The Range of Psychedelic Medicine

Beyond the growing use of substances like MDMA for PTSD and other anxiety and stress conditions, psychedelics of all kinds have been tested with as many mental and physical conditions as you can imagine. Let's take a short dive into the rich history of experimental use psychedelics as medicine.

"The room instantly lit up in a blinding glare of white, white light. I was seized by an ecstasy such as I had never known,” wrote AA's co-founder, Bill Wilson, of his first spiritual experience.He was dropping acid as part of an informal study supervised by a doctor in the ‘50s, when LSD was legal and the power of psychedelic-assisted therapy was heralded as potentially transformative.

So began a lifelong interest in altered states of consciousness that included extensive experiments with LSD. Wilson claimed that his initial experiences were crucial to his recovery and his belief in his mission to create a community of alcoholics helping one another. He was so enthusiastic that he contemplated advising other AA members to take acid, especially those incapable of feeling “a power greater than ourselves.” Still, he acknowledged the limits of its possible benefits: “I don't believe [LSD] has any miraculous property of transforming…sick people into healthy ones overnight,” he wrote to a fellow participant in the study. "[But] it can set up a shining goal on the positive side [and] create a large incentive [to recovery.]” 



The AA fellowship disagreed. The idea of treating those who cannot control their substance use with another substance seemed, then as now, heretical. The link between spirituality and sobriety, however, remains a mainstay of modern recovery.

Today, some four decades after the counter-culture’s widespread recreational use of hallucinogens led to criminalization of the substances, there's a resurgence of interest in their therapeutic potential for mental illness and addiction. A dozen or more studies of LSD, psilocybin (the active ingredient in magic mushrooms) and MDMA (ecstasy) are ongoing in the US, Britain, Israel and Switzerland; a handful of others have recently concluded. Most of the patients involved in these studies are in dire straits: vets with PTSD, the terminally ill who have a terror of death, people with treatment-resistant depression and alcoholics.

The results are consistently positive. Indeed, the PTSD and cancer studies have garnered big headlines recently for their exceptionally beneficial outcomes. But these are tiny pilot studies—and because the drugs are still illegal and mired in controversy and stigma, research is likely to remain stalled.

Advances in neuroscience, coupled with the new model of mental illness and addiction as brain diseases, are largely responsible for rekindling this research. Neurons and their transmitters, receptors, pathways and the like are increasingly viewed as the source of the “self” and perception, cognition, emotion and other functions. Psychedelics have a uniquely powerful, even explosive, effect on both your neurochemistry and your “self.” But the trip itself typically only lasts for about 12 hours. Whether these "mystical" effects deliver enduring benefits is the question researchers seek to answer, for only then could these substances become “medicines.”

Rick Doblin believes the answer is yes. He's the founder and president of the nonprofitMultidisciplinary Association for Psychedelic Studies (MAPS), which funds pilot studies and advocates for these drugs' use in legal medical settings. “Addiction involves past material, a lot of denial and running away. Psychedelics bring material to the surface in ways where people need to surrender to them; it’s hard to hide from yourself under [them],” says Dobin. “The other part is more positive. People often have a spiritual sense of connection that they can later draw strength from.”

Psychedelic-based treatment can cause elevation in mood, openness and changes in values—which, for people with substance use disorders, can cause a reduction in craving, increase in motivation and, ultimately, a reduction in use, says Michael Bogenschutz, MD, a psychiatry professor at the University of New Mexico. “[But] the tricky thing is developing a neurobiological theory. We know a fair amount about the acute effects of psilocybin and drugs like it on the brain, and we’re learning something about the functional effects with fMRI,” he says. “So how do you get from those acute effects to a longer-lasting effect on behavior?”

Hallucinogens have also been tested in smoking cessation. Based on previously positive results, Matthew Johnson, PhD, a Johns Hopkins University addiction researcher, is studying psilocybin’s anti-nicotine effects in 12 people (three administrations of the drug, plus cognitive-behavioral therapy). Three of the four participants who passed the one-year mark have quit smoking, while the fourth has gone from a pack a day to one cigarette a week. (The average rate of success in quitting smoking is between 20% and 40%.)Bogenschutz is investigating whether psilocybin can help alcoholics recover. In his first completed study, five people had two drug sessions over a 12-week period, along with standard Motivational Enhancement Therapy (MET), and at a one-month follow-up (admittedly a short interval) all five reported that they were either abstinent or had markedly reduced their days of heavy drinking. Notably, their drinking patterns remained mostly unchanged during the first month of the study, when they were receiving only the MET, but then dropped sharply following the first psilocybin adventure. 

The future of psychedelics as a “spiritual medicine” is unpredictable. In the short term, research is likely to limp along. A large-scale, controlled and neurobiologically based study is probably at least a decade away—if it ever happens. As neuroscience revolutionizes the entire field of mental illness and addiction research and treatment, however, hallucinogens may well gain legitimacy as a class of chemicals with unique properties worthy of serious investigation. Until then, modern-day Bill Wilsons struggling with recovery are stuck with the black market..

 

 

 

 

Statins Stop Cancer! (No, They Don't)

The real headline here is “More Crap Medical News!”

The real headline here is “More Crap Medical News!”

The stories first started showing up about a week ago, and now they're metastasizing: “Statins linked to dramatic reduction in cancer death rates” blared The Independent. “Patients taking cholesterol-busting drugs are 'half as likely to die'” claimed the Daily Mail. It started in the British tabloids, then spread to India and Pakistan. Now it's hitting US health and medical websites. It's amazing to track its spread, like watching the spread of an annoying virus, just to see the amount of cutting and pasting that tries to pass itself off as journalism. The stories are all close to identical. They all come from the same source. And they're all wrong. 

