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by Vaughan

Far from the madding crowd

March 11, 2009 in Blogs, Mind Hacks by Vaughan

The Economist has an excellent piece on crowd psychology and why group behaviour is essential in calming down street confrontations before they turn violent. Crowds are often associated with senseless aggression, and perhaps the most widely quoted, and most colourful example, is from Gustave Le Bon’s 1895 book The Crowd . He wrote that crowds showed several special characteristics such as “impulsiveness, irritability, incapacity to reason, the absence of judgment and of the critical spirit, the exaggeration of the sentiments, and others besides – which are almost always observed in beings belonging to inferior forms of evolution – in women, savages, and children, for instance”. You can imagine how he went down at parties. Nevertheless, this association between crowds and violence has remained a research focus for many years. Concepts such as deindividuation – a reduction in the feeling of personal identity and responsibility – are invoked to explain why ‘bad things’ supposedly happen when people congregate in groups. This also typically includes explaining why ‘bad things’ are allowed to happen without people intervening – the so-called bystander effect The Economist article is interesting because it looks at research which seems to turn these assumptions on their head. It discusses the work of psychologist Mark Levine , who studies crowd behaviour and has found that crowds actually act to reduce violence in many situations. He has been analysing CCTV footage of incidents that control room operators thought might turn violent, not all of which did. His first observation was that bystanders frequently intervene in incipient fights. The number of escalating gestures did not rise significantly as the size of the group increased, contrary to what the bystander effect would predict. Instead, it was the number of de-escalating gestures that grew. A bigger crowd, in other words, was more likely to suppress a fight. Some incidents did end in violence, of course. To try to work out why, Dr Levine and his colleagues constructed probability trees to help them calculate the likelihood that a violent incident such as a punch being thrown would occur with each successive intervention by a bystander. Using these trees, they were generally able to identify a flashpoint at which the crowd determined which way the fight would go. Judging the fight to begin with the aggressor’s first pointing gesture towards his target, the researchers found that the first intervention usually involved a bystander trying to calm the protagonist down. Next, another would advise the target not to respond. If a third intervention reinforced crowd solidarity, sending the same peaceful message, then a violent outcome became unlikely. But if it did not—if the third bystander vocally took sides, say—then violence was much more likely. It’s a really eye-opening piece that’s well worth reading in full as it overturns both some common popular assumptions and some well-worn psychological clichés. Link to Economist on ‘The kindness of crowds’.

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Far from the madding crowd

My Real-World Adopt

March 6, 2009 in Blogs, Psychology Today by Psychology Today

I didn’t long for a baby who melted into me, who captured my hair between her soft fingers. I longed to be the type of woman who did. It seemed as though this trait were woven into my biology as much as the fair skin and curly hair. As a child I played with dolls, but didn’t fantasize about a real baby I could love, or dream of pregnancy the way some girls do. I never stuck a pillow beneath my dress to pretend I was having a baby. It scared me even then the whole idea of someone growing inside me, and having to push that little person out from between my skinny legs. The girls I played with shriveled their noses at me, then blithely offered to have the baby for me. Babies, with their hands like rose petals and their toes like creamy pebbles, were natural. My lack of maternal instinct was not. The truth is I’d always wanted to adopt. However, I never wanted to adopt a baby. Not that I have anything against babies (I don’t!). But when I spoke of adoption, the words baby, infant and birthmother were never used. I was more interested in adopting someone a bit older, a toddler or – gulp – a child. When my husband and I eventually did adopt, we went further than that. Our daughters were 10 and 13 (almost 11 and 14, actually) when we got them from a Russian detsky dom , children’s home: orphanage in 1999. A teen and a ‘tween–they were, indeed, not babies. Yet from the moment I saw them, during their brief stay as part of a dance troupe sponsored by the adoption agency, I wanted these grown children as much as any mother wants the unborn babies who swim silently in her womb. I don’t see adoption as better or worse than having biological children, stepchildren, foster children or no children at all. I do, however, see it as a different spin in the cycle of family. But I won’t go around saying you should think about adoption the way people (often) tell women they should think about having a baby because biological clocks run out and you’re not getting any younger . I think often about how I made adoption real, but I’m interested in all the people who do real – ancestral lines from the past and future – and the relationships we share with one another. Which makes Adoption Stories for all of us. If you’re adopted or have adopted, if you don’t understand why anyone would want to adopt-or why anyone wouldn’t. If you longed for a baby or didn’t.    

