Cosmic Ordering, CAM and the NHS

A while back, I argued that it might not be a good idea to encourage the use of therapies, such as homeopathy, which work via the "placebo effect". (I've also previously said that what people call "the placebo effect" very often isn't one).

But there's more to say on this. Let us assume that homeopathy, say, is nothing more than a placebo (which it is). Let's further assume that homeopathy is actually quite a good placebo, meaning that when people go to see a homeopath they generally leave feeling better and end up experiencing better health outcomes - for whatever reason. This second assumption is exactly that, an assumption, because to my knowledge no-one has done a study of whether people who use homeopathy actually feel any healthier than they would if they had never heard of homeopathy and just got on with their lives. But let's assume it works.

Now, does this mean that homeopathy is a good thing? Well, sure, if it makes people feel better, it's a good thing. However - it doesn't follow that homeopathy, or any other form of complementary and alternative medicine which works as a placebo, should be available on the NHS. Many have argued that if CAM works, even if only by the placebo effect, it's still a useful thing which the NHS should support if patient's request it. I disagree.
A while back, South Bank University in London was widely mocked for getting a psychic to give a training session on "cosmic ordering". Cosmic ordering is the belief that you can get what you want in life by placing an order with the universe in the form of wishing really hard and then some quantum stuff happens and - I can't write any more of this. It's all crap. Anyway, the head of South Bank defended the session on the grounds that the staff requested it, liked it and found it useful.

Now if I applied for funding from my University to pay for a night down the pub for the whole of my Department I'd get the beaurocratic equivalent of a slap in the face. This despite the fact that people would enjoy it, it would help with team-building, and reduce stress levels. The point is that despite a Departmental night down the pub being, probably, a good thing in many ways, it's just not the kind of thing a University is responsible for. It would be incredibly unprofessional for University money to be spent on that kind of thing.

Likewise, it was unprofessional of South Bank to pay for a psychic to give a training course, even though the attendees liked it. Sorry to sound anal but Universities don't exist to give their staff what they want. They exist to pay their staff in exchange for their professional services & to help them carry out those services.

Likewise, the NHS, I think, doesn't exist to make people feel good, it exists to treat and prevent medical illnesses. So people like homeopathy and find it's helpful for relieving stress-related symptoms. Does that mean the NHS should be paying for it? Only if you believe that the NHS should also be paying for me to take a holiday to Thailand. I don't believe in homeopathy, but I do believe that a week on a Thai beach would do wonders for my stress levels. Or maybe I'd prefer a sweet guitar - I find playing guitar is great for relaxation, but it would be even better if I had a £700 model to play on. My well-being levels would just soar, if only until the novelty wore off. You get the point.

Most "complementary and alternative medicine" is medicine in appearance only. Just because homepaths hand out pills doesn't mean that what they do has anything to do with medicine. It's ritual. It's close to being entertainment, in a sense - which is not to belittle it, because entertainment is an important part of life. I'm sure there are many people for whom their sessions with their homeopath are really very useful. I just don't think the medical services should necessarily be paying for everything that people find helpful.

[BPSDB]

Cosmic Ordering, CAM and the NHS

A while back, I argued that it might not be a good idea to encourage the use of therapies, such as homeopathy, which work via the "placebo effect". (I've also previously said that what people call "the placebo effect" very often isn't one).

But there's more to say on this. Let us assume that homeopathy, say, is nothing more than a placebo (which it is). Let's further assume that homeopathy is actually quite a good placebo, meaning that when people go to see a homeopath they generally leave feeling better and end up experiencing better health outcomes - for whatever reason. This second assumption is exactly that, an assumption, because to my knowledge no-one has done a study of whether people who use homeopathy actually feel any healthier than they would if they had never heard of homeopathy and just got on with their lives. But let's assume it works.

Now, does this mean that homeopathy is a good thing? Well, sure, if it makes people feel better, it's a good thing. However - it doesn't follow that homeopathy, or any other form of complementary and alternative medicine which works as a placebo, should be available on the NHS. Many have argued that if CAM works, even if only by the placebo effect, it's still a useful thing which the NHS should support if patient's request it. I disagree.
A while back, South Bank University in London was widely mocked for getting a psychic to give a training session on "cosmic ordering". Cosmic ordering is the belief that you can get what you want in life by placing an order with the universe in the form of wishing really hard and then some quantum stuff happens and - I can't write any more of this. It's all crap. Anyway, the head of South Bank defended the session on the grounds that the staff requested it, liked it and found it useful.

