What if I told you a new drug had been discovered that could dramatically reduce cardiovascular disease, stroke AND cancer, the three leading killers in the US?
You'd probably think it will take a decade to get FDA approval. Or it must have some ugly side effects.
Or my insurance will never cover it and it must cost a fortune. Or, yeah sure, but do we know what it does to you after 10 or 20 years?
Well it's already in your medicine chest.
A series of reports in the British medical journal Lancet has scrutinized the data from many studies involving thousands of patients and demonstrated a very real anticancer effect from aspirin. The investigators examined aspirin trials that had been conducted for vascular disease and noticed that the aspirin groups had far fewer cancer deaths than the placebo groups. Previous studies using similar data mining techniques had shown that after 5 years of taking 75mg (a very small dose) daily the risk of dying from common cancers decreases by 10%-60% depending on the cancer. This includes prostate, lung, colorectal, esophageal and other cancers. This therapeutic effect is not seen in populations who have taken aspirin every other day.
One analysis in the series published this month on aspirin demonstrated more rapid protective effects in patients who already had cancer. The investigators suggest that this occurs by reducing metastatic disease. In other words, by limiting spread of the cancer.
This makes theoretical sense. Researchers have known for sometime that platelets, the cells in your blood responsible for clot formation, play a pivotal role in the spread of cancer from its primary site in the body. Aspirin targets platelets. In addition to an anti-cancer effect, aspirin has an anti-clotting effect that explains its protective action in cardiovascular disease and stroke. It also explains aspirin's one serious side-effect, bleeding.
Because of the increased risk of bleeding people should consult with a doctor before launching their own trial of aspirin therapy. You should also keep in mind that certain OTC products can increase bleeding risk such as: other anti-inflammatories like ibuprofen, fish oil, angelica, clove garlic, ginger, gingko, Panax ginseng, red clover. tumeric and others.
While more trials will be necessary before aspirin can be recommended as a primary prevention technique for the general population, this is very promising news.
Friday, March 23, 2012
Wednesday, March 21, 2012
Grade Inflation and The American Cardiovascular Report Card
A study published this week in the Journal of the American Medical Association examined the correlation between a set of cardiovascular health metrics and death over the past 20 years. This is an important issue because cardiovascular disease (CVD) is the number one killer in the US causing more than 800,000 deaths per year (1 in 3 of all deaths), with an estimated annual overall cost of $444 billion.
Because sound research has demonstrated a correlation between certain behaviors/lab values and CVD, the American Heart Association (AHA) launched a targeted campaign. The AHA identified three categories of individuals with regard to CVD; ideal, intermediate, and poor.
No one will be surprised that few americans made it into the ideal category. After all, what does it mean to have ideal cardiovascular health? A heart like Lance Armstrong? 5 minute mile? 50 flights of stairs with a pulse of 60? IDEAL! Right?
Wrong.
AHA definition of Ideal:
No Smoking
Physically Active
Normal Blood Pressure
Normal Blood Glucose
Normal Total Cholesterol
Normal Weight
Eating a Healthy Diet
Pretty ordinary sounding stuff. So here's the knock out. Less than 2 percent of adult Americans meet these criteria.
There is some good news. Smoking has declined since 1988.
But the blood pressure and cholesterol categories have not changed, while weight, diet, and blood glucose have worsened.
People who met 6 or more vs 1 or fewer of these measures had a 51% lower risk of all-cause mortality and a 76% lower risk of CVD. Interestingly, meeting more of the cardiovascular measures was associated with lower risk for all-cancer mortality as well.
You really only have to nail 3 of the 7. Eat right, don't smoke, and move. The rest follows.
Tuesday, February 21, 2012
Of Mice and Men and The Question of Free Will
We presume we run the show, choose our profession, our partner, our path. Of course we've heard about instinctual behavior, hard-wired stuff that is dictated by our evolutionary history. And we can accept such theory that explains how some of our evolutionarily prescribed choices are actually quite adaptive, like being drawn to characteristics associated with intelligence and fertility. But what if we were the pawns of parasites.
Here's a David and Goliath story that hits close to home.
We humans are very hospitable. Not only do we host our social circle in our homes, but our bodies are colonized by bacteria whose population dwarfs our own cellular constituents. (see blog entry on gut flora). These squatters can affect all sorts of things such as our metabolism, determining our risk for obesity or diabetes.
One trespasser that has recently drawn researchers interest is Toxoplasmosis, a protozoan parasite. Those aware of toxo were enlightened when pregnant and warned of the dangers cats posed. Toxo's peculiar life cycle holds the key to this story.
