I Think You'll Find It's a Bit More Complicated Than That

by Ben Goldacre

  One major problem with the current publishing model is that it’s hard to give access for free to the motivated public, while still gathering income from institutions. My hunch is that, at some stage, this problem may be partially sidestepped when someone manages an illegal workaround that individuals can play with, but which no university could endorse. I may be wrong, but either way, these are very interesting times for information.

  In January 2013, facing up to thirty-five years in jail for downloading large quantities of academic papers, and under enormous pressure from US prosecutors, Aaron Swartz took his own life. He was twenty-six and extraordinary. A documentary from 2014 about Aaron’s life – The Internet’s Own Boy – is very good, very upsetting, and free to download online.

  BIOLOGISING

  Neuro-Realism

  Guardian, 30 October 2010

  When the BBC tells you, in a headline, that libido problems are in the brain and not in the mind, then you might find yourself wondering what the difference between the two is supposed to be, and whether a science article can really be assuming – in 2010 – that readers buy into some strange form of Cartesian dualism, in which the self is contained by a funny little spirit entity in constant pneumatic connection with the corporeal realm.

  But first let’s look at the experiment the BBC is reporting.

  As far as we know (the study hasn’t yet been published, only presented at a conference) some researchers took seven women with a ‘normal’ sex drive, and nineteen women diagnosed with ‘hypoactive sexual desire disorder’. The participants watched a series of erotic films in a scanner, and while they did so, an MRI machine took images of blood flow in their brains. The women with a normal sex drive had an increased flow of blood to some parts of their brain – some areas associated with emotion – while those with low libido did not.

  Dr Michael Diamond, one of the researchers, tells the Mail: ‘Being able to identify physiological changes, to me provides significant evidence that it’s a true disorder as opposed to a societal construct.’ In the Metro he goes further: ‘Researcher Dr Michael Diamond said the findings offer “significant evidence” that persistent low sex drive – known as hypoactive sexual desire disorder (HSDD) – is a genuine physiological disorder and not made up.’

  This strikes me as an unusual world view. All mental states must have physical correlates, if you believe that the physical activity of the brain is what underlies our sensations, beliefs and experiences: so while different mental states will certainly be associated with different physical states, that doesn’t tell you which caused which. If I do not have the horn, you may well fail to see any increased activity in the part of my brain that lights up when I do have the horn. That doesn’t tell you why I don’t have the horn: maybe I’ve got a lot on my plate, maybe I have a physical problem in my brain, maybe I was raped last year. There could be any number of reasons.

  Far stranger is the idea that a subjective experience must be shown to have a measurable physical correlate in the brain before we can agree that the subjective experience is real, even for matters that are plainly subjective and experiential. If someone is complaining of persistent low sex drive, then they have persistent low sex drive, and even if you could find no physical correlate in the brain whatsoever, that wouldn’t matter: they still have low sex drive.

  Interestingly, the world view being advanced by these researchers and journalists is far from new: in fact, it’s part of a whole series of recurring themes in popular misinterpretations of neuroscience, first described formally in a 2005 paper from Nature Reviews Neuroscience called ‘fMRI in the Public Eye’. To examine how fMRI brain-imaging research was depicted in mainstream media, the researchers conducted a systematic search for every news story about it over a twelve-year period, and then conducted content analysis to identify any recurring themes.

  The first theme they identified was the idea that a brain-imaging experiment ‘can make a phenomenon uncritically real, objective or effective in the eyes of the public’. They described this phenomenon as ‘neuro-realism’, and the idea is best explained through their examples, which mirror these new claims about libido perfectly.

  So, an article in the Washington Post takes a view on pain, and whether the subjective experience of it is enough: ‘Patients have long reported that acupuncture helps relieve their pain, but scientists don’t know why. Could it be an illusion?’ It has an answer: ‘Now brain imaging technology has indicated that the perception of pain relief is accurate.’

  Another article says that brain imaging ‘provides visual proof that acupuncture alleviates pain’. The reality, of course, is much simpler: for your own personal experience of pain, which is all that matters, if you say that your pain is relieved, then your pain is relieved (and I wish good luck to any doctor who tells his patient their pain has gone when it hasn’t, just because some magical scan says it has).

  The New York Times takes a similarly strange tack in a brain-imaging study on fear: ‘Now scientists say the feeling is not only real, but they can show what happens in the brain to cause it.’

  Many people find fatty food to be pleasurable, for the taste, the calories, and any number of other reasons. When a brain-imaging study showed that the reward centres in the brain had increased blood flow after subjects in an experiment ate high-fat foods, the Boston Globe explained: ‘Fat really does bring pleasure.’

  They’re right, it does. But it’s a slightly strange world when a scan of blood flow in the brain is taken as vindication of a subjective mental state, and a way to validate our experience of the world.

  The Stigma Gene

  Guardian, 9 October 2010

  What does it mean to say that a psychological or behavioural condition has a biological cause? Over the past week, more battles have been raging over ADHD, after a paper published by a group of Cardiff researchers found evidence that there is a genetic association with the condition. Their study looked for chromosomal deletions and duplications known as ‘copy number variants’ (CNV), and found that these were present in 16 per cent of the children with ADHD.

