Critical Thinking Feed

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In virtually every way that can be measured, Gen Z’s mental health is worse than that of previous generations. Youth suicide rates are climbing, antidepressant prescriptions for children are common, and the proliferation of mental health diagnoses has not helped the staggering number of kids who are lonely, lost, sad and fearful of growing up. What’s gone wrong with America’s youth?

In Bad Therapy, bestselling investigative journalist Abigail Shrier argues that the problem isn’t the kids—it’s the mental health experts. Drawing on hundreds of interviews with child psychologists, parents, teachers, and young people, Shrier explores the ways the mental health industry has transformed the way we teach, treat, discipline, and even talk to our kids. She reveals that most of the therapeutic approaches have serious side effects and few proven benefits. Among her unsettling findings:

• talk therapy can induce rumination, trapping children in cycles of anxiety and depression
• social Emotional Learning handicaps our most vulnerable children, in both public schools and private
• “gentle parenting” can encourage emotional turbulence – even violence – in children as they lash out, desperate for an adult in charge.

Mental health care can be lifesaving when properly applied to children with severe needs, but for the typical child, the cure can be worse than the disease. Bad Therapy is a must – read for anyone questioning why our efforts to bolster America’s kids have backfired – and what it will take for parents to lead a turnaround.

Abigail Shrier received the Barbara Olson Award for Excellence and Independence in Journalism in 2021. Her bestselling book, Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020), was named a “Best Book” by the Economist and the Times. It has been translated into ten languages. Her new book is Bad Therapy: Why the Kids Aren’t Growing Up.

Shermer and Shrier discuss:

• Irreversible Damage redux: WPATH Files
• Darwin’s Dictim: “all observation must be for or against some view if it is to be of any service.” What view is this book for or against?
• What’s the problem to be solved? Anecdotes vs. Statistics
• Theories: coddling, social media, screen time, generations/life history theory
• Good and bad therapists and therapies
• Does it work?
• Bad therapists or bad parents or bad schools?
• Parenting styles
• As with trans, social contagion vs. real phenomena now acceptable?
• Iatrogenesis: “originating with the healer” (a healer harming a patient)
• Anxiety, depression, suicidal ideation, autism
• ACE (Adverse Childhood Experience): Physical abuse, Sexual abuse, Emotional abuse, Physical neglect, Emotional neglect, Mental illness, Divorce or parental breakup, Substance abuse in the home, Violence against the mother, Incarcerated household member
• Trauma, stress, PTSD, The Body Knows the Score
• Punishment and spanking (corporeal punishment) vs. time outs etc.
• Anti-fragility and resilience
• Diagnosis self-fulfillment: placebo / nocebo effect
• “Doing the work” of therapy
• Goodwill Hunting view of therapy
• Previous quack therapies and psychological pseudoscience:
• The Subliminal Messages scare, the Satanic Panic, the Recovered Memory mania, the Self-Esteem movement, the Multiple Personality craze, the Left-Brain/Right-Brain fad, the Mozart Effect mania, the Vaccine-Autism furor, the Super-predators fear, Attachment Therapy, the Drug Abuse Resistance Education (DARE) program that increased teen drug use, the Scared Straight program that made adolescents more likely to offend, the Critical Incident Stress Debriefing (CISD) program that worsened anxiety and symptoms of post-traumatic stress disorder (PTSD), and many more that have plagued psychology and psychiatry.

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“Nothing in biology makes sense except in the light of evolution.” —Theodosius Dobzhansky

Why can one person smoke and drink heavily into their 90s while another dies from cancer in their 40s? Why are we fat? Why does a suntan look and feel so good if it is bad for us? Why is alternative medicine so popular? Do vaccines work and are they safe? Do toxins in our food cause cancer?

In this article I outline the emerging field of Evolutionary Medicine, looking at how our Stone Age ancestors lived, got sick, and got well over millions of years, and pointing to how we can live longer, healthier, and happier lives today.

As a skeptic, I have learned to often question ideas that are accepted as “common knowledge.” As a physician, I know that some of the drugs and treatments that we are encouraged to use today are only marginally useful at times and sometimes even toxic. Where does evolution come in? I have found that applying evolutionary thinking to common medical knowledge can provide us with fresh insight into the cause and cure of common diseases.

Evolutionary medicine draws insights from three areas of scientific research: (1) archaeologists’ ongoing discoveries about the lives of our paleolithic ancestors; (2) anthropologists’ observations of modern humans living in cultures that have changed little since the Stone Age; and (3) findings of molecular geneticists that have unraveled the story told by our DNA.

These studies have led to fundamental changes in our understanding of what it means to be healthy. We now know that many problems we experience today are, in fact, understandable in terms of the natural capacities that helped us survive in earlier times. Evolutionary medicine can expose many fallacies behind commonly accepted medical practices and the quackery that fosters popular health fads.

What is Evolutionary Medicine?

Some time ago I was invited to co-teach a course in Evolutionary Medicine at the University of California, Santa Barbara. Professors of parasitology and evolutionary biology, Armand Kuris and Bob Warner, explained that they needed a “real doctor” in the class because their knowledge of human disease and medical treatment was understandably limited. Since inviting a practicing physician to join the mix aligns with the interdisciplinary approach for which UCSB has become known, how could I refuse?

We were fortunate to use the just-published Why We Get Sick as the course text. In it, evolutionary theorist George Williams and psychiatrist Randolph Nesse merged their knowledge of health and disease with emerging archaeology and evolutionary biology to begin answering questions about why rather than simply how we get sick.

It soon became impossible to avoid seeing my own patients as the not-so-distant descendants of our Stone Age forbears. From allergies to the most terrifying cancer, from the ravages of mental illness to the most mysterious autoimmune disease, Darwinian evolution was no longer simply an elegant theory. I was seeing its consequences daily: in the diseases from which my patients suffered but also in how they could be healed.

When I began to share these evolutionary insights with my patients—for example, how we heal from a sprained ankle or why so many people struggle with diabetes— it didn’t take long to see positive effects. These conversations often helped patients develop an entirely new approach to problems from which they’d long suffered as significant improvements in their health soon followed.

The Primal Diet

Consider your teeth. Many of the best-preserved fossils we have found are teeth. That’s because tooth enamel is the hardest, longest lasting substance in the body. These fossils reveal that Stone Age teeth had a rough time of it, undergoing wear and tear as tools for cutting and grinding and chewing many hours a day. Remarkably, however, they had few cavities, the number one dental problem we have today! Since cavemen didn’t have toothbrushes, fluoridated water, dental floss, or dentists, why were their teeth so healthy?

The answer is diet. The bacteria that rot teeth feed mainly on sugars. Unlike proteins and fats, sugars are tiny and sticky. Streptococcus mutans, the main bacterial culprit in tooth decay, lives in the crevices around our teeth and turns sugar into lactic acid that then erodes the surrounding dental enamel, leaving holes—or cavities—in which more bacteria can live. We know from genetic studies that S. mutans has existed in its current form for several million years. It has found a good niche, so why mutate?

When fibrous roots, sour fruits, and occasional honey were the only scarce carbohydrates in a paleolithic person’s diet, these bacteria found very little to feed on. In contrast, our modern diet, overloaded as it is with simple carbs and sugary sodas, offers a bacterial paradise. It’s no surprise, then, that dental cavities are the most widespread chronic disease of childhood in the world today.

This understanding about dental hygiene leads to one of the most frequent and important questions I hear in my practice. What should I eat? Our early human ancestors spent several million years gathering and chasing down every bite of food they ate. The reason we covet sweet, salty, and greasy foods today is that they are important for survival and were rare. Not so today. Simply by reaching into the refrigerator, in a few minutes we can snag all the calories we need to get through the day. We know that eating too much is bad for us, but we seem powerless to stop.

The problem is not just a lack of willpower. We spend billions of dollars a year on foods low in carbohydrates, fats, and sugars or high in vitamins, antioxidants, or omega-3 fatty acids—hoping they will help us lose weight. We dish out billions more on diets, unused gym memberships, surgery, and appetite suppressing injections. Meanwhile, our healthcare system is burdened with hundreds of billions spent on obesity-related illnesses. Gluttony may be a vice, but overeating is an epidemic fed by wholly modern myths about food.

In the past 50 years, we’ve witnessed a tidal wave of obesity as nutritionists, doctors and food manufacturers promoted a fear of fatty foods. But low fat doesn’t mean low in calories. And calories count. Making food with less fat often means packing in more carbohydrates to make it appealing. A low-fat label gives us the false impression that we can eat as much of these “harmless, healthy” foods as we want. But if there were an easy diet that really worked, we’d all know about it. We’d all be thin. The fact that so many diet books sell each year is all the evidence we need that none of them is universally effective.

What did our ancestors eat? We can calculate that to get enough calories our earliest primate ancestors spent up to 12 hours a day finding, chewing, and grinding mostly plant-based foods, much as gorillas do today. As they evolved, their diet expanded to include berries, grubs, fruits, eggs, mushrooms, and the occasional small animal when they could catch one. They were omnivores. We estimate that our ancestors consumed up to 300 different foods in a typical week; today we average about 30.

Many of the roots and vegetables on which ancestral humans thrived were loaded with what your mom might call roughage. Stone Age fruit bore little resemblance to today’s plump, sweet, and juicy produce. An apple then looked and tasted more like today’s hard crabapple. Berries were small, and archaic citrus fruits would make a sour lime taste sweet in comparison. Along with honey and later primitive grains, these fruits were the main source of carbohydrates. Before the advent of agriculture barely 12,000 years ago, most foods contained very few starchy carbs. Before people began cultivating wheat, corn, and rice, the wild versions of these grains grew sparsely, had thick husks, and produced few kernels containing little starch. Root crops were tough and required a lot of chewing. Nuts were tiny and bitter, more like today’s acorns. Fruits were scrawny, fibrous, and none too sweet.

Evolutionary Prescription for a Healthy Diet

• Forget about a low-fat diet. Go low-carb instead. Minimize bread, cereal, pasta, potatoes, rice, beans, and other grains. None were on the menu in the Paleolithic.
• Maintain a healthy weight and avoid obesity by restricting the number of calories you’re ingesting to what you burn.
• Be omnivorous. Eat a wide variety of foods to ensure you get all the vitamins and minerals you need—without taking vitamin pills or supplements.
• In the absence of gnawing on bones like a caveman, include dairy products and root vegetables for calcium.
• If you are vegetarian for ethical reasons, you have to be very careful to avoid nutritional deficiencies, especially in children.
• Throw all rules out the window on your birthday and other special occasions. Eat whatever you want and enjoy it.

Since fruit and grains appeared for only a few weeks each year, it was vital for our ancestors to eat as much of them as possible when available, before the birds, insects, and other animals could get to them. When fruit ripened, early humans gorged themselves until they were stuffed—then ate again an hour or two later. As a result, our ancestors evolved a nearly insatiable craving for carbohydrates. The only limit was the size of their stomachs, and those could stretch to accommodate the seasonal abundance.

During times of plenty, Stone Age people ate a whole lot more each day than they needed. Those whose bodies were better at storing up those extra calories as fat, bought some insurance for any lean times ahead and passed on their genes for getting fat on to the next generation. This cycle of abundance and want lasted for millions of years. We are its inheritors.

Paleoanthropologists love to debate, “Which came first, bigger brains or more protein in the diet?” We do know that as our ancestors became cleverer, they became better hunters. (Hunting and tracking may indeed be the evolutionary basis for our ability to think scientifically, but that is another, long story.) Eating animals added protein and fat to their diets, providing more calories often for less effort than eating plants. Before farming changed everything, abundant meat was the main course for hundreds of thousands of years.

Taming fire, roughly one million years ago, was a key evolutionary event. Cooking breaks down starch and proteins, making them easier to chew and digest. More energy became available from every bite. Quickly, time spent chewing dropped from 12 to 3 hours a day. This may have been the advent of leisure; time to sit around the fire and tell stories, sing, and pass along knowledge.

Only a few hundred thousand years after harnessing fire, early hominids set out on their first great migrations around the globe. Humans loved meat. In areas where game was abundant, some settled for tens of thousands of years. When meat became scarce, because of a changing climate, overhunting, or just bad luck, it was time to pick up stakes and search for happier hunting grounds. The disappearance of many species of large animals such as massive marsupials in Australia, ground sloths in North America, and bison, elk, and aurochs in Europe, followed the spread of modern humans.

By the late Stone Age, around 50,000 years ago, Homo sapiens emerged as accomplished and resourceful hunters. Studies show they got around half their calories from meat and fat, 40 percent from roots and vegetables, and 10 percent from fruits and berries. These humans, with bodies and brains similar to yours and mine, ate very well. It is from this time that we have evidence of the first obese people. There probably weren’t many of them, but a few were able to lead pampered, sedentary lives, supported by the advancing skills of the growing tribe. Sculpted images of enormously obese women, known as “Venus” figurines, are among the earliest surviving works of art, carved more than 30,000 years ago. Of course, we don’t know the exact meaning these images held for their late Stone Age makers, but it is likely that they were expressions of beauty, or at least attractiveness. Fat women have been cherished for their fertility in most cultures until very recently. “Survival of the fittest” might be better expressed as “reproduction of the fattest.”

Some hormones evolved to shut down our appetites when we had eaten enough fats and proteins. That is why fatty foods are so “satisfying.” However, others, such as GLP-1—the hormone that the new weight loss drugs Wegovy and Ozempic mimic so effectively—are released by sugar and carbs in our diet. They trigger the production of insulin and in our past helped us to pack away those excess carb calories as fat. In higher doses (mimicked by the weight loss injections) they slow down movement of food through the gut, making us feel “full” and thus suppressing our appetite.

Germ Warfare

Drop the word infection into any conversation and watch ears prick up. Mention diarrhea or COVID, and people will begin to edge away. Measles, mumps, or mononucleosis get little reaction any longer. However, up the ante with herpes, tuberculosis, or syphilis, and you can sense people starting to squirm. Invoke pus, bleeding, or plague, and you are edging beyond the bounds of polite conversation.

Most of us have a primal fear of infectious diseases, for good reason. Alongside medicine’s stellar achievements of the past few centuries—hygiene, antibiotics, vaccines, and vastly safer childbirth—many microbes have battled humans to a draw, and some are even gaining ground. As soon as we conquer one infectious disease, another seems to take its place. We defeat smallpox, arm-by-inoculated-arm, and HIV comes out swinging. COVID-19, a more lethal cousin of the common cold, caused us to apply dampers to the world economy for months. We are in an evolutionary arms race with no end in sight. As the human population rises, there are more hosts for our microscopic enemies to attack.

