The curious psychiatric state of Robert F Kennedy Jr

Robert F Kennedy Jr showed up in a scrum of pro-measles whackos recently. It  me wonder how he got so nuts.

There’s an extensive wikipedia page for him, starting with a time I remember:

He was 9 years old when his uncle, President John F. Kennedy, was assassinated during a political trip to Dallas, and 14 years old when his father was assassinated…

Despite childhood tragedy he was a successful academic and he’s done some decent work legally and for the environment. He seems to have started off the rails in the 80s:

In 1983, at age 29, Kennedy was arrested in a Rapid City, South Dakota airport for heroin possession after a search of his carry-on bag uncovered the drug, following a near overdose in flight.

By 1989 he’d started on vaccines — but not with autism … 

His son Conor suffers from anaphylaxis peanut allergies. Kennedy wrote the foreword to The Peanut Allergy Epidemic, in which he and the authors link increasing food allergies in children to certain vaccines that were approved beginning in 1989

By 2000s he’d jumped from immunizations causing his son’s anaphylactic disorder to immunization causing autism. He became "chairman of “World Mercury Project” (WMP), an advocacy group that focuses on the perceived issue of mercury, in industry and medicine, especially the ethylmercury compound thimerosal in vaccines”. It was a downward spiral from there.

Despite his vaccine delusions and troubled marriages he seems to have maintained a fairly active wealthy person life. He’s said to be a good whitewater kayaker.

Psychiatrically it’s curious. He combines fixed irrational beliefs (the definition of delusions) with relatively high functioning in other domains. He reminds me of L Ron Hubbard, founder of Scientology. 

We need to keep him far from the political world.

Arthritis update (personal note)

My familial arthritis showed up in one finger a few years ago, but in December of 2015 it became a bigger deal [1]. It looked like an early and fast moving symmetric osteoarthritis (OA), but then so did my mother’s before it morphed into something like RA (which ate lungs, joints, etc). OA is really a junk drawer diagnosis so I ended up calling it “familial arthritis”.

After a bit of personal research I ended up with an eclectic rheumatologist who suggested hydroxychloroquine (HCQ). This is a popular Lupus and RA med that started life as an antimalarial. It’s generally well tolerated with one minor side-effect — you can lose your vision. [2]

HCQ has been since tested experimentally in osteoarthritis — and it didn’t seem to do anything. [3] It did work for my mother’s RA though (where it is known to work), and her disease started out looking like mine …

So I’ve been on the HCQ for about two years.

Has it worked?

There’s no way to know, I can only present circumstantial evidence for one person. I have no idea what the disease would have done without treatment.

The joint deformity has not progressed much. To track joint changes I bought a ring sizing set and I use it to measure a selection of PIP (small, distal finger joint) and PIP (join in mid finger) sizes. There hasn’t been much change in joint deformity over the past two years; interestingly the worst measurements were the first set. That’s probably measurement error or some initial soft tissue swelling that’s diminished. 

I don’t have any finger joint redness or pain any more. Sometimes I forget to take the HCQ and I imagine I have some hand stiffness and joint aches — but that seems too fast to be a med effect. I think it’s my imagination. (Though we don’t have a good story for how HCQ works, so who knows.)

My knees aren’t worse; they are better than they were before I started the HCQ. I still do 230 lb CrossFit deep back squats. (I’m a wimp. Average strong guys do well over 350 lb.)

And, yes, I’m still doing the CrossFit. The rheumatologist approves. I thought I’d have to take up underwater hockey instead but I put that one off for now. 

It’s only been two years though. I’ll be more impressed if this is still true in two more years.

- fn -

[1] When I search the blog I see a few prior posts on knee and wrist exercise related aches that were, in retrospect, part of the arthritis.

[2] There are eye exams to try to spot this early, but we know in animal models that the chorea disease progresses for some time after the medication stops. We don’t know the real frequency of this complication — there’s at least a 1/20 chance I’ll get it.

[3] OA, like autism and schizophrenia, is an ill defined collection of things that’s damnably hard to study.

Phenazopyridine (pyridium, AZO) - yet another example of missing research

Phenazopyridine is an old drug, discovered in the 1930s. Chemically it’s classified as an “azo dye”, these chemicals are usually used to color clothing. Phenazopyridine will stain clothing orange. Another Azo dye was once used a seizure med. 

Two-thirds of a dose is excreted unchanged in the urine (and sweat and tears), the rest is metabolized to unknown substances. It has some sort of anesthetic action on the urinary tract, we don’t know how that works. “Trace amounts” may enter the cerebrospinal fluid. With prolonged use there is injury to both liver and kidney.

Historically phenazopyridine was prescribed for use in the very early stages of a bladder infection, before antibiotics did their job (since it’s older than antibiotics I suspect it was used heavily in the past). It’s over the counter now, to be used for one to two days.

Except some patients use phenazopyridine for longer than a few days. Interstitial cystitis is particularly nasty syndrome. Like many poorly understood disorders (osteoarthritis, autism, etc) it’s probably several different disorders that share common features. One pattern of interstitial cystitis causes severe sleep disruption; patients wake up to void every 10 to 60 minutes with very small volume urination. On bladder biopsy the protective lining of the bladder has been disrupted. 

Sleep deprivation is a well understood and effective form of torture, so it’s not surprising that IC patients get a bit desperate (you would too). Phenazopyridine may allow sleep when all else fails. So it’s used more than it should be, especially since it’s available without a prescription.

Since phenazopyridine has an anesthetic effect, we presume it interacts with the peripheral nervous system.  So what happens to the brain with large lifetime doses of phenazopyridine? I can’t see that this has ever been investigated, even in animal models.  Tartrazine, another azo dye used in food coloring, was associated with oxidative brain damage in one rat study.

Medicine is full of things like phenazopyridine. Medications that were adopted long ago, and have received minimal research review since. We could employ an army of scientists studying these drugs. But then we’d have to figure out how to pay for them…

Rheumatic syndromes remind me of pre-quark particle physics

This mornings board review included looking at the evolution of “inflammatory osteoarthritis” from 1970 to 2015. What was once described as an acute “inflammatory” (suddenly red and painful) form of osteoarthritis was later reformulated as “erosive osteoarthritis”, “psoriatic arthritis” and some vaguely described disorder that gradually morphs from osteoarthritis to rheumatoid arthritis — not to be confused with seronegative arthritis.