The real headline here is “More Crap Medical News!” The story suffers from a simple problem: a lack of evidence to back up the headline. A paucity of fact. An unmooring from reality. This, for a supposed medical science story, is fatal. 

Track it back and you find, unsurprisingly, that it all began as a press release (this is warning sign #1: Press releases by their very nature constitute hype; anyone interested in the medical news should know that anything that starts as a PR release should be viewed skeptically). This one was based on a presentation at a medical conference (warning sign #2; like most conference presentations, this one was unpublished in a journal and so lacked formal peer-review; there is no way to judge the quality of the work). And the title of the conference presentation did not include the key word statins (warning sign #3, news headline does not correlate with study). 

The study in question came from a number-crunching group in Britain, which had analyzed close to a million medical files and found that patients with a diagnosis of high cholesterol showed dramatically improved cancer survival rates over those with lower cholesterol levels. Note: They did not track statin use at all.

Hmm. . . . high cholesterol, low cancer mortality. There's actually quite a bit of earlier evidence hinting that low cholesterol might help spur cancer, so it's not too much of a reach to think that higher cholesterol might help fight it. But that wasn't the angle the PR people working to promote the conference went for. They crafted this headline for their press release: “Statins may be associated with reduced mortality in four common cancers.” Odd, no mention of cholesterol, the only thing the researchers tracked for this study. And the inclusion of statins, which the study did not track. 

So where did statins come from, if they weren't in the study? From quotes by two of the authors, apparently in interviews with the PR people. The researchers opined that since just about everybody with high cholesterol was on statins, perhaps statins were the reason for the sizable decline in cancer deaths in high-cholesterol patients. They had no direct new evidence to back up their idea. It was a guess. And the guess got the news.

Well, that's the media. But it's not science.

Which got us working. We dug a bit to find out what scientists who actually have studied statins and cancer say. And we found this:

In summary: statins might trigger cancer. Or they might prevent it. Or they might do nothing. They might improve survival. Or they might not. It sort of depends on whether you're looking at men or women. Or how old they are. Or else these things make little difference.

In other words, we don't know. And that is very depressing. There has actually been quite a bit of work done on cancer and statins. The fact that we don't know after decades of research and hundreds of published studies says to us that if there is a link, it is weak and variable. The mechanisms are complex and unclear.

And the same goes for studies looking at the relationship between serum cholesterol and cancer. Some types of cancer seem to be more common in high-cholesterol patients, others appear to be more common in low-cholesterol patients. And in others it doesn't seem to make any difference. Results are all over the map.

So we're left agreeing with recent reviewers that more or less throw up their hands and call for, you guessed it, more study. More experiments. More clinical trials.

Unfortunately, those trials are really hard to run. In part it's because there are more than 100 kinds of cancer, and it appears that they all don't react the same ways to statins. In part it's because statins have multifold effects. In part it's because both heart disease and cancer take many years to develop, and can arise from multiple causes. In part it's because so many people are taking statins (or have gone on and off them) that it's difficult to put together a clean long-term study.

 

Final thoughts: 1) There's a lot of bad medical reporting out there; 2) conference press releases are evil; and 3) take everything you read about the statin-cancer link with a giant grain of salt. 

How and when could psychedelic therapy go mainstream?

Psychedelic therapy has been in the news recently due to new results from experiments done with fMRI scans of patients on a dose of LSD (see video), to the results of new high-profile MDMA studies being revealed. Many scientists and researchers see a real chance for MDMA to be made a prescription medication. To be clear, the scientific work is being done mostly with an eye toward prescription of MDMA, not decriminalization or legalization. 

So when and how might this happen? Well no one can answer the when (or even if) at this point, but should any of the psychedelic drugs become legal for doctors in the therapy, some interesting plans are already in place for how the clinics would look and operate, and how they would keep their medical drugs off the streets. 

Lets look a little into the questions surrounding the very uncertain future of MDMA therapy:

 

Will medical legalization of MDMA happen in the foreseeable future?

There is a lot we don't know about the medical uses of psychedelics. Because of their legal status, the types of tests used to vet medications for the FDA simply haven't been conducted on most psychedelics. A lot has to be done to move from where the research is now to where it needs to be to have a hope of getting the FDA and DEA to allow medical use. Currently, MDMA is at the phase of research known as Phase II human trials, meaning a drug has passed animal and human tests for safety, and can now be tested on small groups for effects and side effects. Phase III trials, the largest studies needed before the FDA can rule on a new drug, look for statistical data on the effects discovered in Phase II by testing larger numbers of a wider variety of people. This will take years, but likely not decades. The stated goal of MAPS is to have prescription status for MDMA by 2021, which is possible given the rate of completion of Phase II trials. 

 

If MDMA is ever legalized, what sort of training and treatment ideas will work on a large scale?

There's a long road ahead before medical use of psychedelics will be possible. Using MDMA for PTSD has been one of the most studied and tested areas in psychedelic psychotherapy, and once that small wedge is in the door, the hope is that use will expand to other studied conditions like end-of-life anxiety, anxiety disorders, addiction, or recovery from other traumas. This therapy would not involve take-home prescriptions picked up from a pharmacy, but rather consumed on-site under the guidance of therapists in approved clinics.

While clinics like these seem a world away at this moment, many of the hurdles that have kept psychedelics out of scientific and public awareness for the last 45 years are slowly starting to give way. The reason this is such a huge roadblock on the road to medicalization is that Schedule I drugs, unlike those on any other Schedule, are only allowed to be possessed and given out by the DEA or organizations it approves. This creates a bottleneck with tax-payer funded government bodies in the unsavory role of both fighting drugs and dealing them to scientists and researchers. 

 

How will these drugs be kept off the street once legal?

