </span><i style="text-indent: -2em;">Foods</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">11</i><span style="text-indent: -2em;">(13), Article 13. </span><a href="https://doi.org/10.3390/foods11131962" style="text-indent: -2em;">https://doi.org/10.3390/foods11131962</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Shin, J.-H., Kim, C.-S., Cha, L., Kim, S., Lee, S., Chae, S., Chun, W. Y., & Shin, D.-M. (2022). Consumption of 85% cocoa dark chocolate improves mood in association with gut microbial changes in healthy adults: A randomized controlled trial. </span><i style="text-indent: -2em;">The Journal of Nutritional Biochemistry</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">99</i><span style="text-indent: -2em;">, 108854. </span><a href="https://doi.org/10.1016/j.jnutbio.2021.108854" style="text-indent: -2em;">https://doi.org/10.1016/j.jnutbio.2021.108854</a></div><div class="csl-entry"><i style="text-indent: -2em;"><br /></i></div><div class="csl-entry"><i style="text-indent: -2em;">Lead and Cadmium Could Be in Your Dark Chocolate</i><span style="text-indent: -2em;">. (2022, December 15). Consumer Reports. </span><a href="https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/" style="text-indent: -2em;">https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/</a></div><div class="csl-entry"><br /></div><div class="csl-entry"><i style="text-indent: -2em;">Cadmium and Lead Exposure</i><span style="text-indent: -2em;">. (n.d.). Retrieved January 29, 2023, from </span><a href="https://encyclopedia.pub/entry/2829" style="text-indent: -2em;">https://encyclopedia.pub/entry/2829</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Koch, W., Czop, M., Iłowiecka, K., Nawrocka, A., & Wiącek, D. (2022). Dietary Intake of Toxic Heavy Metals with Major Groups of Food Products—Results of Analytical Determinations. </span><i style="text-indent: -2em;">Nutrients</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">14</i><span style="text-indent: -2em;">(8), 1626. </span><a href="https://doi.org/10.3390/nu14081626" style="text-indent: -2em;">https://doi.org/10.3390/nu14081626</a></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1016%2Fj.exger.2020.110933&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The%20short-term%20effect%20of%20dark%20chocolate%20flavanols%20on%20cognition%20in%20older%20adults%3A%20A%20randomized%20controlled%20trial%20(FlaSeCo)&rft.jtitle=Experimental%20Gerontology&rft.stitle=Experimental%20Gerontology&rft.volume=136&rft.aufirst=M.%20H.&rft.aulast=Suominen&rft.au=M.%20H.%20Suominen&rft.au=M.%20M.%20L.%20Laaksonen&rft.au=H.%20Salmenius-Suominen&rft.au=H.%20Kautiainen&rft.au=S.%20-M.%20Hongisto&rft.au=K.%20Tuukkanen&rft.au=S.%20K.%20Jyv%C3%A4korpi&rft.au=K.%20H.%20Pitk%C3%A4l%C3%A4&rft.date=2020-07-15&rft.pages=110933&rft.issn=0531-5565&rft.language=en"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-45167691302511831652022-12-30T12:11:00.004-08:002023-02-03T14:12:09.408-08:00Supplements for Mental Health, Part 3: Omega-3 Fatty Acids & Vitamin D<p>Omega-3 supplements and Vitamin D have seemed very promising for years, to help with general health, depressive symptoms, cognition, or bipolar symptoms. </p><p>But there was a very large randomized controlled trial, of over 18 000 people, with an incredible treatment duration of 5 years. Amazing study! Recipients received a typical good dose of omega-3 (about 1 gram total of EPA+DHA), plus 2000 IU daily of vitamin D. </p><p>The study showed no effect of the supplement compared to placebo. There were no significant differences in depression rating scales, suicides, overall death rate, cancer rates, or heart disease rates. Other findings from this study suggested some possible benefits from Omega-3 for cardiovascular health particularly for people with low dietary fish intake. </p><p>A limitation would be that the study population comprised healthy adults. It may be that using omega-3 supplementation in the treatment of people with established illnesses such as major depressive disorder or bipolar disorder would be more useful. </p><p>One recent study suggested that omega-3 supplementation may have small but significant benefit in postpartum depression. Another recent small meta-analysis suggested some benefit in treating residual depressive symptoms in bipolar disorder. Yet, another good year-long RCT in bipolar patients showed no benefit. </p><p>In ADHD, recent research also showed no benefit from omega-3 in a year-long study. </p><p>In terms of other general health issues, though, there may be benefits from omega-3 and vitamin D supplementation. The same large RCT mentioned initially (the VITAL study) showed about a 15-20% reduction in autoimmune diseases in the omega-3 or vitamin-D supplemented groups. There is other evidence that omega-3 supplements could help in other diseases such as macular degeneration. </p><p>So, in conclusion, omega-3 and vitamin D appear to be quite underwhelming in terms of potential mental health benefits. But there may be some small general health benefits, for particular categories of disease such as autoimmune conditions, for people who may be at risk for deficiencies, such as those of us without much sun exposure, or for those of us who don't eat very much fish. </p><p>Addendum: another study, published by Lavigne & Gibbons in February 2023, showed strong associations between vitamin D supplementation and a lower risk of suicide, in male U.S. veterans, with a stronger association among those with lower vitamin D levels to begin with. But this is a retrospective cohort study, always much weaker than an RCT, and subject to potential non-causal associations. Once again, supplementation with a standard daily dose of vitamin D is reasonable and safe; there is negligible risk of harm, with some suggestive data implying potential benefit in autoimmune conditions and mood symptoms, particularly in those who might have been deficient. </p><p>References:</p><p><br /></p><p><br /></p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1001%2Fjama.2021.21187&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effect%20of%20Long-term%20Supplementation%20With%20Marine%20Omega-3%20Fatty%20Acids%20vs%20Placebo%20on%20Risk%20of%20Depression%20or%20Clinically%20Relevant%20Depressive%20Symptoms%20and%20on%20Change%20in%20Mood%20Scores%3A%20A%20Randomized%20Clinical%20Trial&rft.jtitle=JAMA&rft.stitle=JAMA&rft.volume=326&rft.issue=23&rft.aufirst=Olivia%20I.&rft.aulast=Okereke&rft.au=Olivia%20I.%20Okereke&rft.au=Chirag%20M.%20Vyas&rft.au=David%20Mischoulon&rft.au=Grace%20Chang&rft.au=Nancy%20R.%20Cook&rft.au=Alison%20Weinberg&rft.au=Vadim%20Bubes&rft.au=Trisha%20Copeland&rft.au=Georgina%20Friedenberg&rft.au=I-Min%20Lee&rft.au=Julie%20E.%20Buring&rft.au=Charles%20F.%2C%20III%20Reynolds&rft.au=JoAnn%20E.%20Manson&rft.date=2021-12-21&rft.pages=2385-2394&rft.spage=2385&rft.epage=2394&rft.issn=0098-7484"></span></div><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.4088%2FJCP.19r13106&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Omega-3%20Fatty%20Acid%20Supplementation%20for%20Perinatal%20Depression%3A%20A%20Meta-Analysis&rft.jtitle=The%20Journal%20of%20Clinical%20Psychiatry&rft.stitle=J%20Clin%20Psychiatry&rft.volume=81&rft.issue=5&rft.aufirst=Roel%20J.%20T.&rft.aulast=Mocking&rft.au=Roel%20J.%20T.%20Mocking&rft.au=Katja%20Steijn&rft.au=Carolien%20Roos&rft.au=Johanna%20Assies&rft.au=Veerle%20Bergink&rft.au=Henricus%20G.%20Ruh%C3%A9&rft.au=Aart%20H.%20Schene&rft.date=2020-09-01&rft.pages=13281&rft.issn=0160-6689&rft.language=English"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-62695698996331207622022-12-28T15:53:00.001-08:002022-12-28T15:54:54.699-08:00Supplements for Mental Health, Part 2: Zinc<p> Zinc is a metallic element, and an essential nutrient. </p><p>It is toxic if ingested in excess, with various side effects such as nausea, headache, and diarrhea. High-dose supplementation can cause copper deficiency, typically at doses greater than 100 mg/day. The maximum recommended dose is 40 mg/day, with the standard daily requirement being around 10 mg/day. </p><p>The prevalence of zinc deficiency in North America is about 7.5 % In cases of deficiency, it is obviously beneficial to use supplements. But what about supplementation above a baseline, normal dietary intake? </p><p>There are some positive studies, including RCTs, typically using doses of about 25 mg per day. But a few groups have shown negative results, including a major study of using several nutritional supplements, including zinc, all at once. (Sarris et al, 2019). This group showed that <b>placebo</b> did considerably <b>better</b> than supplements, for treating depression. </p><p>There is in particular no evidence of benefit from zinc supplementation in the treatment of COVID. </p><p>Overall, the research is variable, often low-quality. It is clear, once again, that zinc supplementation is very helpful in situations in which there could be nutritional deficiencies. </p><p>But the risk of supplementing with zinc in a 25 mg per day range would be very low. It could be on a list of things to try, as an adjunct for the treatment of depression or ADHD. It would best be done on a randomized basis, for example to set up your own personal study to take either zinc or placebo for 6 weeks (with the truth of what you were actually taking unknown to you until the trial was over) then with repeated randomized 6-week trials several times, to assess any consistent change in symptoms between placebo and zinc trials. </p><p><br /></p><p><br /></p><p><br /></p><p>References</p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<div class="csl-entry">Lai, J., Moxey, A., Nowak, G., Vashum, K., Bailey, K., & McEvoy, M. (2012). The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. <i>Journal of Affective Disorders</i>, <i>136</i>(1), e31–e39. <a href="https://doi.org/10.1016/j.jad.2011.06.022">https://doi.org/10.1016/j.jad.2011.06.022</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Duncan, A., Yacoubian, C., Watson, N., & Morrison, I. (2015). The risk of copper deficiency in patients prescribed zinc supplements. </span><i style="text-indent: -2em;">Journal of Clinical Pathology</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">68</i><span style="text-indent: -2em;">(9), 723–725. </span><a href="https://doi.org/10.1136/jclinpath-2014-202837" style="text-indent: -2em;">https://doi.org/10.1136/jclinpath-2014-202837</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting. (2012). </span><i style="text-indent: -2em;">PLOS ONE</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">7</i><span style="text-indent: -2em;">(11), e50568. </span><a href="https://doi.org/10.1371/journal.pone.0050568" style="text-indent: -2em;">https://doi.org/10.1371/journal.pone.0050568</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Yosaee, S., Clark, C. C. T., Keshtkaran, Z., Ashourpour, M., Keshani, P., & Soltani, S. (2022). Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials. </span><i style="text-indent: -2em;">General Hospital Psychiatry</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">74</i><span style="text-indent: -2em;">, 110–117. </span><a href="https://doi.org/10.1016/j.genhosppsych.2020.08.001" style="text-indent: -2em;">https://doi.org/10.1016/j.genhosppsych.2020.08.001</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Sarris, J., Byrne, G. J., Stough, C., Bousman, C., Mischoulon, D., Murphy, J., Macdonald, P., Adams, L., Nazareth, S., Oliver, G., Cribb, L., Savage, K., Menon, R., Chamoli, S., Berk, M., & Ng, C. H. (2019). Nutraceuticals for major depressive disorder- more is not merrier: An 8-week double-blind, randomised, controlled trial. </span><i style="text-indent: -2em;">Journal of Affective Disorders</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">245</i><span style="text-indent: -2em;">, 1007–1015. </span><a href="https://doi.org/10.1016/j.jad.2018.11.092" style="text-indent: -2em;">https://doi.org/10.1016/j.jad.2018.11.092</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Thomas, S., Patel, D., Bittel, B., Wolski, K., Wang, Q., Kumar, A., Il’Giovine, Z. J., Mehra, R., McWilliams, C., Nissen, S. E., & Desai, M. Y. (2021). Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial. </span><i style="text-indent: -2em;">JAMA Network Open</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">4</i><span style="text-indent: -2em;">(2), e210369. </span><a href="https://doi.org/10.1001/jamanetworkopen.2021.0369" style="text-indent: -2em;">https://doi.org/10.1001/jamanetworkopen.2021.036</a></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.1016%2Fj.jad.2011.06.022&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The%20efficacy%20of%20zinc%20supplementation%20in%20depression%3A%20Systematic%20review%20of%20randomised%20controlled%20trials&rft.jtitle=Journal%20of%20Affective%20Disorders&rft.stitle=Journal%20of%20Affective%20Disorders&rft.volume=136&rft.issue=1&rft.aufirst=Jun&rft.aulast=Lai&rft.au=Jun%20Lai&rft.au=Annette%20Moxey&rft.au=Gabriel%20Nowak&rft.au=Khanrin%20Vashum&rft.au=Kylie%20Bailey&rft.au=Mark%20McEvoy&rft.date=2012-01-01&rft.pages=e31-e39&rft.spage=e31&rft.epage=e39&rft.issn=0165-0327&rft.language=en"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-17694501315961800512022-12-28T11:01:00.002-08:002022-12-28T12:28:02.517-08:00Supplements for Mental Health, Part 1: Folic Acid <p>The nutritional supplement industry has a global market size of over 300 billion US Dollars annually. This is comparable to all the money spent in the world on fresh fruit and vegetables. </p><p>People generally take supplements with the idea that they will improve health or vitality, or prevent disease. </p><p>What is the current evidence that supplements could help improve mental health? I'll start by looking at vitamin and mineral supplements. </p><p>The vitamin with the most recent attention in the literature is folic acid. This is a B vitamin found in leafy green vegetables, oranges, and other healthy foods. It has been established for many years as an essential supplement for pregnant women, to help reduce the risk of birth defects. </p><p>Supplementation of folic acid during pregnancy may modestly reduce the risk of post-partum depression, but there is a lack of rigorous randomized controlled trials (RCTs) to prove this. </p><p>The most compelling recent study was published in JAMA Psychiatry in 2022, finding a strong association between folic acid supplementation at doses at 1 mg daily, and a substantially reduced risk of suicide. </p><p>But a major negative study was published in 2018: this was an RCT showing no reduction in depression risk with high-dose folic acid supplementation over an amazing 7 years of follow-up. But this study did not specifically look at using folic acid as an augmentation in the treatment of people who already have depression or other mental health problems. </p><p>A 2015 meta-analysis found no significant benefit for short-term use of folic acid as an augmentation for treating depression. </p><p>So in conclusion, there is some evidence of folic acid being useful in treating depression or reducing suicidal ideation, but the findings are by no means definitive, and there are negative studies in RCTs. As with many of these issues, there should be better RCTs with standardized doses (probably 1 or 2 mg daily) and longer durations, looking at using folic acid as an augmentation in people with established mental health symptoms. In the meantime, there is negligible risk to supplementing with folic acid 1 mg daily, so it is ok to do so. </p><p><br /></p><p>References:</p><p><br /></p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<div class="csl-entry"><i>Nutritional Supplements Market Size Report, 2030</i>. (n.d.). Retrieved 28 December 2022, from <a href="https://www.grandviewresearch.com/industry-analysis/nutritional-supplements-market">https://www.grandviewresearch.com/industry-analysis/nutritional-supplements-market</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Global Marketing Associates (2021, March 8). Global fruit and vegetable market: Export opportunity analysis. </span><i style="text-indent: -2em;">Global Marketing Associates</i><span style="text-indent: -2em;">. </span><a href="http://www.globalmarketing1.com/food-beverage/global-fruit-and-vegetable-market-export-opportunity-analysis/" style="text-indent: -2em;">http://www.globalmarketing1.com/food-beverage/global-fruit-and-vegetable-market-export-opportunity-analysis/</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Jin, X., Cheng, Z., Yu, X., Tao, Q., Huang, R., & Wang, S. (2022). Continuous supplementation of folic acid in pregnancy and the risk of perinatal depression–A meta-analysis. </span><i style="text-indent: -2em;">Journal of Affective Disorders</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">302</i><span style="text-indent: -2em;">, 258–272. </span><a href="https://doi.org/10.1016/j.jad.2022.01.080" style="text-indent: -2em;">https://doi.org/10.1016/j.jad.2022.01.080</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Gibbons, R. D., Hur, K., Lavigne, J. E., & Mann, J. J. (2022). Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults. </span><i style="text-indent: -2em;">JAMA Psychiatry</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">79</i><span style="text-indent: -2em;">(11), 1118–1123. </span><a href="https://doi.org/10.1001/jamapsychiatry.2022.2990" style="text-indent: -2em;">https://doi.org/10.1001/jamapsychiatry.2022.2990</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Okereke, O. I., Cook, N. R., Albert, C. M., Denburgh, M. V., Buring, J. E., & Manson, J. E. (2015). Effect of long-term supplementation with folic acid and B vitamins on risk of depression in older women. </span><i style="text-indent: -2em;">The British Journal of Psychiatry</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">206</i><span style="text-indent: -2em;">(4), 324–331. </span><a href="https://doi.org/10.1192/bjp.bp.114.148361" style="text-indent: -2em;">https://doi.org/10.1192/bjp.bp.114.148361</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. </span><i style="text-indent: -2em;">International Psychogeriatrics</i><span style="text-indent: -2em;">, </span><i style="text-indent: -2em;">27</i><span style="text-indent: -2em;">(5), 727–737. </span><a href="https://doi.org/10.1017/S1041610215000046" style="text-indent: -2em;">https://doi.org/10.1017/S1041610215000046</a></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
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<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.type=webpage&rft.title=Nutritional%20Supplements%20Market%20Size%20Report%2C%202030&rft.description=The%20global%20nutritional%20supplements%20market%20size%20is%20expected%20to%20reach%20USD%20358.8%20billion%20in%202021%20and%20is%20expected%20to%20expand%20at%20a%20compound%20annual%20growth%20rate%20(CAGR)%20of%206.3%25%20from%202022%20to%202030.%20Increasing%20awareness%C2%A0regarding%20health%20across%20the%20globe%20has%20markedly%20helped%20the%20market%20to%20thrive.&rft.identifier=https%3A%2F%2Fwww.grandviewresearch.com%2Findustry-analysis%2Fnutritional-supplements-market&rft.language=en"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-55045543866962494182022-12-26T12:02:00.024-08:002023-01-30T11:29:20.021-08:00Reflections on COVID management 2022<p> The COVID pandemic has been one of the most impactful world events of our lifetime. Aside from the disease itself, the community response to the disease has been intense and unprecedented. We have never before seen such prolonged, mandated restrictions and economic shutdowns in response to a global emergency. </p><p><br /></p><p>The pandemic has brought out some of the best and worst of humanity. On the best side, we have seen many people working very hard, at great risk to themselves, to help or save others. We have amazing feats of scientific innovation, in particular the vaccines and other medical treatments developed so quickly. We have communities that came together in support. Governments enacted radical measures to support the population economically during periods of reduced employment. On the negative side, we have seen misinformation, propaganda, hatred, the escalation of the anti-vax movement, and violence. These phemenona are expected in pandemics; there are good authors to follow on this subject, such as Christakis (see <i>Apollo's Arrow), </i>or Taylor (<i>The Psychology of Pandemics). </i></p><p>The pandemic and the community response to the pandemic has affected different people in different ways. For some people the disease itself was devastating, either causing death, critical illness in hospital, or similar devastating effects in loved ones. The majority of people have had a case of COVID, followed by full recovery, most of whom with no perceptible damage to their health, but a large minority of people have varying degrees of disability following acute recovery, in the form of so-called "long COVID." </p><p>The community response to COVID has had variable effects as well. Many people have suffered loneliness, mental health problems, worsened physical health problems, and economic hardship due to restrictions. Many children have had significant disruptions in social and educational development. Those living in abusive homes were more stuck in these harmful situations. Most of us were not able to visit ailing or dying loved ones. The negative impacts have affected some people much more than others. But there have also been positive effects of public health restrictions. Many of us have found ways to connect, work, and learn remotely. Many introverts have been unaffected by restrictions, or have enjoyed them. Many schoolchildren were spared the bullying and other adversity due to school attendance, and actually experienced a reduction in suicide risk. (see Hansen et al., 2022). Some have had bonding time with loved ones or family, living in the same household, that they would never otherwise have had. And many of us have developed a greater engagement for working together as a community, each doing our part, to solve a major world problem. </p><p>I have in the past compared COVID to cigarette exposure, just as an analogy, not as a literal equivalence: a case of COVID, assuming survival and acute recovery, could be compared to the health effects of 10-20 pack years of smoking (that is, a pack a day for 10-20 years), with a full series of vaccinations with boosters reducing this number substantially. Most people in the population are lucky--they can tolerate 10-20 pack years of smoking without any obvious health damage. As a result, a contrarian data scientist could argue that smoking is not very harmful, and should not be restricted (this in fact did happen up until recent decades). But most people with a 10-20 pack year smoking history would have a measurable decrement in many health metrics--they would be less healthy than they would have been had they not smoked. Some of these effects may become more obvious only after decades of time, with higher rates of heart disease, emphysema, reduced exercise tolerance etc. Some people with such smoking history will develop lung cancer, and die, sometimes after a long delay. Children and young adults are even less likely to show acute adverse effects from 10-20 pack years of smoking, since, of course, they are younger and healthier! But of course we can all agree that it would be preposterous to suggest that we should allow children to smoke! Just because children have a much higher survival rate of a harmful agent doesn't mean it is ok for them to be exposed. Similarly, it should never have been assumed that the low COVID death rate in children is a reason to be unconcerned about mass spreading in younger age groups. </p><p>The overall mortality rate from COVID has always been in a medium range, initially a much higher mortality rate than most strains of influenza, but much lower than a disease such as Ebola. At this point the mortality rate is more similar to that of influenza, as a result of mass immunization and infection-induced immunity. But of course, these rates are subject to change (up or down) as new variants are developing as we speak. Unlike seasonal influenza, COVID cases and deaths are simmering, with recurrent waves lasting a few months each, throughout the entire year, over years of time, rather than settling down after the season is over. The mortality rate has always been very strongly dependent on age, with elders having very much more severe effects and a much higher death rate than children or young adults. </p><p> The restrictions and mandates of the past 3 years helped reduce the total number of COVID deaths. They bought time to allow better treatments to be developed, and to allow a mass vaccination campaign. They also reduced surges of hospitalization and ICU use. Despite the restrictions, critical care usage was often right at the brink of overflow. The restrictions prevented a health care catastrophe that would have been much, much worse. </p><p>To this day, I feel that many analysts of this topic don't fully acknowledge or understand how exhausting and frightening it was for workers in critical care medicine in the past 3 years. We were dealing with near overflow situations, especially during the case surges. If we had been more lax about public health restrictions we would have had patients dying in the hallways waiting for ventilators, and other patients without COVID (including heart attack or cancer patients, post-surgical patients, or victims of accidents) dying due to lack of care. The stress, and often trauma, imposed on the exhausted medical staff has not been adequately understood outside this niche community of experts. Critical care experts have been too busy saving lives these past 3 years to busy themselves talking to journalists or trying to engage in public information campaigns. </p><p>A curse of successful public health intervention is that it can cause people to question afterward whether any of it was necessary, rather than have some gratitude that a much, much worse disaster did not happen. </p><p>A contrarian argument based on analysis of death rates in developed countries is a small and potentially misleading component of understanding this issue. There have definitely been excess deaths -- of course -- due to COVID, but the magnitude of this increase has not been shockingly high compared to rates and changes over the past decades, particularly in areas where there were good public health measures and high vaccination rates. In many ways these data are evidence of the effectiveness of the interventions, rather than a sign that we did too much, unnecessarily. Furthermore, death rates alone are the tip of the iceberg regarding health damage, just as a look at mortality rates does not tell the full story regarding the health dangers of smoking. </p><p>Most of us in the medical and public health/epidemiology community have closely followed data on the issue of COVID almost daily over the past 3 years. The epidemiology community in particular has been deeply involved in this analysis. </p><p>Rather than share my own analysis of data right now, I think it's preferable to cite some of the many other experts in mathematics, statistics, microbiology, virology, and epidemiology who have devoted much of their professional focus over the past three years to studying the pandemic. I choose the references below because they represent people and groups with years or decades of established expertise, highest levels of educational achievement from top universities, extensive peer-reviewed publications, no significant biases due to financial profit motives etc., and a balanced, moderate point of view: </p><p><br /></p><p>1) the website "Our World in Data" has been a wonderful source of information, not only about the pandemic, but about a wide variety of other issues going on in the world. I strongly recommend this site, as one to follow regularly. They have curated excellent data about the pandemic. I recommend following all their COVID data, but here is one link in particular, looking at excess deaths: </p><p><a href="https://ourworldindata.org/excess-mortality-covid#excess-mortality-during-covid-19">https://ourworldindata.org/excess-mortality-covid#excess-mortality-during-covid-19</a></p><p><br /></p><p>2) for some local BC experts, I encourage following the <a href="https://bccovid-19group.ca/">UBC Covid-19 Modelling Group</a>. Check out the monthly slide presentation from their website; they also have regular video presentations summarizing their findings. Members include Stanford-trained Ph.D. mathematical biologist Dr. Sally Otto, mathematics professor Dr. Eric Cytrynbaum, Stanford-trained Ph.D. physics professor Dr. Dean Karlen, engineer Dr. Jens von Bergmann, mathematics Ph.D. with specialty in infectious disease modeling Dr. Caroline Colijn, computational biologist Dr. Ailene MacPherson, mathematics professor Dr. James Colliander, statistics professor Dr. Daniel McDonald, mathematician and infectious disease modeler Dr. Dan Coombs, and mathematical biologist Dr. Elisha Are. These are people with years of expertise in data analysis and epidemiological statistics. Before doing one's own personal dive into the data, consider whether this group has already done the work at a more sophisticated level.