Tuesday, April 21, 2009

Fang mail: on hope, faith, optimism, and other popular products.

I know you're out there. I can hear you reloading.
Billy Crystal's character, insult-comic Buddy Young Jr., in the mah-velous (and often overlooked) 1992 comedy-with-a-point, Mr. Saturday Night.

I figured the above epigram was appropriate given the tenor of some of the recent comments on SHAMblog as well as the feedback to my pieces on alternative medic
ine and positive thinking. In fact, today, I present for your reading pleasure salient portions of a critique of the latter piece received by Skeptic, followed by the full text of my response to same. See what you make of it all.

The critique in question was lengthy, and arrived in fully annotated, academic-journal form from
Andrew Newberg, MD, and Mark Waldman, co-authors of several books including How God Changes Your Brain*. Waldman and Newberg tell us that their "research has been published in dozens of peer-reviewed journals and academic texts."

Bracketing themselves as "skeptical researchers with a penchant for thorough and accurate assessments of the strengths and weaknesses of positive thinking and optimism," they argue as follows:

"...We are dismayed by Salerno's apparent lack of comprehension (and exclusion of references to back up his claims) when it comes to the hundreds of studies relating to this important psychological and neurological topic." After accusing me of "not [doing my] homework," they assert that "hope, optimism, and the belief in a positive future (i.e., faith) is essential for human psychological and neurological functioning." They invoke psychiatrist and Nazi death-camp survivor Viktor Frankl, who, in his book, Man's Search for Meaning, said (they're paraphrasing) "the single most important thing that kept a survivor alive was faith. If a prisoner lost faith in the future, he was doomed, because the will to live seldom returned." They then quote Frankl directly a time or two.**

Authors Waldman and Newberg note that optimism is central to the placebo effect, and state that "placebos can cure, on the average, 30% of the majority of physical and emotional diseases." They tell us that a team of National Institutes of Health researchers concluded that optimism also appears to play a "crucial role in controlling anxiety, depression, and rage," and that "even the medical researchers at the Mayo Clinic stress the importance of optimistic thinking for maintaining optimal health. They found that positive thinking decreases stress, helps you resist catching the common cold, reduces your risk of coronary artery disease, eases breathing if you have certain respiratory diseases, and improves your coping skills during hardships."

Waldman and Newberg then provide a laundry list of minor studies suggesting that this or that disease is responsive to positive thinking, adding
that even "an unrealistically optimistic belief about the future appears to be health protective, even when dealing with a disease as serious as AIDS." Finally, they contend that pessimists don't live as long as optimists.
And herewith, my response, written at the invitation of Skeptic editor Michael Shermer:
Sometimes when I receive criticism I'm left wondering: Did they actually read the piece? This is such a case.

For the record, I have never argued that optimism has no legitimate role in life. I argue that the frenzied overselling of optimism as a blanket prescription for all that ails us is one of the more subtly destructive forces in American culture. Just as scholastic self-esteem gurus were dead-wrong when they led us to believe that so-called “bolt-on” self-esteem automatically yields academic excellence, there's no question that today's gurus of optimism have led the nation down the primrose path in declaring that an upbeat attitude is its own foolproof reward. My real quibble, then, is with undue optimism about optimism—“the notion that the riddle of success is more easily solved by attitude than aptitude,” as I wrote near the top of the story. I was primarily indicting the commodification of optimism, and I stand by that assessment. (The gurus are right about one thing, however. Optimism does produce a great deal of wealth: their own.)

Authors Waldman and Newberg, meanwhile, offer us an object lesson in how a few scraps of “emerging science,” as it's called in those smarmy TV ads for dubious new health-care products, become conventional wisdom. They write, for example, that “medical researchers at the Mayo Clinic stress the importance of optimistic thinking for maintaining optimal health. They found that positive thinking decreases stress, helps you resist catching the common cold, reduces your risk of coronary artery disease, eases breathing if you have certain respiratory diseases, and improves your coping skills during hardships.” That's one seriously overstated mouthful, because the Mayo researchers “found” no such thing; if you go to the Mayo site,*** you'll see that they speculate that positive thinking may pay these dividends...and even those tentative declarations are made based on some (cherry-picked?) studies. Not coincidentally, this is the same strategy elevated to an art form by the National Center for Complementary and Alternative Medicine in touting its pet nostrums.