Even with the discovery of antibiotics less than a century ago, bacteria, parasites, and viruses have not retreated. Within a year of the first use of penicillin, some germs were found to resist it. And while vaccines have loosened the stranglehold once held on us by measles, mumps, hepatitis, and polio, as yet we have no shots to prevent HIV, herpes, West Nile, or a horde of other viruses. In the tropics, new strains of influenza emerge annually from animal hosts and spread at jet speed onto the wider world stage.

On the home front, patients come to me every day sneezing and coughing, aching and fevered, hoping an antibiotic will provide a quick fix. Sadly, these drugs have no effect against viral infections and, when used inappropriately, breed drug-resistant bacteria in our bodies. At the same time, some people worry that vaccines against the killer diseases of childhood actually damage their children. They resist immunizations, depending on others to get the shots that derail an epidemic.

Fighting infections has never been easy. Microbes invade our bodies and evade our immune systems in clever ways that science is still deciphering. In the past, they jumped from person to person, while today they leapfrog from city to city. They are nimble adversaries. Evolution happens when genes mutate and spread to the next generation—and many bacteria produce a new generation every 90 minutes!

Nevertheless, working in our favor are the very Stone Age defenses we often misunderstand. Our healthy skin, thick mucus, fever, inflammation, and antibodies are the body’s first responders on the front lines of the fight against infections. We suppress them at our peril. Understanding how our cave-dwelling forebears survived such onslaughts, long before they could reach for a bottle of pills, can teach us how to respond better to infections today.

A Few Paleolithic Symptoms That Have Lingered On

Coughing evolved to clear our airway of foreign particles—dust blown by the wind, smoke from a fire, and food inhaled when we meant to swallow. By forcefully expelling air from our lungs, coughing gets the grime out. A sneeze serves a slightly higher purpose.

Mucus, or phlegm, is also a defense mechanism. This complex and wonderful concoction of proteins and other gooey stuff entraps and disarms germs, helping us to swallow them into our stomachs where powerful acids wait to destroy them.

Evolutionary Prescription for Weight Loss

• Eat fewer calories.
• Eat fatty foods and proteins to satisfy your hunger, rather than starchy, sugary ones. Fats and proteins trigger satiety hormones and take more time to digest.
• Fool your Stone Age appetite by filling up on bulky, low-calorie vegetables such as celery, radishes, and salads. Also, drinking warm liquids such as chicken broth can trick your body into feeling full for a while.
• Watch out for fruit juice and sodas. They are mostly sugar and water.
• Exercise because it’s enjoyable and healthy, but don’t rely on it to shed weight. You’d have to exercise for hours to work off a single sugary soda.
• Eat meals whatever time of day you want to. A calorie is a calorie no matter when you eat it.

What happens when we are confronted with a cold virus? A virus is really very simple. It’s just a bundle of genes, wrapped in a protein coat. All it needs is to find a good place, i.e., you, in which to set up housekeeping, make a few million copies of itself, and then move on. For contagious diseases, it’s the moving on that matters. If they can’t get out of us to a new victim, they die out. Cold viruses such as COVID are spread on airborne droplets of moisture when we cough. Making us cough, by irritating our airways, is the evolutionary tactic a virus uses to spread itself. Diarrhea is a similar strategy of gut viruses, the “stomach bug.”

Well-meaning parents often encourage their sick children to “cough it up” to clear phlegm out of their airways. However, coughing actually irritates our airways. It’s like scratching an itch. The more you scratch, the more irritated it gets. Coughing actually makes a sore throat worse and spreads the virus to others. We are playing right into the virus’s hands.

Sneezing is even worse. Have you ever seen the famous photo of a sneeze, spraying droplets ten feet across a room? Sneezing serves the virus’s purpose by loading them on an express flight to the next victim—our children, coworkers, spouses, or strangers. This is why masks are useful in stopping the spread of airborne viruses. To really be helpful, however, you need a really good mask, such as an N95, made of multiple layers of hydrophobic filters that stop the droplets from ever reaching your nose.

When you feel the need to cough, don’t let the virus win. Suppress it. By drinking a small amount of liquid, you can help your body eliminate the germs by ingesting them. At the same time, you will prevent the irritation and swelling that coughing brings. Sometimes you can’t help but cough. In those cases, your mom had it right: Cover your mouth. Not just a polite hand in front of the face— really press your hand or inner elbow over your mouth to seal off any air from coming out. (And then be sure to wash your hand—thoroughly). This decreases the rapid flow that irritates your airway as well as stops the spread of germs. This was common advice 50 years ago when coughing around others was considered impolite at best.

Unfortunately, all the over-the-counter cough remedies containing dextromethorphan (the DM in Robitussin-DM) and other ingredients don’t do much. They coat your throat, but they don’t help suppress coughing. Without any evidence they are effective, we spend billions a year on cold remedies such as Echinacea, Airborne, vitamin C, Dayquil, Nyquil, antihistamines, decongestants, cough suppressants, and fever reducers that do nothing to shorten the infection and have minimal effect on the symptoms. Some even work against the healing process.

When we take an antihistamine to dry up the sniffles, it limits the mucus available to help engulf the virus. The sole over-the-counter expectorant used in the United States, guaifenesin, thins mucus, which makes it less effective at trapping bacteria. Codeine-based cough suppressants, now very hard to come by, can help and are useful when simply making an effort to suppress the cough fails, especially at night when we need to sleep.

The most effective way to defeat a cold virus is to recognize that we are all in this together. Once we’re infected, washing our hands and covering up when sneezing or coughing is the kindest thing we can do for others. Rest, stay hydrated, and let your immune system do what it evolved to do. When a true cure for the common cold comes along, it won’t need to be advertised or sold in alluring packages at the checkout counter. It will be obvious to all of us because of how well it works, every time. And then, like polio and smallpox, colds will be history.

You Give Me Fever

If evolution is a long war between us and germs, then a cold is a daily skirmish on the front line. While viruses reproduce quickly, our bodies react more slowly. It can take days for our immune system to mobilize specific antibodies to fight a virus.

Over millennia, we evolved a quicker response. Germs are adapted to infect us when our body temperature is normal. By turning up our internal thermostat when we first detect an infection, our bodies make it harder for the virus to grow. Shivering probably evolved to warm us when we got cold. A shaking “chill” making us hot—called a rigor in medicine—is often our first line of defense. When we feel a chill, we want to take to our beds because that is exactly what we should do. If we take a fever reducer, such as aspirin or Tylenol, we can suppress the fever and may feel well enough to be up and around. This can divert energy our body needs to fight off the infection—and affords the virus many more opportunities to spread to others.

Increasing our temperature also speeds up the activity and circulation of disease-fighting white blood cells. In early mammals, those who responded to microbe invasion by developing a fever and limiting their activity would have survived better and passed on these defenses to their descendants. It makes evolutionary sense that children get hotter faster than adults. Kids are more likely to run into germs they have never encountered before and to which they have no immunity. They need the quick general defense a fever can muster.

If a fever provides an evolutionary advantage for a near naked primate, what happens when we bundle up in blankets? We can cause our temperature to rise higher than it naturally would and so overshoot the safety mark. Exceeding 103F (39.5C) degrees can do more harm than good. Extreme temperatures can lead to seizures in children and dehydration and worse in adults. Taking a fever reducer such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil and Motrin), or naproxen (Aleve) is entirely appropriate in these conditions. These medications all short-circuit our body’s natural ability to raise a fever.

Is there any sense in the old saying, “feed a cold and starve a fever”? When we have a simple cold, eating has been shown to quadruple the production of the virus-fighting hormone interferon. When we start to get hot, however, it’s not food we need but fluids. It’s no coincidence that a fever kills our appetite. Fluids trigger the production of interleukin-4, which works particularly well against many of the bacteria that cause fevers. The return of hunger is usually a sign that you are getting better.

A Paradox of Prevention

Polio offers a good example of how “progress” can inadvertently help a virus to spread in a way that evolution couldn’t. Polio is a virus that usually grows in our guts. When excreted, it survives for weeks in freshwater pools and stagnant ponds.

Throughout history, infants who were exposed to the virus early in life while they were still protected by antibodies in their mothers’ milk, usually experienced only a mild infection. Fewer than one in a thousand had the paralytic form associated with the epidemics of the last century.

Paradoxically, modern hygiene in the late nineteenth century prevented infants from ingesting water contaminated with the virus while still breastfeeding. Coming in contact with that virus later in life in swimming pools or ponds, at a time when they were no longer protected by maternal antibodies, caused them to contract the much more serious paralytic form of the disease. By 1900, small epidemics of paralytic polio began to appear throughout the industrialized world. By 1952, with breastfeeding at a minimum and better sanitation more widely practiced, polio infected thousands of children who had failed to acquire immunity in infancy. At its peak in 1950, the epidemic paralyzed 60,000 people a year.

A vaccine developed in 1952 by Jonas Salk arrested the spread of the disease within a few years. Polio is now almost wiped out. However, certain religious and political objections still hamper universal use of the vaccine.

Other diseases that could be eradicated, linger on—mumps, measles, chickenpox, and hepatitis. As vaccination has made certain childhood infections so uncommon in Western countries, some people have become comfortable with not vaccinating their children. These parents are counting on the immunity of those who do get vaccinated (herd immunity) to prevent the spread of these childhood illnesses to their own kids.

Evolutionary Prescription for Toxins

• Be very careful with the dose of all drugs—prescription, over-the-counter and recreational. All can be toxic.
• Unfortunately, alcohol is a toxin. Newer evidence suggests the less the better.
• Get all the vitamins you need from sunshine and a healthy diet, not pills or supplements. Vitamins are essential but can be toxic in large doses.
• Don’t worry about toxins in peanut butter.
• Don’t obsess about buying “organic.” As far as your health is concerned, there is no difference between organic and nonorganic.

Remember measles? Measles ranks high on the list of all-time lethal diseases. By some estimates, measles wiped out up to a third of all the people along the trade routes of the Middle Ages—and that was even before the European Age of Exploration opened vast new territories for the virus. In the past 150 years it has killed 200 million people—including 128,000 in 2021, most under the age of five.

The measles virus evolves very slowly. With so many innocent immune systems to infect in the past, it didn’t need to change much to find plenty of hosts. Luckily, it’s easier to make vaccines for slower-changing viruses because they are so stable. Faster-changing viruses, such as COVID, HIV, and influenza, form more elusive moving targets.

Today, many of us have forgotten how dangerous many formerly common infections were. Measles was a worldwide scourge. Mumps can make men sterile. Rubella can cause birth defects when it infects a pregnant woman. One vaccine, MMR, prevents all three. Diphtheria and Whooping Cough (Pertussis) were once dread diseases of childhood. Tetanus kills. Here too a single vaccine, DPT, prevents all three. Smallpox, which killed 300 million people in the last century, has now been eradicated by a worldwide vaccine campaign.

By skipping vaccination, some parents hope their children will dodge a risk. However, serious side effects of the vaccine occur at a much lower frequency than serious complications of the disease. Fears once raised that measles vaccine causes autism have been thoroughly debunked.

If enough people avoid vaccination, those once serious diseases will continue to evolve and come roaring back. Mumps and whooping cough are returning to the United States. Polio is still making its crippling rounds. Skipping vaccination is a terrible gamble. When these viruses strike, unvaccinated children are the first to fall.

During the COVID-19 pandemic, the science of vaccination became even more politicized. This is unfortunate because priming our immune systems to recognize and fight off infections is one of the most effective and least harmful methods of protection we have. In the Stone Age, every infection set off a race between the “bugs” and our defenses. Vaccines activate this age-old system by injecting tiny amounts of weakened strains of these germs, allowing us to be forearmed.

The Not So Common Cold

Colds are caused by viruses—not by being out in cold weather or getting tired or soaked with rain. Understanding the evolutionary origins of viruses can help us stop them in their tracks. Most cold viruses evolved in enormous prehistoric populations of migrating birds and beasts. Because there were millions of animals in these flocks and herds, viruses could spread from one individual to another, never needing to infect the same creature twice—much like a wave spreading across the water.

By contrast, our paleolithic ancestors lived in isolated bands of a few dozen people. Archaeologists estimate that as recently as 70,000 years ago there were only 10,000 humans alive on the entire planet. Each family or clan clung together as closely as possible, seldom interacting with other groups. Stealing food or mates posed too great a risk to encourage much contact. So even if an animal virus managed to infect a person, it was very difficult for it to spread beyond the group it first entered. The common cold was not so common back in the Stone Age. Clearly, we aren’t going to solve the problem of colds by going back to living in isolated tribes. However, the insights of evolutionary medicine can help in arresting the rapid spread of these and other viruses in our modern world.

Under the Influenza

Influenza, the “flu,” kills around 400,000 people worldwide, and 36,000 people in North America—most years. In flu pandemics, which occur every 20 years or so, tens of millions die.

As with the common cold viruses, the earliest humans didn’t have enough contact with other groups to allow the flu to spread. Yoshiyuki Suzuki (Oxford University), who studies the evolution of influenza, estimates the first flu epidemics in humans occurred no earlier than 8,000 years ago. This coincided with the development of farming and village life, when people, fowl, and pigs first began living cheek by beak by jowl.

Unlike the more stable measles, mumps, and chickenpox viruses, the flu virus changes its outward appearance (that is, it evolves) rapidly. Shrouded in an ever-varying coat of proteins, like a shape-shifter in a science fiction novel, it cloaks itself in order to hide from our immune systems. However, once it gets past our defenses, it always causes the same miserable symptoms—high fever for days, severe body aches, a racking cough, and nasal congestion. It’s like a cold, only much worse.

Flu’s ability to change its surface coat so rapidly forces us to come up with a revised flu vaccine every year. Modern medicine maintains a constant watch for emerging strains in order to predict which to include in the following year’s vaccine. Before the advent of annual flu vaccines, many more people got sick and died of the flu every year, especially those over 60.

Occasionally, farmers and food handlers are infected with a strain of flu derived from another animal at the same time they have a human flu virus in them. When this happens, the two kinds of flu can merge to become an entirely new strain. The combined virus is often better at infecting us because we have no antibodies that recognize its novel appearance. This is how the avian flu pandemics of 1918, 1957, 1968 and the swine flu pandemic of 2009 occurred, and also why some people think COVID-19 originated in a live animal food market in China. (Doing justice to the debate between the “wet market” and the alternative “lab leak” theory of the origin of COVID-19 requires a separate article).