</p><p>3) Dr. Isaac Bogoch is a well-known Canadian infectious disease specialist who has worked hard to inform the public about COVID-related issues. Highly recommended. Can follow on Twitter: @BogochIsaac. </p><p>4) Dr. Eric Topol has also been a great educator about COVID-related issues. He was the chair of cardiovascular medicine for 13 years at the Cleveland Clinic, and has since become a leader in medical research and education. Can follow on Twitter: @EricTopol. </p><p>5) Dr Akiko Iwasaki is a Yale immunobiologist, one of the top specialists in this area in the world. She has done extensive work on the pathophysiology of COVID and long COVID. Amazing scientist and an amazing person. Can follow on Twitter: @VirusesImmunity. </p><p>6) Dr. Trevor Bedford is a professor of biostatistics & computational biology at the Fred Hutch Cancer Centre in Seattle. Can follow on Twitter: @trvrb</p><p>7) Dr. Zeynep Tufekci is a sociologist, with excellent commentary about many aspects of the pandemic, ranging from epidemiologic analysis, to political factors. Can follow on Twitter: @zeynep</p><p>8) Dr. Michael Mina, a Harvard epidemiologist, pathologist & immunologist, has an expertise in mathematical modeling, and during the pandemic has been a leader advocating for better use of rapid testing. Can follow on Twitter: @michaelmina_lab</p><p>9) Dr. Linsey Marr is a Harvard-trained environmental engineer and aerosol scientist, who has been a leader in the research concerning ventilation and mask effectiveness in the containment of respiratory pathogens. I have felt that the improvement of ventilation has been a neglected area in pandemic and overall infectious disease management; such improvement would likely be broadly accepted by most people, regardless of their political leanings or other beliefs. Can follow on Twitter: @linseymarr@fediscience.org</p><p>10) Dr. Nicholas Christakis is a Yale sociologist and physician with expertise in the mathematics of social networks. He is the author of a good introductory book about pandemics in general, and COVID in particular (but this book is in need of a sequel, since it was published only one year into the pandemic). He has vast wisdom and experience in the analysis of pandemics and associated social behaviour. Highly recommended to follow. Twitter: @NAChristakis</p><p>11) Dr. David Boulware is a professor of medicine and infectious disease specialist at University of Minnesota Medical School. He has been an advocate for better randomized-controlled studies of COVID treatments. Such RCTs have been incredibly important, and in my opinion, should have been done on a much larger scale over the past 3 years, to clear up various uncertainties about optimal COVID management. Such good RCT data showed that treatments such as ivermectin and hydroxychloroquine were ineffective, while some other possible alternative treatments such as metformin, are likely to be useful. I feel that many more RCTs should have been done, and should still be done, to replicate and elaborate current findings. </p><p>12) Dr. Marc Veldhoen is an immunologist, a professor of immunology in Lisbon, with training in London, working at Cambridge 2010-2016. I appreciate his clear, authoritative, balanced, erudite efforts to educate the public about immunology in general, and COVID in particular. Twitter: @Marc_Veld</p><p>I have referred to Twitter links above, but also note that Twitter itself is deteriorating due to serious problems in its leadership, so it may be necessary to find the researchers mentioned above in other ways online or in publications. </p><p>The list above is, of course, a tiny slice of the huge, top-notch worldwide COVID research community. The scientists in this area have done excellent work in terms of genomics, pathophysiology, treatment innovation, epidemiology, and data science, as well as looking at social, psychological, and political factors. </p><p>I recommend checking out the leading medical, epidemiology, and other relevant scientific journals, such as <a href="https://www.nature.com/subjects/sars-cov-2">Nature</a>, <a href="https://www.science.org/action/doSearch?AllField=covid">Science</a>, the <a href="https://jamanetwork.com/">JAMA Network journals</a>, the <a href="https://www.nejm.org/coronavirus?query=main_nav_lg">New England Journal of Medicine</a>, <a href="https://www.thelancet.com/">The Lancet</a>, <a href="https://journals.lww.com/epidem/pages/results.aspx?txtKeywords=covid">Epidemiolog</a>y, and <a href="https://academic.oup.com/aje/issue">The American Journal of Epidemiology</a> . The <a href="https://journals.asm.org/topic/collection/covid">American Society for Microbiology</a> is an excellent resource for detailed virology research, and also has some public education resources. When you look at these websites, I encourage browsing through the past year or so of issues, pausing to look at the abstracts of interesting or relevant articles, and choosing a few of the best articles to read in depth. You can search the website to look for articles specifically about COVID. If you have access to a university, you can get full articles from these sites, otherwise you can at least read the abstracts. One of the general takeaways from this perusal of journals should be to understand and appreciate, with some degree of gratitude and awe, the depth and sophistication of the research. </p><p><br /></p><p>I also encourage checking out some of my previous posts about COVID over the past few years (though some of them are a bit outdated or may need some corrections). I consider my major post about polarization & propaganda to be very important: <a href="http://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html">http://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html</a></p><p><br /></p><p>References: </p><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<div class="csl-entry">Links to Journals: </div><div class="csl-entry"><i>COVID-19</i>. (n.d.). ASM Journals. Retrieved January 7, 2023, from <a href="https://journals.asm.org/topic/collection/covid">https://journals.asm.org/topic/collection/covid</a></div><div class="csl-entry"><span style="text-indent: -2em;"><a href="https://www.nature.com/subjects/sars-cov-2">https://www.nature.com/subjects/sars-cov-2</a></span></div><div class="csl-entry"><a href="https://academic.oup.com/aje/issue">https://academic.oup.com/aje/issue</a></div><div class="csl-entry"><span style="text-indent: -2em;"><a href="https://journals.lww.com/epidem/pages/results.aspx?txtKeywords=covid">https://journals.lww.com/epidem/pages/results.aspx?txtKeywords=covid</a></span></div><div class="csl-entry"><a href="https://www.thelancet.com/">https://www.thelancet.com/</a></div><div class="csl-entry"><a href="https://www.nejm.org/coronavirus?query=main_nav_lg">https://www.nejm.org/coronavirus?query=main_nav_lg</a></div><div class="csl-entry"><a href="https://jamanetwork.com/">https://jamanetwork.com/</a></div><div class="csl-entry"><a href="https://www.science.org/action/doSearch?AllField=covid">Science | AAAS</a></div><div class="csl-entry"><br /></div><div class="csl-entry">Books & Articles: </div><div class="csl-entry"><span style="text-indent: -2em;">Hansen, B., Sabia, J. J., & Schaller, J. (2022). </span><i style="text-indent: -2em;">In-Person Schooling and Youth Suicide: Evidence from School Calendars and Pandemic School Closures</i><span style="text-indent: -2em;"> (Working Paper No. 30795). National Bureau of Economic Research. </span><a href="https://doi.org/10.3386/w30795" style="text-indent: -2em;">https://doi.org/10.3386/w30795</a></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Christakis, N. A. (2020). </span><i style="text-indent: -2em;">Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live</i><span style="text-indent: -2em;">. Little, Brown.</span></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Taylor, S. (2019). </span><i style="text-indent: -2em;">The Psychology of Pandemics</i><span style="text-indent: -2em;"> (1st edition). Cambridge Scholars Publishing.</span></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><span style="text-indent: -2em;">Twitter Links: </span></div><div class="csl-entry"><span style="text-indent: -2em;">Timothy Caulfield, an expert on health misinformation & propaganda: </span><a href="https://twitter.com/CaulfieldTim" style="text-indent: -2em;">Timothy Caulfield (@CaulfieldTim) / Twitter</a></div><div class="csl-entry">Dr. David Boulware, infectious disease physician & researcher: <a href="https://twitter.com/boulware_dr" style="text-indent: -2em;">David Boulware, MD MPH (@boulware_dr) / Twitter</a></div><div class="csl-entry">Dr. Nicholas Christakis, physician, sociologist, expert on the social dynamics of pandemics: <a href="https://twitter.com/NAChristakis" style="text-indent: -2em;">Nicholas A. Christakis (@NAChristakis) / Twitter</a></div><div class="csl-entry">Dr. Linsey Marr, engineer, expert in aerosol transmission of viruses: <a href="https://twitter.com/linseymarr" style="text-indent: -2em;">Linsey Marr | @linseymarr@fediscience.org (@linseymarr) / Twitter</a></div><div class="csl-entry">Dr. Michael Mina, immunologist, epidemiologist, focus on virus tes<span style="text-indent: -2em;">ting: </span><a href="https://twitter.com/michaelmina_lab" style="text-indent: -2em;">Michael Mina (@michaelmina_lab) / Twitter</a></div><div class="csl-entry">Dr. Zeynep Tufekci, sociologist with expertise in the political, social, and psychological dynamics of the COVID pandemic: <a href="https://twitter.com/zeynep" style="text-indent: -2em;">zeynep tufekci (@zeynep) / Twitter</a><span style="text-indent: -2em;"> </span></div><div class="csl-entry"><span style="text-indent: -2em;">Dr. Trevor Bedford, biostatistician, his lab focuses on epidemiology & virology: </span><a href="https://twitter.com/trvrb" style="text-indent: -2em;">Trevor Bedford (@trvrb) / Twitter</a></div><div class="csl-entry">Dr. Akiko Iwasaki, Yale immunologist: <a href="https://twitter.com/VirusesImmunity" style="text-indent: -2em;">Prof. Akiko Iwasaki (@VirusesImmunity) / Twitter</a></div><div class="csl-entry">Dr. Eric Topol, cardiovascular medicine expert, curator of COVID information: <a href="https://twitter.com/EricTopol" style="text-indent: -2em;">Eric Topol (@EricTopol) / Twitter</a></div><div class="csl-entry">Dr. Isaac Bogoch, Canadian infectious disease physician, excellent source of general information about the pandemic: <a href="https://twitter.com/BogochIsaac" style="text-indent: -2em;">Isaac Bogoch (@BogochIsaac) / Twitter</a></div><div class="csl-entry">The BC Covid-19 Modelling Group: a team of mathematicians, biostatisticians, and epidemiologists doing excellent, sophisticated quantitative analysis of pandemic data: <a href="https://twitter.com/bcCOVID19group">https://twitter.com/bcCOVID19group</a></div><div class="csl-entry">Dr. Marc Veldhoen, Immunologist: <a href="https://twitter.com/Marc_Veld">https://twitter.com/Marc_Veld</a></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><span style="text-indent: -2em;"><br /></span></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><br /></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=urn%3Aisbn%3A978-1-5275-3959-4&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The%20Psychology%20of%20Pandemics&rft.place=Newcastle%20upon%20Tyne&rft.publisher=Cambridge%20Scholars%20Publishing&rft.edition=1st%20edition&rft.aufirst=Steven&rft.aulast=Taylor&rft.au=Steven%20Taylor&rft.date=2019-12-01&rft.tpages=175&rft.isbn=978-1-5275-3959-4&rft.language=English"></span></div></div><div class="csl-entry"><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=urn%3Aisbn%3A978-0-316-62822-8&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Apollo's%20Arrow%3A%20The%20Profound%20and%20Enduring%20Impact%20of%20Coronavirus%20on%20the%20Way%20We%20Live&rft.publisher=Little%2C%20Brown&rft.aufirst=Nicholas%20A.&rft.aulast=Christakis&rft.au=Nicholas%20A.%20Christakis&rft.date=2020-10-27&rft.tpages=455&rft.isbn=978-0-316-62822-8&rft.language=en"></span></div></div></div><div class="csl-bib-body" style="line-height: 2; margin-left: 2em; text-indent: -2em;">
<span class="Z3988" title="url_ver=Z39.88-2004&ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fzotero.org%3A2&rft_id=info%3Adoi%2F10.3386%2Fw30795&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.type=preprint&rft.title=In-Person%20Schooling%20and%20Youth%20Suicide%3A%20Evidence%20from%20School%20Calendars%20and%20Pandemic%20School%20Closures&rft.description=This%20study%20explores%20the%20effect%20of%20in-person%20schooling%20on%20youth%20suicide.%20We%20document%20three%20key%20findings.%20First%2C%20using%20data%20from%20the%20National%20Vital%20Statistics%20System%20from%201990-2019%2C%20we%20document%20the%20historical%20association%20between%20teen%20suicides%20and%20the%20school%20calendar.%20We%20show%20that%20suicides%20among%2012-to-18-year-olds%20are%20highest%20during%20months%20of%20the%20school%20year%20and%20lowest%20during%20summer%20months%20(June%20through%20August)%20and%20also%20establish%20that%20areas%20with%20schools%20starting%20in%20early%20August%20experience%20increases%20in%20teen%20suicides%20in%20August%2C%20while%20areas%20with%20schools%20starting%20in%20September%20don%E2%80%99t%20see%20youth%20suicides%20rise%20until%20September.%20Second%2C%20we%20show%20that%20this%20seasonal%20pattern%20dramatically%20changed%20in%202020.%20Teen%20suicides%20plummeted%20in%20March%202020%2C%20when%20the%20COVID-19%20pandemic%20began%20in%20the%20U.S.%20and%20remained%20low%20throughout%20the%20summer%20before%20rising%20in%20Fall%202020%20when%20many%20K-12%20schools%20returned%20to%20in-person%20instruction.%20Third%2C%20using%20county-level%20variation%20in%20school%20reopenings%20in%20Fall%202020%20and%20Spring%202021%E2%80%94proxied%20by%20anonymized%20SafeGraph%20smartphone%20data%20on%20elementary%20and%20secondary%20school%20foot%20traffic%E2%80%94we%20find%20that%20returning%20from%20online%20to%20in-person%20schooling%20was%20associated%20with%20a%2012-to-18%20percent%20increase%20teen%20suicides.%20This%20result%20is%20robust%20to%20controls%20for%20seasonal%20effects%20and%20general%20lockdown%20effects%20(proxied%20by%20restaurant%20and%20bar%20foot%20traffic)%2C%20and%20survives%20falsification%20tests%20using%20suicides%20among%20young%20adults%20ages%2019-to-25.%20Auxiliary%20analyses%20using%20Google%20Trends%20queries%20and%20the%20Youth%20Risk%20Behavior%20Survey%20suggests%20that%20bullying%20victimization%20may%20be%20an%20important%20mechanism.&rft.identifier=urn%3Adoi%3A10.3386%2Fw30795&rft.aufirst=Benjamin&rft.aulast=Hansen&rft.au=Benjamin%20Hansen&rft.au=Joseph%20J.%20Sabia&rft.au=Jessamyn%20Schaller&rft.date=2022-12"></span></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-82820331060462258782022-08-18T13:54:00.001-07:002022-08-27T10:40:02.135-07:00How Minds Change by David McRaney: a book review and discussion<p>David McRaney, in his new book called "How Minds Change" (2022), reviews our understanding of why people can form tenacious beliefs which are resistant to change, leading to political polarization, conspiracy theorists, hate groups, cults, anti-vax groups, climate change denialism, etc. </p><p>I have discussed a lot of this material in some of my previous posts. A big focus in McRaney's book is on what strategies are most effective to help with these problems. He shows that simply presenting facts to a person with entrenched beliefs is usually ineffective, and could even cause the person to become even more entrenched in their beliefs. Instead, there are several techniques discussed which have much better success. These techniques are to some degree common-sensical, and are foundations of what might be found in any compassionate interaction, or any psychotherapy scenario. </p><p>He discusses several such strategies, including deep canvasing, the elaboration likelihood model (ELM), street epistemology, and motivational interviewing. All of these are similar--I'll summarize the core features here: </p><p>1) establish rapport. Empathize. The communicator must seem trustworthy, credible, respectful, and reliable. Obtain consent to talk about the issues at hand. </p><p>2) Ask how strongly the person feels about a particular issue; repeat back and clarify; identify a confidence level, such as from 0 to 10; ask how they chose that number; ask how they've judged the quality of their reasons for their choice; summarize; make sure you've done a good job summarizing correctly. </p><p>3) If there are core values influencing the person's opinion, such as about the importance of family, community, safety for children, freedom, loyalty, etc. be sure to empathize, acknowledge, and affirm these. If there are core values in common, be sure to emphasize the commonality. </p><p>3) If their confidence level was not at an extreme (0 or 10), ask why not? </p><p>4) Ask if there was a time in their life before they felt this way about the issue, and if so what led to the change? </p><p>5) share a story about someone affected by the issue.</p><p>6) Share a personal story about why and how you reached your own position, but do not argue. </p><p>7) ask for their rating again, then wrap up and wish the person well, possibly with an invitation to talk again. </p><p>Notably, these techniques do not involve arguing about facts, such as about scientific data. A person holding strong entrenched beliefs may consider contrary facts or data to be false, biased, or irrelevant. They may feel like they are betraying their ingroup or their sacred values if they were to change their position. Yet elsewhere in the book there is an emphasis on facts as well, it is just that there would need to be a tipping point of information frequency within the person's ingroup, beyond which the group opinion starts to change suddenly. Below that level, facts are easily dismissed, ignored, or even used to ironically consolidate their previous beliefs, while labeling the fact-provider as a misguided or even evil outsider. </p><p>In some of McRaney's examples, he shows, as I have discussed before, that strong ingroups can be the main factors causing resistance to rational changes in belief, even if the ingroup's beliefs are causing great harm to themselves and are contrary to their core values (the anti-vax movement is an example). He points out that sometimes people need to leave these ingroups for other reasons, before they become amenable to changing their beliefs. Exiting the ingroup sometimes needs to happen first. But this can be unlikely to happen. To facilitate ingroup members being able to leave, there would need to be a kind, respectful, compassionate approach. If we only show anger and hostility to these ingroups, the members are more likely to rally together, as if protecting themselves from an enemy attack. </p><p>McRaney alludes to many of the practioners of techniques such as deep canvasing having many video examples of the technique, to help others learn and offer constructive feedback about the technique. I think this would be something to check out online, to see examples of people working in this area lead a successful conversation leading to positive change. Otherwise, like so many other techniques in health care or in life, we are stuck with just reading about an idea, rather than practicing and learning "hands on" with the guidance and feedback of others. </p><p>The one critique I have of McRaney's book is that he leaves out discussion of many research leaders in the psychology of conspiracy theorists, cults, and persuasion. Cialdini's work from decades ago is never mentioned. Psychologists such as Sander Van Der Linden are not mentioned. There are some other techniques suggested by these other researchers, including a "fake news inoculation" technique, in which you can learn and practice ways to protect yourself from misleading information. See the website <a href="https://www.getbadnews.com/books/english/">https://www.getbadnews.com/books/english/</a></p><p>Also, the book does not discuss individual variations in people as a factor affecting tenacity of belief, propensity to conspiracy beliefs, resistance to fact-based arguments, etc. In my previous post (<a href="https://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html?m=1">https://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html?m=1</a>) I discuss factors such as past trauma and personality disorders as factors which could cause an individual to hold more rigid harmful or false beliefs. There would need to be some varability in the approach to conversing with someone about these issues, given these individual variations. It may be valuable to focus persuasive efforts on those most ambivalent or amenable to change within a strong ingroup.</p><p><br /></p><p> </p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com1tag:blogger.com,1999:blog-6886575137375451769.post-71146552966068972712022-07-31T11:40:00.008-07:002023-01-05T10:33:59.465-08:00Medical School Admission Criteria: a discussion<p> It is very difficult to get admitted to a medical school. At UBC, only about 10% of applicants are accepted. </p><p>This leads to extreme competition. Students admitted to the program have average university grades just under 90%, and average standardized test scores (from the MCAT) just under the 90th percentile. </p><p>Even if you have average university grades above 90%, it is no guarantee of admission. Only 26% of applicants with such high grades are accepted. </p><p>Therefore, there are other factors which increase the likelihood of admission, aside from grades and standardized test performance. These are so-called "extracurriculars" such as history of volunteering and "leadership activities," reference letters, and performance in a "multiple mini-interview," which involves responding in a desired fashion, within a time limit, to various hypothetical scenarios with a sequence of 10 different interviewers. </p><p>I understand the need to have multiple criteria to judge applicants. But I would like to make the case here that the current selection process is not particularly efficient or fair, it has a very strong bias against people with particular personality types, despite those people being very well-suited to be excellent physicians, and also leads to years of unhealthy, expensive, and wasteful frenzied competition before starting medical school. There is also a bias in favour of people from wealthier families, since such people would more easily be able to afford years of volunteering, cultural exploration, club leadership, MCAT prep courses, tutoring, etc. instead of having to work long hours for years near minimum wage to support educational expenses. </p><p>Imagine who the best future surgeons would be. They would likely have excellent hand-eye coordination, tactile skills, mastery of fine details such as of anatomy, immense patience with meticulous tasks, and ability to remain calm and focused for long periods of time. Some of them might be not be "neurotypical." Many of the most talented such people would not necessarily have great social skills, would not be inclined to volunteer at Big Brothers or at nursing homes, would not be on the executive of university clubs, would not have a history of musical or drama performances, would not seem impressive in rapid interviews, and also may not have high grades in biochemistry or English. I don't believe that any of the relevant surgical talents described above are assessed at all in the medical school admissions process. </p><p>The current medical school admissions process therefore excludes many of the best future surgeons. For many other future surgeons who are fairly accepted, they would have spent perhaps years of extra time padding their CVs with life activities that they were not really interested in, just to keep up with the pre-med competition game. This is a waste not only for these individuals, but for society as a whole (we have budding surgeons who have several fewer years of professional life due to them having spent these years doing CV padding activities). </p><p>Another result of the pre-med competition process is that candidates will be well-motivated to pad their academic transcript with easier courses, so-called "grade boosters," while avoiding difficult or challenging courses which tend to have a low class average. The challenging courses would lead to improved scholarship and wisdom, but people have to avoid them because they could drag their grades down. Most medical colleges do not take into account the difficulty of the courses that people take. In any case, one of the advantages of a standardized exam such as the MCAT is that everyone in the world takes the exact same exam, so there is no selective avoidance of difficult material. </p><p>The competition to show extracurricular volunteering and "leadership activities" also creates a bias against introverts. Many of us are quiet, shy, with relatively solitary habits. Such gentle, quiet people often would make excellent physicians: people who are calm, good listeners, patient, kind, intelligent, sensitive, and skilled. But for a person with this personality style, group involvement, group leadership, and many types of volunteering, are just simply unpleasant or impossible. I am an example of such a quiet, shy, relatively solitary person. </p><p>We should have a selections process that chooses people who are likely to be competent, skilled, and stable. We should have a process that makes it hard for a psychopathic person to get admitted. The existing process does select for competence, stability and skill indirectly through grades, even though most of the actual grades have little to do with skills that would be of clinical use during a medical career. A psychopathic person is less likely to have consistently high grades and a good volunteer record. But many psychopaths could present themselves very well in cross-sectional interviews, while many non-psychopaths who are simply shy or reserved would bomb the interviews. </p><p>What would be reasonable to change the process? I don't think there's an easy answer. I think that grades and MCAT should continue to have a prominent impact on admissions, despite some of the biases involved. Maybe this is unavoidable. People should be rewarded, rather than penalized, for taking difficult courses that may have lower average grades. It would seem very reasonable and practical to be rewarded in the admissions hierarchy if you have proven experience or skill in health care work or in relevant skills; for example, people who have worked in nursing or other allied health fields, as a paramedic, in an anatomy lab, as a technician, doing other work requiring long hours of meticulous focus, veterinary work, or psychotherapeutic work. I think that much less weight should go to performance in a cross-sectional interview process, since this is extremely prone to biases which are not relevant to future medical performance (this reminds me of Kahneman's descriptions of biased and meaningless selection interviews from "Thinking Fast and Slow"). I think that showing "leadership skills" should have minimal impact on admissions, and people should not be penalized in the process for not showing "leadership skills." Furthermore, those who are most ambitious to show such "leadership" are often the worst leaders. </p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com1tag:blogger.com,1999:blog-6886575137375451769.post-50839186069520071572022-05-25T13:48:00.003-07:002022-05-25T19:15:05.115-07:00"The Biology of Desire: Why Addiction is Not a Disease" by Marc Lewis<p>Marc Lewis explores the neurobiology of addiction in this short book, with proposed approaches to better understanding and helping people who are struggling with addictions. </p><p>He comes across very clearly as a compassionate person, with a good understanding and personal experience in this area. Probably someone who would be good to have as a therapist or support in the context of addictive problems. </p><p>The book presents several case stories, which is always a compelling style in describing health care issues. They could be a source of inspiration that could help people in their own journeys through addiction. But of course testimonial accounts have only limited value in a scientific study, since they can introduce very strong biases in the reader, if not accompanied by references to large controlled studies. </p><p>He has good reasons for disparaging what he calls "medicalization" of addiction, and emphasizing his opinion that addiction should not be considered a "disease." Many of these reasons involve emphasis on what most of us would consider "bad medicine," i.e. institutional or even punitive treatment, simple remedies such as drug treatments given without addressing social or psychological issues, etc. He particularly disparages psychiatrists, as though he thinks all psychiatrists enjoy the narrow or excessive brandishing of labels and dispensing of medications without attending to deep understanding, therapeutic compassion, and a biopsychosocial focus, with patients. </p><p>So I found this part of his message to be tiresome. Excessive narrow "medicalization" of almost any issue is not good medicine. Almost any health condition, such as type II diabetes, heart disease, hypertension, and certainly conditions such as anxiety or depression, have spectrums of severity or chronicity; there are very important psychosocial factors, often present for years before the onset of the condition, that influence symptoms, severity, and progression. There are feedback loops involving behaviour which cause spiralling exacerbations or rapidly accumulating harms in all of these conditions. And treatments for diabetes or heart disease need to involve understanding and help with lifestyle, social, and economic factors affecting these conditions, with long-term goals in mind. But it is not necessary to avoid calling diabetes a "disease." Rather, the approach should be, in my opinion, to recognize that any disease state occurs on a continuum. In many cases, there is no clear-cut line between disease or non-disease. The word "disease" does not necessarily imply permanence, or need for invasive, narrow, or institutional treatments. For example, we could agree that viral pharyngitis is a disease, but is not one which normally requires medical intervention. Just as in addiction, many conditions uncontroversially considered "diseases" or at least pathological states, such as pneumonia, COVID, migraine, sciatica secondary to disc prolapse, psychotic episodes, or brain injury, can often recover on their own without any treatment at all; but for some sufferers of these conditions, the symptoms become relentlessly chronic or more difficult to deal with. Just because something has the possibility of improving on its own, or through lifestyle improvements, after days, months, or years, does not mean that it shouldn't be considered a disease. Furthermore, the improvements in many conditions can sometimes be associated with improved perspective or lifestyle, but sometimes the improvements are just random. Many patients I've seen have engaged in all the healthy perspective-taking and good lifestyle habits you can imagine, but are still afflicted by the same tormenting symptoms. Other patients somehow recover from severe problems without changing their lifestyles much at all. </p><p>Hypertension is a disease, with multifactorial causes, which often requires medication but always requires attention to lifestyle factors. Simple, overly reductionistic medical treatments can sometimes help with certain disease states (such as repairing a broken limb) but in many or most disease states, medical treatments are only one branch of helping. The other branches require attention to lifestyle factors, community or social supports, and possibly an existential focus, to help people regain an awareness and passion for long-term goals. But this multi-pronged focus is what I consider to be normal medical care. </p><p>Lewis argues that because the neurobiology of addiction features entirely "normal" activations of normal brain pathways, akin to learning or falling in love, addiction therefore should not be considered a disease. But many conditions in medicine feature activation of normal physiologic functions as a component of their