Given the pervasiveness of placebo success in medical trials, it always surprises me that the use of placebos by medical professionals is explicitly banned (even taking into account the fact that a person in a position of trust would be deceiving you). However, the above article links to an interesting paper written by Adam Kolber – a Bioethics and Law professor, and author of the Neuroethics and Law blog – on the possible ethical use of placebos by medical professionals. Here is its abstract:

Placebo treatments, like sugar pills and saline injections, are effective in treating pain and perhaps a host of other conditions. To use placebos most effectively, however, doctors must mislead patients into believing that they are receiving active medications. While placebo deception is surprisingly common, its legality has rarely been tested. In November 2006, the American Medical Association (AMA) adopted a new ethics provision categorically prohibiting doctors from using placebos deceptively. In so doing, the AMA shifted the legal landscape, making it almost certain that courts will decide that placebo deception violates informed consent requirements.

I argue that the AMA’s new policy is overbroad, insensitive to patient preferences, and likely to have unforeseen consequences. While deception is often exploitative, placebo deception can genuinely benefit patients. Absent stronger evidence to justify a ban than we currently have, deceptive placebos should be treated as scarce medical resources–used sparingly but not categorically prohibited.

One glaring problem with this – no matter how valid the conclusions – is that to use placebos safely and correctly we would need physicians who have the time (and inclination) to thoroughly peruse patient histories – something the overstretched NHS is severely lacking.

On a lighter note, it always amazes me that I learn something new and fascinating every time I read more about the use of placebos. This time my education came from the following paragraphs:

Furthermore, studies done in the 1970s showed that when heroin users inject water (sometimes done deliberately to alleviate cravings when drugs are in short supply), they can experience drug-like euphoria and have been observed to show opiate-like physiological signs such as pupil constriction.

This last point also demonstrates that placebo is not solely about expectancy, belief or ‘being fooled’, as the heroin users knew they were injecting themselves with water. Conditioned responses play a role.

Of course, as with most cases of classical conditioning, this response eventually becomes extinct as the initial stimulus (real heroin) is repeatedly withheld. Still fascinating, though!

(Bonus points if you know why I gave this post its title.)

You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all… Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing… (I can only wait for the final amnesia, the one that can erase and entire life.) – Luis Buñuel

The above quote is from The Lost Mariner, a chapter discussing one of Sacks’ patients, Jimmy G, who – due to Korsakoff’s syndrome – lost both his memories from the previous 35 years, and the ability to create new ones. It’s a touching and sad story where you feel that the only redeeming quality is the fact that this man cannot create new memories; at least then he doesn’t know that he has this problem.
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Six months ago my family-life was ticking along as normal; everything was fine. Then, during a routine operation, my grandmother passed away, leaving my grandfather – a very self-sufficient man approaching 90 – alone in their home of 30 years. While interim accommodation arrangements were being made, my grandfather was found unconscious after suffering a stroke and was admitted to hospital – not even two weeks after his wife’s funeral.

Three months in hospital saw him recover well, and he was eventually placed in a geriatric recovery ward in preparation for release. Whenever I visited him he would get angry at the sports results and moan about the “boring sods” with whom he was sharing a ward with and who refused to go outside for a walk around the hospital’s rather beautiful grounds. This was perfectly normal behaviour.

However I was fearing the worst, and it appears that these fears were well-founded. A month ago he started to develop severe dementia, leading me to make the obvious comparisons between him and Sacks’ patient, Jimmie G, whom I was reading about at the time.

The retrograde loss of memory – and losing the ability to create new memories – is a horrible thing to witness; nothing can really prepare you for it. At the same time it’s difficult to become truly sad at this fact: how can we, when the ‘patient’ themselves is oblivious to the fact – and is seemingly content – due to the fact that the condition itself causes them to lack the ability to comprehend what’s going on?

But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being – matter of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him… Neuropsychologicaly, there is little or nothing you can do; but in the realm of the Individual, there may be much you can do. – Alexander Luria in a letter to Sacks regarding Jimmie G.

These sort of medical conditions always raise interesting issues, but when combined with the general (and severe) decline of physical health in an older patient, some more interesting – and controversial – philosophical, moral, and political subjects are brought up. An important one of which is the topic of non-eugenics euthanasia.

Highly regulated, I believe that euthanasia would be a crucial addition to our public health system for a few exceptional and well-defined situations and circumstances. However, as this is unlikely to happen, I believe strongly that the topic of euthanasia is so important that it is at least worth serious consideration and debate – not just by medical professionals, but by both politicians and the public.

Of course, views on this vary wildly by culture, religion, and even within each individual (agreeing in some cases and not in others, even when the actual medical circumstances are the same), and for one moment please don’t think my family and I are planning any mercy killings – it just raised a debate between us and I wanted to spread the love and ignite your internal debating chamber.

