

Lung Cancer and the Power of Suggestion - techdog
http://asserttrue.blogspot.com/2013/02/lung-cancer-and-power-of-suggestion.html

======
rmc
_Were there millions of depressed people in hiding, in 1955, waiting to come
out of the closet in the 1990s? Was 9.3% of the American adult population (the
percentage now suffering depression) merely suffering in silence, back in
1955? Or did the drug companies and their media flacks convert a relatively
rare psychological condition into a growth industry through massive
advertising and media hype (in other words, through the power of suggestion)?_

The author is trying to claim that many (most/majority?) cases of depression
are made up and hyped. They are trying to claim that it's _impossible_ for
there to be that many actual depressed people now.

But turn it around. How many (openly) gay people/couples are there today?
Millions! But there weren't that many in 1955! So what happened? Was it all
media hype? <sarcasm>Or are we expected to believe that all those gay people
were suffering in silence in the 1950s?!</sarcasm>.

Of course all the gay people were suffering in silence in the 50s. People
don't doubt that. So why the doubt about mental illness?

~~~
tonyarkles
I don't think that the author is trying to claim that depression is made up
and hyped. What he seems to be claiming is that publicity surrounding
depression could have caused an increase in the number of depressed people
through the power of suggestion.

He's not saying that mental illness isn't valid, or that the people with
depression aren't suffering. He's suggesting that the increase could partly be
caused by the immense advertising campaigns surrounding anti-depressants; this
is in no way de-legitimizing depression, just suggesting a possible cause.

~~~
robbiep
Except America is the only industrialised nation that allows direct marketing
of antidepressants to its populace.

Other industrialised countries - Australia, the UK, France and Germany, etc
have also experienced a rise in patients under treatment for these conditions,
in lockstep with the US experience, despite this difference you suggest is
responsible

~~~
rmc
It's like an experimental study that removes a confounding factor!

------
trotsky
It appears you've made some sort of resolution to publish and promote a blog
entry per day in 2013. 40 entries in 41 days this year vs. 46 in all of 2012.
You should reconsider - whatever your reasons were, I doubt they included a
desire to develop a reputation for presenting topics that were sensationalized
and thinly researched [1] produced with a pace that ensures discredited
theories dont get reviewed.

[1] [http://asserttrue.blogspot.com/2013/02/drug-companies-
stop-h...](http://asserttrue.blogspot.com/2013/02/drug-companies-stop-hiding-
your-data.html)

~~~
dfc
Wow, nice spot and they have all been submitted to HN. I have never seen
anyone's submission history be so hell bent on self promotion:

<https://news.ycombinator.com/submitted?id=techdog>

~~~
DanBC
You'd be surprised, there are one or two people who are as blatant.

Just for fun, here are a couple of charts. (<http://imgur.com/a/ywor0>)

------
eksith
"Do Cigarette Warning Labels Help CAUSE Cancer?" No... Long answer: Hell no
and stop doing this.

To the next person with a pseudoscientific gut-feeling-bear-with-me-just-a-
bit-while-I-pull-a-half-baked-idea-out-of-a-number-set-that-does-nothing-to-
corroborate, please don't. Corrolation doesn't equate to causation, no matter
what amount of reality bending assertions you apply. Warning those at high
risk for cancer know they're at high risk and subsequently confirm the
hypothesis doesn't mean the warning was the cause.

~~~
zzzeek
There seems to be a trend of Very Smart People with no experience whatsoever
in a given field, reading some article somewhere, pulling out R and some
graphing software, and proclaiming "I've discovered something that nobody who
actually works in the target field which I knew absolutely nothing about six
hours ago ever found!". I wish those stories would stop getting posted to HN.

~~~
stfu
NO! I absolutely resent that idea that "science" should only be something for
the experts, and everybody without a PhD should shut up about it.

As long as it is just random ranting without any data, it is more than
welcoming that "regular" people try to understand expert opinion and in fact
challenge it. If "facts" are so clear and indisputable, than those amateur
research should easily be shown as wrong.

If not, amateur researcher make a highly valuable contribution. They highlight
the fact, that social science, especially on social phenomenons, is (often)
based on consensus. In this case here, the author makes an excellent
contribution just by highlighting how easy correlation and causation can be
(mis)interpreted.

For example the other day I read and article published in a well regarded
management journal, by authors who claim having found out that the willingness
of users clicking on ads is based on the hours of sunshine per day in that
region. The correlation equals causation phenomenon is quite common among
social scientists who try to show how scientific their contributions are.

