Richard G. Petty, MD

When Is It An Illness?

There’s been a very worrying trend in recent years, and that is constantly to medicalize every kind of behavior: we are no longer allowed to be shy, we have to be “socially phobic;” many things once regarded as vices, like excessive gambling, drinking or eating are now being re-cast as impulse control disorders and adolescent temper tantrums could be “Intermittent explosive disorder.” And I now read a report about giving selective serotonin reuptake inhibitors (SSRI) antidepressants to people with emotional lability.

In April of this year the Public Library of Science published a series of articles on the important topic of “disease mongering,” which two authors define as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” The authors made the point that some of the medicalization of human behavior is being driven by some pharmaceutical companies. They picked on several conditions or illnesses in which claims of prevalence and severity have been inflated in order, they claimed, to generate a need for medicines. One of their targets was female sexual dysfunction, where there has been a serious attempt to convince the public in the United States that 43% of women live with this condition. Many experts have heavily contested those figures.

One of the big worries about expanding the boundaries of an illness is that it is easy to throw out the baby with the bathwater. To use this last example: saying that the figures for female sexual "dysfunction" are inflated can lead some clinicians to dismiss everyone who has a problem, and then not to treat people with genuine organic difficulties. It is tragic to see people referred to a psychiatrist for a physical problem like low testosterone or undiagnosed diabetes or thyroid disease.

There can also be marked differences of opinion about the nature of illness. “Premenstrual dysphoric disorder,” (PMDD), is a particularly severe premenstrual syndrome, with some additional mood features. The American Psychiatric Association has precise diagnostic criteria for PMDD. The regulatory authorities in the European Union decided that this was not a real illness and declined to let a pharmaceutical company market a medicine for it.

I’m all for doing anything that I can to help people and to alleviate suffering. Part of the problem is that it is acceptable to have a “disorder.” The prevailing attitude is that no one can be blamed for being sick. The reality is that by most estimates, 70% of human illness is caused by lifestyle choices. By turning everything into disorders we take away our responsibility for our actions.

Most people are not looking for the causes of their troubles, they want a quick fix. Changing is hard, it is inconvenient and it is much easier to believe a pill will make everything better.

The second issue is that “better living through chemistry” may not be. There’s been a question rumbling round for some time now: has the over-exposure of young people to antibiotics, analgesics and sleeping tablets, been partly responsible for the rise in asthma and in substance abuse in later life? We don’t know the answer but it is important for us to think about.

The third point is that we need to think about what we are doing to ourselves if we want to medicate our way to happiness. Do we really want to deny ourselves the opportunity for becoming happy by our own actions rather than relying on a pill and being told what is normal?

P.S. Four years ago the Nuffield Council on Bioethics produced an important report entitled Genetics and Human Behaviour: the Ethical Context. It looked at some of the ethical challenges that are coming with the constant new discoveries in biology, and warned against the dangers of widening diagnostic categories, to encourage the use of medication by people who would not necessarily be thought of as exhibiting outside the normal range. It is well worth reading.

It’s Not Just Spinach!

The news yesterday of E. coli contaminated spinach must have been enough to make Popeye weep.

According the Centers for Disease Control and Prevention in Atlanta, as of today, 102 people have been infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 19 states, and one person in Wisconsin has perished.

Just to re-iterate what you’ve probably heard on the news already: E. coli is often a nasty resistant little bug that is not always killed by cooking. So the best advice is to throw away any spinach that may be suspect. The bacterium can make you very sick. You may have heard that one person has already died and at least a dozen more are in the hospital.

Several years ago there was an egg-borne Salmonella outbreak in the United Kingdom, and we’ve heard of several outbreaks of hepatitis A related to food contamination. There are outbreaks of food poisoning every now and then. And then there is the constant worry about “Mad cow disease,” that led to the wholesale slaughter of animals in the United Kingdom a couple of years ago.

Overall, Secretary Johanns and his team at the United States Department of Agriculture are doing a good job of protecting us.

