How Do You Think?

Have you ever heard someone make an argument that leaves you shaking your head in disbelief?  Does it seem to you like some people are coming from a completely different reality than your own?  If so, then this blog is for you.  I have spent the last year trying to develop an understanding of the common thought patterns that drive the acrimonious spirit of our social and political dialogue.  I am continually amazed by what I hear coming from seemingly informed people.  I have assumed that some folks are either deluded, disingenuous, or downright ignorant.  There is yet another possibility here, including the reality that different moral schema or belief systems may be driving their thinking.  And if this is the case, how do these divergent processes come to be?  I  have learned a lot through this exploration and feel compelled do provide a recap of the posts I have made.  I want to share with you those posts that have gathered the most traction and some that I believe warrant a bit more attention.

Over the past year I have posted 52 articles often dealing with Erroneous Thought Processes, Intuitive Thinking, and Rational Thought.  Additionally, I have explored the down stream implications of these processes with regard to politics, morality, religion, parenting, memory, willpower, and general perception.  I have attempted to be evidenced-based and objective in this process – striving to avoid the very trappings of confirmation bias and the erroneous processes that I am trying to understand.   As it turns out, the brain is very complicated: and although it is the single most amazing system known to human kind, it can and does lead us astray in very surprising and alarming ways.

As for this blog, the top ten posts, based on the shear number of hits, are as follows:

1. Attribution Error
2. Nonmoral Nature, It is what it is.
3. Multitasking: The Illusion of Efficacy
4. Moral Instinct
5. Pareidolia
6. IAT: Questions of Reliability
7. Are You a Hedgehog or a Fox?
8. What Plato, Descartes, and Kant Got Wrong: Reason Does not Rule
9. Illusion of Punditry
10. Emotion vs.Reason: And the winner is?

What started out as ramblings from a curious guy in a remote corner of New York State ended up being read by folks from all over the planet.  It has been a difficult process at times, consuming huge amounts of time, but it has also been exhilarating and deeply fulfilling.

I have been heavily influenced by several scientists and authors in this exploration.  Of particular importance have been Steven Pinker, Daniel Simons, Christopher Chabris, Jonah Lehrer, Bruce Hood, Carl Sagan, and Malcolm Gladwell.  Exploring the combined works of these men has been full of twists and turns that in some cases necessitated deep re-evaluation of long held beliefs.  Holding myself to important standards – valuing evidence over ideology – has been an important and guiding theme.

Several important concepts have floated to the top as I poked through the diverse literature pertaining to thought processes. Of critical importance has been the realization that what we have, when it comes to our thought processes, is a highly developed yet deeply flawed system that has been shaped by natural selection over millions of years of evolution.  Also important has been my increased understanding of the importance of genes, the basic element of selective pressures, as they play out in morality and political/religious beliefs.  These issues are covered in the top ten posts listed above.

There are other worthy posts that did not garner as much attention as those listed above.  Some of my other favorites included a review of Steven Pinker’s article in the New York Times (also titled Moral Instinct,) a look at Jonathon Haidt’s Moral Foundations Theory in Political Divide, as well as the tricks of Retail Mind Manipulation and the Illusion of Attention.  This latter post and my series on Vaccines and Autism (Part 1, Part 2, Part 3) were perhaps the most important of the lot.  Having the content of these become general knowledge would make the world a safer place.

The evolution of understanding regarding the power and importance of Intuitive relative to Rational Thinking was humbling at times and Daniel Simons’ and Christopher Chabris’ book, The Invisible Gorilla, certainly provided a mind opening experience.  Hey, our intuitive capabilities are incredible (as illustrated by Gladwell in Blink & Lehrer in How We Decide) but the downfalls are amazingly humbling.  I’ve covered other topics such as  happiness, superstition, placebos, and the debate over human nature.