Toxo can only reproduce in a cat's bowels. It then exits in the feces and has the bizarre task of figuring out how to return to this feline homeland. Fortunately for toxo, rodents eat cat feces. And as we all know, cats eat rodents. But evolutions laboratory, unsatisfied with toxo's rate of return, lent a helping hand. It provided toxo with a way of changing rodent behavior. This is a very clever parasite.
First, a few basics on rodent life. Not surprisingly, rodents hate the smell of cat urine and do everything possible to avoid it. A toxo-infected rodent not only looses this aversion, it appears drawn to it.
To make a long story short, toxo rewires the rodent brain, highjacking the anxiety circuit for this particular stimulus and making it fire like a sexual reward pathway. It does this by injecting dopamine, the pleasurable neurotransmitter that is released by cocaine and other euphoriants.
The specificity of toxo's brain surgery is exquisite. Toxo-infected rodents still fear bright lights and open spaces, like healthy ones. They don't wander around engaging in all sorts of risky behavior. The only thing that changes is their reaction to cat urine which goes from "get me outa here" to "I like that!". And that's all toxo needed to return to the feline promised land. If you give toxo-infected rodents a drug that blocks dopamine, their behavior normalizes.
"Great story, so what", you say. Well it seems we humans can also be toxo stooges. Toxo-infected humans are 3-4 times more likely to die in car accidents caused by reckless speeding then non-infected. And an old ER saw warns docs to check motorcyclist organ donors for toxo before harvesting their vitals. So while this infection won't get us into a cat's gut, it appears to have the same effect, short-circuiting an anxiety response and making high risk behavior quite alluring.
To lend credence to this story, imagine what organization might be interested in helping people do life-threatening things that every human instinct resists? Bingo, the military. And they've poured money in toxo
research.
For our purposes, this story is meaningful because it highlights the import of our relationship with those organisms living inside us. This microbiome, represents a new frontier in understanding both health and disease.
Here's a David and Goliath story that hits close to home.
We humans are very hospitable. Not only do we host our social circle in our homes, but our bodies are colonized by bacteria whose population dwarfs our own cellular constituents. (see blog entry on gut flora). These squatters can affect all sorts of things such as our metabolism, determining our risk for obesity or diabetes.
One trespasser that has recently drawn researchers interest is Toxoplasmosis, a protozoan parasite. Those aware of toxo were enlightened when pregnant and warned of the dangers cats posed. Toxo's peculiar life cycle holds the key to this story.
Toxo can only reproduce in a cat's bowels. It then exits in the feces and has the bizarre task of figuring out how to return to this feline homeland. Fortunately for toxo, rodents eat cat feces. And as we all know, cats eat rodents. But evolutions laboratory, unsatisfied with toxo's rate of return, lent a helping hand. It provided toxo with a way of changing rodent behavior. This is a very clever parasite.
First, a few basics on rodent life. Not surprisingly, rodents hate the smell of cat urine and do everything possible to avoid it. A toxo-infected rodent not only looses this aversion, it appears drawn to it.
To make a long story short, toxo rewires the rodent brain, highjacking the anxiety circuit for this particular stimulus and making it fire like a sexual reward pathway. It does this by injecting dopamine, the pleasurable neurotransmitter that is released by cocaine and other euphoriants.
The specificity of toxo's brain surgery is exquisite. Toxo-infected rodents still fear bright lights and open spaces, like healthy ones. They don't wander around engaging in all sorts of risky behavior. The only thing that changes is their reaction to cat urine which goes from "get me outa here" to "I like that!". And that's all toxo needed to return to the feline promised land. If you give toxo-infected rodents a drug that blocks dopamine, their behavior normalizes.
"Great story, so what", you say. Well it seems we humans can also be toxo stooges. Toxo-infected humans are 3-4 times more likely to die in car accidents caused by reckless speeding then non-infected. And an old ER saw warns docs to check motorcyclist organ donors for toxo before harvesting their vitals. So while this infection won't get us into a cat's gut, it appears to have the same effect, short-circuiting an anxiety response and making high risk behavior quite alluring.
To lend credence to this story, imagine what organization might be interested in helping people do life-threatening things that every human instinct resists? Bingo, the military. And they've poured money in toxo
research.
For our purposes, this story is meaningful because it highlights the import of our relationship with those organisms living inside us. This microbiome, represents a new frontier in understanding both health and disease.
Friday, January 27, 2012
Worried Sick: The Age of Anxiety
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, ...
