Book Review: Madness and Memory by Stanley B. Prusiner, M.D.

I thought I'd take a short break from the main themes of this blog to focus on another subject on which I have been working (getting together an edited volume by multiple contributors): How scientists may block important, transformative ideas from gaining prominence because of group biases and prejudices. 

I will review the book Madness and Memory, which is an amazing first-person account of the trials and tribulations of one scientist who somehow managed to keep getting his research funded, and who continuously did very careful studies despite mass skepticism about his discoveries from other scientists as well as from the lay press.

Strangely enough, the skepticism from infectious disease doctors, particularly those who specialize in viruses, continued even after the scientist, author Stanley Prusiner, was awarded the Nobel Prize in medicine for his work!

In this case, I do understand the reasons for the skepticism. Dr. P. discovered an entirely new form of seemingly self-reproducing infectious agent that did not contain either DNA or RNA. These nucleic acids were reasonably thought by almost all biologists to be required for any biological agent to reproduce itself. The new agents are called prions (pree-ons), and consist entirely of proteins. 

They are the definite cause of some obscure neurological degenerative diseases such as Kuru, Scrapie, and Creutzfeld-Jakob disease. (In medical school I knew it as Jakob-Creutzfeld disease - the name reversal has a rather silly story which the author relates in his book. Despite the ramblings of memory "expert" Elizabeth Lofton, my memory that the name had been different when I was in medical school 45 years ago was entirely accurate).

You may also have heard of another important prion-caused entity, dubbed by the press as "mad cow disease." People could get it from eating meat from infected cattle.

Most importantly, prions are quite likely the cause of the more common types of neurodegenerative disorders: Parkinson's Disease, Lewy Body Demetia, and Alzheimer's.

As best as I can understand prions from the descriptions in the book, they are once-normal proteins that had been encoded, as one might expect, by chromosomal DNA in various organisms, but which somehow later changed shape and became almost more of a toxin than an infectious agent. The altered proteins then somehow lead to a chain reaction in which other normal proteins of the same chemical makeup change shape as well, and therefore seem to multiply. 

Tissue with the prions can then be transferred to another organism and then start to destroy the nervous systems in the new beast over extended periods of time. The time before animals become symptomatic can be years. (Before it was found that prions contained no DNA or RNA, these diseases were assumed to be caused by a "slow virus"). It is this property, I surmise, that makes them "infectious."

The fact that Prusiner did not get discouraged when he was being attacked by all sides is very impressive. His networking skills must have been substantial, as every time someone threw a road block in the way of his research, he was able to find someone else who could provide him with an alternative. 

He would literally call up the editors of the most prestigious journals like Cell and Science and discuss his research results before even submitting an article for publication. (When I was an academic, I had no idea that you could even do that! And I probably wouldn't have gotten away with it anyway). He was also able to manage to find help from academics in several seemingly unrelated disciplines who would be key in his discoveries.

At least he didn't have to worry about the privacy rights of his rats and hamsters. Psychiatrists like me who work with subtle and pretext-laden human interactions have to be concerned about that.

The pressures he faced were enormous. In academia, if you don't get enough publications, you don't get tenure, and if you don't get tenure, you no longer have a job. You also live in constant fear that some other scientist somewhere else will beat you to a confirming experiment and publish it before you do, or that someone else will make a discovery that will bring your ideas into question ("A few pages in a reputable journal can render another scientist's years of toil virtually worthless"). 

You get feedback from "peer reviewers" of your submitted work than can be absolutely vicious. Dr. P. had to suddenly find new places to house his rodents due to concerns about animal rights activists who were more concerned with rats than people. The press, always looking for a sexy story, quoted his critics to publicly attack him.

I am envious of anyone like Dr. Pruisner who was so skillful at negotiating academic politics, because I was not. I unfortunately had minimal guidance from those around me. I found it impossible to get funding for researching the phenomena that I was witnessing first hand every day in my practice with my patients with personality disorders and their families, and which only one other author was even writing about. 

