02/28/17

“Conflict” Between Science and Religion

© Michail Panagiotidis | 123rf.com

The watershed event for the perceived conflict between science and religion in American culture was the Scopes Trial. After William Jennings Bryan’s speech opposing the admission of expert testimony on evolution in the trial, the lead defense lawyer, Dudley Malone, said he defied anyone “to believe that this is not a religious question.” Malone went on to say: “We feel we stand with science. We feel we stand with intelligence.” In his closing remarks, the chief prosecutor, Tom Stewart said: “They say it is a battle between religion and science. If it is, I want to serve notice now, in the name of the great God, that I am on the side of religion.” So the premise there was conflict between of science and religion was present within the Scopes Trial from the very beginning.

That battle continues today, notably by individuals like the biologist Richard Dawkins, who said: “I am very hostile to religion because it is enormously dominant, especially in American life. And I don’t buy the argument that it’s harmless.” But is this conflict model the way scientists today see science and religion? Recently, Elaine Howard Ecklund and a team of researchers completed a survey of over 22,500 scientists from around the world. They investigated the scientists’ perceptions of the interface of science and religion, as well as the personal religiosity of the scientists. Their study, “Religion Among Scientists in International Context,” can be found here.

Ecklund et al. acknowledged that globally, science and religion have an “uncertain” relationship. Richard Dawkins sees conflict; but Francis Collins, the Director of the National Institute of Health (NIH), sees compatibility. And the debates resulting from this uncertain relationship have been occurring outside the U.S. For example, there was an uproar among faculty at the University of Hong Kong when Hong Kong’s Education Bureau proposed guidelines to teach intelligent design in the public school system. Debates about science and religion are taking place around the globe and scientists are taking part in the discussions.

Do scientists from national contexts with very different approaches to religion still think the rationalism and supposed secularity of science will overtake the truth claims of religion? Or are they—especially when it comes to matters of personal religious identity—more similar to those in their local national contexts? Is a global science taking over the world of religion? Or are there even ways that religious communities and scientific communities can work together for the common good around the globe?

The Religion Among Scientists in International Context (RASIC) study assessed biologists and physicists from eight regional areas—France, Hong Kong, India, Italy, Taiwan, Turkey, the UK and the US.  RASIC looked at how scientists understood religion, how their religiosity compared to that of their local population, and the implications of their findings for different views on the connection between science and secularity.

In four of the regions, Italy, India, Turkey and Taiwan, over 50% of scientists had a religious affiliation. The highest percentage was in India, where 94% of scientists reported religious affiliations of some sort. The three regions with the lowest reported religious affiliations were France (16%), the United Kingdom (27%) and the United States (30%). In all regions except Hong Kong and Taiwan, a higher proportion of scientists indentified with a religion when they were 16 than they do now. Belief in God among scientists ranged widely from Turkey with the highest (61%) to France with the lowest (5%). The UK and the US, which are at the heart of the global scientific infrastructure, reported proportions consistent with earlier surveys of belief among so-called elite scientists.

Ecklund et al. said that from their data on religious beliefs, practices or identities, it was difficult to conclude that science and religion were in conflict. See “Scientist, What do You Believe?” for more information on the earlier surveys. Also see the table below, taken from the Ecklund et al. report of the RASIC study.

However, when scientists are compared to their local religious populations, there was evidence of lower religiosity among scientists. In France, the UK and the US, the proportion of the general population who attends religious services once a week or more were at least two time larger than the scientists from the same region. The gap was widest in the US, where 33% of the population reported at least weekly attendance, compared to 11% of scientists. “The majority of scientists in the US (60 percent), UK (66 percent), and France (81 percent) are nonattenders.” The proportion of scientists who have a religious identification was lower than the general population in every region but Hong Kong and Taiwan. See Figures 1 and 2 in the Ecklund et al. report for more information on these issues.

The views of scientists on the science-faith interface were counter-intuitive if you believed the conflict narrative. “A substantial majority of physicists and biologists in the eight regional contexts studied do not adhere to this view.” The conflict narrative would also presume most scientists would see the science-religion relationship as one of conflict, and then take the side of science. But only in the UK and the US did those percentages approach or exceed 30%.

The prevailing view among scientists is that science and religion are independent of one another. France, Italy, Taiwan and the US had 50% or more of their scientists seeing religion and science as independent of one another, while all other regions had at least 35%. Ecklund et al suggested that Stephen Jay Gould’s concept of science and religion as “nonoverlapping magisterial” was helpful here. The concept refers to science and religion as nonoverlapping spheres, with science dealing with the empirical observation of the natural world and religion dealing with meaning.

Another surprising finding for the conflict view was with how scientists thought their exposure to science influenced their views on religion. No more than 22% of scientists in the US thought their exposure to science made them less religious; and the US was the region with the highest percentage. See Table 3 taken from the Ecklund et al. report of the RASIC study for more information on these topics.

In her review of the study for BioLogos, Sarah Lane Ritchie gleaned “five surprising facts” from the study, repeating several of those noted above. Significantly for evangelical Christians, she thought the study went a long way in dispelling the myth that scientists themselves are hostile towards religion or not at all religious. When the public discourse surrounding science and religion consistently depicts “evolution-affirming scientists as being at war with evolution-denying religious individuals or groups … it is easy for public perception to become skewed in a way that does not reflect the facts.”

She concluded that not only were many scientists religious, but even those who were not religious generally held an independence view, rather than a conflict view, of how science and religion were related. “This research undermines both the conflict narrative surrounding science and religion, and the assumption that scientists themselves are not religious.” So the conflict model of the relationship between science and religion is not the dominant view of most scientists, but it seems to be deeply influential at the popular level, especially among evangelical Christians in the US. To a certain extent, this influence dates back to the Scopes Trial.

Alister McGrath, who holds advanced degrees in both science and theology, remarked in Science and Religion how the Scopes Trial was a public relations disaster for conservative, fundamentalist Christians. He noted how William Jennings Bryan had unwisely framed the trial as a “duel to the death” between Christianity and atheism. Clarence Darrow, a well-known attorney—and agnostic—on the Scopes defense team, was able discredit Bryan by simply calling him as a witness for the defense.

The legal move was as simple as it was brilliant: Bryan was called to the stand as a witness for the defense, and interrogated concerning his views on evolution. Bryan was forced to admit that he had no knowledge of geology, comparative religions or ancient civilizations, and showed himself to have hopelessly naïve religious views. The “monkey trial” (as it is widely known) came to be seen as a symbol of reactionary religious thinking in the face of scientific progress.

Several scholars consider the Scopes Trial to be a key event in the restructuring of American religion. One of those, Edward Larson, said it would be difficult to overestimate the importance of the Scopes Trial had in transforming Christian fundamentalism in the U.S. Afterwards elite American society stopped taking it seriously. The trial’s setting stamped the entire movement with an irrevocable image of the rural, small town South. The national media stopped covering its normal activities. Conservative Christians rapidly lost power within the mainline denominations. And most significantly, a string of defeats occurred for antievolution legislation in the northern states. While fundamentalists responded by withdrawing from political and cultural encounters for several decades, the Scopes Trial came to embody the “conflict” between science and religion.