The authors also rely on the common ploy of argument-by-poetry, framing philosophy as truth. This is most clear in the several quotes from Frankl. Much like the transcendent line, “All men are created equal,” the Frankl quotes sound terrific but enjoy no scientific standing. As for the charge that I haven't done my homework: Although my piece may not be annotated in strict academic style, I wonder how the authors overlooked the references to the work of Roy Baumeister, Charles Elliott, Charles Sykes, etc.—people who clearly have done their homework. But that's not even the main point. Cleverly, the authors have embraced another staple New Age tactic by inverting the scientific method: telling me it's my job to prove that optimism is ineffective, when in fact it's their job, as members of the movement making all these claims, to conclusively demonstrate the efficacy of optimism, hope, PMA, etc.

We still have no way of knowing whether optimistic people actually do better at life or whether they just feel better about the same old crappy life (and therefore are less motivated to change anything). Do they end up like those American students, steeped in self-esteem, who got the worst grades in international testing but had the highest subjective self-assessments?

To paraphrase the famous line from the movie, “Show us the money.”

Overall, the authors represent a blended (and, as I see it, disingenuous) “compromise” between science and spirituality that, on closer inspection, necessarily calls for throwing science out the window. Waldman and Newberg are authors of a new book, How God Changes Your Brain, whose very premise and central concept—God—cannot, by their own admission, be proved. In their book, Waldman and Newberg write, “Having an accurate perception of reality is not one of the brain's strong points.” And: “The human brain seems to have difficulty separating fantasies from facts.” Fair enough...but is that where a true scientist should leave things? Do we then embrace the fantasies? Isn't it the scientist's job to weed out the real from the unreal; to wean people off the unreal; and to encourage people to work within the realm of the real, even if reality is less comfortable than fantasy? Otherwise what is the purpose of skepticism to begin with?

One final point. What I find amusing about the so-called “studies” of the role of mental outlook in health care is this: If a positive attitude is so decisive in health-care outcomes, then why not do a real controlled study wherein the control group tries to heal itself through PMA alone? Say, let's have two groups of grievously ill heart patients, both with 95 percent blockage of the coronary arteries. Group 1 undergoes heart bypass plus blood thinners, etc. Group 2 forgoes all medical intervention and tries to get better just by visualizing the unclogging of their arteries. (If you like, we can even compose Group 1 from a bunch of pessimistic curmudgeons.)

Report back and tell me how it goes.
* and that has to get consideration as one of the more unintentionally comical titles of recent vintage. Maybe it's just me, but it "reads funny."
** The reason I'm not reproducing their remarks in full is twofold. One, their commentary is very long and massively footnoted (the footnotes themselves go on for several pages). But more importantly, they wrote not to me but to Shermer, who has said he intends to publish it, and therefore deserves the courtesy of owning "first rights" to the material. I think this summary falls under applicable provisions of the "fair comment" rule.
*** This is the actual site that the authors reference in making their case.


Sarsabu said...

How would one make such a study double blind? Could a pretend bypass operation work? Now that would be interesting!

Steve Salerno said...

Sars: What a great idea! Talk about really putting the placebo effect to the test!

Steve Salerno said...

...(realizing, of course, that that could never, ever happen due to liability issues. Can you imagine the outcry from the malpractice-law wing? "You did what? You faked my client's surgery...?!")

Elizabeth said...

Oh, goodness... I have a massive deja vu here, Steve. A while ago, I penned a critical scholarly article on a "research" supposedly proving that gifted children are misdiagnosed with ADHD. I took apart the premise and the actual experiment designed to support it, both of which left a lot to be desired. This was published in a scholarly magazine, which is "the bible" in the field, and immediately (i.e., in the same issue, right next to my critique) followed by not one but two outraged responses accusing me of not only "not understanding" what I was talking about, but also being the more wicked sister of the Devil himself (ok, sorta). One response was from the authors of the initial article and experiment, the subject of my critique, and another from a group(!) of "experts" in the field, who adhere strongly to the view that gifted kids are rampantly misdiagnosed with ADHD and promote this particular view in their various books, presentations (and other money-making ventures, I should add -- not that I think this is their primary motivation, btw; I hope not.)

The responses both missed the gist of my argument and misrepresented my stance to a large degree. And they actually sounded very much like what you've gotten here from Newberg et al. ("We are dismayed by Mika's apparent lack of comprehension... etc.")

So I penned a rejoinder, correcting those misrepresentation (the piece spanned several pages), but by the time I finished it, I got sick, had to put it aside, and ended up not sending it in at all (assuming it was all water under the bridge by the time I finished it). Which, on the one hand, still bothers me to this day, because the databases show the critical responses to my article without showing my article itself or the initial one which motivated me to write mine in the first place; and, on the other hand, I let them have the last -- and incorrect, as far as my stance was represented -- word. But, well.