Prusiner quotes someone named Maurice Maeterlinck about this type of problem: "At every crossway on the road that leads to the future, tradition has placed, against each of us, then thousand men to guard the past."

He also quotes Hilary Koprowski on the "Four stages of adopting a new idea:"

1. "It's impossible, it's nonsense, don't waste my time."

2. "Maybe it's possible, but it's week and uninteresting. It's clearly not  important."

3. "It's true and I told you so. I always said it was a good idea.

4. "I thought of it first."

For anyone interested in understanding what doing science is really like, and what scientists can be up against, I recommend this book.

More Great Quotable Quotes from People Who Agree with Me About Stuff

Today's post is the second of a series of two containing some of my favorite recent quotes that center around themes discussed in this blog. 

As mentioned, I have been collecting the quotes and putting them on my Facebook fan page at http://www.facebook.com/pages/David-M-Allen-MD/80658565761?fref=ts. The ones posted here started in January of 2014, and are loosely organized by topic. 

Family Dysfunction

"Taking responsibility for something and self-blame are horses of two entirely different colors. The former is empowering; the latter is paralyzing." ~ John Rosemond, Ph.D

Chronic Mental Illness

Our prison population is bigger than Slovenia
Cause we put people in jail instead of treating schizophrenia 
        ~ John Oliver

On trying to find the cause of schizophrenia: "30 wasted years of looking for bad mothers followed by 30 wasted years looking for bad genes." ~ E. Fuller Torrey, M.D.

Psychiatric Practice, Electronic Medical Records, and Managed Care

"The shift from benzodiazepines [for anxiety disorders] to antidepressants is one of the most spectacular achievements of propaganda in psychiatry." ~ Giovanni Fava, M.D., clinical professor of psychiatry at SUNY in Buffalo.

"You're complaining about a Freudian slip? Freud should be able to wear whatever he wants." ~ Tony Kreitzberg

"Why would anyone want to teach me to tolerate my pain? My only interest is in removing it!” ~ Cynthia Mueller, a blog reader, when first exposed to the DBT treatment model for borderline personality disorder.

"Methadone and Buprenorphine [suboxone] should be our first line opiates for use in the treatment of severe acute pain. That way, if patients become addicted to them, they would already be taking the appropriate treatment for their addiction!" ~ Steven A. King, M.D.

"The current EHR has destroyed the narrative, especially in psychiatry, and converted the basis of care to a checklist." ~ George Dawson, M.D.

"It's not just about doing the right thing for your patients, it's about proving to someone else that you've done the right thing, and sometimes "I can't quite remember if I'm an underpaid physician or an overpaid data entry clerk!" ~ Dr. J.D., Family physician.

"The proving [that I did right by a patient] takes longer than the doing." Chrisitine Sinsky, M.D.

"You don't need any research to show that if you are cycling people with serious mental illnesses in and out of short stay psychiatric units in 3 - 5 days and basing their stay there on whether or not they are "dangerous" and using treatments that take weeks to work that by definition you are appearing to treat many more patients but providing adequate treatment to very few. You don't need any research to show that when you shift mental health care from psychiatric units run by psychiatrists to county jails that the outcomes will be worse. You don't need any research to show that when people do not get research-based psychotherapies in the manner that they were designed and instead get a few crisis oriented sessions that do not address their basic problems that outcomes cannot hope to be better. When your attitude is that all mental health treatment can proceed by treating common problems with definite social etiologies with medications as fast as possible and not having an intelligent conversation or working alliance with the person affected - it is logical that treatment outcomes will not improve. Treatment outcomes do not improve if you do not provide effective treatment and that is the mental health landscape at this time." ~ George Dawson, M.D.

"I don’t know if anyone has ever not tensed at being told to relax." ~ Carolyn Hax

"Health care systems that allow patients to rate their doctors on satisfaction ratings without considering that patients might be dissatisfied with reality should be held to task." ~ George Dawson, M.D.