Charles Dickens, A Tale of Two Cities
Dickens' words, written in 1859, could aptly describe contemporary society's experience of health and modern medicine, miraculous or mistaken, death defying or dubious. This is a curious state of affairs when one considers the remarkable success medicine has had since the Second World War. A timeline of some medicine's greatest hits reflects this golden age:
Penicillin 1941
Cortisone 1949
Smoking identified as cause of lung cancer and Tuberculosis cured with streptomycin and PAS 1950 Chlorpromazine for schizophrenia and the first intensive care unit 1952
Open heart surgery and polio vaccine 1955
Cardiopulmonary resuscitation 1956
Endoscopy 1959
Oral contraception 1960
Levodopa for Parkinson's disease and hip replacement surgery 1961
Kidney transplantation 1963
Stroke prevention programs and coronary bypass grafting 1964
Heart transplantation 1967
Prenatal diagnosis of Down's syndrome 1969
Neonatal intensive care 1970
Cure of many childhood cancer 1971
CAT scanner 1973
First test-tube baby 1978
Coronary angioplasty 1979
Helicobacter identified as cause of peptic ulcer 1984
Thrombolysis for heart attacks 1987
Triple therapy for AIDS rendering it a nonfatal illness 1996
Viagara therapy for impotence 1998
The previous 2,000 years had seen no significant therapeutic discovery for the scourges of infant mortality, infectious disease, surgical death, cancer, heart disease or mental illness. In 1900, 30% of all deaths occurred among children aged less than 5 years. By the end of the century, that percentage was only 1.4%. In 1900, the three leading causes of death were pneumonia, tuberculosis, and diarrhea, which (together with diphtheria) caused one third of all deaths. Of these deaths, 40% were among children aged less than 5 years. At century's end these diseases were scarce. Heart disease and cancers accounted for more than half of all deaths, with only 4.5% attributable to infectious disease.
The 20th century witnessed a 30 year increase in life expectancy.
And yet, despite these unprecedented advances, more people feel uneasy about their health today than in 1900 or 1940.
Why?
I believe that two events on the hit parade of 20th century medical accomplishment can explain much of the paradoxical loss of confidence in our health; the discovery that smoking caused lung cancer and the realization that high blood pressure caused stroke.
Let's take them one at a time.
The revelation that smoking, a nearly universal postwar habit, caused a fatal illness introduced the idea that health was tied to lifestyle. A habit that seemed to cause no harm in the short term could kill you. From that time forward, people had to wonder what other behaviors might prove lethal.
The impact of connecting high blood pressure to stroke was more insidious. Hypertension is usually silent, causing no symptoms. You go about your business feeling fine. Prior to the discovery that high blood pressure causes stroke, it was fair to presume that if you felt well, you were well. Suddenly how you felt was no guarantee. You no longer had to be sick to visit a doctor. In fact, annual visits became the norm.
The remarkable medical breakthroughs of the latter half of the 20th century also fostered a view that medicine's domain had no limits. All human problems could be remedied by the mighty medical establishment. This expansionism brought annual crops of new diagnoses and new vulnerabilities.
The long arm of medicine now reaches into our living rooms where big pharma describes symptoms and cures on the television, lest we thought we were well.
The most conspicuous example of such thinking today is the conceptualization of obesity as a medical illness. Bullets cause bleeding but cannot be understood as a medical issue. Obesity's roots lie in bad foods and inactivity, not failures of medicine. The solution will not be gastric stapling or a pill.
No doubt, part of this bizarre way of thinking can be owed to the origins of medicine. It has been a field of fixing what's broken. Only recently and reluctantly has it begun to embrace prevention. But there is no question that now our habits are the leading cause of illness. More americans are unhealthy today than in 1900 despite medicine. And we are a more anxious lot, fearful that our cell phones, water bottles, foods, air, are all potential killers. But none of this is in the medical realm.
Perhaps we must look to those most gifted at changing people's behavior. That has never been the doctors. Madison Avenue and the admen, pop idols, sports icons. We must enlist them as health evangelists if we are ever to see anything like the progress of last century.