Now if I applied for funding from my University to pay for a night down the pub for the whole of my Department I'd get the beaurocratic equivalent of a slap in the face. This despite the fact that people would enjoy it, it would help with team-building, and reduce stress levels. The point is that despite a Departmental night down the pub being, probably, a good thing in many ways, it's just not the kind of thing a University is responsible for. It would be incredibly unprofessional for University money to be spent on that kind of thing.

Likewise, it was unprofessional of South Bank to pay for a psychic to give a training course, even though the attendees liked it. Sorry to sound anal but Universities don't exist to give their staff what they want. They exist to pay their staff in exchange for their professional services & to help them carry out those services.

Likewise, the NHS, I think, doesn't exist to make people feel good, it exists to treat and prevent medical illnesses. So people like homeopathy and find it's helpful for relieving stress-related symptoms. Does that mean the NHS should be paying for it? Only if you believe that the NHS should also be paying for me to take a holiday to Thailand. I don't believe in homeopathy, but I do believe that a week on a Thai beach would do wonders for my stress levels. Or maybe I'd prefer a sweet guitar - I find playing guitar is great for relaxation, but it would be even better if I had a £700 model to play on. My well-being levels would just soar, if only until the novelty wore off. You get the point.

Most "complementary and alternative medicine" is medicine in appearance only. Just because homepaths hand out pills doesn't mean that what they do has anything to do with medicine. It's ritual. It's close to being entertainment, in a sense - which is not to belittle it, because entertainment is an important part of life. I'm sure there are many people for whom their sessions with their homeopath are really very useful. I just don't think the medical services should necessarily be paying for everything that people find helpful.

[BPSDB]

Encephalon #67 is coming...

ENCEPHALON, the regular psychology and neuroscience blog carnival, will shortly be arriving at Neuroskeptic. The last few editions were awesome, so don't let me down here - get writing, or get submitting things you've already written, about the brain, the mind, and all that kind of thing.

As always, please email submissions to encephalon{dot}host{at}gmail{dot}com by the 30th March.

Encephalon #67 is coming...

ENCEPHALON, the regular psychology and neuroscience blog carnival, will shortly be arriving at Neuroskeptic. The last few editions were awesome, so don't let me down here - get writing, or get submitting things you've already written, about the brain, the mind, and all that kind of thing.

As always, please email submissions to encephalon{dot}host{at}gmail{dot}com by the 30th March.

Serotonin, Hallucinations & Psychosis

Serotonin, as every newspaper reader knows, is the brain's "feel good chemical". Of course, it's a little bit more complicated than that. A lot more complicated, in fact. But even amongst scientists who are aware of the complexity of serotonin pharmacology, the functions of serotonin are still generally thought of in the context of mood and emotion.
What everyone tends to forget is that serotonin has a wild side. There's a long line of research, stretching back to the 40s, on the role of serotonin in perception and hallucinations.

It all started on Bicycle Day - the 1943 day that Albert Hofmann first experienced the psychedelic effects of LSD ("acid") while riding his bike home from the lab where he first synthesized the drug. Serotonin was discovered in 1948. It was soon noticed that the chemical structure of LSD bears a striking similarity to serotonin - as does psilocybin, the major psychoactive ingredient in "magic mushrooms":You don't need to be a chemist to appreciate the resemblance. So it would be a very reasonable assumption that hallucinogenic drugs work by interfering with the brain's serotonin pathways, and therefore that the serotonin system is somehow involved in regulating thought and perception. Somehow, LSD inteferes with the serotonin system in the brain to cause profoundly altered states of conciousness. That's pretty important.That's also the easy bit. What's been difficult has been working out what hallucinogens actually do in the brain specifically, and how this produces their psychoactive effects. Trends in Pharmacological Sciences has a nice review article on this. To cut a long story short, we still don't know how LSD works, although since research has mostly dried up since the 1970s (everyone's studying happy pills now) this isn't all that surprising.

What has emerged is that LSD and similar compounds all activate the 5HT2A receptor. Interestingly, so do drugs which are chemically rather different, but with similar hallucinogenic effects, such as mescaline, favored by Native Americans and Matrix fans alike. The more potent a drug is at activating the receptor, the less of it you need to take to trip out.

