A new study¹ suggesting that the benefits of SSRIs (antidepressants like prozac) don’t provide clinically significant benefit to most patients has been making the rounds in the news today. Relying on unpublished studies submitted to FDA during the approval process for various SSRI drugs the authors did a meta-analysis and only found a clinically significant difference between the drugs and placebo for the most severely depressed patients, and only then because these patients seem to respond less to placebo not because they respond more to the medication. The news is reporting this as if this class of antidepressants (still considered some of the most effective medications) only makes a big difference for the very depressed but for once the news may be understating the scientific evidence. The truth is that it’s not clear if antidepressants work at all.

The problem is that the trials used to test antidepressant efficacy compare the medication to a sugar pill but most patients and their doctors are able to tell when they aren’t on a sugar pill. Given the small benefits of these antidepressants over placebos the fact that study participants are able to break the blind may well explain the entire effect. For those who are interested I’ll lay out a full argument for this position below the break. However, it’s important to note that just because antidepressants might not work isn’t any reason to stop prescribing them. So long as they give greater response than placebos (i.e. people believe in them) they may be of use to some people. Alternatively one might think these drugs really do have a *very *minor effect in the most depressed individuals, if for no other reason than a system that is sufficiently far from the mean might be (on average) pushed closer by any substantial intervention (think wacking your ipod to make it work) amplified by the placebo effect.

These considerations add weight to the view that depression is not a disease or even condition in the way that Downs syndrom or Asthma is but is instead the extreme end of a distribution. Thus rather than being the result of a determinate dysfunction as those cute Zoloft commercials would have you believe having depression is more like being short². This theory is being advanced by some serious researchers^{3 4}. For some reason, however, these attitudes seem to frequently come part and parcel with the idea that we ought not to treat ‘natural’ sadness, in this case apparently justified by the evolutionary ‘argument’ that sadness must serve some purpose (of course an inclination toward or efficacy at rape might have been selected for as well it would hardly prove it was something important to preserve in modern society). While some would dispute this theory everyone, it seems, is obsessed with distinguishing normal and abnormal sadness.

I could not disagree more forcefully. Far from being an argument to abandon the idea of alleviating suffering via chemical intervention the idea that depression is just an extreme for of unhappiness, if true, militates for research into effective drugs to elevate mood. Would we deny those so short they experience serious hardship or those with GH deficiencies in adulthood treatment with growth hormone just because some of it’s benefits are available to those with average levels of the hormone? Of course one always has to balance benefits with side effects and depending on the drug that balance may very well weigh against treatment in those who are already quite happy (as I understand does for HGH treatment for most people) but it’s hard to imagine that any bearable level of side effects is enough to justify denying an effective treatment to those who are chronically suicidally depressed.

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I don’t think my prior post on telecom immunity explained what I meant very well. Ultimately my concern with holding the telecom companies liable for privacy violations under the current rules is that these rules, like most of our laws, were not designed to be enforced with computational precision. While my recent depressing experience with the jury system has shown me how ridiculously (and disturbingly) far this view can be taken (letting sympathy control) even congress takes it for granted that the prosecution and enforcement of most laws will be curtailed by common sense and good judgement. When the legislature writes laws about speeding it doesn’t write in exceptions for every possible contingency (say taking someone in terrible pain but not at risk of death to the hospital) but expect prosecutors and juries to exercise their judgement and not enforce the law when it leads to perverse results. A brief look at the FISA legislation reveals it is no different.

Critically FISA does not contain any general procedure to handle exceptional circumstances. If the government ever discovered compelling evidence that one of the 5000 people with a certain first name in the US had a live nuclear bomb and planned to detonate shorty FISA would offer no legal means of handling the situation. In this case attempts to execute physical searches on these people might risk spooking the terrorist into early detonation (and is no less of a constitutional violation) and the right answer (if the intel was good) would be to simply monitor all the communications of those individuals and pay them damages after the fact for the constitutional violation. However, FISA doesn’t allow a warrant to be issued without probable cause and being one of 5000 people with a particular name just doesn’t qualify and the executive couldn’t even plausibly bluff the telecoms with one of the non-warrant provisions as they only apply to non-US persons. This is just one hypothetical but it illustrates the point that FISA simply can’t handle all exigent circumstances and may sometimes need to be ignored just like we ignore other laws in an emergency.

