The adolescent risk behavior blog

New experimental evidence suggests why weight loss is not just calories in vs. calories out

2012-01-13T13:08:00.000-08:00

Exercise induces the release of a hormone called irisin, which converts white fat into thermogenic (calorie-burning) brown fat, according to a new paper published Wednesday in Nature. They motivate the paper by saying, "Exercise has the capacity to improve metabolic status in obesity and type 2 diabetes, but the mechanisms are poorly understood. Importantly, exercise increases whole body energy expenditure beyond the calories used in the actual work performed." The paper begins to explain how it may be that exercise burns more calories than those in the actual work: that is, much research in the exercise science literature finds that anaerobic exercise (like strength training and high intensity intervals) burns calories for 48 hours afterwards. Perhaps this hormone begins to explain why.

Meanwhile everyone is still despairing slightly because of the NYT Magazine article suggesting that body weight setpoints make permanent weight loss very difficult for almost everyone. The article mostly quoted people who used very low calorie diets that induce starvation conditions and steady-state cardio. As many have noted, steady state cardio doesn't work. People who stay away from processed food and use high-intensity intervals and strength training may have more luck maintaining weight loss.

If I understand the biochemistry, other research already found that high-intensity exercise increases a related protein (e.g., as found in Tabata's paper, famous for his intervals). We already know that anaerobic exercises burn more calories for longer and result in greater fat loss and less muscle loss. This paper suggests why: anaerobic exercise may be most effective in converting white fat into brown fat.

I am disappointed not to see a practical conclusion --- more weight lifting and intervals, less low-calorie dieting --- in the NYT Magazine article. The message is still "just walk more", which clearly doesn't work, but people say it because it seems realistic and attainable (never mind that it's cold outside.) Instead "do something hard" might result in people pushing themselves more and gaining more of the benefits of exercise demonstrated in this paper. I wonder what state the science would have to be in before the messaging on exercise changes.

After reading the paper, I did 3 simple Tabata intervals, and from this paper now I know that the irisin makes it worthwhile.

The importance of specific health communication

2011-12-08T04:33:00.000-08:00

Often people speak in general terms about the negative effects of smoking. Here's a highly specific risk: smoking at the time of breast surgery can cause nipples to fall off. When the doctor warned his patient in general terms, she didn't really listen. When he told her specifically that her nipples might fall off if she kept smoking, she said she had the motivation to stop right away. That's a very important lesson for health communication in general, but also hard to implement because when public health campaigns do show very specific things that can go wrong, there can be accusations of scare tactics, whether it's showing very specific problems from STIs or very specific problems from smoking.

What's the line between a scare tactic and effective communication?

Emerging adulthood and medical subject headings

2011-11-30T09:06:00.001-08:00

Emerging adulthood has been recognized as a concept in sociology for over a decade, and is generally recognized as extending to age 30. Adolescent health research often extends up to age 25 because brain development continues until about that age. Last year I asked Alan Guttmacher, the head of the National Institute for Child Health and Development (NICHD), about the definition of adolescents for the purposes of NICHD funding, and he said that it's reasonable for research to go past age 18.

In view of that, I'm submitting a new manuscript today, and as I was choosing keywords, I was surprised to notice how they classify ages.

Adults are ages 19-44. Young adults, a term added in 2009, are ages 19-24.

My study is about the transition to adulthood --- how people get college degrees in early 20s and develop professionally in their late 20s and early 30s --- and it doesn't seem to fit into either of these categories. The study examines how the subjects are in the process of becoming adults, socially and economically, but according to the medical subject headers, they are already. It's striking to be reminded of how our systems of thought have changed in such a short time, and an indexing system naturally didn't catch up.

Public sector layoffs among African-Americans

2011-11-29T15:35:00.000-08:00

Kathy Newman wrote about how low SES minorities rely on public sector jobs for social mobility in her book, No Shame in My Game. Newman studied young adults in Washington Heights and nearby areas who were employed in fast food restaurants, as well as some young adults who had applied but were not hired for fast food jobs. Jobs were scarce in the neighborhoods she studied, so that even these fast food jobs had a great deal of competition. Many youth, particularly African-Americans, studied for civil service exams, and regarded these jobs as one of their only ways to achieve a middle class existence, but even these jobs were hard to get. The relatives of her study participants who got civil service jobs were able to build middle class lives for themselves, move to the suburbs, and be role models for the rest of their families. Growing up in a diverse community, I knew at least one minority family who had achieved upward mobility thanks to a federal civil service job.

The current backlash against government, combined with tight budgets, has meant that many African-Americans with these coveted civil service jobs are in danger of losing them. That conclusion was self-evident, or should have been, but I hadn't seen the issue raised (and the issue hadn't occurred to me), until seeing this NY Times article.

People like to mock the government for having exacting requirements to document the procedures followed to ensure that there is no measurable discrimination. I don't how how much time I've spent filling out the EEOC paperwork for the dozens of faculty jobs I've applied for in my life, for instance, and the extensive other measures to make sure that people get treated equally. As much as everyone might mock these efforts, and I'm sure that they are imperfect and clunky, they do seem to have produced more equal opportunity for minorities than the private sector has been able to offer. The private sector may be more "efficient", but they are also less likely to hire people with distinctly minority-sounding names, according to randomized experiments, such as "Are Emily and Greg More Employable than Lakisha and Jamal?".

Publication bias and the result that got away

2011-11-29T15:13:00.000-08:00

An economist writes about his would-have-been dissertation: he gathered the data, did a regression, and found no relationship. So his dissertation was on another topic. 8 years later, he publishes the null relationship. It's refreshing to see someone talking about how publication bias affected their own research, as opposed to the studies published in epidemiology journals that suggest publication bias in macro.

Gluten-free processed foods for the masses

2011-11-27T07:56:00.000-08:00

NY Times published today a fluff piece whose title posed the question whether everyone should go gluten free. Rather than addressing the question in the title, they gave a portrait of a processed food company's endeavor to address this niche market.

I wish they had addressed the question of gluten posed in the title. I'm also baffled by the claim that there's no gluten-free food --- there's plenty of gluten-free food in every single supermarket, and there always has been. The types of processed foods that they address in the article should comprise no more than a few percent of a person's diet. Celiacs used to be lucky for being forced to eschew the processed food-like products that have taken over the standard American diet, such as breakfast cereal, canned soups, cookies, crackers, and frozen foods. With greater quantities of gluten-free processed foods, they are free to be as unhealthy as anyone else.

Jennifer Fox, the former foster child in Seattle who miscarried

2011-11-23T03:29:00.000-08:00

There's a tragic story about a 19 year old formerly homeless young adult in the foster system who says that she miscarried after being kicked in the stomach repeatedly and pepper sprayed. That's excessive force regardless of gender and pregnancy, but another story says that she may have been lying about the miscarriage.

Reading the article, I don't see reason to doubt it given that it was documented by police earlier. She has no obligation to turn over her medical records to the press. And given that she has a foster mother who is abusive enough to call her names in the press, clearly she has little emotional support.

Regardless, I think she is an instructive case of the reason for the Occupy Protests. The research suggests that she'll have more chances in life if she waits a few years to get pregnant until she has attained a community college certificate and has a job and a husband. If she continued the pregnancy she would have higher chances of continued poverty and intimate partner violence.

Still, as a young adult in the foster system, which resources does she have to access higher education, and what chances does she believe she has to get a good job and find a worthwhile future other than as a mother? Most/all young adults who were in the foster system are eligible for Pell grants for community college to find a viable career, but few low SES young adults know that it's worthwhile to fill out the FAFSA or which classes to take in community college that will lead to a career in which they can have dignity and job security, and most community college guidance counselors have literally 500 students whom they're expected to advise so can't have help.

The current system gives disadvantaged young adults flimsy flip flops and then expects people to pull themselves up by the bootstraps.

Income inequality as a threat to adolescents and young adults

2011-11-20T06:14:00.000-08:00

One of the core areas of adolescent health research is on the factors that prevent teens from developing into well-functioning adults: teen pregnancy, substance use, deviance. The assumption behind all of that research is that if teens don't engage in these behaviors, they will be able to become successful, educated, employed adults with families of their own. The current economic conditions threaten that transition to adulthood. Teens aren't assured of the chance to become productive adults, and it becomes more difficult to tell them to avoid risk behavior when their alternatives are so poor. If they have a high risk of unemployment, why not engage in risk behavior?

I recall Johns Hopkins Professor Laurie Zabin's story about working in the first federally funded birth control clinic, which was located in Baltimore in the early 1960s. An 18 year old Appalachian woman walked into the clinic asking for "a birth control" because she had just gotten a job with President Kennedy's Job Corps and for the first time in her life, she suddenly had a reason not to get pregnant.

With that thought, two stories related to income inequality and the Occupy Wall Street protests.

First, one of the markers of an advanced society is high quality infrastructure that the entire society can benefit from: clean/safe water systems, dependable electricity, and dependable and non-corrupt police. The marker of developing countries are private versions of these, such as private security guards and high walls and power generation because the main systems are not dependable. I thought of this while reading a story in the NYT Thursday Style section about how power generators have become a status symbol. The story didn't draw this conclusion, but it seems like an ominous sign of the direction of our society that a private electrical system is a status symbol in view of the lack of dependability of the public system. Particularly typical that many people in the article live in a NY suburb with many bankers.

Second, on police in the Occupy Wall Street protests, in NY and Berkeley and UC Davis: I keep reading the stories about students being beaten without provocation rather than just arrested, and it seems unbelievable. The former Poet Laureate of the United States visited the protest with his wife with the same type of disbelief. His wife got shoved to the ground while talking with an officer about non-violent protest. When he scolded the officer --- what kind of bastard shoves a 60-something year old woman, after all? --- he got beaten, and some of his colleagues got their ribs broken. I have seen similar reports of violence in NYC, UC Davis, and other cities, although not DC or Boston. Has this level of police brutality against non-violent protests been seen since the 1970s? Arguably, this brutality is even more perplexing because in contrast to the Vietnam protests where the police were not at risk of the draft, the protesters are directly fighting for the interests of the police --- fair pay, unionization, and more public spending including on police and the materials they need to do their jobs.

Former Baltimore police officer and sociologist Peter Moskos notes that attacking people without provocation is part of police training that teaches a hands-off approach: if people don't obey orders, they get maced. Smart police don't use this method, however:

Of course we didn’t do it this way, the way were taught. Baltimore police officers are too smart to start urban race riots based on some dumb-ass training. So what did we do to gain compliance? We grabbed people. Hands on. Like real police. And we were good at it....
if police need to remove these students, then the police can go in four officers to one protester and remove them. Lift them up and take them away. Maybe you need one or two more officers with a threatening baton to keep others from getting involved. It really can be that simple.

Exam strategies and meta-education

2011-11-20T05:30:00.001-08:00

The humor site Cracked has a good exam study strategies article. When someone posted this piece on facebook, several faculty members mentioned that they often accumulate more materials than they read.

How many students learn how to learn? Would we have better exam outcomes if we taught students explicitly how to study?

I recall that research shows that such study strategy courses pay off in students doing well in their other courses, but still few students have the opportunity to take such meta-education courses: courses in how to study, learn, and benefit the most from coursework. Instead, students are left on their own to figure out by trial and error and possibly wasting the courses where they do less well because they aren't sure what to do. I know students find these types of courses to be tedious, or they feel like they ought to already know this material, so they act blase about learning the material. I remember feeling that way about Freshman Advisory class in high school, where they taught us how to study before our first exams as we rolled our eyes. The usual tips like don't study in front of the TV or in bed, but the tips stayed with me and every time that I tried to study in bed, I would remind myself that probably it would be a better idea to move to my desk. Although I wouldn't always.

Debunking miracle schools

2011-10-18T17:54:00.000-07:00

Diane Ravitch addresses the phenomenon of miracle schools succinctly:

The subtext [of the concept of 'miracle schools'] is that poverty and resources are not actually problems for urban schools; if they could just test more often and fire more teachers, the corporate reformers imply, then test scores would soar. This analysis suggests that schools enrolling the neediest students do not need more resources, and it rationalizes the current trend of draconian budget cuts for public education.

Apparently there is a blog evaluating the claims of miracle schools and finding that really they aren't.

Americans like the idea of "miracle schools" for the same reason that we like movies about the underdog baseball team winning or the guy in the mail room running the company. Probably not unrelated is how appealing Americans find the concept of achievement without hard work. In reality, resources matter. Giving too much credence to the ideas of miracle schools because we like the narrative could end up depriving >99% of disadvantaged children of the chance to learn and advance, just because we like the narrative of the <1% who succeed despite the bad odds. And it's way cheaper in the short run, even if more expensive in the long run.

Turning the tables on survey research

2011-09-07T15:16:00.000-07:00

Just got off the phone with the Gallup pollster. I am one of their ~1000 person sample on their current health survey. When they asked my profession, I said that I was a survey researcher with health topics, and we both laughed. The coincidence was uncanny.

They ask important questions like approval of the president towards the beginning, along with the 1 question health assessment. They asked if I felt like I was treated with respect at work yesterday, a couple of other working conditions questions, income, and hours, personal stock market investment, as well as pessimism/optimism about economic growth, stock market, personal investment, employment, inflation. Also asked contextual questions such as satisfaction with neighborhood quality, safety, commute time to work.

The questions were of course cursory, such as giving only 2 or 3 option answers (satisfied or not, sometimes a neutral option). No questions had branching options, so every question was asked to every respondent, so only missing data should be due to people hanging up in the middle. The stock market investment quantity was phrased on a logarithmic scale, so above or below 10k, and then presumably other questions.

A couple of the questions were surprisingly badly worded, such as this double-barreled question, "Are you satisfied with the price and availability of fresh fruits and vegetables in your neighborhood?" Lots of availability but high prices here in Dupont Circle.

Short questions require respondents to define the categories themselves. For instance, they asked how many days out of the last 7 days have I exercised. I don't consider walking to be exercise, even walking for 5 miles. I haven't lifted weights or swam in the past week, so I said that I haven't exercised at all. In retrospect, probably it would have been more accurate to say a few days since I have walked more than 5 miles a few times this week.

Two questions I would have been interested in is whether people have a pet, since that goes with the health theme --- people with pets may have better health situation, and everyone likes to hear about pets. Another question is whether single people have a steady romantic relationship since "single" is a big and diverse category, and having a romantic partner could affect health and health outcomes. Of course I would have also liked to know whether people had sex recently, and whether they have safe sex, but I know that Gallup wouldn't do that.

Altogether, it was a 14 minute survey, and they are gathering a dataset that could furnish many papers on the connection between working conditions, attitudes towards the broader economy, political attitudes, and both mental and physical health. I wonder whether they will use the data for that purpose, or if they will just do the univariate and basic bivariate summaries. For sure, I'd appreciate the chance to analyze the data, if I could ever find the time.

The Chicago Tribune is unprepared for college

2011-08-31T14:47:00.000-07:00

The Chicago Tribune published today an article with a plausible headline --- public high school students are unprepared for college --- but their logic is suspect. A state law required public universities to publish the average freshman year GPAs for students from each high school, and the Tribune has published their interpretation of the data. For each university, the Tribune plotted the high school grade point averages (GPAs) of incoming students versus their average GPA in colleges. They conclude that if students have a lower GPA in freshman year of college than high school, that implies that students were unprepared.