pathology. For example, inflammatory states resulting from infection (this is a major pathology in COVID) are activations of the body's defenses to fight off pathogens, but the inflammation itself ends up causing severe tissue destruction. The processes are all "normal" but the circumstances of the disease state (germ + host) cause the reaction to be disastrous. A clear understanding of disease states, mechanisms, and medical interventions to interrupt this cycle, are indicated to save lives and prevent widespread tissue destruction. </p><p>Addictive states can lead to similar destruction of bodies, minds, relationships, and careers. Just because the mechanisms involve activations of normal neural pathways does not mean we should avoid diagnostic language. Problems associated with pathologizing labels, such as stigma (from others or from self) do not mean we have to avoid such labels entirely, but it may mean that the labels should be used with care and humility, rather than in a pejorative manner. </p><p>There is interesting neuroscience describing addictive processes, but sometimes discussion of this can devolve into making overly strong literal claims (e.g. about neuroplasticity), often based on compelling testimonial accounts, without as much robust statistical evidence to back these up. This is a pitfall I've seen with other authors touching on this, such as Doidge. The use of the neuroscientific language then becomes a tool of persuasion, which sounds impressive to most people. But it is much more important in this area to back up claims, especially those based on case studies or testimonial accounts, with careful reference to large controlled studies. </p><p>Lewis has good ideas and a passion for his subject, but his focus on addiction not being a "disease" is needless--it is to some degree a semantic squabble, which subtracts needlessly from the impact of his book. </p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-62081284924146428212022-05-23T11:18:00.002-07:002022-05-23T11:27:45.995-07:00The Elephant in the Brain & The Folly of Fools<p> Two more books to recommend: </p><p><br /></p><p><i>The Folly of Fools </i>(2011) by Robert Trivers and <i>The Elephant in the Brain (2018) </i>by Kevin Simler & Robin Hanson are both about the human tendency to engage in deception: not only the deliberate deception of others but the deception of self. </p><p>Trivers approaches this issue from the point of view of genetics (he was the first to characterize the evolutionary biology of reciprocal altruism). The capacity to deceive can be beneficial to survival, as we see in many species of animals, and in many human examples. But such deception can only work up to a certain point, an equilibrium point in terms of frequency, otherwise the strategy fails. If deception was too frequent, the evolved strategies to counter deception would render the deceptive strategy ineffective. Similarly, cheating can be an evolved strategy, but if cheating occurs too frequently in a population, it would no longer be effective due to widespread awareness and countermeasures in the population. </p><p>Trivers goes on to argue that self-deception is a type of advanced deceptive strategy. The capacity to effectively deceive others is enhanced if we can deceive ourselves. If you REALLY believe you can win a fight (despite poor objective evidence), you are more likely to convince your opponent that you can win, and therefore are more likely to actually win, even if you utterly lack fighting skills. </p><p>Unfortunately, self-deception leads to many serious problems in society. Trivers goes through many examples, showing that horrible accidents, wars, biased research, and religious phenomena, are often driven by self-deceptive factors which end up causing disastrous results. </p><p>His chapter called "religion and self-deception" is particularly recommended. </p><p>While I consider this book important and highly recommended, I did find it often to be quite informal in reasoning, punctuated by forays into humour, but this could be a bit problematic when he is wandering into areas (for example about politics, wars, and religion) that many people could be quite sensitive or easily offended about. There are bound to be sections in this book which could cause people some offense. </p><p><br /></p><p><i>The Elephant in the Brain </i>is quite a remarkable review of ideas from social psychology and behavioural economics. There is influence from Kahneman, Trivers (<i>The Folly of Fools </i>is referenced), Haidt, and many other leaders in the research of this area over the past decades. I think it's astounding that these two authors, who are not specialists in these areas, produced such a comprehensive and compelling summary of this research. </p><p>The thesis of this book is that humans have a powerful motive to signal membership in groups. The tendency to form ingroups is a powerful human trait, evolved over millions of years. Group membership allows us to trust and collaborate with our group members, for safety, defence, maintaining a food supply, dealing with illness, finding a mate, and raising children. But unfortunately, this tendency to form ingroups can become such a powerful motivation, often without our awareness, that it overwhelms reason, fosters needless and often terrible conflict with outgroup members, and can become very destructive or at least inefficient. And the phenomenon tends to perpetuate itself, since members of ingroups (be it political or religious or cultural) tend to socialize, mate, and have children with fellow ingroup members. </p><p>They refer to Bryan Caplan's argument about education, showing that a great deal of education leads to only an indirect signal of skill or competence. Most people do not use subject matter they learned in university very often if at all in the work they do afterwards. Instead, the degree and grades serve mainly as a competitive signal to employers about capacity to achieve work, conform stably to demands, etc. I have reviewed Caplan's book elsewhere (I do have some disagreements about this). </p><p>The authors show that political and religious membership have powerful ingroup effects. The tendency to form strong beliefs about elements of religious doctrine can be understood as a badge of group membership; if one can engage in successful self-deception about these doctrinal elements, it is all the more effective as a group membership badge. The beliefs become shibboleths which can allow some feeling of trust with co-believers, and a sense of distrust or frank dislike of outsiders. Such belief systems can develop independently of rational moral reasoning. While all religious systems contain positive insights about morality (e.g. "love your neighbour as yourself", "blessed are the meek", "blessed are the peacemakers," "judge not lest ye be judged", "do unto others as you would have them do unto you," etc.), the moral prominence of these beautiful insights is often lost in a cloud of doctrine that becomes more about maintaining an emblem of group involvement, an "us" vs. "them" mentality. This mentality is a manifestation of an evolved trait pushing all humans towards group involvement, formation of local communities in which we can feel trust and belonging, but with the unfortunate consequence of having outgroups which we would not trust, and which we would treat with less positivity, warmth, and generosity. </p><p>The same phenomena occur in political beliefs. While there could be core rational beliefs about positions on a political spectrum, with regard to preferred economic strategy, international affairs, management of public works, etc., a great deal of political involvement involves doctrinaire beliefs that are badges of group membership, and which have nothing to do with any understanding of policy. Most people don't even know what the policy positions are, exactly, of the candidates they vote for. Many others support their ingroup's politicians even though the associated policies would be harmful to themselves economically or socially. We have tragically seen this happen during the pandemic. Extreme beliefs about vaccines, masks, etc. became emblems of political group membership; many people made decisions about these issues not because of rational evidence (which strongly supported vaccine and mask use, for the protection of everyone's health, including the anti-vaxxers' own health and well-being), but because of the beliefs of fellow ingroup members in political or religious factions. Masks and vaccines have almost nothing whatsoever to do with religion or politics -- they are simply common-sensical public health measures -- but once these issues became badges of group involvement, the issue spiralled into disaster, to the detriment of everyone. This is an extreme example of the phenomenon shown in the famous children's study, where kids randomly given shirts of a different colour end up forming hostile ingroups, opposed to each other. In the case of the pandemic, a great deal of anti-vax belief was simply driven by factors akin to having a different shirt colour, just to show difference from an opposing outgroup. </p><p>In both books, reference is made to psychiatric theory as an example of self-deception. Psychoanalytic theory is basically a set of ideas akin to religious doctrine, with a strong ingroup community of "believers" who couch discussion of psychiatric issues through the lens of a theoretical system which is mostly fictional. As with religions, there are core beliefs in psychoanalysis which reflect deep insight and wisdom. For example, the idea of psychological defenses came from psychoanalysis, and is ironically an insight into the tendency for humans to engage in self-deception, with the implication that we should try to become aware of our defences, and to be able to set them aside. Similar insights warning about self-deception can be found in religious texts. But most of psychoanalytic theory is arbitrary, based on bizarre inferences made from case reports, coloured by the already biased opinions of the therapists. But as with religious practices, much of the therapeutic value in psychoanalysis has nothing to do with the literal belief system, it has to do with the practice itself. Visiting a trusted minister or priest, who would most likely be kind, gentle, understanding, supportive, and wise, could be a wonderfully healthy practice, as could a meditative practice of daily prayer, or visiting a congregation of loving friends. These healthy and possibly healing effects would occur regardless of the belief system held by the group. Similarly, the practice of psychoanalysis (or psychodynamic therapy more generally) requires frequent visits with a wise, compassionate, gentle, kind therapist who probably has some useful feedback about life problems, and there would be a healing effect of simply having a stable therapeutic relationship over a long period of time, irrespective of the fictional theoretical belief system held, such as strict Freudianism. </p><p>While we can empathize and even endorse the benefits of ingroup membership phenomena, I believe it behooves us to strive for improved rationality, to guide our knowledge and decisions so as to benefit ourselves, our neighbours, and the world in the most effective way. Societies across the world have improved in this way over the centuries, as Steven Pinker has shown us (see <i>Enlightenment Now</i>), but we have a lot of work to do to continue progress in building a just, peaceful, prosperous society. </p><p>In both books, we are wisely cautioned to look to ourselves for our own self-deceptions. It is another human tendency to see self-deception or folly in others, while not noticing our own. In my case, I recognize this will be a work in progress. I surely have beliefs or practices that are products of my ingroup or other biases; I hope that I will be able to keep working on better awareness of these issues over time, in service to my patients and to myself. </p><p><br /></p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-51291553663255587192022-04-25T11:15:00.003-07:002022-04-25T11:15:37.536-07:00Review: Shrinking Violets: The Secret Life of Shyness, by Joe Moran <p> Joe Moran's book is a nice exploration of various historical figures (such as authors, poets, and musicians) who had what he calls "shyness." Moran alludes to his own shyness as well. </p><p>A thematic goal of the book is to understand shyness as a part of the tapestry and variety of human life, as opposed to a pathology that requires treatment, or that is even treatable at all. </p><p>Moran is a good writer--he's an English professor, and it is always a delight to read a book in this type of genre written by someone with a mastery of the language. </p><p>This book is interesting as a historical or biographical journey, but I found it quite limited as a serious study of shyness from a psychiatric point of view. First of all, "shyness" is a very limited term to describe the many varieties of anxiety, introversion, personality styles, and autistic traits likely present in some of his case studies. </p><p>Near the end of the book, Moran encourages a position of gentle acceptance of shyness, but this acceptance seems to disparage the potential value of attempting to help people manage or change their social anxiety or avoidance using therapeutic techniques. One chapter is even called "The War Against Shyness," which is a pretty strong condemnation of the therapeutic culture. </p><p>There are many shy people, who have what might be considered social anxiety or autistic traits, who might find therapy helpful, to improve social skills, to find ways of facing fears more comfortably, or even to reduce anxiety a notch (including with the help of medication). We should always have modest or limited expectations of therapy; also we need to take care to affirm an accepting rather than a pathologizing stance, particularly when social behaviour and experience always exists on a spectrum. Yet the best of modern therapy is affirming and accepting; it just helps people to suffer a little bit less, to help people have a little bit more freedom in their lives to do things they might find meaningful, enjoyable, or essential for survival or prosperity. </p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-45951656717652408662022-04-03T11:41:00.004-07:002022-05-23T11:58:36.951-07:00Review: Blueprint by Nicholas Christakis<p> I am happy to have discovered Christakis and his work, in an area I would call “evolutionary sociology” or “mathematical sociology.” </p><p><i>Blueprint: The Evolutionary Origins of a Good Society </i>is an excellent companion to books by Steven Pinker, Jonathan Haidt, and Richard Dawkins, and even behavioural economists such as Kahneman, looking at issues concerning the genetic components of individual and group behaviour, and the intersection or interplay between “genetic” and “environmental.” Christakis shares Pinker’s general optimism about human progress, though through a social and anthropological lens rather than a strictly individual, rationality-based one. Haidt and Christakis both look at dynamics of group differences, Haidt as a psychologist, Christakis as a sociologist. And Christakis looks at gene-environment interaction on a group level, a continuation or elaboration of Dawkins idea of an “extended phenotype.” </p><p>Near the beginning of the book, there are very interesting case studies presented about small groups that isolated themselves from the rest of society, either through choice (e.g. the Shakers), or through disaster (shipwrecks), then having to develop some means of survival, stability, or happiness. Some organizational styles were successful, especially when there was some form of effective but not overly rigid leadership, combined with respect for individual differences, and a culture encouraging playful interactions. Some styles led to failure (a very low survival rate), such as if warring factions developed, “Lord of the Flies” style, or if the community was either too anarchistic, too insular, or too tyrannical. </p><p>Christakis introduces network analysis of groups, which I would like to learn more about. I consider this to be in the mathematical discipline of “graph theory,” another nice example of pure mathematical concepts and modern data science allowing us a deeply insightful view of aspects of human nature. I consider this type of analysis especially important in this age of online connectivity, which has the potential to amplify or distort connectivity phenomena, leading to powerful forces of social change, leadership, and spread of ideas or culture. </p><p>After finishing this, I am motivated to finally start Christakis’ next book, <i>Apollo’s Arrow</i>, which is about the COVID pandemic, again studying it through the lens of sociology and group dynamics. </p><p>A general takeaway point from this book, from my perspective as a psychiatrist, would be to even more strongly value an understanding of social and group dynamics in a person’s life, to understand the nature of connections, connections of connections, group memberships, friendships, communication, and community, in much greater detail, as a component of understanding psychiatric phenomena and strategizing about therapeutic help, rather than stopping at the level of individual psychology only. </p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-15653672216922318342022-03-23T16:13:00.001-07:002022-03-23T16:13:41.915-07:00The Urge: Our History of Addiction, by Carl Erik Fisher<p><a href="https://www.amazon.ca/Urge-Our-History-Addiction/dp/073523700X" target="_blank"><i>The Urge: Our History of Addiction</i>, by Carl Erik Fisher</a> is a good book about the history of addiction, weaved together with a story of the author's own alcohol use problems and rehab. </p><p>The original use of the word "addiction," as Fisher shows us, was more general or broad, referring to situations we might now consider "behavioural addictions," habit problems, or just very strong preferences. This usage of the word, despite objections from some addictions specialists, may be most accurate from a neurobiological point of view, according to recent evidence. </p><p>He emphasizes many times how addictive phenomena lie on a continuum of severity in different people and within the same person at different points in time, and are influenced strongly by social, economic, and political circumstances. For some people addiction is a symptom of, or a means of coping with, horrible environmental circumstances. For others, it is a trap leading to loss of control even when environmental circumstances have improved or are normal. </p><p>Understanding and helping addiction problems has had an interesting history, with some compassionate medical and community help approaches evolving since the 1800s, but often interrupted or negatively influenced by social factors such as stigma or criminalization. </p><p>I agree with his conclusions, that addiction treatments need to be individualized, and that there can be various different causes or problems which underlie addiction for different people. AA or other 12-step groups can be valuable for many people, but this is not the only effective approach. Other group styles, such as the "SMART" program, can be preferred. Abstinence-based models of treatment may be preferred or necessary for some people, but for others it is effective to aim only for moderation without abstinence. Some people do not want or need peer or group support, and prefer one-on-one counseling. Others may prefer to manage their addictive problems alone; Fisher cites data showing that many people with addictions can recover without any therapeutic treatment at all. There are medications that can help, such as naltrexone. </p><p>Fisher acknowledges the importance of loss of control in addiction, and of the phenomenon of denial which delays or prevents many people from seeking help. </p><p>There have been big problems in addiction management that must change. First, there needs to be much more availability of addiction treatment programs for those who desire or need them. There should not be economic biases causing some groups to have less access than others. For opiate addiction in particular, there needs to be easier availability of methadone or buprenorphine maintenance for those who would like to try this approach. Harm reduction strategies in general have a very strong evidence base. </p><p>Second, public health interventions can be simple and effective, such as restricting the advertising or marketing of addictive products (such measures have been useful for reducing tobacco use in the population). There is still a big corporate influence on policy (from the alcohol or gambling industries, for example), which should not be allowed to continue. Third, there should be less focus on prohibition and criminal punishments, which in general have often made addiction problems worse, particularly by focusing expensive social resources on law enforcement rather than on community improvement and rehabilitation. </p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-39229198569840666112022-03-04T11:36:00.005-08:002022-03-11T09:52:37.047-08:00Belief Bubbles, Delusions, and Overvalued Ideas<p> One of the most important posts that I've written on my blog, in my opinion, has been "<a href="http://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html" target="_blank">Political polarization, propaganda, conspiracy theories, and vaccine hesitancy: a psychiatric approach to understanding and management</a>," initially published on September 1, 2021 but edited and updated numerous times since then. I check periodically how many people visit my blog, and I see that there are relatively few. If I could recommend just one of my articles to be published widely, it would be that one, since I think it is so important regarding individual and public mental and physical health issues in the world today. </p><p>The topics in that post focused on misinformation, propaganda, and deluded beliefs regarding the pandemic. </p><p>I frequently see similar issues at play in my daily work as a psychiatrist. </p><p>What causes fixed false beliefs? When would we call these "delusions" as opposed to overvalued ideas, or simply examples of erroneous thinking? </p><p>In psychotic states, the mind creates delusional beliefs without any reinforcement from a social community. This is caused by genetic factors, abnormalities in dopamine circuitry in the brain, magnified by psychosocial stress. As a result of the individual nature of psychotic illness, fellow members of the community can easily recognize the problem, and hopefully attempt to help. Such delusional beliefs are unlikely to spread in a social network. </p><p>There are examples of "shared psychotic disorders" in which an individual may have a primary psychotic illness, leading to close associates or family members adopting the same beliefs. But this is a relatively rare phenomenon. </p><p>A much more challenging problem occurs when false beliefs are spread in a social network. In this case, the beliefs may or may not have anything directly to do with the other beliefs or values within the social network . For example, extremist anti-vax beliefs are more common in particular religious or political groups, but vaccines have very little to do with theology or ideology. The process of ideological spreading in these cases is analogous to what Dawkins calls a "meme", though driven not by a natural selection process, but by a process akin to "sexual selection." In "sexual selection" traits such as peacock feathers propagate together with traits for recognizing and desiring the initial trait. For example, bird songs or feather colours are sexually selected due to the song or feather itself and the desire of other birds to recognize or value the song or feather. The song or feather comes to be an emblem of the species itself, rather than having other adaptive or communicative value (bright or decorative feathers do not lead to improved flight). Many examples of "mass delusion" such as anti-vax beliefs are likely similar; they have become emblems of membership in particular religious or political communities, which are found to be attractive by those within the communities, even though the beliefs are harmful to the group and contrary to the group's positive values. In this way, they are ironically similar to a virus: anti-vax dialogue and behaviour has become much more prevalent or even dominant in these religious or political groups, such that the groups' core values or policies are utterly neglected or contradicted. People from outside these groups would be disgusted by this phenomenon, leading to the groups becoming more insular, decried as hypocritical and immoral by outsiders, and obviously less able to offer charismatic outreach. In particular, values such as love, care, and freedom are profoundly contradicted by beliefs which decry life-saving public health protections. </p><p>Anti-vaccine and other "anti-public-health" propaganda is extremely harmful to society; it causes needless suffering, death, and economic hardship. The propagation of such ideas is shockingly dissonant with the core values of many of the groups associated with it. Disparate groups have endorsed such beliefs, leading to an unusual medley of fundamentalist religious groups, biker gangs, and racist groups joining in protests or defiance against vaccine and public health mandates. </p><p>It is very difficult to address or improve problems of this sort. When beliefs have been adopted as an emblem of a tight-knit social community, they are strengthened greatly by group association, and group members will defend these ideas from outsiders, almost like people might defend their home or family from invaders. These ideas become adopted as almost sacred core values, as though the beliefs (in this case about vaccination, wearing masks, etc.) were enshrined in a sacred religious text such as the Bible. </p><p>As with psychotic illness, there are degrees of severity. In mild cases of psychosis, affected people may be able to question their beliefs or request help; in more severe cases they have the insight to know that others would see their beliefs as paranoid, so they are able to refrain from discussing their beliefs, even though they still are fully believing their delusions. In more severe cases, people will start expressing, or casually "slipping in" the paranoid ideas in casual conversation (even with a psychiatrist) almost as though to test or evaluate the conversational partner, perhaps to seek a kindred believer or to be warned about a "nonbeliever." As with some examples of religious practice, "believers" may seek to attempt to "convert" others as though expressing the delusion has a sacred value. </p><p>I think it's pretty important as a psychiatrist to gently inform people that there are delusional beliefs going on. With entrenched delusions this may need to be done with the greatest care and empathy, but I do think it needs to be discussed at least a little bit, otherwise there is a risk of the person feeling their delusions have been endorsed. In the case of socially-spread overvalued ideas, it's a more difficult process to address in a therapy setting. In some cases the discussion risks spreading to a focus on ideas concerning religious or cultural beliefs, which are generally off-base. But when new "contagious" beliefs are spreading in a social network, straddling the boundary between a "cultural belief" and a "delusion," unbridled and harmful spreading is more likely. This is similar to the epidemiological dynamics of COVID itself: COVID is deadly, but its death rate is low enough to insert itself into populations in a seemingly harmless way, until a few weeks or months later when hospitals and ICUs are overflowing with severe cases. Ironically, if the mortality rate of COVID was much higher, it might be easier to control at a community level, because there would be more unity of action.</p><p>As I discussed in my "political polarization" post, there are many social actions that can help this situation. It is most valuable for rational, persuasive pro-vaccine, pro-public-health members of affected social groups (such as religious leaders, truckers, political leaders on both sides of the political spectrum, police, military personnel, alternative health care providers, and people formerly part of the anti-vax movement but who have changed their position) to speak out as educators and leaders. Scientists and public health officials, etc. should still do their best to offer effective public communication, with efforts to reach out to these groups, but they are less likely to have a substantial impact in these communities, since they will be dismissed or derided as threatening outsiders. Some of the communicative efforts from scientific leaders could at least involve building a better rapport with disparate communities, so that scientists would not be seen as elitist or part of an "ivory tower," out of touch with the rest of the population. Meanwhile, there is evidence that the rest of us should continue to do our best to combat the spread of misinformation, and to do our best to speak the truth, rationally, resisting the urge to give up in frustration. </p><p><br /></p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com2tag:blogger.com,1999:blog-6886575137375451769.post-66702664248722106452021-12-10T10:12:00.023-08:002022-05-03T14:16:52.221-07:00Recommended Reading 2021: an updated book list <p> Updated list of interesting books that I encourage checking out:</p>
<p><br /></p>
<p>
Steven Pinker:
<a href="https://www.amazon.ca/Better-Angels-Our-Nature-Violence/dp/0143122010/ref=sr_1_2?keywords=steven+pinker+angels&qid=1639156459&sr=8-2" target="_blank"><i>Better Angels of Our Nature: Why Violence has Declined </i></a> (2012)
</p>
<p>
Steven Pinker:
<i><a href="https://www.amazon.ca/Enlightenment-Now-Science-Humanism-Progress/dp/0143111388/ref=sr_1_1?keywords=steven+pinker+enlightenment&qid=1639156636&sr=8-1" target="_blank">Enlightenment Now</a> </i>(2019)
</p>
<p>
Hans Rosling:
<i><a href="https://www.amazon.ca/Factfulness-Reasons-World-Things-Better/dp/1250107814/ref=sr_1_1?keywords=factfulness&qid=1639156713&sr=8-1" target="_blank">Factfulness</a> </i>(2018)
</p>
<p><br /></p>
<p>
These three books, aside from being enjoyable and informative to read, also
give a message of hope, that there are things actually getting better in the
world, thanks to science, reason, and progress in justice, despite the world's
many ongoing gravely serious problems. They do not discount the
gravity of ongoing problems, but are a nice antidote for the resignation or
despair that can set in when faced with an onslaught of depressing daily news
about politics, environment, disease, war, etc.
