It sounds like the whole field is contaminated with mind-body dualism. But there's a bigger problem; even once you accept that humans are fully physical, embodied minds in a sea of whatever chemicals can cross the blood-brain barrier, the scope is wider. Humans are part of a society that can harm them without effective means of redress.
"I began taking blood samples from everybody who came to the clinic. At times it seemed like Transylvania Station. The state Department of Public Health's laboratory tested blood free for anyone under the age of 12 and provided plastic pipettes, finger puncture equipment, and even mailing envelopes at no cost. So, for a while, everyone in the clinic was declared to be under 12 years of age."
Both a nice public healthcare hack and a risky thing to admit in a journal article.
" once you accept that humans are fully physical, embodied minds in a sea of whatever chemicals can cross the blood-brain barrier"
I'm not disagreeing, but is this something that everyone reasonable would agree on without any sort of support?
"Humans are part of a society that can harm them without effective means of redress."
Indeed. I am sad every morning I walk my child to creche and her head (in a pram) is at the same height as the exhaust pipes next to her. Yet, there's nothing to be done, apparently.
"I'm not disagreeing, but is this something that everyone reasonable would agree on without any sort of support?"
We are lucky then that there is a ton of support to this claim. Some people may argue with the word "fully" but if you replace it by "in big part" I don't think one can disagree with that without throwing a century of medical research out of the window.
There is no consensus about how consciousness arises from the brain specifically, or how it works. We're pretty sure that if the brain breaks, the expression of consciousness will also break (occasionally in predictable ways). Further than that, you can make no definite statements about it and call yourself scientific. It's still mostly a philosophical problem with no clear solutions.
"how consciousness arises from the brain specifically"
This seems like the most important question in the universe, and one not nearly studied enough.
For instance, the idea that consciousness is a fundamental feature of the universe that is simply manifested in brains sounds very woo - but hasn't been falsified.
The question of when an animal goes from "unconscious, animate matter" to "thinking self-aware being" seems unclear as well (and is very relevant to medical ethics w.r.t embryo experimentation, etc.)
By comparison to another out-there idea, if we're willing to take the Many-Worlds Interpretation seriously (and enough well-informed scientists do) then I'm not sure it's a _completely_ settled matter that we have a good sense that humans are "fully physical, embodied minds".
However, lead is bad for brains. I think we know that much.
"This seems like the most important question in the universe, and one not nearly studied enough."
If anything, I think the opposite is true. We study it far more than we actually should in some sense, relative to the tools we have.
Bear with me, this is going to seem a strange diversion: One of the biggest problems in particle physics is that the smallest possible tools we can use to examine the universe, like quarks, electrons, photons, etc. are all radically larger than what seems to be the smallest size of the universe itself. Compared to the Planck length, all of those things are enormous. I liken it to trying to determine whether a planet has life on it, when your only tool is the ability to smash other planets into it, and examine the resulting blobs six months later, from a distance so great they're just dots in your telescope. It's really hard to determine how the universe works at such small scales when your smallest tools are orders of magnitude too big.
We have the opposite problem with consciousness research. We have tools that can measure a neuron somewhat. Honestly, we're not even all that great at that. (We can measure voltages fairly well, but our visibility into the deep biochemistry is very weak. Honestly even a single neuron is beyond us in some non-trivial ways.) We have some tools that can take extremely broad averages across massive chunks of neurons. Meanwhile, we have every reason to believe that whatever consciousness is, it lies a good ten+ orders of magnitude above that (we can see this from the fact that it seems to require a human brain to be human conscious, and even the animals that appear to possess a lot of it like dolphins and birds still have brains far, far beyond anything we can treat quantitatively). We're ants trying to determine the nature of the entire planet we're sitting on, and the tools we've got to investigate it are that we can move these grains from here to there.
Occasionally ants get up on their tiny little soap boxes and declare "Damn it, it just shouldn't be that hard to understand our planet with these tools!" Sometimes they declare "It's obviously just all topsoil!" or other equally silly things. It doesn't particularly help; it just shows the smallness of the ant in question.