I don’t think this is a flaw in FISA. We can’t have a general legal process to handle monitoring in truly exigent circumstances without creating the potential for massive abuse by the executive. Rather the law should continue to make these acts illegal so only when the decision maker is suitably convinced of the need to head off imminent danger that they risk legal penalties and do it anyway hoping that people will choose not to prosecute them after the fact. The question is who should be making this call.

Currently the FISA process places that burden primarily on the telecoms. A poor choice as they aren’t in a position to evaluate the true danger being faced. I would agree completely with the strict enforcement of liability against the telcos in the future so long as we tweaked the law to allow the attorney general to issue the telcos a letter assuming their liability for them. Issuing such a letter in violation of the law would carry a criminal sentence for the attorney general ensuring it would only be used in truly exigent circumstances but merely knowing such a general purpose out existed would relieve the telcoms of the need to judge the severity of an illegal request and try to guess how it will be viewed in several years and allow them to always follow the letter of the law.

As far as the current lawsuit is concerned I see a very small benefit and, so long as we retain the current framework, a danger of causing them to second guess government claims of exigency in the future. Or to put the point differently I kinda feel that back when this program started the telecoms were between a rock and a hard place. Remember the (kinda insane) attitude people seemed to have after 9/11? If the telcos had refused to hand over data even if it was illegal when the government said it was vital to stopping terrorists and it turned out that we failed to avert a major attack as a result they would have been held responsible. Once the telcos had signed on to the program they couldn’t very well back out once they realized government officials had overstated the danger since that would simply appear to be an admission of guilt to a jury with retrospective bias.

So obviously it’s good for telephone companies to generally follow the laws about the disclosure of our private data. However, while for most violations of the law there is a compelling argument to exact penalties to deter future behavior I’m far from convinced that this is the case with respect to the involvement of the phone companies in the domestic spying scandal. In particular do we want the phone companies to be second guessing national security requests?

It’s a complicated question but my intuition is that the answer is no. Whatever you think about how clearly illegal their decision was in this particular case what’s relevant for the future is the fact that it’s certainly possible for future government requests to occur in a grey area of the law, especially if they invoke special emergency provisions. Moreover, whether we like it our not in practice the law doesn’t really penalize what it says is illegal on the books. Rather we apply the law flexibly ensuring that what might be technical violations of the law aren’t treated as such in exigent circumstances. However, the only reason not to grant immunity to the telecoms is to create a precedent demanding they second guess executive requests and refuse those they decide are ‘illegal.’ But given our tendency to bias our interpretation of the law depending on the context this means that the telecom companies would have to be making judgements on the actual seriousness of the claimed threat. Even though a genuine urgent, serious need for the disputed information would have caused us to forgive and forget the administrations requests it simply wouldn’t suffice as a defense for a telecom to now try and claim they were justified in bending the rules because it might have been a serious situation.

Now the telecoms aren’t exactly an optimal place to put responsibility for weighing the seriousness of executive need for information and thus what constitutes acceptable grey areas and unacceptable overreaches. I agree this would hardly be a compelling point if there was some great service the telecoms could provide by holding out but the truth is that the executive branch has so many tools and methods for violating the privacy of americans that this liability really brings no benefit. In fact to the extent that people put any faith or trust in this sort of safeguards rather than placing the safeguards and penalties inside the government it puts us at further risk.

I don’t think we should eliminate the law under which the telecoms could have been liable. If it happens again they should need to get another immunity bill passed. Nor do I think the democrats should just role over and sign this bill without a fight. The condition for granting immunity should be a full disclosure by the administration to congress (who could then collectively decide what to disclose to the people) of the full extent of these problems. Then congress should work on passing bills that make high ranking government employees personally liable for knowingly making illegal requests of telecom companies. These people have the information and position to know what is going on and they should be the ones taking the risk in extreme circumstances.