The quotes in the introductory paragraph were taken from Edward Larson’s Pulitzer Prize winning book on the Scopes Trial, Summer for the Gods.

02/24/17

Misdiagnosing Substance Use

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Allen Frances doesn’t like the DSM-5 and you can hear him say so here.  He said our mental health system was in a mess. And he is afraid that with DSM-5, it will get even worse. “People who are essentially normal are being diagnosed with mental disorders they don’t have.” Small changes in the diagnostic system can result in tens of millions of normal people qualifying for a diagnosis. He used himself as an example, stating how he would qualify for several of the DSM-5 disorders. Typical symptoms of grief over his wife’s death, lasting beyond two weeks, would have signified him as having a Major Depressive Disorder.

Anther mistake was combining what had been two different diagnoses of substance use in the DSM-IV—Substance Abuse and Substance Dependence—into one: Substance Use Disorder. Substance Abuse was when someone had recurrent, but intermittent, trouble from recreational binges. Substance Dependence was a continuous and compulsive pattern of use, often with tolerance and withdrawal. The majority of substance abusers “never become addicted in any meaningful sense.”

The two DSM IV diagnoses have radically different implications for treatment planning and for prognosis. Artificially lumping them together in DSM-5 forces inaccurate diagnosis, loses critical clinical information, and stigmatizes as addicts, people whose substance problem is often temporary and influenced by contextual and developmental factors.

Hasin et al., “DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale,” presents the rationale used by the DSM-5 workgroup for substance use disorders for its changes, particularly combining abuse and dependence into one disorder. They recommended the combination as well as dropping one diagnostic criteria (legal problems) and adding one (craving). Two criteria are required to diagnose a Substance Use Disorder. The number of criteria met will indicate mild (2 to 3 criteria), moderate (4 to 5), and severe disorders (6 or more). The following chart, taken from the article, illustrates the changes from DSM-IV to DSM-5.

Frances is not alone in seeing value with two distinct types of substance use disorder. Carleton Erickson in The Science of Addiction noted how the distinction allowed for the differentiation between individuals with drug-related problems who could stop using when they wished (substance abusers), and others who had the disease of chemical dependence. Chemically dependent people have a dysregulation of the mesolimbic dopamine system and generally cannot stop using drugs without intensive intervention into their drug use problems. “According to these criteria, drug abuse in intentional, ‘conscious,’ or voluntary. Drug dependence is pathological and unintended.”

In his article, “DSM-5 Made a Mistake Eliminating Substance Abuse,” Allen Frances indicated the DSM-5 workgroup for substance use disorders based its rationale for dropping Substance Abuse on studies suggesting the distinction was hard to make. He said the results of the studies were not definitive. Moreover, their interpretation was flawed by what he said was a basic DSM-5 misunderstanding of the nature of psychiatric diagnosis. “All DSM disorder overlap with other DSM disorders and also frequently with normality.” Fuzzy boundaries among near diagnostic neighbors are common and not a sufficient excuse to collapse clinically valuable distinctions.

Carleton Erickson’s discussion of the degrees of severity with drug problems helps to illustrate this misunderstanding. He indicated there were mild, moderate and severe forms of both drug abuse and drug dependence. Most people don’t think in terms of severity with substance use problems. You either have a problem or you don’t; you either abuse drugs or you don’t. He then illustrated their relationship to drug-seeking behavior as follows.

Drug Abuse

Drug Dependence

Drug-Seeking

Mild

Little/None

Moderate

Some

Severe

Mild

A Lot

Moderate

Even more

Severe

All the Time

The overlap referred to by Frances occurs between severe drug abuse and mild drug dependence. The inability of psychiatric diagnosis to make a clear distinction here seems to have led to the decision to collapse the abuse and dependence diagnoses into one category in the DSM-5.

I think another overlap between drug abuse and drug dependence happens with regards to self-control. A distinction is necessary between self-control of thoughts, feelings and behavior when drinking and control of the drug intake itself. Any substance use can lead to a loss of self-control over an individual’s thoughts, feelings and behavior. When that loss of control results in recurrent, intermittent trouble, there is a drug abuse problem. The severity of this type of loss of self-control and the related intermittent trouble varies.

Not everyone who abuses a drug experiences the classic sense of losing of control over how much of the drug they use. A loss of control over drug intake—a continuous and compulsive pattern of use—is only evident within drug dependence. And again, the severity of this loss of control over drug intake varies. So I’d adopt Erickson’s degrees of severity with drug abuse and dependence problems as seen below.

Loss of Self-Control in Abuse

Loss of Control over Drug Intake in Dependence

Mild

Moderate

Severe

Mild

Moderate

Severe

A substance abuse problem with severe trouble related to loss of self-control may be indistinguishable from a substance dependence problem with mild loss of control over drug intake. Both people would look at their severe “trouble” and attribute it to drinking or drugging too much. Given an equal motivation to avoid further “trouble,” the substance abuser would likely have an easier time maintaining abstinence. Carleton Erickson said chemical dependence is not a “too much, too often, withdrawal” disease; it’s a “I can’t stop without help disease.” There is a pathological, compulsive pattern to substance use.

There does seem to be a “fuzzy boundary” between Substance Abuse and Substance Dependence. Nevertheless, the distinction still carries some clinical and diagnostic value. I agree with what Allen Frances said: “The change was radical, creates obvious harms, and provides no apparent benefit.” What should clinicians do? Frances suggested they simply ignore the DSM-5 change. He said it was appropriate and clinically preferable to continue making the distinction.

There is nothing sacred or official about the DSM-5 choices — I know because I made the choices for DSM-IV. The ICD coding system is official; the DSM codes are just one groups’ fallible adaptation of them. It is of great significance that the official coding in ICD-10-CM does not follow the DSM-5 decision to eliminate Substance Abuse. Instead, ICD-10-CM retains the DSM-IV terminology and continues to provide separate Substance Abuse and Substance Dependence codes for each of the major classes of substances.

The ICD-11 workgroup, currently in the final stage of development before field tests, will continue to separate Substance Dependence and Harmful Substance Use. The guidelines for dependence are revised and simplified into three diagnostic features: impaired control over substance use; increasing priority in life and physiological features. Severity qualifiers were suggested only for alcohol intoxication. They also introduced a new diagnostic category, with no equivalents in ICD-10 or DSM-5: single episode of harmful use. Frances commented:

The DSM-5 mistake thus places it out of line with ICD-10, ICD-11, previous DSM’s, and well established clinical practice. Clinicians remain truer both to clinical reality and to ICD coding when they ignore the new DSM-5 lumping of substance use disorders and instead continue to distinguish Substance Abuse from Substance Dependence. DSM’s are explicitly meant to be used only as guides, not worshiped as bibles. Clinicians are free to ignore DSM whenever it makes mistakes that go against clinical common sense and the International coding system.

02/20/17

Listening to Marijuana Research

© Mohammed Anwarul Kabir Choudhury

Would it surprise you to know that only .6% of all participants in medical marijuana programs are getting any ongoing medical oversight? Williams et al. assessed medical marijuana programs for Health Affairs according to seven components of traditional medical care and pharmaceutical regulation. The authors found that of the initial 23 states and the District of Columbia who had approved medical marijuana, 14 programs were nonmedical, according to those standards. These fourteen programs collectively enrolled 99.4% of all nationwide participants in medical marijuana programs.

