Archive for the ‘Books’ Category

What a novel! Written in 1884, Flatland explores the idea of a 2D and 1D universe and the maths surrounding that, in an engaging and humorous way. It follows the life of the protagonist, a square, as he describes his world and visits others.

How does a 2D world look for example? You can only see in one dimension so how do you tell the difference between different shapes when everything looks like a line? What challenges does that present for society? For building design? For interacting with other people?

The same issues occur when the square visits lineland, a one dimensional universe. As well as the difficulties of trying to explain another dimension to those who live in said worlds. Upwards, not northwards!

In The Emperor’s New Drugs Irving Kirsch argues that antidepressant do not work. Well, sort of. What he argues is that the majority of the benefits of antidepressants are also found in placebo and that the additional drug benefit of antidepressants is explained by the enhanced placebo effect generated by the significant side-effects of the drugs.

He begins by talking about the meta analysis he did showing that almost all of the benefits from antidepressants come from the placebo effect. When he published this, the response of the medical community was “yeah, well we know that already”.

The problem with working out if antidepressants work is because it is really difficult to control for. You can add a placebo group, but because placebos cause less side effects it is easy to break blind. Indeed, 80% of patients on the drugs in one study were correctable able to guess they were in the test group. Also, the increased side effects could produce an enhanced placebo effect rather than a drug benefit.

Comparator trials, trials in which you compare with other antidepressants, are also problematic because everyone knows they are on an active drug, and therefore everyone can benefit from a strong placebo effect.

If his claims were true, you could surely use any drug as an antidepressant as it just has to cause side effects to work though? As it turns out, that is basically what we have. SSRIs, NDRIs, beta-blockers, stimulants, depressants, they all produce the same success rate in treating depression.

But surely NICE, the National Institute of Clinical Excellence, are here to protect us? In theory yes, but Kirsch claims they have trouble getting all the data they need. Drug companies publish studies multiple times, publish summaries across different studies and combine them in different ways to make it incredibly difficult for NICE to work out whether they have duplicate data in their own meta analysis.

He also attacks the idea that depression is caused by a chemical imbalance. If it is, we should be able to cause healthy people to become depressed by lowering their levels of serotonin and other monoamines. But we can’t.

Also, we should be able to effectively treat the imbalance. But again, we can’t, people just respond consistently no matter what treatment we give them. For example 60% respond to SSRIs and 59% respond to NDRIs. If we assume that is is a chemical imbalance, there is no way those numbers should be able to add up to more than 100%.

In summary, Kirsch argues that antidepressants to not out-perform active placebo and therefore subjecting patients to the significant side effects is unjustifiable.

I would like to read some rebuttals before I come down on one side or the other, but it is certainly a thought-provoking book.

A note for antidepressant users

In this blog post I have tried to set forward the views expressed in The Emperor’s New Drugs. I honestly do not know what to believe. However in April, I wrote a blog post in favour of antidepressants. I have thought about whether I should reference the two, and I think it is probably best that I add this disclaimer.

This book does not claim that antidepressants do not work. They clearly do. The question is whether their entire effect is due to the placebo effect, or whether they have a drug benefit on top. This is not that relevant for a user of antidepressants though. If you are using them, and they help, keep using them, because the placebo effect is a real, clinically proven, measurable health benefit.

And of course, discuss any medication chances or concerns with your doctor.

Ah, The Great American Novel. Mark Twain chronicles the adventures of Huckleberry Finn and Jim, a runaway slave, as they raft down the Mississippi River. Some would see it as an epic tale of the people the two meet while travelling. I, with my in no way biased brain, saw it as the story of Finn deciding between being racially tolerant or following his religion.

Tom Sawyer is an odd character. He just does stupid stuff so that it can be like the movies. Or at least that is the term he would have used if movies had existed in 1884.

I didn’t have the manga edition. But it looks cool.

John Steinbeck is better known for his serious and deeply-moving novels, notably The Grapes of Wrath. However, he did have a sense of humour too and wrote several darkly satirical novels, one of which was Cannery Row.

Set in a working sea-front town in the Great Depression, Cannery Row reminded me every much of Catch-22. Probably because both of the audiobooks I have had the same author. But Heller and Steinbeck display the same utterly dry sense of humour when it comes to writing about less-than-ideal conditions for humans to live in.

It’s fairly short, especially compared to some of his other works, and wanders around with a much more relaxed feel to the plot line.

Boo, Tiffany Aching novels. They’re good, but they’re not adult Discworld good. The discussion of Tiffany’s life as the local witch was good but I wasn’t even really following the Cunning Man stuff. There was no drama as she was obviously going to beat him and did easily.

