Let's Hear It For the VPs

Let's face it: even if you could name all of the presidents (and there are likely few who can), you would find even fewer people who could name all of the vice presidents. In fact, there are people who probably couldn't name one. So Buzzfeed sought to rectify that, in the best way possible. They've listed all 47 vice presidents, ranked by hotness. You're welcome.

Defeating the Clown Threat

As a follow-up to the creepy clown story, I just learned today that the clowns have made their way into the Chicago area. Fortunately, an ad went out to recruit Vikings to defeat the clown:

Looking for a group of people willing to dress up as Vikings and go hunt clowns in the woods. Must supply own chainmail and weapons. Slashing or crushing weapons suggested as clowns are lightly armored. Meade will be supplied

Though the Vikings should easily defeat the clowns, remember: clowns travel in cars to hide their numbers.

The Five-Year Legal Battle Against Bad Science

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a neuroimmune disease that affects 1-2.5 million Americans (17 million worldwide). The symptoms are widespread, ranging from memory issues and poor sleep to pain and swollen lymph nodes. The main symptom, of course, is severe fatigue that results from any kind of exertion, which is caused by an abnormal immune response to exertion that makes it difficult for people with CFS/ME to recover. Though the cause of CFS/ME is unknown, some research suggests it can occur after a bacterial or viral infection.

The best treatment for CFS/ME? According to one study (the so-called PACE trial) published in the prestigious Lancet medical journal, it's cognitive behavioral therapy and exercise. But wait, wouldn't exercise be a really bad idea for people whose immune systems freak out at any kind of exertion (leaving some sufferers bedbound)? That's what a lot of people with CFS/ME said after the article came out and especially after the article influenced treatment recommendations from such places as the Centers for Disease Control and Prevention, Mayo Clinic, and Kaiser. And it turns out, those skeptical patients were right:

If your doctor diagnoses you with chronic fatigue syndrome, you’ll probably get two pieces of advice: Go to a psychotherapist and get some exercise. Your doctor might tell you that either of those treatments will give you a 60 percent chance of getting better and a 20 percent chance of recovering outright. After all, that’s what researchers concluded in a 2011 study published in the prestigious medical journal the Lancet, along with later analyses.

Problem is, the study was bad science. And we’re now finding out exactly how bad.

Under court order, the study’s authors for the first time released their raw data earlier this month. Patients and independent scientists collaborated to analyze it and posted their findings Wednesday on Virology Blog, a site hosted by Columbia microbiology professor Vincent Racaniello. The analysis shows that if you’re already getting standard medical care, your chances of being helped by the treatments are, at best, 10 percent. And your chances of recovery? Nearly nil.

In fact, that 10 percent number is based on a reanalysis by the original authors. The analysis by independent scientists found far worse results: 4.4 percent of exercise patients and 6.8 percent of cognitive therapy patients met the criteria for "recovered," compared to 3.1 percent of people who received neither treatment. None of these differences were statistically significant.

The issues with the study are widespread, ranging from lack of proper blinding, shifting definitions of recovery and improvement between the original protocol and the final analysis, and potentially invalid thresholds for physical functioning. Some critics even suggest the the inclusion criteria are so poorly written, there may be participants in the study who don't even have CFS/ME. As Jonathan Edwards, a professor emeritus of medicine quoted in the article, put it, "They’ve set this trial up to give the strongest possible chance of there being a placebo effect that you can imagine."

And yet, this article passed a rigorous peer review process and was published, in one of the top medical journals. The question that Lancet should be asking at the moment is "How?" Once they figure that out, they need to fix whatever problem they uncover with their system, because this seriously damages their credibility.

This is an interesting counterpoint to the arguments around Susan Fiske's attack on "methodological terrorists," which some (but not all) perceived as being an attack on anyone who dares to criticize published research. In fact, the researchers in the PACE trial claimed they had received death threats - claims that appear to have been false - and the naysayers were referred to as a "vocal minority." However, I see no issue with what the lawsuit set out to do: get the researchers to release their deidentified raw data so that independent statisticians could reanalyze them. This is what good science is all about - replicability, not only in replicating a study but replicating results from the same dataset. And when the analysis approached might be invalid, this includes using different approaches, to see how sensitive the results are to, say, the cut-offs the researchers adopted. (In fact, we refer to this as "sensitivity analysis" - does a different approach make a difference in the results?) Julie Rehmeyer, the author of the article linked above, agrees:

Watching the PACE trial saga has left me both more wary of science and more in love with it. Its misuse has inflicted damage on millions of ME/CFS patients around the world, by promoting ineffectual and possibly harmful treatments and by feeding the idea that the illness is largely psychological. At the same time, science has been the essential tool to repair the problem.

Fat Shaming and Bullying: Why It's All About (Mis)Attribution

Over the weekend, the New York Times published an article on fat shaming, and the bullying people experience for being overweight or obese. Though - as with many articles recently - they tied it to comments from a certain presidential candidate, fat shaming and bullying have been issues for much longer. In fact, I've blogged about weight management and similar topics before, since this was one of my research interests.