Charles Dickens, A Tale of Two Cities
Dickens' words, written in 1859, could aptly describe contemporary society's experience of health and modern medicine, miraculous or mistaken, death defying or dubious. This is a curious state of affairs when one considers the remarkable success medicine has had since the Second World War. A timeline of some medicine's greatest hits reflects this golden age:
Penicillin 1941
Cortisone 1949
Smoking identified as cause of lung cancer and Tuberculosis cured with streptomycin and PAS 1950 Chlorpromazine for schizophrenia and the first intensive care unit 1952
Open heart surgery and polio vaccine 1955
Cardiopulmonary resuscitation 1956
Endoscopy 1959
Oral contraception 1960
Levodopa for Parkinson's disease and hip replacement surgery 1961
Kidney transplantation 1963
Stroke prevention programs and coronary bypass grafting 1964
Heart transplantation 1967
Prenatal diagnosis of Down's syndrome 1969
Neonatal intensive care 1970
Cure of many childhood cancer 1971
CAT scanner 1973
First test-tube baby 1978
Coronary angioplasty 1979
Helicobacter identified as cause of peptic ulcer 1984
Thrombolysis for heart attacks 1987
Triple therapy for AIDS rendering it a nonfatal illness 1996
Viagara therapy for impotence 1998
The previous 2,000 years had seen no significant therapeutic discovery for the scourges of infant mortality, infectious disease, surgical death, cancer, heart disease or mental illness. In 1900, 30% of all deaths occurred among children aged less than 5 years. By the end of the century, that percentage was only 1.4%. In 1900, the three leading causes of death were pneumonia, tuberculosis, and diarrhea, which (together with diphtheria) caused one third of all deaths. Of these deaths, 40% were among children aged less than 5 years. At century's end these diseases were scarce. Heart disease and cancers accounted for more than half of all deaths, with only 4.5% attributable to infectious disease.
The 20th century witnessed a 30 year increase in life expectancy.
And yet, despite these unprecedented advances, more people feel uneasy about their health today than in 1900 or 1940.
Why?
I believe that two events on the hit parade of 20th century medical accomplishment can explain much of the paradoxical loss of confidence in our health; the discovery that smoking caused lung cancer and the realization that high blood pressure caused stroke.
Let's take them one at a time.
The revelation that smoking, a nearly universal postwar habit, caused a fatal illness introduced the idea that health was tied to lifestyle. A habit that seemed to cause no harm in the short term could kill you. From that time forward, people had to wonder what other behaviors might prove lethal.
The impact of connecting high blood pressure to stroke was more insidious. Hypertension is usually silent, causing no symptoms. You go about your business feeling fine. Prior to the discovery that high blood pressure causes stroke, it was fair to presume that if you felt well, you were well. Suddenly how you felt was no guarantee. You no longer had to be sick to visit a doctor. In fact, annual visits became the norm.
The remarkable medical breakthroughs of the latter half of the 20th century also fostered a view that medicine's domain had no limits. All human problems could be remedied by the mighty medical establishment. This expansionism brought annual crops of new diagnoses and new vulnerabilities.
The long arm of medicine now reaches into our living rooms where big pharma describes symptoms and cures on the television, lest we thought we were well.
The most conspicuous example of such thinking today is the conceptualization of obesity as a medical illness. Bullets cause bleeding but cannot be understood as a medical issue. Obesity's roots lie in bad foods and inactivity, not failures of medicine. The solution will not be gastric stapling or a pill.
No doubt, part of this bizarre way of thinking can be owed to the origins of medicine. It has been a field of fixing what's broken. Only recently and reluctantly has it begun to embrace prevention. But there is no question that now our habits are the leading cause of illness. More americans are unhealthy today than in 1900 despite medicine. And we are a more anxious lot, fearful that our cell phones, water bottles, foods, air, are all potential killers. But none of this is in the medical realm.
Perhaps we must look to those most gifted at changing people's behavior. That has never been the doctors. Madison Avenue and the admen, pop idols, sports icons. We must enlist them as health evangelists if we are ever to see anything like the progress of last century.
Friday, January 13, 2012
One Billion Beats?
For some time researchers have noted a strong link between heart rate and survival, an association that holds true for most mammals. Most small mammals have a rapid heart rate and a short life expectancy, while large mammals have a significantly slower heart rate and a correspondingly longer life span. For the majority of mammals, large and small, life expectancy is approximately 1 billion heartbeats.
Investigators have played with this information and successfully prolonged the life span of mice by slowing their heart rate. So where do we humans fit in?
We are no exception. A large epidemiological literature documents the association between heart rate and mortality. Resting rates as low as 75 to 80 beats per minute are associated with significant increases in total mortality and mortality due to coronary heart disease. Beta blockers, agents that are used to decrease heart rate, have proven quite effective in decreasing mortality rates after heart attack. Remarkably, the magnitude of the decrease in mortality is directly proportional to the magnitude of heart rate reduction.
What does all this mean? Is there really a magical number of heart beats and then our time is up? Not quite.