The human brain, no matter how remarkable, is flawed in two fundamental ways.  First, the proclivities toward patternicity (pareidolia), hyperactive agency detection, and superstition, although once adaptive mechanisms, now lead to many errors of thought.  Since the age of enlightenment, when human kind developed the scientific method, we have exponentially expanded our knowledge base regarding the workings of the world and the universe.  These leaps of knowledge have rendered those error prone proclivities unessential for survival.  Regardless, they have remained a dominant cognitive force.  Although our intuition and rapid cognitions have sustained us, and in some ways still do, the everyday illusions impede us in important ways.

Secondly, we are prone to a multitude of cognitive biases that diminish and narrow our capacity to truly understand the world. Time after time I have written of the dangers of ideology with regard to its capacity to put blind-folds on adherents.  Often the blind- folds are absolutely essential to sustain the ideology.  And this is dangerous when truths and facts are denied or innocents are subjugated or brutalized.  As I discussed in Spinoza’s Conjecture:  “We all look at the world through our personal lenses of experience.  Our experiences shape our understanding of the world, and ultimately our understanding of [it], then filters what we take in.  The end result is that we may reject or ignore new and important information simply because it does not conform to our previously held beliefs.

Because of our genetically inscribed tendencies toward mysticism and gullibility, we must make extra effort in order to find truth. As Dr. Steven Novella once wrote:

“We must realize that the default mode of human psychology is to grab onto comforting beliefs for purely emotional reasons, and then justify those beliefs to ourselves with post-hoc rationalizations. It takes effort to rise above this tendency, to step back from our beliefs and our emotional connection to conclusions and focus on the process.”

We must therefore be humble with regard to beliefs and be willing to accept that we are vulnerable to error prone influences outside our awareness.  Recognition and acceptance of these proclivities are important first steps.   Are you ready to move forward?  How do you think?

The human brain is a curious organ.  We are continually learning new and very exciting things about this incredibly complicated masterpiece of evolution.  But, every now and then, we learn something that shakes to the core our understanding of accepted concepts.  This has been the case recently with our understanding of placebos.

Placebos as I’m sure you know, are fake substances, treatments, or procedures that, in and of themselves, have no active ingredient or direct effect.  Regardless of the inert nature of placebos, they can and do elicit some powerful responses.  This has long been attributed to a person’s beliefs and expectations about the legitimacy of effect.  One Japanese study, for example, showed that people who believed they were being exposed to real poison ivy (but were actually exposed to a placebo), developed a painful response that mimicked the actual reaction to legitimate poison ivy (Blakeslee, 1998).  In this study, only the subjects’ belief was responsible for the skin rashes.   The mind’s powerful capacity, in this case, produced very real and painful responses regardless of the presence of any true irritant.

This is the placebo effect.  Again, attribution lies in the person’s beliefs and expectations rather than in the substance, drug, treatment, or procedure.  It is important to note that although the beliefs and expectations emanate from one’s mind, the bodily responses can be very real.  Scientists use placebos in trials to evaluate treatment efficacy because of this innate gullibility.

The gold standard for evaluation of treatment efficacy (in drug trials) involves double-blinded, randomized, and placebo controlled procedures because, people seem to get better simply from getting attention and/or treatment regardless of form (within limits).  This is only true where psychological factors overlay the manifestation of symptoms (Crislip, 2006).  Placebos do little to reduce serious medical issues like MS, stroke, or cancer; but people with particularly subjective experiences of pain, affective disorders, and psychologically mediated disorders can and do report improvements when unknowingly taking placebos.  Formerly, it was presumed that the patient had to believe that the sugar pill was indeed an actual drug.  This presumption is what has been recently questioned.  What if the patient knows it is a placebo, will that reduce the treatment efficacy?  Recent evidence suggests not!