It seems obvious to me that college GPAs are lower than high school GPAs. About 50% of Harvard students were ranked 1 or 2 in their high school graduating class, and probably over 80% had a GPA of 4.0, and yet college GPAs are way lower. Further, college GPAs come from a wide variety of courses, so they're even harder to interpret than high school GPAs. Engineering students have lower GPAs than humanities majors, so a really good high school that sends most of its students to major in engineering might look worse than a mediocre high school that sends most of its students to major in humanities. If college GPAs weren't lower than high school GPA, I would think that the students weren't challenging themselves enough. Finally, high schools with disadvantaged students can be expected to have lower college GPAs not because the students are poorly prepared by their high schools but because the students were disadvantaged.

The report itself is more useful, and it provides a good comparison of the students from each high school that tend to attend each school. Not a comparison of the high schools themselves, of course: enormously confounded by the which students from each school tend to attend the state universities. It does break down GPA by subject. A high school that sends its best students to the University of Illinois at Urbana-Champaign will look like a better high school who sends its best students out of state. Still interesting.

The Tribune's assumption that having a lower GPA in freshman year of college than high school implies that students weren't prepared conflates many issues in an illusion that a few numbers can summarize a high school without any statistical assistance. Is this a reminder that a weak attempt at evidence-based decision-making is worse than none at all?

College students in sex work

2011-08-21T10:52:00.000-07:00

It's not new for college students to engage in allied sex work fields: in the late 1960s or early 70s, my father had a student who was a Harvard student working as a stripper. I wonder if the economy has made this work more common or has increased attention.

This article seems to be in a U Penn publication on 3 Penn students: 2 women who worked in fetishist contexts (foot fetish and dominatrix) and a gay man engaging in traditional sex work. The three students say that they find their work empowering, which isn't surprising especially for the two women who are both acting as dominatrices of older accomplished men. (Who exactly is in charge in a dominatrix scenario --- the man who pays and dictates terms or the woman who executes the scenario --- is an interesting question, which I assume has already been discussed in the women's studies literature.) Whether or not they truly feel empowered by their sex work, their sexualities and maturation seem tied to their work. At least one student describes the sex work as empowering not for the experience of domination but because they know they can support themselves, and it's surprising not to see them engaging in any reflection about whether that ability to earn money from sex is truly economically empowering. No mention of STI or health risks.

This article on the larger context: many women with Harvard and other Ivy email addresses seem to be seeking sugar daddies. The women they interview don't even find as much money as they expected: one just gets some money for a one-time rendez-vous that was never repeated, so basically they're just doing old-fashioned high-risk sex work rather than the "arrangements" publicized on the websites. A huge contrast with the Penn article, which paints a rosier picture.

Both articles are about educated Americans, mostly women, but they seem to have similar tropes to less educated Americans and women from developing countries: only some participants in these relationships call them what they are, and only some acknowledge the coercion and how much they may give up by participating in these exchanges.

MSM sugar daddies in India

2011-08-21T10:39:00.001-07:00

This article covers Indian male college students who are part-time sex workers with upper class clients. The narrative is like that in the more educated classes Africa (female university students in Zimbabwe) or the US (a recent Huffington post article.)

To me, the remarkable part is how frankly these students call themselves sex workers. While normally pejorative, that sex worker label may serve an important role for males who consider themselves heterosexual and want to distance themselves from their "work." Unfortunately, engaging in more likely than not unprotected receptive sex that they're being paid for doesn't mitigate the disease risks to their female partners who will likely never know about their part-time jobs.

Let everyone serve in the military

2011-07-26T02:56:00.000-07:00

With the end of Don't Ask Don't Tell, it turns out that there is one group of adolescents and young adults barred from serving in the US military: d/Deaf and disabled. I had no idea that the US barred them and that most countries allowed. I would ask why there is not more awareness, except I know the answer: disabled issues are often invisible. When will disabled rights acquire the same cachet as minority or gay rights?

Is parents' aversion to teens' sexuality an extension of incest norms?

2011-07-24T05:22:00.000-07:00

Amy Schalet has an op-ed today about parents allowing a teen to have their boyfriend/girlfriend sleep over. I think she's right that it's partially related to sex education, but I think that answer is too facile.

Another issue that she doesn't mention in her op-ed: parents' aversion to thinking about teens' sexuality may also be about incest norms. I have known Dutch young adults who had their opposite sex parent sleep with them when the parent came to visit, and that would never be done in the US as well. Many Americans would find this unusual, at minimum.

Even the most liberal parents are comfortable with their teens' having premarital sex but hope that won't be until after the teens go away to college, and they are uncomfortable teaching their teens about condoms because they're afraid that sends the wrong message that sex now is okay. One question is whether the key ingredient there is the developmental stage represented by being 18 and at college, or whether the key is being AWAY at college. Are parents of boarding school teens relatively accepting with their teens having sex at age 16 since they're out of the house?

Conversely, what many Americans find strange about virginity pledges is how they violate incest norms by drawing the wrong kind of parental attention to teens' sexuality, such as this piece also this week in the NYT. (As an aside, the author also exhibits an all/nothing view about her "purity ring", saying that for awhile she felt that she had to take it off once she had sex, thus making her sexuality even less private than it would have been in a more liberal setting.)

Certainly in some cases, there's a prudery element, but I think it's a broader cultural phenomenon about whom Americans are comfortable talking about sex with, possibly relating to incest norms, which seem to differ between here and the Netherlands.

Plenty of Syph: Fun public health campaign

2011-07-11T12:28:00.000-07:00

The Health Department in Alberta, Canada, has a very cute syphilis awareness website: Plenty of Syph, like Plenty of Fish, but where all the singles have syphilis. Some of the pictures show a really nice oral primary syphilis chancre, a few have a secondary stage rash on a chest, and a few even have tertiary syphilis with gummas around the mouth. Very cute. (The mouth is unsurprisingly a relatively rare location for a syphilis sore, maybe just 10% of the time for primary syphilis. And not sure how common it is to get to tertiary syphilis.)

Medical system biases

2011-06-28T07:17:00.000-07:00

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

2011-06-24T14:20:00.000-07:00

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.

2011-06-22T04:17:00.000-07:00

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?

2011-06-22T03:18:00.000-07:00

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

2011-06-19T05:24:00.000-07:00

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

2011-06-16T04:46:00.000-07:00

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?

2011-06-15T12:38:00.000-07:00

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

2011-06-15T05:59:00.001-07:00

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

2011-06-14T05:12:00.000-07:00

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

2011-06-06T19:51:00.000-07:00

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

2011-06-06T19:29:00.000-07:00

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

2011-06-06T08:45:00.000-07:00

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

Changing biomarkers may not reduce disease risk

2011-05-27T13:38:00.000-07:00

A drug that successfully raises HDL and lowers triglycerides does not reduce heart disease risk. One scientist quoted in the NY Times said that this study indicates that changing biomarkers for disease is not the same thing as preventing the disease. While obvious to many people outside the biomedical world, it's lovely to hear someone from the biomedical complex say that.

Oddly, many folks quoted in the article said that regardless of the study, people should still take the drug or at least talk with their doctor about discontinuing it. Which is a lot like what came out of the National Preventive Services Task Force's report about mammograms for younger women: we want to learn from evidence, but not shake things up.

Throughout the article, different people kept saying that the study implies that raising HDL does not improve heart disease risk, but really they seemed to mean that raising HDL through drugs doesn't work, but as far as I know raising it through exercise and diet does improve heart disease risk.

Everyone already knows the answer: stop eating processed food, start cooking, and exercise. There are no easy answers, but I think that Men's Health magazine has better heart disease prevention than most medical journals. The sooner we get past the nutritional fads that elevate processed foods above unprocessed foods, and use drugs as a short-cut, the healthier we'll be. Isn't it crazy that during the 90s, people saw coconut and chicken with skin and whole milk as dangerous, and pasta and bread and low fat sweetened yogurt as healthy?

Commitment devices versus treatments

2011-05-25T08:00:00.001-07:00

Andrew Gelman has an interesting point in a blog entry about religious commitment devices, such as a WWJD bracelet. He says that the bracelet is not a treatment, but rather it goes along with a set of behaviors and commitments, and it's a sign of that. This issue of commitment devices applies as well to my virginity pledge work: like the WWJD bracelent, the pledge may not be an intervention, but rather it could be a sign that someone has a certain identity, so the pledge itself isn't important.

Conversely, Gelman's argument could be critiqued on the grounds that there are folks who have the set of attitudes and behaviors, some of whom have the bracelet and others of them who don't, and conceivably, it would be possible to balance the two groups and get a treatment effect. Whether the treatment effect of wearing a WWJD bracelet could possibly be meaningful is a good question.

More thought needed.

Emerging Adulthood in the Onion

2011-05-21T23:01:00.000-07:00

According to the Onion, emerging adulthood never ends, and the country is down to its last 100 adults. The article does raise a serious point. When politicians cite emerging adulthood as a sign of the decline of civilization, do they wonder at what kind of model modern politics sets for adolescents and young adults?

In other Onion news, the Planned Parenthood Abortionplex in Kansas is finally open, offering movies, pedicures, shops, and a million abortions a month. I wonder how many people will think that this article is serious.

** UPDATE ***
Some people do think the Onion article about the abortionplex was literal, such as this person who says REPENT AMERICA.

Romanticizing religious strictures

2011-04-26T18:51:00.000-07:00

David Brooks on Friday wrote about the merits of what he calls "rigorous theology." Moderate feel-good religion doesn't cut it, he says. He says that more rigorous religion is what motivates people to behave sexually, and that if Mormons refrain from coffee, that willpower must extend to the rest of their lives. Even setting aside the implicit "without god all is permitted" issue, his premise is dubious. The abstinence movement shows clear examples of religion not motivating people to behave sexually. Evangelical sociologist Mark Regnerus's book about evangelical teens describes how they compartmentalize their sexual behavior from the rest of their religiosity.

As for whether discipline in one area extends to others: I'm not aware of any research of the sort. My understanding of the psychology literature is that willpower is limited: if one is exerting willpower in one area, one has less will power for other efforts. On the other hand, a life-long dietary adherence requires no willpower at all. It's just habit, and habit requires no thought. In fact, people who break dietary restrictions for the first time describe the will-power that it takes to take that first habit-breaking step.

David Brooks keeps kosher himself, so I would think that he would have realized that habitual dietary laws don't impact will-power at all. Perhaps in the throes of Passover bread deprivation (his op-ed was published on the 4th day of Passover), he wanted to believe that his week without bread was bettering himself. Now that he can go back to bread, perhaps Brooks will realize how much he was romanticizing religious strictures. Or perhaps he'll continue keeping Passover for another month because the first week was so rigorous.

Contraception and Casual sex

2011-04-15T04:36:00.000-07:00

Gail Collins writes about the uneasy relationship between social conservatives and contraception. She cites two arguments that social conservatives make about contraception: the first relies on incorrect biology and the second reflects uneasiness with casual sex.

Collins spends more time on the incorrect biology argument, but I think that the social conservatives are more motivated by their unease with casual sex. The incorrect biology is not literally true in any way, but social conservatives may believe that the biology is metaphorically true. That is, many forces within the modern world are inhibiting committed relationships and family formation, and they hypothesize that one of the forces is contraception, which is a logical fallacy, but the emotional argument is understandable.

Social conservatives are terribly troubled by the state of modern sexual ethics, or the lack thereof. Their nostalgia is to some extent false: premarital sex and casual sex were not invented with the birth control pill, and the decline of marriage is explained by a myriad of social, economic, and demographic factors.

Nonetheless, their argument has a real kernel of truth that few deal with because it violates third wave feminism: casual sex is more common than it used to be, and all the research I'm aware of finds that casual sex has more negatives than positives (click on the casual sex label for my earlier summaries of that research).

Casual sex occurs between closed doors, both liberals and conservatives have casual sex, and I know of no policy that would decrease casual sex. Given its murky origins, it's not surprising that social conservatives are indiscriminate in the policies and theories that they scapegoat to explain casual sex. Sex education, family planning, emergency contraception, abortion, and Arnett's theory of emerging adulthood do not cause casual sex, and casual sex probably does not inhibit family formation. Social conservatives just cannot think of better explanations, especially given the relative paucity of research on casual sex. Liberals fear that attacks on casual sex are disguised attacks on reproductive rights, rather than seeing that for many the opposite is true: casual sex is the enemy, and reproductive rights are the scapegoat.

And so we have these repeated battles that really all stem from the same thing: unease with casual sex and delayed family formation.

Most people having this dialogue are married, and most married people have long been insulated from the world of singles and their sexual decisions. Instead, they take sides based on their other political beliefs.

The married social conservatives believe that casual sex comes from liberals, not realizing how much exists organically among conservatives and how many liberals have wholesome sexual ethics and are eager to marry. The married liberals believe that casual sex does no harm as long as both the sex and its casualness are consensual, as if such consent were truly possible. My understanding of the qualitative research (Bogle's Hooking Up) is that women may freely consent to casual sex only within limited circumstances (e.g., experimentation), but see it as second best outside those circumstances; conversely, women create the circumstances that enable casual sex by discounting many men, artificially narrowing their dating pool, giving more power to the few men considered "good catches."

Both married liberals and conservatives have apparently forgotten, or maybe they never experienced, the dating market that makes all of these issues so complicated. We can agree on one thing: most people want to get married and have extremely high expectations for marriage, but the path to marriage is murky for myriad reasons. Until we know otherwise, probably the best we can do is practice good sexual ethics and help individuals wherever we can.

At a policy level, the marriage and family formation research indicates that economic factors inhibit marriage among lower income groups, and the decline of unions, widening income inequality, and reduction in good jobs are likely responsible. If we invested the trillions of dollars needed to upgrade our infrastructure from a D to a B, providing jobs for lower income groups, that could help the country both economically (e.g., improved productivity due to reduction in accidents and water main breaks) and socially (by giving income and good jobs to (mostly) men, some of whom would marry their female companions.)

Origins of eating disorders among religious teens

2011-04-14T05:07:00.000-07:00

This NY Times article about eating disorders among Orthodox Jews raises some theories about the origins of eating disorders in this population, but I think there are some other possibilities.

Modesty may make it harder to dress well for women who are even slightly overweight. Thin women look fine in a wide range of clothes, but slightly overweight women need to be creative in ways that don't always work with modesty restrictions --- showing cleavage is a good way for men not to notice extra fat elsewhere.

Also I suspect that being sexually involved is helpful for overweight women and their partners to feel good about their bodies. For religious women, that reinforcement isn't available. Religious men who have no experience either way may assume that thin women are better in bed. Alternatively, thin partners are more socially valued, and the social value may bring gratification pre-marriage. Likewise, religious women cannot feel sexy or sexually empowered by sexual activity. They may feel sexually empowered about how thin their bodies are, so they may seek thinness as their primary form of feeling sexy.