"You want a tale of two cities...look how the financial services industry has captured regulation to their advantage vs. how doctors have been battered by regulation. But it's based on the mind-set of Goldman Sachs vs. the mindset of the family practitioner...who politically shows up for a gunfight with a butter knife." ~ James O'Brien, M.D.

"Managed care has done an expert job of cost shifting by developing business friendly treatment criteria, abandoning the social and community mission of treating difficult problems associated with mental illness and addiction, and removing the element of humanism from psychiatric treatment. When I first started to practice, discharging people from a hospital when a psychiatrist had serious concerns about whether or not they could make it or whether they would be safe was very uncommon. Today those discharges are the rule rather than the exception largely due to the imaginary dangerousness criteria. "~ George Dawson, M.D.

Drug War

"When we talk about marijuana as a gateway drug, we have to remember that the last three occupants of the White House have smoked marijuana. We can very well say marijuana is a gateway drug to the White House” ~ Carl Hart, Ph.D

Psychiatric Diagnosis

"Then there’s the matter of testing a child to determine if he has ADHD. The plain fact is that none of the published diagnostic criteria depend upon test results. They refer to behavior, period." ~ John Rosemond, Ph.D.

"A [mental] disorder does not operate with [social environmental] discrimination. If something was “wrong” with [your child], she would be obnoxious in front of friends, their parents, teachers, and the people in white coats who came to take her away (tra la, for those who appreciate the reference)."
~ John Rosemond, Ph.D.        

            ("Actually, "Ha Ha" and not "Tra La" ~ Napoleon XIV)

A reader writes that her friends 'recently spent around $300 on their daughter’s birthday party—her first. They bought lots of stuff to entertain their young guests and extended family. The child, a baby, obviously had no clue what was going on. I should mention that the parents are struggling to make ends meet.' As my readers know or should know, I am a psychologist. That qualifies me to determine and assign psychological diagnoses. As such, it seems obvious to me that these parents suffer from a now-commonplace parenting malady known as just plain nuts." ~ John Rosemond, Ph.D.

"One symptom does not make a diagnosis " ~ John Rosemond, Ph.D.

"Test anxiety is frequently not an aberrant psychological response - it is instead the normal anxiety anyone would feel in facing a situation for which they were inadequately prepared." ~ Barbara Oakley, Ph.D.

"Under the influence of intense affects, EVERYBODY becomes an idiot."~ Otto Kernberg, M.D.

"Only in America does 'gotta' substitute for 'wanna' so we can avoid the guilt. " ~ The Last Psychiatrist

ADHD

"An often trivialized cause of irritability, difficulty concentrating, reduced vigilance, distractibility, decreased motivation, lack of energy,and disturbed mood: insufficient sleep syndrome. People with this syndrome, common in our 24 hour society, intentionally curtail sleep for work, social, family, or other reasons. According to the International Classification of Sleep Disorders, a practical and effective remedy does exist: more sleep." ~ Psychiatric News.

"The maps of child obesity in the U.S. look suspiciously like those of the ADHD epidemic, with the highest rates in the deep South." ~ Psycritic

"It’s truly surprising how many parents have been told that if their child did not have ADHD the child would not respond to stimulant drugs. In the blitzkrieg of World War II, German bomber pilots took a stimulant drug with a chemical structure similar to that of Adderall. When the American military discovered how much the stimulants helped German pilots, they put stimulants in the kit of every American and British bomber pilot to improve their concentration and alertness on long-haul missions. Surely not all these pilots had ADHD." ~ Marilyn Wedge, Ph.D.

"...after taking the [drug company-designed screening] ADHD quiz, I've realized that both I and my cat have the dreaded disease. I'm off to get us both the treatment we need." ~ Anonymous comment on one of my blog posts.

Evolutionary Psychology

"Selfishness beats altruism within groups. Altruistic groups beat selfish groups. All else is commentary." ~ David Sloan Wilson, Ph.D.

"We mammals are curiously preoccupied with social hierarchy. You may say you don’t care about status, but if you filled a room with people who said that, they’d soon form a hierarchy based on how anti-status each person claims to be." ~ Loretta Breuning, Ph.D.

