The evil mushrooms

Something of an unconventional post today – I wondered what some of the villainous creatures from the Super Mario Bros. series might look like if they were, well, a little more realistic.

Super Mario Villains

Published in: on February 5, 2011 at 12:16 pm  Comments (2)  
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The placebo protest: under the microscope

Placebo pills

Protesting makes me feel good.

At the end of April last year, I wrote an essay on the rise of protest-based demonstrations as a means of engaging with the public on certain irrational beliefs. While the 10:23 homeopathy campaign and the so-called Boobquake protest were the two references I provided, other examples such as the atheist billboards in the US can be arguably included in the category of what I termed the ‘placebo protest’.

In its simplest terms, protests can be described as any collective’s attempt to coerce others into changing behaviour or taking action, making it a fairly broad category that can include many different forms of public engagement. However, the term also suggests the active opposing of an existing social condition, so is commonly negative or antagonistic in nature. A campaign that promotes the message ‘don’t eat pizza from Joe’s” is a protest, while ‘eat at Joe’s Pizzeria’  is less likely to fall into that category.

While academic literature varies somewhat in the precise boundaries of what constitutes a protest, there is a consensus amongst outreach researchers that any attempt to impact on public behaviour relies on specific environmental conditions (termed ‘opportunities’) to succeed. Identifying these conditions can make the difference between winning people over and wasting resources trying.

A good example of identifying opportunities involves understanding how a target demographic interprets a particular message. Using communication tools that convey subtle variations in meaning between sub-cultures risks losing key messages in translation; using stunts, demonstrations or slogans that mean one thing to the protester (or extend from a culture within that group rather than one understood externally) and another to an audience could make any effort to change behaviour somewhat impotent, or even counter productive.

A significant impediment to identifying opportunities in a demographic is a lack of  – or wide variation in – explicit goals. Terms such as ‘promoting education in…’ and ‘raising awareness of…’ are commonly bandied about without objective qualifiers or even a hint of an observable indicator. Often, the qualities of the target audience might be too broad or be presumed without good evidence. Without clear aims or targets there is an added risk of ad hoc justifications of success, typically relying on output (audience scope and reach) to represent impact (change of behaviour).

For a form of outreach to be a placebo protest, however, there is one last important feature – those engaged have to demonstrate little interest in evaluating the circumstances or effectiveness of their actions. Like placebo medicine, placebo activism is practiced not with a true desire to blind oneself to bias, but simply to feel better on having acted, regardless of the true impact of their efforts.

While I can’t accuse all individuals who are engaged in any single protest campaign of doing so for merely placebo reasons, there is some irony in that a number of people will happily offer explanations for their participation that aren’t unlike the same explanations many users of homeopathy or natural medicine offer; ‘soft science like sociology or psychology is too ineffective to study the effects of what I intuitively already suspect to be true’, ‘it takes all types of action to make a difference’, ‘doing something is better than doing nothing’, and ‘it might not work for all people, but what’s the harm in trying?’

Central to the placebo protest is the apparent assumption that sharing feelings is synonymous with sharing knowledge. An emotional reaction to a wrongdoing leads to encouraging others to see it as silly, immoral or dangerous. That’s not to say this is always ineffective (history is full of examples of fear campaigns that are immensely successful in changing behaviours), however when it comes to rational outreach, should it be the desired approach?

Boobquake was proposed as a scientific study, for example, however was presented more as a satirical exercise poking fun at an Iranian prayer leader’s claim that the exposed skin of females is positively correlated with earthquakes. Either way, it’s unclear as to what – precisely – the point of the exercise was, if not an outlet for indignation. Many people have their own view of the agenda, whether it was to promote scientific values, encourage people to understand more about tectonics, or to simply ridicule a specific view (thereby encouraging an emotional reaction in the population to an emotional claim).

The actual impact, regardless of the intentions, is unknown. Was it antagonistic towards the goals of many feminists? Did it polarise views or change them? Were a significant number of people more aware of the science of earthquakes, or of the importance of statistics in science? It’s not clear. Yet there was still a sense of ‘success’ given it had a large output.

When the sense of success carries more importance than a true understanding, however, science loses out. This is the placebo protest. For a community of people protesting in the name of science, it is a rather bitter hypocrisy.

