Medical system biases

A respectably sized randomized trial finds transcendental meditation has enormous effects on heart attack mortality, decreasing by half. Among the most vulnerable or the most involved in meditation, mortality decreased by 2/3rds. That would be huge even for a drug. As one of the study authors said, "The effect is as large or larger than major categories of drug treatment for cardiovascular disease."

Nonetheless, in spite of the much larger effect from meditation than any drug therapy, the article paraphrases the researchers as saying that the meditation should complement rather than replace drug treatment. If we believe that randomized trials yield correct information that can be used for treatment, why limit the results in this way?

Yes, the results need to be replicated a few times in different populations, etc., but my suspicion is that even after they are replicated (possibly with smaller effect sizes), the "don't stop taking drugs" message will remain.

Given recent results about increased risk of type 2 diabetes from statins and indications of memory problems from statins, those who advocate drugs need to defend their choice more. It seems that there's an implicit bias that treatment within the medical system must be healthier. Similar to the implicit bias against fat that caused Ancel Keys's views to prevail; now new studies that low-fat diets contribute to unhealthy weight gain are rarely publicized.

UPDATE: Now the article has been held back from publication due to last minute data, and the Telegraph took down the article. Wonder why.

Cognitive dissonance in faculty recruiting

The University of South Carolina has what I understand to be a very high quality School of Public Health. They are looking for a tenure-track faculty member with a description that matches my own research fairly well, studying "sexualities, sexual behavior, sexually transmitted infections, HIV/AIDS, teenage pregnancy, LGBT disparities or other sexuality and health issues." Particularly, they want someone who advocates and engages with community, state, national, and global organizations.

I checked their sex ed laws, and according to this profile, they are one of 7 states in the US to prohibit positive depictions of homosexuality in public schools, not a favorable start for any researcher who studies LGBT issues to advocate or engage with the community and local institutions. They also prohibit contraception information other than in the context of future family planning, which is better than nothing. SC is also one of the minority of states to apply for the federal abstinence-only sex education funding, meaning that the programs funded by that funding cannot even mention contraception in any positive way at all.

On the bright side, they also applied for the federal evidence-based sex education and pregnancy prevention funds, which they could certainly use since SC has the third highest gonorrhea rate in the country, and 8% of women ages 15-19 get pregnant each year, and 5% give birth. Looking at the gap between pregnancy and birth rates, it's particularly remarkable because 72% of SC women live in a county without an abortion provider (93% of counties lack an abortion provider), Medicaid does not fund abortions, they mandate a 24 hour waiting period and all procedures 12 weeks and after are a felony with mandatory minimum of 5 years in jail and/or $5000 fine.

Thanks to NARAL and Kaiser for the facts. The SC ACLU also has a long access guide listing all the sexuality, family planning, and related resources (e.g., PFLAG) in the state and neighboring states. So the state fortunately has some resources, even if they get an F by NARAL.

When statistics doesn't cooperate: ratios of regression coefficients.

Everyone knows that there's error in all statistical estimates, but we don't always think about all the implications of that error. Gelman makes the important point about ratios of (among other things) regression coefficients, with implications for instrumental variables (and a cringe-inducing published example). He notes that the ratio of two normal-like variables is Cauchy-like; my recollection from Don Rubin's causal inference class is that he criticized instrumental variables on the grounds that Cauchy distributions have infinite variance, which fills in why Gelman notes that in theory ratios of regression coefficients can take on absurdly large and useless values like 100,000.

The published example comparing regression coefficients is something that people do all the time in conversation without even thinking about it.

Gelman says that the post was really time-consuming to write, so perhaps it counts as a few posts. I agree that it should. In fact, someone could review papers in top journals in the past 5 years and document how frequently this error is made, and that would be a good project.

Do people report embarrassing facts?

I've done some work in whether people report facts about themselves that are sensitive or embarrassing, and it seems that generally people report a surprising amount of sensitive information. Something that I've found fascinating is how people will reveal sensitive information when it's not called for on the humor blog "Damn you autocorrect". Usually, the cases are innocuous or not-so-innocuous, but occasionally the autocorrect will falsely "reveal" information (by correcting text to something not meant) that will induce the correspondent to reveal information that they would not have otherwise said.