One of the study’s coauthors, Dr. Silvia Martins said: “When you’re allowing someone to have access to a certain product as a medication, it needs to be overseen by good medical practices and medical rules.” And that is necessarily based on a clear understanding of the risks and benefits of any medicinal product.

With that in mind, the MIND project at McLean Hospital in Boston is researching medical marijuana (MMJ).  MIND stands for: Marijuana Investigations for Neuroscientific Discovery. Currently MIND is conducting a longitudinal study of MMJ. The first phase of the MIND project assesses subjects at baseline, before beginning their MMJ treatment. They then track their use of marijuana (MJ) and are in touch with researchers biweekly. Follow up visits occur every three months for two years in order to assess the potential impact of MMJ on cognitive function and related brain and quality of life measures.

The second phase is an FDA-approved clinical trial of high-CBD sublingual tincture for treating anxiety. A third and final phase will examine the clinical state and cognition in veterans who are using cannabinoids to treat various conditions, including PTSD, insomnia and pain. The MIND website noted how policy has gone too far ahead of science, so there is little data available on the impact of MMJ on cognitive functioning.

Given the considerable difficulty with cognitive function and disrupted mood experienced by patients with severe medical disorders, the addition of MJ, which has shown promise in alleviating a range of symptoms, could potentially improve cognitive performance. Equally critical, data showing a loss or impairment of cognitive function following the use of MMJ could inform alternative courses of treatment, staggered dosing, and ultimately prevent unjustified exposure to harm. As the number of states who have passed MMJ laws continues to grow, the ‘need to know’ has never been more important, relevant or timely, and has significant implications for public health policy.

Staci Gruber, who is the director of the MIND project, has been doing research into the effects of MJ since the early 1990s and has documented some interesting neurological effects from MJ. She led a 2013 study that found there were differences in the brain’s white matter and impulsivity between teenagers and young adults smoked an average of 25.5 joints of MJ per week and a control group who did not smoke MJ. Their research suggested that in some individuals who begin smoking MJ at an early age, differences in brain function and structure emerge during development. The study sample was small and it was not clear if the brain changes resulted from MJ use or predated MJ use. The changes could have occurred as the result of either chronic MJ use or reflect a delay in brain development in MJ smokers.

These data represent the first report of significant alterations in frontal white matter fiber tract integrity that are associated with self-report measures of impulsivity in chronic, heavy MJ smokers, and appear to be related to age of onset of MJ use. . . . Future investigations should include additional measures of behavioral impulsivity and their relationship to age of onset of MJ use to more fully explore the potential neurodevelopmental aspects of white matter changes in MJ smokers. Findings from this study suggest that changes in white matter microstructure may be predictive or associated with increased impulsivity, and may ultimately contribute to the initiation of MJ use or the inability to discontinue use.

A follow up study done by Gruber and others was published that same year, 2013. The study confirmed that heavy MJ smokers had lower levels of white matter in the corpus callosum region of the brain; and that earlier age of MJ use was associated with these lower levels of white matter. MJ smokers also had higher levels of impulsivity.

Taken together, these findings reinforce the idea that early onset of MJ use negatively impacts white matter development and is associated with behavioral impulsivity, a combination that may have enduring negative effects, particularly on the developing brain. Data from this study highlight the importance of early identification of MJ use among emerging adults and the need for efforts aimed at delaying or preventing the onset of MJ use.

Then a third study by Gruber and her research team at MIND published in the March 2016 issue of the Journal of Studies on Alcohol and Drugs found that MJ smokers had poorer executive brain function than the control group. The difference seemed to be primarily the result of early onset of MJ use, before the age of 16. The differences remained even after the frequency and amounts of MJ used were controlled. Additionally, the early MJ use and the greater amounts of MJ used predicted poorer performance and errors on the Wisconsin Card Sorting Test (WCST), which is used to assess abstract thinking. “The WCST is also considered a measure of executive function because of its reported sensitivity to frontal lobe dysfunction.”

These findings underscore the impact of early onset of marijuana use on executive function impairment independent of increased frequency and magnitude of use. In addition, poorer performance on the WCST may serve as a neuropsychological marker for heavy marijuana users. These results highlight the need for additional research to identify predictors associated with early marijuana use, as exposure to marijuana during a period of developmental vulnerability may result in negative cognitive consequences.

STAT News highlighted Dr. Gruber’s research with MIND in an August 2016 article. She commented there on the commitment of some of her research participants, how they drive two to three hours to be part of the MIND study. “They’re really committed. They really want to know what effect this will have on them.”

After reviewing some of the comments on the STAT article, it seemed to me that several of the pro marijuana readers either missed or ignored a few of her comments in the article. One of her comments was: “There’s a lot we don’t know about long-term effects, and that’s what I’m here to find out.” In a second remark Gruber pointed out that the cannabinoids she studies aren’t the ones that get you high. “But whether you’re for medical marijuana or against it, what we really need is information.”

SAMA (Science and Management of Addictions) president, Kim Bracket, said Staci Gruber has a talent for translating scientific information so that non-scientists can understand. This leads to a third and telling comment by Gruber in the article: “In science, you can have all the findings in the world, but if you can’t communicate them, what good are they?” So far, I think she is communicating her findings clearly and concisely to scientists and non-scientists, legalization activists and opponents to legalization. And we need to continue to listen to what she says.

02/17/17

The Adultery of Addiction

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In 1948, at the First International Convention of Alcoholics Anonymous, Dr. Bob gave his last major talk.  He related for those in attendance his recollections of the beginnings of A.A. He recalled that in the early days they were groping in the dark. The Steps and the Traditions didn’t exist; the A.A. Big Book hadn’t been written yet. But they were convinced the answer to their problems was in the Good Book. And one of the absolutely essential parts of the Bible for them, according to Dr. Bob, was the Sermon on the Mount. But there are two verses in there whose application to 12 Step recovery may seem to be a bit strained.

Matthew 5:31-32, which expresses Jesus’ thoughts on divorce, follows right after he addressed how his followers should understand and apply biblical teaching on adultery and lust. As is typical of his teachings in other areas of the Sermon on the Mount, Jesus turns the Jews understanding of what the Law said about divorce upside down. The passage says:

“It was also said, ‘Whoever divorces his wife, let him give her a certificate of divorce.’ But I say to you that everyone who divorces his wife, except on the ground of sexual immorality, makes her commit adultery, and whoever marries a divorced woman commits adultery.”

Jesus began by referring to Deuteronomy 24:1-4 from the Law of Moses, where if a man wanted to divorce his wife, he was required to give her a formal certificate declaring he was divorcing her. At that time, a man was permitted to divorce his wife, but a wife was not allowed to divorce her husband. She could petition the court, and if her plea was accepted, the court would direct the husband to divorce her. Culturally, to moderns this appears to be an unfair, patriarchal practice. But there was a loose interpretation of that section of the Mosaic Law that made it even more one-sided.

