Author: ken

What Else Can Improve Health?

The common sense view of placebos is that they are fake treatments that, somehow, are effective just because the patient believes in them.  Medical doctors often consider them unethical, a form of cheating.  But the reality is a bit more complex.

Since the mind is not a machine or a computer, the hopes and anxieties, the expectations and beliefs aroused in us by any treatment for an illness will inevitably result in physiological changes in the brain.  We don’t know exactly how this works, but clearly some of those changes can mimic and amplify the effects of “real” treatments.

Olivia Judson writing in The New York Times pointed out that the psychological benefit associated with a placebo can also enhance the impact of ‘real’ treatments.  In fact, it can be impossible to discriminate how much of the effect of the drug is due to the brain’s expectations and how much to the action of the drug itself.

The effects vary tremendously in different populations, and seem to be affected by the attitude of physicians administering the placebos as well as the impressiveness of the “rituals” involved in their use.  Surgery, for example, has usually more psychological impact than injections, which in turn have less impact than pills.

Judson writes: “So the key is to figure out how to maximize that enhancement without lying.  One idea would be to deliberately increase the element of formal ritual in medicine.”   (See, “Enhancing the Placebo.”)

Other psychological factors contribute to health, and there is evidence that people in relationships – even people who have pets – do better.  It is likely, then, that the mere existence of health insurance and access to care will make a difference.  If a sugar pill can help patients get better, it seems likely that just knowing you can get the help you need, without going into debt, will also have a physiological impact on the brain.

To be sure, insurance and access will encourage some to overuse available care.  But it would be good to know more about the placebo effect of healthcare insurance.  Having it might provide more than peace of mind.

The Sadism in Abortion Laws

It’s one thing to oppose abortion, though I am not in that camp myself.  It’s another to regret it – or even discourage it.  I do understand that it is not a simple or easy matter to destroy a budding life.  But some of the new laws being proposed are truly cruel and sadistic.

Tuesday, the Legislature in Oklahoma mandated that a woman must get an ultrasound before any abortion, and it must be done in such a way so that, “the woman can see it and describe the heart, limbs and organs of the fetus. No exceptions are made for rape and incest victims.” (See, “Strict Abortion Measures Enacted in Oklahoma.”

Friday, the Legislature in Florida passed a bill requiring, “all women seeking an abortion to undergo an ultrasound. Even if the women don’t want to see the image, the doctor must still describe it to them.”  The Florida bill is a bit more compassionate than Oklahoma’s, as women may be exempted if they can prove that the fetus resulted from rape.  (See, “Florida House Sends Abortion Bill to Governor.”)

I don’t know if the courts will strike down these provisions as unwarranted invasions of privacy, but I do know that they are punitive and sadistic – and psychologically harmful to those they affect.

So why are we doing this?  Could it be that there is a resurgence of hatred against women, especially women who cross a line in managing their sexual lives?  Is this a new Puritanism?  Or could it be part of a larger movement, escalating all political differences into hateful and abusive conflicts?

I suspect the latter.  Political figures are being threatened and physically attacked as well.  Illegal immigrants are also being assaulted, as well as increasingly targeted by draconian laws.  It’s not just pregnant women.

Beneath these violent developments, I think, is a growing sense of powerlessness, especially among the less affluent.  On the one hand, the rich continue to get richer while the democratic process is obviously hostage to moneyed interests.  On the other, unemployment is still rampant, and people’s ownership of their homes is threatened, while banks are thriving.  The increasing virulence of our politics may reflect an underlying sense among those at most at risk that something – anything — must be done to stem the drift into helplessness.  If you can’t get people to change their behavior at least you can make sure they suffer for it.

If this is the underlying explanation for this destructive trend, we can expect that it will not soon abate.  It took a long time for us to drift into this condition of greater economic inequality, papered over by the credit bubble, and it will take a long time to recover from it.

A Skill in Great Demand

Few of us would doubt that lying can be a useful skill.  Still it was surprising to see this month’s Harvard Business Review report on a study that offered some tips to executives on the subject.

The research by a professor at the Columbia Business School revealed that successful lying requires the confident assertion of power: “A sense of power buffers individuals from the stress of lying and increases their ability to deceive others.”  (See, “Defend Your Research:  Powerful People Are Better Liars.”)

There are distinct involuntary and physiological clues exhibited by people who are lying, telltale signs that can be spotted by those trained to detect them: “involuntary shoulder shrugs, accelerated speech, . . . cognitive impairment, and emotional distress.”  So those who can suppress these signs or cover them over with contrary signals have a real advantage.  On the other hand, the average person’s ability to know that he is being lied to is no better than chance.  “Powerful people like CEOs are better liars, and most people are bad at spotting liars.”  Clearly, it’s a big part of being successful.

But why has lying now become such an important subject of research?  Why in business schools?  Why reported in HBR?

One obvious answer to all three questions is that lying has become increasingly common.  We see obvious examples in Wall Street executives testifying before congress, evading tough questions about their responsibility for the recession and coming up with disingenuous arguments against regulation.  Similarly, energy companies have economized on safety, a fact exposed by the recent mine disaster in West Virginia and last week’s oil leak in the Gulf of Mexico.  Tobacco companies suppressed information about lung cancer, etc. etc.  The naked self-interest of many corporations is becoming more and more difficult to conceal.