Here are the examples:

• Person reveals herpes infection.
  
• Girlfriend reveals interest in breaking up.
  
• Mother reveals that parents suspect son is gay.
  
• Person reveals that she's heard her friend is well-endowed.
  

Only 4 examples and presumably it doesn't always "work" (that is, reveal information that would otherwise be hidden and not revealed on a survey), but I wonder if this could be harnessed somehow as a survey device.

Making statistics adorable: plushy edition

I got a wonderful gift of a plushie Beta distribution, definitely a way to make statistics more adorable. Very sweet, and the beta is wearing a dapper monocle.

They need comedy help in the poster department for catchier/funnier slogans. They also have a poster of relationships between statistical distributions (the third page of this document,) which could be extremely helpful but takes some cognitive effort to figure out which arrows are labeled with what.

Vaginismus: Blame the victim

I've been eagerly reading this blog on vaginismus. The writer has been married over a year without sex. She has visited a sex therapy clinic, and seems to be making progress.

Many of the commenters blame the writer's religion for her problems. When bystanders are confronted with a really difficult situation, some will go to extreme lengths to convince themselves that it could never happen to them. They may think that being in an unconsummated marriage for over a year seems so extremely difficult, there must be some reason that it happened to her and not to other people they know. Presumably it could happen to anyone.

Some criticisms relate to ignorance, but there are so many issues that people never need to think about. How many women know what the hymen looks like? I study sexual initiation, but the anatomical details have never been relevant to me professionally, and I didn't know what the hymen looked like until I saw the above pictures.

How frivolous is sexuality?

On the Society for Adolescent Medicine mailing list, there's a discussion about a pediatrician's 14 year old male patient who has frequent bilateral testicular pain relieved by masturbation. An instantly familiar diagnosis and remarkably not attested in the medical literature. A correspondent forwarded a 11 year old paper from the journal Pediatrics, "Blue Balls": A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion (106:4, October 2000, page 843), with accompanying letters. Featured prominently is the fact that masturbation is a good answer, and that Dr. Jocelyn Elders lost her job for advocating teaching masturbation. The upshot of both the paper and the mailing list discussion is that no one knows anything: the only way available for doctors to address the issue was to suggest ruling out serious medical conditions.

When discussing sexuality issues without severe medical consequences, there's a real uncertainty or self-consciousness: some may see sexuality as existing outside the realm of health and medicine, and dealing with sexuality risks being seen as frivolous. Sexuality is certainly part of health, but when will sexuality be treated as part of health?

Raising kids to deal with frustration

Interesting article by Lori Gottlieb about the neuroses of children with overly involved parents. Frustration and failure is a natural part of growing up, and parents who shield their kids from these negative feelings inhibit their children's abilities to deal with them later.

“'Happiness as a byproduct of living your life is a great thing,' Barry Schwartz, a professor of social theory at Swarthmore College, told me. 'But happiness as a goal is a recipe for disaster.' It’s precisely this goal, though, that many modern parents focus on obsessively—only to see it backfire. Observing this phenomenon, my colleagues and I began to wonder: Could it be that by protecting our kids from unhappiness as children, we’re depriving them of happiness as adults?"


Teaching offspring how to deal with negative feelings apparently occurs in other species as well, not just humans --- perhaps implying that modern parents' attention to happiness is even more maladaptive. I've read that mother cats will deny their kittens the chance to nurse or stop their kittens from nursing before the kittens are done to accustom their kittens to frustration, and kittens who didn't have this experience will grow up to be cats who get frustrated more easily (sharp exhales when something goes wrong.) Apparently, this inability to deal with frustration happens more with cats who grow up without mothers to teach them how to deal with negative emotions; I don't know whether there are overly indulgent mother cats.

This phenomenon of overly attentive parents coincides with the advent of emerging adulthood. Simultaneously, the research finds emerging adulthood is often positive with, for example, better marriage outcomes among those who waited to marry.

Sleeping with subordinates

Most of the reaction that I've seen about Weinergate has been variations on what should or shouldn't happen now. Maureen Dowd's take on Weinergate focuses on what men get out of these power differential relationships where men marry up/equal and then cheat down, in yet another illustration of the sexual economy.