Quarantine, an early scientific method for halting the spread of disease, yields excellent results—if it is done quickly enough. That’s how SARS, the first well-known Coronavirus, was stopped in 2003. With proper public health policies in place, and enough people who take them seriously, we could likely contain any newly emerging virus within weeks, even a novel strain of the flu, without relying on vaccines. However, quarantine is expensive, inconvenient, and may even deprive people of some rights or even their livelihood for a short period. Still, that price would be minuscule compared to the devastation of a full-blown pandemic such as we have recently experienced.

On the home front, the best way to protect ourselves is to be clear about how such germs spread. Not being “part of the herd” and not going out in public when we are sick can go a long way toward stopping the spread. Covering our mouths when we cough or wearing effective masks helps a lot, as does thoroughly washing with plain old soap and water. Washing is a lot more effective than hand sanitizer, which doesn’t kill all types of viruses or even fully remove them from our hands.

Toxins and Cancer

Many things in our world are toxic. Radium, benzene, arsenic, and asbestos are widely known to cause cancer, but most of us are rarely exposed to them. On the other hand, smoking, drinking, obesity, and excess sun exposure together account for about 50 percent of all cancers.

The most significant food toxin known to cause cancer in humans is Aflatoxin, a fungal byproduct found in moldy peanuts. It contributes to the occurrence of liver cancer, mostly in parts of Africa and Asia where the hepatitis B virus, a cofactor for this cancer, is prevalent and moldy food is common. Yet, if you search online, you will find a long list of alleged cancer-causing culprits, including soda, hydrogenated oils, microwave popcorn, farmed fish, refined sugar, white flour, pickled, salted or smoked foods, and grilled red meat. We frequently hear that some common chemical such as the sweetener we use in our coffee “causes cancer.” None of these claims is backed by scientific evidence.

Evolutionary Prescription for Cancer

• Watch your weight. Obesity hikes the odds of several cancers.
• Exercise at least 30 minutes a day, three times a week, to lower your general risk of cancer by about 10 percent.
• Keep vitamin D levels up to snuff by getting 30 minutes of sun three days a week on parts of your body not usually exposed.
• Don’t smoke. You’ll decrease your lifetime risk of lung cancer by 90 percent and your overall risk of dying of any cancer by 25 percent.
• Get a colonoscopy after age 50. You’ll decrease the risk of dying from colon cancer by 80 percent.
• Lower your chance of getting some cancers by a third by saying no to antioxidant and vitamin supplements—particularly A, C and E.
• Girls and young women: Say yes to the new HPV vaccine. It reduces the risk of cervical cancer by 95 percent.

When scientists say a chemical “may cause cancer,” it usually means it was tested and found to damage the DNA of a bacteria or cause tumors in rats. However, such research uses doses hundreds or thousands of times what a person would ingest, pound-for-pound. And rats are genetically different from you and me. They get cancer very easily and that’s why we use them for tests. Just showing that a toxin causes cancer in rats, or abnormal changes in bacteria or cells in a Petri dish, doesn’t come close to demonstrating it will do so in humans. Our livers are three times the size of the whole rat and work hard to protect us. Please don’t misunderstand what I’m saying. I am a scientist. I trust good evidence. However, not all research is done well and we must remain skeptical—though not cynical—especially of fear-inducing claims.

Since we can’t ethically test toxins on humans, we look for “natural experiments”—groups of people exposed to a chemical at work or by accident. We then compare them against a similar but unexposed group to see what effects these toxins have. Beyond a few well-studied carcinogens—and Erin Brockovich’s cinematic arguments about a cancer cluster—there is scant linkage between trace toxins in our environment or food and cancer or other illnesses.

Your plastic water bottle, for example, won’t give you cancer. If it did, we would have detected thousands, indeed millions, of cancer cases already. The same is true for tap water. There’s no credible evidence that food preservatives, deodorant, stress, aluminum, processed foods, aspartame (Equal), or saccharin (Sweet’N Low) cause cancer. If you examine the reports carefully you will see that they are usually based on extrapolating from experiments on cells or animals given huge relative doses and always contain qualifiers such as “can” or “may” cause cancer.

We have always lived in a world chock full of poisons, and we have evolved potent defenses against the natural threats we’ve encountered in our long ascent from the primordial swamp. Our not so fragile forebears thrived among greater toxic threats than we might imagine. Why do some things smell and taste “bad”? Often it’s because they were bad for us. Our tough skin, hardy livers, and purifying kidneys evolved to neutralize many toxins that passed the nose test to make their way past this first line of defense.

Meanwhile, there is no shortage of products being offered to help our bodies “cleanse” ourselves of toxins by using homeopathy, chelation, or colonics. We can buy “probiotics” to counter the antibiotic we took when we had a cold. (The marketers don’t mention that all yogurts have these bacteria—it’s what makes them yogurt in the first place.) We can sweat in saunas, chill in ice baths, soak in spas, or spend money on supplements—all in the name of “cleansing.”

Is there any real evidence that people who make such efforts are healthier than the rest of us? Not one bit. Contrary to countless celebrity testimonials, decades of research provide zero evidence that using any detoxifying products actually improves health or prevents cancer.

Dodging Cancer

There’s a good evolutionary reason why we heal so well from wounds and infections but have trouble fending off cancer. Natural selection, the weeding out of harmful traits, has a hard time acting on illnesses that occur later in life. By the time most cancers appear, people have usually finished having children. A cancer predisposition that appears only after our reproductive years gets a free pass to the next generation.

Children do get cancers, of course. Terrible as these cases are, fortunately they are rare compared to other causes of death. Most cancers occur in older people. The single most important reason cancer is increasing in the developed world is because we are living longer, not because of toxins in our food and environment.

Cancer still kills one in six people worldwide, but that means 84 percent of us will die of something else. In less-developed countries where life expectancy is shorter, most people die of infections and accidents, as in times past. In those places, cancers don’t even make it into the top ten causes of death.

While research has made significant progress against certain cancers, our fear leaves plenty of openings for a Pandora’s box of alternative therapies. This has always been the case with poorly understood diseases. In the days before the discovery of the poliovirus, rumor attributed polio to everything from fleabites to airborne toxins, insecticides, and poverty. When the vaccine came along, some people thought it was the cause. Many of these same suspects are blamed for cancer today.

One popular theory suggests that a diet low in fiber causes colon cancer. This idea arose from a 1979 book that reported a lower rate of colon cancer in men in Africa than in the West. The author attributed this to their high-fiber diet and using a squatting posture during defecation. He forgot to take into account that men in Africa die younger than men in the West, and the rate of colon cancer increases as we age. A meta-analysis of more than 80,000 participants demonstrated that fiber doesn’t prevent colon cancer. Still the myth lives on in health food stores and breakfast cereal ads.

Antioxidants are now popularly claimed to prevent cancer (as well as aging, heart disease, and “inflammation”). These molecules do limit oxidation, a kind of cell damage that can contribute to cancer—in the lab. Remember, however, oxidants and free radicals are part of how our cells fight off infection and clear damaged cells from our bodies! When tested in people, there is no evidence that antioxidants—including beta carotene, lycopene, acai berries, cumin, turmeric, or vitamins A, C or E—can prevent cancer. Vitamin A in excess can cause liver damage, osteoporosis, hair loss, dry skin, and birth defects. It seems our bodies make all the antioxidants we need, so supplementing them can make matters worse. Studies done in actual people, not Petri dishes, show that excess vitamin E, folic acid, and beta-carotene can actually increase the risk of cancer.

Vitamin Supplements

Our Stone (and Iron, Bronze, Middle, and Steam) Age ancestors survived without ever taking vitamin pills, but it wasn’t always easy. In hard times, especially when they roamed into new territory, experienced harsh winters, droughts, and floods, food could be hard to find. Their bodies evolved to be very good at absorbing whatever vitamins they needed, especially when they were in short supply. We inherited this ability to store most vitamins for times of scarcity.

Today, of course, we can buy a plethora of vitamins and minerals off the shelf, mixed in myriad combinations. Some of us gulp down enough to choke a horse. This is a high-risk endeavor because an excess of certain vitamins (A, D, E, and K) can be toxic. Some of our legislators are enthusiastic supporters (read: on the payroll) of the vitamin industry. Vitamins are sold as “dietary supplements,” not as drugs, and are largely unregulated. There are no safety inspections or uniform requirements for those who manufacture or market them, and therefore no guarantee you are getting what you pay for.

This article appeared in Skeptic magazine 28.4
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The only real proof we need for the benefit of vitamin pills should be that taking them makes us healthier. However, people who take them, in small or mega doses, are sick just as often and have just as many other illnesses as those who don’t. Of the 13 known vitamins, six can be taken in overdose. Every year more than 60,000 people in the United States overdose on vitamins—80 percent of them are children under the age of six.

If you eat a variety of unprocessed food you get all the vitamins, minerals, and antioxidants you need. Let your body do all it evolved to do, and you will get just the amounts you need.

Alternative Medicine

Many “alternative” therapies, such as acupuncture, massage, Reiki, homeopathy, aromatherapy, naturopathy, and ayurveda promise to make us well while causing less harm than medicine. Do they work?

As most doctors and some alternative practitioners know, most people who seek medical attention get better on their own, no matter what we do to them. This is because most illnesses are mild and self-limiting. Still, many of us are not content with letting nature take its course. When we feel a sniffle, we reach for some over the counter medicine. None can make us better. When we get better, we want to believe it was because of what we took.

We spend billions each year on brand named pills and folk remedies that have lingered from earlier times. They became popular in the same manner as do all superstitions. One person tried them, got better, and believes the treatment worked. They pass this along through retelling and retailing, and so a so-called cure is born.

Alternative medicine practitioners now use TikTok, YouTube, Facebook and X (Twitter) to speed the spread of their “cures.” Although some of these practices are actually harmful, the false hope they offer to the seriously ill is misleading at best and criminal at worst. Sadly, modern medicine has sometimes been little better, pushing marginally useful pills or physical therapy on us when time and a better understanding of the natural process of healing would accomplish just as much—and at less risk and a lower cost.

What’s Next?

If you find this approach intriguing, I urge you to look further into what evolution has to say about how we heal from injuries, why allergies are more common today than in earlier times, how much sleep we really need, who we find sexually attractive, the benefits of grandparents, how many periods should a woman have in her lifetime, why morning sickness was good for us, why we get depressed, the advantages of Attention Deficit Disorder, what use are emotions, the origins of anxiety, whether cholesterol is really bad for us, why do so many people need glasses, how does sickle cell disease protect some people from malaria, and what can we do to live longer healthier lives. These topics and dozens more are the subject of the fascinating new science of Evolutionary Medicine.

About the Author

William Meller, M.D., is a board-certified internist who runs a medical practice and clinic in Santa Barbara, CA, where he also coordinates three busy medical centers. He has been published in The Journal of the American Medical Association and has been featured in the Wall Street Journal, among other publications. He is the author of the book Evolution Rx: A Practical Guide to Harnessing Our Innate Capacity for Health and Healing.

This controversial treatment for PTSD involves moving the eyes side to side.

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The Holocaust is much discussed, much memorialized, and much portrayed. But there are major aspects of its history that have been overlooked.

Spanning the entirety of the Holocaust, this sweeping history deepens our understanding. Dan Stone—Director of the Holocaust Research Institute at Royal Holloway, University of London—reveals how the idea of “industrial murder” is incomplete: many were killed where they lived in the most brutal of ways. He outlines the depth of collaboration across Europe, arguing persuasively that we need to stop thinking of the Holocaust as an exclusively German project. He also considers the nature of trauma the Holocaust engendered, and why Jewish suffering has yet to be fully reckoned with. And he makes clear that the kernel to understanding Nazi thinking and action is genocidal ideology, providing a deep analysis of its origins.

Drawing on decades of research, The Holocaust: An Unfinished History upends much of what we think we know about the Holocaust. Stone draws on Nazi documents, but also on diaries, post-war testimonies, and even fiction, urging that, in our age of increasing nationalism and xenophobia, it is vital that we understand the true history of the Holocaust.

Dan Stone is Professor of Modern History and Director of the Holocaust Research Institute at Royal Holloway, University of London. He is the author or editor of numerous articles and books, including: Histories of the Holocaust (Oxford University Press); The Liberation of the Camps: The End of the Holocaust and its Aftermath (Yale University Press); and Concentration Camps: A Very Short Introduction (Oxford University Press). His new book is The Holocaust: An Unfinished History.

Shermer and Stone discuss:

• Why this book now? What is unfinished in the history of the Shoah?
• Holocaust denial: 20% of Americans under 30 who, according to a poll by The Economist, believe the Holocaust is a myth. Another 20% believe it is exaggerated
• Just as “Nazism was the most extreme manifestation of sentiments that were quite common, and for which Hitler acted as a kind of rainmaker or shaman”, suggests Stone, the defeat of his regime has left us with “a dark legacy, a deep psychology of fascist fascination and genocidal fantasy that people turn to instinctively in moments of crisis – we see it most clearly in the alt-right and the online world, spreading into the mainstream, of conspiracy theory”
• What was the Holocaust and why did it happen: intentionalism vs. functionalism
• Ideological roots of Nazism and German anti-Semitism
• “ideology, understood as a kind of phantasmagorical conspiracy theory, as the kernel of Nazi thinking and action”
• From ideas to genocide: magical thinking
• Blood and soil
• Hitler’s willing executioners
• The Holocaust as a continent-wide crime
• Motivations of the executioners
• Polish law prohibiting the accusation of Poles complicit in the Holocaust
• Industrial genocide vs. low-tech mass murder
• The banality of evil
• Nearly half of the Holocaust’s six million victims died of starvation in the ghettos or in “face-to-face” shootings in the east.
• Jews were constrained by a profusion of demeaning legislation. They were forbidden to keep typewriters, musical instruments, bicycles and even pets. The sheer variety of persecution was bewildering. It was also chillingly deceptive, persuading some law-abiding Jews that survival was a matter of falling into line. Stone quotes the wrenching letter of a woman reassuring her loved one that getting transported to Theresienstadt, in German-occupied Czechoslovakia, might be better than living in Germany. “My future place of residence represents a sort of ghetto,” she explained. “It has the advantage that, if one obeys all the rules, one lives in some ways without the restrictions one has here.”
• Wannsee Conference of Jan. 20, 1942
• In March 1942, “75 to 80 percent of the Holocaust’s victims were still alive.” Eleven months later, “80 percent of the Holocaust’s victims were dead.”