Deuteronomy 24:1 said a man could write his wife a certificate of divorce if she fell out of favor in his eyes “because he found some indecency in her.” The word for “indecency” in Hebrew can have a sexual connotation, but here it referred vaguely to some failing or sin. By the time period in which Jesus lived, the grounds for divorce could be a failing as trivial as a wife burning the food she cooked for her husband. We could almost say this was an ancient sense of a husband-centered “no fault divorce.” This was the interpretation of the followers of Hillel, a rabbi and teacher during the time of Herod the Great. The school of Shammai, a conservative Pharisee from around the same time period, limited the sense of the Hebrew word for “indecency” to its sexual sense and only permitted divorce for adultery.

Regardless of how an individual understood divorce, it was an accepted practice in Judaism for a man to divorce his wife. However, her husband could not put her outside of his home on a whim; he had to formally release her from her marriage vows. The certificate of divorce was a protection for the woman, indicating she could legally marry someone else. Remarriage for a widowed or divorced woman provided security in the culture of her time. Leon Morris observed: “In first-century Jewish society how else could she live?”

But, Jesus said divorce should not be granted at the whim of the husband; it’s not simply the right or privilege of a man to dispose of his wife whenever he tires of her. Such capriciousness was sin. Jesus said not only does this kind of husband force his wife to commit adultery by her remarriage, but also the man she marries. In God’s eyes the indecency to justify a divorce had to be serious to break the covenant bond of marriage. Apathy towards the wife of your youth or the desire for a younger, prettier “trophy wife” were not acceptable reasons for divorce.

Clearly Jesus saw marriage as a lifelong union between a man and a woman. Addiction can destroy that bond as effectively as adultery. In fact to a spouse, drug and alcohol addiction often feels like the addict or alcoholic is in an adulterous relationship—even when there isn’t another human being involved. There are frequent promises to their partner they are finished with alcohol … cocaine … heroin. Then the partner discovers those were promises without teeth. The addict didn’t follow through with a permanent breakup with their drug/lover.

Farther on in the Sermon on the Mount, in the midst of discussing treasures on earth or in heaven, Jesus tells his audience that whatever they treasure has their heart. Since no one can serve two masters (or lovers), they will be devoted to one or the other, but not both (Matthew 6:19-24). Being with an addict can feel like that. Your partner is in a relationship with something else; and you can’t compete.

In the A.A. Big Book, chapter 8 is “To Wives.” Counter-intuitively, that chapter was written by Bill W.; not his wife, Lois. In Pass It On, Lois said she was hurt Bill insisted on writing it himself. His given reason, so that it would be in the same style as the rest of the book, seems a bit weak. There was, in fact, a section included in the A.A. Big Book, Alcoholics Anonymous, that was written by another hand. “The Doctor’s Opinion” was written by Dr. Silkworth, the doctor who treated Bill at the end of his drinking. I think it is fair to say Bill W. had a strain of chauvinism in him and it showed up here.

Another way to apply Matthew 5:31-32 to recovery is to reflect on how adultery and divorce were frequently used as metaphors to describe idolatry or unfaithfulness to God in the Old Testament prophetic literature. Here, the adultery would be spiritual adultery; a violation of the individual’s relationship with God.

Ezekiel 16:15-35 frames the unfaithfulness of Jerusalem to God as adultery. Jeremiah 3:1-10 similarly describes how Israel polluted the land with her lovers. Israel and Jerusalem are the unfaithful wives. In Malachi, the priests are described as being faithless to the wife of their youth. Adultery, whether it was literal or a metaphor for spiritual unfaithfulness, violated the individual’s covenant before God.

The Lord was witness between you and the wife of your youth, to whom you have been faithless, though she is your companion and your wife by covenant. Did he not make them one, with a portion of the Spirit in their union? And what was the one God seeking? Godly offspring. So guard yourselves in your spirit, and let none of you be faithless to the wife of your youth. “For the man who does not love his wife but divorces her, says the Lord, the God of Israel, covers his garment with violence, says the Lord of hosts. So guard yourselves in your spirit, and do not be faithless.” (Malachi 2:14-16)

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

02/14/17

Psychedelic Depression

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You are lying in a comfortable reclining chair in a private room with low lights. You are dressed in your street clothes, but you are also connected to monitors for blood pressure, pulse and oxygen saturation. A medical practitioner locates a vein on your arm and uses a tiny needle to insert a thin, flexible tube into your vein. You barely feel the needle inserted because it doesn’t hit any muscle. The tube is connected to a bag of fluid raised a couple of feet above your head and it delivers a carefully measured dose of ketamine directly into your bloodstream to treat your depression.

The above description is for a procedure called ketamine infusion, as it was described on the Ketamine Advocacy Network website. Further reading suggests you will have an almost ethereal experience. It could include a dissociative effect, an out-of-body sensation. You will appear to be asleep, but in reality your mind is very active. “In a state of deep relaxation, you may find that you’re able to reflect on past traumas or current anxieties in a very calm, matter-of-fact way – with zero emotional pain.” Many patients prefer to let their thoughts wander. They suggest doing whatever maximizes your sense of calm and relaxation, as long as your doctor agrees.

Although most patients find the experience relaxing and pleasant, some can have brief moments of fright. Patients who begin the infusion in a state of high anxiety seem most susceptible to this. Many are desperately pinning all their hopes on ketamine to relieve their suffering, which is totally understandable but can amp up their anxiety. Some patients get very tense at the thought of not being in total control of their thoughts or body. Try your best to relax before the infusion begins.

What’s not to like about the above-described treatment for depression? First, remember that it is not an FDA-approved treatment. Second, ketamine used in higher doses than in an infusion is the club drug favorite, Special K. Third, the antidepressant effect from ketamine is limited and of an unknown origin.

Ketamine is a Schedule III controlled substance, approved as a general anesthetic. As Peter Simons reported, it is not approved by the FDA as a treatment for depression and other mental health concerns because of a lack of clear benefit and limited knowledge of its risks. There is some truth to the fact that as a generic drug, it is not attractive for pharmaceutical companies to develop it as a therapeutic agent; they won’t make billions of dollars with it. But the research for its efficacy in treating depression is mixed. Simons referred to a new study by Voort et al. in the Journal of Affective Disorders that extended the duration of depressive symptom remission, but did not fully remit the depression.  He said:

Only one of the twelve patients experienced remission of depression. The pattern shown by previous studies is similar. Within hours after treatment, patients experience a euphoric release of depression, but depressive symptoms return within a day or two. For some patients, they return worse than before. Additional treatments every day or every week have the same effect, but the effect is not cumulative. Once weaned off the continual weekly ketamine treatments, around 90% of patients relapse. As evidenced by this current study, even with continuous treatment, only a small number of patients experience any benefit.

Adverse effects can include increased symptoms of depression, anxiety, and suicidality. Only seven of twelve participants reported any therapeutic effect, and only one patient experienced remission by the end of the trial. One person died by suicide and another was hospitalized for suicidality. “These results confirm suspicions that ketamine is a dangerous experimental treatment with limited benefits and serious risks.” These seem to be further reasons why the FDA has yet to approve ketamine as a treatment for depression.

