Thinking and Sleep
There is an important article in a recent issue of the Journal of the American Medical Association (Effects of Sleep Inertia on Cognition Adam T. Wertz; Kenneth P. Wright Jr; Joseph M. Ronda; Charles A. Czeisler JAMA. 2006;295:163-164.)
The study by a team at the Brigham and Women’s Hospital in Boston and the University of Colorado examined the phenomenon of sleep inertia: how long it takes for someone to wake up and think effectively, and to compare that with thinking after a person has been awake for 24 hours. For most of the first three years after I graduated from medical school, I worked on what was then known as a “one in two” on-call roster: every other night and every other weekend. Fortunately that inhumane system was abandoned some years ago, but it was not uncommon to be up and working for three straight days at the weekends, and we all became absolute experts on sleep and how to handle sleep deprivation. The problem was that if we did manage to get a few minutes sleep, there was always the chance of being awoken and being asked immediately to perform important tasks that would require very high levels of thinking and analysis. The results of this new study will not be a surprise to anyone who has done night work, or anyone who has been out all night burning the candle at both ends.
The study participants had had six nights of monitored sleep lasting eight hours per night, they were given a performance test that involved adding randomly generated, two-digit numbers. Based on the results of this test, the researchers concluded the subjects exhibited the most severe impairments to their short-term memory, counting skills and cognitive abilities from sleep inertia within the first three minutes after awakening. The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects were often detectable for up to two hours.
The study follows other research that has looked at the effects of going without sleep for over 24 hours, and found that the cognitive impairments were roughly the same as being drunk. Yet in the Colorado experiments, the cognitive skills of test subjects were worse upon awakening than after extended sleep deprivation: In a nutshell, the effects of sleep inertia may be as bad as or worse than being legally drunk. The most likely explanation is that certain areas of the brain take longer to "wake up".
Previous research has shown that the prefrontal cortex, which is responsible for executive functions: planning, problem solving, complex thought and emotional control, is one of the brain regions that takes longer to come "on-line" following sleep.
What should be the conclusions from these studies?
1. Ideally, nobody should be doing anything really important for 15 to 30 minutes after they wake up.
2. If you are asleep, it’s a much bigger transition to go from that to being awake, rather than staying awake, even for a long time, because then you will be aware that you are drowsy.
3. The study did not examine emotion and motivation, and that may come in to play. If you are asleep in a hotel and the fire alarms go off, you may well be able to wake up and think very well and very quickly for a few minutes, but then you brain plays “catch-up,” and you will once again we groggy and cognitively impaired.
As a young doctor, there was no option: I had to wake up fast and be able to think straight. So I just did it, and fortunately the quality of my decisions seemed to be fine when older and wiser physicians checked them the next morning. Though I am VERY pleased not to have to work like that any more!
Scientific Misconduct
I don’t think that anyone can derive any pleasure at all in the public disgrace of a human being, and the reports about the South Korean cloning scientist Hwang Woo-suk are particularly sad.
This case is enormously high-profile because the claims were so extraordinary, and also because his claims created false hope for hundreds of thousands of people around the globe. I respect and understand the opinions of people who felt, on moral or religious grounds, that the research should not have been attempted at all: it is an incredibly complex ethical issue.
But I would like to focus on the issue of scientific misconduct in general. The sad truth is that it is not uncommon at all. In June of 2005, the journal Nature published an important paper entitled “Scientists behaving badly.” In a survey of more than 3,000 scientists, over a quarter admitted to some failings in their work. Few of them had made things up, or cooked results, but there were even some of those.
Scientific and medical journals, as well as the Government, who commonly hands out a lot of research grants, are all engaged in very serious discussions about this problem, as are pharmaceutical companies, who fund a huge chunk of research. I spent over twenty years working in or administering laboratories, and during that time I have had first hand knowledge of three cases in which data was fabricated and there were major consequences for senior academics. In each case it was a junior researcher who cooked the books and the senior author had just tacked his name onto the publications. I have never published as many papers as I could have, because I always refused to be a “passenger” on a paper: someone who gets authorship credit even if it was not their own research. It’s often done to swell a curriculum vita. But I didn’t want to do that unless I was sure of everything in the paper, and that meant being at the bench doing the work. Somebody was once teasing me and told me that it’s because I’m a Virgo. Well, maybe. I don’t know enough about such things.
So why on earth do people cheat at anything? I find it difficult to understand in science and medicine because my whole life, since I was a child, has been directed toward finding Truth. And to mess with that is almost sacrilegious. Interestingly, many of the cheaters are actually the most gifted of people. Though that’s not always true. The first personal experience that I had was more than 20 years ago, when a more senior member of the department, who was not at all productive, took some of my data out of a file in my desk, and then presented it at a meeting as his own work. Well, I was but a tadpole back then, so I was told to grin and bear it.
Although it is complex, I think that the main reasons for misconduct are:
1. Personal: the career pyramid has steep sides and some people want to climb to the top, come what may. It’s really no different from someone putting cork in his baseball bat, or greasing a cricket ball.