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Do we live inside a simulated reality or a pocket universe embedded in a larger structure about which we know virtually nothing? Is consciousness a purely physical matter, or might it require something extra, something nonphysical? According to the philosopher Eric Schwitzgebel, it’s hard to say. In The Weirdness of the World, Schwitzgebel argues that the answers to these fundamental questions lie beyond our powers of comprehension. We can be certain only that the truth—whatever it is—is weird. Philosophy, he proposes, can aim to open—to reveal possibilities we had not previously appreciated—or to close, to narrow down to the one correct theory of the phenomenon in question. Schwitzgebel argues for a philosophy that opens.

According to Schwitzgebel’s “Universal Bizarreness” thesis, every possible theory of the relation of mind and cosmos defies common sense. According to his complementary “Universal Dubiety” thesis, no general theory of the relationship between mind and cosmos compels rational belief. Might the United States be a conscious organism—a conscious group mind with approximately the intelligence of a rabbit? Might virtually every action we perform cause virtually every possible type of future event, echoing down through the infinite future of an infinite universe? What, if anything, is it like to be a garden snail? Schwitzgebel makes a persuasive case for the thrill of considering the most bizarre philosophical possibilities.

Eric Schwitzgebel is professor of philosophy at the University of California, Riverside. He is the author of A Theory of Jerks and Other Philosophical Misadventures; Perplexities of Consciousness; and Describing Inner Experience?

Schwitzgebel has studied the behavior of philosophers, particularly ethicists, using empirical methods. The articles he has published investigate whether ethicists behave more ethically than other populations. In a 2009 study, Schwitzgebel investigated the rate at which ethics books were missing from academic libraries compared to similar philosophy books. The study found that ethics books were in fact missing at higher rates than comparable texts in other disciplines. Subsequent research has measured the behavior of ethicists at conferences, the perceptions of other philosophers about ethicists, and the self-reported behavior of ethicists. Schwitzgebel’s research did not find that the ethical behavior of ethicists differed from the behavior of professors in other disciplines. In addition, his research found that the moral beliefs of professional philosophers were just as susceptible to being influenced by irrelevant factors as those of non-philosophers. Schwitzgebel has concluded that, “Professional ethicists appear to behave no differently than do non-ethicists of similar social background.”

Shermer and Schwitzgebel discuss:

• bizarreness
• skepticism
• consciousness and sentience
• AI, Turing Test, sentience, existential threat
• idealism, materialism and the ultimate nature of reality
• solipsism and experimental evidence for the existence of an external world
• Are we living in a computer simulation?
• mind-body problem
• truths: external, internal, objective, subjective, and mind-altering drugs
• anthropic principles and fine-tuning of the universe
• theism, atheism, agnosticism, deism, pantheism, panpsychism
• free will, determinism, compatibilism
• Is the universe predetermined?
• entropy, the arrow of time, and causality
• infinity
• souls and immortality, mind uploading
• multiverse, parallel universes, and many worlds hypothesis
• why there is something rather than nothing.

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While not going so far as arguing, as some have, that psychotherapy is always effective, I’d like to present some data and offer some contrasting considerations to Harriet Hall’s article: “Psychotherapy Reconsidered” (in Skeptic 28.1). Probably no other area within social science practice has been so inordinately and unfortunately praised and damned. Many of us working in the field have long been acutely aware of the difficulties to which Hall and others point, as well as other problems. However, we also regularly observe the positive changes in clients’ lives that psychotherapy—properly practiced—has produced, and in many cases, the lives it has saved.

In her article, the late Harriet Hall, whose work I and all skeptics admire and now miss, stated that no-one can provide an objective report about the field, indeed, that there “…aren’t even any basic numbers,” that we don’t know whether psychotherapy works, that it is not based on solid science, and that there is “…no rational basis for choosing a therapy or therapist.”

Hall and other sources she quotes are quite correct in saying that there is much we still don’t know about human psychology, and much that we don’t understand about how the mind and psychotherapy work. Yet it’s also necessary to look at the data and analyses which demonstrate that psychotherapy does work. The case for the defense is made in detail in The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work by Bruce Wampold and Zac Imel, and also in Psychotherapy Relationships That Work by Wampold and John Norcross, both of which present decades of meta-analyses. They review conclusions from an impressive number of psychotherapy studies and show how humans heal in a social context, as well as offer a compelling alternative to the conventional approach to psychotherapy research, which typically concentrates on identifying the most effective treatment for specific disorders by placing an emphasis on the particular components of treatment.

This is a misguided point in Hall’s argument, as she was looking at the differences between treatments rather than between therapists. Studies that previously claimed superiority over one method to another ignored who the treatment provider was.1 We know that these wrong research questions arise from using the medical model where it is imperative to know which treatment is the most effective for a particular disorder. In psychotherapy, and to some extent in medicine generally, the person administering the treatment is absolutely critical. Indeed, in psychotherapy the most important factor is the skill, confidence, and interpersonal flexibility of the therapist delivering the treatment, not the model, method, or “school” they use, their number of years in practice, or even the amount of professional development they’ve had. How we train and supervise therapists largely has little impact on the outcomes of psychotherapy, unless each therapist routinely collects outcome data in every session and adjusts their approach to accommodate each client’s feedback.

The Bad News About Psychotherapy

Hall is right on the point that psychotherapy outcomes have not improved much over the last 50 years. Hans Eysenck’s classic study debunking psychotherapy was performed in 1952.2 His view was not challenged until 1977, when a meta-analysis showed that psychotherapy was effective, and that Eysenck was wrong.3 It found the effect size (ES) for psychotherapy was .8 above the mean of the untreated sample. Recent meta-analyses show that this ES has remained the same over the intervening 50 years, despite the proliferation of diagnoses and treatment models.4

Hall was also accurate in saying that much conflicting data exists from studies about the efficacy of the hundreds of types of psychotherapy. Yet she was incorrect in saying that we don’t even have basic numbers. We now have decades of meta-analyses showing what works and what doesn’t work in psychotherapy.5, 6, 7, 8, 9, 10

Hall was also mostly on-target when she stated, “…proponents of each modality of psychotherapy give us their…impressions about the success of their chosen method.” Decades of clinical trials comparing treatment A to treatment B point to the conclusion that all bona fide psychotherapy models work equally well. This is consistently replicated in trials comparing therapists who use two different yet coherent, convincing, and structured treatments, as long as these treatments provide an explanation for what’s bothering the client in addition to discussing a treatment plan for the client to work hard at overcoming their difficulties. Psychotherapy research clearly shows that all models contribute 0–1 percent towards the outcomes of psychotherapy.11 This means that proponents of Cognitive Behavioral Therapy—or any model—claiming its superiority to other treatments, are not basing their claims on the available evidence.

Another correct statement of Hall’s is that most therapists have no evidence to show that what they’re doing is effective. This lack of evidence led others to conclude that, “Beyond personal impressions and informal feedback, the majority of therapists have no hard, verifiable evidence that anything they do makes a difference…Absent a valid and reliable assessment of their performance, it also stands to reason they cannot possibly know what kind of instruction or guidance would help them improve.”12

For decades, free pen-and-paper measures by which therapists can track their outcomes have been available,13 recently superseded by online versions.14 These Feedback Informed Treatment (FIT) online platforms are easy to use and have been utilized by thousands of therapists around the world to get routine feedback from every client on each session. The result: Data from hundreds of thousands of clients is continually being updated. Regrettably, those of us who use these methods are still a small minority of therapists practicing around the world compared to the unknown numbers who, as Hall rightly pointed out, provide psychotherapy in its manifold (and perhaps unregulated) forms.

The online outcome measurement platforms mentioned above are recommended by the International Center for Clinical Excellence (ICCE).15 For decades, the ICCE has been aggregating data from therapists around the world and so providing evidence that corroborates some of Hall’s critical claims about psychotherapy. Current data show that dropout rates, defined as clients unilaterally stopping treatment without experiencing reliable clinical improvement, are between 20–22 percent among adult populations (even when therapists use FIT).16 Dropout rates are typically higher (40–60 percent) for child and adolescent populations. This raises the unfortunate possibility that dropout rates for therapists who don’t get routine feedback from clients are probably higher still.

Hall was, however, incorrect in stating that we don’t know about the harms of psychotherapy. There are many examples of discussions and analyses of what doesn’t work in psychotherapy and what can cause harm.17 One study of aggregated data shows that the percentage of people who are reliably worse while in treatment is 5–10 percent.18

Regrettably, the data indicate that the average clinician’s outcomes plateau relatively early in their career, despite their thinking they are improving. One review found no evidence that therapists improve beyond their first 50 hours of training in terms of their effectiveness, and a number of studies have found that paraprofessionals with perhaps six weeks of training achieve outcomes on par with psychologists holding a PhD, which is equal to five years of training.19 These data support Hall’s statement that unless they are measuring their outcomes, no therapist knows whether their method is more (or less) effective than the methods used by others. Even then, it leads to a conflation that it’s due to the method instead of the therapist. Studies also show that students often achieve outcomes that are on par or better than their instructors. These facts are amply demonstrated in Witkowski’s discussion with Vikram H. Patel,20 whose mental health care manual Where There Is No Psychiatrist is used primarily in developing countries by non-specialist health workers and volunteers.21

Further, there is now evidence that psychotherapists who have been in practice for a few years see themselves as improving even though the data show no such improvement.22 Psychotherapists are not immune either to cognitive biases or to the Dunning-Kruger effect, and a majority rate themselves as being above average. In other words, psychotherapists generally overestimate their abilities. Finally, meta-analyses show that there is a large variation in effectiveness between clinicians, with a small minority of top performing therapists routinely getting superior outcomes with a wide range of clients. Unfortunately, these “supershrinks” are a rare breed.23

To balance the bad news above, following is some of the data which shows that psychotherapy works.

The Good News About Psychotherapy

Psychotherapy works. It does help people. Since Eysenck’s time and in response to the numerous sources cited by Hall, many studies have demonstrated that the average treated client is better off than eighty percent of the untreated sample.24 That doesn’t mean that psychotherapy is eighty percent effective, but it does mean that if you take the average treated person and you compare them to those in an untreated sample, that average treated person is doing better than eighty percent of people in the untreated sample. This effect size means that psychotherapy outcomes are equivalent to those for coronary artery bypass surgery and four times greater than those for the use of fluoride in preventing tooth decay. As discussed earlier, this has remained constant for 50 years, regardless of the problem being tested or the method being employed.

Just as in surgery, the tools that psychotherapists use are only as effective as the hands that use them. How effective are psychotherapists? Real world studies have looked at this question, asking clinicians to measure their outcomes on a routine basis with each client in every session. They’ve compared these outcomes against those in randomized clinical trials (RCTs). It must be noted that in RCTs researchers have many advantages that real world practitioners do not. These include: (a) a highly select clientele, in that many published studies have a single unitary diagnosis while clinicians routinely deal with clients with two or more comorbidities; (b) they have a lower caseload; and (c) they have ongoing supervision and consultation with some of the world’s leading experts on psychotherapy. Despite all this, the data documents that psychotherapy outcomes are equivalent with those of RCTs.25

Therapists around the world, including me, have been using Feedback Informed Treatment (FIT) for decades. I have been seeing clients since 1981 and my clinical outcomes started to improve when I started incorporating FIT into my practice nearly 20 years ago. Those of us who use FIT routinely get quantitative feedback from every client at the beginning of every session. We ask about the client’s view of the outcomes of therapy in four areas of their life: (1) their individual wellbeing; (2) their close personal relationships; (3) their social interactions; and (4) their overall functioning. This measure is termed the Outcome Rating Scale or ORS.26 At the end of every session, we also get quantitative feedback about four items to gauge the client’s experience of: (1) whether they felt heard, understood, and respected by us in that session; (2) whether we talked about what the client wanted to discuss; (3) whether the therapist’s approach/method was a good fit for the client; and (4) an overall rating for the session, also asking if there was anything missing in that session. This measure is termed the Session Rating Scale or SRS.27 The resulting feedback is successively incorporated into the therapy, ensuring that the client’s voice and preferences are privileged.

Research shows that individual therapists vary widely in their ability to achieve positive outcomes in therapy, so which therapist a client sees is a big factor in determining the outcome of their therapy. Data gathered over a 2.5-year period from nearly 2,000 clients and 91 therapists documented significant variation in effectiveness among the clinicians in the study and found certain high-performing therapists were 10 times more effective than the average clinician.28 One variable that strongly accounted for this difference in outcome effectiveness was the amount of time these therapists devoted outside of therapy to deliberately practicing objectives which were just beyond their level of proficiency.29

What these studies show is that we’ve been looking in the wrong place for the answers as to why the outcomes of psychotherapy have not improved over the last 50 years. We’ve been studying the effects within the therapy room rather than what happens outside of the therapy room, i.e., what clients bring into their therapy and what therapists do before and after they see their clients.

Indeed, clients and their extra-therapeutic factors contribute 87 percent to outcomes of psychotherapy!30 Extra-therapeutic factors comprise the client’s personality, their daily environment, their friends, family, work, good relationships, and community support. On average clients spend less than one hour per week with a therapist. The extra-therapeutic factors are the components of the client’s life to which they return, and which make up the other 167 hours of their week. This begs the question “does this mean that there’s nothing we can do about it?” The key is for therapists to a) attune to these outside factors and resources, and b) tap into them. The remaining 13 percent of treatment effects which accounts for positive outcomes in therapy is made up of: the individual therapist, between 4–9 percent; the working alliance (relationship) between therapist and client, 4.9–8 percent; the expectancy/placebo and rationale for treatment, 4 percent; while the model of therapy contributes an insignificant 0–1 percent. This highlights that who the therapist is and how they relate to their clients is the main variable accounting for positive outcomes outside of the client’s extra-therapeutic factors.

So, how should you choose a therapist?

There is now a movement led by eminent researchers, educators, policymakers, and supervisors in the psychotherapy field to ensure that after graduation therapists consciously and intentionally engage in ongoing Deliberate Practice—critically analyzing their own skills and therapy session performance, continuously practicing their skillset (particularly training their in-the-moment responses to emotionally challenging clients and situations), and seeking expert feedback. Deliberate Practice is based on K. Anders Ericsson’s (who made a name for himself as “the expert on expertise”) three decades of research on the components of expertise in many domains of activity, including in sport, medicine, music, mathematics, business, education, computer programming, and other fields. Building on research in other professional domains such as sports, music, and medicine, a 2015 study was conducted to understand what differentiated top performing therapists from average ones.31 It found that top performing therapists spent 2.5 times more time in Deliberate Practice before and after their client sessions than did average therapists, and 14 times more time in Deliberate Practice than the least effective therapists!