The addictive potential with ketamine is a real concern. The fast-action and rapid fading effect of the drug seems to potentiate its psychological dependency. Ketamine is also widely misused in East and South-East Asia. In Ketamine: Dreams and Realities, Karl Jensen, a British psychiatrist and a leading authority on ketamine said it was far more likely to create periods of dependence than other psychedelic drugs. “The risk is certainly very high in comparison with drugs such as LSD, DMT, and psilocybian mushrooms, but it is not more than half of those who like it.”

Tolerance is rapid and marked; and the ability to remember the experience fades. Some users, he said, will continue to take ketamine for its cocaine-like effects, its calming effects or its potential to relieve anxiety or depression. However, the fading effect can lead to using higher doses in order to resume its dissociation experience. Jensen then gave an extended quote from The Essential Psychedelic Guide, by D.M. Turner, who died from a ketamine-related incident. The Erowid report on Turner said that in 1996 Turner drew a hot bath, injected an unknown amount of ketamine “and settled in for the last trip of his life.” He lost consciousness at some point and drowned. Turner wrote:

A major concern regarding safe use of Ketamine is its very high potential for psychological addiction. A fairly large percentage of those who try Ketamine will consume it non-stop until their supply is exhausted. I’ve seen this in friends I’ve known for many years who are regular psychedelic users and have never before had problems controlling their drug consumption. And I’ve seen the lives of several people who developed an addiction to Ketamine take downward turns. After about two years of once-per-week Ketamine use I even found that I had developed an addiction…Amongst those I know who use Ketamine, I’ve seen very few who can use it in a balanced manner if they have access to it…One of the most remarkable things I experienced in becoming aware of and breaking my Ketamine addiction was the intervention of…[psilocybian mushrooms and DMT]. The DMT provided insights into the negative effects Ketamine was having on my life: a reduction in ambition; a reduction in healthy mortal fears, such as the fear of death; as well as a reluctance to confront fears or difficult tasks and situations directly. Frequent use of Ketamine can lure one as an escape since a blissful and fantastic state of fearless, disembodied consciousness is so easily available.

For more discussion of ketamine and its use as a treatment for depression, see: “Ketamine Desperation,” “Family Likeness in Depression Drugs?”, “Ketamine to the Rescue?”, “Falling Down the K-Hole.”

Although ketamine is a generic drug, esketamine (C13H18CINO) is a patented knock-off of ketamine (C13H16CINO) by Janssen Pharmaceuticals, a division of Johnson & Johnson. In August of 2016 esketamine was granted its second designation by the FDA as a Breakthrough Therapy for treating major depression with an imminent risk of suicide. A Breakthrough Therapy Designation expedites the development process of a drug when it demonstrates the potential for substantial improvement over existing therapies of if it for life-threatening conditions.

Esketamine is an intranasal product, not administered by infusion. Like ketamine, it is a general anaesthetic and a dissociative. It acts primarily as an antagonist with the NMDA receptor, but is also a dopamine reuptake inhibitor. It is more potent and is eliminated more quickly from the body than ketamine. There is also some evidence that it has a more dissociative (hallucinogenic) effect than ketamine.

A study published in Biological Psychiatry by Singh et al. reported the efficacy and safety data from one of the completed FDA trials for esketamine. Science Daily quoted Murray Stein, a deputy editor for Biological Psychiatry, as saying the study showed benefits of the drug over placebo and suggested that the lower of the two doses could be equally effective and also safer. “Though the mechanism of ketamine (and esketamine) antidepressant effects remains unclear, this study clearly demonstrates a benefit, at least in the short term, of this drug for treatment-resistant depression.” Additional clinical trials are testing a wide range of doses to determine the optimal dosing, assessing other possible side effects, and seeking to establish the safety of esketamine in the longer term. Unfortunately, clinical trials don’t last long enough for most drugs to clearly establish an adverse effect like addiction.

There are now two separate drugs in development as fast-acting antidepressants, esketamine and ALKS-5461, whose active ingredients can be reasonably inferred to lead to addiction. As was already mentioned, ketamine is currently classified as a Schedule III controlled substance by the DEA, as is buprenorphine, the active ingredient in ALKS-5461. I hope the FDA will acknowledge the very real risk of addiction with these new molecular entities. The seductive allure of a fast-acting antidepressant could override this concern and lead to their approval as antidepressants without this needed warning. If they are approved, they should at least be classified as Schedule III Controlled Substances.

02/10/17

Guns and Needles

© Roman Legoshyn | 123rf.com

Reporting for The Washington Post, Christopher Ingraham gleaned some grim facts from the recent CDC data on drug and opioid deaths in the U.S. Opioid deaths surpassed 30,000 in 2015; an increase of 5,000 from 2014. Deaths from synthetic opioids like fentanyl rose by over 70% from 2014 to 2015. For the first time since the late 1990s, heroin deaths surpassed traditional opioid painkillers like hydrocodone and oxycodone. The grimmest reality is that more people died in 2015 from heroin-related causes than gun violence. “As recently as 2007, gun homicides outnumbered heroin deaths by more than 5 to 1.”

The above linked Washington Post article graphs and discusses CDC data showing the surge in opioid deaths from 8,280 in 1999 to 33,092 in 2015. You will also find graphs of the death rate increases by three classes of opioids. And there is a graph showing the rapid increase in heroin deaths over the last five years or so to 12,989 in 2015, surpassing gun homicide deaths in 2015 by 10 (12,979).

The CDC MMWR—Morbidity and Mortality Weekly Report—indicated that the rate of drug overdose deaths increased in 30 states and DC; and remained stable in 19 others. Opioid death rates increased by 15.6% from 2014 to 2015. The report suggested the increase was most likely driven by illicitly manufactured fentanyl. These increases were also concentrated in eight states. According to another CDC MMWR from August 26, 2016, those states were: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

During 2014 to 2015 death rates increased overall, as well as for both males and females in the three different classes of opioids. The following chart gives the CDC death rates by class of opioid, year, sex and overall population. The opioid classes are: natural and semi-synthetic opioids (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone and buprenorphine), synthetic opioids (meperidine and fentanyl) and heroin. Heroin is a semi-synthetic opioid, but was assessed separately by the CDC. Methadone is a synthetic opioid but was also assessed separately. See the CDC MMWR for data on methadone deaths.  The “rate” in the chart is the death rate per 100,000 people.

Characteristic

Natural and semi-synthetic opioids

2014

2015

% change in rate, 2014 to 2015

No. (rate)

No. (rate)

Overall

12,159 (3.8)

12,727 (3.9)

2.6%

Sex

Male

6,732 (4.2)

7,117 (4.4)

4.8%

Female

5,427 (3.3)

5,610 (3.4)

3.0%

Characteristic

Synthetic opioids other than methadone

2014

2015

% change in rate, 2014 to 2015

No. (rate)

No. (rate)

Overall

5,544 (1.8)

9,580 (3.1)

72.2%

Sex

Male

3,465 (2.2)

6,560 (4.2)

90.9%

Female

2,079 (1.3)

3,020 (1.9)

46.2%

Characteristic

Heroin

2014

2015

% change in rate, 2014 to 2015

No. (rate)

No. (rate)

Overall

10,574 (3.4)

12,989 (4.1)

20.6%

Sex

Male

8,160 (5.2)

9,881 (6.3)

21.2%

Female

2,414 (1.6)

3,108 (2.0)

25%

From 2014 to 2015, the combined opioid death rates increased by 15.6%. The most radical increases were with synthetic opioids, overwhelmingly from fentanyl. The overall increase was 72.2%, driven primarily by a 90.9% increase in male deaths. Overall heroin deaths in 2015 were higher than the number of deaths from natural and semi-synthetic opioids in 2015. Death rates from natural and semi-synthetic opioids increased as well, but at a more leisurely rate.