</p>
<p>--------------------------</p>
<p>
Thomas Picketty:
<i><a href="https://www.amazon.ca/Capital-Twenty-First-Century-Thomas-Piketty/dp/0674979850/ref=sr_1_1?keywords=piketty&qid=1639156980&sr=8-1" target="_blank">Capital in the Twenty-First Century
</a></i>(2017)
</p>
<p>
This is a masterpiece, a historical analysis of wealth disparity and taxation,
making an extremely compelling moral and economic case for introducing a
better progressive system of wealth, income, and estate taxation. This
is not "socialist" as Picketty does not advocate state control of the market,
but does advocate for fair regulation and progressive taxation in order to
prevent regression to a pre-20th century societal style of wealthy aristocrats
idly owning an increasing majority of national wealth, while most others work
hard to hover near the poverty line, with little chance to progress beyond
that level. I find this issue of great importance as a psychiatrist,
because it touches on the issue of managing poverty and fairness, permitting
access to personal and community growth, in a way that is grounded in freedom
and justice.
</p>
<p>-------------------------</p>
<p>
Richard Prum:
<i><a href="https://www.amazon.ca/Evolution-Beauty-Darwins-Forgotten-Theory/dp/0345804570/ref=sr_1_1?keywords=the+evolution+of+beauty&qid=1639157362&sr=8-1" target="_blank">The Evolution of Beauty</a> </i>(2018)
</p>
<p>
Almost every book or documentary I've seen dealing with evolutionary biology
has emphasized natural selection as the main force of evolutionary change,
while often only mentioning sexual selection in passing. This book deals
with sexual selection, a phenomenon first described by Darwin but relatively
neglected in the next century. This is of interest because Prum argues
that sexual selection leads to a type of "co-evolution" in which esthetic
choices lead to changes in culture which often improve autonomy, especially
for females. As a psychiatrist I think it is interesting as another
emphasis of the cultural and biological foundations of esthetic choice-making
in humans. At the very least, interesting ideas to think
about.
</p>
<p>-------------</p>
<p>
Daniel Kahneman:
<i><a href="https://www.amazon.ca/Thinking-Fast-Slow-Daniel-Kahneman/dp/0385676530/ref=sr_1_2?keywords=kahneman&qid=1639157807&sr=8-2" target="_blank">Thinking: Fast and Slow</a></i> (2013)
</p>
<p>
Daniel Kahneman:
<i><a href="https://www.amazon.ca/Noise-Human-Judgment-Daniel-Kahneman/dp/0316451401/ref=sr_1_1?keywords=kahneman&qid=1639157881&sr=8-1" target="_blank">Noise: A Flaw in Human Judgment</a> </i>(2021)
</p>
<p><br /></p>
<p>
Kahneman's books are must-reads for any person. His 2013 book is a
masterpiece, an introduction to the subject of biases which influence human
judgment. I can't emphasize enough how important this subject is in the
modern world, where our judgments are constantly influenced by factors within
ourselves, and from external sources, which we are not aware of. It is
of relevance in psychiatry or mental health because of the importance for
wellness to make healthy, well-informed, unbiased judgments, and because of
the exaggeration of biases caused by depressive or anxious states.
</p>
<p>-------------------</p>
<p>Jonathan Haidt:
<i><a href="https://www.amazon.ca/Righteous-Mind-Divided-Politics-Religion/dp/0307455777/ref=sr_1_1?crid=24O0LTMMVL4ED&keywords=haidt+the+righteous+mind&qid=1639159359&sprefix=haidt%2Caps%2C221&sr=8-1" target="_blank">The Righteous Mind: Why Good People are Divided by Politics and
Religion</a></i> (2013)</p>
<p>
This is an incredibly important book, of the greatest relevance for the
problems we face in the world in the past few years. It is a
compassionate look at the psychology underlying political, ideological, and
religious difference, with recommendations of ways we can mend these
differences and reduce polarization.
</p>
<p><br /></p>
<p>-------------------------</p><p>Paul Bloom: <i><a href="https://www.chapters.indigo.ca/en-ca/books/against-empathy-the-case-for/9780062339331-item.html?s_campaign=goo-DSA_Books&gclid=EAIaIQobChMInb_0_LLn9AIVTx6tBh341AoHEAAYASAAEgJPIPD_BwE&gclsrc=aw.ds" target="_blank">Against Empathy: The Case for Rational Compassion </a></i>(2016)</p><p>This is a nice application of the psychology of bias, as described by Kahneman and others, to the practice of altruism and of caring for other people. Bloom is a brilliant Yale psychologist, initially from Montreal, who has shown that typical reflexive emotional biases can cause our altruistic behaviour to be surprisingly misdirected, or unfair to those who need it most. I don’t agree with all of his points, but I think this book is essential reading for a person interested in fairness, compassion, altruism, and justice. </p><p>—————————</p>
<p>
Nicholas Christakis,
<i><a href="https://www.amazon.ca/Blueprint-Evolutionary-Origins-Good-Society-ebook/dp/B07F67B9P4/ref=sr_1_4?keywords=christakis&qid=1639160200&sr=8-4" target="_blank">Blueprint: The Evolutionary Origin of a Good Society</a> </i>(2019)
</p>
<p>
Nicholas Christakis,
<i><a href="https://www.amazon.ca/Apollos-Arrow-Profound-Enduring-Coronavirus/dp/0316628212/ref=pd_bxgy_img_1/130-4561835-2545929?pd_rd_w=FvJfF&pf_rd_p=8c482a45-7c0f-409b-937c-741a67b11a67&pf_rd_r=RC349CD7ZGAT8GWBRG70&pd_rd_r=476d04e2-5d08-4e57-98e6-264aceeb164c&pd_rd_wg=aZtLY&pd_rd_i=0316628212&psc=1" target="_blank">Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the
Way we Live</a></i> (2020)
</p>
<p>I'm pleased to have discovered Christakis. <i>Blueprint </i>is a great sociological study of group dynamics-- interesting descriptions of groups surviving on their own in remote locations or after shipwrecks; or groups separating themselves from the rest of society, including small religious enclaves, and an interesting introduction to the mathematical structure of group dynamics in communities. </p><p><i>Apollo's Arrow </i>is a nice review of the sociology of pandemics, including those from long ago as well as Covid since 2020. The only critique is that it was published in late 2020, which is only about halfway through the Covid story as we know it today. </p>
<p>-----------------------------</p>
<p>
Robert Sapolsky,
<i><a href="https://www.goodreads.com/en/book/show/31170723-behave" target="_blank">Behave: The Biology of Humans at our Best and Worst</a> </i>(2017)
</p>
<p>
Of course, on a psychiatrist's reading list, pretty important to include a
title on neuroscience! This is a great, detailed but readable
introduction to how the brain works, with a particular focus on neuroanatomy
and neuroendocrinology. There are a few shortcomings, but overall highly
recommended. Everyone should be introduced to this subject
matter.
</p>
<p>-------------------------------</p>
<p>
Maria Konnikova,
<i><a href="https://www.amazon.ca/Confidence-Game-Fall-Every-Time/dp/0143109871/ref=nodl_" target="_blank">The Confidence Game: Why We Fall for it, Every Time</a></i> (2017)
</p>
<p>
Konnikova is a psychologist who has studied con artists. This book is an
entertaining story of spectacular con artistry over the past century, with
some commentary on the psychology of con artists and their victims. This
subject is incredibly important today, because we are not only prone to being
conned by financial scams, online fraud, etc. but also in choice of political
leaders, as we have seen beginning in 2016. We see that con artists can
often be so persuasive that even after they are exposed and prosecuted,
victims sometimes still support them, because of how effective the con was,
and how humiliating it could be for a victim to admit or understand what
happened. Once again, we see this in particular political leaders since
2016.
</p>
<p>——————————-</p>
<p>
Ellen Peters,
<i><a href="https://www.amazon.ca/Innumeracy-Wild-Misunderstanding-Misusing-Numbers/dp/0190861096/ref=nodl_" target="_blank">Innumeracy in the Wild: Misunderstanding and Misusing Numbers</a></i> (2020)
</p>
<p>
Ellen Peters show us the extent to which the majority of people have poor
understanding of mathematics, even at a basic level of interpreting simple
data. This is of great importance because so many of the decisions we
have to make in the world today, both on a personal and a political level,
require clarity of understanding of issues that are best described in a
quantified way, and an ability to understand and question data
intelligently.
</p>
<p>———————————</p>
<p>
Judea Pearl,
<i><a href="https://www.amazon.ca/Book-Why-Science-Cause-Effect/dp/046509760X/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=1639342638&sr=1-1" target="_blank">The Book of Why</a></i> (2018)
</p>
<p>
This is a book about the science of causality, which could be considered a
branch of statistics. This subject is important in order to understand
information in such a way as to guide decision making rationally, and to
overcome biases. The first half of the book is most interesting, with a
survey of the history of statistics, stories of particular important theorists
whose ego unfortunately slowed down progress in the field (a common theme in
history!), and with an introduction to thinking of problems through a lens of
causality. There is some discussion of the theory underling AI
(artificial intelligence) which is going to be an extremely important area in
all of our personal and cultural lives, from this point forward in history.
The second half of the book gets more technical, and in my opinion this
material would be better presented in a textbook with worked examples, rather
than in an ordinary text.
</p>
<p>———————————-</p>
<p>
John Kelly,
<i><a href="https://www.amazon.ca/Great-Mortality-Intimate-History-Devastating/dp/0060006935/ref=sr_1_1?gclid=Cj0KCQiA2NaNBhDvARIsAEw55hhav4JKpZdYC0taOj5W9zRjoRkbd6QE4PntEGA_RKPPCV1mpMu8EAQaAj19EALw_wcB&hvadid=230007511081&hvdev=c&hvlocphy=9001559&hvnetw=g&hvqmt=e&hvrand=6495046225640455626&hvtargid=kwd-492251943552&hydadcr=22433_10105321&keywords=the+great+mortality&qid=1639353908&sr=8-1" target="_blank">The Great Mortality: An Intimate History of the Black Death, the Most
Devastating Plague of All Time </a></i>(2006)
</p>
<p>
This is an exploration of a very important historical event, arguably the
worst thing ever to have happened in human history. The Black Death,
starting in 1347, killed, quite suddenly, up to 50% of the population.
The scale of this pandemic was hellish beyond anything we can imagine.
It is obviously relevant in the context of our current pandemic. Even
though the Black Death occurred over 650 years ago, we still see the same
extremities of human behaviour showing itself during our present pandemic,
despite all the wisdom we've accumulated over the centuries. This
includes fanatical groups with bizarre theories of causation about the
problem; racist extremists who blamed minority groups for the disease, leading to
mass killings; and some heroic figures who tried to help, at tremendous risk
to themselves.
</p>
<p>------------------------------------</p>
<p>
Robert Cialdini,
<i><a href="https://www.amazon.ca/influence-Psychology-Robert-Cialdini-PhD/dp/006124189X/ref=sr_1_1?crid=3HXELHGVP2LMX&keywords=influence+the+psychology+of+persuasion&qid=1639354786&sprefix=influence%2Caps%2C284&sr=8-1" target="_blank">Influence: The Psychology of Persuasion</a></i> (2006)
</p>
<p>
Cialdini is a psychologist who specialized in persuasion, initially by
studying the tactics used by successful salesmen. He identifies six
major factors increasing the effectiveness of persuasive communication.
This subject matter is relevant for scientists, community leaders, and health
care professionals, in order to convey health information in a way which is
more likely to lead to positive change. Obviously, this is incredibly
relevant during the pandemic. The other reason to be acquainted with
this area is to be empowered to identify unwelcome persuasive techniques being
used by marketers, politicians, or pundits, to avoid being conned or
manipulated. Unfortunately, I see that Cialdini's subsequent work
has been of similar material directed mostly towards businesses and marketers,
without further major contribution as a psychologist. But this initial book
remains as a must-read.
</p>
<p>-----------------------------------</p><p>Richard Dawkins: <i><a href="https://www.amazon.ca/Selfish-Gene-40th-Anniversary/dp/0198788606/ref=sr_1_1?crid=3E1IITC7J85IZ&keywords=selfish+gene&qid=1639158551&sprefix=selfish+gene%2Caps%2C215&sr=8-1" target="_blank">The Selfish Gene </a></i>(1987)</p><p>Richard Dawkins: <i><a href="https://www.amazon.ca/Ancestors-Tale-Pilgrimage-Dawn-Evolution/dp/0618005838/ref=sr_1_2?keywords=ancestors+tale&qid=1639158588&sr=8-2" target="_blank">The Ancestor's Tale</a> </i>(2004)<i> </i></p><p>Richard Dawkins: <i><a href="https://www.amazon.ca/God-Delusion-Richard-Dawkins-ebook/dp/B003JTHWJQ/ref=sr_1_2?keywords=dog+delusion&qid=1639158673&sr=8-2" target="_blank">The God Delusion </a> </i>(2006)</p><p><br /></p><p>Dawkins is one of the greatest science writers. The subject of evolutionary biology should, in my opinion, be familiar to everyone. This is not a dry subject--Dawkins' stories of animal life cycles are often fascinating and beautiful, akin to watching an Attenborough nature documentary. And the scientific thinking is often spectacularly incisive. In my opinion, Dawkins' often scathing critiques of religion are really critiques of fundamentalism in all its forms, and in my opinion are really just challenges to people of faith to be able to accommodate scientific understanding of the world into a belief system which is not rigid or unjust. This is relevant for psychiatry and mental health, both because evolutionary factors obviously contribute to the existence of all human traits and problems, but also because the subject matter itself, and the way in which it has been received by society in the past two centuries, has been impacted by psychological factors including ingroup biases. </p><p>I specifically mention <i>The Ancestor's Tale </i>because at the time I read it, it struck me as my favourite Dawkins book. </p><p>--------------------------</p><p>Steven Pinker: <a href="https://www.amazon.ca/Rationality-What-Seems-Scarce-Matters/dp/0525561994/ref=sr_1_1?crid=193AKTY6910AK&keywords=rationality+steven+pinker&qid=1645117946&sprefix=rationality+%2Caps%2C131&sr=8-1" target="_blank">Rationality: What it is, why it seems scarce, why it matters</a> (2021)</p><p>This book is nice review of other material that would be familiar if you've read some of the other books suggested here, such as by Haidt, Kahneman, and others. The genre is extremely important because our country and the whole world has been afflicted by waves of what Pinker calls "my-side-ism" or "motivated reasoning," driven by ingroup biases, tribalism, polarization, magnified by partisan news sources and misinformation. Pinker is always carefully rational, a pleasure to read, with measured optimism and suggestions of ways we can improve the dire problems we are facing. </p><p>--------------------------- </p>
<p>
<i><a href="https://www.amazon.ca/Astronomy-Today-8th-Eric-Chaisson/dp/0321901673/ref=sr_1_1?keywords=astronomy+today&qid=1639159604&sr=8-1" target="_blank">Astronomy Today</a> </i>
</p>
<p>
Steven Hawking;
<i><a href="https://www.amazon.ca/Brief-History-Time-Stephen-Hawking/dp/0553380168/ref=sr_1_2?keywords=hawking&qid=1639159794&sr=8-2" target="_blank">A Brief History of Time
</a></i>(1998)
</p>
<p>
I include these books here, because I just think everyone should know
something about astronomy and cosmology. It's a foundation of
understanding the universe and its history, it's wonderfully interesting, and
as a psychiatrist I find that it helps us to cultivate a sense of awe and
wonder about nature, the world, and reality, in a way which is deeply
enlivened by the science, and which does not require superstitions or mystical
thinking. In my opinion, it is an example of how scientific
understanding rather than pseudoscience deepens our experience of the world,
of nature, and of our humble role as humans in the universe around us.
I think it's pretty important to know what the sun is made of, how far
away it is, how old it is, what will happen to it in a few billion years, how
far away the stars are, where they came from, etc. For me it is an
intersection of the existential with the scientific, something of great
importance to psychological well-being.
</p>
<p>
I would like to add similar titles relating to science subjects such as
quantum mechanics, relativity, chemistry, paleogeology, and pure mathematics,
as I think these are also sublimely interesting, in the same way that
astronomy is, with similar existential impacts on mental health and
well-being.
</p>
<p>——————————</p>
<p>Video Documentaries</p>
<p>
All of
<a href="https://www.imdb.com/name/nm0041003/" target="_blank">David Attenborough’s nature documentaries</a>
are, in my opinion, essential as part of enjoying nature and understanding the
world. Starting with <i>Planet Earth</i>, in 2006, the photography
is spectacular. A great way to learn, to be inspired, to enjoy nature,
and hopefully to be motivated to do more to protect our world’s environment.
I consider an appreciation and personal experience with nature to be an
important component of maintaining good mental health. Another reason to watch Attenborough is because he is one of the great people, one of the great souls, of the past hundred years, in terms of character, integrity, values, and intellect. </p>
<p>
<a href="https://en.wikipedia.org/wiki/Cosmos:_A_Spacetime_Odyssey" target="_blank">Neil deGrasse Tyson’s 2014 remake of Carl Sagan’s </a><i><a href="https://en.wikipedia.org/wiki/Cosmos:_A_Spacetime_Odyssey" target="_blank">Cosmos</a> </i>series is another great documentary looking at the history of science, with a
particular personal look at interesting people, many of whom you might never
have heard of, who made great contributions to understanding and improving the
world.
</p>
<p>
<i><a href="https://www.imdb.com/title/tt10810430/" target="_blank">The Mind, Explained</a> </i>is a good series of short documentary episodes (20 minutes each) looking at
particular aspects of how the mind works (including subjects such as anxiety,
focus, attention, etc.). I’m impressed how much information they are
able to pack into such brief episodes. They might not always give a full
picture of each issue, but are a great introduction.
</p>
GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-54169319403909411872021-09-01T12:26:00.155-07:002023-01-24T21:31:47.138-08:00Political polarization, propaganda, conspiracy theories, misinformation, and vaccine hesitancy: a psychiatric approach to understanding and management<p class="MsoNormal" style="margin-bottom: 12pt; text-align: left;"><span style="font-family: inherit;"><i><span lang="EN-US">I initially published this post in September 2021, with some additions or editing every month or two since then. </span></i></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;"><i><span lang="EN-US">If you don't have time for a longer
read, I encourage skipping ahead to the end, where I discuss ideas about what
we can do about the problem of vaccine refusal. </span></i><span lang="EN-US"><o:p></o:p></span></span></p><p style="text-align: left;"><b><span style="font-family: inherit;">Introduction</span></b></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Political polarization, propaganda,
and conspiracy theories have caused the world great harm in the past few years.
A related problem has come up recently, with a significant minority of
people refusing COVID-19 vaccination, leading to the pandemic lasting much
longer, claiming many more lives, depleting and exhausting workers in the
health care system, and causing much more economic damage.<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">Another round of this came up in Februrary 2022, with convoys of protesters rallying supporters to challenge vaccine mandates and other public health measures. Protests of this sort are demoralizing and infuriating to those who are trying to help. It is like a town threatened by a giant forest fire, with burning embers blowing into the neighbourhood, but protesters tired of restrictions intimidating the firefighters, surrounding the fire stations with horns blaring (waking tired families and children trying to sleep nearby), and demanding to reclaim their right to have open fires. </p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;">In this post, I will explore the
psychological and social factors contributing to these problems, with
suggestions of things that individuals, community organizations, companies,
church groups, and governments can do to help. </span></p><p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: inherit;">For a brief video introduction to this topic, I recommend a recent short Netflix documentary, <a href="https://www.imdb.com/title/tt15978220/" target="_blank"><i>The Mind: Explained</i>, the episode called <i>"Brainwashing." </i></a> </span></p><p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;">A highly recommended book about how to communicate effectively with people having extremely polarized or conspiratorial beliefs is <i><a href="https://www.amazon.ca/How-Minds-Change-Surprising-Persuasion/dp/0593190297" target="_blank">How Minds Change</a></i> by David McRaney (2022). </p><h1 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Polarization</span></b></h1><p style="text-align: left;"><span style="font-family: inherit;">It has become more common for people to hold extreme political views. There are increasingly hateful and intolerant attitudes towards political opponents. Many of us are familiar with <a href="https://www.pewresearch.org/politics/2014/06/12/political-polarization-in-the-american-public/" target="_blank">the 2014 study done by the Pew Research Center, showing this polarization gradually worsening in the U.S. since 1994</a>.</span></p><h1 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Propaganda</span></b></h1><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Propaganda is false, exaggerated, or
misleading information spread for political or manipulative purposes. Many
large news organizations in the U.S. support a particular political party,
leading to unprecedented exposure to biased information consumed by nearly half
the population. Social media sites such as Twitter and Facebook often lead
people to obtain information only from like-minded others. Not only does this
lead to extreme bias, it also builds a community of online friends or followers
who "egg each other on," ideologically or personally, while denigrating
opponents often in a mocking or hostile way. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Beginning in March 2022, the world has once again seen the most horrific propaganda of all, that which persuades an entire nation to support a war against its neighbour, while preventing its citizens from seeing or understanding the atrocities being committed. </span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><b><span style="font-family: inherit; font-size: small;">Conspiracy Theories</span></b></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Conspiracy theories have become more
common and more bizarre, often associated with ideological positions or a
particular political party. While most of us have had a sometimes amused
tolerance for people holding these beliefs, conspiracy theorists are now more
organized, can magnify and spread their ideas using social media, and have
managed to influence public policy to some degree. I am aware of people in
public positions who seriously believe that COVID-19 vaccines contain
microchips used to track people, and that Bill Gates is somehow responsible for
this. Others believe the moon landing was faked, or even that the earth is
flat. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">Ideas of this sort are now very prevalent, with social media and other news sources contributing to their spread. Such misinformation can often be presented in a professional manner, as though it is valid documentary reporting. This attracts many followers who then continue to spread these ideas. </p><h2 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Anti-Vaxxers</span></b></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">We are all weary of the COVID-19 pandemic.