  What many reports did not tell you – including that in the Guardian – is that this same pattern of CNV was also found in 8 per cent of the children without ADHD. So that’s not a massive difference.

  But more interesting were the moral and cultural interpretations heaped onto this finding, not least by the authors themselves. ‘Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children,’ said Professor Anita Thapar. ‘We hope that these findings will help overcome the stigma associated with ADHD.’

  Does the belief that such problems have a biological cause really help to reduce stigma?

  In 2001, Read and Harre explored attitudes among first-year undergraduate psychology students, with questionnaires designed to probe their beliefs about the causes of mental health problems, and responses on six-point scales to statements like ‘I would be less likely to become romantically involved with someone if I knew they had spent time in a psychiatric hospital.’ People who believed more in a biological or genetic cause were more likely to believe that people with mental health problems are unpredictable and dangerous, more likely to fear them, and more likely to avoid interacting with them. An earlier study in 1999 by Read and Law had similar results.

  In 2002 Walker and Read showed young adults a video portraying a man with psychotic symptoms, such as hallucinations and delusions, then gave them either biogenetic or psychosocial explanations. Yet again, the ‘medical model’ approach significantly increased perceptions of dangerousness and unpredictability.

  In 2004 Dietrich and colleagues conducted a huge series of structured interviews with three representative population samples in Germany, Russia and Mongolia. Endorsing biological factors as the root cause for schizophrenia was associated with a greater desire for social distance.

  And lastly, more compelling than any indiv
idual study, a review of the literature to date in 2006 found that overall, biogenetic causal theories, and labelling something as an ‘illness’, are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. They identified nineteen studies addressing the question. Eighteen found that belief in a genetic or biological cause was associated with more negative attitudes to people with mental health problems. Just one found the opposite, that belief in a genetic or biological cause was associated with more positive attitudes.

  These findings are at odds with everything that many people who campaign against stigma have assumed for many years, but they’re not entirely nonsensical. As Jo Phelan explains in her paper ‘Genetic Bases of Mental Illness – a Cure for Stigma?’, a story about genetic causes may lead to people being conceived of as ‘defective’ or ‘physically distinct’. It can create an ‘associative stigma’ for the whole family, who in turn receive new labels such as ‘at risk’ or ‘carrier’. What’s more, this stigma may persist long after the ADHD symptoms have receded in adulthood: perhaps a partner will wonder, ‘Do I really want to risk having a child with this person, given their genetic predisposition?’

  Perhaps it will go further than that: your children, before they even begin to show any signs of inattentiveness or hyperactivity, will experience a kind of anticipatory stigma. Do they have this condition, just like their father? ‘It’s genetic, you know.’ Perhaps the threshold for attaining a diagnosis of ADHD will be lower for your children: it’s a condition, like many others, after all, with a notably flexible diagnostic boundary.

  Blaming parents is clearly vile. But before reading this research I think I also assumed, unthinkingly, like many people, that a ‘biological cause’ story about mental health problems was inherently valuable for combating stigma. Now I’m not so sure. People who want to combat prejudice may need to challenge their own prejudices too.

  Pink, Pink, Pink, Pink. Pink Moan

  Guardian, 25 August 2007

  I want you to know that I love evolutionary psychologists, because their ideas – like ‘Girls prefer pink because they need to be better at hunting berries’ – are so much fun. Sure, there are problems. For example: we don’t know a lot about life in the Pleistocene period through which humans evolved; their claims sound a bit like ‘just so’ stories, relying on their own internal, circular logic; the existing evidence for genetic influence on behaviour, emotion and cognition is coarse; they only pick the behaviours which they think they can explain, while leaving the rest; and they get themselves in massive trouble as soon as they go beyond examining broad categories of human behaviours across societies and cultures, becoming crassly ethnocentric. But that doesn’t stop me enjoying their ideas.

  This week every single newspaper in the world lapped up the story that scientists have cracked the pink problem. ‘At last, science discovers why blue is for boys but girls really do prefer pink,’ said The Times. And so on.

  The study1 took 208 people in their twenties and asked them to choose their favourite colours between two options, repeatedly, and then graphed their overall preferences. It found overlapping curves, with a significant tendency for men to prefer blue, and female subjects showing a preference for redder, pinker tones. This, the authors speculated (to international excitement and approval), may be because men go out hunting, but women need to be good at interpreting flushed emotional faces, and identifying berries whilst out gathering.

  Now, there are some serious problems here. Firstly, the test wasn’t measuring discriminative ability, just preference. I am yet to be given evidence that my girlfriend has the upper hand in discriminating shades of red as we gambol foraging for the fruits of the forest (which we do).

  But is colour preference cultural or genetic? Well. The ‘girls preferring pink’ thing is not set in stone, and in fact there are good reasons to suspect it is culturally determined. I have always been led to believe by my father – the toughest man in the world – that pink is the correct colour for men’s shirts. In fact, until very recently blue was actively considered soft and girly, while boys wore pink, a tempered form of fierce, dramatic red.