Because these alternative outlets for feeling desirable are not available to Orthodox teens, they need to find other ways of feeling good about themselves. I wonder whether the types of exercise that are incompatible with anorexia, such as weight lifting where it's important to eat minimum amounts of protein (0.5-1 g protein per pound of body weight) and to be moderate in quantity of exercise (every other day, at most), would be helpful. Gymnastics, dancing, rock climbing, and other ways of using that strength could also be helpful in helping teen women feel confident about their bodies, and also staying healthy.

Meanwhile, teen males also need to change their attitudes and how they perceive women of different sizes. That's harder, especially if they do not interact much with the opposite sex.

Sexting and zero tolerance

2011-04-10T11:31:00.000-07:00

Song about breaking religious sex rules

2011-04-07T12:57:00.000-07:00

I'm so proud of our University of Maryland undergraduates who wrote this song, called "I just broke Shomer." (i.e., touched a girl, against some interpretations of Jewish law that disallow touching the opposite sex until marriage.) It reminds me of my friends' 2005 song "No one's really shomer negiah."

Rediscovering second wave feminism

2011-01-12T03:10:00.000-08:00

My college friend Jonathan Liu wrote an incredibly inspiring piece about the sacrifices he made by choosing to be a stay-at-home dad that also applies to making any life decisions: once you make a decision, don't keep looking at all the decisions because "the grass is greener where you tend it." (I'm sure he's not the first to say it, but I've never heard it before, and it's a wonderful saying and a vital point for anyone making any decision.)

His piece was in reaction to another piece by a mother who went part-time in her career after becoming a parent, but who divorced and now wishes that she had been more active in her career. The trend of the last decade for highly educated women to become stay at home moms was treated as a third wave feminist phenomenon --- the trope went that second wavers overemphasized career at the expense of family, but third wave feminists can be confident in their position enough to take time out of their careers to raise their children. (Likewise, some third wavers thought that second wavers were too sexually conservative, and thought that the circumstances had changed enough that it was safe to be promiscuous, but even setting aside questions of the sexual double standard, third wave feminism hasn't erased the economic factors at play in the sexual marketplace, which I've discussed in previous posts about hooking up.)

The third wavers certainly have a point --- some latch-key kids of the past wish their parents had been around for them, and the third wave stay at home phenomenon tries to rectify this. But truly this article just points to where the second wavers were right: economic forces can't be ignored. Women who have prestigious and/or well-paid careers outside the home in addition to children have a more secure position if their marriages fail, as many marriages do --- marriages don't have a 50% failure rate as many say, and everyone has to work to make their marriage as good as possible to avoid divorce, but divorce is certainly common enough to be worth thinking about. And it might even be that women who work outside the home in good jobs might even be less likely to get divorced. I'm not aware of the research on that point, but my knowledge of the research says that they are better off on a range of other metrics.

None of this is to say that anyone's choice is right or wrong. That's an individual decision. To the contrary, as Jonathan said, everyone has to be aware of the true costs of their decision, rather than believing that one choice or the other is an optimal choice. There is no optimal choice in general, but each individual has to figure out what is best for them. Second wave feminism is not a religion, and there's no virtue in adhering to its foundational "tenets" out of blind faith. But there are reasons why stay at home moms of previous generations were not content to stay at home and put their careers second. Many circumstances have changed, every family is different, and so on, but these reasons have certainly not expired. The modern world has made so many things possible, but widows and divorcees are still worse off than married women, working women with good careers are still better insulated from hardship, and second wave classics like the Women's Room are still relevant.

Safe sex ads: where everyone is above average

2010-11-28T08:05:00.000-08:00

New safe sex ad from Candies Foundation with Bristol Palin and Mike Sorrentino from Jersey Shore. First, Bristol looks a bit nervous, fidgeting as she's talking about sex and safe sex, which is odd since I would think they could try refilming until she didn't look nervous. Second, Mr. Sorentino whips out condoms, and brags that they're large-sized, and then offers one to Ms. Palin, just in case. A condom that's too large is only marginally better than no condom at all. What good does it do for a safe sex ad to raise the size issue when, by definition, only a small proportion of their viewers need large-sized condoms? While googling around for information about what proportion of males "need" large condoms, I found an article which said that the market share for a single large-sized brand went up from 5% to 20%, but that the condoms are not actually larger than other condoms.

Balanced arguments are more persuasive

2010-11-28T07:46:00.000-08:00

According to this summary of a meta-analysis, arguments are more persuasive when both sides are presented, even when preaching to the choir. This research explains why abstinence-only sex education --- which is still funded at $50 million per year and requires that only disadvantages of birth control and condoms be presented, not advantages --- does not encourage abstinence as well as comprehensive sex education does, even among those inclined to believe it, and why the only abstinence-only program found effective (the Jemmotts' program) was not one-sided enough to be funded under federal abstinence-only funds.

Vows, oaths, and pledges

2010-10-18T10:20:00.001-07:00

Rabbi Marc Angel explains why virginity pledges don't work, although he's talking about loyalty oaths in Israel, and why they are a bad idea: "To those who are loyal to Israel, oaths are not necessary. To those who are not loyal, oaths won't help."

My Baltimore Sun op-ed defending O'Donnell on abstinence, but not on poverty

2010-09-21T01:54:00.001-07:00

My op-ed in today's Baltimore Sun says that O'Donnell's personal religious beliefs about abstinence and masturbation are reasonably mainstream evangelical beliefs, but that her mainstream Republican beliefs ignore that the Bible says that fortunate, wealthy societies have an obligation to provide for the poor.

Originally I framed the article as we should be sensitive to her because the Bible says to be sensitive to those who are alone through no fault of their own like widows, orphans, and converts, but the Bible also says societies have the obligation to be generous to the poor. This obligation to sensitivity for widows, orphans, and converts seems to extend to be sensitive also to people who are involuntarily single, as virtually all religious single adults are, and abstinence must be a particularly difficult subject for her since abstinence means that she has an idealized view of marriage and her eventual husband she hoped would love her for her beliefs and admire her for having stuck to them since her conversion to become more religious. I liked the parallelism, but it involved too much speculation about her personal life.

More importantly, I'm not a religious authority, so it's not my place to say what we should and shouldn't do.

Two good comments so far on Baltimore Sun. One said how to you judge which beliefs you criticize candidates for. That's a really terrific topic --- many politicians have personal religious beliefs, but they maintain a line between those beliefs and the policies that they support. One example is Joe Lieberman where it's my understanding that his personal religious beliefs should in theory make him more supportive of social programs to help the poor, but lately he has been voting against these programs for what may be political reasons. A case where religious beliefs do influence policy for Christine O'Donnell is that she is clearly extremely anti-abortion and anti-choice --- she would ban abortion even for rape survivors --- and there's every reason to expect she would vote that way, and that's a great reason to vote against her, but that's from her policy statements, not from her religious beliefs. On the other hand, there are some distinguished politicians who have personal beliefs against abortion, and they themselves would not have abortions except under limited circumstances, who have strongly pro-choice voting records. It would be a great study to look at when what we know of candidates' personal religious beliefs agree with their voting records, and when their personal religious beliefs contrast with them. And perhaps this study has already been done. Any political scientists to comment?

Second comment calls for holding politicians accountable for making "rational evidence-based decisions," and oh my, I am so in agreement with that. Not making evidence-based decisions, and instead making decisions for reasons of politics, is extremely common in our government. Paul Krugman is a Nobel Prize winning economist and an expert in the Great Depression, and he's been writing op-eds for the past 2 years saying that we need to give more stimulus or unemployment is going to stay high for years and years, and we are going to lose a generation. And he's been saying the same theme over and over, and he's an extremely distinguished economist, a Nobel Prize winner, and not enough politicians listened to him to affect policy. And the failure to provide fiscal policy that can be adequate stimulus is the worst way that the government can fail people. We're talking about hurting young adults who happen to be coming of age now and during the next several years, and the effects of a worse job market when they come of age will affect them for their ENTIRE LIVES, and they will have not just lower earnings, but (judging by studies of past generations born in high unemployment eras) worse social problems. That's huge, and in my opinion way more important than abstinence education. But, yes, abstinence education is a shame, especially how $50 million abstinence-only funding came back in the health care reform bill in order to get it through Congress. And both of those issues are because of the 60 vote filibuster, and the fact that Senators no longer have to actually filibuster, they can just claim that they are. Some have said that if they actually had to speak for 24 hours straight, they would do it less. Again, the political scientists can speak.

New sex ed game

2010-09-13T11:54:00.000-07:00

This sex ed game Privates is supposed to be fun. I don't use a PC, so I will never know, but it definitely looks better than the web game that they gave as an example of a terrible sex ed game: parts were funny and parts just strange, like their character names: Captain Condom, Power Pap, Willy the Kid (phallic-shaped but short), and Wonder Vag. Really, Wonder Vag. I played for 30 seconds before I had 4th grade flashbacks. Looking forward to hearing how Privates works out.

Virgin dating site

2010-08-06T16:23:00.000-07:00

Virgin dating site "use[s] virginity as a significant compatibility tool to bring people together. Some people may overlook the bonding power of virginity. Virginity as an important common aspect between people can lead to close friendships, or can even serve as a mutual precious gift of marriage."

I wonder how many users they will have and whether any will not also be on eharmony or a big evangelical dating site (presuming that there is an equivalent to jdate for evangelicals.) It is interesting that they would segment the evangelical dating market like this.

Could quantitative students bypass premed requirements?

2010-07-30T12:32:00.000-07:00

Mt Sinai medical school has a program that admits non-science majors who have not taken the traditional premed curriculum, but instead have majored in the humanities and social sciences. These students do just as well, are more likely to spend time doing research, and are twice as likely to become psychiatrists than regular track students.

It's interesting that they limit the exceptions to humanities and social science majors. What about quantitative majors? Is there a med school who will take math, physics, and computer science majors who have not taken all the premed courses? Many science-smart students like learning hard material and are turned off from the grade-conscious nature of premed courses. If you are required to be grade conscious, you don't take risks by taking hard classes: the course that I learned the most from during my freshman year was a full-year math class where I got one of the bottom 2 grades in the 55 person class during the first semester and my advisor urged me to drop the class, but the second semester I was in the top third of the course. It was a trial by fire that helped me in theoretical graduate school statistics courses, and I wouldn't have taken it if I had been afraid of that first semester B-. And if I'd moved up from the 2nd percentile to "only" the 40th percentile, that would have also been a victory. The happy ending is that I learned how to write proofs, or in a pinch fake them reasonably well.

By contrast, I took a premed biology course during my first semester of college, and I loved the material. It was totally fascinating, as were the dissections (though the calves heart smelled), and I think my A- was good enough that I could have been premed if I'd wanted to. The difficult part was keeping my lunch down when my classmates continually asked what was going to be on the test. After half a dozen memory-based quizzes, I was so pleased when a quiz actually asked us to figure something out for ourselves. Finally: thinking! Some of my classmates protested this question because "it wasn't in the textbook!" Someone who spoke that way in a math or physics course would be ridiculed, and an instructor wouldn't even see the need to defend the question. Of course students are required to use critical thinking. In this premed class, memorizing the textbook seemed to be an accepted part of the culture.

From the other side of the lectern, at least in a biostatistics course, premed students were a complete joy to teach. In graduate school, I was the only TF for a 53 student biostatistics class that was 90% premed, and they were some of the nicest and most interested students that I taught. Perhaps they were fun students to teach because only the most intellectually curious premed students self-selected into biostatistics, or because all of the material was highly related to actual medicine rather than abstract science, so they saw the immediate relevance, or because of the way we taught the class with lots of handouts and everything in the textbook and being very clear about expectations.

So I don't mean to stereotype premed students. But as a math and physics undergraduate, the prospect of taking orgo and p-chem was not appealing just because of the culture that I perceived there.

A bigger argument for a quantitative track to med school is that the quantitative fields of study absorb just as much time as the intensive humanities majors: it takes (at least) as much time and coursework to learn to do proofs, derivations, program computer operating systems, and analyze complex datasets, as it does to read, write, and speak foreign languages and write a 200 page senior thesis.

Research idea: alcohol and handedness

2010-07-27T11:57:00.000-07:00

Left-handed respondents over 50 years old drink more often than right-handed respondents in a recent study. If any teen risk data includes handedness, that would be an interesting research project.

Sexually transmitted infection postdoc

2010-07-21T11:07:00.000-07:00

As my time on the CDC's STD postdoctoral fellowship draws to a close, Cake Wrecks featured an appropriate cake (above).

New study on the determination of different suicide attempters

2010-07-15T10:07:00.001-07:00

People with guns in the house are more likely to commit homicide or suicide, according to hundreds of studies in the injury prevention literature. This difference exists even for households that have owned a gun for years, which means that in most cases, the gun was not bought for the purpose of a homicide or suicide that happened years after purchase. The common interpretation of the data is that many people have impulses that might lead them to homicide or suicide, but those who have a gun available can carry out their impulse quickly and easily, so are more likely to do so. By contrast, the suicidal/homicidal impulse does not last long enough for people to actually go and specially buy a gun for the purposes of carrying out their impulse.

Now a study finds that people who attempt suicide by gun are only moderately more likely to attempt again and successfully kill themselves. It may be the case that in many of the gun attempted suicides, the suicidal attempt was just the fulfillment of an impulse facilitated by gun access. If a gun were not available, certainly some people could be determined enough to actually go out and apply for a gun permit and then get a gun, but for many people the impulse would dissipate, and they would not have carried out the impulse.

Other suicide attempt methods associated with only moderate likelihood of a later successful suicide are gassing, jumping from a height, or drowning, and those with low likelihood of successful suicide are cutting and poisoning. Those with high likelihood of successful suicide are hanging, strangulation, or suffocation.

Likely gender is also involved. Cutting and poisoning are more common among women, and women are less likely to be successful at suicide.

The hypothesis about impulse being the cause of gun attempted suicides implies that most of the methods with low or moderate chance of successful later suicide are easily accessible and implemented, and indeed many involve materials easily available and could conceivably be carried out impulsively. The methods with high likelihood of later suicide also involve easily accessible materials, but may involve psychic costs that make them difficult to implement.

In short, I think the Supreme Court may have just increased the suicide and homicide rates by allowing more people easier access to guns that can be available quickly and easily enough to fulfill an impulse that would otherwise dissipate.

2010-07-09T08:49:00.000-07:00

Sarah Palin has a new ad featuring women who, the ad implies, are traditional, sensible moms who know best. The ad makes vague statements like "We don't like the direction this country's going," as the camera lingers over blonde, brunette, grey, and white-haired daughters, mothers, grandmothers, of all shades of white, and even one in a wheelchair with "Don't Tread On Me" on the wheelchair's back. That sure sends a message, but I darn well hope that was completely unintentional. Right?

13 year old girl performs abortion with a pencil

2010-07-01T15:02:00.001-07:00

So many things wrong in this news story: in Pennsylvania, a state requiring parental consent for abortions, a 13 year old girl pregnant by her 30 year old "boyfriend" attempts to perform an abortion with a pencil, goes into labor, boyfriend buries the stillbirth or baby in a plastic shopping bag in the woods, and girl goes into hospital.