There's also no real consensus on what differentiates animate from inanimate matter, but vitalism is no longer a viable take on it. Dualistic theories of consciousness will soon follow vitalism into the dust bin of history.
A lack of definite knowledge isn’t an excuse to fantasize. Every time people have insisted that the gaps in our knowledge imply gods or ghosts, they’re rudely disabused. Every time we learn more about how things work, it turns out magic isn’t a factor at all. Meanwhile we really desperately want to believe in magic. It’s probsbly a good idea to be skeptical of God of The Gaps arguments that appeal to what we wish were true in the face of what appears to be more likely.
I am not trying to appeal to any supernatural explanation. The closest (crude) example I can think of is seeing the effect of a magnet on iron filings for years and then finally determining there's a magnetic field involved. Without study I suppose somebody could conclude that iron filings just really liked magnets and creating interesting formations. I am curious as to the mechanism behind the... subjective experience of being, I guess.
Ultimately, I was simply unsure about the assertion that all parties would naturally agree (without support) to "once you accept that humans are fully physical, embodied minds in a sea of whatever chemicals can cross the blood-brain barrier".
This raises a number of questions, which other people have raised before (Does consciousness require a wet brain or just the information processing that goes on within (or something else)? is a computer that simulates the processes of a brain conscious? Is a computer that simulates 1% of the processes of a brain conscious? I am conscious now, and if my brain were dissolved in acid I would not be, but what structures and processes must be destroyed or interrupted to bring about that end to consciousness, and is it a discrete or continuous phenomenon? Are computers now conscious but only infinitesimally so? Is there a degree of consciousness in any structure that processes information? How would we even know? What is consciousness?)
Careful. Much of the consciousness is more than the brain argument arrises from pro-life religious groups. They argue that brain death, or lack of a physical brain, does not preclude consciousness. This is to support anti-abortion rules and prevent the removal of life support from the brain dead. These arguments are a minefield of religious dogma.
Maybe where you are, but not where I am from. Here, you are considered a religious extremist if you do not support abortion (and I think that this is the reasonable stance, but that is not relevant right now). I'm thus not very concerned with what secondary agenda you associate this argument, and I will definitely not be careful of having an uncertain stance just because this is the case.
Huh, have heard a lot of arguments from pro lifers lately and this wasn't one of them. A discussion of the nature of consciousness and its mechanisms would have been refreshingly elevated, to be honest. Incidentally we're having a vote today on that very topic.
> I'm not disagreeing, but is this something that everyone reasonable would agree on without any sort of support?
Somehow, the field of psychiatry doesn't seem to actually act on it.
Or they do, since they prescribe drugs which are designed to cross the blood-brain barrier, but even when they decide to prescribe drugs, they don't actually do any kind of blood tests to determine which drugs are likely to be effective.
They prescribe drugs based on simply you talking about your own symptoms, or observing your symptoms, and then just trying things until they find something that works or that you report works. They don't even seem to use any kind of formal testing of cognitive functionality to determine what effects the drugs are having; they just rely on purely subjective chats with the patient.
This seems consistent with what I know of psychiatry - and to be clear, I am not someone who disputes that psychiatric medications can be helpful.
Was anyone down-voting this because they said to themselves "no, that's not how psychiatrists work at all"?
To me, believing in the physicality of the mind is the most important qualification a psychiatrist needs. That's not at all consistent with naive behaviorism though.
I think people may have been downvoting me because I misinterpreted the question I was replying to; but I stand by my description of one of the things I find wrong with psychiatry, the lack of much in the way of rigorous objective testing.
Well electric cars will help in the long term because we can localize the pollution control to the power plants. The UK/Europe really has a problem though with diesel ultra fine particulates and the NOx. You might covering your pram with a rain/wind cover that might help as recommended in:
https://www.theguardian.com/environment/2017/mar/09/use-bugg...
