Seth’s blog

Daniel Carlat, a Massachusetts psychiatrist, is the author of the excellent blog The Carlat Psychiatry Blog. He also wrote an excellent article in the New York Times Magazine about working on the side as a drug rep: He told other psychiatrists about new drugs. He quit (or was fired) because telling the truth wasn’t compatible with the job.

Unhinged, his new book (sent to me by the publisher after I asked for it twice — that’s how much I wanted to read it), covers the same ground. Its subtitle (or two subtitles) is/are The Trouble With Psychiatry — A Doctor’s Revelations about a Profession in Crisis. The contents were well-written, but none of it was new to me: the “chemical imbalance” theory of depression is a convenient myth, how drug reps work, how drug companies influence doctors, diagnosis difficulties, the cases of Charles Nemeroff and the like. (I did learn that Nemeroff was called “the boss of bosses” because of his prominence and power.) If any of his criticisms are new to you, this book is a great introduction. He uses many stories of patients to make his points.

Overall, I found the book too calm. What Nemeroff and others like him did I find outrageous but Carlat doesn’t sound outraged. Maybe he is, I have no idea, but his book is more reasonable-sounding than scornful and I would have preferred scornful. At one point he says he wrote an “angry” op-ed for the New York Times about something and I thought: good, some emotion! 

The crisis of the subtitle (”A profession in crisis”) is enticing but is not borne out by the contents. Carlat dislikes aspects X, Y, and Z of his profession, but one person’s dissatisfaction does not equal crisis. I saw no signs he is part of a growing movement. My take on the trouble with psychiatry is that psychiatrists don’t understand what is wrong in almost every case they see and, due to lack of understanding, do a poor job of fixing the problem. Lack of understanding by doctors is nothing new and, until someone has a better understanding, doesn’t pose a professional problem. This basic truth goes unmentioned in Unhinged.

I have yet to see Matt Ridley’s new book The Rational Optimist, which is related to stuff I’ve said about human evolution. But George Monbiot seems to consider it damning that Ridley was chairman of the bank Northern Rock when it failed. Bailout of Northern Rock was an example of government intervention — which The Rational Optimist is against, Monbiot says. Hey, why not attack Ridley for drinking government-supplied water from the tap in his kitchen? What a hypocrite!

In The Emperor’s New Clothes, the king is naked but only a little girl says so. The king’s advisers don’t tell him. I suppose the intended lesson was that powerful people have trouble getting frank answers. That’s pretty obvious. For a CEO, it’s said, the scarcest commodity is truth. Bosses learn this all the time. I learned it the first time I asked one of my students what he thought of the class.

Andersen’s story can be taken differently, partly conveyed by the phrase elephant in the room: Something big and important is overlooked by the supposed experts (in the story, the king’s advisers). It should be obvious — but it isn’t. Or at least no one says anything. This is how Harry Markopolos used the term emperor’s new clothes in No One Would Listen: Madoff was a gigantic fraud, his returns were (to Markopolos) clearly too good to be true, he was enormously visible (in certain circles), but no one said anything. It was as astonishing as a king parading naked. How come no one sees this? Markopolos thought. If you looked at Madoff the right way, he was naked.

That this sort of thing happens isn’t obvious at all. Yet three books — which I’ve just blogged about — have recently appeared with examples. One is the Markopolos book. Another is The Hockey Stick Illusion. Surely there’s overwhelming evidence that humans are causing global warming, right? Well, no. The only clear evidence was that hockey stick — and that’s a statistical artifact. (It looks like an artifact.) The third is The Big Short. It wasn’t easy to find the right sight line from which it was clear that Goldman Sachs et al. were taking on far more risk than they realized but such views existed. I call these books The Emperor’s New Clothes Trilogy. Their broad lesson: Sometimes the “best people” aren’t right. Sometimes there’s a point of view from which they’re glaringly wrong. The Hockey Stick Illusion is about how Stephen McIntyre found this point of view. In No One Would Listen Markopolos found this point of view. In The Big Short several people found this point of view.

This relates to my self-experimentation in two ways. First, the “best people” say self-experimentation is bad. No weight-control researcher does self-experimentation. No sleep researcher does self-experimentation. Surely they know how to do research. It’s their job. Whereas to me it’s glaringly obvious that self-experimentation is an excellent research tool, not just because of my results but also because it makes it so much easier to try new things. The best way to learn is to do, I  believe; self-experimentation makes doing much easier. Second, my self-experimentation uncovered all sorts of results that implied that the expert consensus on this or that was glaringly wrong. The Shangri-La Diet is just one example. Breakfast is good, right? Well, no, breakfast may wake you up too early. And so on. At first, I didn’t grasp the broad lesson I stated earlier (”Sometimes the “best people” aren’t right. . . “) and was amazed by what I was finding. To me, The Emperor’s New Clothes Trilogy is support.