2. Financial: people have told me, though without evidence, that they have changed or withheld information because that’s what the grant-giving body wanted. I once, and only once, had someone tell me what results I would produce if I did a certain study for his company. We were talking about my department being paid a great deal of money to do the work. I am quite sure that his company didn’t know about him saying that, but it was enough for me to show him the door.
3. Some people are so convinced that they are correct, that they fail to see any flaws in their arguments. I remember once seeing an elderly Nobel Prize winner completely misquote some research data so that it fit with his hypothesis. I happened to know about it because I was involved with the research that he quoted. There was no malice involved: that was just the way that he saw things.
4. Hubris: I wonder if this was at play in the Hwang Woo-suk case in Korea? If enough people tell you it’s great, and you so want to believe that you’ve made the breakthrough that everyone wants, eventually you may believe it yourself. The scientist just gets carried along on the bandwagon. And it is not just Hollywood and the Opera that has prima donnas!
I was sorry, recently, to hear of the passing a very fine English physician who once roasted the editor of the British Medical Journal for having had the temerity to reject one of her papers! Because of course she was right, and the editor and the reviewers were not smart enough to understand her work. And yes, science, like any other area of human life, has its sociopaths who will do anything for power and glory; and its hangers on and wannabes who need to do something to say in the loop.
I keep coming back to the same points: we have been given the ability to do this work. We are but stewards of our gifts and of the public’s money. We own neither, and millions of people wait anxiously for us to give them the help and the advice that they need.
So as sad as I am to see the public humiliation of Hwang Woo-suk, I have a final question: How could anyone ever betray that trust?
Addendum: As an addendum to the entry on scientific misconduct: on January 16th, the BBC reported yet another case of scientific misconduct in a study from Norway that was published in the journal the Lancet in October 2005. The Lancet study was entitled "non-steroidal anti-inflammatory drugs and the risk of oral cancer.
According to the reports that have emerged today it appears that the data were entirely fabricated, with 250 of the 908 alleged patients in the study sharing the same birthday.
If the reports are all accurate, it is another tragedy. And I am going to ask again:
The public and the grant giving bodies work hard to give scientists the tools to do research to improve the quality of all our lives. How could anyone ever betray that trust?
Technorati tags: scientific misconduct, hubris, Hwang Woo-suk
Stardust and Dark Matter
Homeopathy R.I.P.?
Homeopathic medicine has now been in use for over two centuries since its basic ideas were rehabilitated by the German physician Samuel Hahnemann. And its essential concepts have always seemed strange to anyone with any scientific training. The central idea is that people have a life force that, if disturbed, can lead to illness. The second idea is the "doctrine of similars, " or of "like curing like." If you peel an onion, then your eyes and nose may start to run. So one treatment for a person with runny eyes and nose might be onion. The third peculiarity of homeopathy is the use of super-dilute remedies that are prepared in a very precise way. There is a nice summary article of some of the basic ideas.
There is an important principle in scientific research which sometimes gets forgotten: there are many different types of study and one of the most fundamental of errors is to mix up pragmatic (does it work?) and mechanistic (how does it work?) experiments. Pragmatic studies usually follow on from clinical observations, and even if something is shown to work, it can take years to work out the mechanisms. Aspirin would be a good example: it was used in various forms for over a century before it was discovered how it worked.
In August of this year the Lancet published an article on homeopathy that has been taken to signal the end of homeopathy. In fact in an accompanying editorial, there was a call for homeopathy to be abandoned, altogether. However, in the three months since then, a number of us have been through the Lancet study very carefully, and have found some snags in it. So far the Lancet has chosen not to publish responses to the article, and the authors themselves have, as of now, refused to disclose exactly which studies they analyzed. This is highly unusual, and should give pause to gleeful skeptics who have taken this one study to be the death knell of this form of treatment. Worse yet, the folk who have dismissed homeopathy based upon media reports of the study, without examining the original.
As examples of some of the astonishing problems identified in the Lancet publication: there was no clear statement of aim. This is normally required before you even begin a piece of research. The investigators first look at every homeopathic study that they could find and then decided which studies to include. This is again a very unusual way of doing things. And then there are a lot of questions about the statistical analysis. We all know that you can use statistics to prove almost anything that you want to, and the debate about the appropriateness of the methods used is going to go on for a very long time.
The next time that somebody tells you that homeopathy is now a dead duck, tell them that the study is still being discussed. And as I have said on previous occasions, we do not make progress on the basis of one single paper. Even Watson and Crick’s model of the structure of DNA had to be confirmed before it was accepted, and going back further, some of the brilliant insights of Albert Einstein were not confirmed for almost fourteen years. But this study has already led to the Swiss Government deciding to reduce reimbursement for homeopathic treatment.
I have also seen some violent criticism of a six-year study involving around 6,500 patients who attended the Bristol Homeopathic Hospital in England. This was a simple naturalistic study that asked a simple question: of all the people who visited the hospital, how many felt better afterwards? This is the kind of audit that is being done all the time to see how people have got on with a hospital or a treatment. It does not "prove" or "disprove" homeopathy, it just asks people how they feel. And most said that they had benefited. To criticize it for not being randomized or placebo controlled is a bit like going to an Italian restaurant and complaining that they don’t serve Chinese food!