~~~
zzzeek
> I absolutely resent that idea that "science" should only be something for
> the experts, and everybody without a PhD should shut up about it.

making some off the cuff, armchair observations within a particular field of
study (and blogging and serially promoting them to hacker news) without even
making casual efforts to familiarize oneself with at least portions the vast
amounts of knowledge publicly available on that field is, generously, pretty
bad "science". And less generously, it's just hubris. This is not an "amateur
researcher", this is someone who apparently based on posting history has a
really high blogging-to-value ratio.

Of course, we all have the right to be clueless. I only requested that perhaps
Hacker News doesn't want to encourage a culture of armchair cluelessness and
particularly someone who appears to be a serial armchair blogger/HN promoter
(see <https://news.ycombinator.com/submitted?id=techdog>).

------
sethev
_In 1955, only 38,200 people in the U.S, were in mental hospitals as a result
of disablement due to depression (C. Silverman, 1968, The Epidemiology of
Depression, Johns Hopkins Press). Today, depression is the leading cause of
disability in the U.S. for people aged 15-44 (according to NIMH stats).
Depression now affects 20.5 million American adults: 14.8 million in the form
of major depressive disorder and 5.7 million in the form of bipolar disorder.
That's a pretty huge jump in numbers: 38,200 to 20 million._

He's comparing the number of of people _insitutionalized in a mental hospital_
in 1955 to the total number of people who suffer from depression in the United
States now. How is that comparison even relevant to anything? How many people
are institutionalized for depression now? My guess is that those numbers
either wouldn't support his narrative or can't be found in a few minutes of
googling like the rest of his "research".

Also notice how he gets to 20 million (a very dramatic number indeed) by
adding together 14.8 million suffering from a major depressive disorder and
5.7 million in the form of bipolar disorder. Are those thing mutually
exclusive?

------
fennecfoxen
If there IS a nocebo effect here, it's mildly implausible that it would have a
really narrow effect like "making people more susceptible to lung cancer". At
a minimum, I'd expect them to be more susceptible to other cancers, and
possibly other diseases and illnesses (the big fat warnings in your face, and
having to bypass them to smoke, acting as some sort of immunosuppressant or
something like that).

Perhaps, if this effect is real, further research could demonstrate that? Or
perhaps there's still a confounding effect somewhere, maybe something related
to how people self-select whether they're going to smoke and some factor which
is correlated both with making that decision in the face of a big fat warning
label _and_ with increased susceptibility to lung cancer?

Anyway. Nice idea for a research paper. Not sure it belongs here until you've
done more though. :P

~~~
PeterisP
+1. Interesting idea for a research article, but post when you've done the
research, not when you've just had the interesting wild hypothesis.

------
to3m
I don't understand why it's so infeasible that improvements in cigarette
technology could result in cigarettes that are worse for one's health because
they've been more aggressively optimised for tar content as officially
measured, or shelf life, or cost of manufacture.

As for the theory that modern smokers simply suck harder, I'm not sure that's
so implausible. Light cigarettes are more common today, and most light
cigarettes seem to get their lightness entirely from lengthier filters that
have small holes in the paper. (If you use the tobacco for some other purpose,
e.g., as filler for an unfiltered marijuana cigarette, then you'll find the
smoke just as harsh and the roach paper no less tarry.) This requires a more
forceful draw to avoid that unpleasant "sucking in air" sensation.

I've also noticed, on the occasions that I've checked recently, that
cigarettes today tend to have lower advertised tar and nicotine content than
the ones I smoked as a teenager. So perhaps that could result in a similar
effect.

~~~
robbiep
Light cigarettes _are in fact_ Worse as a whole as previously heavy smokers
switch brands and start smoking _lighter_ cigarettes

The effect is real and had been studied.

In fact, all of the effect size attempted to be attributed to 'warning labels
causing cancer' can be explained by this paper here

[http://www.ncbi.nlm.nih.gov.ezproxy1.library.usyd.edu.au/m/p...](http://www.ncbi.nlm.nih.gov.ezproxy1.library.usyd.edu.au/m/pubmed/16100660/)

~~~
greenyoda
This URL requires a login from University of Sydney for access.

~~~
robbiep
My bad

Smoking and lung cancer - Tuberk Toraks
<http://www.ncbi.nlm.nih.gov/pubmed/16100660/>

------
gamblor956
Can we please get this website hell-banned?