The Big Short (sent to me by the publisher) is Michael Lewis’s best book, and that’s saying a lot. Moneyball was excellent. The Blind Side was excellent. All three are stories of underdog triumph but The Big Short is about a far more important subject, a far more complicated subject, and has a tremendously dark side. You know the saying: Fool me once, shame on you; fool me twice, shame on me. Well, shame on Wall Street for creating the worst financial disaster ever. But then, as Nassim Taleb puts it, the school-bus driver who crashed a bus full of children were given a new bus. Those who created the disaster were put in charge of fixing it. As Steve Eisman, one of Lewis’s main characters, puts it, “I can understand why Goldman Sachs would want to be included in the conversation about what to do about Wall Street. What I can’t understand is why anyone would listen to them.” (Not just listen. They were allowed to dominate the conversation.) Showing that the foolishness of people at the top in American society has no clear limit.

I could hardly stop reading. Endless fascinating detail. Michael Burry, another main character, discovers he has Asperger’s after his son is turned down by several kindergartens and he tries to understand why. I’ve been talking and reading about data analysis my whole professional life, yet Lewis’s story about how means can be terribly misleading is the best I’ve heard. An average credit score of 600 can be due to two scores of 600 or to scores of 500 and 700, with vastly different consequences. (This escaped the averagers.) Sure, I knew about the conflict of interest of bond rating agencies, such as Moody’s, but Lewis describes it so well I loved reading about it again.

Long ago, I blogged about the importance of insider/outsiders — close enough to understand what’s going on yet far enough away to see the truth. Lewis’s heros, who saw that a tremendous crash was coming, are exactly that. Like Harry Markopolos, they were on the fringes of the financial industry. One of them (Eisman) had a gift for tactlessness, another (Burry) had Asperger’s, and a third group ran their fund from a Berkeley garage. Without them, the people at the top (e.g., the head of Goldman Sachs), who run and crashed our financial system, could plausibly say Nobody could have predicted this. Because of Lewis’s heros, they can’t.

After The Hockey Stick Illusion by Andrew Montford (about Stephen McIntyre’s criticisms of Michael Mann’s hockey-stick graph), I read No One Would Listen by Harry Markopolos (sent to me by the publisher), about the Madoff case. They have plenty in common.

Size. According to Elizabeth Kolbert and New Yorker fact checkers, “thousands of scientists at hundreds of universities in dozens of countries” are sure that humans are disastrously warming the Earth. Madoff stole about $60 billion from thousands of investors. Helped by dozens of hedge-fund managers.

Hans Christian Andersen. The lesson of The Hockey Stick Illusion was that of The Emperor’s New Clothes, as I said. Markopolos mentions that story at least twice.

Failure at the top. In The Hockey Stick Illusion, Nature magazine and the National Academy of Sciences dismiss McIntyre’s criticisms. In No One Would Listen, the Wall Street Journal was given the story and, for three years, failed to do anything with it. They covered it only after Madoff confessed.

Regulatory failure. Science is said to be “self-regulating,” meaning that mistakes will be noticed and fixed by other scientists. Unfortunately for that homily, McIntyre wasn’t a scientist. In No One Would Listen, the no one of the title means no one at the SEC (Securities and Exchange Commission). After hearing Markopolos’s story, a congressman says the SEC “couldn’t find steak at an Outback”.

“It cannot be”. Just as Kolbert believes that a “hoax” of such size isn’t possible, many people told Markopolos that what he was claiming wasn’t possible. One of the best stories in No One Would Listen is about a colleague of Markopolos’s named Frank Casey, who helped Markopolos investigate Madoff. Casey’s job is selling financial products. After a sales call at an insurance company, the prospective customer, after declining to buy anything, asks Casey about Madoff. Casey is stunned. It felt like a random sales call. Casey tells him what he knows. It takes a half hour. Then the insurance executive explains his question. He recently married into “an extremely wealth Jewish family.” Madoff was at his wedding. After the wedding, Madoff took him aside and said he’d get him “set up” (meaning invested in Madoff). The insurance executive, after studying Madoff’s claimed returns, thought something was fishy and refused to invest. This got him in trouble with his father-in-law. “It’s your job as my son-in-law to take care of my daughter, and you should be putting your money with Bernie,” the father-in-law said over and over. His refusal to invest with Madoff is causing serious friction, he tells Casey, and  begs Casey to put what he said in writing so that he can convince his father-in-law to withdraw his money.  Casey writes a long email. The insurance exec brings it to his father-in-law and reads it out loud. “It can’t be,” says his father-in-law. “Bernie wouldn’t do this to me.” The father-in-law does nothing. They lose everything.