So, does this mean that 5HT2A = hallucinogenic effects? The problem with this nice simple theory is lisuride, a potent 5HT2A agonist with no hallucinogenic effects at all. This troublesome result might not disprove the 5HT2A theory, however, in the light of a 2007 experiment finding that LSD has different effects on target cells from lisuride, despite them both binding to the same receptor. Presumably LSD and lisuride do subtly different things to the same receptors (read the paper for a more detailed account).

There's loads more to be said about hallucinogen pharmacology, and I'll be covering some of it in the future. What's interesting - and frustrating - is how few psychopharmacologists are aware of the field. A lot of hallucinogen research is really groundbreaking; the finding that two different agonists of the same receptor can have quite different effects is a really important one. It's certainly a humbling result. After Hallucinogens Recruit Specific Cortical 5-HT2A Receptor-Mediated Signaling Pathways to Affect Behavior, it's impossible not to get to wondering whether other receptors in the brain might have equally complex lives. Hallucinogen research underlines how imperfect our current understanding of the brain is. Plus, hallucinogens are really a lot sexier than antidepressants. Given all of which, it's a shame so few scientists are studying them. Acid - it's not just for ageing hippies.

Link Erowid.org has made available Hofmann's personal archive of over 4,000 papers relating to LSD. A dream come true if that kind of stuff floats your boat & well worth a browse for historical interest.

M GEYER, F VOLLENWEIDER (2008). Serotonin research: contributions to understanding psychoses Trends in Pharmacological Sciences, 29 (9), 445-453 DOI: 10.1016/j.tips.2008.06.006

González-Maeso, J., Weisstaub, N., Zhou, M., Chan, P., Ivic, L., Ang, R., Lira, A., Bradley-Moore, M., Ge, Y., & Zhou, Q. (2007). Hallucinogens Recruit Specific Cortical 5-HT2A Receptor-Mediated Signaling Pathways to Affect Behavior Neuron, 53 (3), 439-452 DOI: 10.1016/j.neuron.2007.01.008

Serotonin, Hallucinations & Psychosis

Serotonin, as every newspaper reader knows, is the brain's "feel good chemical". Of course, it's a little bit more complicated than that. A lot more complicated, in fact. But even amongst scientists who are aware of the complexity of serotonin pharmacology, the functions of serotonin are still generally thought of in the context of mood and emotion.
What everyone tends to forget is that serotonin has a wild side. There's a long line of research, stretching back to the 40s, on the role of serotonin in perception and hallucinations.

It all started on Bicycle Day - the 1943 day that Albert Hofmann first experienced the psychedelic effects of LSD ("acid") while riding his bike home from the lab where he first synthesized the drug. Serotonin was discovered in 1948. It was soon noticed that the chemical structure of LSD bears a striking similarity to serotonin - as does psilocybin, the major psychoactive ingredient in "magic mushrooms":You don't need to be a chemist to appreciate the resemblance. So it would be a very reasonable assumption that hallucinogenic drugs work by interfering with the brain's serotonin pathways, and therefore that the serotonin system is somehow involved in regulating thought and perception. Somehow, LSD inteferes with the serotonin system in the brain to cause profoundly altered states of conciousness. That's pretty important.That's also the easy bit. What's been difficult has been working out what hallucinogens actually do in the brain specifically, and how this produces their psychoactive effects. Trends in Pharmacological Sciences has a nice review article on this. To cut a long story short, we still don't know how LSD works, although since research has mostly dried up since the 1970s (everyone's studying happy pills now) this isn't all that surprising.

What has emerged is that LSD and similar compounds all activate the 5HT2A receptor. Interestingly, so do drugs which are chemically rather different, but with similar hallucinogenic effects, such as mescaline, favored by Native Americans and Matrix fans alike. The more potent a drug is at activating the receptor, the less of it you need to take to trip out.

So, does this mean that 5HT2A = hallucinogenic effects? The problem with this nice simple theory is lisuride, a potent 5HT2A agonist with no hallucinogenic effects at all. This troublesome result might not disprove the 5HT2A theory, however, in the light of a 2007 experiment finding that LSD has different effects on target cells from lisuride, despite them both binding to the same receptor. Presumably LSD and lisuride do subtly different things to the same receptors (read the paper for a more detailed account).