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My Real-World Adopt

Inject Resveratrol, Don’t Drink!

March 6, 2009 in Blogs, Psychology Today by Psychology Today

The claim that red wine, operating through the impact of its component chemical, resveratrol, has health benefits (as seen on 60 Minutes) is actually an anti-alcohol campaign. Moderate drinking of all forms of alcohol has been shown over decades in scores of well-controlled studies by the most prestigious epidemiological research groups to reduce heart disease. Since this is, by far, the way most Americans die, alcohol reduces mortality. A similar series of studies has now shown that moderate drinking reduces dementia. But Americans will never accept this – our attitudes towards and experiences with alcohol are too corrupted. And so people who want to drink alcohol actually ignore that it can be good for you and instead seek strange and fallacious theories that some mysterious chemical may accomplish what alcohol is known to do. I had a neighbor – let’s call him Malcolm — who had some vague idea of what I did; every time he saw me he said, “So, they’ve found that red wine is good for you.” And this was a guy I drank scotch with! Incurably optimistic, I always responded, “No, all forms of alcohol have the same benefits.” Yet each time I saw Malcolm subsequently, he repeated the same erroneous bromide. I finally moved, thank God. Writing in the liberal publication, Slate , a wine drinker says: Personally, I’m thrilled to learn that red wine could help me avoid cancer, outlast opponents on the tennis court, survive a nuclear attack, and lead a long, lucid, and Viagra-free life. However, a little caution is in order. Most of the testing with resveratrol has been done on mice, and they have been given ungodly amounts of the stuff. Every idea in this sequence is negative and wrong. Red wine doesn’t benefit people, alcohol does. Somehow, attributing the advantages of alcohol to wine seems more wholesome – Italians do it! And, for God’s sake – vodka, scotch, and beer can’t be good for you. None of these drinks helps you avoid cancer (actually, that’s a negative sidelight to alcohol’s positive effects). But, of course, this list is meant to be ridiculous, rather than to accurately educate. And then the quick shift – like a three-card Monte player – from wine to resveratrol, which research suggests has its own benefits – when administered to mice in massive doses. All of this is meant to say, “I like wine – I know it’s bad for you – despite this crazy stuff people are saying.” In other words, this supposedly liberal wine lover shares America’s temperance outlook. (To give Mr. Steinberger credit, he is actually saying, “Americans are so kooky they need to justify enjoying wine by thinking of it as medicine.”) But here are the data – in a meta-analysis combining the results of 34 well-designed studies (those controlling for all other possible factors – of course, the authors were Italians): “Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women.” (Except Americans wouldn’t consider 3-4 drinks daily “low levels of alcohol.”) For those of you who don’t register “inversely,” this means, “drink moderately, live longer,” according to the unanimous conclusions of the best research conducted over many years. In the same volume, Harvard researchers in the Health Professionals Study found that, controlling for all other aspects of healthful living (diet, weight, exercise, smoking), drinkers had significantly fewer heart attacks. I know, impossible. Forget that you read this. Research like this, repeated endlessly, has no impact on American attitudes anyhow. Unfortunately, ignoring real data has implications. In terms of our existences here in the United States (as I posted to this blog), the social and geographical groups most likely to drink in the United States have been extending their life spans , while the life expectancies of those least likely to drink have been declining. Okay – integrating drinking into a person’s life is too complex a phenomenon to simply prescribe it. What’s bad is that people think by not drinking they are helping their health! (Obviously, I’m putting alcoholics in a separate group, as the epidemiological research itself does.) So our erroneous attitudes about drinking are part of American’s declining health relative to other nations of the world – whom we are duly striving to convince to live like us. Just as the Archives of Internal Medicine (in which the two prior studies were published) is not an alcohol industry propaganda rag, the most prestigious alcoholism journal in the United States, Alcoholism: Clinical and Experimental Research , has just published the following summary : “brain functional comparisons between older moderate alcohol consumers and nondrinkers have received more recent epidemiological study. In over half of nearly 45 reports since the early 1990s, significantly reduced risks of cognitive loss or dementia in moderate, nonbinge consumers of alcohol (wine, beer, liquor) have been observed. . . .” Here, you summarize what this means. I see the resveratrol scam as a different plot from the one Mr. Steinberger uncovers. I see it as a way to deprive of us of a modern miracle – something people enjoy and do voluntarily prolongs their lives and sharpens their thinking into old age! Is there any better proof that there is a God (and alcohol – albeit wine – does play a significant positive role throughout both the Old and New Testaments)? Oh, and then there’s that grape juice kookiness – don’t get me started! Ah, forget it, Malcolm – Yes, maybe they’ll develop a drug that can do for you what alcohol has already been proven to do. I’m so excited – I’m waiting with bated breath for the drug companies to come up with this unbelievable new pill!