Things wrong:
1. Sexual coercion of minors often happens in families where parents just aren't paying attention. Parents are so out of the picture here that this 30 year old "boyfriend" has been with this girl for 1 year.
2. Even in the best of cases, adolescents have undeveloped judgement. Where teens will not involve their parents, doctors are the next best alternative. Not allowing doctors as an alternative, teens turn to their own judgement. Adolescents' brains aren't fully developed, so they may not see consequences of their actions.
3. Shady characters like pedophiles have poor judgement. This fellow may even be a murderer if baby was born alive, and yet the boyfriend is the only adult acting in this story. A legal abortion would involve doctors and nurses.
4. Finally and most importantly, illegal abortions are dangerous. On top of the trauma of pregnancy which is usually unsafe for a 13 year old, she had to be hospitalized.

Laws have to work at the borderlines. Most pregnant minors are 17 or so, many parents are supportive, and most teens tell their parents about their pregnancies, but 12 year olds do have sex and get pregnant, and often it's in crazy cases like this where the parents are just not paying attention. In my 8th grade class of 70 children in the best-funded school district in Illinois (at the time), we had 1 pregnant girl, and same in the year before us class of 60 children, a pregnancy rate of about 3% for those two years.

In Utah, a similar case of a woman asking to be attacked in order to induce abortion created a new anti-abortion law.

Could this case possibly cause Pennsylvania to alter its abortion laws so that parental consent was no longer required? I wish, but somehow it seems unlikely.

Parent sex education

2010-07-01T10:26:00.000-07:00

A recent XKCD notes that parents may need to teach their parents a lot more about sex now that there are internet popup ads. While it's a funny exaggeration of the situation and it seems to be a new situation, it does illustrate the age-old truth that kids always know more than adults think, making it clear that all the time discussing whether to teach contraception in schools is a waste. A study that I did found that most Southern Baptists surveyed in church Sunday School learn about birth control and STD prevention from their schools and from their peers. Take away the schools, and you are left with peers. And internet pop-up ads.

Quantitative work is not mysterious

2010-07-01T10:19:00.000-07:00

Some are impressed by quantitative skills. Those of us who were math and physics majors (or in my case, both) are more realistic. Monday's xkcd gives a secret trick in the mouse-over box that pops up that all math and physics majors learn. For those who haven't figured it out, I'm glad that there's a comic strip to reveal the secret.

Also, a few weeks ago, there was a good xkcd about the attitude of some science types towards about interdisciplinary work.

Another area of broad agreement: adults aren't sexualized enough

2010-06-28T10:29:00.000-07:00

Camile Paglia says that upper middle class adult culture isn't sexualized enough, which is the same point that many conservative religious movements do. Femininity has been devalued, different roles for men and women has taken out the mystery and magic of relationships, we oversexualize young people and undersexualize adults. Young people are having sex before marriage, and older people are not marrying or not having sex in marriage. These points appear in many evangelical Christian, Catholic, and Orthodox Jewish assessments of culture, and in dating books from across the spectrum. (An example of the latter: Rachel Greenwald, a secular Jew who did a qualitative study of 1000 men about their dating histories, found in her study that one reason that men cite for not continuing a relationship past early dates is that the women dress and behave on dates in the same way as they do in the office.)

We can keep in mind that every model is wrong, but some models are useful: these statements are of course oversimplifications and generalizations. But it's really interesting to see a point where some from the left and some from the right can agree, when they would agree on so little else.

Something we can all agree on: not sexualizing little girls

2010-05-26T10:05:00.000-07:00

USC researchers have released a report on the role of women and girls on children's TV. The research finds that females are underrepresented, portrayed as primarily interested in appearance and romance, and that characters are sexualized. I was shocked to see how two children's TV characters were made over as sexualized. Both characters were originally little girls. Now they look older, thinner, show more skin, and Rainbow Brite especially looks like jail bait.

The right and left wings of the sex education debate don't agree on much, but they do agree that reducing women and girls to sexual and romantic roles is distasteful and inappropriate. I hope that all can find some constructive action to counter these disturbing trends.

Anecdote vs. data: soda taxes

2010-05-24T05:04:00.001-07:00

I'm constantly amazed how many people doubt that tobacco taxes and soda taxes work, even people who are educated and listen to empirical research in other parts of their lives. The reasoning seems to be that because they don't feel particularly price sensitive --- making purchase/quantity decisions based on goods' prices --- they aren't price sensitive. Likewise, because they have seen people continue to smoke and buy cigarettes at high prices, they believe few people are smoking less or quitting smoking due to tobacco taxes.

Campaign for Tobacco Free Kids put out a new report on this subject, documenting simultaneous decrease in smoking and increase in revenues from tobacco taxes. The economic research on the subject indicates that soda taxes could be similarly effective.

Going the other way, many people don't perceive expensive produce as a barrier to produce consumption. If they choose to buy more expensive produce (e.g., shopping at a more expensive store, only organic/local), they don't see that their decision to buy more expensive produce could decrease their fruit and vegetable consumption. At most levels of income, probably they will buy less if the produce costs more. Certainly they would buy more if it were cheaper: I've noticed that yelp reviews of lower cost produce shops and supermarkets commonly remark that they can get several huge bags of produce for the cost of one bag of produce at their regular store, and that they do get more when they shop at these stores (e.g., this one in Chicago).

People who otherwise listen to economic research and use it to guide decisions and opinions in the rest of their lives, and who believe in things that they can't see like germs, atoms, and molecules, somehow don't believe in price elasticity because they can't see it. I wonder if anyone's researched the impact of belief in price elasticity on economic behavior.

Limits of randomized experiments

2010-05-23T08:25:00.001-07:00

I just got back from the Mid-Atlantic Causal Inference Conference, the leading meeting for statisticians who look not just for associations, but for causality. Randomized experiments are the gold standard for causality because randomization ensures that on average, the treatment and comparison groups are similar. Experiments do have limitations, however, that come primarily from their great expense: experiments may need to be small and short duration, weakening the chance that experimenters can see an effect. The study described in this article is a perfect example: 22 autistic children were randomized to a gluten-free, casein-free (GFCF) diet for 18 weeks and then given a "challenge" of these foods about 4 weeks into the trial; by the end of the trial 8 of the subjects had dropped out.

Seemingly, there are hundreds of parents on internet mailing lists and websites putting their children on a GFCF diet. GFCF diet is hard to implement, and it takes weeks or months or practice to get right, and even then an errant crumb can disrupt the progress, and it's unclear how long kids need to be on the diet to see an improvement because determining the starting point is so inexact. A parent can probably remove >90% of gluten and casein from their child's diet starting on day 1, but hunting down the remaining 10% to reach 100% adherence takes a long time. And 99.9998% adherence may be exactly what's required: the FDA definition of gluten-free is 20 ppm. Once the GFCF diet is in place, many parents say that it improves their children. Now a randomized trial that started out with 22 participants and lost 8 of them comes into the news with the headline, "Eliminating Wheat, Milk From Diet Doesn't Help Autistic Kids."

An experiment doesn't have the luxury of trying to refine the diet to make sure that it's being done correctly, or to figure out the length of time the diet needs to continue until there's improvement. An experiment generally determines the treatment in advance rather than trial and error, since trying to get the best result is, to a certain extent, cheating (i.e., risking a spuriously significant result that occurred simply by chance).

A good experiment is an invaluable tool for understanding reality, but a so-so experiment is no better than a qualitative study of people on internet websites.

Chemicals and comparison groups

2010-05-18T07:00:00.000-07:00

Current legislation is trying to ban a plastic that has been used for 50 years to line cans, so I decided to look into how much evidence there is that this plastic is dangerous, and whether the potential substitutes for this plastic are safe. The American Council on Science and Health finds little evidence that this plastic is dangerous; they find no proposals for what plastics might substitute, much less any evidence on the alternatives' safety profiles. Their analysis raises very good points and is worth reading.

Just as in statistics, the important question for any risk analysis is "compared to what?" Nothing is dangerous on an absolute level: risks always have to be weighed against their alternatives. When we banned DDT decades ago, it may or may not have had beneficial effects for the eagle population, but malaria has rebounded: going from millions of cases in Sri Lanka to a couple dozen, and then back up to a million cases after the DDT ban. Malaria still affects hundreds of millions of people around the world, many cases that might be prevented if DDT spraying were allowed. The developed world has not had malaria since the 1940s --- perhaps if malaria had rebounded, perhaps we would see pesticides as the life-saving tools that they are --- but we do have the resurgence of bed bugs, even on the Upper East Side, after they had been almost completely eliminated 50 years ago. Maybe the good effects of the DDT ban are worth hundreds of millions of cases of malaria in the developing world and bedbugs in the developed world, but alternatives always need to be considered. The WHO has backed bringing back DDT because it was so useful.

With the current talk of banning BPA, the comparison group is completely missing. By banning a plastic without discussing alternatives and their risks, we risk having worse alternatives or no alternatives.

Ambivalence or Planned Parenthood

2010-05-16T17:38:00.000-07:00

A lot of evidence finds that a sizable number of young adults are ambivalent about pregnancy: they don't want to get pregnant, but they wouldn't mind if they did. Bill Albert of the National Campaign to Prevent Teen and Unplanned Pregnancy asks whether ambivalence is the right mindset in which to start a family, which reminded me of last week's A Prairie Home Companion.

In honor of Mother's Day, a skit on last week's Prairie Home Companion contrasted today's view of motherhood with the earlier generation. In today's motherhood, the woman says to her husband that they may need to work on their relationship and openness before they are really completely ready for having children, although they've already been married over a dozen years, and the childbirth is assisted by a midwife, a chanting Tibetan monk, and a dolphin named Sparky. The earlier generation, the woman says, "Gee John, I just got back from the doctor, and guess what?" John says, "Guess we ought to get married then." Her childbirth is attended by a doctor who is also a veterinarian, and she runs back to the potato field to finish harvesting right afterwards.

Certainly planning is best, but there is certainly such a thing as too much planning and waiting. Earlier not-quite-planned parenthood is difficult but so are fertility treatments. Parenthood is difficult no matter when it's done; while parenthood is gratifying, according to the research that I'm aware of, people with children are less happy than people without children. May everyone find a middle ground that they can be happy with, and be able to have as many children as they would like.

Fantastic WW2 sex ed film for soldiers

2010-05-14T07:48:00.000-07:00

This film shown to World War II soldiers is already better than any official abstinence-only (a-h criteria compliant) education curriculum. The message is do not have sex, but if you do, use a condom, and it shows a condom and then tells how to put it on, and do not drink so much that you are careless. And then it closes with the typewritten message on the screen, "Do not be so weak as to let some ignorant individual persuade you that you must seek sex relations to be a good sport. If you follow his advice, you are only being a fool."

Short and to the point, and an easy substitute for weeks-long curricula. And this was before there was even effective treatment for either syphilis or gonorrhea. (And before we were aware of chlamydia, herpes, and HPV.) Interestingly, the film was made in 1941, or either in the 24 days after the US declared WW2 or prior to entering WW2. Either way, it's clear that the army clearly anticipated that STIs can be a major problem, and it knew that it had to prevent STIs as much as possible, rather than waiting for them to come up. Unfortunately, there is no such common unifying impetus to prevent STIs today.

Policy proposal: given that some idealize the times before the sexual revolution, states that are reluctant about giving modern comprehensive sex education should limit themselves to material produced by state and federal government bodies prior to the sexual revolution. The vintage government films that I've seen are more practical and factual than the abstinence-only curricula that I've seen.

Why doctors need to know Bayes theorem

2010-05-02T06:17:00.000-07:00

In graduate school, I was the head TF for several general audience statistics courses, and my favorite subject was Bayes theorem because it implies that many "common sense" policies are, in fact, dangerous. Given a dreaded disease, drug use among ship captains or pilots, or anything else, it's so easy to say, "Just test everyone." But in fact, that's not good policy.

Social psychologist Gird Gigerenzer's new book covers some instances of asking doctors to give probabilities to their patients, and they do a horrible job. The question presents the information exactly as doctors are taught: prevalence, sensitivity, and specificity (false positives).

The probability that one of these women has breast cancer is 0.8 percent. If a woman has breast cancer, the probability is 90 percent that she will have a positive mammogram. If a woman does not have breast cancer, the probability is 7 percent that she will still have a positive mammogram. Imagine a woman who has a positive mammogram. What is the probability that she actually has breast cancer?

A prestigious doctor, department chief with 30 years of experience "was visibly nervous while trying to figure out what he would tell the woman. After mulling the numbers over, he finally estimated the woman’s probability of having breast cancer, given that she has a positive mammogram, to be 90 percent. Nervously, he added, ‘Oh, what nonsense. I can’t do this. You should test my daughter; she is studying medicine.’ He knew that his estimate was wrong, but he did not know how to reason better. Despite the fact that he had spent 10 minutes wringing his mind for an answer, he could not figure out how to draw a sound inference from the probabilities."

And he was typical: more than 90% of the doctors were wrong, mostly very wrong.

When the question was posed in terms that are easier for people to understand, nearly all of the doctors got the question right.

Sweden has had sex education since 1918

2010-04-12T10:03:00.000-07:00

While doing a literature review for a paper about syphilis, I learned that Sweden has had what we would now call comprehensive sex education since 1918 ("Venereal Diseases and Sex Education", Report by a Swedish Government Committee, British Medical Journal, vol 1, no. 3204, May 27, 1922, p.842), as part of their "venereal disease" prevention law.

A 1943 discussion of sex education shows that current discussions are almost identical to past dicussions. The Archbishop of Canterbury noted that "if men and women would abstain from fornication the problem would be reduced greatly and become a purely medical matter. The bulk of the evil is primarily a moral problem." and he suggested that by distributing condoms to the troops "the implication is that many are expected to practice fornication" and thus it increases. One person cited one example in which moral suasion worked to prevent sex among soldiers --- the Black Sea Army in World War I --- and that the forces would respond if chastity were portrayed "in the right way".

On the other side, a medical officer from St. Pancras argued that the Church's teaching was unhelpful and that creating a taboo against premarital sex causes those who break the taboo to become rebels and outcasts. An alderman calls for sex education for those age 13 and up since otherwise they will learn about sex from "street talk", while a doctor calls for sex ed starting at age 11. Meanwhile, a minister in the Church said that he has discussed venereal diseases openly for years, and in a separate report, a psychiatrist noted that "The clergy were more broad-minded than schoolmasters."

Three months without federal abstinence-only funding

2010-04-11T06:20:00.000-07:00

The US had 3 months without abstinence-only funding on the books before the health reform law reinstated it: $50 million a year for 5 years for the states, the exact same level of state-level abstinence funding as in the previous administration, even though fewer states are applying for the funds. Even Alaska under Sarah Palin "missed the deadline" for abstinence grants in the last round. (No Sarah Palin jokes. Missing the deadline just seems to be the politically expedient method of not participating in abstinence funding.)