I can only imagine that my rejoinder would have spurred more of the same from the same people and we could continue this circular "discussion" till the proverbial cows would come home.

This is the "beauty" of such exchanges, I'm afraid, and you just found yourself in the midst of one, again. :) So congratulations on a job well done -- in all respects! (Seriously.)

Elizabeth said...

You know what's really funny, Steve, is that heavy artillery of academic titles, articles, citations and footnotes that gets pulled out to intimidate and quiet the critic.

As if having all those on their side would somehow change or obscure the fact that the emperor has no clothes -- something obvious to anyone with just common sense.

Speaking of common sense and other such rare commodities, there is an ad in this week's "Parade" magazine (yes, I admit, I read it at breakfast -- whatever there is to read there) for Neurostin -- which is mental "superfuel" that "may help reverse the damage caused by stress and age." (Note the cautious language of that claim -- admirable, no?)

A fragment from this ad read as follows:

Until now, it was believed that there was no way to safely and naturally produce this remarkable mental "superfuel." But after years of extensive research and testing, microbiologists and brain researchers at the University of North Carolina, in England at Newcastle General Hospital, and at the prestigious Weizmann Institute of Science in Israel have developed a way to boost choline* production. Their breakthrough formula also helps stimulate new brain cell growth, leading to a significant improvement in memory, concentration and helps clear stubborn "brain fog."

This exciting breakthrough discovery is now available in a time-release capsule called Neurostin Complex-Memory Pill that is available without a prescription to anyone looking to sharpen their memory. Etc. etc.
Now I am as interested as the next person in clearing that stubborn brain fog (or am even more interested than the next person, I suspect), so imagine my deep disappointment when I was finally able to read that really teeny tiny print at the very bottom of the page:

These statements have not been evaluated by the FDA. (...) Neurostin is not endorsed, associated or affiliated in any way with Newcastle Hospital, UNC, or the Weizmann Institute.What? Say it ain't so...

P.S. WV is pleading... ;)

*According to the ad, "choline is one of the brain's most important nutrients."

Elizabeth said...

OK, it's me again (sorry). The more I read your post, the more outraged I get.

That positive thinking crap really gets under my skin. It can be insulting. Really.

Just yesterday I had an encounter with a nurse in a doc's office where I went for my post-surgery check-up and we talked about my brain tumor and surgery. She was pleased (as am I, of course) that the tumor was benign, but when I mentioned that this particular kind of tumor tends to grow back in many patients (and in different parts of the brain), she immediately brushed aside both that information and my concern, giving me a lecture on the importance of positive thinking and attitude -- as a means of, supposedly, preventing the tumor's recurrence and living my life "to the fullest."

I felt dismissed and saddened. First of all, that kind of thinking suggests that I am responsible for the growth of the tumor by cultivating my insufficiently PMA. Second, it is plain stupid -- no amount of positive thinking (or denial, if you will) is going to stop or reverse the process once it's started (hope it hasn't, btw). And third, I'd rather rely on MRI than PMA, on the condition that it's read by a responsible and qualified professional. (BTW, maybe it was the radiologist's own PMA that made him miss my tumor in the MRI slides from two years ago.)

Steve Salerno said...

Good points throughout, Eliz. Look, I have no quibble with people who have legit complaints about stuff I write. And in the final analysis, a lot of this comes down to individual opinion (and might be unprovable anyway, for either side, despite my calls for more meaningful studies). But the thing I've never understood is how you can attack somebody's research and "homework" on the basis of the type of shoddy argumentation that my critics exhibit here, notably in the manner in which they twist and hype the so-called "findings" on the Mayo site: They took out all the qualifiers and conditionals and simply stipulated the info as proven fact! That doesn't happen by accident. It's willful deception done under the guise of being "scholarly."

To your point about the Parade ad, what tickles me most nowadays is this ostensible crusade to make yogurt sound like this treasure-trove of exotic and proprietary substances. Have you noticed? One yogurt features some obscure microbe called "bifidus regularus" (I'm spelling phonetically, so forgive me) and another has "l. casei immunitas," or whatever the hell they call it. Obviously the "scientific names" were chosen to evoke certain marketing-based benefits. Cracks me up.

I'm thinking of coming out with a line of yogurts for men that incorporate a newly discovered microbe, "I. erectus impressivarus." Whaddya think?

Elizabeth said...

I. erectus impressivarus.I think it's an excellent idea, Steve, and I see a huge market potential in it.

That, and the miraculous antidepressant prescribed to Lisa Simpson in the last Sunday's episode: Ignoritall.