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Inject Resveratrol, Don’t Drink!

Healing in Israel/Gaza

March 5, 2009 in Blogs, Psychology Today by Psychology Today

March 2, 2009 I’m returning to the Middle East after 9 months away, in the wake of the War in Gaza and the ongoing shelling of the south of Israel by Hamas. Read about our mission here . Our team is in Israel for 4 days: Amy, who runs our program of clinical supervision for our Israeli and Palestinian faculty. Dan and Lee-Ann, who coordinate both programs on the US side and Afrim and Jusuf, psychiatrists from Kosovo, whom I first met when they we’re refugees in Macedonia during the 1999 NATO bombing of Kosovo. Amy and I have worked together for 10 years. Afrim and Jusuf are like brothers. It seems that Dan and I have been everywhere together, and Lee-Ann, our newest member, has done a fabulous job with logistics for the trip. We hit the ground running, heading to Sderot, which has been shelled from Gaza for 8 years, as soon as we wake up on the first morning after our arrival. Naftali, our Israel program director, (we’ve trained some 300 health and mental health professionals in Israel over the last 5 years), is doing the driving, and will be introducing us to colleagues who are dealing with the ongoing trauma in Israel’s south. First stop: the SCIENCE AND RELIGIOUS ELEMENTARY SCHOOL, a meeting with the principal, Dina Chouri as well as Miri Asoulin, a teacher who has come through part of our training program and heads up the “Havens of Calm” program. “Havens of Calm” is a room apart from the school with bean bag chairs, crayons, games, a place for kids to come express their feelings and simply hang out when they need to. Miri is exactly the kind of teacher you wish your children had-or wish you might have had yourself. She has the kind of smile that erases all the doubts you have about your own worthiness, that makes you feel that everything you do is not just alright, but really really interesting. Over the last 7 years, while shells fell in and around Sderot, perhaps 60 percent of the kids used the “Havens of Calm” room. During the recent war, and in its aftermath, everyone does.” “For a long time,” Miri tells us, “the children have been nervous and angry; they have trouble sleeping and are wetting their beds. Now, from the time the war began, there are new symptoms. Now the children tend to find scapegoats. One class had an election for what classmate they wanted to most to be dead. They cannot fight against the rockets, so the anger has to go somewhere,” she says. “In the beginning,” a psychologist who consults with the school, added, “the children were crying and anxious. Now, sometimes, they go into a total freeze when the red alert (the signal that a Qassam rocket is about to fall). One eight year old girl’s body was like a stone. She couldn’t move her hands or feet for four hours.” Miri and a number of the other teachers and counselors in this and other Sderot schools find the techniques they learned from The Center for Mind-Body Medicine to be enormously helpful for themselves-for they too work, and often live, amidst the falling rockets-and for the kids. She shows us pictures that the children have done of huge rockets falling on their town and of Gaza burning. The children seem more hopeful, but their parents are not. In Sderot, and in nearby Shaar Ha Negev, we hear voices of distress and disillusionment. “The people felt strong during the war,” one psychologist tells us. “They thought the rocket attacks from Gaza would be over. But now the war is finished, and still we have Qassams almost every day. What was the point?” More to come.