However, our heart rate is one of the most sensitive early markers of the effects of stress, a sort of canary in the coal mine. By stress I mean any environmental (eg. pollution), psychological (eg. living with a sick family member or difficult job situation), or biological (eg. elevated blood pressure or blood sugar or inflammation) phenomenon that impairs health. Such stressors affect the system that controls heart rate. Therefore changes in that system provide one of the earliest measureable signals in the development of disease.
To give you an idea of the exquisite sensitivity of heart rate measurements in revealing early disease, I'll give you some startling examples.
As an individual's blood sugar readings creep up, but before leaving the normal range, indicating the start of a process where insulin sensitivity is decreasing, there are characteristic changes in heart rate testing. The same is true of rising cholesterol levels, blood pressure and body weight.
In other words, simple noninvasive heart rate tests can be more sensitive and provide observable changes earlier than blood testing. As importantly, certain exercises can reverse these changes and prevent the onset of illness. First let's give you the background for this physiology.
In order to understand how heart rate is affected by stressors, we need to review that part of the nervous system that is responsible for adjusting our pulse in response to these cues. Unlike the voluntary nervous system which sends messages from brain to muscle so we can move about, the autonomic nervous system directs the "support functions" so to speak. It changes circulation so you don't pass out when you jump out of bed, raises your heart rate when you run for the bus, and brings it back to a resting rate when you get to your seat on the bus. This branch of the nervous system was called "autonomic" because it was thought to be automatic, requiring not only no thought, but no input from higher neural centers in the brain (not so). The heart and vasculature, lungs, stomach, liver, pancrease, spleen, and gastrointestinal tract are all regulated by the autonomic nervous system thereby controlling digestion, heart rate, blood pressure and many other essential functions.
This part of the nervous system acts through two separate, opposing and therefore alternately activated, subsystems, the sympathetic and parasympathetic branches. The "fight or flight" response is orchestrated by the sympathetic division and the parasympathetic division oversees such things as digestion, energy storage, and growth and repair, sort of peace time activities.
This set up has worked brilliantly, beautifully fine tuned by millions of years of evolution. It has allowed countless zebra to escape the lions' claw as well as primates like us to kill and not be killed, grow and reproduce. So what changed? How did this system designed to get us through stressful situations become maladaptive?
The environment in which evolution crafted our nervous system provided short-lived stressors. A predator approaches, you run, you escape or you're eaten. This scenario might have lasted 10-15 minutes.
Contrast that with typical contemporary stress. You wake up after a night of insufficient sleep because you were anxious about the presentation today that will determine a promotion and the colleague competing for the position is the brother-in-law of your boss, completely incompetent, but will probably beat you on this one, and you could really kill him, not only because he's an idiot and drives you crazy, but because your daughter is about to start college and chose the private (read unaffordable) school over the state one your son attends where you just found out he is on academic probation. You see my point.
Put simply, ongoing stress is a recent invention. And our response to it makes us sick. The epidemic prevalence of stroke, heart attack, obesity, stomach ulcer, irritable bowel syndrome, chronic fatigue syndrome, depression and anxiety, insomnia, infertility, compromised immune function and accelerated aging is largely due to chronic stress.
In my next entry I will speak about how we can prevent these maladies through interventions that directly repair the imbalance that chronic stress causes in the autonomic nervous system.
Investigators have played with this information and successfully prolonged the life span of mice by slowing their heart rate. So where do we humans fit in?
We are no exception. A large epidemiological literature documents the association between heart rate and mortality. Resting rates as low as 75 to 80 beats per minute are associated with significant increases in total mortality and mortality due to coronary heart disease. Beta blockers, agents that are used to decrease heart rate, have proven quite effective in decreasing mortality rates after heart attack. Remarkably, the magnitude of the decrease in mortality is directly proportional to the magnitude of heart rate reduction.
What does all this mean? Is there really a magical number of heart beats and then our time is up? Not quite.
However, our heart rate is one of the most sensitive early markers of the effects of stress, a sort of canary in the coal mine. By stress I mean any environmental (eg. pollution), psychological (eg. living with a sick family member or difficult job situation), or biological (eg. elevated blood pressure or blood sugar or inflammation) phenomenon that impairs health. Such stressors affect the system that controls heart rate. Therefore changes in that system provide one of the earliest measureable signals in the development of disease.
To give you an idea of the exquisite sensitivity of heart rate measurements in revealing early disease, I'll give you some startling examples.
As an individual's blood sugar readings creep up, but before leaving the normal range, indicating the start of a process where insulin sensitivity is decreasing, there are characteristic changes in heart rate testing. The same is true of rising cholesterol levels, blood pressure and body weight.