Homeopathy is no "cure all," but I will not abandon it unless we get some far more impressive data than that from the Lancet paper, for not only have I seen it work in patients and in animals with monotonous regularity, but because behind the scenes, we have been seeing more and more research coming not from patient studies, but from physics and cell biology laboratories, that seems to be giving the specialty a firm theoretical footing.
I shall continue to report both the positive and the negative studies as they are published, and offering guidance about how we can use different forms of treatment in combination.
Technorati tags: homeopathy
Autism and Mirror Neurons
On November 28th, I made some comments about the discovery of "mirror neurons" in the frontal cortex that enable us to imitate other people. I have just seen a most interesting report implicating these cells in autism. The paper was published in the journal Nature, but click here for a good summary.
Autism, an illness that affects a person’s ability to communicate with others and to mount appropriate responses to environmental cues, is part of a spectrum of developmental differences, which run all the way from people who are severely disabled to people who function at extremely high levels. In recent years there has been renewed interest in the apparently linked disorder, called Asperger’s Syndrome. There has been a lot of speculation that some well-known high achievers have a form of it. We are always loath to describe something as an "illness, " unless there are strong grounds for doing so: some people’s brains are just wired differently. So perhaps the best criterion for calling something an "illness," is whether it is causing suffering. I was once cussed out by someone whom I had treated for a manic illness. He was as happy as a clam and was not suffering in the slightest. But he was causing great suffering to his wife and young children. And to fellow motorists, as he drove his car at extremely high speed down the wrong side of the highway.
Researchers from the University of California in Los Angeles found that some children with autism had less brain activation in a region in the frontal lobes that is involved in understanding another person’s state of mind. The degree of activation of the ‘mirror neurons’ in this region correlated with measures of social impairment. The children with the lowest activation had the most severe social impairment.
I do not doubt the value of this neurological approach to autism, but it is important to recognize that it is only a part of the picture. We also need to respect the importance of other ways of looking at an individual. As an example, using the Four Quadrant model developed by the philosopher Ken Wilber, we also need to consider not just the objective neurological aspect, but also the subjective, social an cultural aspects of a person. And each of these perspectives is irreducible: we cannot explain culture by neurons or how your liver works by an appeal to cultural dynamics.
So although studies like this are valuable in that they show that there is a neurological association with autism, and it is not the result of, say, bad parenting, they do not tell us the whole story. And we must not allow these findings to blind us to the other domains when we are working on coping strategies or treatments.
"I loathe the expression "What makes him tick." It is the American mind, looking for simple and singular solution that uses the foolish expression. A person not only ticks, he also chimes and strikes the hour, falls and breaks and has to be put together again, and sometimes stops like an electric clock in a thunderstorm."
–James Thurber (American Writer, 1894-1961)
Technorati Tags: autism Ken Wilber More blogs about Mirror Neurons.
Charles Darwin Revisited
This week there is a timely article in Newsweek Magazine about Charles Darwin the man.
The article begins with these words:
"He had planned to enter the ministry, but his discoveries on a fateful voyage 170 years ago shook his faith and changed our conception of the origins of life."
That emphasizes a very important point: Darwin was lead to propose his theories based on observation. He was so troubled by the direction in which these observations were leading him, that it would be 25 years before he published his observations and theories.
Now we are seeing another round of attacks on the notions of evolutionary theory. Critics use the term "Darwinism," yet no scientist that I know ever would. Yes, he was ONE of the people who first came up with the theory, but the theories have been refined and tested for over one hundred years. The Oxford biologist Richard Dawkins, a passionate defender of evolutionary theory and an outspoken atheist, once said that evolution "made it possible to be an intellectually fulfilled atheist."
While it is absolutely true that we can conceptualize a mechanism for the development of species, does it also mean that the theory necessarily exclude the existence of a Higher Power? No, of course not. Current scientific models have been developed to examine the physical world. When scientists have strayed into areas in which they have no special expertise, they can easily run into trouble. And they simply do not have models or methodologies for examining questions of purpose and meaning.
A complete model needs us to honor and respect all of the realms and domains of existence. Evolution OR intelligent design is a false dichotomy. Cannot the answer be evolution AND intelligence?
Technorati tag: More blogs about Charles Darwin.
Synchronicity
In my forthcoming book, Sacred Cycles: Regaining Health and Harmony by Mastering the Natural Rhythms of Life, I disucss synchronicity as a really important aspect of our lives. The notion of synchronicity, or meaningful coincidences, was first proposed by the famous Swiss psychologist Carl Jung and his friend the Nobel Prize-winning physicist, Wolfgang Pauli. Are there really such connections in our lives, or do we live simply at the whim of random chance in a Universe whose every law has been laid bare by the impassive probing of modern science?
There have been countless attempts by mathematicians and physicists to explain away synchronicity, which some skeptics describe as some sort of refuge of the mathematically challenged. Yet other plenty of other scientists have said, “Wait a minute, there really may be something here.” Or is the whole discussion a pointless comparison of objective mathematical apples with subjective metaphysical pears?
I am very interested in hearing your views as well as any personal experiences.
Technorati tags: synchronicity Carl Jung