Every single article posted by techdog is an article from this blog, and every
single one of these articles is factually and demonstrably wrong, written by
someone who has very little understanding of statistical analysis or any of
the specific topics the article purport to address.

~~~
greenyoda
But in spite of all that, it has managed to provoke some interesting
discussion here.

------
PeterisP
The first article graph of woman lung cancer rates raises some red flags - a
huge increase in woman lung cancer caused by cigarettes would be expected a
couple of decades after the huge increase in woman (as opposed to mostly-male)
smoking in first half of 20th century.

In order for that graph to facilitate truth instead of misleading, it needs to
include either (a) woman smoking rates by year, or (b) male lung cancer rates,
not woman.

~~~
rmc
Good point. If at some point the median man smoked 20 cigarettes a day, and
the median woman smoked 0, then lots of men will get lung cancer and women
won't. If things change to 10 and 10, then the average number of cigarettes
will stay the same, but the number of people who smoke at least 10 will have
doubled. This is how the lung cancer rate can go up with the number of
cigarettes going down.

Another way to measure it would be to look at "how much lung cancer is there
per smoker".

------
Kylekramer
Seems more like an variation of what psych and behavioral economics calls the
"what the hell" effect than "power of suggestion". "What the hell" effect says
once your willpower fails and you give into temptation to begin doing negative
behaviors, you are much more likely to go all in (think eating a single donut
on a diet then polishing off the box). By making the cancer threat real post
purchase and reminding of the ultimate consequence every time you light up,
they may be pushing people to throw their hands up and just keep smoking.

Of course, like this article, this is just a untested theory I pulled out of
my ass.

------
jere
I'm not sure how the article goes from interesting hypothesis (which it is) to
near certainty.

>If we rule out changes in cigaret design and environmental factors as
explanations for the enormous increase in lung cancer, what are we left with?

Seems like a false dichotomy to me. It can't be X, so it has to be Y.

>All of these would affect smokers and non-smokers equally. And yet lung
cancer rates have not gone up for non-smokers.

This isn't necessarily true. It could be a synergistic effect, where some
external factor increases cancer rates when smoking is also involved.

~~~
abecedarius
Some data to help think up such effects:
<http://www.kidon.com/smoke/percentages3.htm>

Differences in diet was an obvious idea, but it's not obvious to me what Japan
and Israel might have in common.

------
joshgel
Or, very simply, life expectancy has increased significantly during this time
period. Since, "Of course, it takes years of smoking to get lung cancer", more
people live to the age where they get lung cancer.

------
joshrice
What about the use of additives in cigarettes that started around the 1960s?
From wikipedia on 'cigarette': "According to data from the World Health
Organization,[40] the amount of tobacco per 1000 cigarettes fell from 2.28
pounds in 1960 to 0.91 pounds in 1999, largely as a result of reconstituting
tobacco, fluffing and additives."

------
brownbat
Maybe as smoking went from an "everyone" activity to a more marginalized
activity, you get worse health outcomes in that group for other reasons.

How does the fitness of the median smoker today compare to the fitness of the
median smoker in the 1950s? What about wealth, access to treatment, etc?

------
zwischenzug
One other explanation I can think of for higher lung cancer rates is that
people are living longer, so more likely to succumb to cancer in the end.

But like someone else said, the idea that these trends have not been examined
and explained to death by better-informed people is risible.

------
yial
The only problem I see here is his argument about placebos - while the placebo
effect is a strong one (and I believe in it), there is a current lack of
control over placebos (I e sometimes drug companies try to use placebos that
cause side affects) that are currently used in the industry. Otherwise. This
is an interesting idea.

~~~
rmc
If you're testing your drug against a placebo, and the drug has a negative
side effect, then you should try to make sure the placebo has the same/similar
side effect. The whole point of double blind testing against a placebo is to
test against something that appears similar.

Remember doctors aren't supposed to know what patients in a trial are on drugs
vs placebo (that's the 'double' in double blind, the patient and the doctor is
blind). If the real drug has a horrible side effect and the placebo doesn't,
then the doctor will be able to figure out what patient is getting what, and
you no longer have a double blind test.

------
dfc
I am curious about "cigaret," wiktionary says it is a dated form of cigarette.

I have trouble looking at the graph without being distracted by "cigaret" but
firefox's dictionary is not marking it as a misspelling so it must be accepted
somewhere. Where is this spelling still commonplace?

------
ck2
Or it could be all the coal burning pollution catching up to us?

~~~
greenyoda
Or any of the thousands of other chemicals, such as flame retardants, that we
breathe in all our lives.

------
jQueryIsAwesome
Or you know, people who have smoked is more likely to have kids with cancer or
who where second-hand smokers at an age they can't remember now.

Also, campaigns against brest cancer had an exponential grow too but somehow
the rate of breast cancer is about the same, or do your hypothesis includes
lungs being more affected by perceptions than any other organ?