Cops should do the same test. There was an NPR story a while back about a school, mostly black, that did poorly on a standardized test. The school officials declared the test racist. The science teacher couldn’t find that from the test. He wondered about lead. Low and behold the school was full of lead poisoned children. They started treatment and the scores improved by the end of the year ( the also abated the houses with grant money).
We know lead causes aggression issues. We know poor communities have higher incidence of lead in their homes. How many criminals could be prevented, or reformed with lead treatment?
When a chemical that you were dosed with, and willingly did not and would never take, is determined that it made you do erratic and/or dangerous behavior, should the courts find you at fault?
It's different when you willingly take a drug (eg: meth) and you end up hurting or killing someone on it. You chose to take the drugs which lead to violence.
The article was about the lack of utility of testing for it in individual psychiatric cases. When you have a correlated problem like an entire school underperforming for no apparent reason (that is, even by the standards of a poor school, it is exceptionally poor), the math changes a lot. You have a rational reason to suspect some sort of correlated cause.
Fair warning, this is a bit of a comment trap, insofar as the post is less about lead per se, and more about a class of decision-making problems involving the allocation of scarce resources and massive uncertainty.
But incidentally, public health and governing bodies should definitely work to reduce lead in communities, regardless of the duty of psychiatrists.
And maybe some researcher should improve chelation? But there are other things to work on, and that might be simply intractable, so maybe not.
It would be nice if HN had an all-around light moderation policy, with the sole exception that commenters who clearly haven't read the article and are debating with the title be barred from commenting for a certain period of time.
Betteridge's law of headlines is an adage that states: "Any headline that ends in a question mark can be answered by the word no." It is named after Ian Betteridge, a British technology journalist, although the principle is much older. As with similar "laws", it is intended to be humorous rather than the literal truth.
If the patient is chronically not well, they will often show symptoms of depression. Diagnosis of exclusion that can't find the cause often ends with depression diagnosis.
In this sense depression is a trashcan diagnosis. It's the default end for short decision tree.
Depression is not a diagnosis. The diagnosis is "iatrogenic depression", "substance abuse related depression", "pervasive depressive disorser", "bipolar disorder related depression", "developmental disorder related depression", "adjustment disorder" and only very finally there is the "idiopathic major depressive disorder" and a few gradations thereof, which is the trashcan.
And I've probably skipped a few. (E.g. genetic folate metabolism disorder, thyroid related)
Treatments are different in each.
Lead, mercury and some other heavy metal exposure is one of iatrogenic. They are not commonly tested as they are rare causes and tests are not specific.
(As opposed for thyroid panel and folate check which are highly specific.)
1. Doctors don't appear to even think about lead poisoning unless you give them big fat clues like "My job is scraping lead paint off a bridge." What they don't think about, they don't ask about, just like everyone else.
2. The patients presenting with psychiatric symptoms that could be caused by lead poisoning are much more likely to be near the poverty line than a random sampling of people with stress and depression. Insurance companies are not likely to pay for lead blood tests unless they see a good reason to do so, and poor people are much less likely to have insurance in the first place.
True. But the article speaks of more than just lead poisoning.
> And when you’ve answered that, what about copper? Omega-3/omega-6 ratio? Vitamin D levels? Cortisol? Magnesium balance? The methylation cycle? Cortisol? Mitochondrial function? Inflammation? Covert viral infections? Covert autoimmune disorders? Paraneoplastic syndromes? Allergies? Light exposure? Circadian rhythm? Selenium? Lithium levels in your local water supply? Insulin resistance? Gut microbiome? PANDAS? FODMAPs? Structural brain abnormalities? And that’s not even getting into the psychosocial stuff!
I want my doctor to tell me what tests have what probability of being positive, and the cost, so I can make an informed decision.
Half of the things do not require tests at all. E.g. light exposure and circadian rhythm are answered in a questionnaire. (And sleep quality - clue to sleep apnea.) Likewise allergies and their medication or major gut diseases.