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Healing in Israel/Gaza

Sorting out the placebo effect in teen depression studies [Neuron Culture]

March 5, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

Philip Dawdy takes a interesting look at a new study of the safety of placebo arms in clinical trials of antidepressants in teens. My own quick scan of the study [which Dawdy makes available as pdf download ] suggests it’s full of great nuggets. Its take-home: Placebo treatments produced remission rates of 48%, while the rate for active treatment was 59%. And, quite interestingly, the study concludes: Patients who responded to placebo generally retained their response. Those who did not respond to placebo subsequently responded to active treatment at the same rates as those initiallyl assigned to active treatments. There were no differences between groups in rates of suicidal events, study retention, or symptom worsening. In other words, placebo left options open, and avoided most side-effects, at the cost of reaching 5 of 10 patients rather than 6 of 10. (Effectiveness rates of both placebo and treatment vary among trials; these are a bit higher than rates in other meta-analyses I’ve read, but fairly on target.) These findings are full of implications, some of which Dawdy lays out below. (Point of info: You’ll see different rates for ‘response’ and ‘remission’ here. Response means their symptoms eased at least a little. Remission means their symptoms lifted enough to classify them as no longer depressed.) Read the rest of this post… | Read the comments on this post…

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Sorting out the placebo effect in teen depression studies [Neuron Culture]

A brief (small-"r") resurrection [Dr. Joan Bushwell's Chimpanzee Refuge]