Bah. Humbug. It’s as bad as our mushy and obsolete classifications of neuropsychiatric disorders.

Unlike the neuropsychiatric disorders (autism, schizophrenia, etc) though, the rheumatic syndromes remind me of pre-quark partial physics. Lots and lots of fermions (neutrons, protons, etc etc) with mysterious distinctions; understanding the composing quarks brought a sort of sense to the world. Perhaps one day we’ll learn that seemingly distinct rheumatic syndromes are combinations of underlying simpler pathologies that in different contexts (microbiome, immune system etc) seem to make up different disorders...

Ok, not a great analogy. Just a thought. Classifications are powerful though, and that means they can be misleading — and harmful.

Update: On a quick literature scan it looks like psoriatic arthritis treatments (TNF inhibitors) haven’t worked that well for erosive osteoarthritis, which does suggest that inflammatory arthritis split is clinically meaningful...

Gene-environment interactions and the modesty of 2014 personalized medicine: Obesity, Reefer madness

Between 2007 and 2008 my work life got unusually exciting. Most of the time I work on software development in well understood aspects of medicine, but back then we were, once again, super-excited about genomics and “personalized medicine”. I made a couple of funded trips to meet with Stanford research teams maintaining genomic ontologies. I had a blast using exciting tools for navigating poorly maintained and unreliable massive web UI databases of gene-phenotype relationships.

At last we were going to realize the NIH predictions of 1994 — 10 years late, but better late then never.

Then the hammer fell. My 2008 post on schizophrenia [1] doesn’t talk about the work I was doing then, but it explains why we gave up. The disorders we cared about, schizophrenia, diabetes, lipid disorders, depression and so on, didn’t have a handful of generic recipes. Turns out there are hundreds, or thousands, or “recipes” for schizophrenia made up of environment (especially intra-uterine) and lots and lots of interacting genes. Even worse — lots of seemingly “normal” minds run on brains built with buggy genomics. Turned out “family” (genetic relative) history was a much more useful guide to predicting disease and treatment than genomic analysis — and that didn’t justify big investments.

Everything stopped, and then health care IT turned from the excitement of personalized medicine to the painful tedium of “meaningful use” and the more scientifically tractable domain of population health.

I still follow the field of course, and there has been slow but interesting progress …

Gene Linked to Obesity Hasn’t Always Been a Problem, Study Finds

… In 2007, researchers discovered that people with a common variant of FTO tend to be heavier than those without it. … Two copies of the gene bring 7 extra pounds — and increase a person’s risk of becoming obese by 50 percent.

… A new study shows that FTO became a risk only in people born after World War II.

… A variant of a gene called AKT1, for example, can raise the risk of psychosis — but only if the carrier smokes a lot of marijuana….

Small progress admittedly, but scientifically interesting. Exercise is good for most things — but we know that for most people moderate exercise [2] doesn’t add much to dietary control of weight. For people with the FTO gene though, exercise might indeed control weight. People with AKT1 are susceptible to persistent Reefer Madness — they really shouldn’t use marijuana [3]. In a related vein, there’s some evidence that the dementia protection of exercise is much stronger in the 14% of Americans with the APOE4 gene variant [4] than in APOE4 negative populations.

Progress — but darned slow. At this rate it will take decades to build what we expected before the year 2000.

- fn -

[1] Quite a good post, if I say so myself. I’d forgotten autism was once considered a variant of pediatric schizophrenia. We’re again merging both of those diagnostic categories.

[2] Extreme exercise is another matter, but one that’s rather hard to study. Though there is this recent NYT article on super-short higher intensity workouts that are to CrossFit as a snack is to a smorgasbord.

[3] Incidentally, marijuana legalization will be a boon to addiction medicine. Investors now include rehab clinics in the category of cannabis business opportunities.

[4] Why is a nasty gene so prevalent? The Wikipedia article mentions APOE4 helps with Vitamin D update — a particular problem in northern europeans. We presume it does have some survival advantage in some settings.

The Einstellung effect: simple truths we cannot see.

Epistemic closure (in political thought). Confirmation bias [6]. Availability heuristic (Kahneman System 1). Premature cognitive commitment. Even, perhaps [5], delusion. These are all forms of cognitive bias [1].

They drive me nuts [7]. Not because I have a problem with the concept of cognitive bias, but because I always know I’m missing something obvious.

It’s just out there. A better solution to a problem, something I’m doing wrong and can’t see it, a problem I don’t even know I have. Something in my blind spot that’s closing fast. An opportunity, a threat an ….. argggggggghhh!

Ok, I’m back. Do you know how hard it is to find a paper bag in 2014?

Cognitive bias is why, more than most people I know, I’m always seeking criticism. That includes anybody, often not a friend [2], who is happy to tell me why I’m an idiot. Every so often see what I missed, and the joy of that correction more than compensates for minor tweaks of my thick skin.

So I’m happy to point to a new entry in the ‘what am I missing’ category — the Einstellung Effect. This is best described in a SciAm article that’s available from the 1st author’s web site (pdf, see also 2008 academic pub). Bilalić and McLeod’s work adds neurophysiology to one version of premature cognitive closure; a tantalizing connection given how much we seem to think with our bodies [3].

Their recent research has explored cognitive error in expert chess players whose very expertise leads them to errors more naive players would avoid. They seem to have adopted their visual cortex to solve certain thinking problems [4], and thus to be afflicted by the visual processing adaptations that evolved for the physical world (emphases mine)…

Why Good Thoughts Block Better Ones, Bilalić and McLeod, SciAm March 2014

…  Building on Luchins’s early work, psychologists replicated the Einstellung effect in many different laboratory studies with both novices and experts exercising a range of mental abilities, but exactly how and why it happened was never clear. Recently, by recording the eye movements of highly skilled chess players, we have solved the mystery. It turns out that people under the influence of this cognitive shortcut are literally blind to certain details in their environment that could provide them with a more effective solution. New research also suggests that many different cognitive biases discovered by psychologists over the years—those in the courtroom and the hospital, for instance— are in fact variations of the Einstellung effect.