Another Washington Post article by Christopher Ingraham, “Where opiates killed the most people in 2015,” again used CDC data to compose a series of maps. These maps illustrated which states in 2016 had the most opioid deaths overall and also by classes of opioids: heroin, synthetic and natural (natural and semi-synthetic). Nationally, there were roughly 10.4 opioid overdose deaths per 100,000 people. But New England, and the Ohio/Kentucky/West Virginia had the highest rates. Ohio, West Virginia and Connecticut had the highest death rates from heroin overdoses, between 20 and 36.

Synthetic opioid deaths were primarily located along the East Coast. The national death rate from synthetic opioids is 3.1 per 100,000. In Rhode Island it’s 13.2; in Massachusetts it’s 14.4; and in New Hampshire it’s 24.1. Ohio and West Virginia weren’t far behind. Deaths from natural and semi-synthetic opioids were concentrated in West Virginia and Utah. There is also a table of raw data by state in the article.  The following map, taken from the article, is for overall opioid deaths in the U.S. for 2015.

The following chart, taken from the 2016 National Drug Threat Assessment Summary, combines CDC data for deaths by drug poisoning, homicide, firearms and motor vehicle crashes between 1999 and 2014. You can clearly see how overdose deaths have risen, outpacing the other causes of death. The 2016 NDTA Summary said drug overdose deaths are at the highest level ever recorded. “In 2014, approximately 129 people died every day as a result of drug poisoning.” Since 2010, there has been a 248% increase in heroin overdose deaths.

The U.S. has seen a dramatic increase in the availability of heroin in the last ten years, allowing the heroin threat to expand exponentially.  The increases with heroin production in Mexico have guaranteed a steady supply of low-cost heroin, despite the increases in the number of users over the past decade. While heroin from four source areas (Mexico, South America, Southwest Asia, and Southeast Asia) can be found somewhere in the U.S., Mexico is the main source of heroin. South America is the second most common source. Mexican heroin accounted for 79% of the total weight of heroin analyzed by the Heroin Signature Program.

The domestic supply of Mexico-sourced heroin is more than sufficient to satisfy current U.S. market demand. Moreover, Mexican heroin traffickers are able to keep the supply steady and reliable. This is evidenced by high availability levels in U.S. heroin markets and low retail-level prices.

The number of individuals who used heroin in the month prior to a National Survey on Drug Use and Health (NSDUH) increased by 154% between 2007 and 2014. There was a 51% increase in just the last year of the survey; 27% reported lifetime heroin use. “The estimated number of new heroin initiates doubled between 2007 (106,000) and 2014 (212,000).” See the following graph for more information on current heroin users between 2007 and 2014 from the 2016 NDTA Summary.

So far we’ve looked at the opioid epidemic from the perspective of national statistics and surveys. But I want to close with a more up-close-and-personal look at the issue. During the summer of 2016, I read Gun, Needle, Spoon by Patrick O’Neil. Gun is a compelling look at the life of a “current heroin user.” Patrick has over fifteen years clean now, but gives you a clear-eyed, non-blinking look into the abyss of heroin addiction in his memoir. What follows are a couple of paragraphs of life in that nightmare. Read Gun, Needle, Spoon for more.

Technically, kicking heroin takes three days. Every junkie’s kick is slightly different, yet the symptoms are the same. For me it starts out with an unpleasant familiar taste in the back of my throat. My nose begins to run, I sneeze a lot, and my eyes water. Then the aches arrive, followed by vomiting and diarrhea. There’s no sleeping. I’m either cold and shivering or hot and continually sweating. My muscles cramp, my head feels thick, and all I think about is doing more dope in order to not be in such misery. . . .The digital clock on the desk in the living room read 11:55 PM. I light a cigarette and stare at the gun. Before I can really think about it, I pull on a pair of jeans and get dressed. Digging through a pile of dirty clothes, I find a black bandana and tie it loosely around my neck. I slip the gun into my waistband, button my overcoat, and quickly open the front door.

P.S. There is good new here. Patrick just wrote that he received a pardon from the governor of California for his past crimes. You can read about the day he received his pardon here. And take the time to congratulate him, will you?

02/7/17

No Contest; No Victory

photo of the Scopes Trial; Clarence Darrow and the defense team.

A few years ago Rachael Gross wrote an article for Slate entitled: “Evolution is Finally Winning Out Over Creationism.” She noted how few issues have divided Americans as bitterly as Darwin’s theory of evolution by natural selection. She thought it was “woeful” that “the majority of people in Europe and in many other parts of the world accept evolution,” while 4 in 10 adult Americans believe that humans have existed in their present form since the beginning of time. Evolutionary theory does not exist in a vacuum, she said. It is supported by findings in geology, paleontology, biomedicine, and other fields. “If we want to be a nation of politically and scientifically literate and informed people, then we have to teach good science—and that starts with evolution.”

But we need to ask what kind of evolution and what kind of creationism she means. Is it evolution that occurred entirely through natural processes or did a supreme being use evolution to bring about and develop nature? There also should be a consistent distinction between individuals who hold that humans have existed in their present form since the beginning (PFB) from those who believe in evolution guided by a supreme being (ESB), and those who affirm humans evolved by natural processes (ENP). Gross also cited two polls in her discussion. Although each poll used a different construct to describe what they meant by “creationism,” she did not point out the differences between them.

One poll was by Gallup and one was by the Pew Research Center. When Gross discussed changes since 2009 in the Pew surveys, the 2009 data can be found here. The Pew 2014 poll looking at evolution did not break down all the age groups by the three categories on origins. But it did report that US adults overall were as follows: 31% said humans existed in their present form from the beginning (PFB); 24% believed their evolution was guided by a supreme being (ESB); and 35% believed evolution occurred from a natural process (ENP). When looking at individuals between the ages of 18-29 in 2009 and 2014 from the Pew polls, on their views of human origins, we get the following data.

So there is evidence suggesting younger American adults are adjusting their position on human origins to the secular evolution position. But when Gross said that 73% of US adults under 30 believe in some kind of evolution, she combined believers in evolution through natural processes, or secular evolution, with those who believed in evolution through a supreme being. There is a significant philosophical gap between the action of a supreme being creating human beings, either through evolution or as fully formed individuals, and humans evolving through an entirely natural process without the action of a supreme being. See “Structure of an Evolutionary Revolution” on this website for more on this difference.