March 4, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

Two months ago I posted about a short video created by a West Coast ministry depicting the alleged intervention of God in the life of a deeply troubled man, a presentation I discovered during a spin through Jared White’s site , “Finite Calls Infinite.” Jared’s observation : Check out what this guy went through and how God intervened supernaturally to change his life. It’s amazing! I wish they’d include more of the details, but it’s nevertheless an inspiration. No matter how far you’ve gone into the realms of darkness, God’s light will still penetrate! Given Jared’s enthusiasm, I expected to find that something remarkable had happened in Mike Leehan’s life–the “miraculous” curing of a disease, or even something as mundane as finding a winning lottery ticket in a bus terminal restroom immediately following a bout of prayer. If you watch the video, you find that what happened can fairly be summarized as: Man with clear mental issues and a history of conflicted feelings about God is visited by members of the ministry, and in their presence has a revelation in which God calls him to do His work for the rest of his life. Those are the facts. Yesterday, Jared apparently discovered my post and left a comment in which he asked: I have just one simple question for you: how do you know that whatever was described in this video isn’t actually true? On what basis do you accuse this man or this church of lying? Furthermore, aren’t scientists supposed to search out knowledge and meaning in spite of personal bias and follow the evidence wherever it may lead regardless of comfort level or preference? It seems to me that you’ve already decided how reality is framed, and thus anything that contradicts your predetermined conclusion you dismiss out of hand. I fail to see how that is scientific, open-minded, or free-thinking. I left a long reply, but it’s worth visiting what is going on here. Originally, I posted about this because Jared’s enthusiasm represents a classic example of confirmation bias . Religious folk often exemplify this interpretive flaw, which only makes sense; one who spends much of every day praying to or thinking about Jesus will naturally attribute events they perceive as remarkable in some way to divine authorship. In a world in which gods cannot be troubled to actually show themselves, this is understandable. Yet aside from the fact that private visions cannot constitute evidence for anything, the fact that non-Christians can and do have exactly the same kinds of “awakenings” as a result of a nearly infinite variety of experiences (praying to other gods; running 26 miles flat-out; dropping acid; transcendental meditation) underscores the reality–that people simply view “life-altering” experiences through the lens of their pre-existing beliefs. Note the gross error in Jared’s thinking. He sees a skeptical viewpoint as being not only mean-spirited but unscientific. In other words, because I dismiss the likelihood of God having anything to do with an event in which there is no evidentiary reason to suspect deities playing a role, I am being close-minded. Yet I doubt that he would consider himself closed-minded if he laughed off my claim that my own “salvation” from, say, a lengthy spell of depression is undeniably attributable to blessings from aliens from Altair-6. He would, I presume, expect me to support this claim in some way before accepting it. But he makes an exception, and a grossly unjustifiable one, for himself and other Christians. It’s that simple. I am also confident that Jared believes that he indeed arrived at his belief in the Christian deity because he was willing to “follow the evidence, wherever it may lead.” I don’t think he’s lying when he claims to have evidence for his god, as he implicitly does, but I would certainly invite him to present it. I am sure he will not–possibly with the observation that I’m a mocker who won’t change his mind anyway–and equally certain that he cannot. The point here is not to denigrate something that made Mike Leehan feel better or mock, in a throwaway manner, something that makes Jared and millions of other people feel better. It is to point out what a huge divide exists between religious believers and others in terms of what represents “freethought” and rational inquiry. People like Jared epitomize close-mindedness when they basically try to insulate their ideas from criticism despite having no evidence to support them. If you were to give all the Jareds of the world truth serum, some of them might admit that they arrived at their religious convictions–Christian, Hindu, Muslim, Zoroastrian or animist–first and have spent years since then trying to come up with justifications for their beliefs when challenged. But I think there’s something deeper at work; I think Jared (clearly an intelligent man) does think he has evidence for what he believes. But naturally he cannot articulate this, because he’s wrong. Watching people like Jared talk themselves in bumbling circles, if nothing else, provides an object lesson in how religious programming can forcefully disrupt or ruin someone’s ability to not only apply logic, but to comprehend it. To posit that something is true yet be unable to support this claim with evidence, yet label someone closed-minded for not accepting the same thing (one of countless takes on a basic delusion) at face value, is obviously loopy. But it’s part of the way millions of people approach the world every day. Anyway, if nothing else, maybe he and other Christians can read this and understand the real basis for skeptical inquiry. I have no more of an inherent commitment to denying a divine Jesus than I do my putative aliens or any other extraordinarily unlikely construct. But refusing to start from a conclusion and work backward is not closed-mindedness, however accompanied it may be by gratuitous jocularity. Read the comments on this post…

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A brief (small-"r") resurrection [Dr. Joan Bushwell's Chimpanzee Refuge]

Depression Post 4: The Serotonin Theory (and why it’s probably wrong) [Neurotopia]

March 4, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

Ok, the serotonin theory of depression may not be wrong. But it is definitely incomplete. One might ask why we use serotonergic drugs to treat depression if the theory behind it is wrong. A good question, but to this I say: because it worked. (I love the Zoloft depressed marshmallow. He’s so cute!) This is post four of my series on depression. For previous posts on the etiology of depression , the pharmacotherapies for depression , and how depression is evaulated in the lab , please play link hopscotch! I’ve also got a very recent post on the serotonin system which can give you some more background. The original antidepressants, the monoamine oxidase inhibitors and tricyclic antidepressants, were originally used to treat other diseases, such as tuberculosis and psychosis, and found to be effective for depression as a sideline. Did people know how they worked? Nope, but they appeared to work (though only in a subset of the population), and so they came into use. Some people might get up in arms about this, and yell about how we shouldn’t use drugs unless we know how they work. But if we spent our lives doing that, no one would have ever made asprin. Or morphine. Heck, no one would have patented Ritalin. We know THAT Ritalin works, and we know what Ritalin does in the brain, but do we know why Ritalin calms down people with ADHD when it’s really a stimulant? Not really, no. But it’s still out there, because it works. And the serotonin-based antidepressants do work in some people. Only in about 60% of patients at best, and at their best, they only perform 30% better than placebo. But the modern selective serotonin reuptake inhibitors (SSRIs) still work in a set of depressed patients, and they do so with far fewer side effects than pre-existing drugs. And what can I say, we haven’t really got anything better yet. Except cocaine. That’s a GREAT antidepressant, but it obviously has some issues. So where did this serotonin theory of depression come from? And why is it flawed? Read the rest of this post… | Read the comments on this post…