… the mere possibility of the smothered mate move was stubbornly masking alternative solutions… infrared camera revealed that even when the players said they were looking for a faster solution—and indeed believed they were doing so—they did not actually shift their gaze away from the squares they had already identified as part of the smothered mate move.

I think of Delusion as an extreme manifestation of the Einstellung effect. Given our emerging understanding of autism and schizophrenia as similar manifestations of a neural network injury, I wonder if we’ll find connections between delusional beliefs and visual networks…

- fn -

[1] I love Wikipedia’s “List” articles; I suspect Google’s Knowledge Graph loves ‘em too. See also Wikipedia’s recursive Lists of Lists of Lists. 

[2] My favorite corrector is an app.net correspondent who I don’t know enough to claim as a friend, but who is a wonderfully cordial correspondent. That’s the best of all.

[3] An extraordinarily brilliant college roommate, who was later disabled by a schizophrenia like disorder, first suggested this to me in 1981. So the modern literature did not surprise me. Incidentally, he subsequently acquired a PhD and joined a NASA research facility. He found a way around his disorder.

[4] No, I cannot resist thinking of using GPUs to solve parallelism problems faster than CPUs.

[5] I personally think of delusion as an extreme form of cognitive closure; and I think it’s far more common than the psychotic disorders. An area ripe for research.

[6] Via the Einstellung article, a fantastic quote from one Francis Bacon’s 1620 Novum Organum:

“The human understanding when it has once adopted an opinion . . . draws all things else to support and agree with it. And though there be a greater number and weight of instances to be found on the other side, yet these it either neglects or despises, or else by some distinction sets aside and rejects.... Men ... mark the events where they are fulfilled, but where they fail, though this happen much oftener, neglect and pass them by. But with far more subtlety does this mischief insinuate itself into philosophy and the sciences, in which the first conclusion colours and brings into conformity with itself all that comes after.”

Bacon always amazes. I’d declare him “father of cognitive science” for this quote alone. “Epistemic closure” is not new …

[7] This isn’t a new obsession. As a first year med student @1982 I devoured a 1970s text on clinical diagnosis that listed common cognitive errors, beginning with confirmation bias. This book has been rewritten many times since, alas the title and author are lost to my memory.

How could we create an evidence-based classification of disorders of the mind?

The software/hardware metaphor is usually considered as misleading as every other model of mind we've come up with.

I don't agree. My guess is it's an unusually good model -- one rooted in the physics of computation. Anything sufficiently complex can compute, which is, souls aside, the same as running a mind...

... in an alternative abstract universe closely related to the one described by the Navier-Stokes equations, it is possible for a body of fluid to form a sort of computer, which can build a self-replicating fluid robot ...

... A central insight of computer science is that, whenever a physical phenomenon is complex enough, it should be possible to use it to build a universal computer ...

Our minds have emerged to run on our desperately hacked and half-broken brains - in hundreds if not tens of thousands of years. In evolutionary terms that's insanely fast (and did it really never happen before?). Minds route around damage and adapt, as much as they can, to both adolescent transformation and adult senescence; they run and run until they slowly fade like a degraded hologram. It's no wonder minds are so diverse.

When that diversity intersects with the peculiar demands of our technocentric world we get "Traits that Reduce Relative Economic Productivity" -- and we get poverty and suffering. We get disease, and so we need names.

We need names because our minds can't reason with pure patterns -- we're not that smart. With names we can do studies, make predictions, select and test treatments.

Names are treacherous though. Once our minds create a category, it frames  our thinking. We choose a path, and it becomes the only path. It might be a good path for a time, but eventually we have to start over. Over the past ten years researchers and psychiatrists have realized that our old "DSM" categories are obsolete.

So how could we start over? One approach, informed by the history of early 20th century medicine, is to classify disorders by underlying physiology. That's where terms like 'connectopathy' come from, and why we try to define mind disorders by gene patterns.

We need to do that, but lately I've wondered if it's the wrong direction. If minds really are somewhat independent of the substrate brain, then we may find that disorders of the substrate only loosely predict the outcomes of the mind. Very similar physiological disorders, for example, might produce disabling delusions in one mind and mere idiosyncrasies in another.

So maybe we need another way to attach labels to patterns of mind. One way to do this would be to create a catalogue of testable traits for things like belief-persistence, anxiety-response, digit-span, trauma-persistence, novelty-seeking, obsessiveness, pattern-formation and the like. My guess is that we could identify 25-50 that would span traits that are currently loosely associated with both normal variation and TRREPs like low IQ, schizophrenia, and autism. Run those tests a range of humanity, then do cluster analysis and name the clusters.

Then start from there.

 See also:

• Be the Best You can Be: Rebooting pyschiatry: time for a new set of disorders (2013)
• Gordon's Notes: The evolutionary history of minds (2008)
• Be the Best You can Be: Redefining mental retardation and autism - the revolution ahead (2006)
• Be the Best You can Be: Very annoying: the diagnostic criteria for Asperger's are not all that useful (2005) - this was part of the body of work that led to retiring the diagnosis of "Asperger's Syndrome"

Human domestication, the evolution of beauty, and your wisdom tooth extraction

My 16yo is having his wisdom teeth removed tomorrow. Blame it on human domestication.

The Economist explains the process. Domestication, whether it occurs in humans, foxes, or wolves, involves changes to "estradiol and neurotransmitters such as serotonin" (for example). These changes make humans less violent and better care givers and partners -- major survival advantages for a social animal. They also have unexpected side-effects, like shortened muzzles and flattened faces for wolves, foxes, (cows?) and humans.

Since domesticated humans out-compete undomesticated humans, the physiologic markers of domestication become selected for. They being to appear beautiful. Sex selection reinforces the domestication process.

It seems to be ongoing ...

 The evolution of beauty: Face the facts | The Economist:

... People also seem to be more beautiful now than they were in the past—precisely as would be expected if beauty is still evolving...

Which may be why we are becoming less violent.

Of course a shortened muzzle and smaller mandible have side-effects. Teeth in rapidly domesticating animals don't have room to move. Which is good news for orthodontists, and bad news for wisdom teeth.

See also:

• A link between autism and the domestication of humans and dog: "MET gene selection appears to be related to human and canine domestication, including sociability. Variants of it are associated with autism-like behavior."
• The canid domestication of homo sapiens brutalis

For American adults are poverty and disability the same thing?

[Preface 9/6/13: I am enjoying the app.net discussion thread on this with @duerig and @clarkgoble. When reading this, try substituting TRREP - Trait that Reduces Relative Economic Productivity for the word "disability". Also, please note disability is not inability. In my experience parenting/coaching two children with disabilities I think of managing disability like building a railroad across mountainous terrain. Sometimes reinforce, somethings divert, always forward.]

-- 

Anosmia is not a disability.

Well, technically, it is. Humans are supposed to come with a sense of smell. For most of human existence anosmia was a significant survival problem. At the least, it helps to known when food has gone bad. So Anosmia is a biological disability.

In today's America though, there's not much obvious economic downside to anosmia. Diminished appetite is more of a feature than a defect. There are many jobs where a keen sense of smell is a disadvantage -- including, I can assure you, medical practice. Anosmia is a biological disability, but it's not an economic disability. Not here and now anyway -- once it would have been.

Disability is contextual, it's the combination of variation, environment and measured outcome that defines disability.

What about if I lose my right leg? Am I disabled then? Well, if I delivered mail I'd have a problem -- but in my job an insurance company would snort milk out its proverbial nose if I tried to claim longterm disability.

I think you can see where I'm going with this. Stephen Hawking is an extreme example -- you can have a lot of physical disability and not be economically disabled.

So how can I become disabled? 

Probably not through my "risky" CrossFit hobby,  but my benign bicycle commute is another matter. Until that glorious day when humans are no longer allowed to drive cars, I'm at risk of a catastrophic head injury. An injury that may impact my cognitive processing, my disposition to use cognition ("rationality"), my judgment and temperament -- and leave me as completely disabled for high income work as if I were 85 [1]. At that point, barring insurance, I'm economically disabled and impoverished.

Clearly, acquired cognitive injury can be disabling. So what of congenital cognitive disorders like low functioning autism or severe impulse disorders? Impulsivity, inability to plan, very low IQ ... Clearly disabling. Without income support from family or government, extreme poverty is likely.

Ahh, but what of those born with average IQ, average rationality, average judgment, average temperament? Employment is likely -- but earnings will be limited. To be average in the economy of 2013 is to sit on the borderline of poverty -- and of disability. The difference will be decided by other factors, factors like race, location, and family wealth. An average person who looks and acts "white" and is born to a middle class family in Minnesota may make it into the dwindling middle class (for a time), an average person who looks and acts "black" and is born to a poor family in Mississippi is going to be impoverished.

Which brings me to my question - for American adults are poverty and disability the same thing? Not entirely -- race, residence, and family income have an impact, particularly within some ill-defined "middle range" of "native disability". Not entirely -- but they are clearly related. 

How related? Consider this OECD graph of poverty rates across nations with very different cultures, attitudes and histories:

 

Across Finland, Denmark, Sweden and the US we see a "natural" or baseline (pre-transfer) adult poverty rate of 24-32%, with Swede and the US both at 28%. Not coincidentally, 30% is what I suspect our baseline rate of mass disability is today.

We can and should deal with poverty-enhancing factors like racism, unfunded schools and the like. That will make a difference for many -- and, if all goes well, we might get the US baseline poverty rate to be more like Denmark's. We'll go from 28% to 24%. Ok, maybe, in a perfect world, we get our baseline rate from 28% to 20%. Maybe.

To really deal with poverty though, we need to understand what real disability is. Economic disability in 2013 isn't a missing leg, it's poor judgment, weak rationality, low IQ, disposition to substance abuse. To conquer poverty, we will need to conquer disability - either with Danish style income transfers or with something better.

I think we can do better.

- fn -

[1] Social security is simply a form of insurance for age-related disability with an arbitrary (but pragmatic) substitution of chronology for disability measurement.

See also

• The Post-AI era is also the era of mass disability 12/2012
• Mass disability and the middle class 9/11
• Unemployment and the new American economy - with some fixes 1/2011. There are things we can do. Ok, maybe not the US, but maybe China.
• ADHD, CDD, and Related Conditions 2002. I just came across this. This was one of the last old-school web pages I did before I started writing blog posts. It anticipates a lot of what I've written since.
• Disability and poverty - Wikipedia - yes, this isn't original :-).
• Various Supports for Low-Income Families Reduce Poverty and Have Long-Term Positive Effects On Families and Children — Center on Budget and Policy Priorities 7/2013 

 

Tax bullets to pay for better mental health care

We tax cigarettes to offset some of the social costs of tobacco use. This is type of Pigovian Tax.

We could tax bullets to offset the direct costs of America's weapons glut, but it's hard to make up for murder. 

Better to prevent the murders.

So tax bullets to pay for better mental health care.

All psychiatrists, social workers and primary care physicians know what a train wreck American psychiatry mental health care is. Rich state, poor state, it's a train wreck everywhere. Families don't know what to do for impaired loved ones - because, often, there's nothing available.

There are many things that could be done. We lack will, and we lack money.

The money problem is easy to solve.

Tax the bullets.

See also:

• Be the Best You can Be: Violence and the natural history of Autism - so what do we know? 3/2009: We known almost nothing. Looking at this case history, I suspect "Andrew" had a childhood history of Asperger's followed by late adolescent onset of schizophrenia; atypical because of his preexisting connectopathy. In truth, however, our 21st century psychiatric classifications are the equivalent of 19th century medical classification.
• Gordon's Notes: Aurora - the rational response is better schizophrenia management 7/2012: Ebert and Collins links are, of course, just as relevant today. Same with my 7/12 posts.
• NRA Sets 1,000 Killed In School Shooting As Amount It Would Take For Them To Reconsider Much Of Anything | The Onion - America's Finest News Source 5/2012. Yep.
• When My Crazy Father Actually Lost His Mind - NYTimes.com 6/2012. A typical tour of American mental health. Nothing unusual about it.
• App.net thread on this topic, with appreciation to Clark G.