This article appeared in Skeptic magazine 28.4
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Experts in the field encourage therapists, supervisors, educators, and licensing bodies to “change the rules” about how psychotherapists are trained and how psychotherapy is practiced.32 The research reviewed here highlights that we can do this in two main ways: first, by making our clients’ voices the central focus of psychotherapy by routinely engaging in Feedback Informed Treatment with every client in every session to create a culture of feedback; and second, by each therapist receiving guidance from a coach who uses Deliberate Practice. To ensure accountability to clients, health insurance companies, and the psychotherapy field itself, this should be the basis for all practice, training, accreditation, and ongoing licensing of therapists.

In summary, psychotherapy does work. For readers who are curious to explore why psychotherapy works and which factors contribute to it doing so, I’d highly recommend Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness33 and its accompanying Field Guide to Better Results.34

About the Author

Vivian Baruch is a relationship coach, counselor, psychotherapist, and clinical supervisor specializing in relationship issues for singles and couples. She has been practicing since 1981, has been a psychotherapy educator at the Australian College of Applied Psychology, and taught supervision to psychotherapists at the University of Canberra. In 2004, she trained with Scott D. Miller, and has been using Feedback Informed Treatment (FIT) for 20 years to routinely incorporate her clients’ feedback into her psychotherapy and supervision work.

References

1. https://rb.gy/iw4yb
2. https://rb.gy/4y3su
3. https://rb.gy/bc9u9
4. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
5. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
6. Norcross, J. C., & Lambert, M. J. (Eds.). (2019). Psychotherapy Relationships That Work: Volume 2: Evidence-Based Therapist Responsiveness. Oxford University Press.
7. https://rb.gy/qm2hz
8. https://rb.gy/x7bm9
9. https://rb.gy/rfq74
10. https://rb.gy/rz91t
11. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
12. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
13. https://rb.gy/edpb6
14. https://rb.gy/ktioc
15. https://rb.gy/2bjuy
16. https://rb.gy/6f55y
17. https://rb.gy/tpuo2
18. https://rb.gy/uqp3k
19. https://rb.gy/obhfg
20. Witkowski, T. (2020). Shaping Psychology: Perspectives on Legacy, Controversy and the Future of the Field. Springer Nature.
21. Patel, V. (2003). Where There Is No Psychiatrist: A Mental Health Care Manual. RCPsych publications.
22. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
23. Ricks, D. F. (1974). Supershrink: Methods of a Therapist Judged Successful on the Basis of Adult Outcomes of Adolescent Patients. In D.F. Ricks, A. Thomas, & M. Roff (Eds.), Life History Research in Psychopathology: III. University of Minnesota Press.
24. https://rb.gy/obhfg
25. https://rb.gy/uulpw
26. https://rb.gy/d5mbx
27. Ibid.
28. https://rb.gy/0hvy3
29. https://rb.gy/rkr85
30. Wampold, B.E., & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge.
31. https://rb.gy/ye406
32. https://rb.gy/r2jb8
33. Miller, S.D., Hubble, M.A., & Chow, D. (2020). Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. American Psychological Association.
34. https://rb.gy/f3c3e

Part 3 in our roundup of scientists who took the ultimate plunge and experimented on themselves.

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A conversation with Leah Goldstein on becoming a kickboxing world champion, ultra-endurance cyclist, and an elite commando combating terrorism. For this she was to be honored at the International Women’s Day event… until she was disinvited and canceled.

This is her story.

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Over a billion copies of the Qur’an exist – yet it remains an enigma. Its classical Arabic language resists simple translation, and its non-linear style of abstract musings defies categorization. Moreover, those who champion its sanctity and compete to claim its mantle offer widely diverging interpretations of its core message – at times with explosive results.

Building on his intimate portrait of the Qur’an’s prophet in Muhammad the World-Changer, Mohamad Jebara returns with a vivid profile of the book itself. While viewed in retrospect as the grand scripture of triumphant empires, Jebara reveals how the Qur’an unfolded over 22 years amidst intense persecution, suffering, and loneliness. The Life of the Qur’an recounts this vivid drama as a biography examining the book’s obscured heritage, complex revelation, and contested legacy.

The author believes that the Qur’an re-emerges with clarity as a dynamic life force that seeks to inspire human beings to unleash their dormant potential despite often-overwhelming odds – in order to transform themselves and the world.

Mohamad Jebara is a scriptural philologist and prominent exegetist known for his eloquent oratory style as well as his efforts to bridge cultural and religious divides. A semanticist and historian of Semitic cultures, he has served as Chief Imam as well as headmaster of several Qur’anic and Arabic language academies. Jebara has lectured to diverse audiences around the world; briefed senior policy makers; and published in prominent newspapers and magazines. A respected voice in Islamic scholarship, Jebara advocates for positive social change.

Shermer and Jebara discuss:

• Who wrote the Qur’an and why?
• Do Muslims believe it was written by Muhammad divinely inspired, or is it suppose to be the literal words of God/Allah?
• Why do we need a new translation and interpretation of the Qur’an?
• What inspired a Westerner raised in public school to write a biography of Muhammad and a history of the Islamic holy book?
• Is the Muslim world stagnating? And how does the biography of the Quran and Islam’s founder aim to help the situation?
• What is the “Semitic mindset”?
• How is the Qur’an the first “Post-Modern” book?
• Many Westerners believe that the Qur’an endorses violence, Jihad, and Sharia Law over secular laws and constitutions. What does it really say?
• Christianity and Judaism went through the Enlightenment and came out the other side much more tolerant and peaceful. Has Islam had its Enlightenment? Does Islam and the Muslim world need reforming?
• the meaning of “Allahu Akbar”
• women in Islam
• female genital mutilation
• What percentage of Muslims want Sharia Law, and where in the world?

Sharia, or Islamic law, offers moral and legal guidance for nearly all aspects of life – from marriage and divorce, to inheritance and contracts, to criminal punishments. Sharia, in its broadest definition, refers to the ethical principles set down in Islam’s holy book (the Quran) and examples of actions by the Prophet Muhammad (sunna).

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Skeptic: Let’s start with the big questions. What is the problem to be solved? And why is systems biology the right method to find the answer?

Leroy Hood: The problem is this great complexity. Reductionism is the approach where you take an element of a complex system and study that element in enormous detail. However, studying one element in a complex system gives you no insight into how the complex system works. Systems biology highlights something extremely important—namely, biological networks underlie all of the complex responses and phenotypes of human beings. So, we first identify the network components and then study their dynamics. Systems biology takes a global, holistic view of a problem by thinking in terms of the networks that encode the information that is responsible for each phenotype, and so forth. The most fascinating part of the systems approach is that it can be applied to any kind of complex problem—physiological, psychological, or sociological.

Skeptic: Take DNA. Crick & Watson drilled down to the molecular structure—that’s reductionism. But then you have to build back out to the phenotype and the entire body, and how it interacts with systems both within the body and externally.

Hood: Correct. That’s systems biology. The first thing to figure out is what are the elements of information that DNA encodes—the genes. Once you’ve identified the 20,000 or so genes, you figure out how these genes connect to form these networks. Finally, you watch the networks operate during the dynamics of what you are studying. The really important thing about systems is that they operate across multiple scales. A system can be thought of at the level of one molecule, one cell, an organ, or at the level of the whole organism, and then you really begin to see how the various hierarchical levels operate differently in space and time.

Nathan Price: There has been tension between molecular biologists and systems biologists, especially in the early days, because molecular biology sometimes can feel very satisfying and concrete: “Here’s the protein…and here is its sequence.” In contrast, when building a system, you often see very complex relationships amongst all these.

Skeptic: OK. Let’s consider weight loss and diets. Why are diets faddish? And during a particular fad, why does a particular diet work for some, but not others?

Price: Let me give a specific example. First, studies in which we compared people who went on to lose weight with those who didn’t. In the thousands of measurements we’ve made, was there anything predictive about whether or not people would lose weight? When we looked at metabolites and proteins—once you normalize for BMI—nothing. But in the microbiome, two features were predictive.

The first was how fast your microbiome was growing. If your bacteria are growing fast, every calorie you eat is a calorie either for yourself or your microbiome. If your microbiome is consuming more, it is easier to lose weight. The second big factor is whether the genes in your microbiome are more likely to break down complex carbohydrates. Let’s say you eat a sweet potato. Some microbiomes will break that down into simple sugars that will spike your insulin more, making it harder to lose weight. But if you have a microbiome that will break down those same complex carbohydrates into short-chain fatty acids, it’s easier to lose weight. That was quite predictive and captured a fair amount of the variance between individuals.

Another big example is trying to lower something like LDL cholesterol. Some of that is genetically encoded and you can predict the blood level of LDL cholesterol from the genome, without knowing anything about a person’s diet or lifestyle. So we looked at whether people going through a wellness program could lower their LDL cholesterol without medication. If you had high LDL but your genome predicted low, you could lower it. But if your genome predicted high and you were high, you couldn’t. That is an incredibly useful tool that lets us know what you can change easily and what is going to be hard to change.

In short, we have a totally new method to look at your genetic potential versus your actual outcome. You get a roadmap of which lifestyle changes will make the greatest difference to your health. That’s big!

Skeptic: Hopefully, that kind of test will soon be available in every doctor’s office.

Hood: Exactly! That’s why I’ve proposed a second genome initiative where we take a million people for 10 years and conduct all these analyses. This will give us all the correlations for 150 different genetic risks, and all the correlations with the phenotype, so we can show unequivocally how this transforms the quality of your life. I guarantee that today we’re giving drugs to many people who should never be taking them. They could manage themselves just by diet and exercise.

Skeptic: You write that the 10 most popular drugs in the U.S. work for only about 10 percent of the people treated. Seriously?

Hood: Isn’t that absolutely striking? Yet it is true. A critical outcome of the million-person project is that we’ll have blood biomarkers that can tell us, unequivocally, which individuals are going to respond to particular drugs and which are not. That’s something pharma companies would hate because their bottom line likes this idea of one drug for everybody.

Price: Another factor is that your microbiome transforms about 13 percent of the drugs you take. That means you could be taking a drug, but if you have the wrong microbiome, it could change that compound so that you’re not even on the drug you think you are. This is a big problem that drug companies need to start thinking about systemically.

Skeptic: So, what exactly is the microbiome?

Price: Understanding the microbiome is one of the hottest areas in health and has just emerged quite recently. The microbiome is the bacteria and other small organisms that live on your skin and in your gut. Everything you take into your body—food, a supplement, a drug—passes through the microbiome before it gets to you. There are now tests that provide useful information about your microbiome.

For starters, you can see how your microbiome affects your digestion. You might have microbes that are making too much ammonia, which will cause your stomach to not be acidic enough to break down your food the way you need to. We can evaluate that. Recently, we ran a trial on people with Irritable Bowel Syndrome (IBS). They can now get a test, implement personalized interventions, and resolve their symptoms—in most cases—over the course of about a month.

The 10 most popular drugs in the U.S. work for only about 10 percent of the people treated.

Skeptic: Now that’s individualized medicine. When this knowledge and technology aren’t available, we have to resort to large-scale treatments. “Here’s the problem. Here’s our drug. Give it to everybody with that problem and hope maybe half get better.”

Hood: And today, thanks to the million-person genome project, the genome itself is going to reveal a whole series of diseases. For example, there are roughly 7,000 rare diseases. Many are single-gene defects. For each of those, we’re going to have to find a drug that works. And it’s going to be essential to examine the genome as early in life as possible because some cause disease during childhood or infancy. You want to know immediately which gene defects you have. Your physician will hopefully have these data and keep track of these things for you.

Skeptic: In that example, what would be the financial model for pharmaceutical companies?

Hood: First, the small molecule drugs today can only attack five percent of the proteins that exist in your genome. That’s a very small number. The pharmaceutical companies will need to generate lots of new drugs that can attack more than five percent. Second, they must figure out how to scale the research. If the clinical trial is going to cost three billion dollars per trial, it’s never going to work for individualized medicine. You need really efficient ways of generating lots of drugs and screening them effectively. Third, the federal government is probably going to have to help financially. A disease that’s devastating in infancy wipes out the productivity of that person for life. Avoid that and you have a productive, creative, functional citizen. You can make compelling arguments for being able to deal with these diseases at an appropriate time.

These are things pharmaceutical companies are just barely beginning to think about at a proper scale.

Skeptic: So we’re really at an intersection between academia, private industry, and government to make the transition from raw knowledge to application to industrial-size production of such kits and applications.

Price: We can progressively get access to information in ways that are simpler and cheaper than before. We already have the microbiome test and the blood measurement device that we hope will soon be approved in the United States. It’s already FDA-approved for a supervised blood draw, in which you need another person to stand next to you while you do it. We have successfully tested this in trials, including a big one of nearly 20,000 people with the University of Cambridge. So far, there have been no reported adverse events. And we have a 99.9 percent success rate of being able to get a measurement off the device when people use it at home. You can obtain your own blood sample and drop it in the mail.

Skeptic: This sounds somewhat similar to Elizabeth Holmes and Theranos.

Price: There are two different paths you can take on blood analysis. One is that you can try to get conventional clinical lab tests, which are typically done on large volumes of blood, and you try to miniaturize that. That’s what Theranos tried. And they failed. In fact, they were fraudulent all along the way, which is why Elizabeth Holmes is now in prison. Pretty much all other companies that tried to go down that route have also failed.

But there’s another path—the one that we’re pursuing—in which you use small volumes of blood to do what are called omics-based measures. These are your metabolomics (measuring all the metabolites out of the blood) or proteomics (measuring all the proteins). Those technologies, based on mass spectrometry or on capture agents, are only done on very small volumes.

We can make thousands of measurements out of that small volume. The challenge is how to interpret all of that information. Working with that data, tying it to health outcomes, connecting it to electronic health records, and monitoring people’s health is a much bigger challenge. It’s much more of an AI-data problem than anything else. And I’d much rather try to solve the information technology challenge than go down the Theranos road.

Hood: What Elizabeth Holmes projected is going to be done. I just want to say that it is a valid way of thinking about the technology. Technically, it’s far more difficult. But we are going to learn how. It’s going to take 10 or 15 years. It’s just a matter of getting appropriate, miniaturized measurements in microfluidics or nanotechnology.

Skeptic: Let’s talk about the future of medicine. What is CRISPR?