Some Great Quotable Quotes from People Who Agree with Me About Stuff - Part I

Some people just naturally have a way with words, and succinctly summarize ideas using comments that I wish I had come up with. 

Today's post, the first of a series of two, contains some of my favorite recent quotes that center around themes discussed in this blog. Many of them come from three of my favorite sources of great quotes: advice columnist Carolyn Hax, parenting advisor John Rosemond, and fellow blogger George Dawson.

Of course, the authors of these quotes and I do not agree about many other things, but so what?

I have been collecting the quotes and putting them on my Facebook fan page at http://www.facebook.com/pages/David-M-Allen-MD/80658565761?fref=ts. The ones contained in this post and the next started in January of 2014, and are loosely organized by topic.

You may find a hidden joke or two among the mayhem.

Psychiatric and Psychotherapy Research

"A significant p value does not specify the probability that the same result can be reproduced in another study." ~ Prof. Gerd Gigerenzer, Max Planck Institute for Human Development.

"If being cited [as a reference in another published study] meant being read, citation statistics might well be a useful criterion. Yet a study estimated that of the articles cited, only 20% had actually been read... For instance, the most important publication in 20th-century biology, Watson and Crick’s paper on the double helix, was rarely cited in the first 10 years after its publication. Innovative ideas take time to be appreciated."
       ~ Prof. Gerd Gigerenzer

It's all in how you look at it, Department:

Medscape News Story about a Study: "Individuals with a neurotic personality type may have reduced brain plasticity during the performance of working memory tasks that may affect their ability to store memories, say US researchers in findings that show the opposite effect in people with a conscientious personality."

         Said one commenter in response: "It is nice to have documentation what those of us who have hired office help have known for years. Personnel with personal problems that occupies their minds continuously are unable to perform satisfactorily in the office."

" I have lost count of the number of papers [that "study" what is supposed to be major depressive disorder] I have read where the depression rating scores were what I consider to be low to trivial." ~ George Dawson, M.D.

In a PTSD study comparing CBT to psychodynamic therapy: "The so-called psychodynamic therapists were also forbidden to discuss the trauma that brought the patient to treatment. Imagine that—you come to treatment for PTSD because you have experienced a traumatic event, and your therapist is forbidden from discussing it with you. When patients brought up the trauma, the therapists were instructed to change the topic." ~ Jonathan Shedler, Ph.D. 

"Evidence based data' is suggestive but typically based on group data, hence only suggestive when working with a single patient. Other sources of suggestions are also available." ~ Thad Harshbarger, Ph.D.  

"The notion that biological changes going on during early adolescence predispose the young teen to all manner of difficult behavior is a myth belied historically, cross-culturally, and by the fact that plenty of young teens are respectful, obedient, and hard-working. That last fact is conclusive evidence to the effect that despite hype to the contrary, there are no changes going on in the young adolescent brain that make inevitable any sort of problematic behavior." ~ John Rosemond, Ph.D.

"When every study reported by a particular group of researchers just happens to reinforce their shared belief system, it makes me skeptical." ~ Loretta Graziano Breuning, Ph.D. 
         Are you listening, CBT and bipolar II researchers?

"Neuroscientist: someone who knows how little we know about the brain." ~ Neuroskeptic

“Maybe sometimes it’s the questions that are biased, not the answers,” ~ John Ioannidis, Ph.D., on bias in medical research - for example,drug companies comparing their new drugs against those already known to be inferior to others on the market.

"Blaming personality disorders on brain pathology due to bad genes is like "blaming badly written software on the hardware." ~ "SwissCheese," who commented on a post on my Psychology Today blog and says he's a computer scientist married to someone with borderline personality disorder.

"The NIMH devotes almost all of its enormous research budget to glamorous, but very long shot, biological research that over the past four decades has contributed exactly nothing to the treatment and lives of the severely [mentally] ill." ~ Allen Frances, M.D.