When talking about making a powerful drug more accessible for medical use, the first question asked is often about how to make sure these drugs don’t get into the hands of unauthorized users or drug dealers. With the model of psychedelic therapy currently being pushed by MAPS, this problem is addressed from the outset. These drugs would only be available from a qualified therapist, in single doses, and only to be consumed on-site at their office or clinic. There are no plastic bottles with 30 or 60 pills in them that are taken home, tempting patients to be abusers or dealers. Also, only 2-4 doses are included in the entire regimen of therapy over a total of 8-12 weeks. This means only small amounts of the drug will need to be produced, stocked, and transported, reducing the potential profits from stealing or skimming from shipments. Overall, the therapeutic model for MDMA as it is evolving will have tighter controls over the drug itself, and less production of the drug in general, than almost any other abuse-prone prescription drugs now available. 

Cholesterol: How Low Should You Go?

Statins lower cholesterol -- but is that necessarily a good thing? 

Statins lower cholesterol -- but is that necessarily a good thing? 

Two new research papers add more fuel to the never-ending debates about cholesterol and cardiovascular disease. You would think that after decades of intensive global study and the use of truckloads of cholesterol-lowering drugs by millions of patients, we'd be able to settle this.

At the heart of the controversy (yes, purposeful use of “heart”) is something most doctors and patients take as gospel: Lower cholesterol = lower risk of heart problems. This, in a highly simplified form, is what's called the “cholesterol hypothesis.” It sits at the center of modern preventive heart care, has launched a thousand low-fat diets, has made cholesterol-lowering statins into the best-selling drugs in history . . . and is looking more and more questionable.

The latest evidence comes from studies published in JAMA Internal Medicine and BMJ (British Medical Journal) Open.

The JAMA piece tracked more than 31,000 patients who were taking statins, comparing outcomes to LDL-C levels (low-density lipoprotein cholesterol – the infamous “bad cholesterol” doctors focus on in blood tests). To their surprise, they found that patients who were getting their LDL-C down to the lowest levels – below 70mg/dL, the target for many statin regimens – did no better than patients who only got them down between 70 and 100. Anything below about 90 seemed to do nothing to prevent heart attacks. Lower was not necessarily better. A strike against the cholesterol hypothesis.

The BMJ Open paper went the next step. A systematic review of existing studies led authors to the conclusion that lower LDL-C not only didn't seem to do much to lower all-cause mortality in patients over 60 years of age, but might actually be bad for older patients. As LDL-C levels went down, cardiovascular mortality went up. “This finding is inconsistent with the cholesterol hypothesis,” the authors, with notable understatement, concluded. “Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis.” Strike two.

Both studies are already being raked over the coals. There is a lot of money at play around the cholesterol hypothesis, there are plenty of counter-studies that show that lowering cholesterol goes along with lower risks of heart disease, and no amount of new research seems to solve the issue.

But the fact that decades of study leave us here does make you wonder – not only about the cholesterol hypothesis, but about the ability of “evidence-based medicine” to come to definitive conclusions when the benefits are small and the stakes are high.

 

 

Are Psychedelics Dangers, Healers, or Both?

There’s an old saying in medicine, that all things are poison, the only difference between poison and medicine being the dose. Indeed this can be true when drugs are taken in the wrong amounts or in the wrong conditions. Even when used properly, all drugs carry risks of side effects. They may be habit forming, damage neurons or (semi)permanently alter neurotransmitter levels. They may weaken the body's natural defenses. Any chemical or substance has a level at which it becomes more harmful than helpful to the human body. Psychedelics can certainly be draining mentally and physically, and do cause long term changes in brain chemistry. But the operative question, as it should be with all medicine, is “is this substance doing enough good to offset the bad?” The body of evidence suggests that, yes, at medically-approved doses and with accompanying therapy, the use of most psychedelics has a very good safety and side-effect profile. In trials with substances from LSD to psilocybin containing “magic” mushrooms to MDMA, the reported negative effects, even in long-term followup studies, have been less severe than many prescription medications already in use.

Of the more than 40,000 people studied (with LSD, mescaline, and psilocybin) before the prohibition of most psychedelic research, and the several hundred who have taken part in very limited trials (mostly with MDMA) as restrictions have eased over the last few years, almost no one has reported serious long-term health consequences of the kinds reported to be brought on by heavy recreational use.

What has been observed are some surprisingly high rates of benefits for hard-to-treat conditions like alcoholism, PTSD, anxiety about terminal illnesses, and other conditions. Many trials of psychedelics have been conducted on “treatment-resistant” populations of patients, often those who have already tried several other treatments over months or years without resolving their issues. In one famous study, a group of smokers, who had been averaging a pack a day for over 30 year, and tried to quit and average of six times, 60% were smoke-free a year after the study, compared to just a 35% success rate for the next most successful medication. In study after study about overcoming addictions, breaking neurotic habits, or adjusting to large life changes like illness and death, psychedelic-assisted therapy has been slowly creating a very positive picture of the potential of these substances to address some of the most difficult to treat and least understood psychological and social conditions that plague the western world. 

Our newest Naked Facts book - MDMA Psychedelic Therapy - details the history, controversies, and effects of this largely repressed and unknown therapy. Look for it coming in print and digital forms to Amazon next week! 

In the meantime, why not check out our blog, our articles, our twitter feed, or browse the growing library of Naked Facts books for sale on amazon?

How can MDMA treat PTSD?

MDMA (the pure form of the street drug Molly, Ecstasy, or X) may be especially useful for PTSD, since it can decrease fear and fear-based reactions without impairing the patient's memory or blocking other genuine emotions. Stress-induced activity in the fear center of the brain, the amygdala, has been observably reduced in brain scans of MDMA therapy patients. This, combined with increases in trust, empathy, and expressiveness make MDMA, in the minds of many psychotherapists, a very promising drug for enhancing the effects of various types of talk and touch therapies. Patients can revisit traumatic memories without being overwhelmed by fear, stress, and anxiety, while their therapists can make good use of more open and empathetic interactions.