Price: CRISPR allows you to go into a genome and essentially edit any base pairs that you want. Incredibly powerful, it holds the potential to end all genetic-related disease, or at least monogenetic defects. Huntington’s disease is a compelling example. Unlike most genetic traits, it has essentially 100 percent penetrance. If you have the gene for Huntington’s, you will get Huntington’s disease. But you can CRISPR it out. Even in the embryonic stage! That eliminates the gene, and all your progeny forever will not carry it. That’s amazing.

Skeptic: What about stem cells?

Price: Stem cells are the body’s raw materials—cells from which all other cells with specialized functions derive. They are very powerful because they are generative. They grow all other cell types. Of particular interest are induced pluripotent stem cells which are programmed to grow tissue. And so, you put them in—in a way taking a leap of faith—trusting in the intelligence of the stem cells to act on their programs and to rebuild the right tissue. It’s all evidence-based, but we don’t fully understand the logic of how they do it.

Skeptic: What about cancer?

Price: Most of us may have already had cancers in our lives, but they started and then our immune system cleared them out. However, when you develop a tumor, your immune system didn’t recognize. The cancer fooled your immune system. Immunotherapies—not trying to kill the cancer off with a drug, but rather teaching the immune system to get the cancer that it missed—are one of the most exciting developments.

If you know the molecular properties of the cells that have become cancers and were missed by your immune system, you can create a vector that will look for certain gene expressions or molecular properties or some combinatoric aspect of those cells, then go in and initiate a program that will stick a molecule up from the outside of the cell. That molecule will act as a signal to macrophages, which are cells in the immune system that come and eat other cells, in this case destroying the tumor cells.

We have a totally new method to look at your genetic potential versus your actual outcome. You get a roadmap of which lifestyle changes will make the greatest difference to your health.

Skeptic: What about stories of injecting tumors with vaccines? Jimmy Carter was treated this way for his brain tumor.

Price: It’s a similar idea. You take pieces of the cancer cells, and then you create antibodies. You’re placing a signal into the immune system that says these are fragments of something foreign. Your immune system can then look for those specific tumor cells and kill them. It doesn’t yet work for the majority of cancers, but for the fraction that it does, it’s amazing.

Skeptic: Is part of the problem that there are so many different kinds of cancers, and they’re different in each body?

Price: Exactly. And that is why precision medicine is probably more advanced in cancer research than any other area. You can pull out the tumor and you can sequence it. You can look at its gene expression, its metabolites, and its proteins. You can take your genome and the genome of your cancer and design a map of exactly what’s different about those cells. You can do this on a per-person basis, and it’s at the core of individualized therapy.

I think the term cancer is a total misnomer. We should move away from terms like prostate cancer, lung cancer, or breast cancer. It should always be cancers. Cancers are a huge, massively heterogeneous, highly diverse set of diseases and conditions and molecular mutations, not at all a single phenomenon.

Skeptic: Starting today, what can each one of us do to be healthier?

Price: Exercise. You lose between zero and one percent of your muscle mass per year as you age. Decade after decade, that adds up. You become frail in your later years. There are things you really want to be able to do when you’re older—for example, to stand up from the ground without any assistance. When you’re young, that’s easy; when you’re older, it gets harder. If you lose that ability, you’re putting yourself at much greater risk. Balance and posture are also important. So are stretching and range of mobility.

Skeptic: And what can we do to keep our minds healthy?

Price: I think that we have really been on the wrong track in Alzheimer’s, for a long time.

First, people almost always say amyloid plaques cause Alzheimer’s. I don’t think that’s true. I think the biggest factor is metabolism and what the brain has to do to maintain energy. Your brain is only two percent of your body’s biomass, but it uses 20 percent of your body’s energy. That’s 10 times more metabolically demanding than the body average. So, every second of every day, you’ve got to supply it with energy. As you get older, your ability to perfuse oxygen into your brain through your blood vessels goes down. It decreases, just like muscle mass.

As that happens, certain regions of the brain become lower in oxygen. The amount of energy that you can create goes below the amount that you need, so certain neurons start dying. As they die, you put more demand on the remaining neurons. Their demand goes up while their supply stays the same. Then they die, which puts even more pressure on those remaining. So you get this cascade of cell death.

The second big factor that everyone knows about is that if you have the gene APOE, you have a high risk of Alzheimer’s. How can your neurons keep making a lot of energy under these low-oxygen conditions? Supporting cells, called astrocytes, are really important here. There is a 9:1 ratio of astrocytes to neurons, and they support energy generation in the neurons. So you want to keep the cholesterol level in the astrocytes low in order to keep energy generation high in neurons under low oxygen conditions.

APOE has a role in the transport of cholesterol out of astrocytes. APOE4 does it slowly, APOE2 does it fast. And if all you do is take those two facts—the lowering of oxygen and the difference in the efficiency of keeping positive energy balance under that condition—you can recapitulate the ages at which all the different genotypes get Alzheimer’s disease with very close accuracy. That’s true for a whole range of genetic and environmental backgrounds.

This article appeared in Skeptic magazine 28.4
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Then there’s a gene called TREM2 that has to do with the energetics of what’s required to clear debris. If these cells are dying, you get all this debris that you’ve got to clean out. That comes at an energetic cost. And if you spend energy doing that, you don’t have as much energy left to protect the nerve. As your neurons die and you lose synapses, as that synapse firing goes down, you cross a threshold where you can no longer do what’s called Hebbian learning—what fires together, wires together. But you don’t have enough firing to learn, so the brain has to secrete a molecule in order to recruit additional synapses— amyloid beta. It is brought in by the brain or made by the brain in order to recruit these synapses so you can keep cognition going. Now, as a byproduct, these things glom together and form amyloid plaques. Amyloid can embed in your blood vessels and constrict them, which then gets us back to the central problem of limited energy because it’s limiting oxygenation into the brain. But the plaques aren’t the cause of the disease.

Skeptic: So, what can be done to prevent that or treat it?

Price: Exercise. Under the model I just described, it’s obvious why.

Skeptic: How do you see the future of health and wellness?

Hood: I think any brand-new idea almost never can be achieved in the context of an existing bureaucracy. Bureaucracies are honed by the past, can barely deal with the present, and have difficulty dealing with the future. Initially, 80 percent of the biologists in the U.S. were opposed to the Human Genome Project.

As a young assistant professor at Caltech, I started thinking about where I wanted my future scientific career. I had a real interest in human biology and disease. It was 1970 and I was dismayed by the complexity of the problem and by the lack of tools we had for dealing with it. I decided to develop instruments that allowed one to read and write DNA, which could decipher that complexity by generating big data from individual humans. Put simply, lots of information on individuals that—when analyzed—could lead to insights into wellness and prevention.

I hope we were able to convince you that this sort of thinking is absolutely mandatory for improving healthcare in the future, and that scientific research is now on the right track.

This print interview has been edited from a longer conversation on The Michael Shermer Show.

About the Interviewees

Leroy Hood developed the DNA sequencer which enabled the reading of the entire human genetic code as part of the Human Genome Project. His work was also instrumental in the creation of treatment for AIDS. Hood founded the discipline of systems biology and is one of only 15 individuals elected to all three U.S. National Academies (the National Academy of Science, the National Academy of Engineering, and the Institute of Medicine).

Nathan Price is Chief Science Officer of Thorne HealthTech and Professor at the Institute for Systems Biology. Selected as an Emerging Leader in Health and Medicine by the National Academy of Medicine, he received the Grace A. Goldsmith Award for his work on scientific wellness, and is the author of more than 200 peer-reviewed scientific publications

In 2006, a flying saucer spent minutes literally hovering right above Chicago's O'Hare International Airport... so the story goes.

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Generations have been taught that evolution implies there is no overarching purpose to our existence, that life has no fundamental meaning. We are merely the accumulation of tens of thousands of intricate molecular accidents. Some scientists take this logic one step further, suggesting that evolution is intrinsically atheistic and goes against the concept of God.

With respect to our evolution, nature seems to have endowed us with competing dispositions, what Wilkinson calls the dual potential of human nature. We are pulled in different directions: selfishness and altruism, aggression and cooperation, lust and love.

By using principles from a variety of scientific disciplines, Yale Professor Samuel Wilkinson provides a framework for human evolution that reveals an overarching purpose to our existence.

Wilkinson claims that this purpose, at least one of them, is to choose between the good and evil impulses that nature has created within us. Our life is a test. This is a truth, as old as history it seems, that has been espoused by so many of the world’s religions. From a certain framework, Wilkinson believes that these aspects of human nature—including how evolution shaped us—are evidence for the existence of a God, not against it.

Closely related to this is meaning. What is the meaning of life? Based on the scientific data, it would seem that one such meaning is to develop deep and abiding relationships. At least that is what most people report are the most meaningful aspects of their lives. This is a function of our evolution. It is how we were created.

Samuel T. Wilkinson is Assistant Professor of Psychiatry at Yale University, where he also serves as Associate Director of the Yale Depression Research Program. He received his MD from Johns Hopkins School of Medicine. His articles have been featured in the New York Times, the Washington Post, and the Wall Street Journal. He has been the recipient of many awards, including Top Advancements & Breakthroughs from the Brain and Behavior Research Foundation; Top Ten Psychiatry Papers by the New England Journal of Medicine, the Samuel Novey Writing Prize in Psychological Medicine (Johns Hopkins); the Thomas Detre Award (Yale University); and the Seymour Lustman Award (Yale University). His new book is Purpose: What Evolution and Human Nature Imply About the Meaning of our Existence.

Shermer and Wilkinson discuss:

• evolution: random chance or guided process?
• selfishness and altruism
• aggression and cooperation
• inner demons and better angels
• love and lust
• free will and determinism
• the good life
• the good society
• empirical truths, mythic truths, religious truths, pragmatic truths
• Is there a cosmic courthouse where evil will be corrected in the next life?
• theodicy and the problem of evil: Why do bad things happen to good people?

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Could humans unknowingly be a part of a larger superorganism—one with its own motivations and goals, one that is alive, and conscious, and has the power to shape the future of our species? This is the fascinating theory from author and futurist Byron Reese, who calls this human superorganism “Agora.”

In We Are Agora, Reese starts by asking the question, “What is life and how did it form?” From there, he looks at how multicellular life came about, how consciousness emerged, and how other superorganisms in nature have formed. Then, he poses eight big questions based on the Agora theory, including:

• If ants have colonies, bees have hives, and we have our bodies, how does Agora manifest itself? Does it have a body?
• Can Agora explain things that happen that are both under our control and near universally undesirable, such as war?
• How can Agora theory explain long-term progress we’ve made in the world?

In this unique and ambitious work that spans all of human history and looks boldly into its future, Reese melds science and history to look at the human species from a fresh new perspective. We Are Agora will give readers a better understanding of where we’ve been, where we’re going, and how our fates are intertwined.

Byron Reese is an Austin-based entrepreneur with a quarter-century of experience building and running technology companies. A recognized authority on AI who holds a number of technology patents, Byron is a futurist with a strong conviction that technology will help bring about a new golden age of humanity. He gives talks around the world about how technology is changing work, education, and culture. He is the author of four books on technology; his previous title The Fourth Age was described by the New York Times as “entertaining and engaging.” Bloomberg Businessweek credits Reese with having “quietly pioneered a new breed of media company.” The Financial Times reported that he “is typical of the new wave of internet entrepreneurs out to turn the economics of the media industry on its head.” He and his work have been featured in hundreds of news outlets, including the New York Times, Washington Post, Entrepreneur, USA Today, Reader’s Digest, and NPR.

Shermer and Reese discuss:

• What is an organism and what is a superorganism?
• What is life?
• Why do things die?
• the origins of life, multicellular life, and complex organisms
• What is the self?
• emergence
• consciousness
• social insects: bees, ants, termites
• Is the Internet a superorganism?
• Will AI create a superorganism?
• Is AI an existential threat?
• Could AI become sentient or conscious?
• the hard problem of consciousness
• cities as superorganisms
• planetary superorganisms
• Are we living in a simulation?
• Why are we here?

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

What happens when sex is more about identity than pleasure, intimacy, or interaction? And what happens when culture warriors gang up on sexuality—and from several directions? And has this affected our mental health? After over 40 years and 40,000 sessions with individuals and couples as a Licensed Marriage and Family Therapist and Certified Sex Therapist, I am growing alarmed at the changes I see taking place in our society— most notably, the prospects for using sexuality to nourish ourselves physically or emotionally are declining. Simply stated, sex is seen less and less as an activity that contributes to mental health. Instead, it’s increasingly seen as an abstraction, only vaguely related to the currently more important activity of establishing and policing identity.

Changing Definitions

Even though our culture today seems dominated by sexual issues, it isn’t really sex that many people have on their mind. These days, cultural conversations about sexuality often focus on issues such as skepticism regarding true consent in heterosexual sex, a huge expansion of the definition of trauma, the invention and legitimation of “sex addiction,” and newly imposed limits on when it is acceptable to express interest in sex with someone for the first time.

Many Americans increasingly seem to want to protect themselves from sex, rather than embrace it. Note that enthusiastically pursuing your sexual identity or orientation is not the same thing as embracing sexuality itself. And knowing what you don’t want is not the same as knowing what you do want.

In fact, many of the newly minted sexual identities and orientations are about not having sex: asexual (lacking in sexual attraction to others), graysexual (inbetween asexual and sexual), aromantic (little to no romantic feelings toward others), or lithromantic (can feel romantic love but has no need for those feelings to be reciprocated). When people talk about sexual identity, they’re referring less to what they do, and more to the community to which they belong. In fact, as Temple University’s Jennifer Pollitt says, “There is a huge difference between orientation, behavior, and identity. The sexual or romantic behavior you engage in does not necessarily correlate with the identity that you’re using to describe your experiences or orientation.”1

If behavior “does not correlate with identity,” then what is identity based on? And on what basis do individuals decide to accept their own erotic behavior? Until recently, the convergence of behavior and identity was considered an important aspect of mental health. Now, in addition to turning language on its head, this conception of sex seems to endorse “splitting” (black-and-white, all-or-nothing thinking), which most psychologists—from the most Freudian to the most modern—agree is psychologically harmful.

Those attached to gender discourse may use the language of sex, but what they’re really talking about is self-image and community, not sexuality. Their conversations are not about a dyadic connection with another, which has been, historically, considered a hallmark of adult development and mental health.

Trends

Not surprisingly, the two generations that have gone through puberty most recently indeed have sex less than previous generations of late teens and young adults. UCLA’s annual California Health Interview Survey is the country’s largest state health survey. In 2021, it found that the number of Californians ages 18–30 reporting no sexual partners in the prior year reached 38 percent,2 almost double the number a mere ten years earlier. This trend is, I submit, part of a larger society-wide mental health challenge.