So there is this interesting article in the NYT describing a study that shows girls in highschool who think they have lower social status gain more weight than girls with higher social status. Now I think this is a very interesting direction to pursue but the suggestions the study authors offered in response to it were totally absurd.

Parents concerned about a girl’s weight should look not only at eating habits but also at their child’s social network, encouraging relationships with friends and enrolling kids in group activities, the researchers said.

Have these researchers never been to highschool? Do they really think that having your mother fret over your social relationships is going to help?

And as part of other anti-obesity measures, school officials should consider implementing programs to help girls build social skills, they added.

“I think schools have a lot of influence,’’ said lead author Adina R. Lemeshow, now a project analyst at the New York City Department of Health and Mental Hygiene. “It’s about fostering secure and supportive social environments in which girls feel more accepted.’’

Did they read their own damn article? They reported that social status affects obesity not ’social skills.’ Not everyone can be on top of the social hierarchy. No amount of intervention by the school can change the fact that 10% of the HS will be the least popular 10% of the highschool.

Much has been made recently over the fact that people are more inclined to say they will vote for Barack in polls or caucuses then they are to vote for him in a secret ballot. The supposed explanation of this is that people are reluctant to admit their racist biases to pollsters or in caucuses but in the privacy of the voting both they can’t bring themselves to vote a black man. The ‘evidence’ for this is merely the fact that other studies have revealed that people are reluctant to admit their racism to pollsters.

Now in a nation of 300 million obviously this description will describe at least one person but this theory seems more motivated by the desire of Barack voters to feel good about themselves and outraged at those who won’t vote for him than than by serious thought. It would be silly to deny that race cuts both ways in this election (i.e. Barack loses as well as gains votes because of his race) but is it reasonable to think that voters who view themselves as race blind but aren’t would tell pollsters they are voting for Barack? It seems more plausible these voters would simply say they are voting for Hillary and give some other explanation. After all we don’t see online daters telling lies about who they want to date. They just offer non-racial explanations for what can be shown to be strongly race motivated behavior.

A much more plausible explanation for the majority of this effect is the symbolism of voting for Hillary as opposed to Barack. As I’ve observed in conversations around campus and discussions at IDS (debate club) even the Hillary supporters view her as a cynical, conniving politician who is represents the standard wheeling and dealing approach to politics. Now I think it’s rank stupidity to fall into this emotional trap where we assume that campaign donations, realpolitik, experience in washington are bad things just because they are in tension with apple pie and some idealized view of our republic we learned in third grade but given the preconceptions of most Americans this makes a vote for Hillary a cynical pessimistic vote. Many people undoubtedly think that the imperfect real world requires a cynical, well-connected politician like Hillary but feel bad about it. While saying you are voting for Hillary doesn’t project the idea that you are racist it does project the idea that you cynically reject the message of hope and change that Barack seems to stand for in the popular imagination.

Anyway having said this I should add that I’ve started to warm up to Obama a fair bit recently. Some of his campaign proposals encouraged me to go download his audiobook and away from the stupid idealism of his public persona I’m starting to have more confidence he would be an excellent president. Given the tone of his book, his constant anthropological relationship to myths and symbolism and clear understanding of the harsh dog eat dog nature of the world I’m starting to think he is a very smart man who is extremely skilled at projecting a certain mythic status and symbolic role for himself but isn’t the sort of idealistic antidote to realpolitik that his supporters take him to be.

What particularly swayed me towards Obama is the trajectory of his religious belief. More or less it seems (though I haven’t gotten here in the book yet) that for much of his life he was curious about religion but was unwilling to actually believe in it until he was a political figure who really needed a ‘faith’ to connect with the community. As it is I’m now sorta unsure who I prefer (leaning vaguely Obama) but if I knew he had really joined his church for political expediency I would support him in an instant.