Likewise, when the association of American Atheists launched a billboard campaign in time for Christmas, 2010, telling people ‘You know it’s a myth!’, it’s hard to know what the real aim was. At face value, it might serve as encouragement for members of the driving public who hold some theistic beliefs to abandon them. How successful was it? Are billboards an effective means for spending such funds, or could they have achieved the same (or better) results by spending it elsewhere? If they’re successful, how did it compete against the reciprocal billboard funded by Catholics stating ‘You know it’s real’?

What of the 10:23 campaign, now in its second year? Interestingly, one individual decided to take a closer look at the 2010 homeopathic ‘suicide’ stunt and seek some evidence of its impact.

As a part of a research project, David Waldock sampled reports from the mainstream and social media and analysed them in relation to the event. Focusing on a single objective of the campaign – ‘To educate the public about the full story of homeopathy, to cause them to question and become opinionated about homeopathy’ – he found that the context of the various forms of media discussion changed from being more scientific and clinical to being more political, tending towards language that reflected regulation rather than the specific mechanics of the practice.

Of course, this lays the foundation for a rather interesting discussion. Given evidence of a discourse that is leaning towards regulation, should this be the goal of future protests? Is it better to influence politics and act top-down, or should activists continue to focus on changing attitudes from the bottom-up? Are resources being well used if this is the response, or should they change?

The important thing is, useful discussion can now progress further on the back of potential evidence than on blind assertions. David’s work is by no means the final word on the matter, but it has at least provided grist for the mill and is a clear attempt at marrying observed consequences with actions.

For activism to be successful, it needs to be done with evidence, experience and expertise. Currently, protests and stunts seem to be performed more as a means of expressing frustration, anger or bigotry than a measured way of encouraging a change of culture. As such, success is measured by how many people know you’re upset.

Yet if we truly wish to combat the poor consequences of irrational thinking, we need to identify what makes outreach effective, and distinguish this from occasions when it is merely a way to placate the irate.

The Others

 

Apothecary

Medicines stupid people use (nb., I'm not one of them).

“How can skeptics have a dialogue with homeopaths?” Michelle asks that modern well of insight and wisdom, ‘Yahoo’. “[W]ithout pointing out the stupidity of their arguments? I’m thinking about the paranoid ramblings about big pharma as well as the ignorance of simple science.”

Ignoring for a moment the framing of Michelle’s query, I was interested to scan through the responses for a solution two centuries of debate on the topic might have overlooked.

“Crucially, homeopaths lack the educational level to understand how their potions can only be water,” says Dave, a top contributor. Another top contributor says, “They only start with the fallacies to avoid providing evidence – so no matter what they crap on about, keep dragging them back to evidence.”

“Never argue with an idiot, they’ll drag you down to their level and beat you with experience,” says Flizbap 2.0.

And on it goes. There are some that advocate avoidance of engagement without resorting to well-poisoning or flippant antagonism, but for the most part the advice involves engaging in a behaviour anthropologists and other social scientists refer to as ‘othering‘.

Regardless of the intentions, the practice involves judgments of inferiority or impeded progress based on observations of contrasting social beliefs, behaviours and values. It is born of ethnocentrism, where observations are made with the assumption that one’s own experiences define what is objectively desirable. The result is a sense that a group of people, ‘them’, is inferior to one’s own company, or ‘us’, on account of differences in beliefs and values.

By the dawn of the 21st century, however, ethnology has had enough of an influence on the developed world that it’s become difficult to ‘other’ non-local cultures without seeming naïve or xenophobic. Most people have come to see that subsistence farming or hunter-gathering is not a mark of inferiority or low intelligence, and limited technological dependence is a socioeconomic issue rather than a cultural or cognitive failing. Openly claiming a village in the Papua New Guinea highland is ignorant, stupid or indulgent in logical fallacies would probably raise eyebrows, leading such discussions on cultural practices to be couched in less derisive terms. While the debate over racial intelligence might continue, it’s harder to find people who justify their beliefs by pointing out contrasting traditions, lifestyles or cultural practices.

However, within national borders, ethnocentrism returns with all of the ignorance of our colonial ancestors. If it’s one habit we can’t seem to shake, it’s that our nationalistic heritage has embedded in us a strong correlation between culture and country, as if by being white and sharing an accent our cultural values must be homogeneous. As a result, othering occurs far easier with those who appear (at least superficially) to share an ethnic background.