The drug itself might have some long-term mental and emotional benefits, but most of its use, according to the therapists who work with it, is as an agent to help the patient and therapist more quickly and easily explore and resolve whatever trauma the patient is suffering. Many studies have shown long-term changes in brain chemistry and neurotransmitter levels from MDMA, although whether these changes are positive or negative is an ongoing debate. But MDMA therapy is mostly about using the unique effects of MDMA to put a patient in an optimal state for therapy to have its biggest possible impact. While some lingering effects of MDMA may be positive, the therapy is more about using the open, empathetic MDMA space to boost therapy.

In most MDMA sessions and studies, the goal of the therapist is to support, not direct, the patient's ongoing experience. Trust, safety, and well-being of the patient are more important than addressing any certain issue or meeting goals of the therapy or study. The therapist invites the patient to consider various frameworks and approaches for their own healing, but does not try to direct the patient’s train of thought, except if they become dangerously agitated. The ultimate goal is to enable the processing of trauma without causing any new trauma. In practice, this approach can be pretty “hands-off” for the therapists, who may spend much of the actual MDMA session in silence or simply encouraging the patient to more deeply explore whatever thoughts and feeling are arising. As important as it is for the therapist to not try to influence the session too much, it is also important for the patient to not get in their own way by trying to push or mold the experience in some preconceived way.

Therapy relies on the “empathetic presence” of the therapist, which means not trying to fit the process onto their own ideas or frameworks, while staying open and adaptive to whatever the patient might experience. Leaving choice and interpretation up to the patient, while gently guiding when problems arise, is the difficult balance therapists seek to achieve in MDMA sessions.

The principle that the body knows how to heal itself is extended to the mental healing in MDMA therapy, where therapists believe the innate emotional intelligence of the patient can bring about healing if properly encouraged and supported. The concept of the body healing itself (as opposed to the medicine healing the body) is accepted in a lot of areas in western science and medicine, but the idea that the mind could spontaneously heal itself from trauma when aided by the insights and openness of psychedelics drugs continues to be a hard swallow for many doctors, scientists, and politicians. 

What is the Future of PTSD Treatment?

Could there be one basic therapy for PTSD? With the vast range of treatment options available now for PTSD, the obvious question is which one or ones are most effective? Combinations of talk therapy and some sort of relaxation technique (guided imagery, meditation, etc) are very popular and have success rates significantly better than either therapy alone. Guided imagery, for example, is a component in about 25% of patients' treatment in VA hospitals. This argues that some form, or several forms, of success-boosting alternative treatments should be combined with the current “gold standard” psychotherapy treatments to form a new standard of care based on program success.

As the ways scientists can measure and track the chemical and electrical signals of the brain become more refined, new horizons are opening up for machines to give us useful live feedback not just in the laboratory, but in the therapist's office too. Along with these science- and technology-driven innovations, sufferers of PTSD have been looking to the past for answers as well. Breathing, relaxation, yoga, marital arts, and spiritual practices that are hundreds or thousands of years old are all becoming increasingly popular. As these two very different sides influence and inform the current best practice therapies, we are already seeing the emergence of highly successful therapies combining standard psychotherapy, relaxation/spiritual/alternative therapy, brain response/scanning, and occasionally drugs. These sorts of fusion therapies exist in some forms already, usually under the name-brand of a doctor or center, and many claim surprising cure rates using some cocktail of fractions of existing therapies and a healthy dose of their own ideas. The plus side is that there is currently a huge amount of competition and innovation in this area, the minus side is that this means studies are few and often not well performed or funded for most of these proprietary methods. Science doesn't like multiple variables, and combination therapies are notoriously hard to gather the sort of good clean data on that scientists want.

The treatment of PTSD has evolved rapidly since it began in earnest after World War I. Variously therapies, drugs, and practices or exercises have been adopted, modified, combined, or discarded in a rapid way over the last 100 years. PTSD is nothing if not complex, and it has been one of the most difficult and mysterious mental conditions to study, gather data on, and treat successfully. While most of the world hasn't come very far in eradicating the root causes of PTSD, our understanding of the functioning of the body, personality, and brain has vastly improved the treatment of PTSD and many other mental conditions. Some numbers have started to look very good with regards to PTSD, others are still pretty scary and are real problems to be solved. The length and expense of traditional therapies (and their high dropout rate), poor early detection and screening, over-medication, and the generally unimpressive success rate of current PTSD drugs are all areas for improvement and innovations. This and a lot more are being developed and studied constantly in hospitals, universities, and private clinics around the world.

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What to Ask When Reading the Latest Science News #7: Who Ran the Story?

As if they knew . . . 

As if they knew . . . 

All news is not created equal. This is why careful consumers of the science news take not of not just what the story is, but who wrote it and where it first ran.

There are so many places to get the news today that we talk not in terms of newspapers or TV, but about vehicles that carry the news to us. And there are a million of them, from Twitter and Facebook feeds to the Associated Press to your local barber or hairdresser. They vary in quality and reliability. 

The first thing to do when you hear something that interests you is to trace it back. It's kind of like being an archaeologist, digging down through the rubble to find the earliest traces, the place it all began. A tweet will go to a post which references a story, and so forth. Get back to where the news first showed up. Usually it will be either a news story or a blog post. If you can't find the source, forget the story -- you can't believe it until you can pin it down. 

Now you can start your real work. We've talked a lot about how you can judge the quality of the information in the story. Now consider the quality of the people who put it together. 

It starts with the writer. What qualifies them to write the story? Do they have any background in science or science journalism? Who do they work for? 