Millions have died or suffered severe disease, and many others have had severe
financial losses. Many more are going to die. Most COVID patients will recover
fully, but a significant minority of survivors will have long-term health
consequences (so-called "long covid"), with symptoms such as chronic fatigue and respiratory problems. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">We have vaccines that can cause large reductions in pandemic-related severe disease and death. The rapid development and mass distribution of vaccines since 2020 is one of the most outstanding scientific achievements in
history. We also have other knowledge about control of viral respiratory
disease, such as about mask usage, ventilation improvement, frequent home
testing, etc. which, together with vaccination, could have brought our countries out
of the pandemic much more quickly, with much less economic hardship, with much less psychological or social hardship, and with much less loss of life. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">No vaccine is perfect. There are small risks of side effects, including some rare serious problems; but these risks are much lower than risks caused by COVID itself. Also, very few vaccines lead to perfect "sterilizing" immunity. The main impact of COVID vaccines has been to reduce the probability of severe disease, hospitalization, and death from COVID, while having a much smaller effect to reduce milder disease. This protective effect also gradually fades over 6-12 months, though probably does not disappear entirely, requiring booster vaccinations at this point, while new COVID waves are continuing. There is accumulating evidence that the vaccines also reduce the probability of developing "long covid." Because of high vaccination rates in Canada, especially in older cohorts, we narrowly averted the disastrous hospital and critical care overflow that would otherwise have occurred in the waves before 2023. Vaccine development, like any other human process, is never perfect either; there may be many steps of the COVID vaccine development story, such as political or economic issues, to criticize in some way. But this should not distract us from appreciating how these vaccines have saved more lives, prevented more years of life lost, than almost any health intervention in our history. </p><p style="text-align: left;">
<span style="font-family: inherit;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">But a significant minority of people refuse to
be vaccinated, refuse to use masks, and even refuse to acknowledge that the
pandemic is a serious problem. </span><a href="https://www.forbes.com/sites/roberthart/2021/09/05/by-the-numbers-whos-refusing-covid-vaccinations-and-why/?sh=7cc6eae552ea" target="_blank">Those who refuse are more likely to belong to particular political or religious groups, are more likely to watch particular news channels, and are more likely to have less education</a>. </span></p><p style="text-align: left;">Unvaccinated people from 2020-2022 were much, much more likely to require hospitalization, including intensive care. At this point, recipients of recent vaccine boosters continue to have a much lower hospitalization rate. From 2020 to early 2022, hospitals all over the world were filled to capacity, and beyond, by unvaccinated COVID patients. If everyone had been vaccinated, there would still have been hospitalized patients (since the vaccines are not perfect), but there would never have been overflow or a major strain on the health care system. Because of inadequate vaccination rates, everyone else (vaccinated or not) had much more limited access to medical services, including elective surgery and ICU. Because of people who refused vaccination, it became much more dangerous for all of us to have a heart attack or a case of appendicitis. Furthermore, the staff in the hospitals were overworked to the point of exhaustion, the horror of the situation magnified further by the needlessness of it. Vaccine refusal caused extreme harm to health care workers all over the world, and led the health care system itself to the brink of total breakdown. </p><p style="text-align: left;">A new horrific development following all of this, is the increasing prevalence of refusal to get vaccines against previously eradicated diseases such as polio and measles. If this continues, it is likely that we will once again see children needlessly paralyzed or killed from preventable infectious diseases, for the first time in decades. </p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Anti-vax beliefs and other bizarre
beliefs about COVID can be shockingly extreme and unchangeable: we have many
examples of people remaining convinced that COVID is a hoax, right up to the
moment of their death from respiratory failure in an ICU bed. Medical
colleagues of mine, working in rural areas with low vaccine uptake, have
described many stories like this during the pandemic. There are horrifying
examples of hospital workers being threatened or attacked by people convinced
that the medical care is somehow harmful. There are examples of public health officials who are afraid to advocate for vaccines, due to having received intense harassment and even violent threats. </span></p><h1 style="text-align: left;"><b><span style="font-family: inherit;"><span style="font-size: small;">Alternative Medicine</span> </span></b></h1><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">In many cases, bizarre beliefs about
COVID are an extension of unusual ideas about health care. The alternative medicine industry has a market size of about $100
billion per year. Parts of this industry harmlessly promote healthy lifestyle
habits, nutrition, or evidence-based care, but there are a lot of
exaggerated or false claims made in the sales of alternative medical services
and products. Alternative health care can involve bizarre or even delusional
beliefs about illness. There can be distrust
for evidence-based medical science, and loyal allegiance to the alternative
practitioners despite harmful practices. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">I realize it is excessive and unfair to simply condemn alternative medicine. Many people have had bad experiences of conventional health care. And many people have experienced kindness, generosity, support, and helpful guidance from alternative practitioners. Many alternative practitioners have wisdom in particular rehabilitative techniques, and some knowledge of conventional medicine. Some supplements or alternative remedies do have a reasonable evidence base, sometimes on par with standard treatments. Conversely, conventional physicians sometimes recommend treatments including prescription drugs or surgery which in some cases have a questionable foundation in evidence. </p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">Problems in modern medicine, including expense, access problems, or brief, impersonal clinical encounters, can feed some frustrated people's pursuit of alternative health care providers who may have more time for empathic support or apparent understanding. Unfortunately, this apparent understanding is often based on fictional beliefs couched in pseudoscientific language that can sound impressive or convincing.</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">There are frequent examples of misguided beliefs in alternative health care practice, particularly when the practitioners are marketing expensive products, pushing bizarre theories of causation using expensive, unnecessary pseudoscientific testing procedures, fomenting distrust in conventional medicine, or discouraging patients or clients from seeking proven therapies, including medications or vaccines. </p><h1 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Con Artistry & Fraud</span></b></h1><p style="text-align: left;"><span style="font-family: inherit;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Many people with
strong opinions opposing vaccines, supporting quack treatments for COVID, or
supporting particular political leaders since 2016, have been conned -- that
is, they have been victims of fraud. They have been sold something that seemed
very attractive to them at the time, but the goods they've obtained are
worthless or harmful to themselves and others. But many people would feel an
embarrassing or humiliating injury to their pride to admit that they were
conned; so instead, they double down on their support for con artists
(including particular politicians) or quack remedies. </span></span></p><p style="text-align: left;"><span style="font-family: inherit;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">There is a fascinating
research literature on this subject. I would start with Maria Konnikova's book,</span> <i><a href="https://www.amazon.ca/Confidence-Game-Fall-Every-Time/dp/0143109871/ref=sr_1_1?dchild=1&gclid=CjwKCAjwk6-LBhBZEiwAOUUDpw1NXOi76CGyf3DMBBzllwdat_QGHAt4OaimxOHWMy5Dx_Vs8rEMMRoC_U8QAvD_BwE&hvadid=346555063198&hvdev=c&hvlocphy=9001559&hvnetw=g&hvqmt=b&hvrand=8571417401786238278&hvtargid=kwd-360668014214&hydadcr=27650_10600059&keywords=the+confidence+game+book&qid=1634499023&sr=8-1" target="_blank">The Confidence Game: why we fall for it...every time</a>.</i> <span>Her book is a series
of case studies of various types of spectacular con artistry & fraud, with
some discussion of the psychology underlying this. The next scholar to be
acquainted with is</span> <a href="http://www.brookeharrington.com" target="_blank">Brooke Harrington, a Dartmouth College sociologist</a>. I'm in the midst of reading through
this work. One of her questions has to do with justice: when should a person
who has been conned into doing something harmful be considered an offender requiring management in the criminal justice system, instead of only a victim
requiring compassionate care?</span></p><p style="text-align: left;"><span style="font-family: inherit;">I see these issues as closely tied
together, fed by the same underlying causes. Together they are driving people
and nations apart; they have caused needless suffering, death, and economic
hardship during the COVID pandemic, and have led to an unprecedented threat to
democracy in some parts of the world.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">These are not new problems: they have
been with us throughout history. Many of us associate propaganda with World War
II or the Soviet Union, not modern-day western democracies. Many of us
associate bizarre or erroneous beliefs about health with previous centuries, in
which people attributed disease to evil spirits, "excesses of bile,"
or an excess of blood in the body requiring treatment by bloodletting.
Unfortunately, bizarre beliefs about health are alive and well in modern
society. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It is crucial to understand and study
these problems, to know why they happen and what can be done to improve the
situation. A thorough analysis requires input from many fields, including from
historians, political scientists, sociologists, public health experts, and
psychologists. </span></p><h1 style="margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit; font-size: small;"><b>Myside Bias and Motivated Reasoning</b></span></h1><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">The most powerful factor, in my opinion, driving extreme political difference, extreme contrarian views about the pandemic, and "anti-vax" ideas, is what Steven Pinker, in </span><a href="https://www.amazon.ca/Rationality-What-Seems-Scarce-Matters/dp/0525561994/ref=sr_1_1?crid=193AKTY6910AK&keywords=rationality+steven+pinker&qid=1645117946&sprefix=rationality+%2Caps%2C131&sr=8-1" target="_blank">Rationality: What it is, why it seems scarce, why it matters</a> (2021),<span style="font-family: inherit;"> calls "myside bias," which then gives rise to so-called "motivated reasoning." This is the tendency to selectively attend to evidence which supports your pre-existing opinion, and to discount or ignore evidence which refutes your opinion. We are all prone to this. Your opinions, ideas, and beliefs about almost any issue can become associated with your identity, or your group, or your "side," with differences of opinion or contrary evidence representing some kind of a threat to your identity or values. Contrary evidence could even bolster your initial opinion further, almost as though your ideas are like a family or village being attacked by outsiders, leading to the community rallying and strengthening itself in response. Myside bias and motivated reasoning are greatly magnified in groups, and are caused or fueled by many of the factors which I will describe below. </span></p><h1 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Haidt: The Righteous Mind</span></b></h1><p style="text-align: left;"><span style="font-family: inherit;">I recommend reading </span><i style="font-family: inherit;"><a href="https://www.amazon.ca/Righteous-Mind-Divided-Politics-Religion/dp/0307455777/ref=sr_1_1?dchild=1&keywords=the+righteous+mind&qid=1634502212&sr=8-1" target="_blank">Jonathan Haidt's book, The Righteous Mind: Why Good People are Divided by Politics and Religion</a>--</i><span style="font-family: inherit;">an excellent introduction to the
psychological factors which drive ideological differences. Haidt presents
himself as a moderate, or even a right-leaning moderate, which I think at the
very least should increase the readership and acceptance of this book across a
wider swath of the political spectrum.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h2 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Group Loyalty, Tribalism & Ingroup Bias</span></b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Haidt concludes that there is a human
trait of feeling loyal to groups; those groups with stronger or more frequent
loyalty traits among members will have advantages in survival and prosperity.
These groups will be more cohesive and better able to defend themselves against
outsiders. Some individuals value group loyalty above all other values; this is
partially a heritable trait. While loyalty is a virtue, it can also lead to
group members continuing or even fanatically increasing their loyal devotion
when the group is engaging in destructive or corrupt behaviours, even when such
behaviours are causing suffering to the group members themselves. The most
extreme examples of fanatical group loyalty are seen in cults, but variations
of this phenomenon are seen in daily life--in our families, our communities,
our sports teams, our religions, our political groups, and our nations. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">We have seen groups with extreme
opposition to COVID vaccination harassing exhausted health care workers outside
hospitals. Other
groups participated in 2021 in an unprecedented mob attack on a world
capital. Yet members of these groups previously may have valued ethical
principles, such as fairness, hospitality, helpfulness, and the rule of law.
Fanatical group allegiance can cause members to stray towards behaviour that is
contrary to the group's previous fundamental values. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Groups containing devoutly loyal
individuals are likely to have higher hostility to outsiders. Loyalty is a good
thing, but in the setting of polarization, propaganda, conspiracy theories, and
vaccine hesitancy, such unthinking, rigid loyalty is destructive to others and
destructive to the group members themselves. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">One of the suggestions Haidt has about
improving the problem of polarization is to maintain open dialogue, value the
principle of respectful debate, and foster friendships between people and
groups with different views. This would involve cultivating friendships between
those on the "left" and "right" of the political spectrum,
rather than devolving into hostility and becoming "enemies." But this
approach is not very helpful for dealing with fanatical or extremist groups; at
that point, friendly debate and social warmth will not be possible. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Unfortunately, many people holding
anti-vax beliefs and other strongly polarized positions have become too extreme
to allow respectful social connection. Yet there are many others whose
positions are moderate or ambivalent on these issues, including friends,
relatives, and neighbors of extremists. These are the people most amenable to
friendly engagement. <o:p></o:p></span></p><h1 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">The psychology of Conspiracy Theories</span></b></h1><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Lack of feeling in control, need for certainty</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">According to psychologists studying
this area, such as Van Prooijen and Douglas, conspiracy theorists often feel a
lack of agency or control, a need to make sense of complex or confusing
situations going on in life or in the world, a desire for being respected (but
not feeling that such respect is being given), and a need for certainty. Like
other delusions or overvalued ideas, conspiratorial thinking can give rise to a
feeling of relief, since there is an explanation about why a problem is
happening, even though the beliefs are fictional. The explanation, and the excitement
of being part of a select group of fellow believers, can give back some feeling
of control or certainty, a new sense of purpose. Other people's skepticism
could be perceived as a noble challenge to be faced. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">In helping this problem therapeutically, people trapped in conspiracy beliefs need to be shown personal respect and empathy, before any attempt to challenge or refute the false beliefs. </p><h4 style="text-align: left;"><span style="font-family: inherit;"> <b>Past Psychological Adversity or Trauma </b></span></h4><p style="text-align: left;"><span style="font-family: inherit;"><span>Prior psychological
hardship can sometimes drive people into a fearful, angry, hateful,
distrustful, or even paranoid state, with relief of ongoing psychological
stress found in narrow or rigid ideologies. Others, including refugees, may
have understandable reasons not to trust authorities or the government.</span> <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02462%EF%BB%BF/full" target="_blank">Neuroscientist Nafees Hamid has shown that experiences of social exclusion or discrimination contribute to radicalization.</a> In some cases, people with a history
of trauma or social rejection will find comfort, support, and belonging in
groups, such as churches and other community organizations, or extremist fringe
groups, even if these organizations are engaging in extreme polarization or
conspiracy beliefs. Members of these groups will naturally feel protective and
loyal towards the group and the group's beliefs, even if these beliefs are
causing harm to others. Therefore, some people develop anti-vax beliefs as a
result of their past trauma. </span></p><p style="text-align: left;"><span style="font-family: inherit;">The possibility of past trauma should always be
kept in mind when dealing with someone who is trapped in a conspiracy theory
mindset, with compassionate support offered, while always challenging the false beliefs. </span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h4 style="text-align: left;"><span style="font-family: inherit;"> <b>Personality Disorders</b></span></h4><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Personality disorders are common,
affecting several percent of the population, with milder symptoms affecting
many more. They cause lifelong disruption in relationships, behaviour, and
emotional stability; people with personality disorders often lack insight that
they have a problem. They are caused by a combination of hereditary factors and
long-term environmental adversity, such as childhood abuse. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Many conspiracy theorists have
narcissistic personality: they believe they are better, more insightful, more
informed, and more intelligent than other people, and that other people's
skepticism or rational arguments are signs of stupidity or inferiority. They
are unable to tolerate critical feedback. A softer type of narcissism is due to
unmet psychological needs to feel unique. When extreme narcissism is present in
a major world leader (as was the case starting in 2016) the entire group of
followers can adopt a narcissistic attitude, even if these traits would
normally be abhorrent, or entirely at odds with the group's previous religious
or ethical standards.<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Another factor is obsessive-compulsive
personality. Here, there is a rigid understanding of moral issues, a tendency
to be quickly and firmly judgmental, and a tendency to favour a polarized view
of issues. Again, such character traits would generally be difficult to tolerate,
but when present in a charismatic leader, they become endorsed by the group
itself. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Schizotypal and paranoid personality
disorders can also lead to conspiracy theory beliefs. With these personality
variants, people have low-grade delusional beliefs, magical thinking,
superstitions, and mild paranoia. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Finally, there is antisocial
personality, which leads to criminal behaviour, a lack of empathy, callous
disregard for others' suffering, manipulative behaviour towards others, and
compulsive lying, despite showing superficial charm. We have seen this factor
in a major political leader since 2016 and in many con artists profiting from
the pandemic. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">It should be noted that many conspiracy theorists do not have personality disorders. They have been swept into false beliefs due to misinformation and group allegiances, but are otherwise mentally well, sometimes well-educated and intelligent. </p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;">In order to help people who have personality disorders, compassionate understanding is required. There are various therapeutic systems that are useful, including CBT and DBT. Motivational interviewing techniques are also likely valuable. Sometimes medications could be of some modest help, at least to reduce specific symptoms such as anxiety, irritability, or low-grade paranoia. But in order for there to be any possibility of therapeutic help, there would need to be a safe, stable therapeutic frame. If a person is angry, volatile, or behaving dangerously, therapy is impossible unless there can be strict boundaries guaranteeing safety. For some people, these boundaries can be difficult or impossible to negotiate. Furthermore, many people suffering from personality disorders lack insight about their problems, and lack the desire to work on personal change in a therapy setting. The first step, in these cases, is often to impose limits on negative behaviour. This is why antisocial personality, for example, usually needs to be dealt with in the justice system. </p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Low Education, Innumeracy, & Lack of knowledge about the world</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Many conspiracy theorists have lower
levels of education, lower levels of intelligence, and a desire for accuracy or
meaning but a lack of the cognitive tools to find this rationally. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Innumeracy, a lack of scientific
knowledge, a lack of statistical knowledge, and a general lack of knowledge
about the world (for example, about history, culture, geography, or economics)
are significant factors contributing to poor personal and political decisions.
Even relatively intelligent people who are not broadly educated and informed
are more prone to ingroup biases and conspiracy theories. <o:p></o:p></span></p><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://www.amazon.ca/Innumeracy-Wild-Misunderstanding-Misusing-Numbers/dp/0190861096" target="_blank">Ellen Peters' book <i>Innumeracy in the Wild: Misunderstanding and Misusing Numbers</i></a> <span>is a detailed account
of poor mathematical skill in the population. She shows that only a small
minority of people have the skills needed to accurately interpret data, and to
correctly guide decision-making. As a result, most people either make erroneous
conclusions about data, or are dependent on others to interpret the data for
them. This makes people vulnerable to political influence from people who
misconstrue data. These influencers may have a deliberately manipulative goal,
or may be inadvertently misleading because they are also innumerate.</span></span></p><p style="text-align: left;"><span style="font-family: inherit;"><span>Without aptitude in
science, critical thinking, and reason, verbal ability alone does not protect
against being drawn into ingroup biases or conspiratorial thinking. Brittany
Shoots-Reinhard, Ellen Peters, and others have done a lot of work over the past
decade looking at the relationship between intellectual ability and
decision-making.</span> <a href="https://www.sciencedirect.com/science/article/pii/S0160289621000647" target="_blank">They recently published an article showing that people with higher verbal ability are more likely to have polarized responses to COVID-19, and to consume more polarized media</a>. Numerical skill did not predict higher polarization. </span></p><p style="text-align: left;"><span style="font-family: inherit;">This suggests that people often use
verbal intelligence, not to improve their reasoning or judgment, but to more
efficiently gather information that supports their pre-existing views, often
ideological and determined by ingroup biases. This is especially problematic at
a political level, since verbal intelligence is a more important skill than
numerical or scientific intelligence for a politician to be successful, or for
a celebrity to be influential. Therefore, we have people who are more likely to
have polarized beliefs holding positions of influence in society.</span></p>
<p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">If we see studies looking at the
effects of education on various psychological phenomena, beliefs, or
ideologies, we need to look at the type of education, with a particular look at
numeracy, logic, and reasoning skills, as well as the degree to which the
education contains subject matter about global issues, such as history,
geography, environmental science, economics, etc. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It should be noted that some individuals swept into conspiratorial thinking are intelligent and well-educated, and may have good analytical skills. They are influenced in their misinformation journey by other factors such as group allegiances. They may use their intellectual skills to spread misinformation more effectively, or even become seen as experts in their communities. </span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">The internet and news-bubbles</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">The internet provides a medium in
which people with extreme beliefs can easily form a community, which in
conjunction with traits for group loyalty, leads to them forming a strong
identity, an "us vs. them" mentality, and a resistance to rational
evidence from outside the group. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It is not enough to address this
problem on a one-on-one basis. There are political, economic, and educational
factors that are likely to help, on an individual and societal level. I'll come
back to this later. <o:p></o:p></span></p><h2 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Polarized News Sources & Propaganda</span></b></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Major news networks in various parts
of the world are deliberately propagating conspiratorial thinking and fomenting
polarization, catering to entrenched members of particular ingroups. These
networks have a profit motive, but the owners of the networks are also driven
by ideological beliefs to push this to further extremes. They are popular and
tend to have high ratings, especially when they are denigrating ideological
opponents in a dramatic way. These news networks lack any form of regulation
that prevents or limits harm (particularly in the U.S., after the removal of
the FCC fairness doctrine in 1987). <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Unfortunately, this has led to a steep
decline in the quality of news information that many people are consuming. Fans
also form an ingroup loyalty to the news service itself, such that mainstream
news may be deemed "fake" or biased. Many fans normally value
kindness, civility, education, politeness, the rule of law, balanced debate,
and religious beliefs rooted in love and compassion. But due to powerful
ingroup loyalty effects, the fans of these news services can embrace leaders or
pundits who are unstable, mean-spirited, and bullying.<o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It is important not to underestimate
how powerful and destructive propaganda can be; we have to realize that the
freedoms we have enjoyed in modern democracies can be quickly eroded under the
influence of powerful and well-financed propaganda efforts.<o:p></o:p></span></p><h1 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Cognitive Biases </span></b></span></h1><p style="text-align: left;"><span style="font-family: inherit;"><span>Cognitive biases are
"shortcuts" of thinking which allow us to make decisions more
quickly. These shortcuts can be useful, since we don't always have the time to
analyze every issue in our life in detail. But they can cause massive errors in
judgment, especially when we are not even aware of them. For an introduction to
this area of psychology, I recommend reading Daniel Kahneman: he is the one
psychologist to have won a Nobel Prize.</span> H<a href="https://www.amazon.ca/Thinking-Fast-Slow-Daniel-Kahneman/dp/0385676530/ref=sr_1_1?crid=S9STFWWATLCL&dchild=1&keywords=thinking+fast+and+slow&qid=1634502921&sprefix=thinking+%2Caps%2C237&sr=8-1" target="_blank">is book Thinking: Fast and Slow</a><i> </i>is fun to read and a summary of Kahneman's masterful research. I'd like to review some of the more common cognitive biases which perpetuate conspiratorial thinking, political polarization, and ideological extremism: </span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Reactance</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Reactance_(psychology)" target="_blank">Reactance</a> is the urge to do the opposite of what
someone wants you to do to resist a perceived constraint upon your freedom.
This has been one of the driving factors causing resistance to pandemic-based
public health restrictions and vaccinations, and which drives political
polarization more generally. A component of the reason many people are refusing
vaccination or defying pandemic restrictions is reactance or defiance, because
they don't like being told what to do, especially by people who they may see as
outside their ingroup.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Reactive Devaluation</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Reactive_devaluation" target="_blank">Reactive devaluation</a> is the tendency to devalue an idea or
a proposal, only because the idea comes from an opponent. So almost any idea
coming from a political opponent is reflexively devalued and opposed,
regardless of whether it is rational, correct, or helpful. If the same idea had
come from an ingroup member, it would be approved enthusiastically. Reactive
devaluation is profoundly self-destructive, not only to individuals, but to
entire nations. Unfortunately we see this daily in U.S. politics. Once again,
this is a reason many people oppose advice about vaccination or public health
measures.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Projection</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Projection is attributing to other
people the feelings or problems that you have yourself. For example, you may
feel angry with someone, but in a conversation you may have a strong belief
that it is the other person who is angry at you. While projection is not
typically considered a cognitive bias, it is a common psychological mechanism
among those with personality disorders, and among con artists. In the former
group, projection is often "unconscious"-- that is, people project
without even realizing they're doing it. It would be an issue to be addressed
in psychotherapy. In the latter group, it is used deliberately and consciously
as a manipulative technique. A well-known political leader after 2016 could be
seen to engage in both forms of projection every week--accusing others of bad
qualities or behaviours that were obviously his own. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">In a conversation with someone holding
fanatical anti-vax beliefs, you may encourage the person to be more informed of
evidence. But that person will project: they will claim that it is you who are
not aware of the evidence! They will deny being conned themselves, but will
claim that it is you who have been conned! Many anti-vaxxers are calling people
who follow public health guidelines "sheep," while it is the
anti-vaxxers who are often passively swept up in mindless herd behaviour. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">The Availability Cascade</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">The "availability cascade"
and the "illusion of truth effect" refer to the tendency to believe a
statement simply because it has been repeated frequently, or because it is easy
to understand, even though the statement is false. Many beliefs about the
pandemic, including those from conspiracy theorists or those from the
"anti-vax" groups, seem more believable simply due to frequent
repetition. The staggering daily abundance of frank lies emerging from a major
world leader from 2016-2020 were often not perceived to be lies by many people,
due to the frequency of exposure and the cognitive ease involved in processing
such statements. Or sometimes people did not care that they were lies.
Sometimes hateful speech is unfortunately too easy to process cognitively; it
may appeal to some deep, primitive component of our brains that is excited by
rage and deprecating others. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Confirmation Bias</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Confirmation_bias" target="_blank">Confirmation bias</a> is the tendency to only look
selectively at evidence which supports a previous position. This is driven
partly by powerful ingroup loyalty. Even when there is overwhelming evidence to
support a contrary position, people suffering from confirmation bias will often
remain stubbornly insistent that their own narrow, outdated, or invalid
research findings are correct.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Anchoring</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Anchoring_(cognitive_bias)" target="_blank">Anchoring</a> is the tendency to stick with an
initial position or estimate, or to be swayed by it strongly. If you have
started having a particular belief, there is a tendency to maintain it. This is
particularly true if there are personality traits valuing consistency,
commitment, and loyalty more strongly than traits valuing rationality,
compassion, or wisdom. One can become irrationally "loyal" to
initially-held ideas (such as about perceived harms of vaccines. or about
supporting a political leader who proves to be dangerously unstable) even if
these ideas are self-destructively inaccurate and contrary to other values.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">The Dunning-Kruger Effect</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect" target="_blank">The Dunning-Kruger effect</a> and the "overconfidence
effect" refer to a tendency for unskilled people to overestimate their
ability. We see this with many people making strong claims about specialized
areas (such as about epidemiology or virology during the pandemic) despite
minimal expertise. Unfortunately, such people can be quite persuasive, not
because of their expertise, but because they may be popular and have a loud or
persistent voice. On the other hand, many experts may have a rather modest
voice, and therefore their accurate messages are under-amplified.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> </span> <b style="font-family: inherit;"><span style="font-size: small;">Present Moment Bias</span></b></h3><p style="text-align: left;"><span style="font-family: inherit;">"Hyperbolic discounting" or <a href="https://en.wikipedia.org/wiki/Present_bias" target="_blank">present moment bias</a>, is the preference for immediate
payoffs relative to later payoffs. On an individual level, this reflects a lack
of self-control when faced by temptations. On a community level, it leads to
neglect of long-term societal needs, such as health, environmental integrity,
and education, in favour of immediate profits, even if such profits cause
severe long-term pollution, economic damage, or health damage. We see this in
the pandemic management as well--many are unwilling to make a short-term
sacrifice (such as maintaining social distancing or mask use) even though such
small sacrifices would lead to much larger longer-term gains in health,
prosperity, and survival for themselves, their families, and their communities.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">The Sunk Cost Fallacy</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;">The "irrational escalation" fallacy or <a href="https://en.wikipedia.org/wiki/Sunk_cost#Fallacy_effect" target="_blank">sunk cost fallacy</a> is the tendency to continue investment in a
decision that was made previously, despite new evidence that the decision was
wrong. Basically, it can be humiliating or injurious to pride to change one's
mind, so it can feel easier to hold onto one's mistaken views or decisions
rather than change them. </span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"><b><span> </span><span style="font-size: small;">Normalcy Bias</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;">The <a href="https://en.wikipedia.org/wiki/Normalcy_bias" target="_blank">normalcy b</a>ias is the refusal to plan for or react to
a disaster which has never happened before. If you live in an earthquake zone,
but have never seen or experienced an earthquake, you are less likely to
consider how to survive an earthquake or protect your home. It is much less
likely that you would undertake expensive large-scale disaster preparations.
This phenomenon has happened with COVID. Many experts were well-prepared; there
were even organized national preparations for pandemics, but some leaders of
major governments dispensed with all of this. The same problem is likely to
happen on a much worse scale regarding the ongoing degradation of the earth's
environment (disappearance of forests, mass extinctions, degradation of
fisheries, loss of wildlife habitats, and climate change). Once a disaster is
already underway (such as a house fire or earthquake or flood or pandemic or
climate change) it is much, much harder to reverse the situation; it becomes
much, much more expensive if not impossible to find a solution. Prevention is
much, much more affordable and efficient than expensive disaster management.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> </span><span style="font-family: inherit;"> </span><b style="font-family: inherit;"><span style="font-size: small;">The Ostrich Effect</span></b></h3><p style="text-align: left;"><span style="font-family: inherit;"> The ostrich effect is the tendency to
ignore an obvious negative situation. Once again, we saw this in a major
country upon the outbreak of COVID, and we see this with the environmental
& climate change problems. On a personal level, we see this in the tendency
for people not to seek medical help when they notice a serious problem, just
hoping that it will go away on its own. It is driven by some combination of
fear (in this case fear of the truth and fear of how difficult the treatment
might be), and magical thinking (i.e. somehow believing that if you don't look
at a problem, then it will go away).</span></p><h2 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">What to Do About Cognitive Biases</span></b></span></h2><p style="text-align: left;">Daniel Kahneman, the world's leading expert on cognitive biases, is doubtful that we can eliminate cognitive bias. Even people who are very well-educated about this issue are still prone to bias, just like everybody else. The best we can do is educate ourselves about this, be watchful for bias in ourselves and others, collaborate together to make better judgments, and be open to feedback from others on this issue. Whole communities should be open to critique from other communities, and not try to shut down debate or discussion. </p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><p style="text-align: left;"><span style="font-family: inherit;"> ------</span></p><h2 style="text-align: left;"><span style="font-family: inherit; font-size: small;"><b>Similarity to Addictions </b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Ideological bias and conspiracy
thinking have a lot in common with addictions, since they are harmful to
individuals and communities, but hard to escape. People often dabble with
polarized or conspiracy-based ideas a little bit at first, often influenced by
psychological adversities, family or peer culture, and genetic risk factors,
then become more and more drawn into problematic behaviour over time; in this
way, it is like someone trying cocaine with their friends a few times per year
at parties, then escalating gradually towards weekly, then daily use, all the while justifying the behaviour as harmless, enjoyable, or a cultural norm. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Addictive behaviour can cause deep
satisfaction or relief in the moment; moving away from addictions can be
challenging and painful; people often cannot do it without external help.
Furthermore, many people with moderate to severe addictions deny they have a
problem, and do not see any reason to change. They may see their addictive
behaviour as simply a lifestyle choice, enjoyed by many friends, with any
problems lying with other people who criticize them. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Addictions are strongly entrenched by
a peer group of fellow addicts. Moving away from addictions often requires
that people let go of their current social network, leading to feelings of
loss, loneliness, boredom, and a lack of meaning. This is one of the reasons
that we have to offer social and community support to people if we would like
to help them move away from entrenched polarization or ideological biases. <o:p></o:p></span></p><h2 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Biases & Educational factors beginning in childhood</span></b></h2><p style="text-align: left;"><span style="font-family: inherit;">Many biases and educational factors
causing people to be trapped in a narrow or hostile ingroup begin during
childhood, with parents, family, and community members teaching and influencing
the children. Many people believe things only because their parents, teachers,
and peers believed them. After childhood, people will be more likely to
associate with, befriend, marry, or have children with others who are similar; this further entrenches previous beliefs
and makes differing belief seem strange or wrong. </span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Heredity</span></b></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">There is a hereditary influence on the
tendency to be dogmatic or stubbornly adherent to ideologies, and on general
intelligence. But hereditary predispositions are never absolute, and are never
purely good or bad. Hereditary factors, if channelled through a healthy
environment, can lead to good individual lives and a healthy community. <o:p></o:p></span></p><h3 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">Refusal to admit mistakes</span></b></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">One last huge psychological factor is
refusal to admit mistakes. Many people would rather carry on with a previous
decision even if it is leading to disastrous results. They would be
embarrassed, ashamed, or would not "save face" if they had to admit
they made a terrible mistake, or if they had to reverse their position on an
important issue. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">This stubbornness can be an extremely
powerful factor; it could be a psychological defense, a way of protecting a
person against the need to feel intense shame and regret for past decisions
which caused terrible harm. This phenomenon is fed by some of the biases listed
above, such as the sunk cost fallacy, anchoring, and ingroup biases. Instead of
owning up to a bad decision, people will go through a remarkable feat of
denial, to persuade themselves that they didn't make any mistake at all. Many
people hold onto strong anti-vax beliefs or conspiracy theories for this
reason. They might be willing to change their mind, but the cost of admitting a
big mistake is too high. <o:p></o:p></span></p><h2 style="text-align: left;"><span style="font-family: inherit;"> <b><span style="font-size: small;">Well-funded corporate groups & "think tanks"</span></b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Wealthy corporate donors with strong
ideological positions are funding marketing campaigns and employing the small
cohort of contrarian scientists to push policies opposing vaccination, public
health measures, environmental protections, and other public policy ideas they
see as relevant to their ideologies or profits. These corporate groups or
"think tanks" have members who are part of the political or religious
ingroups described above. Their biases are not just individual, but organized,
powerful, and very well-funded, often with billions of dollars of financial
support. <o:p></o:p></span></p><p style="text-align: left;"><span style="font-family: inherit;">Oxford-trained Duke University public health scholar <a href="https://blogs.bmj.com/bmj/2021/09/13/covid-19-and-the-new-merchants-of-doubt/">Gavin Yamey has warned us</a> about the influence of such groups, and has compared their tactics to those used in past decades by the tobacco industry: denying or twisting health risk data, to plant seeds of doubt in the population, in order to maintain profits of a multi-billion dollar industry despite the terrible harms it caused. </span></p><h3 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">External Political Interference</span></b></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Other nations with antagonistic
relationships with our own are attempting to propagate conspiracy theories and
extremist groups, mainly using social media, in an attempt to disrupt or weaken
our nations. This is a national defense issue. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><br /></p><h2 style="text-align: left;"><b><span style="font-family: inherit; font-size: small;">What to do about it</span></b></h2><p style="text-align: left;"><span style="font-family: inherit;">There is a lot that can be done about this problem:</span></p><h2 style="text-align: left;"><span style="font-family: inherit;">1) <span style="font-size: small;">How Minds Change </span></span></h2><p style="text-align: left;"><span style="font-size: small;">David McRaney, in his 2022 book <i>How Minds Change: The Surprising Science of Belief, Opinion, and Persuasion</i>, describes techniques to communicate with people who have strongly entrenched beliefs. I strongly recommend this book. The ideas are based on showing respect, empathy, establishing rapport, sharing personal stories, searching for higher principles in common, gentle inquiry about the person's sources of evidence for their belief, and honest exchange of your own view, but without arguing or showing anger or contempt. </span></p><h2 style="text-align: left;"><span style="font-family: inherit;">2) </span><span style="font-family: inherit; font-size: small;">Inoculation against Misinformation</span></h2><div>Van der Linden et al. have shown that so-called "inoculation" techniques can protect people from misinformation.<a href="https://www.science.org/doi/10.1126/sciadv.abo6254" target="_blank">(see link). </a> This involves exposure to videos explaining how misinformation techniques work. They have even devised an online game called <a href="https://www.getbadnews.com/books/english/" target="_blank">"Bad News"</a> (see link) which helps people see how powerful misinformation techniques can be, in a gamified form. This technique is similar to the best ideas from CBT (cognitive-behavioural therapy): the therapy requires exposure, following informed consent, to the heart of the problem, in order to overcome it and be protected from future adversity. </div><h2 style="text-align: left;"><span style="font-family: inherit;"> 3) <b> <span style="font-size: small;">Massive campaign to provide information & counter misinformation</span></b></span></h2><p style="text-align: left;"><span style="font-family: inherit;"><a href="https://psyarxiv.com/247bs/" target="_blank">According to MIT post-doc Ben Tappin</a>, people differing due to an ideological
divide are still persuadable using reasoned arguments. A major reason
ideological divides lead to such tenacious resistance to change is the lack of
exposure of ingroups to such reasoned argument, and the extreme prevalence of
ingroup exposure to false arguments. Therefore, it makes sense to keep up our
efforts to provide accurate information, and not give up or become resigned,
believing that anti-vaxxers or other ingroup members are not persuadable.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;">We cannot only have health experts,
such as government health officers, speaking to the public. Many anti-vax
people will not be persuaded at all by a public leader. We need to have
spokespeople in the information campaign representing ingroups associated with
the anti-vax movement. We need to have right-wing political leaders, religious
leaders, celebrities, sports stars, people with different levels of education,
and people from different employment groups, all involved in this marketing and
information campaign.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">We specifically need to hear from
people who were formerly part of the anti-vax movement, who have changed their
mind. We need to hear directly from people who are severely ill in hospital,
preferably with video. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;">Consideration should be given to
prosecution of those spreading misinformation.</span></p><p style="text-align: left;">
</p><h2 style="margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;">4) </span><b style="font-family: inherit;"><span style="font-size: small;">Addressing Myside Bias by emphasizing unity</span></b></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Polarized differences and myside bias can be reduced by emphasizing that we are all on the "same team." Such a principle of unity, of treating all fellow humans with equal respect, regardless of nationality or culture, is consistent with the laws or constitutions of most countries, and with the principles of most religions. We all want to prosper, to live a healthy, happy life, to live in peace, and to have freedom while also acknowledging the need for cooperation. We have a shared humanity despite the existence of national or cultural borders. Unity between divided groups often improves if the groups need to work together to solve a larger external threat. In this sense, it is unfortunate that the pandemic (a worldwide threat) has not led to a greater degree of unity between nations. Environmental degradation is another massive looming threat of this kind. Disagreement about the nature of such threats, and about the type of action needed, is part of the problem. </span></p><h3 style="text-align: left;"><span style="font-family: inherit;">5) <b><span style="font-size: small;">Friendship, Diplomacy, and Trade between opponents</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"> We should strive to develop friendships and trade relationships between members of opposing groups. Steven Pinker emphasizes this point in his book on the history of violence in society, <a href="https://www.amazon.ca/Better-Angels-Our-Nature-Violence/dp/0143122010/ref=sr_1_1?crid=JW8BPCV4BHEV&dchild=1&keywords=better+angels+of+our+nature+by+steven+pinker&qid=1634504604&sprefix=better+angels%2Caps%2C227&sr=8-1" target="_blank"> </a><i><a href="https://www.amazon.ca/Better-Angels-Our-Nature-Violence/dp/0143122010/ref=sr_1_1?crid=JW8BPCV4BHEV&dchild=1&keywords=better+angels+of+our+nature+by+steven+pinker&qid=1634504604&sprefix=better+angels%2Caps%2C227&sr=8-1" target="_blank">Better Angels of Our Nature: Why Violence has Declined</a>. </i></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">This principle could be objected to,
using extreme examples: most of us would not consider it appropriate or helpful
to have cultivated friendships with Nazis during World War II. But most members
of opposing groups are not extremists; they are moderates. It is necessary to
denounce extremism, but this does not mean denouncing almost half of the entire
population on the other side of an ideological divide. If there is to be anyone
influencing or learning from each other, there has to be ongoing friendship. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">6) <b><span style="font-size: small;">Experiential Education</span></b></span></h3><p style="text-align: left;"><span style="font-family: inherit;"> Direct experiential education is
extremely important. People need to take tours through overflowing intensive
care units, meet the burned out but highly compassionate and expert staff, and
be aware of the suffering patients there. There will be many patients who are
members of their very own ingroup. I think this will be very persuasive, but
this has barely been done at all during the pandemic. Of course, there are
technical, ethical, and privacy-related barriers to having such tours, but
these barriers could be overcome with good planning. At the very least, there
should be embedded journalists in these environments, just as embedded
journalists have been allowed access to war zones.</span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">7) <b><span style="font-size: small;">Vaccine Education</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Specific education about
vaccine-preventable diseases (such as polio, measles, or smallpox) is important
and helpful. Many people don't understand how severe these diseases were, and
how remarkably effective vaccines have been to spare hundreds of millions of
people (mostly children) terrible suffering and death. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Specific education about how vaccines
work is important. Many people simply do not know these things. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">8) <b><span style="font-size: small;">Ingroup leaders as educators and influencers</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Members of ingroups (most likely
moderates) will be much more influential as sources of education and
information, than members of outgroups, who will most likely be dismissed if
they are even heard at all. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">In the case of the pandemic,
encouragement of vaccination from religious leaders and right-wing moderates
will be useful to persuade others in this community to be vaccinated. Leaders
of these ingroups must denounce extremism and violent behaviour. <o:p></o:p></span></p><h2 style="text-align: left;"><span style="font-family: inherit;">9) <b><span style="font-size: small;">Emphasis on underlying values</span></b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">The importance of emphasizing
underlying values is a point made by Haidt. People on the right-wing of the
political spectrum tend to value loyalty, family, and purity. Issues such as
environmental protection and vaccination are consistent with values of loyalty
and purity. It is loyalty to country, loyalty to one's own children (looking
after their present and future well-being, enjoyment, and prosperity), and
loyalty to God (who would want to care for all people, to encourage peace on
earth, to care for the place we live, and to help people help one another). The
idea of purity is well-served by plans to protect the environment and to
protect the body from a devastating infection. <o:p></o:p></span></p><h2 style="text-align: left;"><span style="font-family: inherit;">10) <b><span style="font-size: small;">Stop funding propaganda outlets</span></b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Steps should be taken by individuals
and corporations to stop financial support for propaganda outlets, and to
support independent, unbiased journalism. In general, we would not want our
news sources to be influenced by wealthy donors or political parties. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">11)<span style="font-size: small;"> <b>Beware of partisan "think tanks"</b></span></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Good investigative journalism is
needed to show financial and political influences coming from partisan think
tanks and corporate lobby groups. I hope that if people can become more aware
of these issues, there could be organized efforts to oppose such groups, and
legislation to limit their power. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">National security efforts are
critical, to prevent other nations from contributing to propaganda and
extremist groups in our countries. Investigative journalism is essential, as is
monitoring of "bots" and fake social media accounts, etc. Government
action is likely to be necessary. <o:p></o:p></span></p><h2 style="text-align: left;"><span style="font-family: inherit;">12) <b><span style="font-size: small;">Reduce social media polarization</span></b></span></h2><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Steps should be taken, on a personal
and political level, to reduce the tendency for social media platforms such as
Twitter and Facebook to produce "news bubbles" and to foment division
or extremism. This could involve persuading social media companies (through
individual and government intervention) to adjust the algorithms on their
sites, to help reduce exposure to extremist positions or false information, and
to help "fact check." On a personal level, one of the options is
simply to reduce or stop using social media. </span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;"><o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">13) <b><span style="font-size: small;">Psychiatric techniques</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">As a psychiatrist, it is often
impossible to challenge entrenched biases with a patient unless there is a very
strong therapeutic alliance, rapport, and trust. Even then, the amount of
change to expect is very limited and slow, especially in the short term. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It is possible to encourage education,
to help patients expand their horizons a little bit. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">If there are low-grade psychotic
symptoms underlying belief in conspiracy theories, an antipsychotic medication
could be useful, but most people with this issue would not be willing to try
this. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">If past trauma or adversity is driving
involvement with conspiracy theories or destructive ingroup behaviour, then
compassionate, empathic trauma-informed treatment could be helpful. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Cognitive-behavioural therapy (CBT),
in principle, could help people to recognize and change cognitive distortions
or biases, but the nature of longstanding ideological bias is less amenable to
change, in part due to a lack of insight on the part of those having these
problems, and in part due to powerful resistances to change that people have
developed over a lifetime, maintained or magnified by like-minded family and
peers. <o:p></o:p></span></p><div style="text-align: left;"><span style="font-family: inherit;">Motivational interviewing is another
set of techniques that would be useful to engage with someone having problems
due to polarization, conspiracy theories, ideological propaganda, or anti-vax
ideas. This is a style of therapy used to help people with addictions. Its
foundation has to do with acknowledging a spectrum of insight and
willingness/readiness to change for people with addictive problems, and to
match the treatment with the level of readiness. While motivational
interviewing is a suitable therapeutic style, it is also to some degree a
pretty obvious, common-sensical approach. In any case, I encourage checking out
a workbook about motivational interviewing, or some YouTube videos teaching the
basics. </span></div><h3 style="text-align: left;"><span style="font-family: inherit;">14) <b><span style="font-size: small;">Empathy with honesty </span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">In a conversation or debate with a
person espousing a conspiracy theory or following some type of propaganda,
empathy is needed for the conversation to continue. In conversing with someone
who has a delusional belief, it is important that the person you're talking to
knows your honest position on the issue, and knows that you are prepared to
back up your position with good evidence, but it is essential that you show
understanding of their feelings about the matter, and that the discussion does
not deteriorate into a shouting match or into personal attacks. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">As stated in number 8) above, it could
be useful in a debate or conversation with conspiracy theorists, anti-vaxxers,
etc. to find examples of prominent people within their ingroups who have
changed their mind and moderated their position, while still endorsing and
supporting the ingroup. This could include examples of politicians, religious
leaders, and celebrities your debate partner might support or admire, who are
now endorsing vaccination or other relevant policy issues. As of December 2021, I am aware of one notorious
member of this ingroup, a major U.S. political leader, who is now supporting
vaccinations. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;"> 15) <b><span style="font-size: small;">Possible need to end the conversation or relationship</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Open dialogue requires safety and
fairness. It is impossible to have a productive discussion with someone
shouting at you, threatening you, or monopolizing the conversation. If the
person you are talking to cannot behave in a physically safe and respectful
manner, then it is necessary to end the discussion. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It may be necessary to end some
relationships altogether, because continued contact may prove to be too
aggravating and stressful over time, distracting us from more positive and
helpful engagements or relationships. But if the conversation or relationship
does end, I encourage people to remain polite, gentle, and civil, maybe with the possibility of re-establishing the relationship in the future, if the situation improves. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">16) <b><span style="font-size: small;">Social Pressure & celebrity influence</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">It can be helpful to make use of media
to show that public health measures such as vaccination & mask usage--and
environmental measures such as recycling, reducing carbon emissions, and
ecological protection--are attractive, fashionable, and cool. Conversely, media
can help show that being an anti-vaxxer or a polluter is very unattractive. This
type of work could involve the help of celebrities, sports stars,
"influencers" and models.<o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">17) <b><span style="font-size: small;">Justice</span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">In order to deal with con artists or
fraud, we usually need to involve the criminal justice system. For a person who
willfully neglects safety behaviour, and causes harm to others, there would be legal consequences. For example, almost everyone, regardless of political
orientation, would agree that we should prosecute drunk drivers, especially if they harm someone on the road. Rehabilitative treatment should
be offered as well, for example to treat alcoholism. There is a continuum in our society between debatable contrarian opinion on one side, fraud and frank propaganda on the other. Obviously we shouldn't suppress contrarian opinion using the power of the legal system, but there should be consideration of prosecution in cases where frank lies are causing substantial harm to individual and public health, especially when the perpetrators are profiting financially. <o:p></o:p></span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">For con artists who are successfully
prosecuted, it can often be the case that the victims who were conned,
sometimes leading to severe financial or physical harm, will still insist that
they were not victims at all. They may continue to support the con artist even
after prosecution and conviction. Such is the tenacious power of people's need
to "save face" -- admitting they were conned by someone they and their family and friends have admired for years as a hero can be embarrassing and
humiliating. In order to make this process easier, it is necessary for fellow
con victims to come forward and admit the truth. We see a few examples (though not enough) of this
happening with previous supporters of a well-known political leader since 2016,
which hopefully will lead the way to broader positive change. <o:p></o:p></span></p><h3 style="text-align: left;"><span style="font-family: inherit;">18) <b><span style="font-size: small;">Be politically involved! Vote! </span></b></span></h3><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span lang="EN-US" style="font-family: inherit;">Some extremist or fanatical groups
have been organizing protests, frightening and obstructing health care workers
and patients at hospitals in recent days. Others are threatening the foundations of democracy itself. <o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in; text-align: left;"><span style="font-family: inherit;">It is necessary to become more
politically aware and involved. In an age where democracy itself is under
threat, it is essential to use your right to vote, and to help & encourage
others to vote as well. If people become so discouraged or cynical about the
present state of affairs that they don't even bother to vote, then our nation's
and our world's problems will be dealt with by people who are very ill-equipped
to solve them. </span></p><p style="text-align: left;"><span style="font-family: inherit;"><br /></span></p><p style="text-align: left;"><b><span style="font-family: inherit;">Selected Readings & References</span></b></p><p style="text-align: left;"><span style="font-family: inherit; font-size: small;">Armstrong, Karen. The Battle for God: A history of
fundamentalism. (2001)</span></p><p style="text-align: left;">
</p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Brashier, N. M., Pennycook, G., Berinsky, A. J., & Rand,
D. G. (2021). Timing matters when correcting fake news. Proceedings of the
National Academy of Sciences, 118(5).</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Bergstom, C. and West, J. <i>Calling Bullshit: The Art of Skepticism in a Data-Driven World </i>(2020). </span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Briant, Emma Louise (2015). Propaganda and
Counter-terrorism. Manchester: Manchester University Press. p. 9.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Christakis, Chris. Apollo's Arrow: The profound and enduring
impact of coronavirus on the way we live. (2020)</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Dawkins, R. The God Delusion (2006).</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">Dawkins, R. Outgrowing God (2019).</span><span style="font-size: small;"> </span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><o:p><span> </span></o:p><span style="font-size: small;"> </span><span style="font-size: small;">(note: Dawkins is a critic of religion, but I think it is good for any religious person to
understand the reasons for this;</span><span style="font-size: small;"> </span><span style="font-size: small;">I mention these books
here because they address the subject of how people come to form extremely
strong and often irrational ideological positions, and how people can move away from this, while gaining some education about basic science)</span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Douglas, K. M. (2021). COVID-19 conspiracy theories. Group
Processes & Intergroup Relations, 24(2), 270-275.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Douglas, Karen et al, Understanding Conspiracy Theories.
Political Psychology 40, Suppl. 1, 2019</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Epstein, Z., Berinsky, A. J., Cole, R., Gully, A.,
Pennycook, G., & Rand, D. G. (2021). Developing an accuracy-prompt toolkit
to reduce COVID-19 misinformation online. Harvard Kennedy School Misinformation
Review.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Haidt, J. The Righteous Mind: Why Good People are Divided by
Politics and Religion (2012).</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Harrington, B. (2012). The sociology of financial fraud. In
The Oxford handbook of the sociology of finance.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">https://theconversation.com/why-people-believe-in-conspiracy-theories-and-how-to-change-their-minds-82514</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Johnson DK et al. "Combating Vaccine Hesitancy with
Vaccine-Preventable Disease Familiarization" Vaccines 2019, 7. 39</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Kahneman, D. Thinking: Fast and Slow. (2013).</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Kelly, J. (2006). The Great Mortality: an intimate history
of the Black Death.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Konnikova, M. (2016). The confidence game: Why we fall for
it. Every Time. New York.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Lewandowsky, S., & Van Der Linden, S. (2021). Countering
misinformation and fake news through inoculation and prebunking. European
Review of Social Psychology, 1-38.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Marchlewska, M., Green, R., Cichocka, A., Molenda, Z., &
Douglas, K. M. (2021). From bad to worse: Avoidance coping with stress
increases conspiracy beliefs. British Journal of Social Psychology.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">McRaney, David. <i>How Minds Change: The Surprising Science of Belief, Opinion, and Persuasion</i>. 2022. </span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Pennycook, G., & Rand, D. G. (2021). The psychology of
fake news. Trends in cognitive sciences.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Pennycook, G., McPhetres, J., Zhang, Y., Lu, J. G., &
Rand, D. G. (2020). Fighting COVID-19 misinformation on social media:
Experimental evidence for a scalable accuracy-nudge intervention. Psychological
science, 31(7), 770-780.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Pennycook, G., McPhetres, J., Bago, B., & Rand, D. G.
(2020). Predictors of attitudes and misperceptions about COVID-19 in Canada,
the UK, and the USA. PsyArXiv, 10, 1-25.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Peters, Maertens, R., Roozenbeek, J., Basol, M., & van
der Linden, S. (2021). Long-term effectiveness of inoculation against
misinformation: Three longitudinal experiments. Journal of Experimental
Psychology: Applied, 27(1), 1.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">Peters, Ellen. Innumeracy in the Wild: Misunderstanding
and Misusing Numbers. Oxford (2020).</span><span style="font-size: small;"> </span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">Pinker, S. Better Angels of Our Nature: Why Violence has
declined (2012).</span><span style="font-size: small;"> </span></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">Pinker, S. <a href="https://www.amazon.ca/Rationality-What-Seems-Scarce-Matters/dp/0525561994/ref=sr_1_1?crid=193AKTY6910AK&keywords=rationality+steven+pinker&qid=1645117946&sprefix=rationality+%2Caps%2C131&sr=8-1" target="_blank">Rationality: What it is, why it seems scarce, why it matters</a> (2021)</span></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;">Pretus, C., Hamid, N., Sheikh, H., Ginges, J., Tobeña, A.,
Davis, R., ... & Atran, S. (2018). Neural and behavioral correlates of
sacred values and vulnerability to violent extremism. Frontiers in psychology,
9, 2462.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;">Prum, Richard. The Evolution of Beauty: How Darwin's
Forgotten Theory of Mate Choice Shapes the Animal World - and Us. Anchor
(2018).</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Rathje, S., Van Bavel, J. J., & van der Linden, S.
(2021). Out-group animosity drives engagement on social media. Proceedings of
the National Academy of Sciences, 118(26).</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;">Rutjens et al, "Science skepticism across 24
countries."<span style="mso-spacerun: yes;"> </span>Social Psychological
and Personality Science 2021.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Shoots-Reinhard et al. "Ability-related political
polarization in the COVID-19 pandemic" Intelligence 88, 2021, 101580</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Swire‐Thompson, B., Ecker, U. K., Lewandowsky, S., &
Berinsky, A. J. (2020). They might be a liar but they’re my liar: Source
evaluation and the prevalence of misinformation. Political Psychology, 41(1),
21-34.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;"></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;">Tappin, B. M. (2021, October 4). Exposure to Arguments and
Evidence Changes Partisan Attitudes Even in the Face of Countervailing Leader
Cues. https://doi.org/10.31234/osf.io/247bs<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Taylor, S. (2019). The psychology of pandemics: Preparing
for the next global outbreak of infectious disease. Cambridge Scholars
Publishing</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span>technologyreview.com/2020/07/15/1004950/how-to-talk-to-conspiracy-theorists-and-still-be-kind/</span><span><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Van Bavel, J. J., Baicker, K., Boggio, P. S., Capraro, V.,
Cichocka, A., Cikara, M., ... & Willer, R. (2020). Using social and
behavioural science to support COVID-19 pandemic response. Nature human
behaviour, 4(5), 460-471.</span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Van der Linden, S., Panagopoulos, C., Azevedo, F., &
Jost, J. T. (2021). The paranoid style in American politics revisited: An
ideological asymmetry in conspiratorial thinking. Political Psychology, 42(1),
23-51.n </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Van Prooijen & Kuijper, "A comparison of extreme religious and political ideologies: Similar worldviews but different grievances", Personality and Individual Differences 159 (2020)</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">Van Prooijen & Krouwel, "Psychological features of
extreme political ideologies."</span><span style="font-size: small;">
</span><span style="font-size: small;">Current Directions in Psychological Science 2019 28(2) 159-163.</span><span style="font-size: small;"> </span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">van Prooijen et al, "connecting the dots: Illusory
pattern perception predicts belief in conspiracies and the
supernatural."</span><span style="font-size: small;"> </span><span style="font-size: small;">Aug 21, 2017/</span><span style="font-size: small;"> </span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit;"><span style="font-size: small;">van Prooijen and Song, "The cultural dimension of
intergroup conspiracy theories."</span><span style="font-size: small;">
</span><span style="font-size: small;">August 13, 2020.</span><span style="font-size: small;"> </span></span></p>
<p class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">Zimbardo, P. (2011). The Lucifer effect: How good people
turn evil. Random House.</span></p><p class="MsoNormal"><span style="font-family: inherit;"><o:p></o:p></span></p><br /><p></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com1tag:blogger.com,1999:blog-6886575137375451769.post-54994611918163921132021-06-11T11:34:00.009-07:002021-12-16T08:18:00.885-08:00Mental Health Reform: reflections & ideas for changeOn February 1, 2020 I began work as a psychiatrist at my own private office. <div><br /></div><div>Before then I worked at a large academic institution for about 20 years, and was the leader of the psychiatric team there for 13 years. I have always loved my work very much. I have been very privileged and lucky to have had such a job, during those 20 years. It has been meaningful and enjoyable, for the most part, to care for my patients over the years. And there were many wonderful colleagues and other staff at my clinic, who made our work more enjoyable, safe, and helpful. We worked very, very hard. There was a sense of community, like a type of family. But I feel incredible relief to have left this position. Now, after 15 months away from it, I feel I can have a gentle reflection upon some of the problems which developed there over the years. <br />
<br />
I would like to describe some instances of what I think can go wrong during a well-meaning effort to plan for change in community mental health care. I do not want this post to be understood as a ranting complaint from a disgruntled person, but rather I would hope to simply tell the truth, from my point of view, about some events that happened, with reflections on ways to prevent such problems in the future. I am happy and grateful for my present and my past, but I do feel there are a few things to be said. <br />
<br />
Mental health reform became a big issue in the community where I worked, over the last 5 years or more. A lot of extra money appeared in the budget for this, and some care was wisely taken to plan for how to spend it. <br />
<br />
Many meetings took place, to discuss mental health care reform. <div><br /></div><div>A team of consultants from another country was hired, and flown over several times to assess the situation. I presume this occurred at quite considerable expense. Their recommendations and presentations appeared to be a very polished lobbying effort. During these presentations, which included some academic citations to support their positions, there was never actually any room for debate about the research they were citing or for the positions they were advocating, despite the presence in our academic community of many experts. <br />
<br />A plan eventually developed, devoted to the idea of collaboration among different helping disciplines. </div><div><br /><div>The meetings would tend to begin with a lot of self-congratulation about progress, followed by lengthy, repetitive monologues, laden with jargon. I was usually the only psychiatrist present in all of these meetings. I was always very concerned that I never come across as arrogant or disrespectful of others, given my own privileged position. I abhor professional arrogance, so I aimed to remain quiet, to be calm, to try to listen respectfully. </div><div>
<br />
But eventually, after many hours of such meetings, I realized that major decisions were being made about health care planning, with a lot of money involved, with almost no debate or critical challenge. These changes affected my patients, my colleagues, my morale, the group's morale, and my own philosophy of practice. Almost none of the money was directly helping my clinic. I personally did not have any voice in these meetings: my comments or input were not welcomed, and I think I actually was considered difficult or uncooperative because I didn't seem to go along with the plan. On several occasions I was told, very directly, to discontinue my comments. When I gathered feedback from professional colleagues (who otherwise had no voice in all of this), and summarized their comments in a brief written document (as was requested of me), the document was rejected, and never submitted, because it was deemed not positive enough. <br />
<br />
The foundations of my own philosophy of practice are simple: make time for patients, listen to them, be available, be gentle, be kind, build trust, be humble, try to honour a patient's wishes. I believe that good care cannot be rushed. Mental health care can sometimes be done with great efficiency and speed, but more often it takes a lot of time and patience. Almost everyone I have ever seen in my career has been tired of seeing people for help who did not really have time for them. </div><div><br /></div><div>In terms of larger-scale, organizational philosophy, my foundation would also be simple: take care of the staff! Everyone, including cleaning staff, clerical workers, nurses, GPs, and specialists, should feel safe, respected, cared for, and heard, in a healthy organization. Be on the lookout for "burnout" especially when a system is strained by high demand. Policies that seem efficient on the surface may be quite deeply harmful, if they lead to a type of "assembly line" experience for either the staff or for the people trying to access the system. </div><div><br /></div><div>Some tools of efficiency, such as computerized records systems, may seem efficient, and may have many uses, but they may be expensive, inconvenient, slow, prone to error, time-consuming, obstructive to rapport with patients, and very heavily marketed by software companies which are earning a lot of money, often trying to sell impressive-sounding features which are actually unnecessary (I feel very fortunate to have found a perfect electronic records system myself, called "Jane," which is far superior, and much less expensive, than the system used at my previous workplace). </div><div><br /></div><div> One reason I wanted to speak out, even at risk of sounding "difficult" or uncooperative, was to advocate for my patients. I was responsible for the care of patients with the most severe, chronic mental illnesses, yet my input about mental health was not allowed, or was met with rolled eyes and even direct requests that I stay quiet. Furthermore, none of my psychiatric colleagues were ever present or allowed to contribute to these meetings, beyond a couple of occasions in several years. These colleagues were never officially on the payroll, they always worked privately and paid overhead to be in our group. In fact, my psychiatrist colleagues were always a free service from the point of view of the institutional budget--they actually earned money for the institution by paying overhead. They earned less money than most other psychiatrists in the community, but stuck with the group due to their love of the work. These colleagues never had any voice in the institution's mental health care policy. I felt that I had to speak for this group as well. <br />
<br />
This went on for years. Patient care suffered. I was the only person in all of these meetings able to do psychiatric consultations for people with severe illness who had been waiting for months, yet I was sitting in redundant, lengthy policy meetings in which I was not even allowed to contribute. I thought of my patients, which led me to try to speak up, even at risk of sounding "difficult." </div><div><br />
One of the themes of the new policy was "collaboration." But ironically, because of the policy meetings, the actual collaboration meetings which I and my counselor colleagues had enjoyed for years, in which we would discuss mental health care in general, as well as immediate, serious clinical issues about specific students, were cancelled.<br />
<br />One summer, there was a series of meetings devoted to drafting a formal care algorithm for treating depression. This was yet another absurd journey. The subject was the foundation of what most of the counselors in the group had studied for years, in graduate school. The subject was arguably the focus of my entire 20-year career. Yet, once again, I and other experienced professional colleagues were mostly silenced, and assigned into small groups to prepare some kind of treatment "algorithm" in an essay-like form. I thought of all the patients who were not seen while we were doing this. <br />
<br />
This was especially troubling, as I found the whole process more and more ethically objectionable. We should begin by ensuring that people are assessed well, are respected, are heard, and their wishes about their own care honoured to the best of our ability. Many algorithmic branches should be negotiated by a well-educated caregiver and the patient or client, not dictated by a flow chart. Good care requires deep attention to building a trusting, caring relationship, empathy, understanding, and a therapeutic alliance. Furthermore, restricting any "algorithm" to only consider depression is inappropriate, since most people coming for help have various other problems other than depression, which would all have to be considered together. <br />
<br />During another meeting the entire group of 100 or so people was asked in advance to fill out a Myers-Briggs questionnaire. The entire group was subdivided according to their Myers-Briggs personality type, and made to sit at separate tables. Some Myers-Briggs types are more rare, while others are more common. Many tables were full. A few tables had only one person. <br />
<br />
The Myers-Briggs personality assessment has very limited validity. It can lead to fallacious polarization of traits which actually lie on a continuum. But in any case, personal testing data about psychological traits or symptoms is intimate: it is arguably in a similar league as any other medical test. It is inappropriate to have to share such information in a group setting. There were a few people in the less common personality categories who ended up sitting alone. To divide the group up like this was an example of what NOT to do with mental health labeling: to actually separate people on the basis of differences, leaving some people alone. It was introducing new labels, stigma, and separation, needlessly. To top things off, it surely would have cost money, going to a company making large profits, to purchase these tests. In addition to the cost of paying everyone's salary for this, there was also the cost of room reservation and catering. Most importantly, there was once again the cost of severely ill patients who were not being seen. </div><div><br /></div><div>Another meeting featured a visiting expert, who had some national fame. I would once again love to know how much his travel expenses and speaking fees were. He was a charismatic speaker, with remarkable orational skills. Everyone loved his presentation. But one thing stood out for me...one of his opinions had to do with what he thought were excessive mental health resources being offered to people with what he considered minor problems. In a hushed tone, he summarized the problem as being "narcissistic entitlement" on the part of the people seeking mental health care. I have no doubt that there is a lot of narcissistic entitlement out there, but to dismiss an entire category of people, and to advocate for major policy change in mental health, based on this assumption, is prejudicial. I have to wonder how often some famous policy-makers actually work with patients in a therapy setting. Once again, there was no actual debate on this, just discussion groups affirming what had already been said. </div><div><br /></div><div>Another meeting was entitled "Stepped Care Anxiety." It was a presentation led by a local research psychiatrist with a lot of experience in community programs, though someone who spent little time actually seeing or caring for patients at this point in his career. Once again, clinical care of patients was cancelled in order for staff to attend this presentation. Initially I thought the meeting would literally be about "stepped care anxiety"-- that is, anxiety induced in caregivers upon being presented with another tiresome trendy catchphrase. But the title was actually just a product of some difficulties with English, and the meeting was about "stepped care FOR anxiety." Basically, the idea of stepped care is to offer more care to people who have more severe problems, and less care to people with less severe problems. As people improve, start to reduce their level of care. This is a statement of the obvious, of course, and is what all of us would naturally do anyway. There seemed to be an implicit assumption that psychiatrists in particular would be seeing patients unnecessarily, even if they were well or not in need of further care, and that we needed guidance to step away from this wasteful practice. I was asked to be well-prepared for this meeting, by reviewing the materials in advance. But once again there was no real meaningful discussion about this, aside from a review of obvious principles. A deeper discussion of care would have allowed for the idea of actually spending time to know patients over a longer period of time, regardless of symptom severity, so as to prevent severe recurrences of mental illness, rather than saving our clinical attention only for emergencies. Stepped care, when applied dogmatically, is yet another ideological system which leads to superficiality of care, a type of fast-food equivalent in mental health provision. <br /><br />
After a lull in these meetings, the next chapter began with new hiring in the institution. This time even more money was spent on expensive administrative positions, instead of on badly-needed direct health care. Some of the administrative positions were filled by clinicians, so in addition to the cost of paying these administrative salaries, an extra cost to the community was of an expert clinician paid to do office work and attend meetings instead of using desperately needed skills to help patients directly. I think of how many hundreds of thousands of dollars per year were spent on this increase in administrative funding, while actual clinical care languished. Our clinical unit had barely grown in decades, despite serving a community which had rapidly expanded, perhaps even doubled in size. Encounters with the administration were negative and morale-depleting. I dreaded them. I really just wanted to see and take care of my patients. My other priority was to take care of my coworkers and colleagues. But I felt powerless to do anything for them. </div><div><br /></div><div>One of the meetings--again arranged by cancelling our actual work with patients--was with a visiting specialist who had invented a new way to see more patients more quickly. A psychiatrist would join a GP for a 30-minute "mini-assessment." That way, more people could have psychiatry assessments, there would be shorter wait lists, and the primary care doctors would feel more supported. Once again, there was no opportunity for any critical discussion, during or after this presentation. The thing is, such assessments are pretty much the opposite of what I consider to be good psychiatric practice. Assessments cannot be rushed. Imagine if you had to see someone for a difficult, very personal problem or issue, and had to discuss it in 30 minutes, with two people in the room, one of whom a stranger, with the understanding that your future care would be guided by the new expert's opinion during this fragmentary discussion. It is arrogant on the part of psychiatrists to assume that extremely brief visits could lead to diagnostic or therapeutic insights that the other caregivers had not already thought of. Such brief assessments, and other schemes in mental health care similar to them, tend to bias the conclusions towards medication management, since this is the easiest type of thing to construe in a short assessment, without knowing a patient well. Assessments and good care take time--there is no avoiding this! Relationships cannot be rushed. </div><div><br /></div><div>Satisfaction surveys following such changes could also be quite biased and misleading, in the same way that taking a survey of people leaving a fast-food restaurant could give a biased view of food services quality in a community. Many people might be quite pleased to have convenient fast food, but those who would suffer the most from such policy would not be included in the survey, since they would not be using the services. </div><div><br />
I am deeply relieved to have left that place! But I miss my colleagues, I know they are good people and skilled professionals. My decades of work there, despite the frustrations at the end, were a labour of love, for which I am deeply grateful. While I have voiced some complaints above, the years at my previous position helped make me a better person, and taught me a lot about how to be a good doctor. <br />
<br /><div><br /></div><div>Here are some basic ideas, based on my experience, for organizing a program of mental health care reform: <br /><br />1) the expenses involved in the reform program should always be transparent, especially in a public institution. If consultants or experts are brought in to give presentations to the group, it should be clear to everyone, including the public, how much money was spent on their travel expenses and any other compensations. Catering and room costs should be made clear. And most importantly of all, if there are 100 helping professionals who spend 3 hours at a meeting, it should be made very clear that this represents a cost of 300 person-hours of care. That is, 300 people could have had a 1-hour therapy session or evaluation. 30 people could have had a basic 10-session treatment for depression or an anxiety disorder, which could possibly have saved lives. </div><div><br /></div><div>2) critical debate should always be welcomed. If there are experts in the group, their expertise and experience should be shared. If a visiting expert is flown in, the group's responsibility is not to simply compliment the visitor, listen politely, and clap -- at a major academic institution, or anywhere else in society, there is a responsibility, a duty even, to engage in vigorous, intelligent debate, especially when there are critical issues about health, well-being, and morality, being discussed. </div><div><br /></div><div>3) it should be absolutely unacceptable for anyone working in the system to feel that their voice or opinion would ever be suppressed. </div><div><br /></div><div>4) consideration should be given, at a very high priority, to the morale and well-being of the workers, not just to the efficiency of the work. </div><div><br /></div><div>5) if there are to be catered lunches and time off given to staff for collaborative meetings, or to bolster group cohesion, then ALL the staff should be included, including the cleaning staff. Most of us don't even know who the cleaning staff are. </div><div><br /></div><div>6) I have a very specific idea about the economics of care provision. There are many underemployed counselors in the community, who often have to spend a lot of money renting private office space. Many can't make it, and end up working in some other field. But there is a lot of office space vacant in large institutions or campuses during evenings and weekends. This space could be offered at a very low or free lease rate, to increase the number of hours of care available for people in the community. This would be a win-win situation for underemployed counselors as well as for the community of people in need of more care. Clinical office space should be provided with a much higher priority than administrative office space, particularly when there is a severe shortage of clinical care. </div><div><br /></div><div>For salaried care workers, I think that a blended payment model (that is, baseline salary plus some component of "fee for service") would be very efficient to increase care provision. Some workers (counselors or doctors) might want to work longer, or less typical, hours, and I am quite certain that there would be a high demand in the community for these extra hours. But there would have to be a fair and convenient model of compensation. Current salary schemes do not allow such flexibility. <br />
<br /><br />If you are interested in mental health policy, I encourage you to use your voice, to be aware of changes going on in your community, and to get involved in the reform process. <br />
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<br /></div></div></div></div>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-22684584427186202022021-05-20T16:46:00.002-07:002021-12-11T19:11:23.343-08:00Review: Sex at Dusk by Lynn Saxon<p>I read this book a second time recently. </p><p>I appreciate that such a scholarly and well-researched text was written by an amateur scientist. It was written as a critique of a more popular book with a similar title. This other book attempted to make a case that humans in the pre-agricultural era (i.e. over 10 000 years ago) had a much more promiscuous lifestyle, which for them was supposedly healthier and more peaceful--then with the implication that we should try to emulate this in modern society. </p><p>Saxon's book looks at almost every claim made by the other authors, and shows how their analysis was biased, incomplete, or just completely wrong, in terms of historical and anthropological data, as well as genetics and evolutionary biology. Saxon shows that the authors of the other book particularly do not address the very dark side of almost every case study described. The areas of focus in both books include social and sexual behaviour in primate species most closely related to humans (chimpanzees, bonobos, and gorillas), as well as cultures of remote present-day groups, such as those living in the Amazon. A particular emphasis is the genetic basis (through natural selection) of behavioural traits. </p><p>The subject of the genetic foundations of animal behaviour, and of the mechanism of evolution through natural selection, should be part of everyone's common knowledge. Books by naturalists, biologists, or geneticists on this subject are not only informative from a scientific point of view, but are fascinating in the same way that watching a good nature documentary would be: most of us are unaware of the life cycles and behavioural patterns of most of the species with whom we share the earth. The stories, often about species that many of us have never heard of, but also sometimes about familiar species, are almost always interesting, but sometimes shocking or disturbing or intensely dramatic. The best science writer in this genre is Richard Dawkins -- whether or not you like his philosophical point of view, it is essential and often entertaining reading to learn about other species, with the eye of a great naturalist. </p><p>Saxon shows that we cannot escape some of the problems which exist in relationship and sexual dynamics in humans, including jealousy. There is a strong genetic foundation for pair bonding in our species, though not without tensions, jealousies, and strong desires, which differ between the sexes, to have other relationships outside of the pair bond; but such excursions outside of a pair bond cannot occur without a substantial cost, often manifest in behaviour which is in part genetically determined. </p><p>None of these genetic factors justifies a social policy which constrains relationship choices... social and relationship freedoms, as well as guaranteed personal rights, are aspects of social justice that have thankfully grown in our country in the past century; they must be created and legislated, whether or not they have always been favoured in our species through genetic/natural selective forces in the distant past. </p><p><br /></p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-15231367852073545212021-05-06T11:42:00.006-07:002021-12-11T19:11:35.054-08:00Review: Capital in the Twenty-First Century, by Thomas Piketty<p> Thomas Piketty is a French economist, whose book "Capital in the Twenty-First Century" is a great analysis of the history of wealth, economic inequality, and taxation through the past two centuries, focusing especially on Europe and North America. </p><p><br /></p><p>I highly recommend this book. It is very long and detailed, and much of it is hard to understand fully for a person not experienced in economics or finance. For a brief introduction to Piketty's work, there is a good documentary with the same title, which is also worth watching. But the documentary does not contain nearly as much detailed analysis of the problems and proposed solutions, compared to the book. </p><p>This book is important to read, to become familiar with these issues. We all pay taxes, and most of us complain about them, but few of us understand the history of taxation, and the reasons why taxes are the way they are. Even for those who are experts in the area, it seems to me that relatively few people (such as economists) have a good understanding of economic history. </p><p><br /></p><p>Piketty shows that income inequality was extremely high in the 1800s in Europe, leading to some people with enormous estates, while much of the population lived near or below the poverty line. Most of the wealth in the society was owned by a very small number of people. This changed dramatically mainly as a result of the world wars, and the resulting policy changes after the wars. </p><p><br /></p><p>Prior to the wars, those with enormous wealth paid very little tax, and this wealth was also passed through inheritance with very little tax either. After the wars, progressive taxation of income and estates led to a large improvement in this type of extreme inequality, and allowed a much larger number of people (such as those in the middle class) to own a larger portion of national wealth. </p><p><br /></p><p>Interestingly, the United States in the 1950s-1970s had one of the most fair and progressive taxation schemes in the world, leading to improvements in economic inequality, before regressing substantially in the 1980s and beyond. </p><p><br /></p><p>Piketty shows that there are not only political and social consequences of having a society allowing extreme wealth to accumulate for a small number of people, without those people having to earn this wealth through work, there is also an economic consequence, since economic efficiency is not well-served or incentivized this way. </p><p><br /></p><p>His suggested solutions to this problem include having a progressive income tax, a progressive tax on estates & inheritance, and a progressive tax on capital or total personal wealth. By progressive, he means paying a higher rate for higher levels of income, and a lower rate for lower levels. At present, there are many examples Picketty shows where the system is not progressive, but regressive--that is, people with extreme levels of wealth actually pay an overall lower marginal rate on their vast incomes, compared to those in the middle class. </p><p><br /></p><p>The main barrier to a progressive tax on capital (i.e. a tax on invested fortunes), is that such investments are often hidden; many extremely wealthy people hide their wealth in offshore banks, etc. so it is hard for governments to understand how much wealth there is. These are so-called "tax shelters." In order to solve this problem, governments across the world would have to come together and cooperate with sharing banking information, to create a type of global wealth census, or "cadastre." </p><p><br /></p><p>How is this relevant to psychiatry? Economic issues, including poverty, are extremely important in the causation and management of mental health problems. Universal health care, and universal comprehensive education (including university college, or other training) is possible in all countries, and can be improved where it currently exists, such as in Canada. But health care is expensive, and needs to be fairly subsidized. Taxation issues obstruct the provision of efficient social services, including health care. </p><p><br /></p><p>Also, greed in general, without a principle of making social or community contribution, is a factor contributing to declining mental health, and to more social problems including crime. </p><p><br /></p><p>I did not find Piketty's analysis or recommendations to be "radical" at all. They are not in opposition to free-market economics, but rather are supportive of a system where markets could be free for all, without rapidly escalating and uncontrolled excesses. </p><p><br /></p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-61585652103851543032021-01-11T13:53:00.014-08:002022-12-22T14:33:31.110-08:00COVID-19, Psychiatry, and Politics: an update and reflection on 2020<p> COVID-19 update January 2021</p><p>I come to this issue as a psychiatrist. I am not an infectious disease specialist, immunologist, virologist, or epidemiologist. But I am well-educated in all of these fields, at least to an undergraduate and MD level, boosted further by my background in mathematics & statistics. As an undergraduate science student another of my special interests was microbiology. I have always tried to follow developments in general medicine and medical research over the years, alongside developments in psychiatry. Epidemiology and the science of efficient, valid study design and data analysis are essential components of modern psychiatry. </p><p>I also have personal experience with this issue. A close family member nearly died of COVID-19 and most likely will have long-term serious health consequences despite having survived. One family member works on an acute COVID ward. Four other family members are physicians or nurses working in acute care medicine and are in close proximity to this issue in their practices. Another close family member is a virologist, part of a Canadian team that studies COVID-19 and is developing another vaccine. An increasing number of colleagues, friends, and patients have been affected by the virus. </p><p>This bears no similarity whatsoever to any other infectious disease epidemic that I have seen in my lifetime. It is nothing like the seasonal flu. </p><p>COVID-19 is the worst public health catastrophe to have befallen the world since the great pandemic of 1918. </p><p>There have been about 2 million deaths due to COVID-19 in the world so far. This is a tiny fraction of the number of deaths that would have occurred if we had carried on as usual, as though this were an ordinary outbreak of the flu. </p><p>Let’s imagine that we had not introduced any significant public health measures, and that we had treated COVID-19 like any other seasonal flu outbreak: </p><p>The current understanding of COVID-19 mortality risk, of about 1% overall, would imply a total anticipated worldwide death count of 50 million if no public health measures had been taken to slow the spread of the disease, mostly over the course of one year. That represents over 500 million years of life lost, equivalent to all the years of life lost from murders and other violence in about 20 years of time. </p><p>But these 50 million deaths do not even begin to estimate the other impacts on the population that would have happened: </p><p>Hospital wards and intensive care units would have been overflowing for a year or more, leading to many more deaths: people with other diseases and injuries would have been unable to access care, forcing healthcare professionals to let many people die without the curative treatments that otherwise would have been available. Unfortunately we see this going on right now in many places of the world, including in Canada, despite the strong public health measures we have taken. </p><p>Dealing with such devastating trauma would have caused many healthcare workers post-traumatic illness, in many cases for the rest of their lives. Many workers would have had to leave their careers. Many would have died by suicide. For such workers, it would be equivalent to working on the front lines of a major war on a daily basis for an entire year. Unfortunately, this is going on in many areas of the world, despite the measures taken. </p><p>And, unlike other epidemics of viral respiratory disease, COVID-19 has a clear propensity to cause lasting tissue damage, not only to the lungs, but to other organs including the brain. There would have been a much higher burden of lasting or permanent disability as a result, if the disease had been allowed to spread unchecked through the population. </p><p>For people who have shockingly had doubts about the severity of the situation, I have wished that they could visit the many patients in agonizing, suffocating respiratory failure on their journey to a nightmarish ICU stay. Ironically, the good public health measures in many places have limited ICU overflow, so that relatively few people in these places know any friends or neighbours who have suffered this way—but because of this success, many poorly-informed people do not have a realistic understanding of the horror of the situation. </p><p>The strict measures we have taken have absolutely been necessary to prevent the present catastrophe from being a hundred times worse. </p><p><br /></p><p>But the measures were not nearly enough, except in a few countries. </p><p>It is fair enough to observe that if a vaccine, massive-scale testing, or effective acute treatments had been impossible to achieve, it would have made sense to just let the disease gradually run its course, with just enough public health intervention to prevent the hospitals from overflowing. </p><p>But most of us were optimistic enough to anticipate that a vaccine and other treatments would be developed over the space of months to years, therefore it was imperative to slow the spread as much as possible, not only to delay deaths and suffering, but to prevent them entirely and allow a return to full normality. </p><p><br /></p><p>Here are some thoughts of other measures that I think would have been necessary or helpful: </p><p><br /></p><p>1) One of the unique aspects of COVID-19 is its very strong age-dependent morbidity and mortality characteristics. In young, healthy adults under 30, it is indeed usually (though not always) a mild or even trivial viral infection. But with every advancing year of the victim's age, the disease becomes more deadly. </p><p>This fact, in my opinion, could have been used to design some very simple basic research studies. It would involve healthy young volunteers, fully informed of risk, to be exposed voluntarily to the virus in a quarantined, medically-supported setting. The risk would be comparable to that of volunteers for military service. </p><p>This would have allowed research to determine the exact effect size of measures such as mask usage, mask type, ventilation effects, and inoculum size, in determining rate of spread and severity of ensuing disease. We would know exactly the likelihood of airborne spread, fomite spread, and direct contact spread, therefore guiding us about optimal preventive measures. </p><p>Right now we have very good evidence about the usefulness of masks to reduce viral spread, but a prospective, controlled study in humans would show, beyond the shadow of a doubt, with the highest standards of scientific reliability, the exact effectiveness of widespread or solitary mask use. When equipped with the unequivocal study data, governments could then have invested appropriately in mask manufacturing for the whole population (including high-grade N95 masks if needed). </p><p>I suspect the results would have shown a significant but modest benefit of masks, with better effectiveness for higher-grade medical masks. This could have generated a massive government intervention to supply such masks and mandate them for the whole population, using war powers of the government to compel industrial production. </p><p>Such studies would also have shown, with absolute proof, the degree and length of immunity conferred by prior COVID infection, and also whether disease severity would be impacted by inoculum size. If a smaller inoculum led to milder disease, this would be another reason to mandate mask use. </p><p>Such studies would also have been ideal to quickly test treatment strategies. The whole hydroxychloroquine fiasco, which the world saw earlier this year, could have been dealt with and resolved within a month or so, allowing us to move on more quickly to find other treatments that could have been more effective. As it was, hydroxychloroquine became yet another issue tainted by propaganda, misinformation, and mind-numbing ignorance about how to conduct valid medical research. </p><p>Such studies could have demonstrated the degree to which major ventilation improvements in indoor settings (such as with MERV-13 or HEPA filtration at a high number of air changes per hour) could have reduced the risk of viral spread, particularly when combined with modest distancing measures. This would have allowed us to determine effective safety protocols for settings such as classrooms and restaurants, possibly allowing all of these establishments to operate more safely during the pandemic. Alternatively, the data might have shown that safety would not improve much with these measures, requiring that such settings be at least temporarily shut down. </p><p>The studies would also have had the benefit of most likely producing an increased number of immune individuals, thereby preventing participants in the study from ever spreading the virus to anyone else. </p><p>A modification of this study approach, which should still be done, and is uncontroversial, is to do more substantial animal studies to demonstrate airborne spread characteristics and the effect size of ventilation improvements. </p><p>2) Ventilation</p><p>Thankfully, mask mandates have become much more a norm, though this should have been done many months sooner. </p><p>A relatively neglected issue, which could be simply addressed, concerns improvements to interior ventilation, given evidence that COVID is spread at least in part through airborne transmission. If every classroom, workplace, restaurant, and home, had simple ventilation improvements (open windows, HEPA filtration, etc.) there could be a significant reduction in the risk and rate of spread. </p><p>Each individual method (distancing, limitation of the size of groups and time spent in group spaces indoors, masks, ventilation, disinfection) has a limited effect size, but in combination, if done consistently, lead to much more substantial protection. </p><p>3) Mass testing</p><p>The development of population scale rapid, frequent virologic testing could also have led to a rapid end to the pandemic, while allowing much more freedom to work & socialize. If every person in the population was tested daily or weekly, every positive person could have isolated for a few weeks; this would rapidly have limited cases. This approach alone could theoretically lead to the extinction of the virus. I do not know what type of technological limitations impeded this approach, but it seems to me an area that was never developed as fully as it could have been. I suspect the vast resources of the US science, technology, and manufacturing community could have led to big developments in this area, if the government response had been more normal. </p><p>2) Media and Political Issues</p><p>I am ashamed to observe that most of the medical community, and in particular the psychiatric community, has not had the courage to comment on political factors which have led to immense, needless, catastrophic suffering for individuals, economies, and the world as a whole. </p><p>Prior to 2021, Canada's southerly neighbour was afflicted by a devastating failure of leadership. We are afraid to comment, as professionals, about psychopathic and narcissistic traits accompanied by staggering incompetence, ignorance, self-absorption, affective instability, almost continuous lying, and callous disregard, in a major political leader. It does not require advanced therapeutic insight to see this--the behaviours were in plain view on almost a daily basis for years. I am reminded of a cartoon or fantasy villain, with a team of minions, not unlike the villain from a "Batman" movie or a Tolkien novel, with just as much power, though with less intelligence or criminal aptitude. I am also reminded of a caricaturized bully character from film, such as "Biff" from "Back to the Future." </p><p>If similar behaviour had been going on in the partner of one our patients, I am quite certain we would come out and at least speculate directly about this with our patient, with a message of stern warning In this case, the "patient" is an entire nation, and the "partner" is an extremely unstable, abusive leader, but one whose demagoguery and propaganda have allowed a significant segment of the population to remain devoted, as though members of a death cult, sometimes to a fanatical degree. </p><p>There has been a devastating barrage of misinformation and propaganda that has caused a bizarre politicization of simple community health measures. In part, I attribute this directly to the leader, whose egregious incompetence and callous disregard has allowed what could have been an inspired, ingenious response from one of the world's great countries to devolve into utter chaos, madness, and mass death. This behaviour has affected not only the US but the whole world. The world's response to COVID has been set back greatly, because the world's leader in advanced medicine and scientific research has been suppressed, languishing in a cloud of needless chaos. </p><p>The US could have engineered a rapid, massive research response, akin to the Manhattan Project, or the race to land astronauts on the moon, combined with public health measures, to have emerged an inspired leader in this crisis, leading to decades of respect and appreciation from people all over the world, bolstering its image and authority forever. Many of the world's greatest virologists and other health experts are American, and I can only imagine what sorrow, anger, and frustration they must have had this past year to see their country's disastrous and frightening response. Not only has the response been catastrophic, the leadership is so steeped in denial about the gravity of the situation, and probably so ashamed of its incompetence, that it is trying to convince people that it was never a serious problem in the first place, that it was all over-blown. It is like trying to convince people that World War II never happened (interestingly, the total number of deaths in World War II is comparable to the number of deaths that would be caused by COVID-19 if nothing was done about it). </p><p>There are complex causes for this phenomenon, but one element of the problem is the polarization of news information found online. It is very problematic when a group of individuals holding extreme or delusional views can all meet together on an internet-based forum or social media, and be exposed only to repetition and escalation of their beliefs. In this way, it is again very much like the dynamics found in cults. </p><p>What can be done about this? It is a hard problem, but I hope that companies responsible for such polarization, such as Twitter or Facebook, can take much stronger steps to prevent their sites from magnifying extremism and polarization, while still honouring freedom of expression. </p><p>Experts and leaders need to ensure that the entire population has access to good-quality information, and is not trapped in a "news bubble." </p><p>Leadership change is of course a key requirement for problems of this type to improve.</p><p>Twitter and other news sites have had a negative effect on my own morale. I have found that stopping news and Twitter exposure entirely for several months has been helpful. I think that it would be sound mental health advice for all of us to severely limit the amount of time we spend watching news or engaging with social media. Probably one hour per week would be a reasonable maximum. Exposure to standard news sources, such as major world newspapers, should accompany any exposure to "news bubbles." </p><p>In Conclusion: </p><p>I was always an optimist about this problem. I thought we should have had much, much stricter measures earlier on, so that we could have followed a course similar to New Zealand. We still should do this, but it is like a forest fire: it is so, so much harder to control it if you have left it burning for a long time, instead of dealing with it properly at the beginning. I anticipated that we would develop better treatments or a vaccine sooner than expected, and I am relieved and delighted that this has come to be. </p><p>But the pandemic is not over yet. We should be fighting hard, with every possible public health measure, until the population is vaccinated. Then the war will be won, and we can carry on with a more normal life again. Despite the devastation, we will have learned a lot, and some of our adaptations and innovations will stay with us forever—for example, I predict many of us will continue to do much more remote or video-based work, often from home. I hope it can be a time of healing, peace, and reconciliation, with preparations and changes put into place to prevent this type of disaster from ever happening again. </p><p>The Next Crisis: </p><p>The next crisis, or at least one of the big next crises, is an even bigger one, which is inexorably coming (it has been happening already for decades): it is environmental degradation and climate change. Unfortunately some of the same factors which caused catastrophic delays in responding to the COVID pandemic are now causing delays responding appropriately to the environmental crises. We need to be acting now to do much, much more about this. A starting point for education on this issue would be David Attenborough's documentary, "A Life on our Planet." It is both a sorrowful, tearful account of the state of the world's environment, but also contains a message of hope and a call for action. </p><p>There is always hope despite the severity of any problem. It is important not to allow frustration, cynicism, or despair to deter us from taking the actions we can to help. </p>GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-16103496526271217852020-07-18T17:36:00.002-07:002022-03-04T11:43:52.546-08:00BC COVID-19 Update, July 18, 2020The management of the pandemic in BC has been very successful, thanks to everyone's hard work and sacrifice over the past months.<br />
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Some of us, such as emergency room or ICU staff, ambulance workers, and staff at grocery stores, have had to take on much more risk than the rest. We need to show gratitude for this hard work: the 7:00 PM celebration every day is a small symbol of this.<br />
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However, since the restrictions have loosened, we have predictably had an increase in cases again over the past few weeks.<br />
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<b>I think there is a significant risk that the cases could escalate again quickly</b>. Then we would be in the same predicament as in March and April, although I think we would be better prepared.<br />
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<b>Here is what we can do right now to prevent cases from continuing to surge, and to maintain our hard-won gains against the pandemic: </b><br />
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1)<b> People need to wear masks whenever they are indoors around strangers.</b> This includes in grocery stores, shopping malls, and on public transit. All staff in grocery stores should be wearing masks.<br />
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Masks do not eliminate the risk of contagion, but they very clearly reduce it enough to make a big difference. Mask use has not been emphasized strongly enough by public health authorities.<br />
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I think that we should give free high-quality masks to everyone in the population. These should be made available at the entrance to every business, and at transit stations. A home-made mask is fine--anything is better than nothing. A good medical-quality mask is better, and an N95 is best of all. Masks are available for sale at retail outlets such as Canadian Tire.<br />
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The evidence that has accumulated over the past months has shown a much lower risk of contagion outside, including in groups. So I am much less worried about the need for a mask mandate outdoors, although I continue to think that the more mask use the better, when around other people. <b>I do think that there should be a mask mandate for grocery stores, shopping malls, public transit, and other indoor spaces in which strangers could meet each other. </b><br />
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2) <b>Maintain social distancing, also known as "physical distancing." </b>The farther you are from an infected person, the smaller the risk of contagion. During the whole pandemic we have recommended 2 metres, or 6 feet, of distance between people. I recommend this as a bare minimum. The more distance, the better. Social distancing is absolutely crucial if you are in an indoor environment.<br />
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3) <b>Grocery stores and other businesses should continue to limit the number of people allowed inside at one time.</b><br />
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4) <b>I think that if you are going to a restaurant, you should take out</b>. Sitting inside at a restaurant is a needless high risk activity. The thought of opening bars seems like madness to me.<br />
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The evidence in the past months has also showed that the main route of contagion is through respiratory droplets. There may be a small degree of true "airborne" transmission, but most spread is through close contact indoors with an infected person. Many such infected persons do not have any symptoms, so there would be no way to know you are in contact with someone who has the infection.<br />
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The risk of such spread is greatly increased when people are talking, shouting, or singing, and the probability of contagion of course increases with the duration of time spent in a high-risk environment. So a restaurant meal indoors around strangers, all of whom talking and laughing without masks, is very high risk. The ventilation system in such an enclosed space can cause contagion in people downstream with respect to the air flow.<br />
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5) <b>We are enjoying more social contact with friends and relatives, but we should continue to maintain a limited social "bubble." </b> Now is not a time to be inviting new friends to your home, or having dinner parties. If you want a social dinner, consider having a picnic or a barbecue outside.<br />
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6) Hand-washing practices and cleaning surfaces such as doorknobs or shopping carts, are still recommended, but my reading of existing evidence is that contagion from surfaces (so-called "fomite transmission") is not likely. The main mechanism of spread is through respiratory droplets in the air, spread by coughing, sneezing, talking, or simply exhaling. Therefore, we should maintain good hand-washing practices but we do not need to be as worried about this, and we do not need to frantically increase efforts to sanitize surfaces. Our efforts should be spent primarily on reducing contact with strangers, reducing contact with crowded indoor spaces, increasing mask use, and maintaining social distancing.<br />
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7) <b>Working from home should be encouraged whenever possible. </b>An office workplace, with people in close proximity without masks, is very high-risk in my opinion. Government support should continue to allow working from home, and financial support for people who need to take a leave from work.<br />
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8) <b>I do not support any plan of students returning to attend classes indoors. </b> If there could be group activities planned for outdoor learning, in conjunction with video lessons from home, this might be a reasonably safe balance.<br />
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9) <b>On a community level, the more we can increase testing and tracing, the better we will be able to control, or even end, the pandemic.</b> We can learn from other places that are controlling the pandemic very well, such as South Korea and Germany. For example, if a home-test kit was available, manufactured with massive government-supported investment, freely provided, and if every person in the population could test themselves weekly, we could rapidly isolate almost every COVID-19 carrier, and the pandemic would be over within a month or two. Such mass-scale testing is far from being available, but this thought experiment demonstrates how incredibly important it is to test as much as possible, including random people in the population, and people without symptoms; from there it is essential to have a system to isolate every person with a positive test as quickly as possible, as well to inform and temporarily isolate any known contacts. This system takes leadership, organization, a vast investment of money, commitment, and hard work to set up and run. <br />
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10) <b>Follow reliable sources for information</b>. In BC, we are fortunate to have Dr. Bonnie Henry, who has been a great leader through this emergency. There are good people to follow on Twitter for COVID-related information: for BC news, there is @BCGovNews. I recommend Eric Topol (@EricTopol), Max Roser (@MaxCRoser), Nicholas Christakis (@NAChristakis), the Canadian ID physician Isaac Bogoch (@BogochIsaac), David Boulware (@boulware_dr), @AndyBiotech, and for some more sophisticated virology, Professor Akiko Iwasaki (@VirusesImmunity). There are many others, but I think these are a good start.<br />
<br />GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-57029012404940738982020-05-26T15:00:00.003-07:002022-03-04T11:44:01.848-08:0015 Average Years of Life Lost for each COVID-19 death<div>
The following is a very rough estimate, which would be subject to refinement or correction, but I believe it is reasonably accurate. </div>
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Here are some calculations to show approximate average years of life lost for each COVID-19 death in the population. They are based on mortality statistics of COVID-19 deaths, </div>
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which shows that about 49% of people dying were age 75+ (each of whom lost 6 years of life on average); 25% of people dying were ages 65-75 (each of whom lost about 15 years of life on average); 22% of people dying were ages 45-64 (each of whom lost about 30 years of life on average), 4% of people dying were ages 18-44 (each of whom lost about 55 years of life on average), and 0.05% of people dying were younger than 18 (each of whom lost about 70 years of life on average). </div>
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Therefore the average years of life lost for each COVID-19 death is </div>
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(0.49 * 6) + (0.25 * 15) + (0.22 * 30) + (0.04 * 55) + (.0005 * 70) = 15.525</div>
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So each COVID-19 death in the population leads to an average loss of 15 years of life.</div>
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The calculation is based on tables of COVID-19 deaths by age, all of which give quite similar numbers, combined with life expectancy tables (in this case from Statistics Canada). </div>
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The US population therefore, in just 4 months time has had about 1.5 million years of life lost from COVID-19 (probably an underestimate), which is about as many years of life lost as from all the murders in the US in 2 years' time.<br />
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Reference for murder YLL statistics: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607680/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607680/</a><br />
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<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; width: 1184px;"><colgroup><col style="width: 51pt;" width="68"></col><col style="mso-width-alt: 8755; mso-width-source: userset; width: 192pt;" width="257"></col><col style="mso-width-alt: 14045; mso-width-source: userset; width: 309pt;" width="412"></col><col style="mso-width-alt: 15240; mso-width-source: userset; width: 335pt;" width="447"></col></colgroup><tbody>
<tr height="19" style="height: 14.25pt;"><td height="19" style="height: 14.25pt;"><br /></td><td><br />Update: through the course of 2020, there were about 375 000 COVID-related deaths in the US, representing over 4 million years of life lost, which is a similar impact on the population as <br />all of the murders in over 5 years' time. </td><td></td><td align="right">6</td>
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GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0tag:blogger.com,1999:blog-6886575137375451769.post-58118902932025589042020-05-02T18:32:00.002-07:002022-03-04T11:44:13.029-08:00Why strict social distancing and massively increased testing are important to solve the COVID-19 problemThere are various clear arguments about why social distancing is important in managing the pandemic.<br />
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Most would agree that obviously distancing will reduce spreading. But many people might wonder why it is necessary to continue social distancing even when case numbers are dropping, or when the situation appears to have improved, especially when distancing measures are causing such hardship.<br />
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When considering any sort of physical system or intervention, it is often interesting, logically, to consider what happens when an intervention is applied at the theoretical extremes.<br />
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<b>Thought experiment #1: the two hypothetical extremes of social distancing</b><br />
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The two extremes for social distancing would be the following:<br />
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case #1) every person on earth (all 7.8 billion of us) would maintain over 2 metres (6 feet) of distance from every other person on earth, continuously for the next 4-6 weeks.<br />
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case #2) every person on earth (all 7.8 billion of us) would have direct contact (maybe a handshake, a hug, and a kiss) with every other human on earth, all in the same day!<br />
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What would happen with each of these extremes, given current COVID-19 infections?<br />
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<b>Case #1: with maximum social distancing, pandemic over in 6 weeks, with 10 000 to 100 000 </b><b>deaths</b><br />
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In case #1, there would be no spreading. Of the current 10 million or so people who might carry the virus at the beginning of the 6 week period, perhaps 0.1 - 1% would die, which means 10 000 - 100 000 deaths. This is the lowest possible number of deaths from the pandemic, unless a cure is found in the next 6 weeks. <br />
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After that 4-6 week period, the virus would be gone, and COVID-19 would no longer exist in the human population, unless it was introduced again from animals. The pandemic would be permanently, completely over. A variety of other human diseases would probably be greatly reduced as well.<br />
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<b>Case #2: with maximum social contact, pandemic over in 6 weeks, with up to 160 million deaths</b><br />
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In case #2, everyone would contract the virus. The death rate would be higher than case #1 since health care resources would be massively overwhelmed. Let's say a 2 % death rate, which means 160 million deaths, all over a 1-2 month period, which would basically be the worst devastation in human history. After this point, the virus would also most likely be done, people would probably be immune, and the pandemic would be over.<br />
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We can see by comparing case #1 and case #2, which differ only in how much social distancing took place, that <b>social distancing has a clear , huge effect on mortality</b>. The maximum effect of social distancing alone would be to reduce deaths about a thousand-fold and to put an end to the pandemic.<br />
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Conclusion: By social distancing alone, it is possible to theoretically end the pandemic in 6 weeks, with a minimum of fatalities. But of course such a plan would prevent most normal activities in society for over a month. <br />
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<b>Thought experiment #2: the two hypothetical extremes of testing</b><br />
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The two extremes of testing are as follows:<br />
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case 3) Every person could instantaneously know if they were a viral carrier, at every moment. An imaginary device to accomplish this would, for example, be an electronic monitor that everyone would wear, that would instantaneously light up if a virus was detected in someone's exhaled breath.<br />
A watered-down version of this, which is theoretically possible at present (if not feasible at scale yet), would be to have every person in the population tested every single day, with results available in minutes.<br />
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case 4) No testing at all would take place. This is not far from what is really happening in some places.<br />
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What could happen in each of these cases?<br />
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<b>Case #3: with maximum testing, pandemic over in 6 weeks, 10 000 to 100 000 deaths, with minimal disruption to daily quality of life</b><br />
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Every person with virus detected could promptly isolate, eliminating any chance of spread. Since the tests would be done continuously on all people, there would be no chance for asymptomatic spreading. The mortality result would be similar to Case #1 above, with the pandemic over in 6 weeks, with under 100 000 deaths. But unlike Case #1 above, Case #3 would only require a 6-week isolation of the 1% or so of the population which carries the virus. The other 99% of us would be entirely free to live normally, with no social distancing required.<br />
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<b>Case #4: with no testing, pandemic over in years, or never over, with 4 million deaths </b><br />
With no testing, we would have gradual spread to the entire population, occurring over a period of months to years. It would continue spreading because of asymptomatic transmission. We could assume a lower death rate than case #2, since the health system would be less overwhelmed, and there would also be more time to develop better treatments. So let us assume a 0.05% death rate overall. This means about 4 million deaths.<br />
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Conclusion: <b>testing, done as frequently as possible, and of as many people in the population as possible, has a clear, huge effect on mortality, on the duration of the pandemic, and on preserving a more normal quality of life</b>. Testing and isolating alone could also end the pandemic in 6 weeks, with a minimum of life or economic disruption.<br />
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What conclusions can we take from these hypothetical thought-experiments?<br />
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Social distancing obviously works. The logic above shows it. It needs to be extremely rigorous and disciplined, with everyone participating, in order for it to help best. If some people are not participating, the virus still has a chance to spread.<br />
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There are actions that will increase the effectiveness of social distancing, to “magnify” it if you will. These actions include widespread face mask usage, plastic barriers, hand-washing, and frequent disinfection.<br />
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Frequent testing also works. Experiments are not necessary to prove this. The logic outlined above proves it! With a maximum of testing, the pandemic could be over in 6 weeks, but unlike the social distancing technique, it would require much less disruption to the population, to lifestyle, and to the economy.<br />
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In practice, we are imperfect people, our governments are very imperfect, and also the technology required to put these two types of ideas into place are limited. It takes time and money to manufacture test kits and to develop the infrastructure to distribute or administer them, and to arrange to isolate every positive.<br />
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What can we do in the meantime? Individuals do not have the power to make more frequent testing happen. But individuals can adhere to social distancing with as much discipline as possible. This clearly will help.<br />
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What can businesses, schools, churches, and other group organizations do? They can enforce rules of social distancing for their employees, students, or members. They can sponsor campaigns to persuade others to follow the rules. They could use their political influence to urge governments to do the same.<br />
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Industries could participate, to the best of their ability, in the mass-manufacture of testing kits if possible, and of other useful technology, such as masks.<br />
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Governments have some power to enforce social distancing, and in my opinion they should use it, if they want the pandemic to end sooner, to save more lives, and to get the economy going sooner.<br />
Governments and industry also have the power to maximize the production and deployment of tests. If the number of tests could be increased 10-fold, or 100-fold, or 1000-fold compared to where they are now, this will put a very powerful brake on the pandemic, and give us the chance to eliminate the virus entirely, with the smallest possible disruption to our lives. Really, I don't understand what they have been waiting for; every day of not maximizing test kit production is a day of needlessly careening towards greater and greater catastrophe and death.<br />
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If both distancing and testing are done in a non-committal, half-hearted, slipshod manner, then there will be probably some reduction in case numbers, a "bending of the curve," but the pandemic will drag on possibly for years, or until a vaccine is found to work, is mass-produced, and given to the entire population.<br />
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There are, of course, other things to work on towards solving the COVID-19 problem, especially vaccine development. But this is likely to take quite a long time. It would be unprecedented for a new effective vaccine to be available within a year. But then, I am always amazed with what human ingenuity can accomplish, so I wouldn't be surprised if a good vaccine is indeed developed in record time.<br />
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There is also the hope that new, more effective drug treatments can be found. This research is just beginning to hint at some more effective developments. I wouldn't be surprised if much better drug treatments will come along in the next months as well.<br />
<br />GKhttp://www.blogger.com/profile/14714377295981745087noreply@blogger.com0