What’s missed is that within our own community there are shades of culture and sub culture that pool, ebb and overlap. Healthcare is just one example, yet one that has significant consequences beyond other examples of cultural behaviour such as art or language. Medicine in the context of a scientific product leads many to interpret healthcare as a ‘culture without a culture‘. Science and medicine is typically presented as timeless, truthful and above all, objectively correct. It’s strictly biophysical, with its sociocultural component reduced to a vestigial nub.

As such, it’s far easier to other those who demonstrate contrasting medical behaviours. Lack of intellect or education can be easily held up as reasons for their alternative beliefs without evidence, as it’s assumed that all else must be equal. As such, archaic and empty solutions such as ‘better education’ or legal enforcement is suggested as a way of making people see sense.

In truth, there is a multitude of reasons why people use alternative medicines, few of which (if any) have much of a direct link with a level of education or cognitive deficiencies. Rather, values in what constitutes good evidence, familial traditions, cultural identities and distrust of contrasting sociocultural groups play far greater roles in determining health behaviour than university degrees or brain function. In other words, the very same factors medical anthropologists deal with abroad when studying any other health culture are responsible for the same alternative beliefs in our own community.

The question on how best to address culture change is also just as relevant here as it is elsewhere. It’s all well and good that African or Indigenous communities retain their cultural heritage, but what does one do when it conflicts with treatments for HIV, alcohol abuse or diabetes? This is a question a good friend of mine is currently researching through the Australian National University; as you might expect, the resulting discussion demands more than a simplistic ‘they need better education’ or ‘they’re just stupid’. Yet it’s not a novel dilemma; whether it’s vaccination, water sanitation, nutrition or infant care, the question of how to effectively assist diverse communities in improving and maintaining their health and wellbeing has occupied anthropologists for years, producing rich debate and diverse results.

Ironically, those who propose answers for Michelle seem to identify as individuals who would normally value science as a way of presenting useful solutions to a problem. Why then do few seem to be informed by research? Why are the answers without citations or references, seeming to be based on little more than personal hunches or folk wisdom?

Based on my own experience, few would be inclined to look further as they already assume to be correct. Science works for some things…unless you already think you know, at which point it’s all rhetoric and pedantry. Social science is a soft science, therefore gut feelings and intuition are as useful (if not more so).

Michelle’s question and many of the answers reveal the roadblock we face here in our efforts to address alternative healthcare. Rather than treating it as a legitimate sociological question, where science might provide some insight, the issue is reduced to a dichotomy of smart vs. stupid, of educated vs. naive. When those are the questions we ask, we certainly can’t hope for any productive answers.

Keep your eye on the ball

For all purposes, our nervous system has one hell of a difficult task to accomplish – it needs to take in numerous stimuli all occurring either simultaneously or in some sort of temporal order and determine if there is a pattern worth responding to. While other tissues only need to make a few hormones or make some polymer twitch, neurons need to be constantly opening and closing protein gates to balance various ions. In other words, your brain does a lot of work, and therefore uses the lion’s share of energy your body takes in to do so.

Change blindness is one of those classic demonstrations of the gaps that exist in our perception where our nervous system has evolved to take a bit of a gamble. While the specific neurology of it is still questioned, it is an indication that sensing visual information isn’t the same as observing it, and our short term memory isn’t always as reliable as we might believe. A flicker, or momentary change of attention, is all it takes to reset our comprehension of what sits in front of us in plain sight. Take this aircraft, for example. It might take you a while to notice what is missing*.

Psychologists from Harvard University have demonstrated a rather interesting illusion which goes further in showing how easily overwhelmed our perception can be through simple change and movement. There findings are due to be published in Current Biology.

Watch the clip below by paying close attention to the cross in the middle. The dots will change colour for about five seconds before the surrounding ring begins to rotate back and forth.

Now, watch it again, only this time watch one of the coloured dots. Where before they appeared to cease changing, on closer observation they do nothing of the sort.

Why?

The phenomenon has been termed ‘silencing’, and describes how it’s difficult to recognise change in a moving object. There could be two reasons this happens. One is that the observer sees the original state of an object and simply doesn’t update it with the new information (termed ‘freezing’). The other possibility is that the observer sees whatever the current state is, but doesn’t mark a change between the two therefore isn’t aware of any moment of difference (known as ‘implicit updating’).