The difference between current funding and the previous administration seems to be $154 million: community organizations are no longer given abstinence grants ($141 million in 2009) and the Adolescent Family Life abstinence program is no longer listed in the budget ($13 million in 2009). Not funding AFL is surprising, and I wonder if I've missed something since that program has been funded consistently since the early 1980s, but I don't see in the 2011 HHS budget; this program generally flies under the radar and is usually not mentioned in media reports about abstinence education, even though organizations like Advocates for Youth track it.

The decrease in abstinence-only education funding from $204 million to $50 million represents additional good news: the $50 million is going to states who are scrutinized more heavily. For instance, some states have laws requiring that all sex education be medically accurate. On the other hand, increasing numbers of states require contraception to be taught in sex education, which may mean that even if the states wanted to apply for the abstinence funds, their state law mandates a curriculum that is incompatible with the abstinence education requirements. The a-h definition of abstinence education in the Title V is so restrictive that the only abstinence-only program that has ever been shown effective (Jemmott and Jemmott's research) could not be funded under Title V.

Another difference between the pre-2009 and current HHS budgets is that abstinence was featured prominently in the budget in 2009 and before. Many pages of the pre-2009 budgets mentioned abstinence, and there was a whole subsection describing all the sources of abstinence funding and their histories. The 2011 budget doesn't have any text about abstinence and only includes abstinence in the itemized totals, mostly for past years, and has "--" where future years of abstinence funding are supposed to be listed. (The new 50 million a year isn't yet listed in the 2011 budget.)

While the country had only the 3 month period between the zero-ing out of abstinence education at the end of December 2009 and the passage of the health reform bill at the end of March 2010, there's certainly a big shift.

The really interesting question is how many states will apply for abstinence funds, since more states now have comprehensive sex education laws that are incompatible with applying for the funds, and whether it would be possible for the a-h definition to be changed. Or if the $50 million will go only to the states with strong abstinence-only constituencies such as Louisiana and Texas.

Sex Education of the Weird

2010-04-09T14:08:00.000-07:00

A recent News of the Weird had two pieces of news related to sex education, but the weirdest was in this Thursday's New York Times.

First, abstinence-only sex education was the explanation for a teen's harassment of women:

Sheriff's deputies in Austin, Texas, arrested Anthony Gigliotti, 17, after complaints that the teen was annoying women by following them around in public and snapping photographs of their clothed body parts. Gigliotti told one deputy that he needed the photos because the sex education at his Lake Travis High School was inadequate. [KXAN-TV (Austin), 2-2-10]

On the other hand, condom education isn't necessarily safe either:

Clumsy: Teacher Karen Hollander filed a lawsuit in November against the New York City Department of Education after taking a fall on "slippery foreign substances," including condoms, on the floor at the High School of Art & Design. Since schools distribute condoms on campus, she said, the department is responsible when students open them and discard them during the lunch period, littering the floor. [New York Daily News, 11-21-09]

The weirdest of all, however, was in the New York Times. In response to a new comprehensive sex education law that requires contraception education to be included in any sex education course, the district attorney of a county in Wisconsin "warned that teachers face 'possible criminal liability' for teaching youths how to use contraceptives."

As the GAO found, some fraction of abstinence-only education just isn't true. While well-intentioned, this prosecutor's warning is no exception.

Do teens consider oral sex to be sex?

2010-04-06T18:55:00.000-07:00

A recent study finds that only 20% of a convenience sample of teens consider oral sex to be sex. This finding has been documented anecdotally, such as in the classic scene from the 1994 movie _Clerks_, where the main character is described to hear the discrepancy in his girlfriend's number of sexual partners and number of oral sex partners. (3 vs. 37.) He had only been told about the former.

Of course there's the caveat that this convenience sample has no implications about US teens' norms in general since the sample wasn't random.

Public vs. private virginity pledges

2010-03-04T09:40:00.001-08:00

The abstinence movement has been marked by grand gestures, and yet Melanie Bersamin found that teens who promise themselves to abstain until marriage are more likely to delay sex, while teens who take virginity pledges are not likely to delay sex. I gave a presentation about virginity pledges recently, so when I read the following, I thought of it:

The first tablets of the Ten Commandments, given with so much drama, were
destroyed. The second tablets, given privately and quietly, survived and became
the spiritual foundation of the people of Israel.

The Me'am Lo'ez points to the moral of this story: the really important and
lasting things in life are often done by individuals in privacy, through their
own exertions. Things done with much publicity may not be as permanent. (Marc Angel)

Perhaps the virginity pledge movement was a victim of its own success: the public nature of the pledges, the 1.5 billion in abstinence funding, and the attempts to seem trendy may have been the sound and fury signifying nothing of the first ten commandments.

Positive predictive values and gun control

2010-02-17T12:59:00.000-08:00

The US has a number of workplace and school shootings, and each incident goes the same way. Media dig up events from the perpetrator's past (putting the perpetrator's name everywhere when the perpetrator's name really should forgotten, and the victims the ones who are remembered), including criminal record, complaints from co-workers, qualitative assessments of the shooter's mental health, and random anecdotes, and all of these events are assembled to answer the question of whether someone could have known that the perpetrator was so crazy.

While some of these incidents from a perpetrator's past are indeed crazy, they have poor positive predictive value: the most recent shooter apparently punched a woman over a booster seat at an IHOP. But such ironic and strange incidents happen all the time, which I know as an avid reader of News of the Weird. Attempting to predict who will go bezerk is like looking for a needle in a haystack: many people do minor strange, crazy things, and even do so multiple times, but most people who do minor strange things will not commit homicide. Even looking at more severe incidents, such as shooting a brother at age 20, may not necessarily predict future violence. Though allegedly sending a bomb to a dissertation committee member seems more likely to predict future violence, she was cleared of that charge.

Attempting to predict who will snap begs the question. We can't. Even if we had Big Brother comprehensive databases of every person's past, and were willing to disregard rules of evidence and dropped charges, we couldn't predict severe violence. The real issue is not which people are likely to snap, but rather why our gun control policy allows people such easy access to firearms that when they do snap they can do so much damage. Human psychology is fallible, but in countries without easy access to firearms, the damage comes in the form of broken objects, bruises and broken bones, and perhaps even a stabbing. Firearms create more damage, and damage that is most likely to be deadly.

. . .

Speaking of News of the Weird, here's one from last year about a Yale PhD and professor:

Love Can Mess You Up: Before Arthur David Horn met his future bride Lynette (a "metaphysical healer") in 1988, he was a tenured professor at Colorado State, with a Ph.D. in anthropology from Yale, teaching a mainstream course in human evolution. With Lynette's guidance (after a revelatory week with her in California's Trinity Mountains, searching for Bigfoot), Horn evolved, himself, resigning from Colorado State and seeking to remedy his inadequate Ivy League education. At a conference in Denver in September, Horn said he now realizes that humans come from an alien race of shape-shifting reptilians that continue to control civilization through the secretive leaders known as the Illuminati. Other panelists in Denver included enthusiasts describing their own experiences with various alien races. [Rocky Mountain Collegian, 9-28-09]

NY Times on the undergraduate sexual economy

2010-02-08T04:51:00.000-08:00

Just as Katherine Bogle found: The NY Times reports that women are outnumbering men on campus, and turning to hookups in hopes of hooking a man. Based on both what I've learned anecdotally and also read in Rachel Greenwald's qualitative study of dating among adults, that's counterproductive. As someone told me when explaining why he thought early sex was intrinsically casual sex, "Everyone knows that if you have sex on the first date, you'll never see each other again."

If their concerns are long term, as many of these women and those in Bogle's study said, the women's decision to eliminate half the men to start with is also counterproductive. The article describes a campus that is 60% female where half the men are undesirable, and half of the desirable are coupled. Take a campus of 1000 students (all straight): 500 available women, 200 "undesirable" men, 100 available "desirable" men, and 100 each coupled "desirable" men and women. Effectively, the women have created a situation where the gender ratio is 5:1 female to desirable male, when it would otherwise be 5:3. Of course all the women expect that they are going to be the lucky 10% in a couple, so it would seem that this situation doesn't hurt them. In fact, since it seems likely that even couples are more unstable in a 5:1 gender ratio than a 5:3 gender ratio, labeling half the men as undesirable hurts even coupled women.

As one woman quoted in the article said, "As for a man’s cheating, “that’s a thing that girls let slide, because you have to. If you don’t let it slide, you don’t have a boyfriend.”" (Obviously counterproductive, no matter what the gender ratio is.)

Webster's dictionary is too sexually explicit

2010-01-25T07:29:00.000-08:00

This article reads like it's from the Onion, but in fact parents really do seem to have asked their school district to ban the dictionary from the school library because of its definition of "oral sex," and the district complied.

Not only that, but the school district is looking for more objectionable words in the dictionary. ' "It's hard to sit and read the dictionary, but we'll be looking to find other things of a graphic nature," district spokeswoman Betti Cadmus told the paper [the Guardian].' Just ask any 8 year old. Those "graphic" words are the first words a curious 8 year old turns to when they open any dictionary.

What do school officials think the dictionary is for? Kids don't need to look up terms that they have ample information about such as "flower" and "toe". They need to look up ideas that they do not have ready access to, such as sexual behavior, substance use, and intelligence, as a quote from a board member illustrates well:

Board member Randy Freeman, an elementary school teacher and parent to four daughters in Menifee schools... said it's "a prestigious dictionary that's used in the Riverside County spelling bee, but I also imagine there are words in there of concern."

In other words, it sounds like he's never opened a dictionary.

"Hooking up" in the medical literature

2010-01-22T15:56:00.000-08:00

Searching pubmed for the term "hooking up" reveals the following (sex-related) articles:

First mention was in 2003 in the Journal of Sex Research, and the most interesting paper by far: "both women and men rated their peers as being more comfortable engaging in these behaviors than they rated themselves. Men expressed more comfort than did women in engaging in these behaviors, and both sexes overestimated the other gender s comfort with hooking up behaviors."

Second mention: 2007, in J Interpersonal Violence about unwanted sexual experiences while hooking up.

2008: 3 mentions.
1. Hookups more likely among extraversion and less likely among low conscientious. [Note: this puts some context behind qualitative study of Bogle that women perceived all "dateable" men as interested only in hooking up: these women may view only high extraversion and low conscientious as dateable, while the low extraversion and high conscientious may have been considered less dateable.]
2. Oral sex seems not to be regretted, just vaginal sex, and especially with a one-time-only encounter or with someone met in last 24 hours.
3. More likely among higher income, white, alcohol users; women less positive reactions.

2009: 3 mentions.
1. The first longitudinal study looking for predictors of hookups (measured in the second wave), but nothing surprising: alcohol, high school hook-ups predict college hookups. Any sex in hookups associated with psychological distress for women but not men.
2. Qualitative study: men also have feelings about casual sex, not all positive, and not all no-strings-attached.
3. Hookups may have higher than normal STI risk, and may undermine sexual self-efficacy.

Interesting to find that there are only 8 articles that turn up. Obviously casual sex is more common in the literature, but the phenomenon of "hooking up" may be more widespread or normative than past casual sex. Certainly the first paper, about students' own attitudes towards casual sex being more ambivalent than their perceptions of their peers' beliefs, may not have been true a few decades ago.

An elderly psychiatrist's theories of casual sex

2010-01-22T15:50:00.000-08:00

A recent paper in Dec 2009 found no greater mental health problems among students who "hook up" than students who don't.

I thought of this paper while reading the sex chapter in a book by psychiatrist Frederic Flach (1927-2006) who wrote much on resilience and depression. The thing I find so refreshing about his writing is how theory-based it is. I do not know whether the theories are right, but they allow him to tell a cohesive story in a way that data-driven writing would not.

1. Adolescence is a time for identity formation. Early sex interferes with that purpose of adolescence, and prevents sex from being integrated with their full identity. Sexual pressure may translate into substance use instead of the sex that they're not prepared for.

2. It's good that sexual guilt has been removed, but guilt also had a good effect of keeping people out of sexual affairs that may hurt people's self-worth or sense of personal integrity and lead to depression, such as marital infidelity, premature sex, or degrading situations.

3. The modern era has depersonalized many aspects of life, and people may be treated as statistical objects instead of people. Alienation is not rare. Sex has also been made impersonal in some contexts, but that may be because of the general social phenomenon of depersonalization, rather than something unique to devaluing sex (as some claim).

4. Sex may also be used to alleviate general loneliness and alienation, rather than for sexual purposes, and it's not successful at that. Low self-esteem in fact makes it hard to create a good relationship with trust and love, thus further reducing self-esteem.

5. Based on theories of Erikson and Buber, it's important for sex to occur within a framework of emotional intimacy, love, trust, and sharing everyday activities and life. If the primary sexual outlet is casual sex, "the inevitable enhancement of self-esteem that results from the complete experience does not occur and a slow, progressive waning in self-worth takes place, however it may be denied. Sexual harmony is not rooted in fine technique; rather, its foundation lies in both partners generously sharing with each other their bodies and their souls." (p. 97-98).

What I like the most about this analysis is that it posits distinct theories about what will happen in dynamic way that we can't capture easily with quantitative data. Data has to be extensive in order to capture a primary sexual outlet being casual sex, the absence of love, and a decline in self-worth. Not to mention being able to define and measure love and self-worth in meaningful ways. And the existing quantitative data on casual sex doesn't come close to being able to capture this.

This analysis does imply that given the choice of sex without love or no sex at all, the latter is preferable. Alternatively, it's optimistic, rejecting the idea of love as ever impossible.

Sexual fluidity in males

2010-01-22T04:03:00.001-08:00

An extremely rare case of sexual fluidity in males: The Day I decided to Stop Being Gay.

This anecdote is similar to the qualitative study by Lisa Diamond, published in the book Sexual Fluidity, who documented 100 lesbian/bisexual/other women who spontaneously changed sexual orientation over the course of the 10 years after they graduated college.

The theory of sexual orientation that I'm familiar with are that female sexuality is more fluid, and male sexuality is more fixed --- though neither sexuality can be made to change, but rather may change spontaneously --- but this anecdote is an example counter to the view of male sexuality as being relatively more fixed.

He says he has another friend with a similar story. Will people start speaking of "gay until straight-marriage" as they do "lesbian until graduation"? GUS (GUM?) is a better acronym than LUG anyhow.

I wonder how it will turn out for him in 10 or 20 years. I do think that any woman would justifiably hesitate to marry him.

Next abortion restriction: must name the baby before abortion

2010-01-16T21:14:00.000-08:00

Onion News Network: "New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion". The piece includes many other abortion law spoofs including 3 week post nursery-painting reflection period, a law that requires a woman who gets an abortion to donate a kidney, and pharmacists dispensing birth control in a blood red box with a skull on it while chanting "god have mercy on us" in Latin.

Non-useful graphical display of data: in the comics

2010-01-13T04:35:00.000-08:00

Today's xkcd has a fantastic illustration of exactly what non-useful data display is.

Some displays of data are no more informative than the pie chart.