The problem with fat shaming is that it is widespread, and the bullying and negative comments about weight begin early and continue even among adults:

Rebecca Puhl, the deputy director of the University of Connecticut’s Rudd Center for Food Policy and Obesity, and her colleagues find that weight is the most common reason children are bullied in school. In one study, nearly 85 percent of adolescents reported seeing overweight classmates teased in gym class.

Dr. Puhl and her colleagues asked fat kids who was doing the bullying. It turned out that it was not just friends and classmates but also teachers and — for more than a third of the bullied — parents.

“If these kids are not safe at school or at home, where are they going to be supported?” Dr. Puhl asked.

How can parents - who (hopefully) would reprimand their children for being bullies - also participate in this behavior? The issue, I suspect, comes down to attribution: is the person "to blame" for the condition? Though children may tease others simply for being different, as we grow older, we are taught that difference is not always bad. Further, we learn (again, hopefully) not to judge others who are different for reasons beyond their own control. That is, we shouldn't make fun of someone who has a disease that is not their fault.

The issue with overweight and obesity is that many people do not consider it to be a disease, even if the medical community for the most part does. Instead, they view it as a lifestyle choice, and see no issue with judging others they perceive have made bad choices. It's all about attribution. If I believe a person is overweight or obese because they lack the willpower to eat healthy portions and/or engage in physical activity (that is, I attribute the cause of their condition to their own behavior), what's the issue with denigrating them? Attribution theorists would argue that we engage in this kind of thinking regularly - determining whether someone is at fault for their situation - and that our conclusions impact a variety of behaviors.

Errors in attribution lead a variety of negative behaviors, like blaming the victim. There's an additional level here, though, in that people perceive the shaming and bullying as potentially helpful to the individual being shamed. That is, they think it will help motivate the individual to change:

“There tends to be this public perception that maybe fat shaming is O.K. because it will provide motivation to lose weight,” Dr. Puhl said. Instead, she adds, “it is very harmful to health.”

Research suggests that even people who overweight or obese (which amounts to about two-thirds of the general population) share many of these same beliefs. And of course, when we judge our own behavior, we all think of things we should be doing differently to be more healthy. I know I should exercise more, eat healthier, and drink less beer. Would making these changes help me lose weight? Probably, but then there's more to it that. In fact, anyone who has made these lifestyle changes knows (myself included) it is still very difficult to lose weight and even more difficult to maintain weight loss. For many years, I was 20-25 pounds overweight, and despite trying everything I could, was not able to lose much. What finally worked was a complete accident - I was prescribed a medication for a different purpose that had a side effect of weight loss. But as with other treatments for overweight and obesity, like bypass surgery, it's perceived by many to be "cheating." I didn't work to lose that weight.

What we need to do is to change perceptions about overweight and obesity. If the key is attribution, that's where we need to focus our efforts.

How I'll Be Spending October

As I've blogged about many times, I love horror movies. I watch them year-round, but October is the time of year I get to geek out about them publicly and repeatedly. Recently, Hello Giggles shared a list of movies to check out on Netflix this October. Here they are, along with my thoughts:

• They Look Like People - Hey, a horror movie I'm not familiar with! It uses the "warning messages by phone" trope, but despite that, it goes on the list!
• The Amityville Horror (2005 version) - I'll be honest, I'm often hesitant to check out remakes of movies I like, especially with horror movies, where the truly scary part is often revealed at the end. What that means is, if a movie is well-known, everyone knows the punchline, so the movie instead becomes a test of "how scary can we make it" (which often fails or devolves into overuse of gore/cheap tricks without any thoughts to cohesion and storyline: the House of Wax remake is one example of this). The original Amityville was awesomely creepy, so I never checked out the remake. But I should at least give it a shot. I can always bail partway through if it turns out to suck (as I did on a few items on the list).
• The Human Centipede - This one goes on my list of nope. It's really not my idea of good horror (see aforementioned overuse of gore/cheap tricks without coherent storyline), but maybe I should check it out. It goes on the "will watch if I get time" list.
• Would You Rather - This has been on my recommended list for a while now. It goes on the list!
• Hush - Another one that has been recommended for a while - another item on the list!
• Scream 2 - Meh. The first one was good, but I didn't totally get the appeal. It all went downhill after that.
• The Lazarus Effect - I checked this one out last October, mainly because I LOVE LOVE LOVE Olivia Wilde. I thought it was a cool concept until it got into that annoying "You only use 10% of your brain" crap. I think I started writing a review but got distracted.
• The Awakening - I also watched this last October. It was enjoyable, though one of the "twists" was predictable.
• The Taking of Deborah Logan - Watched, and reviewed here.
• The Nightmare - This is a documentary shot like a horror movie, dealing with a scary phenomenon known as sleep paralysis. I've heard good things, and since I've suffered from sleep paralysis in the past, I've been meaning to watch. I will this month and will have to write a review/post about the phenomenon itself. Stay tuned!
• Dark Skies - I started watching and got bored. But I should probably revisit, because I hear good things.
• The Uninvited - Just as I'm hesitant to watch remakes of old horror movies, I'm hesitant on remakes of international horror movies. For every Ring (an awesome remake of an awesome Japanese horror movie), there's The Eye (a bloody awful remake of an awesome Chinese horror movie) - see also The Grudge or Dark Water. This one is based on a Korean horror movie. In these cases, I usually prefer to watch the original, but I'll give it a shot.
• Dead Silence - I'll be honest, I've been meaning to see this movie but dolls freak me out. I'm not kidding.
• Housebound - One of my favorite genre mashups - horror and comedy. It's been on my list!
• V/H/S - This one was recommended to me a couple years ago, and it is seriously awesome. It's a series of vignettes, and 3/4 of them are super creepy. One was just okay.
• Pontypool - I watched this one last year when it popped up in the Netflix horror movie list. I was surprised at the poor ratings/reviews, because I really loved it, so I'm thrilled to see it getting some love this year. It takes the notion of contagious illness/zombification and turns it on its head.
• Dead Snow - Another movie I wasn't aware of! Yay!
• Hellraiser - An old favorite - I can't believe I've never reviewed it. I should remedy that this year.
• Re-Animator - This one, however, I definitely reviewed. Love this movie and all its ridiculousness.
• The Babadook - It's been in my Netflix queue for a while.
• The Fly (1958) - So after all the flack I've given to remakes, I'm sad to admit I've only seen the remake of this movie. Time to remedy that.
• The Host - I heard about this one and found the premise kind of dumb, but I'm happy to try it out.
• The Exorcist - Another favorite. Once again, I can't believe I've never written a review.
• Queen of the Damned - I got bored and fell asleep. I doubt I'll try again.
• Contracted - One of my complaints about horror (and yes, I still love the genre) is that it punishes sexuality, often in women. This movie seemed to be the worst example of that, but since I've heard good things from people I trust, I'm willing to try it out.
• Holidays - I started watching and got bored. But I'm willing to revisit.

Diagnosing Presidential Candidates

Being a psychologist, I've had many people speak to me about Trump and his potential psychological diagnoses. Though I remind people I'm a social psychologist (focused on studying behavior and not trained in therapy or diagnosis), I also know that trained clinical psychologists and other mental health professionals are also hesitant to offer their opinions on Trump's mental health. Psychiatrist Mark Goldenberg shares why:

I’m not supposed to answer that question. To underline that point, the American Psychiatric Assn. issued a statement this month reminding its physician members, myself included, to avoid psychoanalyzing the presidential candidates.

That ethical standard has been in place for decades. In 1964, thousands of psychiatrists, in response to a magazine survey, openly questioned then-GOP nominee Barry Goldwater’s fitness for White House duty. Several psychiatrists offered specific diagnoses. The fact that so many psychiatrists were willing to casually diagnose a person they'd never met embarrassed the profession and led to the codification of the so-called Goldwater Rule — no professional opinions on people we have not personally examined.

Dr. Goldenberg recognizes the Goldwater Rule is problematic, for a few reasons. First, the Goldwater Rule may stop professionals from offering diagnoses, but doesn't stop non-psychiatrists/psychologists from diagnosing. This results in a great deal of misinformation and misused terminology. He also suggests that not offering his opinion on Trump's mental health "feels like an abdication of moral responsibility." But he goes on to offer some great arguments about why professionals should continue to avoid diagnosing Trump, and why such diagnoses don't really matter anyway:

Casually and pejoratively tossing around psychiatric labels to describe unusual or distasteful behavior is stigmatizing to those who are suffering with mental disorders. Calling Trump, say, a narcissist, does not adequately explain his toxic behavior or exemplify the condition. I know and treat plenty of people with narcissism, and none of them publicly incite violence or malign entire ethnic groups.

Trump should never be president, but not because he may or may not have a mental disorder. He shouldn't be president because he disparages women, denigrates Mexicans and Muslims and mocks the disabled. He shouldn't be president because he demonizes the media and impugns those who challenge him. He shouldn't be president because he insinuates that his rivals might be assassinated and advocates the commission of war crimes. He shouldn't be president because he rejects science and demonstrates a remarkable lack of knowledge or interest when it comes to foreign and domestic policy.

As a psychiatrist, I don’t have a public opinion on Trump. As a citizen, I certainly do.

So perhaps, when it comes to diagnosing, it's best to let sleeping dogs lie.

Yelp for Academic Journals

This such a great idea, I can't believe no one has thought it before! This website lets you leave reviews for journals you've worked with. So (to name a couple different experiences I've had) whether the editor was prompt in responding to questions, or the review process took over a year and the paper kept getting lost in the shuffle, you can finally share that information with the masses. Huzzah!

Though all reviews are anonymous, they ask you to set up an account - this allows them to make sure no one misuses the system. They also provide a few basic rules:

1. Accurately report your own experiences.
2. Do not use anyone’s name.
3. No links.
4. Stay on topic.

Basically, don't be a troll and stay on target: