Promiscuous Facts

Is it spaghetti or barbed wire? Are you suffering from acid reflux?

Joseph Dumit, Ph.D. — Tue, 30 Dec 2008 20:54:06 +0000

This is the opening challenge in a Direct-To-Consumer (DTC) television commercial for Nexium, first aired in 2004. The aim of the commercial is to connect directly with the experience of heartburn sufferers so that they see themselves in the persons in the ads whom we are then told suffer from acid reflux disease, a disease that appears identical with heartburn.

it's different for people with acid reflux disease,
because you know the heartburn's gonna nail you.

The image of food turning into barbed wire is both a lived anticipation and a reality we are told.

And over time that acid could shred your esophagus.
Next time, Nexium, the new purple pill.
For many, one prescription Nexium daily means
24-hour heartburn relief;
more importantly, it also heals acid-reflux erosions.

Nexium, for those who lived through the early 2000s, was felicitously named as the next Prilosec, the original purple pill by AstraZeneca. Prilosec was going off patent so it would be available generically, and inexpensively by other companies. This meant that AstraZeneca's top product was to become its fiercest competition -- the corporate version of a genius baby turning into a rampaging monster. Nexium was a variant on the Prilosec molecule that could be sold by brand name and using the same brand color.

And healing is such a great feeling.

One of the aims of an ad like this is to reframe the experience of heartburn, heightening the fear of consequences, and associating it to acid-reflux disease so that you can see multiple reasons for getting on a daily treatment. The other aim is to capture all those Prilosec users and bring them over to Nexium.

Other serious stomach conditions may still exist.
Talk to your doctor.
The most common side-effects of Nexium are
headache, diarrhea and abdominal pain.Don't let acid reflux eat at you!
Next time, ask your doctor about Nexium.

The pre-emptory tone is typical of DTC ads, we the consumers are asked to ask our doctors about the drug. This does work, to pre-empt our doctors, and studies show that they do prescribe more then (1.5 to 5 times more!).

I've been collecting DTC pharmaceutical ads for about eight years now on and off -- television and magazine ads. They are part of the research i've been conducting for a book I'm working on, Drugs for Life, on the increasing amount of medications that are part of our lives in the U.S. DTC started in earnest in 1999, so in this blog I'll be featuring and discussing our decade of ads in order to open up a conversation in Psychology Today about these techniques of persuasion and education, and to think about their effect on our sense of health and illness, risk and treatments.

Why scientists should be allowed to take brain-enhancing drugs

Joseph Dumit, Ph.D. — Fri, 18 Apr 2008 08:45:55 +0000

20% of scientists responding to a survey in Nature claimed to have used cognitive-boosting drugs, including Ritalin and Provigil (Modafinil) to enable them to perform better, sleep more efficiently, or increase their concentration or memory. These are the same drugs given daily to millions of children in the US to improve school performance. In most cases it looks like the scientists' use was either illegal or quasi-legal at best. Yet scientists should not have to take these drugs clandestinely. Instead their use should be an open experiment in the advantages and disadvantages of these drugs.

The US has been slow to give these drugs a proper screening, partly because it seems to have an all-or-nothing, medically-good or socially-evil approach to drugs. Either a drug is good because it helps bring someone up to normal (like Ritalin or Adderall for attention-deficit disorder) or it is evil because the very fact that it enhances daily life threatens to become addictive. In some cases, the same drug, e.g. amphetamine, is both evil (as speed) and good (as Adderall), yet the latter are prescribed to and advertised as helping to "improve academic productivity". Unfortunately, we know tragically little about the effects of decades long daily dosages of these drugs on the children who are receiving them. These kids are part of a transformative but uncontrolled social experiment.

Pediatrician & fellow PsyToday blogger, Lawrence Diller has suggested in his fascinating book, The Last Normal Child, that we are in the midst of a major shift in cognitive enhancement around these drugs. He has encountered more and more parents and children approaching him to prescribe ritalin and other ADHD drugs explicitly to improve their test scores and they want to take them only while studying and taking the tests. Ritalin-like drugs are regularly being sold under the table at high schools and colleges across the country for the same reasons. A kind-of-truth seems to be emerging: ritalin-like drugs work, at least in some people, and they have few side-effects, at least in the short term. It is a new ethical dilemma for students that I have talked to: Is taking ritalin for the SATs or a final "cheating" or just leveling the field? (Some other week, I'll revisit a similar debate over the use of drugs in chess and bridge when these "sports" attempted to join the Olympics. For now see slashdot on "mind doping").