In my family, many of us have made it clear that if we were in such an awful physical and psychological state that life were no longer enjoyable and was a chore, that we wouldn’t want to be kept alive. One member has even gone so far as to say (in all seriousness), that if this were the case they would be eternally grateful if we were to assist them in dying. Of course, current legislation makes entertaining this thought pointless.

“Don’t think because I’m not saying much that I wouldn’t like to say a lot.”

Of course, Lawrence isn’t anyone I know; he’s a character played by Bill Nighy in Richard Curtis’ The Girl in the Café and – unlike the films Curtis usually pens – it isn’t so much a rom com as a rom pol – a word I would like to take credit for, meaning romantic-political-drama.

How I came to watch The Girl is almost as interesting as the film itself: randomly traversing the Interwebs one day I passed through LifeHack and onto Ingrid’s wonderful online home. Captivated by her quirky, funky e-cards and her beautiful photographs, I read on and duly added the site as one of my regular reads, soon succumbing and joining The Girl on Tour. I’ll let Ingrid explain:

I think this is a wonderful and important film that needs to be seen by as many people as possible. That’s why I decided to send my The Girl In The Cafe DVD on a tour. The Girl has been on tour for more than a year now, she has visited more than 60 people already, and is planning to visit people in 20 (and counting) different countries. If you want to participate all you have to do is send an email to be put on the list. And when the film gets to you, you watch it, write a review on your blog and send it to the next person on the list.

The mighty Bill Nighy has called this project “very cool” and “very admirable”.

So, what’s it about, and is it any good?

In short, the film charts the unlikely and troublesome relationship between Lawrence (a high-profile civil servant, played by Nighy) and Gina (the delectable Kelly Macdonald – Trainspotting and No Country for Old Men). In truth, however, it’s a story about standing up for your beliefs no matter what the consequences, governmental bureaucracy as an inherent problem within the G8, and the ongoing struggle of trying to solve one of the most important global problems of our time: extreme poverty.

Lawrence works for the Chancellor of the Exchequer as part of the British contingent working on solving the first of the eight Millennium Development Goals. As the film progresses we see Gina confront a number of high profile politicians over what she sees as their lack of action, and it is here where the film turns into not-so-much a political drama, as an advert for the admirable MAKEPOVERTYHISTORY campaign (or the ONE campaign, as it is better known in the U.S.).

I’m unsure about the numerous confrontation scenes and the over-simplification of such an important issue, but I suppose it is a film and as such it has to make economics and politics enjoyable! The message, of course, is much more important than any film can be: if you read at an average pace, 40 people have died of causes directly linked to extreme poverty since you started reading my post. That is what the film is about.

“Look, you wouldn’t care, perhaps, to meet again?”

After doing some research and compiling a list of possible subscriptions, I’m presenting them here as a way to keep track of them and also in hope that you may chip in with your thoughts and recommendations to liven up my daily commute.

BBC Worldwide

• Anything from the BBC Radio 4 archives. Highlights include:
  • In Our Time with Melvyn Bragg – “The History of Ideas”
  • Analysis – “Making sense of the ideas that change the world”
  • All in the Mind – “Exploring the limits and potential of the mind”
  • The Reith Lectures – “Annual radio lectures, given by leading figures of the day”
  • From Our Own Correspondent – “Personal reflections by BBC correspondents around the world”
    
  • The Material World – “Reports on developments across the sciences”
    

• The Naked Scientists – “Stripping science down to its bare essentials” (in association with Cambridge University)

• BBC Newsnight - Not strictly a podcast, but you can’t miss Newsnight!
  

National Public Radio (US) a.k.a. NPR

• Intelligence Squared – also known as IQ2 U.S. While you’re at it, check out the live London Debates.
• RadioLab – “Science meets culture, and information sounds like music”
• Science Friday – “Making science user-friendly”
  
• Fresh Air – “Probing questions, revelatory interviews and unusual insights”
• On the Media – “Explores how the media ’sausage’ is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression”
  

CBC Radio One

• Quirks and Quarks – “Science that defi(n)es gravity”
• (The Best of) Ideas – “…About contemporary thought”

ABC Radio National (Australia)

• All in the Mind – “From dreaming to depression, addiction to artificial intelligence, consciousness to coma, psychoanalysis to psychopathy, free will to forgetting – exploring the human condition through the mind’s eye”
• Philosopher’s Zone – “Your guide through the strange thickets of logic, metaphysics and ethics”
• Big Ideas – “thinking on major social, cultural, scientific or political issues”

IdeaCast – “Breakthrough ideas and commentary from leading thinkers in business and management” from The Harvard Business Review

EconTalk from The Library of Economics and Liberty on “the economics behind current events, markets, free trade, and the curiosities of everyday decision-making”