This may be part of the larger picture of the growing disparity between the rich and poor in our society.  Not only does that fact have to be covered over, those who are richer have, as a result, become more powerful and intimidating to those below.

But something else is happening in our culture: we are less interested in getting at the truth, more addicted to quick, simple answers and finding culprits, people to blame rather than people to set things right.  More of us may be educated now, but attention spans are shrinking.  Even those who know better, often no longer bother trying to be heard.

“Optics” is the new buzzword.  Appearance and spin influence public opinion more than facts.  Moreover, our political system is more and more hostage to the expensive arts of advertising and public relations.  Not everything said by executives and politicians are outright lies, necessarily, but the relationship between what they say and what is true is increasingly tenuous and irrelevant.

So appearing to believe what you say gets to be more and more important, and conviction becomes a skill to be studied and taught.  HBR, as usual, is just trying to be right where the action is.

The Army’s Failing WTUs

The army set up Warrior Transition Units to deal with returning soldiers traumatized by their service in Iraq and Afghanistan, but in many instances it appears to being failing as badly as the system it was designed to replace.

A report in The New York Times chronicles the problems that led one soldier to say, “Being in the W.T.U. is worse than being in Iraq.”  (See, “In Army’s Trauma Care Units, Feeling Warehoused.”)

For one thing, the units emphasize medication to treat depression, anxiety, nightmares and other sleep disorders.  But often the medications cause the soldiers be disoriented and confused, undermining their ability to show up for their duties.  Sometimes them can’t keep track of the different drugs prescribed for them.  According to The Times, many of them resort to heroin as a cure-all, which not only further incapacitates them but also saddles them with the additional, intractable problem of addiction.

An over-emphasis on medication is a common failing in the U.S.  In this case it is doubly tragic because it serves as an excuse to abandon the returning soldiers.  They spend a lot of time in their rooms, staring at the walls or watching TV, forced to face their demons alone.

A closer reading of the report suggest that the underlying reason the program is failing is that it is run by officers who have no direct experience themselves of the tasks and the problems they are attempting to manage:  “At the top of the command are traditional Army officers, not health care professionals.”

If those managing a system lack clear understanding of the nature of the work the system is engaged in doing, the system is virtually doomed to failure.  Well-intentioned and even well-informed amateurs can’t really do the job:  they really can’t understand the issues faced down the line by those who actually do the work, while those who do it can’t easily approach and find the ways to communicate with them.  The system becomes over dependent on formal rules, standards and guidelines.  Inevitably those at different levels of authority will be emphasizing different things and work at cross-purposes, while deprived of the subtle and often unconscious cues that could tell them something is wrong.

This is true for any enterprise, but even more so for systems that provide human services.  Such systems reverberate with complex and sometimes contradictory resonances and cues.  To be effective in them you really have to be alert and open to knowing what you don’t know you know, and able to hear what others can’t so easily say.

“Fraud” at Goldman

The SEC’s charge that Goldman Sachs engaged in fraud has captivated public attention, though many lawyers note that this is a legal grey area with considerable room for disagreement.  Alan Deshowitz commented on The Daily Beast:  “Securities fraud is an accordion-like term that expands and contracts over time, depending on the outrage of the public, the mood of the media, and the discretion of law-enforcement officials.”

But, he added:  “To an outsider, what Goldman was doing doesn’t pass the smell test.” (See, “The Fallacy of ‘Fraud.’”)

This suggests that, regardless of what happens in federal court, the real trial will be in the court of public opinion, and it will revolve around Goldman’s Sachs unique position as both the most successful and most reviled of financial firms.  Is it a “giant vampire squid” or a unique incubator for fiscal genius?  Are they the smartest guys around or a conspiratorial band that will stoop at virtually nothing to make a profit?

This public trial has been going on for some time now, and the balance seems to be shifting against the firm.  CEO Blankfein’s lame apologies  and their PR gestures about limiting executive salaries and are more than offset by the announcement of this quarter’s $3.5 billion profit.  While so many are still out of a job, this makes them seem like profiteers – especially since those profits don’t add to productivity or jobs.

The Dean of the Rotman School of Management, Roger Martin, comments that the kind of skimming off of profits that add no value to productivity, “will continue to march forward until the rules of the game are changed. Under the current ones, the folks who make the most money in America create zero value. . . . Yet our society rewards them most.” (See, “Goldman’s Shell Game.”)

A trial would bring out a number of facts, and that might be the most useful contribution to this debate.  It will also elicit more public discussion, keeping the issue in the forefront of our minds for a considerable amount of time.

Right now, between the demonization and the idealization, it’s hard to think straight.  The projections of evil, the envy and competition, the climate of suspicion, the extraordinary success — all these make it hard to see what’s really there.

And perhaps the real outcome will not be the jury’s verdict so much as the opportunity the trial will provide to think about the kind of financial industry we want and to move towards creating the laws and regulatory agencies that will get us there.