Sex with the help (Schwarzenegger and Strauss-Kahn) has a storied and ancient history. Sex with the secretary or work subordinate (Clinton, Gingrich, Edwards) is retro if not ancient. Perhaps the internet difference is not the lack of physical contact, but the wider range of subordinates it allows contact with: blackjack dealer, porn star, college students, and single moms. If this "cheating down" is more about power than sex --- or about insecurity seeking external validation for being a "geek who buffed up" --- the physical acts are beside the point.

Dowd emphasizes the marrying up aspect of these cases of adultery, certainly true in socioeconomic terms, but adultery by high-ranking men has often been about complementing their wives' high socioeconomic status with the reproductive potential of younger women.

In pseudo-economic terms, men have different preferences in different contexts: intelligence and status in public; youth in private. The trophy wife is such a laughable stereotype, and men have gotten used to similarly well-educated wives, that wives are almost always within socially acceptable age and education limits. (Another example of inconsistent preferences is men who are attracted to overweight women in private but would never commit to one in public.)

Few equal status women would agree to an illicit relationship, and as Dowd points out, some lower status women are put off by how pitiful the man seems. Sometimes the lower status women will sometimes accept the sketchy and possibly unsafe sex with a higher status man over the straight-forward relationship with a same status man. Before this current scandal, have we ever found out just how many women turned down these other adulterers and saw them as pitifully validation-seeking? An interesting question is how to interpret the adulterous relationships where the partners are closer in status (e.g., Edwards) --- a sign of healthier self-esteem?

Tables are better than plots (April Fools) and other reading

• A several participant discussion of plots vs. tables begins with a 5 page piece by Andrew Gelman about why tables are better than plots, concluding with "I recommend using Excel, which has some really nice defaults as well as options such as those 3-D colored bar charts." April Fools! The remaining pieces knock down the straw man.
  
• At Society for Research on Child Development this March, I asked NICHD head Alan Guttmacher for the current scope of the "child health and development" that his institute covers since some say that adolescence extends until 25 because the brain is not fully developed until then. He said that age 25 is a fine age to use as the end of child development. The National Campaign has issued areport on young adulthood describing this changing stage of life.
  
• AP grading and what it's like to grade AP exams. I was surprised that 85-90% of these history exams were written by 9th and 10th graders.
  
• Humor in romantic relationships: women have more romantic interest in online dating profiles that are funny (in their opinion) than not funny. No difference for men's assessment of women. Practical implications aside (Do any men like me for my sense of humor?), this study is a great example of how gender could be used as a counterfactual, even though they didn't use it here. Now that people are frequently represented not just by resumes (as in studies of racial discrimination in choosing interview candidates) but by electronic profiles on facebook or dating sites, we can alter gender or other immutable characteristics on the electronic profiles and infer causal effects.
  
• Seating location and voting behavior on FDA advisory committees: those who speak later may have less influence on the vote, perhaps attributable to seating location.
  

Attractiveness ratings

A Psychology Today article about attractiveness ratings in the Add Health data has yielded some interesting responses: that it's wrong offensive inanity and apparently not unprecedented awfulness that can't be replicated in reanalysis and could cause the author to join the Bell Curve author at a conservative think-tank and become an anti-PC crusader.

One aspect that I've not seen discussed is whether the author has anything in common with his research targets given that in other contexts, it's been widely noted that both African-American women (the target of the original article) and Asian men (like the author) are marginalized in the dating marketplace: e.g., on this African-American dating website, OK Cupid's data analysis, and a roundtable where I presented at American Sociological Association included a paper about how gender stereotypes hurt Asian-American men because Asians in general are considered "feminine" and African-American women because African-Americans in general are considered "masculine": hyperfeminine women and hypermasculine men are considered desirable, but feminine men and masculine women are not. Separate research documents how Asian men may feel emasculated, and allegedly business research documents issues with incorrect condom sizes in Asia.

Marginalization is a well-known explanation for bigotry, although of course not an excuse.

Would-be position

My faculty homepage at Stony Brook Medical School, which cancelled my position due to NY State funding cuts. Sigh.