Should Psychiatry Test for Lead More?
slatestarcodex.com
slatestarcodex.com
Also, from the original paper, via the linked LJ: https://siderea.dreamwidth.org/1388220.html
"I began taking blood samples from everybody who came to the clinic. At times it seemed like Transylvania Station. The state Department of Public Health's laboratory tested blood free for anyone under the age of 12 and provided plastic pipettes, finger puncture equipment, and even mailing envelopes at no cost. So, for a while, everyone in the clinic was declared to be under 12 years of age."
Both a nice public healthcare hack and a risky thing to admit in a journal article.
I'm not disagreeing, but is this something that everyone reasonable would agree on without any sort of support?
"Humans are part of a society that can harm them without effective means of redress."
Indeed. I am sad every morning I walk my child to creche and her head (in a pram) is at the same height as the exhaust pipes next to her. Yet, there's nothing to be done, apparently.
We are lucky then that there is a ton of support to this claim. Some people may argue with the word "fully" but if you replace it by "in big part" I don't think one can disagree with that without throwing a century of medical research out of the window.
This seems like the most important question in the universe, and one not nearly studied enough.
For instance, the idea that consciousness is a fundamental feature of the universe that is simply manifested in brains sounds very woo - but hasn't been falsified.
The question of when an animal goes from "unconscious, animate matter" to "thinking self-aware being" seems unclear as well (and is very relevant to medical ethics w.r.t embryo experimentation, etc.)
By comparison to another out-there idea, if we're willing to take the Many-Worlds Interpretation seriously (and enough well-informed scientists do) then I'm not sure it's a _completely_ settled matter that we have a good sense that humans are "fully physical, embodied minds".
However, lead is bad for brains. I think we know that much.
If anything, I think the opposite is true. We study it far more than we actually should in some sense, relative to the tools we have.
Bear with me, this is going to seem a strange diversion: One of the biggest problems in particle physics is that the smallest possible tools we can use to examine the universe, like quarks, electrons, photons, etc. are all radically larger than what seems to be the smallest size of the universe itself. Compared to the Planck length, all of those things are enormous. I liken it to trying to determine whether a planet has life on it, when your only tool is the ability to smash other planets into it, and examine the resulting blobs six months later, from a distance so great they're just dots in your telescope. It's really hard to determine how the universe works at such small scales when your smallest tools are orders of magnitude too big.
We have the opposite problem with consciousness research. We have tools that can measure a neuron somewhat. Honestly, we're not even all that great at that. (We can measure voltages fairly well, but our visibility into the deep biochemistry is very weak. Honestly even a single neuron is beyond us in some non-trivial ways.) We have some tools that can take extremely broad averages across massive chunks of neurons. Meanwhile, we have every reason to believe that whatever consciousness is, it lies a good ten+ orders of magnitude above that (we can see this from the fact that it seems to require a human brain to be human conscious, and even the animals that appear to possess a lot of it like dolphins and birds still have brains far, far beyond anything we can treat quantitatively). We're ants trying to determine the nature of the entire planet we're sitting on, and the tools we've got to investigate it are that we can move these grains from here to there.
Occasionally ants get up on their tiny little soap boxes and declare "Damn it, it just shouldn't be that hard to understand our planet with these tools!" Sometimes they declare "It's obviously just all topsoil!" or other equally silly things. It doesn't particularly help; it just shows the smallness of the ant in question.
Ultimately, I was simply unsure about the assertion that all parties would naturally agree (without support) to "once you accept that humans are fully physical, embodied minds in a sea of whatever chemicals can cross the blood-brain barrier".
This raises a number of questions, which other people have raised before (Does consciousness require a wet brain or just the information processing that goes on within (or something else)? is a computer that simulates the processes of a brain conscious? Is a computer that simulates 1% of the processes of a brain conscious? I am conscious now, and if my brain were dissolved in acid I would not be, but what structures and processes must be destroyed or interrupted to bring about that end to consciousness, and is it a discrete or continuous phenomenon? Are computers now conscious but only infinitesimally so? Is there a degree of consciousness in any structure that processes information? How would we even know? What is consciousness?)
I would try to elaborate, but really it's better described at the articles (and sources for same) here - https://en.wikipedia.org/wiki/Hard_problem_of_consciousness
I accept this comment is weak. However, it's not an assertion as to what the nature of consciousness is.
Somehow, the field of psychiatry doesn't seem to actually act on it.
Or they do, since they prescribe drugs which are designed to cross the blood-brain barrier, but even when they decide to prescribe drugs, they don't actually do any kind of blood tests to determine which drugs are likely to be effective.
They prescribe drugs based on simply you talking about your own symptoms, or observing your symptoms, and then just trying things until they find something that works or that you report works. They don't even seem to use any kind of formal testing of cognitive functionality to determine what effects the drugs are having; they just rely on purely subjective chats with the patient.
Was anyone down-voting this because they said to themselves "no, that's not how psychiatrists work at all"?
To me, believing in the physicality of the mind is the most important qualification a psychiatrist needs. That's not at all consistent with naive behaviorism though.
What humans are is far from settled.
We know lead causes aggression issues. We know poor communities have higher incidence of lead in their homes. How many criminals could be prevented, or reformed with lead treatment?
When a chemical that you were dosed with, and willingly did not and would never take, is determined that it made you do erratic and/or dangerous behavior, should the courts find you at fault?
It's different when you willingly take a drug (eg: meth) and you end up hurting or killing someone on it. You chose to take the drugs which lead to violence.
I know of nobody who willingly doses Pb.
https://www.motherjones.com/environment/2016/02/lead-exposur...
But incidentally, public health and governing bodies should definitely work to reduce lead in communities, regardless of the duty of psychiatrists.
And maybe some researcher should improve chelation? But there are other things to work on, and that might be simply intractable, so maybe not.
Betteridge's law of headlines is an adage that states: "Any headline that ends in a question mark can be answered by the word no." It is named after Ian Betteridge, a British technology journalist, although the principle is much older. As with similar "laws", it is intended to be humorous rather than the literal truth.
In this sense depression is a trashcan diagnosis. It's the default end for short decision tree.
Lead, mercury and some other heavy metal exposure is one of iatrogenic. They are not commonly tested as they are rare causes and tests are not specific. (As opposed for thyroid panel and folate check which are highly specific.)
1. Doctors don't appear to even think about lead poisoning unless you give them big fat clues like "My job is scraping lead paint off a bridge." What they don't think about, they don't ask about, just like everyone else.
2. The patients presenting with psychiatric symptoms that could be caused by lead poisoning are much more likely to be near the poverty line than a random sampling of people with stress and depression. Insurance companies are not likely to pay for lead blood tests unless they see a good reason to do so, and poor people are much less likely to have insurance in the first place.
> And when you’ve answered that, what about copper? Omega-3/omega-6 ratio? Vitamin D levels? Cortisol? Magnesium balance? The methylation cycle? Cortisol? Mitochondrial function? Inflammation? Covert viral infections? Covert autoimmune disorders? Paraneoplastic syndromes? Allergies? Light exposure? Circadian rhythm? Selenium? Lithium levels in your local water supply? Insulin resistance? Gut microbiome? PANDAS? FODMAPs? Structural brain abnormalities? And that’s not even getting into the psychosocial stuff!
I want my doctor to tell me what tests have what probability of being positive, and the cost, so I can make an informed decision.
Water sample is less useful as many people use enough bottled water and diffuse sources (out of home) to make test at any one location pointless. Leave it to epidemiology. Just ask if the person is taking lithium.
Insulin resistance is done with the standard metabolic and blood panel. These are best done as screening regularly. (But nobody wants to pay for that.) Since you will be checking thyroid why not extend.
Gut microbiome is speculative. We do not even have tests. Brain abnormalities? Either it is in history (major surgeries, seizures) or we don't even know what they are.
Vitamins and microelements are also speculative.
I'm not saying to replace doctors with ML, but it seems like a great opportunity to provide a list of potential illnesses with associated confidence %s for the doctor to then follow up as potential leads.
They should also look at environmental toxins. "Sick" houses, etc.
And physiological problems.
Anecdotally, I've seen a lot of mental health treatment that went after symptoms while ignoring root causes.
P.S. Over time, physically induced problems can lead to outright mental problems. PTSD, for example.
Also, IANAD.
This disagrees with literally everything I have ever heard or seen in the healthcare industry, whether that's from doctors (family), drug development (friends), or healthcare-focused finance (career).
Everyone I've ever known or worked with in healthcare has always been 100% about trying to make people better. Yes, even in finance, where I evaluated biotech stocks to make recommendations to buy or sell. The better the the drug worked, the more excited everyone was about it. It's so hard to make a drug, that some sort of evil "let's help them but not cure them" approach isn't even possible, not that anyone I know would even want that.
Yes, there was that Goldman Sachs report floating around a couple months ago about the difficulties to businesses when finding cures, but even that report's takeaway was about the need for finding companies that continue to innovate and come up with new therapies.
But I see them as outliers who have been largely penalized (jail time, stock collapse, etc), not as indicative of the industry. The reason there was such a backlash is because the vast majority of the industry are good people, and these sorts of behaviors are shocking.
I guess I meant literally everyone I've ever known personally has been like that. When you look at the news, yeah, you do see scandals. But I maintain that the idea that the industry would collude to not make cures is wrong. And similarly with doctors and their treatment of patients, which I've also seen argued.
Why would you need to collude to make a decision like that? Everyone in that industry makes the same sort of analysis, I imagine. "How many doses of this will we sell, how much will they cost to make, and how much will we be able to charge for them?"
If the equation indicates you'll lose money, exactly why wouldn't you just move on, assuming you're a for-profit business? You can always lobby for government or philanthropy or something to pay for the drug, but how many instances are there of a company just saying we're gonna lose at least a billion on this thing but it will be great and help a lot of people?
(it's an honest question - maybe you've got an example that will make everybody a little happier)
The main treatment if actual exposure is known and chronic is to... stop the exposure.