…Open Source “Inverting the traditional relationship between broadcast and the web: not a podcast with a web community; a web community that produces a podcast”

Physics for Future Presidents with Richard Muller – “What every world leader needs to know”

Scientific American’s Science Talk – “Exploring cutting-edge breakthroughs and controversial issues with leading scientists”

Seminars About Long-term Thinking (SALT) – “promoting ’slower/better’ thinking”. Part of The Long Now Foundation

The Skeptics’ Guide to the Universe – “Your escape to reality”

Studio 360 and specifically its Design for the Real World segment – “Get inside the creative mind: a smart and surprising guide to what’s happening in pop culture and the arts”

Philosophy Talk with Stanford University’s Professors of Philosophy – “The program that questions everything… except your intelligence”

The CERN Podcast is recorded in situ at CERN’s Large Hadron Collider with special ‘celebrity’ guests – “A cocktail of entertaining chat shows with a bit of particle physics thrown in”

That’s quite a few isn’t it? Of course there are many more great ones I’ve missed that may be of equal or greater interest to me as all of the above, so if you know of any please let me know (yes, I am actually begging).

How about these popular ones that I left out of the above list purposefully – am I being foolish in demoting these to the footer: Slate’s ‘Daily Podcast’ or ‘Explainer’, This Week in Tech, The Glenn and Helen Show, Shire Network News, This American Life, World Beyond the Headlines, Common Sense, BrainStuff from HowStuffWorks, The Guardian’s Science Weekly, Selected Shorts, The Economist, The Writers’ Block, This Week in Science, Sex is Fun and Open Source Sex with Violet Blue. Regarding those last two: one’s on the physiology of sex and the other is written for women; both are supposed to be interesting; and I imagine they’re both super-NSFW.

Sources or: Where I Found These

• Digg’s Best Podcasts
• Open Culture’s Podcast Library (Open Culture is a great site I first got directed to back in May 2007 with their great collection of Foreign Language Learning Podcasts)
• Ask MetaFilter’s What are the most intellectually stimulating podcasts?

To cut a long story short, I have now pencilled-in a trip to Shrewsbury for the weekend following next year’s anniversary as not only is Shrewsbury Darwin’s birth place, but it’s also the location of an annual, month-long celebration of his life and work, and also where my father currently lives. Two birds, one stone, and all that jazz.

On a slightly different note, all this talk of hard science is making me want to mention the book I’m currently reading: John Allen Paulos’ Innumeracy: Mathematical Illiteracy and its Consequences. Initially sceptical that it would be written for the maths-newcomer, I became impressed as Paulos describes with gusto the common – and frankly dangerous – pitfalls that everyone faces when living in an innumerate country. Encouraging his readers to view the world in a more quantitative way, I found myself grasping for paper and pencil a few times as he succinctly describes potential consequences of innumeracy:

• Inaccurate reporting of news stories and insufficient scepticism in assessing these stories
• Financial mismanagement and accumulation of consumer debt, specifically related to misunderstanding of compound interest
• Loss of money on gambling, in particular caused by belief in the gambler’s fallacy
• Belief in pseudoscience: “Innumeracy and pseudoscience are often associated, in part because of the ease with which mathematical certainty can be invoked, to bludgeon the innumerate into a dumb acquiescence.“
• Poor assessment of risk, for example, refusing to fly by aeroplane (a relatively safe form of transport) while taking unnecessary risks in a car (where an accident is more likely)

It’s a book I definitely recommend for both the innumerate and the mathematically proficient. The former will learn a lot and hopefully gain a renewed sense of wanting to brush up on those GCSE maths skills, while the latter will get introduced to some interesting topics – a couple of which I covered in my previous post on mathematical ‘paradoxes’.

Off on another slightly related tangent, I recently came across an interesting article Prof. Paulos wrote for ABC News: 12 Irreligious Questions to the Candidates (via kottke):

Is it right to suggest, as many have, that atheists and agnostics are somehow less moral when the numbers on crime, divorce, alcoholism and other measures of social dysfunction show that non-believers in the United States are extremely under-represented in each category?

Ah to hell with it, have another tenuously-linked topic… The above book (Innumeracy) has renewed my interest in performing mental math and better thinking – a personal development subject I first started working on about 12 months ago with the help of the Mentat Wiki – an interesting website from the author of Mind Performance Hacks. Providing you with new memory ’systems’, you can use these to perform some useful (and not-so-useful) memory feats and improve your maths, all without the use of a calculator or other aid.

Yeah, that’s right baby: squaring and cubing large numbers… in my head! Hell yeah, that’s how I roll!

And seeing as it’s Valentine’s Day, have some VD cards you can send to your ‘loved’ one. Perfect. (Bitter? Me?  No.)