Baumol's disease and the demographic transition: Productivity asymmetry means children are increasingly expensive

There have been a flurry of articles lately on the cost of raising an American child, including a NYT blog post. This old news to students of demography, I remember reading about this back in the 80s. In agricultural societies children are a net economic gain, in industrial societies the gain is less, and in post-industrial societies they are a net negative for parents.

I should add, by the way, that traditional evaluations of the cost of children underestimate the cost. They assume a healthy neurotypical child. A special needs child is vastly more expensive, and approximately 5-10% of post-industrial children are relatively disabled by 'autism' (whatever that is), low average IQ, schizophrenia, affective disorders and the like.

So this is old material, but I don't recall a theoretical framework explaining why child raising takes a larger and larger proportion of income as a society becomes wealthier. The answer, of course, is Baumol's cost disease.

Child raising is one of those tasks with minimal productivity increases. Indeed, as output requirements rise to meet the narrowing demands of a post-labor economy, productivity may be negative over time. Certainly much of the cost is related to education and health care, two domains with notoriously slow productivity growth. Baumol's work teaches us that as overall productivity and wealth increase, relatively low productivity labor will consume increasing fractions of total income.

This seems to be an obvious insight, but a cursory Google search didn't find any articles or posts connecting demographic transitions with Baumol's Cost Disease. Until now.

Is labor lumpish in whitewater times?

Krugman is famously dismissive about claims of structural aspects to underemployment (though years ago he wasn't as sure). DeLong, I think, is less sure.

Krugman points to the uniformity of underemployment. If there were structural causes, wouldn't we see areas of relative strength? It seems a bit much to claim that multiple broad-coverage structural shocks would produce such a homogeneous picture.

Fortunately, I fly under the radar (esp. under Paul's), so I am free to wonder about labor in the post-AI era complicated by the the rise of China and India and the enabling effect of IT on financial fraud. Stories like this catch my attention ...

Fix Law Schools - Atlantic Vincent Rougeau  Mobile

... the jobs and high pay that used to greet new attorneys at large firms are gone, wiped away by innovations such as software that takes seconds to do the document discovery that once occupied junior attorneys for scores of (billable) hours while they learned their profession..

Enhanced search and discovery is only one small piece of the post-AI world, but there's a case to be made that it wiped out large portions of a profession. Brynjolfsson and McAfee expand that case in Race Against the Machine [1], though almost all of their fixes [1] increase economic output rather than addressing the core issue of mass disability. The exception, perhaps deliberately numbered 13 of 19, is easy to miss ...

13. Make it comparatively more attractive to hire a person than to buy more technology through incentives, rather than regulation. This can be done by, among other things, decreasing employer payroll taxes and providing subsidies or tax breaks for employing people who have been out of work for a long time. Taxes on congestion and pollution can more than make up for the reduced labor taxes.

Of course by "pollution ... tax" they mean "Carbon Tax" [1]. The fix here is the same fix that has been applied to provide employment for persons with cognitive disabilities such as low IQ and/or autism. In the modern world disability is a relative term that applies to a larger population.

If our whitewater times continue, we will either go there or go nowhere.

[1] They're popular at the "Singularity University" and their fixes are published in "World Future Society". Outcasts they are. Their fan base probably explains why the can't use the "Carbon" word, WFS/SU people have a weird problem with letter C. 

See also:

• Slavery, technology, and the future of the weak 2/2012. What do you do with a labor surplus?
• DeLong, Mankiw and the Problem of the Weak 10/2006. When Mankiw was almost readable.
• Mass disability and the middle class 9/2011

Who were the crazy genius scientists?

Which famous scientists and/or mathematicians were also "crazy" (e.g. - far outside behavioral "norms") during their adult productive lives (excluding those, like Pauling, who became eccentric at an age where dementia is common)?

My current list is ...

1. Newton: Perhaps autism spectrum, but he was so brilliant, and so bizarre, that he's untypable. He's outside of the human range. He may have hard mercury poisoning late in life, or perhaps a late-onset schizophrenia-like psychosis.
2. John Nash: paranoid schizophrenic, though somewhat late-onset. His recovery is remarkable, as was Newton's -- but he was psychotic for a longer time period.
3. Kurt Godel: schizotypal, later in life delusional beliefs with paranoid features.
4. Nikolai Tesla: OCD, Autism spectrum?
5. Henry Cavendish: social phobia, anxiety disorder.
6. Boltzmann: bipolar disorder (classic)

Our classifications of mental illness are pretty weak even in normal IQ adults; this group is probably unclassifiable. Who else should be on the list?

Update: Philip K Dick wasn't quite in this group, but his late-onset pyschosis experience resembles Tesla's. Matt suggested Godel and Boltzmann. The pattern of schizotypal personality disorder behaviors with late-onset deterioration or psychosis might apply to Tesla, Newton and Godel. Botlzmann and Nash had more classic neurospychiatric disorders.

These are most extraordinary minds. It would not be surprising if they had extraordinary dysfunctions.

Update 6/7/2012: An academic opinion.

Thinking about autism

There is truth here  ...

The Autism Wars - NYTimes.com

...The term has become so diffuse in the public mind that people start to see it as a fad,” said Emily Willingham, who is a co-editor of “The Thinking Person’s Guide to Autism.” “If we could identify individual needs based on specific gaps, instead of considering autism itself as a disorder, that would be preferable. We all have our gaps that need work.”...

Practically speaking, however, it will take years to separate services from labels -- even when the label are not terribly useful. The legal and regulatory framework is rigid by design.

Mass disability and the middle class

My paper magazine has another article on the Argentinification of America - Can the Middle Class Be Saved? - The Atlantic.

I'll skim it sometime, but I doubt there's much new there. We know the story.  The bourgeois heart of America is fading. In its place are the poor, the near poor, the rich and the near rich.