In other words, simple noninvasive heart rate tests can be more sensitive and provide observable changes earlier than blood testing. As importantly, certain exercises can reverse these changes and prevent the onset of illness. First let's give you the background for this physiology.
In order to understand how heart rate is affected by stressors, we need to review that part of the nervous system that is responsible for adjusting our pulse in response to these cues. Unlike the voluntary nervous system which sends messages from brain to muscle so we can move about, the autonomic nervous system directs the "support functions" so to speak. It changes circulation so you don't pass out when you jump out of bed, raises your heart rate when you run for the bus, and brings it back to a resting rate when you get to your seat on the bus. This branch of the nervous system was called "autonomic" because it was thought to be automatic, requiring not only no thought, but no input from higher neural centers in the brain (not so). The heart and vasculature, lungs, stomach, liver, pancrease, spleen, and gastrointestinal tract are all regulated by the autonomic nervous system thereby controlling digestion, heart rate, blood pressure and many other essential functions.
This part of the nervous system acts through two separate, opposing and therefore alternately activated, subsystems, the sympathetic and parasympathetic branches. The "fight or flight" response is orchestrated by the sympathetic division and the parasympathetic division oversees such things as digestion, energy storage, and growth and repair, sort of peace time activities.
This set up has worked brilliantly, beautifully fine tuned by millions of years of evolution. It has allowed countless zebra to escape the lions' claw as well as primates like us to kill and not be killed, grow and reproduce. So what changed? How did this system designed to get us through stressful situations become maladaptive?
The environment in which evolution crafted our nervous system provided short-lived stressors. A predator approaches, you run, you escape or you're eaten. This scenario might have lasted 10-15 minutes.
Contrast that with typical contemporary stress. You wake up after a night of insufficient sleep because you were anxious about the presentation today that will determine a promotion and the colleague competing for the position is the brother-in-law of your boss, completely incompetent, but will probably beat you on this one, and you could really kill him, not only because he's an idiot and drives you crazy, but because your daughter is about to start college and chose the private (read unaffordable) school over the state one your son attends where you just found out he is on academic probation. You see my point.
Put simply, ongoing stress is a recent invention. And our response to it makes us sick. The epidemic prevalence of stroke, heart attack, obesity, stomach ulcer, irritable bowel syndrome, chronic fatigue syndrome, depression and anxiety, insomnia, infertility, compromised immune function and accelerated aging is largely due to chronic stress.
In my next entry I will speak about how we can prevent these maladies through interventions that directly repair the imbalance that chronic stress causes in the autonomic nervous system.
Wednesday, December 14, 2011
Our Two Selves: Experiencing and Remembering
The past decade has witnessed an explosion of new ways to look at how we humans make decisions. These insights have sprouted from the fields of psychology, computational neuroscience and behavioral economics. The traditional model of how we choose centered around psychic conflict, warring parts of the mind, instinct versus reason, id against ego, unconscious motivations avoiding conscious recognition. Both Freud and Plato used allegories of mental conflict that depicted a battle between a horse and it's rider.
The horse provides the locomotor energy, and the rider has the prerogative of determining the
goal and of guiding the movements of his powerful mount towards it. But all too often in the
relations between the ego and the id we find a picture of the less ideal situation in which the
rider is obliged to guide his horse in the direction in which it itself wants to go.
Freud from New Introductory Lectures on Psychoanalysis
The charioteer of the human soul drives a pair, and one of the horses is noble and
of noble breed, but the other quite the opposite in breed and character. Therefore in our case the
driving is necessarily difficult and troublesome.
Plato Phaedrus
Both these thinkers paint a picture of human intellect or reason fighting forces within us that lead us astray. These unconscious agents distort our perception of "reality" and hide our true motivations. But there has always been an optimism about overcoming these influences through self-awareness and discipline.
More recent work is less sanguine about even such basic things as our ability to know what makes us happy, or the capacity to store accurate memories of what we've experienced.
Daniel Kahneman, who received the Nobel Prize in Economic Sciences in 2002 for his work on decision making, has elegantly demonstrated how our brain is designed in such a way that we often cannot trust our preferences to reflect our interests. His work vividly shows how this is a consequence of having two mental operating systems, an experiencing self and a remembering self.
The experiencing self is the you in the moment who lives through the event. The remembering self is the you that writes the history. It is also the remembering self that is consulted when planning the future. Choices are made based on the remembering self's construction of what happened in the past. Now here's the problem. The experiencing self and the remembering self don't agree on what happened. In fact, Kahneman has shown that certain discrepancies are hard wired. Let's look at some examples.