Within the Pew 2014 Religious Landscape Study, 73% of individuals between the ages of 18-29 were fairly certain or absolutely certain there was a God; another 8% believed in God, but were not too certain of that belief; and 19% did not believe in God or did not know if they believed in God. So there would seem to be a large portion of 18 to 29 year old individuals (perhaps 32%) who believed in God and who also believed in natural evolution. I don’t think they should be referred to as necessarily gravitating towards secular evolution. If their belief in God holds, a category like deistic evolution would seem to better describe them.  The category of individuals who believe God created through evolution, ESB, also has the potential to grow larger as views on human origins shift. It is not an inevitable transition to an entirely secular sense of evolution as the older group of people believing humans existed in their present form from the beginning die off.

The Gallup poll Rachel Gross mentioned added a further distinction to the humans created in their present form by adding that God created humans in their present form 10,000 years ago. This position on human origins would be consistent with a group of Christian believers known as young earth creationists (YEC), which hold that all things were created within the 10,000-year timeframe. However, there is a necessary distinction between YEC and PFB—humans existed in their present form since the beginning—if the beginning of the heavens and earth was billions of years ago, and the creation of beginning of humans was significantly longer than 10,000 years ago. This position is what Denis Lamoureux and others have referred to as progressive creationism. See his web lectures in “Beyond the ‘Evolution’ vs. ‘Creation’ Debate,” particularly “Views on the Origin of Universe & Life.”

But an option consistent with a progressive creationist position of human origins was not offered in the Gallup poll—or in any other poll on human origins that I am aware of. The Gallup poll has been asking the same three-part question about human origins, given as follows, since 1982:

Which of the following statements comes closest to you views on the origin and development of human beings? 1) Human beings have developed over millions of years from less advanced forms of life, but god guided this process. 2) Human beings have developed over millions of years from less advanced forms of life, but God has no part in this process. 3) God created human beings pretty much in their present form at one time within the last 10,000 years or so.

The Gallup and the Pew polls implicitly include the evolution—creation dichotomy in the structure of their questions. In both surveys there are two evolutionary positions and one creationist position. The Pew questions more accurately focused on the flash point issue of human evolution, while the Gallup poll collapses the age of the earth variable—held only by young earth creationists—into their creationist position. Not surprisingly, the percentages between the two polls show some differences. The following Gallup chart illustrates the results on the issue dating back to 1982.

As a result, a creation-evolution dichotomy is perpetuated. Arguing that Christians need to choose between science and religion has become entrenched in the dispute since the Scopes Trial. And “fundamentalists” are as much to blame as those holding to a secular or godless sense of evolution. Ironically, William Jennings Bryan held and publicly affirmed a human origins position consistent with what I’ve identified here as progressive creation. He saw Darwinism as a dangerous idea because he thought people would lose their consciousness of God’s presence in their daily lives.

In a speech he first gave in 1904, “Prince of Peace,” Bryan said he had a right to assume a Creator back of the creation. “And no matter how long you draw out the process of creation, so long as God stands back of it you cannot shake my faith in Jehovah.” In Summer for the Gods, Edward Larson commented how this allowed for an extended geologic history and even for a kind of theistic evolution. But Bryan “dug in his heels” regarding the supernatural creation of humans. He saw it as “one of the test questions of the Christian.”

I do not carry the doctrine of evolution as far as some do; I am not yet convinced that man is a lineal descendent of the lower animals. I do not mean to find fault with you if you want to accept the theory; all I mean to say is that while you may trace your ancestry back to the monkey if you find pleasure or pride in doing so, you shall not connect me with your family tree without more evidence than has yet been produced.

He concluded his speech by saying that one of the reasons he objected to the theory of evolution was because if man was linked to the monkey, it became an important question whether humanity was going towards the monkey or coming away from him. “I do not know of any argument that may be used to prove man is an improved monkey that may not be used just as well to prove that the monkey is a degenerate man, and the latter theory is more plausible than the former.” You can listen to a vocal dramatization of his speech here on YouTube; there is a text only copy here. There are content differences between the two because Bryan gave the speech repeatedly over the years. The given quotes are from the text of the oral YouTube version of “Prince of Peace.”

The Bill Nye-Ken Ham debate in 2014 had neither the historical significance nor the drama of the Scopes Trial. But it does illustrate how times have changed and how, rightly or wrongly, the young earth creationist position on human origins, represented by Ken Ham, has become identified as the default view of biblical Christians. You can watch a video on the debate here.

An NPR article, “Who ‘Won’ the Creation vs. Evolution Debate?,” noted the live online debate drew 500,000 viewers at one point. By the middle of November in 2016, the YouTube video had over 5,700,000 views. Britain’s Christian Today website took a poll on who “won” the debate and had 42,567 responses. Ninety two percent thought Bill Nye won, while only 8 percent thought Ken Ham won. Michael Schulson, writing for The Daily Beast, thought Nye’s willingness to engage Ham in a debate threatened to reduce substantive issues to mere spectacle.

The televangelist Pat Robertson thought Ken Ham made a mockery out of Christians. Quoted in The Christian Post, Robertson said he was able to find his faith in the evolutionary process itself. “I don’t believe in so-called evolution as non-theistic. I believe that God started it all and he’s in charge of all of it. The fact that you have progressive evolution under his control. That doesn’t hurt my faith at all.” You can watch a short video of Robertson’s views on The Christian Post link. Robertson further said: “Let’s be real; let’s not make a joke of ourselves.”

A little over a month after the Scopes Trial concluded, Clarence Darrow wrote to H. L. Mencken, one of the reporters who covered the Scopes Trial: “I made up my mind to show the country what an ignoramus he [Bryan] was and I succeeded.” The more things change, the more they stay the same. Christians believing in creation are still seen and portrayed as ignoramuses. The Memphis paper, the Commercial Appeal made the following comment about the infamous exchange between Darrow and Bryan in the Scopes Trial:

It was not a contest. Consequently there was no victory. Darrow succeeded in showing that Bryan knows little about the science of the world. Bryan succeeded in bearing witness bravely to the faith which he believes transcends all the learning of men.

If you are interested in learning more about the Scopes Trial, try this page about the Scopes Trial Museum or the Wikipedia page on the Scopes Trial. You can also read: Summer for the Gods, a Pulitzer Prize winning book about the Scopes Trial and “Structure of an Evolutionary Revolution.” Also, look at: When All the God Trembled, which discusses Darwinism and the Scopes Trial.

02/3/17

“Political” Science?

© Luis Molinero Martinez | 123rf.com

A 2014 study by a well known researcher from Columbia University indicated that “Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities.” The press release for the study said it was the first study to look at the consequences of anti-gay prejudice for mortality. The study’s lead author, Mark Hatzenbuehler, said: “The results of this study suggest a broadening of the consequences of prejudice to include premature death.” The authors thought their study’s results highlighted the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations. A significant and potentially important finding—except it may not be true.

The original study, “Structural Stigma and All-Cause Mortality in Sexual Minority Populations” by Hatzenbuehler et al. was published in the February 2014 issue of Social Science & Medicine. Another researcher, Mark Regnerus, set out to replicate the Hatzenbuehler et al. study, but was not able to do so. Regenerus included a more refined imputation strategy in his replication, but still failed to find any significant results. “No data imputation approach yielded parameters that supported the original study’s conclusions.” Regenerus said:

Ten different approaches to multiple imputation of missing data yielded none in which the effect of structural stigma on the mortality of sexual minorities was statistically significant. Minimally, the original study’s structural stigma variable (and hence its key result) is so sensitive to subjective measurement decisions as to be rendered unreliable.