I have thought of this, for years, as the rise of mass disability. In the post-AI world the landscape of American employment is monotonous. There's work for people like me, not so much for some I love. Once they would have worked a simple job, but there's not much call for that these days. Simple jobs have been automated; there's only room for a small number of Walmart greeters. Moderately complex jobs have been outsourced.

Within the ecosystem of modern capitalism a significant percentage of Americans are maladapted. I'd guess about 25%; now 35% thanks to the lesser depression.

There are two ways to manage this - excluding the Swiftian solution.

One is to apply the subsidized employment strategies developed for adults with autism and low IQ. Doing this on a large scale would require substantial tax increases, particularly on the wealthy.

Another approach is to bias the economy to a more diverse landscape with a greater variety of employment opportunities -- including manufacturing. This is, depending on whether you are an optimist or realist, the approach of either modern Germany or Nehru's India. This bias compromises "comparative advantage", so we can expect this economy, all else being equal, to have a lower than maximal output. Since in our world the benefits of total productivity flow disproportionately to the wealthy (winner take all), this is equivalent to a progressive tax on an entire society.

So, either way,  the solution is a form of taxation. Either direct taxation and redistribution, or a decrease in overall growth.

I suspect that we will eventually do both.

See also:

• Unemployment and the new American economy - with some fixes (1/11)
• Post-industrial employment: adjusting to a new world (5/10)

Care of special needs adults in post-employment America

The Dow is doing very well, though some expect that to change shortly. For most Americans, however, the Great Recession grinds on. The percent of employed adult Americans (employment-population ratio) is now back to where it was in 1976, when most women weren't in the workforce. The annual incomes of the bottom 90% of US families has been flat since 1973.

Against this, we see about 50 million Americans with a disability and 24 million with a severe disability. Looking forward, barring US adoption of Canada's brilliant solution, intractable American demographics means fewer workers supporting more disabled persons -- even as those workers are faced with decreasing employment options and stagnant or falling wages.

So it's not surprising that societal care for the weak is being withdrawn ...

When Children With Autism Become Adults - Goehner 4/13/11 - NYTimes

... As the explosion of children who were found to have autism in the 1990s begins to transition from the school to the adult system, experts caution about the coming wave.

“We estimate there are going to be half a million children with autism in the next 10 years who will become adults,” said Peter Bell, executive vice president for programs and services of the advocacy group Autism Speaks.

Services for adults with autism exist, but unlike school services, they are not mandated, and there are fewer of them. Combined with shrinking government budgets, the challenges are daunting.

“We are facing a crisis of money and work force,” said Nancy Thaler, executive director of the National Association of State Directors of Developmental Disabilities Services. “The cohort of people who will need services — including aging baby boomers — is growing much faster than the cohort of working-age adults that provide care.”

To help parents navigate this difficult journey, in January Autism Speaks introduced a free Transition Tool Kit for parents and their adolescent children with autism. The kit includes information about such critical issues as community life, housing, employment and developing self-advocacy skills...

... Many young adults with autism have transitioned into large residential systems, whether group homes or institutions, offering round-the-clock services. But waiting lists can be long. And increasingly, in an effort to stem costs, states are moving away from the group home model into family-based care, a trend that started about 10 years ago.

... Nationwide, 59 percent of people who receive autism services are living with their families, according to Mr. Lakin.

Living with one’s family may not always be best for a person with autism. Nor is it what many families, who assume their grown child will move into a group home, for example, envision for their future. But options are limited, and given the high demand for out-of-home residential services, Mr. Lakin said, “families really need to think about a longer and more central involvement in their adult child’s life than they have in the past.”

The good news is that many states are providing more support for people with autism who live with their families. They are also giving families greater flexibility and control over budgets with so-called consumer-controlled services, which reimburse families that hire friends or relatives, rather than outside caregivers, for regular care.

Connecticut and Arizona, for example, pay for care provided by family members, a growing trend. Other states, like Pennsylvania, have programs in which contracts are issued for people with autism to live with other families. And Vermont and New Hampshire pioneered a model of providing funding directly to families.

Some families have pooled their own money and entered into cooperatives with other families, a challenge that can take years...

.. Among the most powerful advocates are siblings of those with developmental disabilities. “Sibs have always played a really important role; we just haven’t identified them as sibs,” Mr. Lakin said. “We’ve identified them as agency leaders and social workers occupationally. But the real impulse of their work is that they were a sibling.”

Don Meyer, the founder and director of the Sibling Support Project and the creator of Sibshops, a network of programs for young siblings of children with special needs, said: “Parents need to share their plans for their special-needs child with their typically developing kids. After Mom and Dad are no longer there, it is likely it will be the brothers and sisters who will ensure their sibling leads a dignified life, living and working in the community.”...

It doesn't require a lot of imagination to predict how this will turn out. Among other things, we should expect a return to orphanages (esp. for special needs children) and the return of longterm institutions for the destitute disabled.

This might be a good time to consider the Canadian Solution for immigration. Maybe we should even take a look at where America's trillions are going. Just saying.

Wetware routers and intermittent consciousness

Today's Carl Zimmer article gives new insight into the nature of consciousness. Even in neurotypical brains decision tasks create a psychic bottleneck, which is also a sort of perceptual blindspot. Our consciousness goes "offline", very briefly, when we make choices (emphases mine) ...

The Brain: The "Router" in Your Head—a Bottleneck of Processing | Carl Zimmer | DISCOVER Magazine:

... The brain is, in the words of neuroscientist Floyd Bloom, “the most complex [jg: known] structure that exists in the universe.” Its trillions of connections let it carry out all sorts of sophisticated computations in very little time. You can scan a crowded lobby and pick out a familiar face in a fraction of a second, a task that pushes even today’s best computers to their limit. Yet multiplying 357 by 289, a task that demands a puny amount of processing, leaves most of us struggling.

... The fact that we struggle with certain simple tasks speaks volumes about how we are wired. It turns out the evolution of our complex brain has come at a price: Sometimes we end up with a mental traffic jam in there...

... If we don’t have enough time between two tasks, we slow down on the second one—a lag known as the “psychological refractory period.”...