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Depression Post 4: The Serotonin Theory (and why it’s probably wrong) [Neurotopia]

Using Initmacy To Get Sex

March 3, 2009 in Blogs, Psychology Today by Psychology Today

When asked “What do most people do on a date?” Martin (age 10) replied: “On the first date, they just tell each other lies, and that usually gets them interested enough to go for a second date.” I doubt that Martin realized just how accurate he was. There is more deception in dating than in any other social context in our culture. So the obvious question would have to be something like this: “If deception runs rampant when I am in the dating scene, how can I know whether I am dating a jerk? How can I tell whether this is someone who is going to tilt the nice-to-nasty ratio so that I end up with more nasty than I had bargained for?” I would like to offer the following litmus test. [By the way, next week I will offer a litmus test for discerning a jerkett.] One day in class a young woman remarked: “I just can’t understand why men don’t want to get intimate — why won’t you get close?” To this, a man in the back of the room piped up (obviously without thinking a whole lot before speaking): “We do too want to get close, but you women just won’t put out.” For a moment, I thought a fight was going to break out right there on the spot, but in the end, we had a lively, engaging, and fruitful discussion. The bottom line is this: Men are inclined to use intimacy to get sex. The problem is not that we men don’t know how to be intimate — in other words, how to show fondness and affectionate, how to be warm and romantic, how to touch and hug, how to listen to what is going on in your life. We know how — we have done it many times in the past and we will do it many more times in the future. The problem is that we typically only do these things when there is a pay-off. We were talking about this phenomenon one day in a different class and a female student had a flash of insight as she suddenly blurted out: “Just last week, my partner and I were having this great conversation and in the middle of it, he said, ‘Have we talked enough yet?’ I didn’t get it at the time, but now I know just what he was saying!” She was angry. (This couple is no longer together.) So here is the litmus test. Is he capable of touch that is not a part of foreplay? Is he capable of simply holding you without it leading to a pay-off for him? Does he express his affection for you even when he doesn’t have his sights set on getting you into bed? Does he spend time listening to you / talking with you even when sex is not going to be an outcome? This gets somewhat complicated because of the fact that women are inclined to use sex to get intimacy. So we man have grown rather accustomed to this tit-for-tat arrangement. But if you want to know whether he is a prince or whether he is a toad hidden behind a prince’s mask, see if he is capable of intimacy — is he capable of warmth, fondness, touch, affection, romance, sincere give-and-take conversation — without sex being an expected part of the package? If he is, then there is a pretty good chance that the nice-to-nasty ratio will not unexpectantly be flipped over, adding to the scar tissue on your heart.       Using Intimacy To Get Sex Custom Teaser When asked “What do most people do on a date?” Martin (age 10) replied: “On the first date, they just tell each other lies, and that usually gets them interested enough to go for a second date.” Teaser Image SexIntimacy.jpg Love Bytes Editors Pick:  0Editors Pick