Subjects had a hand immersed in ice water at a temperature that causes moderate pain. They were told that they would have three trials. While the hand was in the water the other hand used a keyboard to continuously record their level of pain. The first trial lasted 60 seconds. The second trial lasted 90 seconds, however in the last 30 seconds the water was slowly warmed by 1 degree (better but still painful). For the third trial, they were allowed to choose which of the first two trials was less disagreeable, and repeat that one.
Here's what they found. Are you sitting down? 80% of the subjects who reported experiencing some decrease in their pain in the last 30 seconds of the second trial chose to repeat the 90 second experience! In other words, their remembering self selected the option that required an additional 30 seconds of suffering.
What gives?
Many similar experiments have revealed two rules that govern the remembering self's recording of an experience.
1.Duration does not count.
2. Only the peak (best or worst moment) and the end of the experience are registered.
This has profound implications. For instance, should a doctor attempt to minimize a patient's memory of pain or experience of it? A procedure's duration and anesthesia level would be addressed differently depending on the priority.
It is only by confusing experience and memory that we believe experiences can be ruined. Kahneman speaks of "the tyranny of the remembering self" in the way it makes decisions.
We seem to be in the business of creating memories, not experiences.
I'll leave you with a question that will tell you something about your relationship with experience versus memory. You have a choice of two vacations. One is your fantasy of the perfect getaway. It could not be improved upon. The second is a typical good vacation. The only caveat is that if you choose to go on the dream vacation, you will have no memory of it.
Your call.
The horse provides the locomotor energy, and the rider has the prerogative of determining the
goal and of guiding the movements of his powerful mount towards it. But all too often in the
relations between the ego and the id we find a picture of the less ideal situation in which the
rider is obliged to guide his horse in the direction in which it itself wants to go.
Freud from New Introductory Lectures on Psychoanalysis
The charioteer of the human soul drives a pair, and one of the horses is noble and
of noble breed, but the other quite the opposite in breed and character. Therefore in our case the
driving is necessarily difficult and troublesome.
Plato Phaedrus
Both these thinkers paint a picture of human intellect or reason fighting forces within us that lead us astray. These unconscious agents distort our perception of "reality" and hide our true motivations. But there has always been an optimism about overcoming these influences through self-awareness and discipline.
More recent work is less sanguine about even such basic things as our ability to know what makes us happy, or the capacity to store accurate memories of what we've experienced.
Daniel Kahneman, who received the Nobel Prize in Economic Sciences in 2002 for his work on decision making, has elegantly demonstrated how our brain is designed in such a way that we often cannot trust our preferences to reflect our interests. His work vividly shows how this is a consequence of having two mental operating systems, an experiencing self and a remembering self.
The experiencing self is the you in the moment who lives through the event. The remembering self is the you that writes the history. It is also the remembering self that is consulted when planning the future. Choices are made based on the remembering self's construction of what happened in the past. Now here's the problem. The experiencing self and the remembering self don't agree on what happened. In fact, Kahneman has shown that certain discrepancies are hard wired. Let's look at some examples.
Subjects had a hand immersed in ice water at a temperature that causes moderate pain. They were told that they would have three trials. While the hand was in the water the other hand used a keyboard to continuously record their level of pain. The first trial lasted 60 seconds. The second trial lasted 90 seconds, however in the last 30 seconds the water was slowly warmed by 1 degree (better but still painful). For the third trial, they were allowed to choose which of the first two trials was less disagreeable, and repeat that one.
Here's what they found. Are you sitting down? 80% of the subjects who reported experiencing some decrease in their pain in the last 30 seconds of the second trial chose to repeat the 90 second experience! In other words, their remembering self selected the option that required an additional 30 seconds of suffering.
What gives?
Many similar experiments have revealed two rules that govern the remembering self's recording of an experience.
1.Duration does not count.
2. Only the peak (best or worst moment) and the end of the experience are registered.
This has profound implications. For instance, should a doctor attempt to minimize a patient's memory of pain or experience of it? A procedure's duration and anesthesia level would be addressed differently depending on the priority.
It is only by confusing experience and memory that we believe experiences can be ruined. Kahneman speaks of "the tyranny of the remembering self" in the way it makes decisions.
We seem to be in the business of creating memories, not experiences.
I'll leave you with a question that will tell you something about your relationship with experience versus memory. You have a choice of two vacations. One is your fantasy of the perfect getaway. It could not be improved upon. The second is a typical good vacation. The only caveat is that if you choose to go on the dream vacation, you will have no memory of it.
Your call.