Water sample is less useful as many people use enough bottled water and diffuse sources (out of home) to make test at any one location pointless. Leave it to epidemiology. Just ask if the person is taking lithium.
Insulin resistance is done with the standard metabolic and blood panel. These are best done as screening regularly. (But nobody wants to pay for that.) Since you will be checking thyroid why not extend.
Gut microbiome is speculative. We do not even have tests. Brain abnormalities? Either it is in history (major surgeries, seizures) or we don't even know what they are.
This right here is why I'm a large proponent of using ML/AI for computer assisted diagnosis. Unlike a doctor, a computer won't forget about a possible diagnosis.
I'm not saying to replace doctors with ML, but it seems like a great opportunity to provide a list of potential illnesses with associated confidence %s for the doctor to then follow up as potential leads.
Heavy metal poisoning is a cause of mental illness that is reversible and does not require the patient to take drugs for the rest of their lives. We like selling drugs to people for the rest of their lives in this country.
I despise this sentiment. It's one of those tired cliches like "if you're not the customer you're the product", which at first pass seems like some cute insight, but is actually awful at predicting anything about reality.
This disagrees with literally everything I have ever heard or seen in the healthcare industry, whether that's from doctors (family), drug development (friends), or healthcare-focused finance (career).
Everyone I've ever known or worked with in healthcare has always been 100% about trying to make people better. Yes, even in finance, where I evaluated biotech stocks to make recommendations to buy or sell. The better the the drug worked, the more excited everyone was about it. It's so hard to make a drug, that some sort of evil "let's help them but not cure them" approach isn't even possible, not that anyone I know would even want that.
Yes, there was that Goldman Sachs report floating around a couple months ago about the difficulties to businesses when finding cures, but even that report's takeaway was about the need for finding companies that continue to innovate and come up with new therapies.
It's hard to believe that you've never heard or seen anything that was not 100% about trying to make people better. (pay-for-delay, Valeant, evergreening, Theranos, citizen's petitions, Shkreli, off-label promotion, Insys, medicare fraud, Paxil, kickbacks...)
You're right, of course, and those are good counterexamples. In fact, one of the stocks I helped cover collapsed overnight when fraud was uncovered.
But I see them as outliers who have been largely penalized (jail time, stock collapse, etc), not as indicative of the industry. The reason there was such a backlash is because the vast majority of the industry are good people, and these sorts of behaviors are shocking.
I guess I meant literally everyone I've ever known personally has been like that. When you look at the news, yeah, you do see scandals. But I maintain that the idea that the industry would collude to not make cures is wrong. And similarly with doctors and their treatment of patients, which I've also seen argued.
> But I maintain that the idea that the industry would collude to not make cures is wrong.
Why would you need to collude to make a decision like that? Everyone in that industry makes the same sort of analysis, I imagine. "How many doses of this will we sell, how much will they cost to make, and how much will we be able to charge for them?"
If the equation indicates you'll lose money, exactly why wouldn't you just move on, assuming you're a for-profit business? You can always lobby for government or philanthropy or something to pay for the drug, but how many instances are there of a company just saying we're gonna lose at least a billion on this thing but it will be great and help a lot of people?
(it's an honest question - maybe you've got an example that will make everybody a little happier)
Chelation is ineffective at repairing damage done by chronic heavy metal intake.
It is mostly useful for acute toxicity. (And potentially cleaning up cholesterol arterial plaque, that is being investigated.)
It has major side effects. Even in trial like 15% drop out rates were reported due to side effects.
The main treatment if actual exposure is known and chronic is to... stop the exposure.
Also, from the original paper, via the linked LJ: https://siderea.dreamwidth.org/1388220.html
"I began taking blood samples from everybody who came to the clinic. At times it seemed like Transylvania Station. The state Department of Public Health's laboratory tested blood free for anyone under the age of 12 and provided plastic pipettes, finger puncture equipment, and even mailing envelopes at no cost. So, for a while, everyone in the clinic was declared to be under 12 years of age."
Both a nice public healthcare hack and a risky thing to admit in a journal article.