Be aware, though, that apart from food, there are many other places that bacteria and occasionally viruses can lurk:

  1. Makeup: the ingredients in makeup can make good breeding grounds for some bacteria. Don’t keep makeup for too long, particularly if it’s been in a hot damp place
  2. People carry a lot of bugs. That doesn’t mean that you have to become worried about being around them, but it’s best not to get in an elevator is someone’s coughing or sneezing. I’d like to say the same thing about planes, but that’s usually not practical. I’ve many times had to use homeopathic remedies after a flight to prevent a cold – or worse – from emerging. Others have even taken antibiotics after a long flight next to someone nursing a cold. A bit illogical in my view: most upper respiratory tract infections are viral.
  3. Many bacteria and a few viruses get transferred to hands and doorknobs. You cannot spend your life being terrified of such things: it ruined the life of Howard Hughes, and in real life Adrian Monk would really be suffering. But you can wash you hands – with soap – in warm water for one minute whenever you get the chance. Studies have shown that most people don’t wash their hands properly. And I like those little sterilizing towels that you can carry with you.
  4. Change your toothbrush every 2-3 weeks.
  5. If you can afford them, those Ionic Breeze devices do seem to help keep the air cleaner.
  6. And I’m sure that I do not need to remind you, gentle reader, of the importance of carefully washing your hands after visiting a rest room.

September 11th

We all have our own memories of what we were doing on that awful day.

I was lecturing at a University in New Jersey, when people started walking in and out and my cell phone began to ring. I stopped speaking and my friend – the chairman of the department – and I spoke for a moment before he announced what had happened. And he had the prescience to say, “Today America has changed forever.”

I stayed in New Jersey and Pennsylvania for the rest of the week and it was a good thing that I did: I visited a number of hospitals where the staff was in shock, and it was helpful to have someone from outside give advice on how to handle such a traumatic situation.

A year later I returned to the same department to do a special lecture. My topic: the psychology and biology of human violence.

Darwin Awards

I just received a question, about whether I knew anything about what Darwin Awards were?

Well, as it happens I do.

In the midst of tales of gloom and doom, but also stories of amazing hope, courage and possibility, I thought that I should share with you their origin, despite, of course, wanting nothing to do with them.

The Darwin Award carries no monetary reward, just some recognition. Often posthumously. It is an honor given to people whose questionable judgment leads them inadvertently to improve the human gene pool by removing themselves from it.

The Darwin Awards have an amusing website, though the outcomes of some of the events were not amusing in the slightest.

They include Russian soldiers who found a canister containing a white powder on a garbage dump. Presumably Russian mothers do not tell their sons to avoid unknown white powders on military garbage dumps. The soldiers decided to use said powder as a substitute for talcum powder and as something to smoke. Sad to say, the white powder in question was thallium, and putting it on your skin or worse yet in your lungs is suboptimal.

Other "winners" tried things like juggling a hand grenade; jumping out of a plane to film sky divers but forgetting to wear a parachute; and using a cigarette lighter to illuminate a fuel tank to make sure that it contained nothing flammable. The list is a long one.

But I have a question: if such foolish behavior will likely remove the perpetrator from the gene pool, how come that there are still so many silly things going on around the world??

Discuss.

Labor Day Trivia With a Twist

The English language must be one of the oddest. Well actually I know that it is. Except perhaps for those few languages that have managed to get by with hardly any words for emotion. Or the ones that have hundreds of ways of describing snow.

In English there are more than one thousand words describing groups of things, usually animals. Many of these words go back to the Middle Ages: fun to look up on a wet English afternoon. And many have been taking up some of my precious neural storage space for a very long time.

In today’s trivia corner, the question came up as to what name is given to a group of cats? I knew that one, it’s a clowder, and if they’re kittens, it’s a kyndyll, also spelt kindle.

Then I started putting together a few others that I remembered, and looked up a couple more. If you type “Collective nouns” into Google you’ll get hundreds, but I’m not sure about some of them!

Here are a few fun ones:
Army of frogs or ants

Bale of turtles 

Band of gorillas 

Baren of mules
Bed of clams or oysters 

Bevy of quail or swans 

Brace of ducks 

Brood of chicks
Business of ferrets
Cast of hawks 

Cete of badgers 

Charm of goldfinches or hummingbirds
Chine of polecats
Cloud of gnats
Clutch of chicks
Colony of rabbits, ants, gulls and bats
Company of wigeons (they’re dabbling ducks found all over North America)

Congregation of plovers
Convocation of eagles 

Covert of coots 

Covey of quail or partridge
Cry of hounds
Down of hares 

Draft of fish (That one’s rarely used these days)
Dryft (drift) of tame swine 

Drove of cattle, sheep, pigs 
(In the Middle Ages, cows were also called kine or kyne)
Exaltation of larks 