Now go to the organization that ran the story. Is it reliable? Keep in mind that media are driven by different motives than scientists. They tend to highlight stories that attract eyeballs, not the ones that are most important. So you get a lot of controversy stories, “everything you know is wrong” pieces, and often stories that are based on more sensational, less reliable subject matter. Better-quality outlets tone down the sensationalism in favor of substance. Lower-quality vehicles trumpet catchy headlines and graphics, followed by substance-free stories.

Take-home: The more sensational the headline, the less trustworthy the story.

Who do you trust? When it comes to science news, you're generally safer relying on organizations that have money and staff enough to do careful fact checking and editing. This isn't always true – some one-off science blogs can be very good – but it's true enough to serve as a rule of thumb. The job of science journalist isn't easy. Good ones have to know science, and they have to know how to write for the public. That's a pretty rare combination. And only a very few newspapers and other media can afford to pay skilled science writers, plus the editing staff to back them up. Those that do offer more reliable stories. Examples of top shops include the New York Times and The Guardian in the newspaper world; The Economist and The Atlantic among magazines; and the BBC when it comes to broadcasting.  

Bigger newspapers, magazines, and news organizations have the staff and structure to check and edit and recheck information before putting it out. Fred, the blogger working out of his basement, does not. In between are a huge number of websites and publications that vary widely in quality.

When it comes to science writing, the web offers risks along with riches. The move among many big mainstream media companies to cut back on science journalism has freed a lot of talent, much of which has been migrating online. Scientists themselves have added a lot of good blogs.The result is what some people see as a golden age of online science writing. 

But watch out: Research that is reported in advocacy publications (put out by groups trying to push a specific agenda, no matter what that agenda is) should always be viewed with skepticism. Ditto the increasing amount of “news” that is rewritten from corporate press releases. When in doubt, cross-check stories in more respected publications or websites.

PTSD: Can we cure or only treat?

PTSD is a huge and still-growing global mental health issue, but the detection, diagnosis, and therapy for PTSD remains a mixed bag. While vast improvements have been made in the past hundred years in antipsychotic drugs and evidence-based systems of talk therapy, there are others areas where the science still hasn't advanced very far. Getting people to seek out help in the first place remains a huge problem, and education for vulnerable groups and families is pretty much only self-driven. The medications we have can manage many of the most severe symptoms, but they do not cure the underlying issues. Most medications used for this purpose come with unwanted mental and physical side effects, especially with long-term use. Self-medication with alcohol or other drugs is still a massive and largely hidden problem as it has been all throughout history. Nothing is as well-researched as these mainstream talk therapies – various forms of individual and group analysis and counseling – and they have the most consistent level of success.

Today, we know that drugs are not enough. It was only after Vietnam, with more and better studies and increased social support for soldiers, rape victims, and other trauma survivors, that understanding and specifying PTSD in the modern way we think of it was finally possible. Over the last 40 years, several therapies have been refined into more effective tools for managing PTSD and supported by medications with fewer side effects. But still patients are still told going into therapy that to expect a “cure” is unrealistic. The goal now, set forth in most main-stream PTSD therapies, is for patients to get symptoms managed to a level where they are no longer interfering in life. Newer therapies, evidence-based and refined through 40 years of testing, are beginning to have some success in freeing patients from a need for ongoing life-time medication or therapy. That's the good news. The bad news is that the success rates of these intense therapies are not great, and drop-out rates from the programs are fairly high.

The history of PTSD, (like you'll find in our book!) shows us that we still have a long way to go in understanding, diagnosing, and treating this unique condition. Today's humans experience lower levels of violence than any other time in history, but warfare, abuse, death, and disasters continue to take their toll on those who live through them. Thankfully, understanding, support, and access to effective therapy from professionals is now available to nearly anyone in the developed world.  

Question #6: What Kind of Study?

Science can be done a lot of different ways. Sometimes it's observational, done by researchers quietly watching and noting what's happening. Sometimes it's experimental, done by manipulating things in a laboratory or a hospital. Sometimes it's statistical, done by crunching numbers and finding patterns in data that other people have gathered. There are combinations and variations on all of these. When you start to parse it out, there are a lot of ways to do science. Here are some basic approaches for medical research alone:

No matter what the method, the goal is generally the same: to understand the world and universe we live in. But there are many ways to get there. Before you can weigh the value of the latest science news, you have to pin down what kind of study was used.

Here's a tip: Laboratory experiments are more controllable – researchers can generally do a better job of getting rid of factors that might interfere with the question they’re trying to answer (variables)– and provide more definitive answers. Observational and survey studies can often be more fuzzy. You can carefully define the behavior of chemicals in the controlled setting of a lab, but the effects of personal behavior on health involve a lot more factors that can throw off results.

The more variables there are, generally, the harder it is to come to firm conclusions. Diet and health studies are famous for this. Say you survey a lot of people about what they eat, and then track their health. Maybe you find something interesting: People who eat a lot of kumquats have longer life spans on average. And the inevitable news story comes out, “Kumquats Help You Live Longer!”

Don't believe it. First thing is to know the difference between correlation (one thing seems to happen at about the same time or in about the same amount as another thing) and causation (one thing causes another thing). I like this graph from our friends at Spurious Correlations, which certainly looks like a correlation. But causation, um, maybe not:

Surveys themselves are usually questionable. There are a lot of ifs, buts, and maybes involved in making and analyzing surveys. How the question is asked is important. How the survey is sent out, who responds and who doesn't, and how the numbers are crunched all make a difference. A lot of tools have been developed to make survey work more accurate, but there is no way to eliminate all the biases.

If you don't believe me, take a look at the recent poll results for the Democratic Party primary in Michigan. All of them – all of them – showed Hillary Clinton winning by, on average, around 20 percentage points. These were done by the most sophisticated survey experts on the planet. And they were all wrong. This example might not be scientific, but it shows the pitfalls of depending on surveys alone to draw important conclusions. 