We must consider a few important things about placebos.  The American Medical Association says that “the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.”  Regardless, Kaptchuk et al (2010) noted “a recent national survey of internists and rheumatologists in the US found that while only small numbers of US physicians surreptitiously use inert placebo pills and injections, approximately 50% prescribe medications that they consider to have no specific effect on patients’ conditions and are used solely as placebos (sometimes called “impure placebos”).  “Prescribing placebos necessarily involves deception and this brings the practice into question.  But deception may no longer be necessary!

Researchers at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, Massachusetts just published a startling study (Placebos without deception: A randomized controlled trial in irritable bowel syndrome) in the Public Library of Science journal PLoS ONE (Kaptchuk, 2010).  And as the title suggests, placebos were knowingly used to evaluate their effectiveness in treating irritable bowel syndrome (IBS).   Participants were recruited from advertisements for “a novel mind-body management study of IBS” in newspapers and fliers and from referrals from health care professionals.  The authors note that the symptoms of IBS constitute one of the top 10 reasons people seek primary-care treatment.

Eighty, primarily female (70%) subjects with a mean age of 47 years (±18 yrs.), diagnosed with Irritable Bowel Syndrome (IBS), were randomly assigned to one of two groups for a three week trial.  One group was an open-label placebo group where the treatment provided was acknowledged to be placebo pills “made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes.”  The second group received no-treatment but they did receive the same quality of interaction with health-care providers that the open placebo participants received.   Several standardized measures of IBS symptom severity were used.

The subjects knew they were taking inert pills – but the suggestion was made, by the physician, that the pills have resulted in significant improvements in previous clinical trials (which was true and due to placebo effect).  As it turns out, the open-label placebo produced significantly higher mean global improvement scores at both the 11-day trial midpoint and at the end of the three week treatment.

Of the participants in the open- or honest-placebo group, 59% experienced adequate relief versus 35% of those in the no treatment group.  The authors concluded that “Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.”  The difference between the groups is substantial.  Although 35% of the subjects in the no treatment group experienced adequate symptom resolution without any treatment, they were the recipients of some physician attention. Such attention alone is associated with improved outcomes.  Further, the 24 point difference is unlikely to be explained by differences in the natural history of the disease (the natural ebb and flow of symptom presentation) or regression toward the mean (the natural tendency for repeated measures to move more closely to the average value) (Crislip, 2006).  Because subjects were randomly assigned to the groups, these latter effects are likely to cancel each other out.

So, as it turns out, taking an honest-placebo may substantially reduce IBS symptoms in over half of sufferers.  How does this happen?  I suggest that because an authority figure suggested that the pill had resulted in significant symptom reduction in previous trials there remains a high probability of the expectancy effect.  I question whether it should be considered an “Honest-Placebo.”

So we have the attention provided by the physician, the expectancy affect, and the added ritual of taking the pills.  The authors suggest that this latter factor may play an important role in the effect.  Regardless, the sugar pill appears to have done something.  Perhaps this helps explain why billions of dollars are spent annually on vitamins, “natural remedies,” and homeopathy despite lack of biological plausibility or evidence of treatment efficacy.   We are, it seems, inherently gullible people.  Placebos work, because the mind is a powerful thing – simply thinking you’re being treated, can make you feel better.  Also on the plus side – no long list of scary side effects – although, we could get them, I suppose, if doctors were to imply the possibility.

References:

Blakeslee, S., (1998). Placebos Prove So Powerful Even Experts Are Surprised; New Studies Explore the Brain’s Triumph Over Reality. New York Times 10/13/98. http://www.nytimes.com/1998/10/13/science/placebos-prove-so-powerful-even-experts-are-surprised-new-studies-explore-brain.html?scp=1&sq=poison+ivy+placebo&st=nyt&pagewanted=all

Crislip, M. (2006). QuackCast 5. Placebo Effect. Alt.med effects are often attributed to the placebo effect. .5/22/06

Kaptchuk, T.J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., et al. (2010). Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE 5(12).  http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015591#aff1

Knox, R. (2010). Fake Pills Can Work, Even If Patients Know It. National Public Radio Health Blog. 12/23/10.