Now I occasionally complain about the reporting of some science story in the press but that’s mostly for what amounts to poor choice of analogy in what is essentially a fluff piece that props up public support for science research. This particular example is something different. It’s not only negligent, if not downright fraudulent, as far as journalism goes but is likely to fairly directly result in the death of at least one woman. True, many newspaper stories likely result in a gain or loss of life years but when the loss of life is an obvious effect of misleading reporting.

What I’m talking about is the article in the East Bay Express on the Gardasil vaccine for HPV (thus cervical cancer) titled “One Less“. True, the article describes the ‘controversy’ about the Gardasil vaccine’s deadly side effects for HPV (thus Cervical cancer) without article asserts nothing factually untrue. I don’t doubt the mother of the girl who died as the result of blod clots shortly after taking the vaccine really said the quotes attributed to her nor that the semi-anonymous remarks really do come from someone who had the shots. However, the whole article is set up to portray these as reasonable fears that are on one side of a ‘growing debate’ while plastering a picture of a sweet little 17 year old who died after taking the vaccine on the front of the print magazine with the “One Less” slogan of Gardasil written over it.

I mean the arguments for the involvement of Gardasil are really this bad:

“Some are pretty hard to discount as being a reaction,” Grothe said. “When a patient dies of a blood clot three hours after getting a Gardasil vaccination, that’s pretty consistent to me.”

Of course all the medical professionals interviewed point out that the birth control pills being taken by the girls who died are likely the cause but that doesn’t stop the article from throwing logic overboard to pander to the emotions of a grieving mother and friends or by mixing in real concerns and disadvantages of the vaccine as if they were concessions. Of course even if you grant that the vaccine is as horrible as the grieving mother trying to blame it claims it is hard to see how the harms would overwhelm the 4,000 deaths it could save a year not to mention the suffering it could erase.

Given that newspaper articles like this generate readers and likely convince people not to take the vaccine I have grave doubts about the ability of jurors to evaluate expert testimony in drug and medical device trials.

I’m listening to an religious commentator on NPR talking about the anti-Mormon bias that Mitt Romney’s campaign revealed. Now I don’t know if there is much evidence of this supposed ‘bias’ or not but I’m sure that the comparison to antisemitism is unfounded. The Jews (since we don’t really mean Semites) are a cultural and ethnic group as well as a religious one and antisemitism refers to a prejudice against this ethnic/cultural group not hostility to the Jewish religion. There is every difference in the world between questioning someone’s judgement because he believes something stupid and hating them because of their heritage. Mormons (like every religious person) can always choose to believe something more reasonable but you can’t choose to have a different ethnicity.

Of course not all types of undesirable prejudice rest on immutable characteristics. Certainly the unfounded bias and suspicion of catholics at an earlier time in our history is another black mark on our past. However, what made this a harmful prejudice rather than a reasonable disagreement over religious views is the nature of the suspicion that Catholics labored under. It wasn’t merely that people felt catholics believed stupid things or even thought this made their judgement suspect. This might warrant voting against them for president but wouldn’t stop you from being friends with them or accepting them into society. Rather there was a general antipathy toward Catholics that extended to viewing them as inferior people. There is no good reason to believe there is any substantial antipathy for Mormons the way there used to be for Catholics. Even hard core religious right types seems to view Mormons as merely having wacked out religious beliefs but generally being good people.

Still if you think that merely voting against someone on the basis of your religious views is prejudiced and unacceptable then Romney supporters don’t have much ground to stand on. After all Romney has repeatedly made statements about the importance of having someone of faith in the white house. You can’t have it both ways. Either religious views are reflections of the person’s identity and character and thus valid considerations for the voting booth or they aren’t and atheism shouldn’t be seen as a disqualifier for election.

I mean Jesus Christ this is like running on a campaign of ‘kicking out those damn wetbacks’ and then complaining that people didn’t vote for you because you’re black.