The 5 year pregnancy and other religious methods of dealing with deviance

2010-01-08T11:56:00.001-08:00

One of the recurrent issues with religious restrictions on sexuality is how to deal with sexual transgressions. If a married woman's husband away has been away for 12 months, and she gives birth, how does a religion address this? The rabbis of the Talmud 1500 years ago declared that the length of pregnancy was 9 months, but birth can sometimes be delayed by 3 months, resulting in a 12 month pregnancy (Yevamot 80b). Apparently Muslim authorities made similar declarations, saying that a pregnancy can last 2, 4, or even 5 years. Likewise, I've heard of writings that a first pregnancy can be only 3 months long and yield a full-grown baby.

The source in the linked article is decrying this unscientific thinking, but it seems like the best alternative in a religious society that denies a high prevalance of transgression. Everyone knows that pregnancies are 9 months long (+/-), and much less than this will result in a small infant and much more than this is impossible, but declaring that reality fits the moral order rather than admitting the frequency of immorality is definitely more humane than calling people out on transgressions and treating them poorly. Which the editorialist seems interested in doing:

from a moral perspective, how can I provide a jurisprudential loophole for a woman who was probably promiscuous after the death of her husband and then presented her baby, conceived in sin, as a baby of her dead husband by relying on the [notion] of a hidden pregnancy or on a fatwa issued by some [cleric] or religious school? This is what happened on December 14, 1927 at a shari'a court in Mecca. The qadi... ruled that the baby was conceived by the woman's dead husband who had died five years previously.

Obviously the best option is to recognize that it's normal for healthy people to have sex, sometimes when it's against their religion's rules, and to provide a structure so that the best outcomes can prevail: sex ed, contraception, reasonable expectations. When that's not an option, a 5 year pregnancy seems like a great alternative.

Dead salmon CAN think! Or an argument for multiple comparison corrections

2009-12-29T05:41:00.000-08:00

Just over five years ago, a New Square fish store owner and his employee claimed to have had a talking carp:

Mr. Rosen said that when he approached the fish he heard it uttering warnings and commands in Hebrew.

"It said `Tzaruch shemirah' and `Hasof bah,' " he said, "which essentially means that everyone needs to account for themselves because the end is near."

The fish commanded Mr. Rosen to pray and to study the Torah and identified itself as the soul of a local Hasidic man who died last year, childless. The man often bought carp at the shop for the Sabbath meals of poorer village residents.

Few believed them, though many jokes were made such as the gefillte fish manufacturer who considered taking on the slogan "Our fish speaks for itself".

Now neuroscientists have documented brain activity, not just in a live carp of the story, but in a dead salmon, in the paper, Neural correlates of interspecies perspective taking in the post-mortem Atlantic Salmon: An argument for multiple comparisons correction. As they put it in their Methods section:

Subject. One mature Atlantic Salmon (Salmo salar) participated in the fMRI study. The salmon was approximately 18 inches long, weighed 3.8 lbs, and was not alive at the time of scanning.

Task. The task administered to the salmon involved completing an open-ended mentalizing task. The salmon was shown a series of photographs depicting human individuals in social situations with a specified emotional valence. The salmon was asked to determine what emotion the individual in the photo must have been experiencing.

Just picture the scene for a moment. I would love to talk to the research assistant who had to talk to the salmon and show it pictures. What kind of "mentalizing" does a person have while speaking to a dead fish?

The conclusion:

Can we conclude from this data that the salmon is engaging in the perspective-taking task? Certainly not. What we can determine is that random noise in the EPI timeseries may yield spurious results if multiple comparisons are not controlled for. Adaptive methods for controlling the false discovery rate and familywise error rate are excellent options and are widely available in all major fMRI analysis packages. We argue that relying on standard statistical thresholds (p < 0.001) and low minimum cluster sizes (k > 8) is an ineffective control for multiple comparisons. We further argue that the vast majority of fMRI studies should be utilizing multiple comparisons correction as standard practice in the computation of their statistics.

The study was also covered by Science News in an article on lack of replicability of fMRI experiments. The Science News story includes a quote that is a good idea for everyone, whether or not they do fMRI experiments: “Statistics should support common sense. If the math is so complicated that you don’t understand it, do something else.”

When this study wins the Ignobel Prize, you can say you saw that prediction here first.

Is it possible to restore the norm of no premarital sex?

2009-12-15T08:53:00.001-08:00

News today about gaps in sex education has a fantastically clear quote about the goals of conservative policy towards sex education:

"I don't think we'll be able to overcome this problem unless we restore the social norm of not having sex and not getting pregnant before marriage," said Peter Sprigg, senior fellow for policy studies at the Family Research Council.

Social conservatives do not generally support research about social norms about sexuality, so we do not know as much about sexual norms as we would otherwise. According to the earliest representative studies by sociologist Ira Reiss, the attitudes to allow what Ira Reiss called "permissiveness with affection" started shifting in the 1940s, and the shift was well underway by 1950 and definitely by 1960 when Ira Reiss wrote Premarital Sex in America (the link goes to the actual book). It seems unlikely that such a long-standing attitude shift could be easily reversed. By now, it is the standard that even many Evangelicals follow. If they marry right after college, it's possible they may abstain, but if they marry later, it's very unlikely, and many do marry later.

I would argue that permissiveness with affection is not a policy issue. No public health problems result from premarital sex within long-term committed monogamous relationships. Disease spread is self-limiting. Still, if changing that social norm is a worthy public policy goal, they have to look to more recent trends first.

One norm that has changed more recently are attitudes towards what Reiss calls "permissiveness without affection:" just as AIDS was emerging in the early 1980s, academics were declaring this to be the new norm. From the poll data in the link (which I would guess is an incomplete picture of the available data), it looks like endorsement of the norm may have declined with AIDS/HIV, and has begun to reemerge to some extent and even become part of public discourse, with everyone having heard of the idea of "Friends with Benefits". Unlike permissiveness with affection, there is some degree of a public health justification due to the herpes and HPV risks.

But that means you have to acknowledge that that nearly all Americans have premarital sex, and teach real sex education to protect them.

And then you have to think of a policy that can change social norms. Incidentally, changing social norms would seem to be totally inconsistent with a limited government of the sort that Conservatives say they want.

Open letter to Senator Lieberman

2009-12-15T04:30:00.000-08:00

Dear Senator Lieberman,

As a Harvard Health Policy PhD and Jew, I am sad to hear that you are weakening health care reform.

As a Health Policy PhD, I refer you to my professors in the Harvard Health Policy program, who say the original Senate health care bill is the best available solution.

As a Jew, I remind you that the Rabbinic Sages teach us not to be like the men of Sodom who would say שלי שלי ושלך שלך "What is mine is mine and what is yours is yours." The Sages taught that justifying inequality is not just negligence, but actually evil.

The present US system could be a model for Sodom: discounted prices to the rich/insured/healthy and inflated prices to the poor/sick/uninsured. Any solution that perpetuates inequalities between privileged/healthy and poor/sick perpetuates the health care system of Sodom.

Strong health care reform is a policy and Jewish imperative.

Janet Rosenbaum, Ph.D. Health Policy, Harvard 2008
Johns Hopkins Bloomberg School of Public Health

Quantifying and qualifying casual sex

2009-12-14T05:44:00.000-08:00

A recent paper compares measure of "psychological wellbeing" between people whose most recent relationship was casual versus serious, and finds no difference. The paper motivates itself by the speculation in public discourse and the teachings of abstinence-only sex education that casual sex is harmful.

The qualitative research on the subject of casual sex seems pretty clear that, to the extent that they exist, the harms of casual sex would be unlikely to be found on a psychometric measure. Kathleen Bogle's qualitative study found that college-aged women feel frustrated and sometimes their feelings are hurt by differing expectations, which is also consistent with what Laura Sessions-Stepp reports in her journalistic book. I haven't ever seen anyone suggest higher rates of mental illness among people who have casual sex. It seems highly unlikely that casual sex poses a public mental health problem. (Casual sex does likely increase the total lifetime number of sex partners, so increases STD risk, but that's not the main issue here.)

The lack of a quantitative measure for romantic frustration doesn't make it unimportant. Just as quantitative research finds that married men seem to be in better physical and mental health than unmarried, but no difference for women, doesn't diminish the importance of the desire of many unmarried women to be in committed relationships. Likewise, quantitative research finds that people with children are more unhappy than people without, and yet there is an entire medical subfield dedicated to making people unhappy by helping them have children. (Likewise, my understanding is that US medical doctors stopped performing sex reassignment surgery after quantitative studies found no improvement after surgery, and yet qualitatively transgendered people who choose surgery report an improvement.)

Intangibles are important. Keep those qualitative studies coming.

Abstinence-only music videos.

2009-11-29T14:07:00.000-08:00

Washington City Paper features Top Five Abstinence Only music videos as well as a music video about the Christian Side Hug.

The potentially most negative video for STD prevention, "Ain't NO safe way" shows a couple in a drive-through. The man says no on the grounds that sex is dangerous. The woman holds up a condom saying vacantly as if hypnotized, "If they give these out in school, it must be safe." Her eyes widen further, unblinking, crazed, as she intones, "Don't worry. It's SAFE." "Safe" echoes in the background. Heavy metal music starts with "Wages of Sin = DEATH" on TV screens blinking in the background. (The boy says no, and gets out of the car, and the girl drives away disappointed.)

All five of these fall into the shaming language of "lose" and "take" virginity, and one girl even telling her friend "you should be ashamed" for having sex, as well as the ethnic stereotypes: many feature black women saying no to black men, and none feature Asians (who are disproportionately represented among virginity pledgers, but the stereotype is that they have no problem saying no.) Nor do they include black men turning down women.

Twilight books romanticize domestic violence?

2009-11-24T20:51:00.000-08:00

The Twilight book series has been thought of as promoting abstinence, so I've followed it somewhat because of my work. I found it interesting to read this post, which goes through the checklist from the National Domestic Violence hotline for Bella and Edward's relationship, and finds 15 signs that their relationship is abusive. Fifteen! I have only read articles about the books and movies, not read the books or seen the movies myself, so I am frankly surprised to hear that Edward throws Bella through a glass table. But even the other signs, like repeated statements of jealousy, abandoning her in a dangerous place, threatening suicide. . . This is supposed to be romantic? Religious groups can't possibly approve of these books, abstinence message or no.

Also: the view from a school librarian (and member of my Cambridge synagogue).

Hormonal contraception makes women less attractive and choose worse partners, says review paper

2009-10-08T06:34:00.000-07:00

A few months ago, I said that hormonal contraception (the pill, Depo, etc.) messes up women's choice of mates because of results we knew that women choose differently and asked whether that's responsible for higher divorces in those couples. We still don't know that information, whether divorce is more likely among women who chose their partners using hormonal contraception.

But a review paper has come out solidifying that finding that women choose partners differently on hormonal contraception than off and adding that women are less attractive while they're taking it because it suppresses ovulation (during which women are more attractive to men).

That's another reason to add to the book that just came out saying that women ought to consider other methods besides the pill.

Hormonal contraception is a standard, and evidence probably won't change that, but there are other equally reliable methods of pregnancy prevention such as intrauterine contraception (IUC) that currently have miniscule proportions of women using them. I wonder whether we'll see even a slight shift.

(Conflict of interest disclosure: I have a very nice pen given to me by the company that makes an IUC device that I happen to have used this morning, but really that's not why I wrote that. This is just the first time I've ever had one of those legendary conflicts of interest.)

Political compromises on sex ed

2009-10-05T11:12:00.000-07:00

I'm an ardent moderate, but I find the administration's compromises counterproductive. Obviously the stimulus compromise didn't work: the bill was watered down, and virtually no Republicans voted for it anyhow.

If the health bill passes, the sex education situation will go to $50 million for abstinence-only education, $50 million for evidence-based comprehensive sex education, and $25 million for experimental comprehensive sex education. That's not compromise. That's going also against popular opinion: 52% of even politically "very conservative" parents favor teaching birth control in schools, and 89% of the general population of parents. Just as most of the public and most physicians favor the public option, but that doesn't make it into policy either.

More importantly, it's going agsinst the findings of the Congressionally-mandated study finding that abstinence-only sex education doesn't work.

They're not listening to either the public or the researchers they hired.

Why the placebo effect is an effect

2009-10-02T04:23:00.000-07:00

There was an interesting article in Wired recently that spoke about the placebo effect getting stronger: that the pre-post difference from a placebo drug is greater than it was a decade or two ago and that it differs between countries. That is, if you are looking at antidepressants and your outcome measure is a score on the Beck Depression Inventory that measures how depressed someone is, the score before the drug minus the score after the drug is different now than it was 10 years ago.

One criticism of the article is that the placebo effect cannot be considered an effect unless it is compared with another experimental condition. Since drug trials don't include both patients who receive a placebo and patients who receive nothing, there is no such thing as a placebo effect unless we know what the pre-post difference would have been in the absence of the placebo. Without a nothing arm to compare with, the writer contends that the pre-post difference in the placebo arm of a trial is just by definition the background noise in the trial.

I think that he's making a semantic point because a true placebo effect is impossible to measure.

To break the problem down further:

We do not know what the pre-post difference in a nothing arm of a trial would be. In some trials and for some diseases, there would be spontaneous improvement in the patient's condition: in that case, the pre-post difference in the placebo might just be that spontaneous improvement that would have happened if nothing were done.

In some trials and for some diseases, there would not be much change in the patient's condition, so the nothing arm would have no difference: in that case, the pre-post difference in the placebo arm would represent an "effect" and we could say that we have a placebo effect.

The question is which diseases have spontaneous improvement and which don't. There are three ways I can think of to figure this out.

1. A randomized clinical trial with patients that actually have some disease in which half the patients get a sugar pill and half the patients get nothing. No human subjects board would authorize this trial. Second, the study would not measure what we want it to. Ethically patients have to be told that the two possibilities are sugar pill and nothing. The Wired article contends that the placebo "effect" is based on a patient's prior beliefs about a drug's effectiveness, so it's specific to the drug, rather than being just the effect of a plain sugar pill.

2. The placebo effect could in theory be measured with matching, were there any subjects to match them to. The placebo pre-post difference can be defined in two ways: the pre-post difference of the sugar pill plus the pre-post difference of enrolling in the trial, or just the pre-post difference of the sugar pill alone. I would say it's the former. In that case, where we want to measure the effect of enrolling in a trial and taking a sugar pill, we could match normal patients with placebo patients based on their records and compare their pre-post differences. Except for the fact that medical records of normal patients with a disease are there because the patients are getting some treatment from their doctors. So there's no group to compare the placebo patients to.

3. The one remaining possibility is for each drug trial to divide their control group into two unequal groups: one receiving a sugar pill would be the larger group and one being put on a waiting list for the drug would be a smaller group. The problem is that placebos serve two purposes: one is for the statistical purpose and one is to keep the participants in the study and encourage them against taking other treatments. Depending on the condition, a control participant put on a waiting list might leave the trial or take another treatment in addition to the waiting list. So you might lose a good portion of the nothing arm of the trial.

Given the impossibility of rigorous measurement of what would happen under no treatment, the best we can do is guess which are the diseases where symptoms spontaneously resolve and which are the diseases where they don't. And that's what we already do when we talk about a placebo effect. We compare the pre-post difference in the placebo arm of a trial with our beliefs about what the pre-post difference would be with no treatment. In that sense, the placebo effect is really an effect. It's just imprecise.