Fall of woodcocks
Flange of baboons
Flight of birds 

Flock of sheep, geese, ducks 

Gaggle of geese 

Gam of whales 

Gang of elk 

Grist of bees
Harras of horses 

Herd of cattle, deer, elephants, horses, and sheep
Hive of bees
Horde of gnats 

Hover of trout 

Husk of hares 

Kettle of hawks
Labor of moles
Lepe or leap of leopards 

Leash of foxes 

Litter of pigs, cats, dogs 

Murder of crows 

Murmuration of starlings 

Muster of peacocks 

Mute of hounds 

Nest of rabbits, vipers, turtles and hornets
Nide, or nye of pheasants 

Pack of dogs, hounds, wolves, and mules
Parliament of rooks or owls 

Pod of dolphins, whales or seals
Pride of lions
Raft of ducks (paddling around on water) 

Rafter of turkeys 

Rag of colts
Route of wolves
School of fish (At one time they were called shoals of fish)
Scold of jays
Sculk of foxes
Sedge of cranes, bitterns, herons 
shoal of bass
Singular of boars
Shrewdness of apes 

Skein of geese (In flight)
Skulk (sculk) of foxes 

Sloth or sleuth of bears 

Sounder of wild swine or boars  

Span of mules 

Spring of teal 

Stud of mares 

Swarm of bees
Team of ducks, horses, pigs, oxen 

Tribe of goats 

Troop of kangaroos or monkeys
Unkindness of ravens

Volary of birds 

Walk of snipe 

Watch of nightingales 

Wedge of swans 

Wing of plovers 

Yoke of oxen
Zeal of zebras

There are some very funny ones that can’t be genuine. Try these:
An addition of mathematicians
A brace of orthodontists
A bunch of florists
A clutch of car mechanics
A concert of yes-men
An expense of consultants
A flash of paparazzi
An intrigue of politicians
A prickle of hedgehogs
A rash of dermatologists
A tedium of golfers

This is all harmless fun. But there’s also a slightly more serious side to it. Developing your vocabulary, even for odd words like these, appears to reduce your risk of developing age-related cognitive decline and should help keep you mentally sharp.

And I’ve got the brain scans to prove it!

When Being First Is Not the Only Thing

Regular readers and anyone who’s looked at my blogroll, knows that I like Zach Lynch’s consistently insightful blog.

He has been working on a project for four years, and now it appears that someone is coming out with some of the same ideas in a book that is due to arrive in late September.

This does not look to me like plagiarism. Once a new idea is out there, it quickly spreads, and people will run with it.

You might be interested to see some of the comments that I made on Zach’s site.

The other book may be superb. But the important point is that although being first is the only thing in competitive games, in the world of ideas that will help us, being first is not the only thing.

Being correct is the only thing.

Disclosure

There’s a sad situation rumbling around the psychiatric and neurological worlds this week.

The Chairman of the Department of Psychiatry at Emory University in Atlanta is reported to be stepping down as Editor of the prestigious journal Neuropsychopharmacology, after failing to disclose that he had a financial interest in a treatment about which he had written approvingly.

The editor says that this was simply a clerical error, as on the previous occasion in 2003 when he published an article in which there was a conflict of interest.

This is all a great shame: the treatment that he talked about in this paper – vagal nerve stimulation – really does appear to be a genuine advance in the management of treatment resistant depression.

It is also eminently avoidable. Anybody who is an expert in their field will likely be asked to consult to a wide range of bodies. I have advised many pharmaceutical companies, governments and non-governmental agencies around the globe. Whenever I lecture, wherever it is in the world and whatever the subject, I always show a slide with a list of all the people with whom I have worked, and my office constantly updates the list, so that it can be appended to every document that we send out. And because I consult so widely, I don’t hold stock in any pharmaceutical or medical devices companies.

But here is another piece of failed disclosure. There is a comment to the report at the Scientist. The writer says that “Psychiatry has the greatest conflict of interest possible–they are prescribing drugs and, in this case, mechanical "treatments" for conditions that have no verifiable physical cause.”

This is absolutely and totally untrue. There are mountains of data confirming the physical component of most major psychiatric illnesses. And every day, all over the world, people in their tens of thousands are saved and their lives restored by pharmacological treatments used together with psychological and social help.

This is the same nonsense promulgated earlier this year by Tom Cruise. It reminds me of the critics of Galileo who refused to look through his telescope.

The writer herself fails to disclose that she is also involved in Scientology.

Cultural Competence

One of the problems about so many self-help articles is not only that their authors have often not done their homework, neglecting research and sometimes ignoring the dictates of common sense, but they also tend to be culturally myopic.