Writing for the National Review, Maggie Gallagher said that Regenerus’s failure to replicate the Hatzenbuehler et al. study amounted to a repudiation of that study. She also thought the study was faked. “When social justice displaces truth as the core value of academics, bad things happen to science.” She implied Hatzenbuehler might have slipped a bogus study into a major social-science journal, “confident that nobody would want to review and contest its findings, which so please the overwhelmingly liberal academy.”

Gallagher then referred to Mark Regenerus as an emerging scientific hero; a “modern-day Galileo standing up to the new theology of the Left.” But I think she misses the point. Both Hatzenbuehler and Regenerus are doing exactly what they are supposed to do in science: publishing their results and attempting to replicate the research of others. Henry Bauer, a professor of Chemistry & Scientific Studies at Virginia Polytechnic Institute and State University, describes how the “knowledge filter” in science can help uncover the real failures and confirm the true successes.

Bauer asks what would happen if most scientists rounded off or fudged their findings. What if they thought more about who wanted results and less about what an experiment actually showed? “To understand why science may be reliable or unreliable, you have to recognize that science is done by human beings, and that how they interact with one another is absolutely crucial.” He then went on to describe how frontier science leads to publication in the primary literature.

If those [findings] seem interesting enough to others, they’ll be used and thereby tested and perhaps modified or extended – or found to be untrue. Whatever survives as useful knowledge gets cited in other articles and eventually in review articles and monographs, the secondary literature, which is considerably more consensual and reliable than the primary literature.

Regenerus’s findings themselves have to be replicated; by more than one additional study before Gallagher’s assessment that Regenerus repudiated Hatzenbuehler et al. is confirmed. Concluding the study was faked or bogus based just upon his findings is irresponsible and goes beyond what Regenerus himself said.

Regenerus said the findings of the Hatzenbuehler et al. study seemed to be very sensitive to subjective decisions made about the imputation of missing data, “decisions to which readers are not privy.” He also thought the structural stigma variable itself was questionable, “Hence the original study’s claims that such stigma stably accounts for 12 years of diminished life span among sexual minorities seems unfounded, since it is entirely mitigated in multiple attempts to replicate the imputed stigma variable.” He thought his study highlighted the importance of cooperation and transparency in science.

The unavailability of the original study’s syntax and the insufficient description of multiple imputation procedures leave unclear the reasons for the failed replication. It does, however, suggest that the results are far more contingent and tenuous than the original authors conveyed. This should not be read as a commentary on missing data or on the broader field of the study of social stigma on physical and emotional health outcomes, but rather as a call to greater transparency in science (Ioannidis, 2005). While the original study is not unique in its lack of details about multiple imputation procedures, future efforts ought to include supplementary material (online) enabling scholars elsewhere to evaluate and replicate studies’ central findings (Rezvan et al., 2015). This would enhance the educational content of studies as well as improve disciplinary rigor across research domains.

Regenerus is not a scientific hero and Hatzenbuehler is not a research villain. But two other individuals identified by Gallagher in her article may fit within those categories.

Michael LaCour co-authored a paper along with Donald Green that was published in the prestigious journal Science in December of 2014. The original article abstract said: “LaCour and Green demonstrate that simply a 20-minute conversation with a gay canvasser produced a large and sustained shift in attitudes toward same-sex marriage for Los Angeles County residents.” Green is a highly respected political science professor now at Columbia. LaCour was a political science grad student at UCLA.

Back in September of 2013, Michael LaCour met with David Broockman at the annual meeting of the American Political Science Association and showed him some of the early results of his study. Writing for NYMag.com, Jesse Singal noted how Broockman was “blown away” by some of the results LaCour shared with him. LaCour also told him he was looking to get Donald Green as a coauthor on the paper. Coincidentally, Green happened to be Broockman’s undergraduate advisor when they were both at Yale.

Singal pointed out that LaCour’s results were so noteworthy because they contradicted every established belief about political persuasion. “The sheer magnitude of effect LaCour had found in his study simply doesn’t happen — piles of previous research had shown that.” In early 2015, Broockman decided to replicate LaCour’s findings. The first clue there was something wrong was when he realized the estimated cost for a replication would be a cool million dollars. Where would a grad student like LaCour get the money or funding for a study like that? That first anomaly eventually led to: “Irregularities in LaCour (2014),” a 27 page report he coauthored with Josh Kalla and Yale University political scientist, Peter Arnow.

“Irregularities” is diplomatic phrasing; what the trio found was that there’s no evidence LaCour ever actually collaborated with uSamp, the survey firm he claimed to have worked with to produce his data, and that he most likely didn’t commission any surveys whatsoever. Instead, he took a preexisting dataset, pawned it off as his own, and faked the persuasion “effects” of the canvassing. It’s the sort of brazen data fraud you just don’t see that often, especially in a journal like Science.

Green quickly emailed the journal and asked for a retraction, which he received. When contacted about comments that he had failed in his supervisory role for the study, Green said that assessment was entirely fair: “I am deeply embarrassed that I did not suspect and discover the fabrication of the survey data and grateful to the team of researchers who brought it to my attention.”

LaCour had a job offer as an incoming assistant professor at Princeton rescinded. He also reportedly lied about several items on his curriculum vitae, including grants and a teaching award. You can review a post mortem of the LaCour controversy by Neuroskeptic for Discover Magazine here. Neuroskeptic thought LaCour’s objections to Broockman et al. were weak. He also thought Lacour’s objections to the findings of Broockman et al. failed to refute their central criticism.

Cases of seeming scientific fraud, like that of LaCour, draw attention to themselves when they are discovered. Writing for STAT News, Ivan Orlansky and Adam Marcus described a survey by researchers in the Netherlands of working scientists. They were asked to score 60 research misbehaviors according to their impressions of how often the misbehaviors occur, their preventability, the impact on truth (validity), and the impact of trust between scientists.  The respondents were more concerned with sloppy science than scientific fraud. Fraud, when it occurred, has a significant impact on truth and public trust. But those cases are rare; and detected cases are even rarer. They concluded:

Our ranking results seem to suggest that selective reporting, selective citing, and flaws in quality assurance and mentoring are the major evils of modern research. A picture emerges not of concern about wholesale fraud but of profound concerns that many scientists may be cutting corners and engage in sloppy science, possibly with a view to get more positive and more spectacular results that will be easier to publish in a high-impact journal and will attract many citations. In the fostering of responsible conduct of research, we recommend to develop interventions that actively discourage the high-ranking misbehaviors from our study.

So it would seem that problems with the Hatzenbuehler et al. study are not fraud, but could be due to smaller more pervasive issues in its research, such as a shoddy methodology. The LaCour case catches more attention and generates mistrust because of its apparent fraud. Orlansky and Marcus are right. Although not as flashy as fraudulent research, the smaller, less outrageous research sins are a greater threat to scientific credibility. Gallagher may have let her own ideology influence how she emphasized these two cases, but she was unquestionably right in her concluding remarks:  “Science is not right-wing or left-wing. But to work, it needs scientists fearlessly committed to truth over their preferred outcomes.”