There are questions to ask with other kinds of reports as well. Were medical studies done on humans or animals (mouse and rat results are notoriously hard to extend to real humans)? How many people were studied (the more, the better)? For how long?

And so forth. Once you start looking critically at how the study was done, you're well on your way to getting a better understanding of its value. 

 

Why People Get Whiplash from Reading the Latest Science News

You know how it is: Today's science news (especially today's diet or nutrition news) seems to contradict what you heard yesterday. Coffee causes cancer! Coffee prevents cancer! Eggs are bad for you! Eggs are good for you! And so on. 

We've been posting a list of questions readers should ask whenever they see a science story (check out our earlier blog posts to see more). Answering them will help separate solid and well-researched stories from hype and hot air. 

Underlying it all, though, is a more central point: Science doesn't exist to give you definitive answers. What most people don't realize — and what a lot of people making money off of science don't like to admit — is that scientific research is less The Word of Truth than it is an endless debate. Of course results contradict other results. Of course interpretations differ. Of course there is critique and sniping, revision and re-revision and re-re-revision. That's what science is all about. It's not final conclusions. It's a shape shifting, moving target, or a string of best guesses.

Uncertainty is an unavoidable part of current investigations

The paradox is that people look to the science news for just the sort of certainty they will never find. It is because, I think, they have the wrong idea of what science is and what it can do. 

The key here is teaching that science is a process, not an end point. Each individual study is merely one punch in a long sparring match, not the final word on anything.  I found a good summary of the issue in a publication of the European Food Information Council (EUFIC), part of which I share here: 

The scientific process is a road of discovery. It is the process of gaining knowledge about the universe through the observation of measurable evidence. Contrary to what many people believe, this ‘road’ is not a straight, smooth motorway: researchers may take different directions of exploration, going down routes that twist, turn, and sometimes even backtrack or come to a dead end, before the facts are uncovered. Even then, the facts uncovered may be only part of a larger, partially understood phenomenon, which requires further research before we come to more complete answers.

As a result, the scientific process—how studies are designed, conducted, and reported—frequently generates a great deal of debate. Tracking the debate is often key to putting new research into context. With that in mind, new research studies published in scientific journals should be viewed as discussions among scientists. In these discussions, almost no one gets to have the final word, as it is rare that a study provides a final, complete answer. In fact, occasionally even old, accepted research results are revisited and discussed again. With the benefit of new information or technology, scientists sometimes see previous research results in a new light. The publication of research findings allows researchers to get opinions and critiques on their work by other experts, which not only confirms or contradicts their conclusions but also adds to the body of literature on a subject and so helps shape future research.

The bottom line is that dialogues characterized by cycles of revision, conjecture, assertion, and contradiction are frequently key to investigating a subject.  Although such cycles often frustrate non-scientists and contribute to increasing public skepticism about advice on food and health, it is important to understand that science is evolutionary, not revolutionary. Because scientific research explores the unknown, uncertainty is an unavoidable part of current investigations.

PTSD: What is Trauma?

The word “trauma” covers a wide range of intense, violent, deadly, or terrifying experiences. A trauma in the context of PTSD refers to the event itself. What happened after the event is all post (after) trauma. Trauma is a fuzzier term than PTSD, which has an exact medical meaning. It is important to remember that most of the time a traumatic experience will not result in PTSD; fewer than 10% of people who experience trauma develop PTSD. Most of the common immediate responses to trauma, such as anger, violence, hiding, sadness, numbness, and so forth, are normal human reactions to traumatic events and generally fade naturally within days or weeks. PTSD only happens when these responses continue or get worse long after the trauma. When the body and mind get stuck as if responding to these extreme situations all the time, PTSD can be the result.

The CDC has some excellent basic info on PTSD and Trauma in this PDF (warning: PDF)

Traumas are generally events we do not expect and are unprepared for. It can take a long time to get over the emotional pain of traumatic events, and getting back to 'normal life' can be a struggle. Traumas can be mental or physical, and are often both to some degree. Brain injury for instance, is correlated with both stress and anger issues and PTSD, and is one of the most common injuries for returning soldiers. While the traumas themselves may be physical, mental, or both, PTSD itself is a mental condition, not a physical one.

The response to trauma is very individual, and what deeply affects one person may be shrugged off by someone else. This very individual response to trauma is one reason PTSD is under-reported in groups like the military. Because some people “can't take it” during or after combat, they feel like something about their mind must be weak compared to other peoples'. Feelings of guilt and personal inadequacy can lead people to avoid seeking help when they really need it.

Trauma is different from stress. Trauma is usually caused by a huge, unexpected tragic event, or series of events. Everyday stresses like paying bills, dealing with in-laws, or being in a minor accident might contribute to depression, anxiety, or just general frustration, but they don't count as trauma. Even the death of a loved one, unless it was violent or unexpected, is extremely unlikely to cause PTSD. Trauma, and the possibility of PTSD, involve violent or horrific events that are far outside the realm of everyday experience. This isn't to say that trauma can only be caused by single horrific events. It can be worse when the trauma is repeated, and a significant number of those with PTSD, including most soldiers, develop it from being in extreme situations for an extended time. So it's possible to develop PTSD from just one large traumatic event, or from a series of events which, taken together, are traumatic. Just the everyday activities of certain careers, such as being a prisoner, police officer, homeless, or working in an emergency room, can be enough to build up over time and cause PTSD.  

Want to more about trauma, PTSD, and the many symptoms and conditions that often come with it? Our easy-to-read Naked Facts books cover complex, debated topics in a way that's approachable and useful for patients, friends, and family!

We want to keep you up to date on what we're doing! Check out our feeds on facebook, twitter, or RSS to get notice of new Naked Facts titles, links to solid studies and interesting data, alerts of new posts articles on naked-facts.com, amazon giveaways, and more!  