I’ve spent a great deal of time in different cultures and some of the advice proffered by a few American business experts would quickly get you shown the door in Japan or Germany!

I’ve just learned that Wal-Mart is pulling out of Germany, writing off a loss of around $1 billion. Part of the problem was that this super successful American company failed to understand German culture. It attempted to introduce the “greeters,” that are a familiar sight in the United States. Germans found it offensive to be confronted by someone ordered to smile at every customer. To a German, a broad toothy grin may be seen as intrusive and an invasion of privacy.

My personal background, extensive travels and work with people from every corner of the world, have made me very sensitive to these differences, and I’m often asked for advice before people head off to do teach, speak or to do business overseas. I was very pleased to find out about a company that specializes in training executives to be culturally competent, and one of the tools that they use is cultural profiling.

I just read an excellent article in the Telegraph by Michael Gates, in which he describes a moment in Finland, when he asked someone how they were, to get the response, “You asked me that last week.” Ask a German how they are, and they will probably spend the next ten minutes telling you.

Different cultures have very different ideas and attitudes toward time, space, truth, privacy, authority, individuality, and, of course, gender. The glass ceiling is still alive and well in many cultures. Children are raised quite differently in different cultures: I knew a British doctor working in the pharmaceutical industry. Her company sent her to the United States for three years, but in less than two she and her family were back in England: she did not like the effects of American education on her children.

The Expat Telegraph website has also launched a series of “National Cultural Profiles.” This is a terrific resource to help us understand the thinking patterns of the world’s major cultures. The resource has been taken from the CultureActive cultural web program that is used throughout the world by governments, non-governmental organizations and corporations. It is also the core of a project (InterCulturalEdge) based at Duke University’s Fuqua Business School in North Carolina.

CultureActive is based on the work of Richard D. Lewis, the author of When Cultures Collide, a book that I recommend highly. He is the chairman of Richard Lewis Communications. Lewis has developed a theory, known as the Lewis Model of Culture. He classifies cultures into three main types:

  1. Linear-active
  2. Multi-active
  3. Reactive

These National Cultural Profiles are different from typical country profiles that you find in the Encyclopedia Britannica or the CIA website that detail economic or political data. These profiles concentrate on key cultural questions such as values, beliefs and communication.

There are free mini-introductions available at the Expat Telegraph website, and there are much more detailed profiles available for subscribers.

CultureActive also allows you to complete your own Personal Cultural Profile by filling in an online questionnaire.

Learning how to communicate with people from different cultures is essential if you hope to expand your own personal horizons, as well as developing your business.

“Civilization is the order and freedom promoting cultural activity.”
–Will Durant (American Historian, 1885-1981)

Scientific American Podcasts

One of the very many useful resources on the Internet is the Scientific American website.

Attached to it is a weekly podcast that summarizes a few of the most important recent new items.

For those of us engaged in developing, evolving and refining a new model of reality that will have practical applications to health, wellness and personal evolution, it’s really important to know about the most up to date discoveries of conventional science. And how they fit in with – or challenge – our attempts to grow our field.

So many people have claimed to create new models that have collapsed at the first challenge. They usually contain the words "quantum" or "Einstein" somewhere near the beginning, or some half-remembered piece of High School or "Pop" psychology. It is usually easy to see that most have not done their homework!

We have instead been embracing new data from many sciences, from clinical experience, from intuitives and spiritual teachers and constantly testing the concepts and methods to see if they can be refined or improved. I’m pleased to report that we have been making rapid progress.

Enjoy the podcasts!

Plague: A Follow Up

I’ve had a lot of very positive feedback about my article about global warming and the risk of Plague.

One person said that he didn’t want to think about something scary like that. Which reminded me a bit of our new kitten, who has still not worked out that if she can’t see you, then maybe you can still see her. She hides her head in a large stand of Pampas grass and assumes that she’s now invisible….

As the conversation with Mr. Head-In-the-Sand continued, I had a sudden flashback to the Hitchhiker’s Guide to the Galaxy, in which the "Ravenous Bugblatter Beast of Traal" was described as "so mind-bogglingly stupid that it assumes that if you can’t see it, then it can’t see you."

I just received this report from the Centers for Disease Control (CDC) in Atlanta.

As you will see, there have been very few cases of Plague in the United States and the CDC keeps a close watch for us. The article also lists some of the key clinical featres of the illness.

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