Further, it's reasonable to assume that whatever the pre-post difference under nothing is, it's not going to change with time in any systematic way. If we could put all the placebo arms of, say, antidepressant trials together and find a trend with time, that's not sampling error. And that's exactly what the Wired article is talking about.

Statisticians protest at G-20 conference for safer data mining

2009-10-02T04:10:00.000-07:00

Dating miners protest alongside United Steelworkers at the G-20 conference. My favorites: "Repeal Power Laws," "Our Sets. Our Axiom of Choice."

They even got John Oliver from the Daily Show to join in. I can't read the sign he is holding.

Booty Call journal article

2009-10-01T13:24:00.000-07:00

Journal of Sex Research published an article about "The 'Booty Call': A Compromise Between Men's and Women's Ideal Mating Strategies." It is not even slightly representative, just some Texas undergraduates, but its conclusions are similar to those of the book Hooking Up that I reviewed here. Hooking Up was a qualitative study of two undergraduate populations that followed subjects in college and a year or two after graduation.

Here are its conclusions:

With regards to accepting versus rejecting booty call partners, physical attractiveness was considered the most important criteria by both genders. Fourth, whereas men tended to cite other reasons related to sexual access, women tended to cite reasons related to friendship, compatibility, and personality. Fifth, for booty calls that do not progress into long-term relationships, both genders attribute the lack of progression to the man's not wanting a long-term relationship. Taken together, our results suggest that, although booty calls are mostly a sexual relationship whereby physical attractiveness is important, there are elements in which booty calls differ from other casual sexual relationships, such as one-night stands or hookups. In addition, whereas men tend to favor the sexual aspects of booty calls, women tend to favor other, more long-term oriented considerations. These findings are consistent with our overall hypothesis that the booty call may represent a compromise between the short-term, sexual nature of men's ideal relationships and the long-term, commitment ideally favored by women.

As with Hooking Up, the women surveyed have long-term ideas in mind but are willing to settle for short-term. Unlike Hooking Up, none of the women discuss an initial stage of experimentation with hooking up when they did not want a long-term relationship and just wanted to experiment with short-term. Perhaps the survey did not ask them about that.

An open letter to Senator Orrin Hatch

2009-09-30T17:55:00.001-07:00

Dear Senator Hatch,

I am the author of two of the approximately ten published papers about the sexual behavior of virginity pledgers. I found that virginity pledgers may lie about their sexual pasts and that they are less likely to use condoms when they do have sex.

Thank you for thinking of my research when you added an amendment for $50 million of Abstinence-Only Sex Education funds to the health reform bill. If the federal government does not fund abstinence education, my research into the sexual behavior of virginity pledgers and evangelical adolescents would lack policy relevance, so I'm truly grateful for this opportunity.

Nonetheless, I have to turn down this generous offer. I have a surfeit of other research topics, and I've moved on with my research. Even most abstinence proponents have moved on with their efforts. Every abstinence proponent I've spoken with, including leading Southern Baptists, seem to accept that their approach to sex education needs to be reworked. The evangelical media's reaction to my most recent paper finding virginity pledges do not work was mild (in the case of Focus on the Family Radio and the Baptist Press) and even favorable (in the case of Christianity Today).

More importantly, as you know, the case against Abstinence-Only Sex Education was definitively made by the Congressionally-mandated evaluation of the program published in 2007 by Mathematica Policy Research.

I consider that perhaps you made this amendment for ironic effect: if your amendment stays in the bill, the Democrats who favor health reform will have to vote for your abstinence funding. If so, your point was made, and I have laughed heartily at the irony. Now you can remove it.

Best of luck in your continued efforts.

Love,

Janet Rosenbaum, PhD

Baptists debate abstinence ... from alcohol

2009-09-24T08:25:00.001-07:00

Apparently there's a debate within the various streams of Baptists about whether abstinence from alcohol is still a necessary part of their religion. The anti-abstinence say that alcohol abstinence is a historical remanent of the Temperance/Prohibition Movement 100 years ago and the pro-abstinence say that it's important to draw a firm line so that no one is tempted to get drunk.

I wonder whether they'll be having a similar debate in 100 years about some aspects of sexual abstinence. That's kind-of a naive question.

Bumper sticker of the day

2009-09-23T08:44:00.000-07:00

"DON'T DRINK AND PARK: Accidents cause people"

I saw this bumpersticker last night while driving home from a Harvard interviewing workshop. It was just text. Now that I google the phrase, I find some depictions that definitely aren't the classical meaning of "parking."

Condom ads

2009-09-20T21:10:00.000-07:00

Condom ads around the world.

My favorites: 1970s style US porn, condoms dancing Bollywood style, and Kenyan Trust-brand condoms covering an umbrella. According to youtube, the Kenyan ad was banned.

Women's recurrent need for self-defense

2009-09-17T10:14:00.000-07:00

We had three related stories in the news this week:

India's women-only train cars, necessary due to extensive harassment and recent increase of women working outside the home;
the murder of a Yale graduate student by a co-worker, which New Haven police emphasize is an issue of workplace violence, not domestic or street violence;
a Hopkins undergraduate's accidental killing of an intruder using a samurai sword.

I'm glad that the New Haven police again emphasize that the primary risk to women is the people they know rather than strangers on the street. People have an easier time thinking about self-defense from strangers. Strangers are the least likely attackers, but the line between an attack and a non-attack is brighter, which may be why the Hopkins undergrad was able to take such decisive action; it's obvious that the intruder did not belong there and had already committed a crime. In the case of an acquaintance, it's harder to find the line between minor conflict and potential violence.

According to the National Crime Victimization NCVS survey, 2 million people are the victim of workplace violence on average each year, with homicide being only the extreme of the scale of violence. Workplace violence is the second highest cause of workplace death for women. I wonder how these figures compare with other countries, and what proportion are due to guns, or whether the US is somehow more violent due to inequalities.

Hearing these stories, I've been feeling grateful that my mother took me to a multi-week self-defense class when I was a young adolescent. The class was run by a Chicago organization Chimera that emphasized response possible at each level of escalation, and the realistic responses that women can make to each level appropriate to the situation.

Judging from the murderer's injuries --- "bruises and abrasions on his arms, a mark under his eye, a scratch on his right ear, and a bruise or deep scratch to his chest" --- the victim employed the most common ineffective self-defense tactics. If someone is intent on hurting a woman, the only way for her to stop them is to disable them somehow. Arms and chest are strong, especially on a man, but we learned that even strong people have weak parts and effective self-defense includes poking eyes, striking nose with the palm, using keys as weapons, stomping on tiny foot bones, and dislocating knees.

Of course it's impossible to know what really happened, and everything is much easier said than done especially given the judgement call necessary to realize whether one is really in danger. This attack reminds me to take a self-defense refresher course and makes me thankful that I learned self-defense from an active feminist group as an adolescent so that it became subconscious, reflexive knowledge. I hope that I never find out how well I learned this material.

May her family and fiance be comforted in their loss.

Health reform letter to the editor

2009-09-15T19:27:00.000-07:00

I wrote a letter to the editor of a Baltimore Jewish publication. It sounds like they will not publish it, so here it is:

Dear Editor,

As a graduate of both Shaarei Tzedek Medical Center's Schlesinger Institute Medical Ethics program in Jerusalem and Harvard's Ph.D. program in Health Policy, I was excited to see an article on the health care reform debate in this month's WWW because there are certainly Jewish perspectives on the issue. I read it through eagerly but was disappointed that the piece turned out to be boiler-plate rhetoric with a tenuous connection to facts.

For instance, the author says "there is no one in the country who is really uninsured" because everyone can just go to the emergency room and hospitals get reimbursed for that care. This system actually jeopardizes the health of both uninsured patients and hospitals: patients delay seeking care until an emergency, and hospitals go out of business because reimbursement does not directly cover uncompensated care but rather comes indirectly. For instance, a hospital which gives more care to uninsured might make 5% more on hernia operations; unsurprisingly, books do not always balance.

Other claims were irrelevant distractions, such as about end of life care. Government programs already cover the most vulnerable patients such as the elderly, certain terminally ill patients, wounded military members, and veterans through the government insurance program Medicare and government health care provided at Veteran's Affairs (VA) and military hospitals. End of life care is clearly not an issue with these current programs.

Far from ending life, government-provided health care at VA and military hospitals has saved lives in this war that would have been lost in the nation's 9 previous wars. These lives were saved due to comparative effectiveness research, the field funded in the stimulus package for $1 billion that was unfairly maligned by conservative commentators as leading to "death panels." In the 1990-91 Persian Gulf War, 24% of injured soldiers died from their wounds --- the same proportion as in Vietnam and a bit higher than the 19% in the 1898 Spanish-American War and 21% in World War I --- so technology does not seem to be the key factor in reducing wound fatality. In the current wars in Iraq and Afghanistan, only 10% of injured soldiers died from their wounds, largely because of improvements in care delivery (Gawande NEJM 2004). Health services researchers discovered that battlefield stabilization of injured soldiers and rapid movement to US military hospitals reduced wound lethality. The resulting "government interference in the doctor-patient relationship" literally saved twice as many lives as would have been saved by the old system in which battlefield surgeons held onto patients as long as possible rather than moving them through the system.

The Rabbis of the Talmud teach us not to be like the men of Sodom who would say "What is mine is mine and what is yours is yours." Many of us are lucky enough to have secure jobs with stable health insurance, but even giving tzedakah [charity] to pay for the health care of the uninsured is not enough to help the uninsured. Hospitals charge much higher prices to uninsured individuals, while insurance companies have leverage to insist on lower fees. If Sodom had a modern health care system, they could model it on this situation: discounted prices to the rich (health insurance companies) and inflated prices to the poor. Any solution that perpetuates this inequality in pricing between privileged and poor perpetuates the health care system of Sodom.

Prevention is the best medicine, of course. May we all have a new year of health so that we do not personally need the health care system.

Janet Rosenbaum, PhD

Overly conservative statistics and yogurt

2009-09-13T07:11:00.000-07:00

Are overly conservative statistics preventing the adoption of low-risk potentially beneficial health care?

It seems like probiotics are being talked about everywhere. We know that "good bacteria" are vital in many cases: babies delivered vaginally versus via c-section, for instance, have better immune function due in part to the bacterial colonization they get on their way out. (Of course, if the mother has chlamydia or other bad bacteria, the babies can get colonized by those too and develop eye infections.) Now that flu is in the air, people are citing studies that certain probiotics can help prevent and shorten flu infection. Probiotics are inexpensive and reasonably harmless: the worst side-effects I've seen attributed to them are the same as placebos such as mild GI distress. Probiotics seem like the canonical case of "can't hurt, could help." Kefir and yogurt are tasty, too.

Recently I ran across an immunologist's summary of the report of a 2005 Yale medical school conference about probiotics, mentioning among other things that probiotics might be able to help a disease a friend has. The hypothesized mechanism makes sense that it would help, so I looked at the Cochrane reviews, a formalized method for summarizing medical literature, and they say there's no evidence. The only studies were so hopelessly small, though, that there's no way to know at this point. So I looked up "probiotics" in Cochrane and got these results showing that there are about 82 abstracts relevant to probiotics. Of the 10 or so that I read, the only ones where Cochrane said there was conclusive evidence was for acute infectious diarrhea.

An interesting case: pediatric antibiotic-induced diarrhea. They noted the effects of missing data: if all the study drop-outs were treatment failure, which seems unlikely, the treatment doesn't work. Immediately after that, they acknowledge that there is almost no downside to the treatment: "Probiotics were generally well tolerated and side effects occurred infrequently." and yet they conclude, "Although current data are promising, there is insufficient evidence to routinely recommend the use of probiotics for the prevention of pediatric AAD."

In other words, there's no downside to using probiotics, but because the overly conservative statistical analysis that counts all treatment drop-outs as failures finds that they don't work, they can't recommend them. There are many reasons why subjects might have dropped out of this study, primarily boiling down to the studies being almost certainly poorly funded and unable to adequately compensate busy parents of sick children needing to catch up on their lives after their children recovered. That caution in counting drop-outs as failures is reasonable in some cases: for instance, if the proposed treatment is invasive or risky. Or in the case of the female condom hearings the commercial sex workers who dropped out of the study could have been the ones for whom the condoms didn't work as well. In this case of probiotics, they're virtually risk free and there's a good reason why parents may have dropped out of the study.

In medical statistics (biostatistics), the methods most commonly used are straight out of a textbook, rules of thumb that apply in general. Obviously context counts and we should be more conservative when there's a risk and less conservative when there's little risk. Biostatistics is not my primary area, but I have helped doctors out with the occasional clinical trial, using the textbook methods because that's what they wanted. There are many better methods that could be used to analyze this data, such as decision theory that accounts for risks, or missing data methods that model the potential outcomes of the study drop-outs. Biostatisticians have no malpractice risks, so there's no reason they couldn't be less conservative in their choice of data analysis methods to account for risk. Somehow the conservatism that US doctors practice under has spread to biostatisticians, though. Until statistics becomes less conservative in their analysis methods, patients may end up missing out on low-risk treatments still being studied.

David Kessler's The End of Overeating

2009-09-06T05:20:00.000-07:00

I remember when David Kessler became head of the FDA when I was in middle school. As an MD with a JD, he was a model for combining policy interests with scientific knowledge of health. In my middle school judgement, I found what he said incredibly sensible and just plain smart, and I decided that I should also get an MD/JD so I could grow up to be David Kessler.

Middle school judgements are sometimes exaggerated, but his book The End of Overeating does not disappoint in terms of the breadth of information that it tries to integrate. Kessler combines both human and animal research, frank and sometimes shocking conversations with food consultants revealing the secrets of increasing consumption (e.g., soft drink companies attempting to induce people to drink less water), and a food travelogue to create a compelling story to explain American obesity. For instance, Kessler discusses methods of food manufacture that causes processed restaurant chain food to break down the protein structure of meat and inject marinade so that it can be consumed more quickly than standard meat.

One of his central points is that sugar, salt, and fat combine to make food compelling ("hyperpalatable"), but he treats these elements as if they are interchangeable, but all hyperpalatable foods that he gives as examples have elements with a high glycemic index (breading, sugar, etc.) and the nutrition literature recognizes a distinction between fat and sugar. For instance, rats will overeat on pure sugar, pure fat, and sugar/fat mixtures, but only fat or sugar/fat mixtures increases weight but rats don't gain weight on sugar (one area in which they're clearly different from people --- witness the Snackwells effect which he mentions as well). Rats have few problems discontinuing fat, but discontinuation from sugar causes withdrawal symptoms similar to opioid withdrawal. (Avena NM, Rada P, Hoebel BG. Sugar and fat bingeing have notable differences in addictive-like behavior. J Nutr. 2009 Mar;139(3):623-8. Epub 2009 Jan 28.)

His theory and examples are also disjointed from each other. To bolster his claim that sugar alone is not enough to create hyperpalatability, he describes experiments in which people find skim milk with sugar added unpalatable but really like cream with sugar added, but then he contradicts this theory by describing his own struggles that lead him to eat an entire box of Snackwells fat-free cookies in a short period.