... Psychologists have long been puzzled by the psychological refractory period because it doesn’t fit with other things we know about how the brain works. We are very good at doing many things at once... Yet there are simple jobs—like math problems—that our brains can handle only one at a time. It is as if signals were flying down a 20-lane superhighway, and then the road narrowed to a single lane...

Each time we perform a task we perform it in three steps. Step 1: Take in information from the senses. Step 2: Figure out what to do in response. Step 3: Carry out that plan by moving muscles...

...  scientists varied one of the three steps of the thought process to see if they could change the length of the psychological refractory period. Only when they tinkered with step 2—figuring out what response to make—could they produce a change...

... when we have any two simple decisions to make, we must wait for the first task to move through a bottleneck before taking on the second. That is what makes mental multiplication so hard. Instead of carrying out many steps simultaneously, we have to do them one at a time.

... In 2008 the scientists reported that during the psychological refractory period, a network of brain regions are consistently active, some near the front of the brain and some near the back...

... these regions appear to be part of a network that is important for our awareness of our own experiences. This helps explain why we are oblivious to our mental traffic jams.

.. The brain began measuring how long a task took only after the previous task moved out of the bottleneck. Whenever a perception of a sound or a letter got stuck in the mental traffic jam, the subjects were not aware of it...

... The neurons that take in sensory information send it to a neural network that he and his colleagues call the "router." Like the router in a computer network, the brain’s version can be reconfigured to send signals to different locations. Depending on the task at hand, it can direct signals to the parts of the brain that produce speech, for instance, or to the parts that can make a foot push down on a brake pedal. Each time the router switches to a new configuration, however, it experiences a slight delay...

The "router" theory is very much an unproven model. If something like it holds up, however, we will find variations in router performance. There may be advantages and costs to different router algorithms. There will be articles on router performance in autism and schizophrenia and in disorders of consciousness (coma, etc). Perhaps we will discover ways  to train and retrain our internal routers for different settings.

It wasn't the primary emphasis of the article, but I'm struck again by the contingent and intermittent nature of our consciousness. Continuity of consciousness is very much an illusion. We are offline, briefly, thousands of times a day.

How quickly can humans evolve?

Even fifteen years ago cognitive science courses taught that the human mind was frozen in the Paleolithic Pleistocene. Humans didn’t evolve any more

Now we wonder how fast can humans evolve ...

Scientists Cite Fastest Case of Human Evolution – Nicholas Wade - NYTimes.com

…. Comparing the genomes of Tibetans and Han Chinese, the majority ethnic group in China, the biologists found that at least 30 genes had undergone evolutionary change in the Tibetans as they adapted to life on the high plateau. Tibetans and Han Chinese split apart as recently as 3,000 years ago, say the biologists, a group at the Beijing Genomics Institute led by Xin Yi and Jian Wang. The report appears in Friday’s issue of Science.

If confirmed, this would be the most recent known example of human evolutionary change. Until now, the most recent such change was the spread of lactose tolerance — the ability to digest milk in adulthood — among northern Europeans about 7,500 years ago. But archaeologists say that the Tibetan plateau was inhabited much earlier than 3,000 years ago and that the geneticists’ date is incorrect.

When lowlanders try to live at high altitudes, their blood thickens as the body tries to counteract the low oxygen levels by churning out more red blood cells. This overproduction of red blood cells leads to chronic mountain sickness and to lesser fertility — Han Chinese living in Tibet have three times the infant mortality of Tibetans…

This is vicious selection; in pre-technological times the infant mortality gap was probably even greater.

Which reminds me of something I wrote two months ago …

… Even after the development of agriculture and writing we see thousand year intervals of relative stasis in China, Egypt and Mesopotamia. How could this be when our fundamental technologies change in decades. Are the minds of modern Egyptians radically different from the minds of only 6,000 years ago? Why? Why do we see this graph at this time in human history?

What did humans do in Georgian caves for 30,000 years? Thirty thousand years of waving and sewing and nothing changes?! They could not have had the same brains we have. They seem more … Neandertal…

Six thousand years is twice the time it took humans to adapt to the Tibetan plateaus. So that’s plenty of time for brains to change.

Except brains are qualitatively different from red cells. Brains are a platform for minds. Left handed people flip hemispheric specializations, and yet seem to think very much like right handed people.

Think about that. Mutations that flip cardiac orientation are 100% lethal. Flipping hemispheres though – the mind adapts. People born with half a brain can function in human society. Five percent of the population have big ugly looking mutations in brain development systems – yet they seem fine.

The human mind can run similarly on a diverse infrastructure. The software analogy is irresistible. A browser running on an iPhone can look and act a lot like one running on a Win 7 box – but the two systems are very different.

This gives a lot more leeway to evolution. It means that the ‘variation controls’ on the genetic programs for neural development can be “set” (by evolution) to “high variation” – and we can still turn out functioning humans minds. It means that brains may be evolving very quickly – over the course of a thousands of years.

It will be interesting to compare the DNA of Homo sapiens 2000 BCE with Homo sapiens 2010 ACE.

See also

• The evolution of the human brain- ASPM, microcephalin and FOXP2 (2005)
• Human evolution- a pillar falls (2007)
• The evolutionary wonder of reading – hints from intracranial electrophysiology (2009)
• Is schizophrenia the price we pay for an evolving brain? (2007)
• Schizophrenia and autism- evolutionary disorders? (2007)
• Structural variation in the human genome and its r... [Annu Rev Med. 2010]
• The new history is deep history (2010)
• What if we could see the diversity of minds? (2008)
• What is schizophrenia- Not what we thought (2008)

Update 7/20/2010: John Hawks reviews the evidence for active selection. I think when he talks about "demographics" he might be talking about how the unification of dispersed human populations causes new phenotypes to emerge -- but he's tip-toeing around something and is being cryptic.

50 million Neandertals living today

Or 50 million Neandertal equivalents ....

NEANDERTALS LIVE! | john (Neandertal) hawks weblog

... In genetic terms, we can ask, how many times has the average Neandertal-derived gene been replicated in our present gene pool? Those aren't Neandertal individuals -- that is, a forensic anthropologist wouldn't classify them as Neandertals. They're the genetic equivalent.

The answer to this is also simple: In absolute terms, the Neandertals are here around us, yawping from the rooftops.