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Using Initmacy To Get Sex

by Vaughan

Junk food marketers rediscover the Crockus

March 1, 2009 in Blogs, Mind Hacks by Vaughan

The following is from a recent New York Times article on how snack food company Frito-Lay have based their latest women-focused campaign on ‘neuromarketing’. Parts of the article nearly made with weep with despair. [Advertising agency] Juniper Park used neuromarketing in a slightly different way. Ms. Nykoliation began by researching how women’s brains compared with men’s, so the firm could adjust the marketing accordingly. Her research suggested that the communication center in women’s brains was more developed, leading her to infer that women could process ads with more complexity and more pieces of information. Hang on a minute. Communication centre larger in women? She doesn’t mean… the crockus by any chance? A memory and emotional center, the hippocampus, was proportionally larger in women, so Ms. Nykoliation concluded that women would look for characters they could empathize with. Stop sniffing the TipEx. And research Ms. Nykoliation read linked the anterior cingulate cortex, which processes decision-making and was larger in women, to feelings of guilt. (Experts differ on how directly functions or feelings are associated with various parts of the brain.) Ms. Nykoliation then asked NeuroFocus to review her assumptions and, as Juniper Park developed ads, to test the ads to verify that women liked them. We should have guessed a ‘neuromarketing’ company would be involved. Neuromarketing is an interesting research field looking at the neuroscience of buyer decisions but so far there is not a single scrap of data that shows neuroscience can better predict buyer decisions that plain old ‘marketing’. In other words, if you’re wanting to actually market a product, it’s a huge waste of money. However, that hasn’t stopped various ‘neuromarketing’ companies from springing up and selling their sweet nothings to large corporations for hard cash. I say a huge waste of money, but it did get them a feature in The New York Times who also posted their commercial online, so maybe it’s not such a daft move after all. Link to NYT article.

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Junk food marketers rediscover the Crockus

How much rat poison should you give a patient? Genetics helps [Genetic Future]

February 19, 2009 in Blogs, Developing Intelligence by ScienceBlog

Warfarin (a.k.a. Coumadin, Jantoven, Marevan, or Waran) is the most widely-prescribed blood-thinning agent on the market. It’s also (in the words of Howard McLeod ) a “terrible drug” – it has a very narrow therapeutic window, meaning that the minimal useful dose and the maximal safe dose are very close together. (The effects of over-dosing on warfarin – reduced blood clotting – are so severe that the drug is also used as a highly effective rat poison.) To further complicate things, the dosage of the drug that is both effective and safe differs widely between individuals , and is known to be altered both by environmental factors (e.g. smoking) and by genetics. This variation means that determining the right dosage for a patient is a fairly hit-and-miss affair, and patients often have to be tested at several different doses before a stable dose is found. At the current time there are two genetic variants known to explain a fairly large chunk of this variation, one in a gene involved in drug metabolism ( CYP2C9 ) and another in a gene involved in the clotting response ( VKORC1 ). A paper in this week’s New England Journal of Medicine looked at whether the use of genetic information from these two variants could improve the ability of clinicians to predict the optimal dosage for patients. The short answer is: yes . The authors used data from 4,043 patients to determine the optimal parameters for their prediction algorithm, and then tested the results on a validation set of 1,009 subjects. They found that the addition of genetic information significantly increased the accuracy of dose predictions, with the improvements being  seen mainly in patients at the extremes (i.e. those who required higher or lower doses of the drug than the population average). The clinical benefits of this testing are clear: incorporating genetic data means that more patients will be placed on the correct dosage of warfarin from the outset , rather than having to go through multiple (potentially dangerous) trial runs at different doses before settling on a stable figure. Further studies on the genetic variants associated with warfarin response, as well as gene-environment interactions, should improve predictive performance even further. The authors have made their prediction algorithm available as a nifty online calculator . I noted in my post last week on routine whole-genome sequencing of newborns that the real clinical benefits of widespread genetic screening will come first in pharmacogenomics – these results provide a neat demonstration of this process in action. Subscribe to Genetic Future . Read the comments on this post…

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How much rat poison should you give a patient? Genetics helps [Genetic Future]