How to Read the Science News #5: Who Published the Study?

When you're reading the popular science news – that gee-whiz stream of “Can you believe this?” “Miracle cure!” and “Everything you know is wrong” – it helps to ask a few questions. Here's #5 on the list: Where was the original research published?

Who do you trust?

Who do you trust?

This might sound dry and boring, but it's important. And pretty easy to answer. Real-world science doesn't matter, at least from a professional standpoint, until it's been published in a scientific journal. The standard process goes like this: A researcher does some science – conducts a series of experiments, crunches some numbers, makes a series of observations, whatever – and finds something that looks like a valuable new addition to their field. They don't blog it or go to their local newspaper. No, the first thing they do is write it up in the form of a formal research article and submit it to a scientific journal. The journal editors then review it and send it out to a few other researchers in the field for some critical feedback. It's called “peer review,” and it's a very important step. Letting other scientists look over the unpublished work in private allows them to comment on experimental shortcomings, question methods, analyze data, put it into context. It's an important quality control step. Only after the paper passes this peer review (often after several rounds of back-and-forth editing) is it published.

Most real scientists (as opposed to company PR people, marketers, or makers of diet supplements, skin rejuvenation creams, and other sciencey-sounding products) will not talk to the media until their work has been published in a scientific journal. If the news story you're reading doesn't mention an article published in a journal, be suspicious. Either the “scientist” whose work is being touted is not a scientist at all, or the work is not worthy of publication.

And even if a scientific journal is cited, it doesn't mean that the work is legit. Today, a number of publishers have figured out that you can start a publication that looks and sounds like a scientific journal, but is really a place where just about anybody can get just about anything published if they pay a fee. There is little quality control. 

How can you tell a legit journal from one that's not? Scientists have a pretty strong sense of what the top journals are. There is a sort of pecking order, with the most respected ones at the top, for every field of science. If you can get your research published in a top journal, it will have greater impact on the field. Their quality control is good, and the competition to get into them is fierce. In theory, top journals publish only top papers. 

There are different ways of measuring the best journals, but almost always a few major players are at the top of the general science list: Science (and its various sub-journals), Nature (and its sub-journals), The Proceedings of the National Academy of Sciences (PNAS), the publications of the Royal Society in the UK (the oldest of the group), and PLOS ONE (the youngest). Anything published in these journals can be trusted as a legit advance in science. You can find out more about top science journals here and here.

So it pays to know (a) that the research was published in any sort of scientific journal and (b) what that journal was. If the news was not based on a journal article – say it was based on interviews instead, or some “doctor” making claims – don't buy it at face value. You have to ask a few more questions: What are their credentials? What is their agenda? Will they profit from their statements? 

#4: Who Profits?

Question #4 in our ongoing series of things to ask when you're thinking about the science news: Who profits from the story? Okay this sounds cynical, but we have to get real: A lot of science and health stories in the news are there not because of the inherent value of the research, but  because they profit somebody. Sometimes it's denominated  in dollars, sometimes it's measured by political power, or how it furthers a social agenda. 

And everybody’s got an agenda. We know, we know, science is supposed to be neutral, pure, objective, and above all this, right?

A little, maybe. But not entirely. And certainly not when it comes to the science news. The stuff that makes it into the news -- a tiny fraction of the science that is done every day -- is often the end result of a complicated system that is more like making a business deal than presenting new knowledge. News organizations want to attract more eyeballs and bring in more advertising income. Corporations want to sell things and reward shareholders. Nonprofits want to trumpet successes and build support. Scientists want recognition and grant money. This is not to say that there are not selfless and goodhearted people in all these fields, but rather to emphasize that there are other strong forces at play. 

There remains the noble goal of increasing the sum total of human knowledge – the agenda of the best scientists. That gets something into a research journal, not all over Twitter. Most science  is slow, cautious, and incremental, adding small bits to correct, confirm, or tweak what we already know. That doesn’t make for exciting news copy. So the media play up other angles, highlighting controversies (even where little controversy might really exist), hyping little things as if they were big things, working harder to attract readers than to give a clear idea about an issue.

Add to that the endless pressure from special-interest groups who use science to promote their endeavors. When tobacco companies were attacked because cigarettes were shown to cause cancer, they fought back with a handful of well-paid scientists who argued the opposite view. They managed to take an issue on which the majority of scientists agreed, and make it look like an argument between two equally balanced sides. The same technique is being used to make the scientific consensus on climate change into a debatable point. There are so many researchers in the world that you can always find someone with a Ph.D. to argue your point for you. And the media loves that. A good fight always attracts an audience, so the media play up both sides, regardless of how valid the arguments. 

That's the suspicious side of the news. It's only gotten worse since big newspapers and news organizations cut back on positions for trained science writers, the kind who can judge what's real news and what's smoke. The good side is represented by organizations that actually seek out real news and present it fairly. SciCentral links to many of these; the BBC and Science Daily are reliably good.

Is the science news you read based on substance, or it ginned up to promote an agenda? Whenever you read a story, ask yourself, “Who profits?” It will help you put the hype into perspective. 

Question #3 When Reading the Science News: Who Paid for It?

Take a closer look . . . 

Take a closer look . . . 

Another in a series of questions we hope every reader asks when perusing the latest science news (previous posts here and here). After making sure that the latest "breakthrough" is based on some real research and finding out who did it, it's time to peel back the next layer:

#3 Who paid for it? Hundreds of scientific advances are published in research journals every day. But only a tiny fraction make it into the news. Many break into the news not because they're important in and of themselves, but because somebody pushed them out onto the TV, splashed them across the web, or spun them into newspaper headlines. Often that somebody has an agenda. As a critical consumer of the news, it's your job to see through it. 