There's loads more to be said about hallucinogen pharmacology, and I'll be covering some of it in the future. What's interesting - and frustrating - is how few psychopharmacologists are aware of the field. A lot of hallucinogen research is really groundbreaking; the finding that two different agonists of the same receptor can have quite different effects is a really important one. It's certainly a humbling result. After Hallucinogens Recruit Specific Cortical 5-HT2A Receptor-Mediated Signaling Pathways to Affect Behavior, it's impossible not to get to wondering whether other receptors in the brain might have equally complex lives. Hallucinogen research underlines how imperfect our current understanding of the brain is. Plus, hallucinogens are really a lot sexier than antidepressants. Given all of which, it's a shame so few scientists are studying them. Acid - it's not just for ageing hippies.

Link Erowid.org has made available Hofmann's personal archive of over 4,000 papers relating to LSD. A dream come true if that kind of stuff floats your boat & well worth a browse for historical interest.

M GEYER, F VOLLENWEIDER (2008). Serotonin research: contributions to understanding psychoses Trends in Pharmacological Sciences, 29 (9), 445-453 DOI: 10.1016/j.tips.2008.06.006

González-Maeso, J., Weisstaub, N., Zhou, M., Chan, P., Ivic, L., Ang, R., Lira, A., Bradley-Moore, M., Ge, Y., & Zhou, Q. (2007). Hallucinogens Recruit Specific Cortical 5-HT2A Receptor-Mediated Signaling Pathways to Affect Behavior Neuron, 53 (3), 439-452 DOI: 10.1016/j.neuron.2007.01.008

Nature "Does" Science Communication

The past few weeks has seen Nature (and Nature Neuroscience) run a series of features about science communication - science journalism, science blogging, and so on. They're all worth reading, and very readable, but, perhaps inevitably they raise more questions than they answer.

The basic assumption behind all of the articles is that communicating science to the public is A Good Thing, and scientists should be trying to help with it - whether by blogging about science, or helping to write press releases, or talking more to journalists.
I'm not sure about this. Sure - good, accurate information about science should be available to anyone who looks for it. But the same goes for history, or politics, or cricket. If people want to know about something, they should be able to read good stuff that's been written about it. I think there is an awful lot of great science writing out there, both in books, in print, and online. You can never have enough of it, though, so scientists should certainly be encouraged to write about science or help others to write about science in this way.

What I find questionable, though, is the idea that people who aren't really interested in science should be the targets of science communication. The Nature editorial of 19th March warns that

An average citizen is unlikely to search the web for the Higgs boson or the proteasome if he or she doesn't hear about it first on, say, a cable news channel. And as mass media sheds its scientific expertise, science's mass market presence will become harder to maintain.

Which is true, but I can't help but ask, why should the average citizen know or care about the Higgs boson? I find the Higgs boson quite interesting, although I admit, not as interesting as the brain. But I don't think that everyone should share my tastes. Personally, I find cricket deadly boring; I've never read the cricket pages of the newspaper, and I don't think I ever will. But some people are really into it, and good for them. If you prefer cricket to particle physics, who am I, or the editors of Nature, to say that's a problem?

The obvious response to what I've just said is that in a democracy, people have to know about science, because a lot of the major challenges facing our society involve science. If the public are ignorant about science, we won't be able to deal effectively with, say, climate change. There's probably some truth in that, but I suspect it's more important to educate people about climate change specifically, than to try to get them interested in Higgs bosons and hope that their passion for physics somehow "spills over" into a concern for the environment.

So, personally, I'm not really concerned if the public aren't interested in science. What concerns me is when they're actively fed inaccurate information about science. This just my personal take, but I would far rather that the newspapers never run another story about neuroimaging, say, than they keep on running rubbish ones.

Nature (2009). It's good to blog Nature, 457 (7233), 1058-1058 DOI: 10.1038/4571058a

Brumfiel, G. (2009). Science journalism: Supplanting the old media? Nature, 458 (7236), 274-277 DOI: 10.1038/458274a

Nature (2009). Filling the void Nature, 458 (7236), 260-260 DOI: 10.1038/458260a

Nature Neuroscience (2009). Getting the word out Nature Neuroscience, 12 (3), 235-235 DOI: 10.1038/nn0309-235