My modest proposal: Scientists are already doing the drugs, so let's go ahead and acknowledge this as a grand clinical trial and see what works. Scientists are the perfect subjects to collectively self-study these drugs. Their careers depend on long-term constant and consistent production of quality cognitive work. They have many incentives to experiment with drugs that might help them in this, and as scientists, they are well-trained in keeping track of data. Presumably, if side-effects occurred, they would be deemed not worth the risk of slightly better concentration or memory, and colleagues could be enrolled to note psychological changes. Aside from their natural competitiveness, scientists are good at sharing data, and the pooled collective information about these drugs would be invaluable to our society, nation, and the world.

Full disclosure: I haven't tried these cognitive enhancing drugs. I'd prefer to have more data.

How Neuroscience Can Help You Get Smarter

Joseph Dumit, Ph.D. — Tue, 08 Apr 2008 18:36:52 +0000

One of the holy grails of neuroscience research is a brain experiment that shows us how to live better and teaches us how to think better. From the Bell Curve to PET scans, we hope that studies of our neurology and psychology will guide us in designing our society too. Using the latest findings about the brain to raise your child is the latest prize in this search.

One of the most fascinating articles in neuroscience I've read recently was "The Secret to Raising Smart Kids", by Carol Dweck. This article discusses a set of research projects by Dweck and others on how different views of intelligence held by children affect their school performance. Those kids with a "fixed mindset" think that intelligence is innate and those kids with a "growth mindset" think that you intelligence is something you improve through working hard. What Dweck found is that kids with the fixed mindset gave up when they encountered really hard problems, apparently because they imagined they had hit their plateau; if they were really talented, then the problems would have been easy. Growth-oriented kids, however, treat difficult problems as opportunities to improve their intelligence. Not surprisingly, growth-oriented kids continue to improve in school.

Here's the kicker: you can change a child's mindset by having them read neuroscience, but choose it carefully! Dweck did an experiment where she gave one group of kids regular instruction and another group instruction plus an article about how neurons continue to grow throughout life and can be encouraged to grow through effort. Those kids who read this article tended to adopt the growth mindset, and do better than the other kids. This is neurosci-therapy, akin to bibliotherapy where psychologists have clients read books to improve their outlook. Our faith in neuroscience gives these findings the ability to change our minds (and maybe our brains).

Dweck has been researching and promoting this outlook for years. Dweck has a book, Mindset, and may or may not be finishing a software program (called Brainology) that takes this idea further, allowing kids to play with a simulated brain and watch neurons grow, further cementing a growth mindset.

Most of the discussion online about Dweck's work is concerned with the robustness of her findings and whether she is careful enough to distinguish intelligence from schoolwork. Many psychologists think that intelligence is one of the most innate and fixed parts of our minds, based upon many of their tests which show that it doesn't change much as you age. But perhaps their project is a bit circular in that the very act of giving someone a "test of their intelligence" encourages them to adopt a fixed mindset! Feel free to delve into Dweck's work and the intelligence debates if you want to form a proper opinion about them.

Which brings us the kicker to the kicker. We may wish that neuroscientists could run an experiment which would settle once and for all whether intelligence can be improved or not. But to do that we'd have to figure out what we really want intelligence to mean, especially for our kids. And that turns out to be precisely the problem. Both fixed and growth perspectives have good points, but they disagree on what is worth measuring and for what reasons. And each article you read reinforces one notion or the other. This is a scientific deadlock, and Dweck is suggesting a radical view: choose the neuroscience you read to fit the society you want to live in.

The real lesson for me here is that every bit of neuroscience you read potentially pushes you to adopt a particular mindset. Not just about intelligence and performance, but society, relationships, addiction, sexuality, aggression, etc. We need to pay close attention to this neuroscience-feedback. And this isn't all that different from choosing to watch CNN or FoxNews or IndyMedia -- where they each show facts, but which facts they show and how they are framed, helps to reinforce a particular view of the world.

I didn't expect it to be such a short circuit in neuroscience. But I do know what I'm going to teach my son about his brain.