With the ubiquity of internet, social media, and smartphones, young people are less interested in distraction-free, in-person relating. They don’t develop the necessary skills to create or enjoy it, which include patience, listening, fluency in social cues, reading the impact of what they say on others, and tolerating/ignoring the possibility that something interesting is happening somewhere else.

The demand to feel emotionally safe and unchallenged as much as possible interferes with intimacy as well. Readers will recognize countless instances of young people being “offended” instead of disagreeing, bristling at “microaggressions” and “cultural appropriations” that aren’t about them, and not wanting to debate those who view things differently. In addition, young people are now launching into adulthood later, so they don’t have as much privacy or money, and don’t aspire to being in a couple nearly as much. Consequently, one of the main things about sex—“it’s what you do in a dyad”—has less appeal. The current ease of masturbating to pornography exacerbates this by facilitating erotic experiences that are about seeing and imagining, rather than feeling physically and emotionally.

At the same time, many young people are self-identifying with new versions of sexual identity and orientation at higher rates than ever before. According to a 2022 Gallup poll, the percentage of U.S. adults who identify as something other than heterosexual has doubled over the last 10 years, from 3.5 percent in 2012 to 7.1 percent.3 The change is mostly seen among those age 30 and under.

Identity and Community

American society now instructs young people to express their ordinary alienation, angst, anxiety, identity concerns, and resentments in the language of gender (along with race). This automatically provides many of today’s youth with a community in which they can participate and to which they can belong. Naturally, almost everyone wants to feel that they belong to something—that’s part of mental health. Yet it’s easy to see that claiming membership in these various communities is not completely harmless.

The now-common insistence that everyone reveal their pronouns (i.e., their gender identity) in completely non-sexual environments (such as university lectures, medical settings, commercial websites, email signature lines, and social media profiles) is accompanied by the new insistence that anyone who prefers not to do so is declaring that they are unfriendly toward LGBT people. Little consideration is given to the possibility that someone might not consider their gender to be the most salient part of their identity (which, for example, might be their race, religion, ethnicity, or profession). Or that they feel it is a private matter and no one else’s business.

These communities can even harm one’s health in the form of permanent and irreversible interventions, such as puberty blockers and surgeries intended to change sex. Advocates for gender-affirming care have worked hard to portray it as lifesaving and suicide prevention by fearmongering with inflated statistics about suicidal ideation. But when researchers compared transgender youth with teens suffering from mental health problems, there was little difference in suicide rates between the groups. Transgender youth are not much more suicidal than teens with garden variety mental illness, which means that failing to affirm a child’s transgender identity does not drive suicidal behavior. A recent study analyzed data from the world’s largest pediatric gender clinic, the UK’s Tavistock, and found the rate of completed youth suicides to be 0.03 percent, which is hardly a suicide epidemic.4 In reality, very few youths who identify as transgender ever commit suicide. And it really is true that concerned parents are being fed false suicide statistics that misleads them into believing their child is likely to kill themselves if they don’t consent to puberty blockers, hormones, and surgeries for them.

Claims that scientific studies show clear mental health benefits of gender-affirming medical treatments for transgender youth are not supported by evidence. Some of the studies commonly touted as demonstrating positive mental health outcomes show no or possibly even negative association between administering hormones and mental health. Studies purporting to demonstrate mental health benefits are often misleading due to their short follow up durations, often spanning just a few months to two years. There is no long-term data on this experimental protocol, and it is typically within the 4–8 year range that individuals start expressing regret.

But frightened, unhealthy thinking about sexuality is not limited to any political or cultural viewpoint. As I detailed in my book America’s War On Sex,5 the conservative religious Right generally opposes whatever makes sex simpler, safer, more enjoyable, and easier to separate from stable monogamous relationships. Rather than focusing on healthy pleasure (including how satisfying sex supports stable marriage), they tend to focus more on the unhealthy aspects of sex, such as emotional danger, STIs, coercion and violence, and unwanted pregnancies.

The Right has always disliked the optionality and autonomy of sexual exploration, opposing unmarried women having easy access to birth control pills; fighting the availability of sex toys; and restricting TV advertising of products such as condoms and tampons. Today’s manifestation of this instinct now extends to banning books from public and school libraries; restricting gender medicine; banning private swing clubs; and requiring registration to watch internet porn (currently enacted in Utah, Virginia, and Louisiana, with a dozen more states pending).

Masturbation and Mental Health

Whether we like to acknowledge it or not, masturbation is the primary sex life of almost everyone. And how you manage and accept or reject this fact can have a large influence on your mental health. Masturbation typically involves fantasy, and so talk of masturbation inevitably turns to pornography. Unfortunately, commentators and activists of all ideologies seem to agree that viewing pornography somehow colonizes a viewer’s brain so that he (always a he) becomes a dangerous, amoral predator who wants to have sex with every woman except his own mate.

Whether our fantasies involve pornography or not, they reveal a common theme about humans— that privately, we’re all perverts.

In their 2011 book A Billion Wicked Thoughts,6 data scientists Ogi Ogas and Sai Goddam revealed the most common sexual terms among 400 million internet searches. Being coerced is by far the most common sexual fantasy of women. Large (i.e., taboo) age differences between partners is a very popular fantasy of both men and women. This tells us that people’s public pronouncements about others’ masturbation are mostly performative, designed to imply that “I’m moral, I’m not over-sexed, and I definitely don’t have risky sexual impulses inside me.”

The fear of sexual fantasy reaches its climax with the anti-masturbation and anti-pornography NoFap movement. It currently claims over 300,000 members, and its website logs almost two million monthly visitors. With an anti-science tradition stretching back to noncredentialed activist Gary Wilson and to Christian fundamentalism, the group claims a wide range of harms from masturbating and watching porn, and corresponding benefits in abstaining from them—without any valid empirical evidence.

Of course, some people do masturbate or use pornography in self-defeating ways, but they often have mental health struggles with, for example, OCD, depression, bipolar disorder, Asperger’s or autism, or borderline personality disorder.

While masturbation itself is not a prerequisite for mental health, vilifying it and obsessively struggling to maintain abstinence can undermine having a healthy mental life. Those compensatory behaviors tend to demonize one’s own sexual impulses, which are then often experienced as rage and shame—turned in on oneself (which typically leads to depression), or focused outward (as explosiveness or even violence). As Andrew Sullivan wrote, “the suppression of these core emotions [sexuality] and the denial of their resolution in love always leads to personal distortion and compulsion and loss of perspective.”7

Psychology, Sex, and Mental Health

American psychotherapy has never been comfortable or well-educated about sexuality—for example, you can get a license to practice without hearing the words “vibrator” or “oral sex” in your training. And now the profession has extended its distance from ordinary or positive sexuality by instead focusing more on trauma and identity while disparaging pornography. Meanwhile, it has no answer to common issues such as desire discrepancy, infidelity after the other partner has lost desire, purity culture, adolescent sexuality, or the impact of technology on sexuality.

Psychologists used to include sexual desire and satisfaction in their profile of mental health. Today, the focus regarding sex is about trauma, consent, sex addiction, porn addiction, love addiction, “emotional affairs,” and sexual identity and orientation.

As a profession, psychologists are refusing to challenge even the most extreme activists, instead abandoning kids and families to gender-affirming specialists. While psychology has extensively studied questions such as “Why can’t some alcoholics take even one drink a year?” and “What’s the difference between sadness and depression?” and “What predicts whether a couple will divorce?” it dares not touch tough questions such as “Why is ‘asexual’ suddenly a complex orientation rather than a simple preference?” or “If children can’t consent to sex with an adult, why are they competent to select their gender?” or “How do we account for concentrated clusters of young teens claiming they’re transgender or non-binary in certain schools, when there aren’t similar clusters across town?”

As a result, psychology has only limited tools in dealing with children or adults with questions about gender or orientation. Almost overnight, gender-affirming specialists have acquired great status and professional power.

But by validating even the extremes of gender choice, gender spectrum, and gender activism industry in schools, the media, psychology, medicine, and elsewhere, our society now encourages young people to express their ordinary alienation, angst, anxiety, identity concerns, and resentments in the language of gender. Wouldn’t it be better if young people would simply say “It’s my life!” instead of “I just discovered I’m gender queer and demand hormones and surgery.”

Sexual Intelligence

Despite all these issues we can be intelligent about sex. To that end, there are three dimensions to enjoyable sex: self-acceptance, communication, and emotional skills. Together, these make up what I call Sexual Intelligence. Despite the contrasting public policy and psychosocial goals of both the political Left and the Right, each side in the culture wars should promote Sexual Intelligence as a vehicle for both societal and individual mental health.

This article appeared in Skeptic magazine 28.4
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Sexual Intelligence enables individuals to make choices that fit their own values, create stable erotic partnerships, resist mass media messages of perfectionism, encourage thoughtful decision-making, and resist impulsivity while allowing for self-expression. These are all good for mental health. And they are contrary to aggressive activism, name-calling, discrimination, and feeling threatened by others’ choices, from any direction or worldview.

Sexual Intelligence also depends on recognizing that information itself is not the enemy. Talking about sexuality and asking questions does not equal discrimination or “violence.” Likewise, acknowledging that humans are a varied group is a simple acceptance of the fact that adults need the skills of getting along with each other—i.e., communication and respect.

That approach to sexuality would greatly promote the mental health of everyone. It would also help cool down the culture wars. Healthy sex, after all, benefits all of society.

About the Author

Marty Klein has been a Licensed Marriage & Family Therapist and Certified Sex Therapist for 42 years—over 40,000 sessions with individuals and couples. Marty is an outspoken critic of many popular and clinical ideas about sexuality and emotional health; for example, he is regarded as the foremost critic of the concept of sex addiction. A former instructor at Stanford Medical School, Marty’s humor, insights, and down-to-earth approach are regularly featured in the national media, such as the New York Times, the New Yorker, and NPR. He is the author of seven books on sexuality, including Sexual Intelligence and Beyond Orgasm.

References

1. https://tinyurl.com/3ctw74z7
2. https://tinyurl.com/393wx5f7
3. https://tinyurl.com/552wpktv
4. https://tinyurl.com/ysdrce7b
5. https://tinyurl.com/4pz8e4df
6. https://tinyurl.com/abctfwm7
7. https://tinyurl.com/mr3cbzu5

Can everything important about you and those you interact with be boiled down to a single digit?

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Have you ever noticed that what is thrilling on Monday tends to become boring on Friday? Even exciting relationships, stimulating jobs, and breathtaking works of art lose their sparkle after a while. People stop noticing what is most wonderful in their own lives. They also stop noticing what is terrible. They get used to dirty air. They stay in abusive relationships. People grow to accept authoritarianism and take foolish risks. They become unconcerned by their own misconduct, blind to inequality, and are more liable to believe misinformation than ever before.

But what if we could find a way to see everything anew? What if you could regain sensitivity, not only to the great things in your life, but also to the terrible things you stopped noticing and so don’t try to change?

Now, neuroscience professor Tali Sharot and Harvard law professor (and presidential advisor) Cass R. Sunstein investigate why we stop noticing both the great and not-so-great things around us and how to “dishabituate” at the office, in the bedroom, at the store, on social media, and in the voting booth. This groundbreaking work, based on decades of research in the psychological and biological sciences, illuminates how we can reignite the sparks of joy, innovate, and recognize where improvements urgently need to be made. The key to this disruption — to seeing, feeling, and noticing again — is change. By temporarily changing your environment, changing the rules, changing the people you interact with — or even just stepping back and imagining change — you regain sensitivity, allowing you to more clearly identify the bad and more deeply appreciate the good.

Tali Sharot is a professor of cognitive neuroscience at University College London and MIT. She is the founder and director of the Affective Brain Lab. She has written for outlets including the New York Times, Time, Washington Post, has been a repeated guest on CNN, NBC, MSNBC, a presenter on the BBC, and served as an advisor for global companies and government projects. Her work has won her prestigious fellowships and prizes from the Wellcome Trust, American Psychological Society, British Psychological Society, and others. Her popular TED talks have accumulated more than a dozen million views. Before becoming a neuroscientist, Sharot worked in the financial industry. She is the author of award-winning books: The Optimism Bias and The Influential Mind. Her new book, co-authored with Cass Sunstein, is Look Again: The Power of Noticing What Was Always There.

Shermer and Sharot discuss:

• the best day of her life
• the evolutionary origins of habituation
• habituation at work, at home, and in the bedroom
• Why don’t we habituate to extreme pain?
• Twilight Zone episode: criminal Henry dies and goes to heaven where he gets everything he wants but grows bored and wants to go to the other place
• Conflicting Problem: Why is it that even when we have wonderful things in our life – a great job, a loving family, a comfortable house – those things don’t necessarily bring us daily joy when they really should? Why is it that even when terrible things are happening around us — sexism, racism, cracks in our personal relationships, inefficiencies at the workplace – we often carry on and perhaps don’t even notice, and therefore don’t try to change these things?
• midlife crisis
• marriage, romance, monogamy, infidelity
• depression
• happiness and variety
• Negativity Bias
• social media
• creativity and habituation disruption
• lying and misinformation
• Trump: habituation to his lies, lawsuits, etc.
• Illusory Truth Effect: the tendency to believe repeated statements
• Truth Bias: the tendency to believe what we are told
• Tali’s experience getting scammed in London
• risk habituation
• discrimination, anti-Semitism, racism, bigotry
• tyranny
• moral progress: we have to overcome the habituation of lacking rights (women in the 1970s)
• preference falsification: people often fail to say what they like and think because of existing social norms
• pluralistic ignorance and the rise of the Nazis.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

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A new economic war for critical minerals has begun, and The War Below is an urgent dispatch from its front lines. To build electric vehicles, solar panels, cell phones, and millions of other devices means the world must dig more mines to extract lithium, copper, and other vital building blocks. But mines are deeply unpopular, even as they have a role to play in fighting climate change and powering crucial technologies. These tensions have sparked a worldwide reckoning over the sourcing of necessary materials, and no one understands the complexities of these issues better than Ernest Scheyder, whose exclusive access to sites around the globe has allowed him to gain unparalleled insights into a future without fossil fuels.

The War Below reveals the explosive brawl among industry titans, conservationists, community groups, policymakers, and many others over whether some places are too special to mine or whether the habitats of rare plants, sensitive ecosystems, Indigenous holy sites, and other places should be dug up for their riches.

With vivid and engaging writing, Scheyder shows the human toll of this war and explains why recycling and other newer technologies have struggled to gain widespread use. He also expertly chronicles Washington’s attempts to wean itself off supplies from China, the global leader in mineral production and processing. The War Below paints a powerfully honest and nuanced picture of what is at stake in this new fight for energy independence, revealing how America and the rest of the world’s hunt for the “new oil” directly affects us all.