Friday, December 2, 2011
The Trouble With Knowing Thyself
In the August 2010 entry "A Hen Is Just An Egg's Way of Making Another Egg" we showed how the driving force behind natural selection is survival and reproduction, not truth, and gave several examples of deception in nature. Our evolutionary history has hardwired false belief systems that turn out to be an essential part of our nature.
For example, it has been repeatedly proven that men overperceive the sexual interest and intent of women. The Darwinian rational for such a distortion is that the cost of this misbelief is much less detrimental to reproductive success than it's opposite, that is the man's sense that the woman is uninterested. For women, not surprisingly, the cost asymmetry is reversed. For a woman to falsely believe in a man's interest in familial investment is more detrimental because it will result in abandonment and therefore a lower chance of the offspring's survival. If she were wrong in this biased perception of a man's familial investment, it would merely delay reproduction, a much less costly error. Let the mating dance begin.
Evolution has also crafted certain misbeliefs about ourselves. One particularly striking example is the "better than average effect". Most people judge themselves to be more intelligent, honest, original, friendly, and reliable than the average person. Drivers who have been hospitalized as a consequence of their poor driving, rate themselves as having better than average driving skills. My favorite example is that most people perceive themselves as less prone to such self-serving distortions than others.
Traditional psychological theories have considered a close relationship with truth as an essential ingredient of mental health. We're no longer so sure. In an amusing study, investigators assessed reality testing (how accurate one's observations are about oneself and the environment) in people on a spectrum of moods. The scale ran from clinically depressed, moderately depressed, normal mood, elevated mood, to manic. Surprisingly the moderately depressed won the contest, providing the most "accurate" responses. The normal mood group consistently demonstrated unrealistically positive evaluations of themselves and their loved ones, exaggerated perceptions of personal control or mastery, and unrealistic optimism about the future.
These positive illusions are more accurately understood as design features of a normal mind rather than a brain function failure. In fact such positive misbeliefs are key to physical health as well. Unrealistically positive views about one's medical condition have been repeatedly linked to better outcomes than more accurate beliefs.
One might wonder how we are so good at fooling ourselves.
Because deceit is so fundamental in animal communication, there must be a strong selection to spot deception. This in turn led to a selection for self-deception, burying certain facts and motivations in the unconscious, so as to be the least obvious when our deception is being enacted. This protective failsafe- like system filters what we will allow ourselves to know.
We know our neighbor better than ourselves.
In the next entry we'll take a look at some of the ways our memory distorts things and how that makes it difficult to know how to pursue happiness.
For example, it has been repeatedly proven that men overperceive the sexual interest and intent of women. The Darwinian rational for such a distortion is that the cost of this misbelief is much less detrimental to reproductive success than it's opposite, that is the man's sense that the woman is uninterested. For women, not surprisingly, the cost asymmetry is reversed. For a woman to falsely believe in a man's interest in familial investment is more detrimental because it will result in abandonment and therefore a lower chance of the offspring's survival. If she were wrong in this biased perception of a man's familial investment, it would merely delay reproduction, a much less costly error. Let the mating dance begin.
Evolution has also crafted certain misbeliefs about ourselves. One particularly striking example is the "better than average effect". Most people judge themselves to be more intelligent, honest, original, friendly, and reliable than the average person. Drivers who have been hospitalized as a consequence of their poor driving, rate themselves as having better than average driving skills. My favorite example is that most people perceive themselves as less prone to such self-serving distortions than others.
Traditional psychological theories have considered a close relationship with truth as an essential ingredient of mental health. We're no longer so sure. In an amusing study, investigators assessed reality testing (how accurate one's observations are about oneself and the environment) in people on a spectrum of moods. The scale ran from clinically depressed, moderately depressed, normal mood, elevated mood, to manic. Surprisingly the moderately depressed won the contest, providing the most "accurate" responses. The normal mood group consistently demonstrated unrealistically positive evaluations of themselves and their loved ones, exaggerated perceptions of personal control or mastery, and unrealistic optimism about the future.
These positive illusions are more accurately understood as design features of a normal mind rather than a brain function failure. In fact such positive misbeliefs are key to physical health as well. Unrealistically positive views about one's medical condition have been repeatedly linked to better outcomes than more accurate beliefs.
One might wonder how we are so good at fooling ourselves.
Because deceit is so fundamental in animal communication, there must be a strong selection to spot deception. This in turn led to a selection for self-deception, burying certain facts and motivations in the unconscious, so as to be the least obvious when our deception is being enacted. This protective failsafe- like system filters what we will allow ourselves to know.
We know our neighbor better than ourselves.
In the next entry we'll take a look at some of the ways our memory distorts things and how that makes it difficult to know how to pursue happiness.
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