There are more than five billion people living outside of Africa today. If they are one percent Neandertal, that's the genetic equivalent of fifty million Neandertals walking the Earth around us.

Does that sound minor? If I told you that your average gene would be replicated into fifty million copies in the future, would you be satisfied? Maybe your ambition is greater, but I think the Neandertals have done very well for themselves.

Does this mean that Neandertals belong in our species, Homo sapiens?

Yes.

Interbreeding with fertile offspring in nature. That's the biological species concept.

Dogs look a lot more diverse than modern humans and neandertal humans, and they interbreed happily. We are one with Neandertal. Tell the BBC, Walking with Cavemen needs an epilogue.

Hawks has written a long, excited, essay with the occasional sentence fragments. He's probably been hitting the champagne. Today's Nature articles on the Neandertal genome are a validation of his research and his enthusiasms.

There's more (emphases mine).

... Burbano and colleagues put together a microarray including all the amino acid changes inferred to have happened on the human lineage. They used this to genotype the Neandertal DNA, and show that out of more than 10,000 amino acid changes that happened in human evolution, only 88 of them are shared by humans today but not present in the Neandertals.

That's amazingly few.

Green and colleagues did a similar exercise, except they went looking for "selective sweeps" in the ancestors of today's' humans. ... They identify 212 regions that seem to be new selected genes present in humans and not in Neandertals. This number is probably fairly close to the real number of selected changes in the ancestry of modern humans, because it includes non-coding changes that might have been selected.

Again, that's really a small number. We have roughly 200,000-300,000 years for these to have occurred on the human lineage -- after the inferred population divergence with Neandertals, but early enough that one of these selected genes could reach fixation in the expanding and dispersing human population. That makes roughly one selected substitution per 1000 years.

Which is more or less the rate that we infer by comparing humans and chimpanzees. What this means is simple: The origin of modern humans was nothing special, in adaptive terms. To the extent that we can see adaptive genetic changes, they happened at the basic long-term rate that they happened during the rest of our evolution.

Now from my perspective, this means something even more interesting. In our earlier work, we inferred a recent acceleration of human evolution from living human populations. That is a measure of the number of new selected mutations that have arisen very recently, within the last 40,000 years. And most of those happened within the past 10,000 years.

In that short time period, more than a couple thousand selected changes arose in the different human populations we surveyed. We demonstrated that this was a genuine acceleration, because it is much higher than the rate that could have occurred across human evolution, from the human-chimpanzee ancestor.

What we now know is that this is a genuine acceleration compared to the evolution of modern humans, within the last couple hundred thousand years.

Our recent evolution, after the dispersal of human populations across the world, was much faster than the evolution of Late Pleistocene populations. In adaptive terms, it is really true -- we're more different from early "modern" humans today, than they were from Neandertals. Possibly many times more different.

Now take a look at my recent post on deep history...

... Even after the development of agriculture and writing we see thousand year intervals of relative stasis in China, Egypt and Mesopotamia. How could this be when our fundamental technologies change in decades. Are the minds of modern Egyptians radically different from the minds of only 6,000 years ago? Why? Why do we see this graph at this time in human history?...

Why do we go from steam engines to iPads in a few human lifespans? Why do we have so much schizophrenia and autism? Our brains have been rewired at top speed; accidents are common.

A big day in science, a big day for Darwin, a bad day for creationists. The Neandertals, of course, must have had souls ...

Update: More from Carl Zimmer. When I wrote the above sentence about autism and schizophrenia, much less the original post some years ago, I didn't know this ...

If you believe the difference between humans and Neanderthals is primarily in the way we think, then you may be intrigued by the strongly selected genes that have been linked to the brain. These genes got their links to the brain thanks to the mental disorders that they can help produce when they mutate. For exampe, one gene, called AUTS2, gets its name from its link to autism. Another strongly-selected human gene, NRG3, has been linked to schizophrenia...

So the brain changes that occurred after Neandertal, in the time of deep history, have associations with the disorder of schizophrenia and autism.

In 2007 I wrote: Is schizophrenia the price we pay for an evolving brain? and I speculated that we could consider autism and schizophrenia to be "evolutionary disorders".

Update 10/6/2010: Clearly prescient: Your Mother Was a Neanderthal #4 (Time Warp Trio). Also, Robert Sawyer must be feeling cheerful today. Lastly, do read the whole Hawks essay. There were a lot of hominin-variants roaming the world 50,000 years ago, and they were likely "dynamic" (or at least - kinetic). We need a word with less historic baggage than "breed" to replace "species" in this discussion.

Update 10/7/2010: The Economist has a good summary, with more on what I've been calling evolutionary disorders.

... But an examination of the 20 largest regions that have evolved in this way shows that they include several genes associated with cognitive ability—and whose malfunction causes serious mental problems. The presence of an extra copy of DYRK1A is linked to Down’s syndrome; mutation of NRG3 is linked to schizophrenia; mutations of CADPS2 and AUTS2 are linked to autism. These four genes therefore look like good places to start the search for modern humanity’s essence...

Incidentally, I did a google search on "evolutionary disorders" and the term has been in use for a year or two. I had the earliest hit I saw though!

Zimmer's article has the clearest overview so far, with a balanced review of the scientific debates.

Jim Carrey - enemy of the enlightenment

A recent NYT article about a non-rational attack on H1N1 immunization mentioned this group is now active against immunization, because of a faith-based belief that autism arises from immunization ...

Science-Based Medicine - Jenny McCarthy, Jim Carrey, and “Green Our Vaccines”: Anti-vaccine, not “pro-safe vaccine”

...“Green Our Vaccines” rally, led by the celebrity couple Jenny McCarthy and Jim Carrey and organized and funded by Talk About Curing Autism (TACA), Generation Rescue (upon whose board McCarthy now sits)...

Carrey joins Oprah in the class of people who combine non-rational and harmful beliefs with the power of wealth and celebrity.

Anyone know of a rogues gallery of these enemies of enlightenment 2.0? We need an annual award ceremony where these sad fools receive appropriate recognition. Maybe SEFORA could launch one? Brad, you're good at this sort of thing ...