Sunday, February 21, 2010

How an Unstable Meritocracy Has Failed America

David Brooks’ interesting NY Times Op-Ed column points out that while American society has become more fair and open, the level of trust and respect of our institutions has plummeted. The male WASP, blue-blood establishment of the past has given way to a new establishment in which religion, family, race, and gender are no longer as important. People get into the top schools largely based on intelligence and academic achievement, and after they graduate they move into positions of power in government, business, and academia. This can be seen as a triumph of meritocracy, a system in which people are promoted and reach leadership positions based on ability. Isn’t that a good thing, something that generations of Americans have longed for, something that harks back to the anti-aristocratic heritage of the American Revolution?

Brooks points out that this meritocratic establishment is lacking in several respects. One is that it’s based on a narrow (academic) definition of talent. This definition lacks context and empathy, two important factors for good decision making. In recent years, members of the political and economic elite have made some poor decisions that have severely harmed American long-term interests.

Another problem with the current meritocracy (a point which was made by the authors of The Bell Curve) is that members of it live almost entirely separate lives from everyone else. They go to their elite schools, work in a rarefied environment, live in gated communities, and marry and socialize with other elites. They could care less about ordinary people.

Another problem is that solidarity among elites is weaker. The socially connected, inbred WASP elite may have competed with each other, but didn’t fight an all-out war, as elites do today. Is it in the best interests of the country that Democrats and Republicans can’t agree with each other on anything?

A related problem is that our society is too transparent. No one knew at the time that JFK was having various love affairs, because certain topics were considered off-limits to reporters. Was it in the best interest of the country that Bill Clinton was impeached for sexual indiscretions?

The most important problem with meritocracy is that it is unstable and based on short-term thinking. The WASP elite could trace their lineage back generations, and this family-centric perspective encouraged long-term thinking. The 1960’s revolution and its aftermath swept away the WASP elite, but didn’t put any stable social structures in its place. The U.S. has been a very unstable country since this revolution. This instability occurs at every level of society, from the family breakdown, drug abuse, and crime in the inner cities, to the reckless gambling of Wall Street elites that led to the current Great Recession. Schools and infrastructure have declined as our political leaders put special interests over the interests of the country as a whole.

Brooks doesn’t offer any solutions to this problem. While we can’t go back to the 1950’s, I think that we need to start rolling back some of the reforms that have led us to our present dire situation. We need to regain our appreciation for social stability and social structures, for family connections, and for long-term thinking. Creative public policy ideas that involve such an appreciation need to be formulated and implemented.

Sunday, February 7, 2010

New educational video

Watch this new educational video, entitled "Magnetoreception and Psychiatric Disorders: Two Great Biological Mysteries of Our Time. Part One—The Psychological Magnetic Map." (Video transcript available here)

Monday, February 1, 2010

Antidepressants Are No Better Than Placebo

Newsweek’s cover story reinforces what researchers concluded in a recent article in JAMA—that for the vast majority of patients, antidepressants are no better than placebo. In fact, antidepressants are worse than placebo, because they have side effects. Only for patients with more severe forms of depression do these pills have any significant benefit.

Considering that 2008 antidepressant sales in the U.S. were $9.6 billion, it seems that if one wants to control spiraling health care costs, substituting sugar pills for antidepressants would be effective. If anything, we’re going in the opposite direction. Antidepressant users doubled in the 10 years from 1996 to 2005. Aggressive marketing by Big Pharma to both doctors and customers has expanded antidepressant use, even while the evidence of their effectiveness has been seriously questioned. As the Newsweek article states, “antidepressants are basically expensive Tic Tacs.”

Antidepressants are also used to control OCD. I feel that my OCD/tic disorder was helped by Anafranil, an older antidepressant. While this benefit could be due to the placebo effect, I doubt it. I think that from a biological perspective OCD is more similar to severe depression than to anxiety disorders, with which it is classified by the current DSM. Both OCD and severe depression are helped by antidepressants.

The distinction between antidepressant effectiveness in severe and light/moderate depression reinforces my view that a more individualized/case-by-case approach is needed for psychiatric disorders. As Dr. Klitzman says in a separate Newsweek article, paraphrasing Tolstoy, “every unhappy individual is unhappy in his or her own way.” It’s possible that light/moderate depression is a reaction to negative life events, while serious depression, OCD, and bipolar disorder are something completely different.

My human magnetoreception hypothesis connects these serious disorders with the Earth’s magnetic field. Since magnetoreception is dependent on childhood experience, i.e. where and when someone grew up, each of these magnetoreceptive people needs to be tested and evaluated individually. While the same drug may work in many people, the location of their magnetic home will vary based on their childhood experience. Also, their sleeping behavior and environment is likely different, so recommendations on changing this behavior and environment need to be tailored to the individual circumstances. This is similar to psychotherapy, in that therapy needs to be cognizant of the individual’s background, interests, intelligence, and personality.

In conclusion, we need to stop prescribing antidepressants to people for whom they have no benefit over placebo. For those with more serious disorders like severe depression, OCD, and bipolar disorder, antidepressants and other medications are useful. In the future, if my human magnetoreception hypothesis is confirmed, there will likely be more effective treatments that combine behavioral changes and futuristic devices.