A theory based on macronutrients has extreme limits. While he does talk about flavor with food consultants, he doesn't incorporate flavor into his theory; obviously flavor is complicated. In a few places he says that obviously sugar in the absence of fat isn't a problem because people aren't eating sugar straight out of the bag, not considering that it's not exactly common to see people drinking oil out of the bottle or eating sticks of butter. Flavor is of course the important moderator: people will eat large numbers of meringues, jelly beans, angel food cake, Snackwell cookies, and all sorts of high calorie fat free foods, just as they will eat bacon (and I can't think of any other examples of fatty foods that derive nearly 100% of their calories from fat, to be comparable to jelly beans). An interesting counterpoint would be if he performed experiments in which he tested consumption of food in the absence of flavor, such by wearing noseplugs, as Seth Roberts has experimented with on a small scale.

He makes some strange claims about people historically eating low-fat meat and cites USDA data that people eat more fat than ever before, though other USDA data says that fat consumption has decreased since the 1970s and only sugar consumption has increased.

The book's chapters were short and did not tie together well, so his argument came off as more simplistic and repetitive than if he had written longer chapters that would have necessarily tied his argument together well. Even the short chapters sometimes ended abruptly. For instance, he has a chapter about Cinnabon, the 730 calorie pastry (sidenote: I remember from the only time I had a Cinnabon sometime in middle school that it had 500 calories and being horrified; I decided to check that calorie count again, and in fact now it's 730. Now that 500 calorie cookies are common, Cinnabons had to become 50% larger than before!) He interviews the creator of the Cinnabon and reveals that she had second thoughts about her creation, echoing Cookie Monster's refrain that "cookies are a sometimes food", and that she had created the Cinnabon to be a treat. He adds in a tantalizing last detail that she used to suffer from eating disorders and was unable to distinguish hunger from other needs, but then he ends the chapter abruptly without relating her eating disorder to her second thoughts about having created the Cinnabon.

The chapters about how to resist food are not new and have been covered better elsewhere such as in Brian Wansink's Mindless Eating as well as of course in the literature.

The book does add to the plausible explanations for the rise of obesity in the US, and it's well worth taking an afternoon to read this book. The quotes from food consultants about how to create "irresistible" and multi-layered "eating experiences" ("eatertainment") were especially revealing of the great deal of effort food companies have exerted to produce American obesity.

R Statistics flash mob for Tuesday

2009-09-03T09:24:00.000-07:00

Wow, this is too funny.

> From: The R Flashmob Project
>Subject: R Flashmob #2
>
>You are invited to take part in R Flashmob, the project that makes the
>world a better place by posting helpful questions and answers about the
>R statistical language to the programmer’s Q & A site stackoverflow.com
>
>Please forward this to other people you know who might like to join.
>
>FAQ
>
>Q. Why would I want to join an inexplicable R mob?
>
>A. Tons of other people are doing it.
>
>Q. Why else?
>
>A. Stackoverflow was built specifically for handling programming questions.
>It’s a better mousetrap. It offers search (and is well indexed by search engines),
>tagging, voting, the ability to choose the “best” answer to a question, and the ability to
>edit questions and answers as technology progresses. It has a karma system to
>reward people who are happy to help and discourage MLJs (mailing list jerks).
>
>Q. Do the organizers of this MOB have any commercial interest in stackoverflow?
>
A. None at all. We’re just convinced it is the best way to help and promote R. All
>the content submitted to stackoverflow is protected by a Creative Commons
>CC-Wiki License, meaning anyone is free to copy, distribute, transmit, and
>remix the information on stackoverflow. All the content on stackoverflow is
>regularly made available for download by the public.
>
>INSTRUCTIONS – R MOB #2
>Location: stackoverflow.com
>Start Date: Tuesday, September 8th, 2009
>Start Time:
>10:04 AM – US Pacific
>11:04 AM – US Mountiain
>12:04 PM – US Central
>1:04 PM – US Eastern
>6:04 PM – UK
>7:04 PM – Continental W. Europe
>5:04 AM (Weds) – New Zealand (birthplace of R)
>Duration: 50 minutes
>
>(1) At some point during the day on September 8th, synchronize your watch to
>http://timeanddate.com/worldclock/personal.html?cities=137,75,64,179,136,37,22
>
>(2) The mob should form at precisely 4 minutes past the hour and not beforehand.
>
>(3) At 4 minutes past the hour, you should arrive at stackoverflow.com, log in,
>and post 3 R questions. Be sure to tag the questions “R”. See the posting
>guidelines at http://stackoverflow.com/faq to understand what makes a good
>question.
>
>(4) Follow R Flashmob updates at http://twitter.com/rstatsmob
>
>(5) Post twitter messages tagged #rstats and #rstatsmob during the mob,
>providing links to your questions.
>
>(6) During the R MOB, you can chat with other participants on the #R channel
>on IRC (freenode). To do this, install the Chatzilla extension on Firefox.
>Click “freenode” on the main screen. Then type /join #R in the field at the
>bottom of the screen. Then chat.
>
>(7) If you finish posting your three questions within the 50 minutes, stick
> around to answer questions and give “up votes” to good questions and answers.
>
>(8) IMPORTANT: After posting, sign the R Flashmob guestbook at
>http://bit.ly/6F8B2
>
>(9) Return to what you would otherwise have been doing. Await
>instructions for R MOB #3.

Off-topic: Gluten-free blogger dies

2009-09-03T05:17:00.001-07:00

David Marc Fischer, the 46 year old author of the most useful gluten-free blog Gluten-free NYC died last month on August 6 apparently from leukemia. His blog was distinctive for giving gluten-free medical and policy news, rather than focussing exclusively on food food food. Also, he sounded like a nice guy who I'd wanted to meet. May his family be comforted in their loss.

Texas wins a prize for high teen births

2009-09-01T08:48:00.000-07:00

Texas papers such as the Dallas Morning News and Houston Chronicle are the only papers in the country reporting the results for Texas of a Child Trends teen pregnancy study that is supposed to come out tomorrow. I can only assume that being allowed to break a story early is a reward for their cities' stellar performances: Dallas has the highest proportion of repeat teen births and Houston leads in births under age 15. Of course there is nothing funny about any of this.

The majority are to Latinos. About 95% of Texas schools provide no information other than abstinence to students, a policy supported by white-majority churches such as the Southern Baptist Conference. The lack of information may disproportionately impact Latinos, however, who may come from cultures where sex and birth control are not discussed and may have less access to the internet or other sources of information.

"Treasure or target?" Quiz

2009-08-28T08:13:00.000-07:00

Feministe blog has the review of an abstinence-only curriculum that includes a quiz called "are you a treasure or a target?" They have 6 questions that are interesting situations. For instance, one question asks what to wear now that micro minis are fashionable: a micro mini, cargo shorts, or a skirt a few inches above the knee. And they label the options in that order of preference, which seems pretty arbitrary to me.

Social scientists conduct large long time frame studies to find the optimal answers, so I can't say that I know what the "right" answer is to any of these questions. Amusing to think about conducting a study where some women are randomized to wear different clothing styles to see what the outcome is. Actually that would be a fantastic trial. Five conditions:

1. Covering everything except hands and feet, though maybe not hair?, a la Little Mosque on the Prairie character Rayyan Hamoudi whose style is so admired there are blogs that try to figure out where to find her clothes.

2. Covering knee to elbow, more or less, a la Mayim Biyalik or the Hot Chani style. As far as I can tell, this is roughly the Mormon guidelines as well as the guidelines for those who consider themselves to practice "Authentic Judaism".

3. Regular tomboy style: jeans, cargo shorts, loose t-shirt.

4. Mainstream Evangelical Christian style, so a bit more conservative than normal: no cleavage, no midriff, small number of inches above knee.

5. Standard US fashion style. Whatever is featured by H&M, Zara, etc.

I'd love to see the experiment that would randomize people to different styles to see whether they acted in a way that fit their clothing. Separately, I wonder if you randomized people to dress straight out like a member of a religion (e.g., non-Muslims actually wearing a hijab or non-Mormons actually wearing the secret undergarment), some people would end converting to the religion. Such an experiment would answer a really fundamental question in social science about to what extent behavior is determined by internal cues or social cues. It would also be enormously un-PC.

But that's neither here nor there. Quizzes are arbitrary and we have no way of knowing what the "right" answer in these circumstances.

The general idea of choosing dates who are interested in long-term relationships seems like a valid concern, as shown by Bogle's Hooking Up book and Laura Sessions Stepp's book that late adolescent women who choose dates without knowing (or in denial of) their dates' relationship objectives often end up disappointed and frustrated by a lack of long-term relationships.

Of course asking about claimed objectives isn't enough. I went on a date with a gentleman who professed serious interest in a long-term relationship and eventually marriage, and he seemed considerate and sensitive. On our third date, I asked him about his sexual history (one of the privileges of my profession). He told me that in addition to his 5 relationships that lasted more than a year (in some cases much longer), he had gone out on 3-5 dates with 20-35 women whom he had sex with and he stressed earnestly that at the time he had sex with them he had intended to go out with them again. He trailed off.

I have no idea what gives him only a 12.5-20.0% chance of deciding to initiate a year-long relationship with a woman he has sex with, and perhaps he doesn't either. Going purely on the statistics, this guy seems like an unlikely bet, which honestly didn't surprise me: something about him had led me to keep my distance. Giving the benefit of the doubt, I'm guessing this is what the quiz is trying to get women to be aware of, and that seems reasonable also from a third wave feminist perspective: knowing the prior probabilities can't hurt; if a woman doesn't care for a long-term relationship and just wants a sexual relationship, that's her choice as well.

Review of You're Teaching My Child WHAT?

2009-08-27T13:06:00.000-07:00

Dr. Miriam Grossman, formerly Anonymous MD, has written another book, entitled You're Teaching My Child WHAT? A Physician Exposes the Lies of Sex Education and How They Harm Your Child. My thoughts about this book are almost identical to my review of her earlier book, perhaps because the books have nearly identical tone and content. As I stated in that review, "This evident alarmism --- PC is so insidious that the author must remain anonymous or risk Birkenstocks being thrown through her front windows --- that pervades the book may cause parents and aggrieved social conservatives to pick up the book, but it does no good for Dr. Anonymous's arguments and alienates people who might otherwise agree with her." As in her previous book, Dr. Grossman makes valid points in the most invalid ways, alleging cover-ups and duplicity and a single radical academic agenda when none exists.

I have three responses specific to this book.

First, Dr. Grossman refers multiple times to a controversy between parents and experts, for instance saying "The `experts' are wrong, and parents are right." presuming parents are opposed to the allegedly radical agenda of comprehensive sex education. In fact, nearly all parents, even very conservative parents, favor school sex education that teaches birth control: 89% of all parents, more than 80% of Born Again Christian parents, and 51% of parents who call themselves politically very conservative.

Second, Dr. Grossman identifies herself in this book as an Orthodox Jew. I find it strange that she spends an entire chapter lambasting the sex education advocacy group SIECUS for encouraging sexual experimentation rather than abstinence when the only sex education curriculum developed by Orthodox Jewish institutions is based on SIECUS guidelines (Life Values and Intimacy Education sponsored by Yeshiva University's Center for the Jewish Future, published by KTAV, all institutions considered arbiters of "Authentic Judaism"). She does not try to reconcile this discrepancy, I suspect because that would blur the simple dichotomy she is trying to create between religion/parents/tradition (=good) and academia/sex education advocates/SIECUS (=bad).

Third, her chapters on homosexuality and gender identity, the latter entitled "Genderland", are problematic in ways beyond the scope of this review. She cites some legitimate research such as Lisa Diamond's fantastic 10 year longitudinal qualitative study of lesbian and bisexual women published in the 2008 book Sexual Fluidity: Understanding Women's Love and Desire. Diamond found that nearly all of her women subjects' sexual orientations seemed to change spontaneously. Grossman uses spontaneous sexual orientation change among women to bolster the case for attempting to induce changes in sexual orientation among both men and women. Besides the spontaneous vs. attempted induced changes difference, Diamond looked only at women. Grossman lists many differences between men and women in the realm of sexuality earlier in her book, all of which would imply that a study of women's sexual orientations has no relevance to men's sexual orientations. Of course mentioning NARTH is a total non-starter.

This book does make some valid points and could be readable if all the alarmist bits were pulled out and the rest toned down. As I stated in my review of her previous book, I don't think that her points are repressed at the level of academic research, but as in many areas perhaps research simply is not adequately disseminated: this certainly wouldn't be the first area where quality of health care suffered because practitioners followed their intuitions instead of evidence-based guidelines or the evidence was never disseminated in the first place.

Cutting out the alarmism would make the book about 20% shorter but would give it a chance of being looked at by those she critiques. It seems like she's not interested in dialogue, just in fomenting alarm among the alarmed. Too bad. It could have been otherwise. She wrote this book while a recipient of a Clara Booth Luce fellowship, a fund that has funded moderate research by journalist Laura Sessions Stepp, also an affiliate of the moderate group National Campaign Against Teen and Unplanned Pregnancy.

What a wasted opportunity for dialogue.

Is the Pill worth it?

2009-08-25T15:26:00.000-07:00

Birth control pills are the default contraception method to such an extent that many people use the word "contraceptives" to mean birth control pills to the exclusion of all other methods, not realizing that diaphragms, condoms, sponges, IUDs, and withdrawal, among others, also count as contraceptives.

Birth control pills come with a raft of side-effects including weight gain, depression, and potentially fatal blood clots (such as deep vein thrombosis and strokes), but their popularity seems to improve their perceived safety. A new book looks at the risks of birth control pills, given the big and small health risks of them.

Of course this view is not new at all. The Boston Women's Health Collective famously recommended in Our Bodies Ourselves using barrier methods only: you know exactly what they're doing and their effects end once you remove them from the body. The ultimate transparency. Plus they prevent STDs.

Unfortunately barrier methods besides condoms are rarely used: diaphragms are used by less than 1% of contracepting women and the only company making the cervical cap discontinued it due to lack of demand.

Perhaps this book will convince some of its readers into looking into barrier methods instead. Plus condom plus diaphragm is at least as effective as the pill in typical use. (Here's the math: effectiveness of each alone is 80% in typical use, so effectiveness of both together is 96% (1-(1-.8)^2=.96), which is better than the 94% typical use effectiveness of the pill cited in the article.)

Health communication in action

2009-08-24T11:19:00.000-07:00

One of the standard anti-tobacco initiatives is to have graphic pictures and statements on cigarette packages to warn consumers. This dialogue shows one effect of the warnings.

Supermarket | London, UK

Me: “Can I help you, sir?”

Customer: “A packet of 20 Marlboro Lights, please.”

(I hand him the cigarettes.)

Customer: “Wait, I don’t want these ones.

Me: “Why? They’re Marlboro Lights. Did you change your mind?”

Customer: “No, I don’t want ones with this health warning about cigarettes causing impotency.”

Me: “Ok. Do you want ’smoking harms those around you,’ or ’smoking causes testicular cancer?’”

Customer: “Give me the ‘harms others’ ones.”

I'm not sure if that dialogue implies that the messages work or not.