Ernest Scheyder is a senior correspondent for Reuters, covering the green energy transition and the minerals that undergird it. He previously covered the US shale oil revolution, politics, and the environment, and held roles at the Associated Press and the Bangor Daily News. A native of Maine, Scheyder is a graduate of the University of Maine and Columbia Journalism School. Visit his website at ErnestScheyder.com and follow him on Twitter @ErnestScheyder.

Shermer and Scheyder discuss:

• how, as a Reuters reporter, Scheyder came to this issue
• rare earth metals
• lithium and copper
• aluminum and other precious metals
• How much rare earth metals will we need by 2050, 2100, and beyond?
• How do lithium-ion batteries work compared to lead-acid? What are the alternatives?
• How crucial are these technologies necessary to combat climate change?
• Will EVs completely replace all other automobiles?
• Can renewables completely replace fossil fuels without nuclear?
• recycling electronic waste
• how mining works in the U.S., China, Chile, Russia, elsewhere
• types of mines: hard-rock vs. soft-rock, open-pit vs. deep earth
• public vs. private ownership of mines (Bureau of Mines)
• what companies like Apple and Tesla are doing about the coming problem
• Native American rights to land containing valuable mines
• third world labor exploitation
• electric leaf blowers and weed wackers.

If you enjoy the podcast, please show your support by making a $5 or $10 monthly donation.

Throughout most of the last century, both political Right1 and Left2 were unified, a rare occurrence in itself, in their opposition to the decriminalization of marijuana. By 2023, public opinion had shifted. Most Americans now support legalization for medical and recreational use,3 and this support extends across the political divide. Nearly two-thirds of the electorate supports legalization, making it one of the least divisive issues in the country.4 At this writing, 23 states have legalized recreational marijuana, along with Washington, DC, and Guam.5

The third that opposes legalization remains, though, and there are reasoned arguments against legalization. Significant research establishing the adverse effects of marijuana consumption exists, noting its correlation with neurophysical decline,6 cognitive impairment,7 highway deaths,8 lower educational attainment,9 addiction,10 and other adverse health effects.11 Within the last decade, correlations have been found between both distal and proximal drug use (including the use of marijuana) and sexual aggression.12

Buchanan, Michigan (Callie Lipkin / Gallery Stock), “The Nicest Place in America (2020)”

There are also reasonable arguments against legalization based on the burdens it is claimed it would produce on society: the tax revenue received from the longstanding legal sale of alcohol and tobacco pales in comparison to the costs of healthcare for the individuals who consume them.13 So some argue marijuana legalization would only further increase the costs to the taxpayer.

In 2019, Alex Berenson of the New York Times published Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence. In it, Berenson warned that paranoia, one of the established side effects of marijuana consumption, is likely to trigger violence in those suffering from psychosis.14 The book was predictably lauded by those pundits who saw it as a revelatory argument against legalization.15 Berenson cited stories such as that of Raina Thaiday, who stabbed eight children to death, seven of which were her own (the eighth was her niece). Berenson noted the ruling of schizophrenia for Thaiday, in which the Justice who presided over her case wrote, “All the psychiatrists thought that it is likely that (Thaiday’s) long-term use of cannabis caused (Thaiday’s) mental illness schizophrenia to emerge.”16 Tell Your Children is chock full of historical tragedies such as Thaiday’s from the 1970s to the present day. The book describes scalping, mutilation, mass shootings, and spousal murder by psychotic perpetrators triggered by smoking marijuana. The author warned that today’s marijuana is considerably more potent (that is, higher concentration of THC) than that used 40+ years ago, and so predicted that such atrocities will only get worse. Yet Berenson’s argument is not new. Cannabis-induced violence has been argued by the U.S. Department of Justice for decades.17

New research challenged the Department’s claims, examining the rates of violent crime in states that had legalized medical and recreational marijuana. The data suggested that legalization not only failed to increase violent crime rates, but it also possibly led to a decline in crimes such as homicide, robbery, and aggravated assault.18 Likewise, Tell Your Children was challenged by many in the scientific community. They argued the author was guilty of confusing correlation with causation and selectively selecting his data, and even likened his anecdotal data to the long-discredited “reefer madness” panic of the past.19

Having grown up during the 1980s at the height of the War on Drugs, I read Tell Your Children with interest, and asked myself if Berenson’s fears were valid. Was he right? Turns out, I live in a small Michigan community that offers an ideal cluster sample in which to test his claims. It’s called Buchanan.

In the fall of 2020, I heard a radio ad calling for nominations to be considered for Reader’s Digest’s Nicest Place in America. I wrote about Buchanan. My essay won.20 Reporters from around the world covered the story.21 Coincidentally, that same year, Buchanan fully implemented marijuana legalization.22 Michigan had passed a medical marijuana law in 2008, and we’d spent the previous 10 years respectfully debating whether or not to follow suit in our small town. In the fall of 2019, the city adopted a plan for six dispensaries.

Location of marijuana dispensaries in Buchanan, MI

The Nicest Place in America has since become the go-to destination for Michigan stoners. At this writing, there is one legal dispensary for every 860 residents, one of the highest per capita ratios in the state.23 We even have a local marijuana ambassador, Freddie “The Stoner” Miller, who’s been seen on the Jimmy Kimmel Live! TV show.24

Buchanan seemed like the perfect case study of the effects of marijuana legalization. Did The Nicest Place in America see an increase in violent crime rates in the years following its adoption of recreational marijuana? I began by looking up our demographics. I found that, in many ways, Buchanan is a microcosm of America. We have a population of 4,270 and enjoy a diverse citizenry that is 83.2 percent White, 11 percent Biracial, 4.38 percent African American, Hispanic (.445 percent), and Asian (.445 percent). We have a poverty rate of 7.85 percent and a median household income of $43,668.

Much of Buchanan’s demographic data is comparable to that of the United States as a whole, though the U.S. has a considerably larger Hispanic population (18.2 percent), a larger median household income ($64,994), and a higher poverty rate (12.8 percent). Buchanan’s industrial statistics are likewise similar to those of the nation, with the workforce distributed across manufacturing, education, retail trade, and professional and technical services.25 Perhaps most significantly, Buchanan’s unemployment insurance claims skyrocketed to record levels in April 2020, as did those throughout the country.

This article appeared in Skeptic magazine 28.4
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I then called Sean Denison, Buchanan’s mayor. He told me he’d seen no evidence of violent crime increase since 2020. When I called Tim Ganus, our Police Chief, he told me that he also doubted crime spiked. Still, though, to really know, you need data. I submitted a Freedom of Information Act Request to the Buchanan Police Department to obtain arrest records for violent crimes from 2016 to 2022. Chief Ganus called me again to establish what I meant by “violent crime.” I told him he knew more about this than I did, so I’d leave it up to him. He suggested arrests for assault and for those that would constitute a felony. I concurred. One week later, I had the information in hand. Each report encompassed one calendar year.

Here’s what I found:

There was a total of 855 adult arrests between January 1, 2016, and December 31, 2022. Of these, there were a total of 105 (12.2 percent) arrests deemed “violent.” These offenses included nonaggravated assault, aggravated felonious assault, sexual assault, parental kidnapping, and robbery.

• In 2016, there were 29 arrests, one for parental kidnapping, one for sexual assault, 21 nonaggravated (misdemeanor level) assaults, and six aggravated (felonious) assaults.
• In 2017, there were 17 arrests, one for robbery, 12 for non-aggravated (misdemeanor level) assaults, and four for aggravated felonious assault.
• In 2018, there were 23 arrests, one for robbery, 17 for non-aggravated assault, and five for aggravated felonious assault.
• In 2019, there were 21 arrests, two for sexual assault, 17 for non-aggravated assault, and two for aggravated felonious assault.
• In 2020, the first full year of implementation, there were 21 arrests, two for sexual assault, 15 for non-aggravated assault, and four for aggravated felonious assault.
• In 2021, the second year of implementation, there were 19 arrests, one for parental kidnapping, three for sexual assault, one for forcible sexual contact, nine for non-aggravated assault, and four for aggravated felonious assault.
• In 2022, the third year of the implementation, there were 22 arrests, 16 for non-aggravated assault and six for aggravated felonious assault.

Did violent crime increase in Buchanan after 2020? Hardly. Any fears of increased violent crime following marijuana legalization in The Nicest Place in America proved unwarranted. We’re still safe, and so, I’m glad to report, is our title.

About the Author

John D. Van Dyke is an academic and science educator. His personal website is www.vandykerevue.org.

References

1. https://rb.gy/17hag
2. https://rb.gy/fzigf
3. https://rb.gy/rkncw
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5. https://rb.gy/m049q
6. https://rb.gy/4a3e9
7. https://rb.gy/36zd3
8. https://rb.gy/eft8n
9. https://rb.gy/m2mcd
10. Shover, C.L., David, C.S., Gordon, S.C., & Humphreys, K. (n.d.). Association between medical cannabis laws and opioid overdose mortality has reversed over time. PNAS, 116(26).
11. https://rb.gy/m2mcd
12. https://rb.gy/wofyp
13. https://rb.gy/ifprp
14. https://rb.gy/hi3zc
15. https://rb.gy/iibix
16. Berenson, A. (2019). Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence. Free Press.
17. Inciardi Inciardi, J. A., & Saum, C. A. (1998). Legalizing Drugs Would Increase Violent Crime (From Illegal Drugs, p. 142–150, 1998, Charles P. Cozic, ed. See NCJ-169238).
18. https://rb.gy/k7fmq
19. https://rb.gy/luf2z
20. https://rb.gy/c1xun
21. https://rb.gy/annph
22. https://rb.gy/cg4xr
23. https://rb.gy/cqg5s
24. https://rb.gy/1xmah
25. https://rb.gy/0is0v

What were these early UFOs that chased and harried World War II fighter pilots?

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Four years on, Covid is clearly here to stay. So what do we do now? Drawing on his expertise as one of the world’s top virologists, Dr. Paul Offit helps weary readers address that crucial question in this brief, definitive guide.

As a member of the FDA Vaccine Advisory Committee and a former member of the Advisory Committee for Immunization Practices to the CDC, Offit has been in the room for the creation of policies that have affected hundreds of millions of people. In these pages, he marshals the power of hindsight to offer a fascinating frontline look at where we were, where we are, and where we’re heading in the now-permanent fight against the disease.

Accompanied by a companion website populated with breaking news and relevant commentary, this book contains everything you need to know to navigate Covid going forward. Offit addresses fundamental issues like boosters, immunity induced by natural infection, and what it means to be fully vaccinated. He explores the dueling origin stories of the disease, tracing today’s strident anti-vax rhetoric to twelve online sources and tracking the fallout. He breaks down long Covid—what it is, and what the known treatments are. And he looks to the future, revealing whether we can make a better vaccine, whether it should be mandated, and providing a crucial list of fourteen takeaways to eradicate further spread.

Paul A. Offit, M.D. is the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and the Maurice R. Hilleman Professor of Vaccinology and Professor of Pediatrics at the University of Pennsylvania. He has appeared on The Today Show, Good Morning America, CBS This Morning, 60 Minutes, and many other programs. Offit has published more than 170 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC and WHO. In 2021 he was awarded the Edward Jenner Lifetime Achievement Award in Vaccinology from the 15th Vaccine Congress. He is the author of numerous books including: Do You Believe in Magic?: Vitamins, Supplements and All things Natural; Vaccinated: From Cowpox to mRNA, the Remarkable Story of Vaccines; Deadly Choices: How the Anti-Vaccine Movement Threatens Us All; You Bet Your Life: From Blood Transfusion to Mass Vaccination, the Long and Risky History of Medical Innovation; and Pandora’s Lab: Seven Stories of Science Gone Wrong. His new book is Tell Me When It’s Over: An Expert’s Guide to Deciphering Covid Myths and Navigating Our Post-Pandemic World.

Shermer and Offit discuss:

• How do you know that the Covid-19 vaccines are not the 8th story of science gone wrong, or part of the long and risky history of medical innovation?
• Loss of trust in medical and scientific institutions (Anthony Fauci, Francis Collins)
• Overall assessment of what went right and wrong with the Covid-19 pandemic
• Pandemic vs. epidemic
• Influenza caused 800,000 hospitalizations & 60,000 deaths
• Testing, masking, social isolation
• Mandates vs. recommendations
• Is the cure worse than the disease?
• Closing of schools, restaurants, salons, parks, beaches, hiking trails, etc.
• The cost to the economy of the shut downs
• The cost to the education of children of the shut downs
• Comparative method: which countries and states did better or worse?
• Viral: The Search for the Origin of Covid-19 by Alina Chan and Matt Ridley
• Lab Leak hypothesis vs. Zoonomic hypothesis
• Living with SARS-CoV-2 and its variants
• Vaccines and autism
• RFK, Jr. and his conspiracy theories
• Debating anti-vaxxers (Rogan and elsewhere)
• Treatments: hydroxychloroquine, ivermectin, remdesivir, Vitamin D, Paxlovid, Tamiflu, retroviral medicines, monoclonal antibodies, convalescent plasma
• High risk vs. low risk groups; age, sex, race, pregnancy, weight, preconditions, immune compromised
• Myocarditis, Robert Malone, mRNA vaccines, Joe Rogan, RFKJ, Peter Hotez, Del Bigtree
• Spike protein made by Covid vaccines: toxic? (the spike protein the mRNA vaccines make cannot fuse to our cells. Normally, SARS-CoV-2 attaches to cells via the spike protein, then enters cells through a process called fusion….p. 107
• Stanford professor Jay Bhattacharya censored for signing the Great Barrington Declaration (“focused protection” of the people most at risk): Wall Street Journal OpEd: “Is the Coronavirus as Deadly as They Say?”, which argued there was little evidence to support shelter-in-place orders and quarantines In March 2021, Bhattacharya called the Covid-19 lockdowns the “biggest public health mistake we’ve ever made” and argued that “The harm to people is catastrophic”. Blacklisted by Twitter.

How civilization might change:

• Medical: Coronavirus is here to stay—herd immunity naturally and through vaccines
• Personal and Public Health: handshakes, hugs, and other human contact; masks, social distancing, hygiene
• Economics and Business
• Travel, conferences, meetings
• Marriage, dating, sex, and home life
• Entertainment, vacations, bars and restaurants
• Education and schools
• Politics and society (and a better understanding of freedom and why it is restricted).

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