Dylan Evans is an academic who works on robots with emotions. Or he was until he sold his house, moved himself and a group of volunteers to Scotland and tried to live out an experiment in whether he could survive the apocalypse. Turns out, he couldn’t.

This book really interested me. Unfortunately, there was not that much about the actual experiment in there. It doesn’t even begin until a third of the way into the book and most of the book is about the mental breakdown he had because of it and his subsequent time in hospital.

This in itself is interesting, though. The realisation of what he has done. In the novel, he talks about re-reading The Blank Slate and remembering that people are not the noble savage he hoped they would be when freed from society. That strong leadership is needed. He had even reviewed the book for a newspaper and yet still ignored it when starting his experiment. It is a sobering reminder into the mind’s power to compartmentalise.

He also realised that society is actually really good. You can lead The Good Life if you want to, but there is simply no reason you need to grow your own vegetables and make your toothpaste – the stuff you can get at the supermarket is fine. Better often.

Does this mean that any vision of utopia is dead? Yes. Deal with it.

The Varieties of Religious Experience is a 1907 book by psychologist William James. I first came across James in Richard Wiseman’s book Rip It Up in which Wiseman talked about James’ beliefs in behaviourism, a subject which much evidence is now converging on.

James was also interested in religion as well and gave a series of lectures in 1901/1902, which formed this book. He focuses on direct experiences – that is to say the people who not only talked to god, but god talks back to them.

It was tough going. I didn’t find the language a problem but the subject matter is heavy and following the points made was at time difficult, even though each case was well illustrated by anecdotes.

It was interesting that he briefly mentioned the rise of atheist churches in the form of the flourishing Ethical Societies that were on the rise at the time. From Comte’s Religion of Humanist to the Sunday Assemblies currently sweeping the world, it’s interesting to see how the wheel turns.

A Portrait of the Artist as a Young Man is James Joyce’s first novel. As a consequence, his literary style is still developing and as a consequence, large segments of this novel are understandable.

It follows the adventures of Stephen Dedalus, later to appear in Ulysses, throughout his young life.

The best bit is the fire and brimstone preaching. I’ve never heard a preacher having a proper go at it, so the description in this was brilliant. It goes into so much detail about how the tortures are so bad, how the flame never cools and how you never acclimatise to the torment. Scary stuff!

Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong is a book by David Goldhill about the American healthcare system.

Their healthcare is comparable to that provided by the NHS. However we rank better because we spend only a third of the money the US does. Someone told me they spend more tax money than we do, even before the insurance costs, though I do not have a source for that.

Goldhill points out a number of problems, some common across all healthcare systems, others specific to America:

• Holistic care, phsycholical factors in recovery and control of infections are often overlooked – for example making the ward look nice, keeping records electronically and emptying the bins before they overflow.
• Insurance systems do not make sense because healthcare is not a risk, it is an inevitability.
• There are incentives to take medication – you can take statins to lower your blood pressure, or you can lead a healthy and active lifestyle. Your insurance pays for the former but not the latter.
• There is little focus on cost in insurance-based systems.
• 68% of hospital beds in America are provided by non-profit hospitals, yet they do not produce better results than for-profit ones.
• Medical errors, hospital-acquired infection and over-treatment kill as many people as many major medical conditions

His solution is to crap the insurance system and replace it with a loan based system. A typical American will spend around $1,300,000 on healthcare over their life-system so Goldhill suggests giving them that as fund, with a small insurance system for catastrophic conditions that cost more (though he argues nobody would charge more in a market-based system).

On a tangent, he also talks about how state assistance to buy a house actually helps rich home-owners rather than first-time buyers. I blogged about this in June.

Reading it, it made me glad we have the NHS. Of course, it may be a case of the grass is always greener where you live (which is now a thing) as the NHS is proving highly ineffective for me at the moment. Overall, as I said at the start though, we probably get the better deal spending far less on health care for a slightly better life expectancy.

Why Not Eat Insects? is a 1885 book by Vincent M. Holt. Surprisingly enough, it is a book advocating the consumption of insects. And why not? They are nutritious, tasty and plentiful.

He starts off by tackling the prejudice against eating them. We think it is a weird yet people all over the world do it. We worry that they will have fed on the wrong stuff, but this is unfounded. Most insects are vegetarians. Compare this to pigs. They will eat anything. Lobsters too. Lobsters are often caught wild and so you have no idea what they have eaten; putrified dead fish being one of their favourite meals.

He then goes on to suggest how to catch, prepare and cook a variety of insects including snails, moths, woodlice, caterpillars and others. He even concludes with some sample menus you could use for a dinner party!

It’s quite a small book; I got through the entire thing in about 45 minutes. It is also a reproduction and suffers from some flaws in the process, so is perfectly readable.