  There is no reason why you should take my word for this. Back in the days when ladies had a home journal (in 1918) the Ladies Home Journal wrote: ‘There has been a great diversity of opinion on the subject, but the generally accepted rule is pink for the boy and blue for the girl. The reason is that pink being a more decided and stronger color is more suitable for the boy, while blue, which is more delicate and dainty, is prettier for the girl.’

  The Sunday Sentinel in 1914 told American mothers: ‘If you like the color note on the little one’s garments, use pink for the boy and blue for the girl, if you are a follower of convention.’ Some sources suggest it wasn’t until the 1940s that the modern gender associations of girly pink became widely accepted. Pink is, therefore, perhaps not biologically girly. Boys who were raised in pink frilly dresses went down mines and fought in World War II. Clothing conventions do change over time.

  But within this study, was the preference stable across cultures? Well, no, not even in this experiment, where they had some Chinese test subjects too. For these participants, not only were the differences in the overlapping curves not so extreme, but the favourite colours were a kind of red for boys and a bit pinker for girls (not blue); and they had more of a red preference overall. Red, you see, is a lucky colour in contemporary Chinese culture.

  Also snuggled away in the paper was the information that femininity scores on the Bem Sex Role Inventory correlated significantly with colour preference. Now, the BSRI is a joy from the 1970s, a self-rated test explicitly designed to measure how much you adhere to socially desirable, stereotypically masculine and feminine personality characteristics.

  Anyone can take this test online, for free: you simply mark on a score sheet from one to seven how much you feel you suit words like ‘theatrical’, ‘assertive’, ‘sympathetic’, ‘adaptable’ or ‘tactful’; and then your score is totted up at the end. So, it turns out that women who describe themselves as ‘yielding’, ‘cheerful’, ‘gullible’, ‘feminine’ and ‘do not use harsh language’ also prefer pink. Thanks for the warning: I’ll try to use this to avoid them in future.

  It’s worth being critical and thoughtful about these stories; not because it’s fun to be mean, but because that’s what the authors would want, and also because stories about genes and culture are an important part of the stories we tell ourselves about who and what we are, our sense of personal responsibility, and the inevitability in our gender roles.

  STATISTICS

  Guns Don’t Kill People, Puppies Do

  Guardian, 13 February 2010

  Often one data point isn’t enough to spot a pattern – or even to say that an event is interesting and exceptional – because numbers are all about context and constraints. At one end there are the simple examples. ‘Mum Beats Odds of 50 Million-to-One to Have 3 Babies on Same Date’ was the headline for the Daily Express on Thursday. If that phenomenon was really so unlikely, then since there are fewer than a million births a year in the UK, this would genuinely be a very rare event.

  The Express’s number is calculated as 365 × 365 × 365 = 48,627,125. But in fact it’s out by an order of magnitude. One in 50 million would be the odds against someone having three siblings who share one particular prespecified birth date, which the editors of the Daily Express had sealed in an envelope and given to a lawyer fifty years ago. In reality there is no constraint on which day the first baby gets born on, so after that, we’re just interested in the odds of two more babies sharing that same birthday, which are 365 × 365 = 133,225 to one. And those odds might even be a bit lower: if you two feel friskier in winter, for example, your babies might tend to be born in the autumn.

  Then there is the context. Living on your street, hanging out with the people from work, it’s easy to miss the sheer scale of humanity on the planet. In England and Wales
there were 725,440 births last year. From the Office for National Statistics (ONS) Statistical Bulletin ‘Who is Having Babies’, 14 per cent of these were third births, and another 9 per cent were fourth or subsequent births. So there are 102,000 third children born a year, 167,000 third or more-th children, and if we include the rest of the Kingdom there are even more. All of which means that on average – since the odds of three shared birthdays is about 133,225 to one, and there are 167,000 third births a year in England – this specific birthday coincidence will occur about once or twice a year in the UK. To be written about in the Express it would also need to be a birth within a marriage, which gives us 55,000 chances a year, or once every two years.

  When you forget about numerical constraints, all kinds of things can start to look spooky: in a group of twenty-three people, there is a 50 per cent chance that two of them will share a birthday, because any pair of birthdays on any date is acceptable. When you forget about numerical context, things can look weird too: if Uri Geller gets a nation in front of the telly to tap their broken watches against the screen, and ring the call centre if the watch starts ticking again, then with viewing figures of a few million there will be more excited calls than the switchboard can handle.

  If you turned to your friend and said, ‘You know, a lot of funny things have happened to me, quite unexpectedly, over the course of a lifetime, but let me take a moment to specify right now the one thing that would seriously freak me out, over the next twelve hours, which would be if my dog trod on the trigger of my gun, and accidentally shot me in the face,’ and then your dog shot you in the calf, that would be weird. So ‘Dog Shoots Man’ was a big story in America this week, to the delight of headline writers. But here’s ‘Dog Shoots Man in the Back’ from Memphis in 2007, another in Iowa only two months later, and my own personal favourite: ‘Puppy Shoots Man: Dog Put Paw on Gun’s Trigger as Owner Tried to Kill Him’.