"The trial result generally depends on rating scale or clinician global rating scale results that grossly oversimplify the condition and measure parameters that are irrelevant in clinical settings. The best example I can think of is depression rating scales that list DSM criteria for depression and then apply a Likert dimension to those symptoms. In clinical practice it is common to see hundreds of patients with the same score on this scale who have a full spectrum of disability from absolutely none to totally disabled. Which population might be more likely to exhibit an antidepressant effect? " ~ Richard Dawson, M.D.

"Published' and ‘true' are not synonyms" ~ Brian Nosek, Ph.D., a psychology professor at the University of Virginia in Charlottesville

"Laboratory studies of social attention have largely focused on the extraction of social information from images (e.g., photos and videos). However, in the natural world attending to real people involves both the reading of social cues and the sending of social signals. ... the influence of another individual on human behaviour is so pronounced that the implied social presence of another person is enough to have a profound effect on where people look, what they say and do, and even modify their willingness to cheat or to engage in prosocial behaviours." ~ Alan Kingstone, Ph.D.

"The hypothalamus is involved in the body's centrally important "Four F's:" fight, flight, feeding, and sex." ~ Otto Kernberg, M.D.

"No man should escape our universities without knowing how little he knows." ~ J. Robert Oppenheimer

"The biggest misconception here seems to be that patients are accurate reporters and they have no unconscious agenda." ~ George Dawson, M.D.

Relationships

"No one can help you if you’d rather be safe than brave.” ~ Carolyn Hax

"Hiding how you feel is how love dies. You think he backed the wrong horse here? Then say so. A grown-up won’t make you pay." ~ Carolyn Hax

"You want a spouse who wants to meet your needs, as part of a commitment to mutual support." ~ Carolyn Hax

What to say to a spouse who refuses to see a marriage counselor when you request it, because he or she doesn't have a problem, it's all just you: "But you do have a problem: Your marriage is in trouble." ~ Annie's Mailbox

"You either aren’t up to this challenge or you don’t want to be, and that’s all you need to know, because choosing a life partner isn’t about being open-minded or fair or noble. It isn’t just about loving or being in love, either. It’s about an unflinching estimation of what works." ~ Carolyn Hax

"One problem that recurs more and more frequently these days, in books and plays and movies, is the inability of people to communicate with the people they love: husbands and wives who can't communicate, children who can't communicate with their parents, and so on. And the characters in these books and plays and so on, and in real life, I might add, spend hours bemoaning the fact that they can't communicate. I feel that if a person can't communicate, the very least he can do is to shut up." ~ Tom Lehrer

"If people are determined to be insulted, they will find a way to be insulted." ~ Amy Dickinson

Parenting

"An adult who enters into a power struggle with a child is no longer acting like an authority figure; therefore, the only person with any power in an adult-child power struggle is the child." ~ John Rosemond, Ph.D.

Letter to advice columnist Carolyn Hax: I am happy he is sharing his interests (in rap music) with me and I have explained to him my perspective that the material makes me uneasy for all of the above reasons. His interest continues unabated. Do I set certain limits on what he can listen to (he is 14) or do I just let it be and hope he grows out of it?

          Ms. Hax's answer: You omitted (c) Raise him, then trust him, to be one of the millions of people who are able to distinguish between an art form and an instruction manual for the treatment of others.

"I, too, am skeptical of the 'Oh you’ll love them when they’re yours' line. Some people regret having kids and just know they can’t say that out loud, and I’d wager there’s a bigger population who don’t even let themselves think that." ~ Carolyn Hax

"Helicopter parenting now seems to have blossumed into Apache Blackhawk parenting." - John Rosemond, Ph.D.

"Parents help their kids with homework, often downright doing it for them; they help their kids study for tests; and they demand of educators that their kids’ school experience be immaculate. I don’t believe that pouring more money into education has worked or is going to work, but I do believe that teachers should be duly compensated for putting up with this garbage. " ~ John Rosemond, Ph.D.

"Parents who are not on the same parenting page will not get on the same page by regarding and treating their differences as a parenting problem. It's a marital problem." ~ John Rosemond, Ph.D.

To be continued.....