Elizabeth said...

I've never understood is how you can attack somebody's research and "homework" on the basis of the type of shoddy argumentation that my critics exhibit here, notably in the manner in which they twist and hype the so-called "findings" on the Mayo site: They took out all the qualifiers and conditionals and simply stipulated the info as proven fact! That doesn't happen by accident. It's willful deception done under the guise of being "scholarly."Yes, it is deception. Willful probably too, though may be not totally conscious (if that makes sense). It's part of the "wounded ego cognitive sequelae" (my impromptu name of the problem ;), where the criticized party (or a party somehow invested in the issue under critique) reacts personally to it enlarging the real scope of the criticism and/or misrepresenting its gist. So they write a response that makes you think that they either did not really read your critique, or if they did, they did not understand portions of it or perhaps even the whole thing.

We see this on blogs, in journalism, politics, in everyday situations in "real life," and in academic circles, all the time.

But in that latter instance, it is especially disappointing, more so when one introduces himself as a "skeptical researcher with a penchant for thorough and accurate assessments of the strengths and weaknesses" of his subject. (Yeah, riiiight.)

Anonymous said...

Hi Elizabeth

I'd love to see your article as the way I have been taught is that ADHD kids often have an dyslexic/aspergers/autism comorbidity and these are the people that are often gifted in a paticular subject or ability.


Steve Salerno said...

People, I know this sounds like a cop-out, and maybe to some (small) degree it is, but please understand that I cannot always drop everything to provide detailed follow-up answers to questions raised by offhand/in-passing remarks I make in the course of writing or commenting on this blog. (Sometimes I can't even drop anything. That's how far behind I get.) This blog is a labor of love--sometimes--and I spend way too much time on it as it is. The questions about Edwin Black are there for the finding, especially if you have access to Lexis/Nexis and such. I have to leave it there for now. This also explains, e.g., why I've never provided the detailed critique of Byron Katie that people keep asking me for. If I'm going to do it, I want to do justice to it. I don't want to treat the entire subject in a few clever paragraphs of "snarkistry."

Eliz: The Lisa Simpson line is, of course, a cleaned-up version of the more colloquial reference, whose first syllable is that same Anglo-Saxon gerund I left out of the piece for Skeptic, where I quote my coach.

Steve Salerno said...

Eliz: Well, it's not in the gerund form--it's just the root word--but you get my drift.

Elizabeth said...

Londoner, contact me off-blog (my e-mail address is in my profile) and I'll send it to you.

Elizabeth said...

Yes, Steve, I do. (BTW, I could use some of the drug myself. Actually, more than "some.")

Anonymous said...

'I'm thinking of coming out with a line of yogurts for men that incorporate a newly discovered microbe, "I. erectus impressivarus." Whaddya think?'

I think you've hit on the next big thing, the scam of the century, hitting every marketing and selling point to 'worried middle-aged man'. Scientist Bob will be keen to JV with you I'm sure.

Sarabu asks whether a pretend bypass operation would work. There has been a lot of good work done on placebo, including a pretend key-hole knee surgery that definitely 'works' as well as the real thing. Strange brains we have, changed by god or not.

Elizabeth, no-one, including your nurse, likes to confront mortality, their own or anyone elses. We're all going to die, none of us likes hearing that or having to think about it. We're all of us suckers for salvation, whether it comes as a PMA, viagra flavoured yoghurt, faith in the ability of science to find a cure for old age and death or the latest trendy god-concept.

Common sense tells any observer with two brain cells to rub together that none of us get out of this alive.

Given that given, Frankl's determination to not give up in the face of the unimaginable horror that man visits on his fellow man in the name of power politics--not, note, the natural dying process we all face---- is as close to heroic as anything I've come across in my long and interesting life.

Anonymous said...

's OK Steve, you can't keep all the plates in the air all the time.

Case said...

>> This blog is a labor of love--sometimes--and I spend way too much time on it as it is.

And we love you for it, Steve.

BTW, and this proves that I am the stubborn plodder I told you about, I'm almost ready to re-launch Shamsite as a fan site for the book. The first launch idea from December did not take shape as I would have liked because recruiting people to "wiki" with quality has proved too much of a challenge.

I think you'll enjoy, or at least view with curiosity, the re-launch in May as it involves a lot of video all about SHAM.

Thank you again for all the work you do on this blog. It provides a lot of perspective and intelligent thinking (although somewhat more controversially at times for my tastes) that cannot be found anywhere else.