Both explanations are shown to occur with other forms of illusion. But the results of the study indicated that the illusion is a case of seeing different colours without seeing them change.

The likely reason for this has to do with how our retina maps onto our brain. As a moving image drifts across the back of our eye, it proceeds to activate a line of photoreceptors, which in turn send those messages to a corresponding line of tissue in our brain’s visual processing system. Normally, a static, changing image will prompt a nervous reaction that says ‘this pattern isn’t like it was before’. But, if it moves quickly enough from one patch of neurons to another, the same resources aren’t capable of performing this act of recognition.  To do so would demand something a little more complicated than we currently have.

If the eye tracks the changing object, however, the object remains on the same section of retina, allowing it to persist long enough in the corresponding section of the visual processing system for a variation to become apparent. The take-home-message from this is that if your eye isn’t tracking it, change simply isn’t important enough for the brain to waste energy on bringing it to your awareness.

Yet another example of how our circuitry isn’t wired for truth, but rather for economy.

*Check out the engine beneath the wing.

For additional illusions used in the study, see this Harvard website.

Published in: on January 9, 2011 at 10:37 pm  Leave a Comment  
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If you please – just don’t lie

Believe it or not...it still might make you feel better

When it comes to alternative medicine, there is arguably no greater misunderstood phenomenon than the placebo effect. It’s not uncommon to hear it feature as a defence supporting the efficacy of treatments that otherwise have no evidence for performing as claimed. It is the modicum of benefit that is proferred when it has been scientifically determined that a touch, tincture or totem has been shown otherwise impotent.

Much of the present common understanding of the effect stems from a 1955 book titled The Powerful Placebo by Henry Beecher – an American anaesthiologist who stressed the need for double blinding in clinical testing and was the first to attempt to quantify the placebo’s action. While the placebo effect is argued to be a significant confounding factor in determining useful from useless treatments, Beecher presented the placebo effect as clinical, citing data that demonstrated a percentage of patients were ‘satisfactorily relieved’ by sham treatments.

Since then, other studies have suggested the placebo effect is physiological – that in spite of having zero bioactive components, the act of treatment alone can still help improve a patient’s biophysical functioning. For example, in a 1977 study stomach ulcers were found to have decreased in size following a placebo treatment.

On such evidence, it seems that the mind truly holds sway over the body’s matter. By merely perceiving a treatment works, an individual’s biology will make a greater effort to fix itself.

Yet there is an increasing amount of evidence showing that the placebo effect – or at least, this interpretation of it – is a myth. Any influence a sham treatment has over the variables can be reduced to psychological factors, with past studies falling foul of poor methods.

However, in the very least, it still leaves room for inactive treatments to make patients believe they’re feeling better. And, given western medicine primarily concerns itself with the individual patient ‘s sense of wellbeing, it might be argued that placebos could be used to placate a patient where no other treatment is available.

Ethically, such actions are highly questionable. Few physicians would feel comfortable duping a patient into thinking they’re receiving a treatment, when in fact they’re getting a fake pill or potion. Not to say this has stopped some from administering fake treatments without patient consent.

A new study now shows we might have the wrong end of the stick altogether – that any psychological bias towards placebos comes as a result of its superficial resemblance to treatment. Giving rationality too much credence, it was assumed that a patient needed to suspect that their treatment was legitimate. Instead, it seems the same effects might arise regardless of whether the patient knows the treatment has no bioactive components, putting lie to the claim that ‘it’ll work if you believe it will’.

Ed Yong has a great write-up on the study at his blog. While the study’s method left room for plenty of questions, if its results are legitimate it demonstrates that simply engaging in medical ritual might be enough to bias a patient’s disposition towards their wellbeing. The patient needn’t be led to accept there is a biophysical foundation to the ritual – just that there is a semblance of medical intervention.

The precise limits of the placebo effect and its cultural relationship remain fuzzy. Whether it will ever be an ethical approch to medication is hard to ascertain. However, knowing that a personal rationalisation might not be necessary for a patient to benefit from medical ritual is a positive step to better understanding how the way a patient is treated can be as important as the treatment itself.

 

 

Published in: on December 23, 2010 at 8:15 pm  Leave a Comment  
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