Most reputable science journals demand that scientists publishing research in their pages disclose whether they’re in the pay of companies who might profit from the results. A company making a new drug, for instance, might try  to publicize the product by putting out positive research results. The company might get some PR firm to ghost-write the potentially profitable findings in the most positive way, then get the scientist to sign off, and submit it to a journal. It look like real science. But it's really a form of marketing.

The point is that it's not pure science. It's science done for profit. And good journals make sure that readers know about it by demanding that the authors of the paper disclose any potential conflicts of interest, any firms they work for that stand to make a profit off the results. The problem is that while the journal might include that information (the best ones do, but not all of them), news stories often don't. If you're really interested in knowing whether a story is slanted, sometimes you have to go back to the original research paper and check for yourself. 

If the study was backed by a for-profit company, be skeptical. But it's not only corporations that you have to watch out for. The same rules apply if the research was done or funded by a public interest group devoted to promoting a particular cause. Any self-interested sponsoring group will be tempted to highlight results that favor their agenda and bury conflicting evidence. 

It doesn't necessarily mean that the science is bad. It just means that it might be slanted, or skewed, or pushed beyond its real level of importance. Critical readers need to take that into account. 

PTSD: What You Might Not Know

The latest book in the Naked Facts series is now up for sale on Amazon! In it, we explore Post-Traumatic Stress Disorder, or PTSD, and look at the history, treatments, research, and current expert opinions on this widespread, but little-understood condition. We want people to understand not just individual issues or numbers, but to have the context and scientific landscape in focus around the subject to really understand how it relates to them and their concerns. So here's a quick landscape of PTSD, what it is, who gets it, and how we look at treatment. We'll be diving more into each of these areas in frequent new posts, along with other science and medicine news.

PTSD is the term is used by the mental health community to describe long-term negative reactions to events so stressful or shocking that they cause ongoing negative thoughts, feelings, and behaviors long after the events are over. Events like theses are called traumas, or traumatic events. PTSD sufferers can experience unwanted memories, dreams, or flashbacks. Memories and events too painful to process can leave sufferers in a permanently scared or alert mental state that can lead to anger, exhaustion, and depression. PTSD is caused by a traumatic event, and getting the to root of the trauma itself is often the focus of therapy. Other therapies focus on managing the symptoms – easing anxiety, helping with sleep, and so on.

PTSD is a widespread condition both in the United States and globally, with around 8% of the US population estimated to suffer from it at some point in their lives. Soldiers, police officers, prisoners, the homeless, and victims of physical or sexual abuse all run a higher risk of developing PTSD, but the condition can happen in anyone who lives through extremely dangerous or terrifying events, or things like natural disasters or seeing someone violently killed.

Much is being learned about how to help sufferers. Both medications and talk therapies exist that are very effective in combating the symptoms of PTSD and addressing the root issues that brought the condition on in the first place. However, there are still some major issues with the current top therapies. While knowledge of what can cause PTSD and how to address it has gotten much better, there are still more questions than answers when it comes to this quiet epidemic.

We'll be posting over the next weeks and months on current issues affecting PTSD sufferers, as well as its history, research, and therapies, all from a big picture, open and honest, scientific perspective. Of course you can support us and learn a whole lot more about any of the subjects we discuss by buying one of our Naked Facts books! We put a lot of time into them and think the series, as it expands, will be accessible and informative in a way everyday people can understand. We envision these books as a great resource for support groups, schools, friends and families that deal with these issues, conditions, or medications.

We want to keep you up to date on what we're doing! Check out our feeds on facebook, or twitter to get notice of new Naked Facts titles, links to solid studies and interesting data, alerts of new posts articles on naked-facts.com, amazon giveaways, and more.  

Question #2: Who Did the Original Research?

Science is fun! And maybe even profitable.

Science is fun! And maybe even profitable.

Any good science news story has to answer some basic questions. If it doesn't, don't believe it. Top of the list: who did the original research, when and where? If the work was done by scientists working for a for-profit company or politically motivated think tank, be skeptical. Those people are paid by people who have an agenda, and the "facts" presented are likely to be carefully groomed to promote that agenda, not give you the full story. It's not that industrial or politically motivated research is worthless -- some of our greatest advances were made in the labs of for-profit businesses, from Bell to Tesla (both the old Wizard and the new car) -- but they tend to be advances in making stuff rather than advancing the frontiers of science. When it comes to scientific research, look for studies run by scientists at top universities or respected publicly funded research groups like the National Institutes of Health. They're less driven by money (although not entirely) and more likely to present the truths of nature as revealed to them, rather than attired in the raiment of profit. 

When the research was done is important, too. In the past two weeks I've read two big-headline stories in big-name news sites that were all about work actually done more than a decade ago. The "news" was not new at all. But you'd never find that out without digging down behind the headlines to the original papers. More on that later. . . 

Question #1: Where's the Proof?

Nothing to do with science, just couldn't resist the headline.

Nothing to do with science, just couldn't resist the headline.

Every Naked Facts book includes a handy guide to help you judge the latest science news. It's our way of dealing with the crappy science coverage in most news media, most of which headline poorly written "gee whiz" stories that give readers whiplash when one story is contradicted by the next (Today: "Coffee Causes Cancer!" Tomorrow: "Coffee Stops Cancer!"). It's not good for readers, and it's not good for science. 

So we put together a list of seven simple questions to ask the next time you read about a "breakthrough".  We'll run one of these tips every day for the next week. 

Question #1: Where’s the proof? This seems almost too simple. But many people reading the news don’t pay attention to the one thing that really matters: Where’s the evidence that this “discovery” is real? Never accept anything just because a reporter says so. Demand proof. If the story doesn't quote some real scientists from real laboratories and refer to some real articles in real journals, junk it. The reporter's trying to scam you. 

More tomorrow.