Join the clots – Strokes and the oral contraceptive pill

 

Doing the rounds on Facebook recently was a story broadcast on Channel Seven News (Brisbane) from the 22nd of June 2015. It was the story of a previously healthy young Melbourne woman who suffered a stroke at work. She was simply sitting at her desk, and was suddenly unable to move her arm to control her mouse. Because of the quick thinking of one of her co-workers, Melissa James got urgent medical attention and appears to have made a very good recovery.

Channel Seven’s angle on this story was that Melissa’s oral contraceptive pill Yasmin was to blame. Perhaps it was. Perhaps it wasn’t. No one can fairly say from the limited information that was given in the two minute clip.

The report also suggested that Yasmin was responsible for strokes in countless other women, stating that Bayer, Yasmin’s manufacturer, was paying out billions of dollars in damages, and that Yasmin caused a “six-fold increase in strokes”, potentially putting hundreds of thousands of women at risk.

That the oral contraceptive pill is associated with an increase risk of strokes is not in contention. Strokes and blood clots are well known to be side effects of the pill. Remember, any drug that has an effect is also going to have side effects. The oral contraceptive pill is no different. The question then becomes: Is the pill still safe to use, or should women be ditching it in favour of other forms of contraception?

To answer that, one has to start trawling through statistics. Don’t worry, I promise there won’t be too many numbers, because statistics make my brain hurt. Instead, I want to show you a few graphs, because it’s actually much easier to understand the risk of the pill if you have the right perspective.

One of the largest and most recent studies on the risk of strokes and the oral contraceptive pill was done in Denmark in 2012 [1]. Lidegaard and colleagues followed 1,626,158 women over a decade, and analysed the risk of strokes while using different forms of hormonal contraception. The sheer number of women involved in the study make the statistics very strong. Overall, women taking Yasmin were 1.64 times more likely to have a stroke than the average woman not taking any contraception.

Even at this early stage, there are two important points to consider:
1. I’m not sure what source the Channel Seven reporter was quoting when she suggested that Yasmin was six times more likely to cause strokes. Certainly, the numbers in this study don’t come close to this, and
2. A relative risk of 1.64 is the same as saying there was a 64% increase in stroke risk. This still sounds bad for Yasmin … until you look at the risks for some of the other pills discussed in the study.

JoinTheClots_Fig1_optimised

The graph shows that there are actually quite a few contraceptive pills that have a higher risk of stroke than Yasmin. According to the numbers of Lidegaard et al, Yasmin is not all that spectacular – just somewhere in the middle in terms of the risk of stroke, compared with common pills.

Though when you factor in a broader array of pills, other contraceptive methods, and other everyday situations for women, the risk of stroke from Yasmin, or any pill for that matter, doesn’t look bad at all.

JoinTheClots_Fig2_optimised

The risk of stroke from taking Yasmin is nothing compared to the risk of stroke in the few weeks after birth, but there are no news reports of the dangers of stroke after having a baby.

There’s probably a couple of reasons for that – post-partum strokes are brought about by babies, which are cute and cuddly, and not by multinational drug companies, which are repugnant and evil, and much more newsworthy. It’s also because even though the risk of stroke in the few weeks after delivery is nearly 25-times higher than the stroke risk for an average non-pregnant woman, that number is still so small on average that the overall chance of getting a stroke in the few weeks after delivery (in statistical parlance, the “absolute risk”), is tiny.

JoinTheClots_Fig3_optimised(additional statistics: [2] and flying risk extrapolated from [3])

In the Lidegaard study, there were 2260 strokes in 9,336,662 person-years. That’s a rate of only 24.2 strokes for every 100,000 women in a year. Even though the risk of stroke after birth is still very high, it hardly creates a impression on the graph of absolute risk. And because the risk from most contraceptives is quite a bit lower, they don’t even make a blip.

Thinking about it in a different way, even with the increased risk of taking Yasmin, for every 100,000 women taking Yasmin for a year, there will only be an extra 16 strokes on average compared to the general population. 16 in 100,000 … that’s like trying to find a straight middle-aged man at a One Direction concert.

Which brings us to the take home messages:

1. Always take health stories on the news with a pinch of salt. The media often use a liberal amount of poetic licence to sell their stories. I’m not sure where Channel Seven got their source material, but it doesn’t seem to fit the data that I’ve unearthed in a quick search of the medical literature. The story of Melissa James is newsworthy as an exploration of the struggle of a young woman who suffered a tragic complication, and I’m really glad for her that she seems to be winning that battle. But her story can’t be extrapolated to every other woman on Yasmin, or any other pill for that matter. The statistics suggest that experiences like that of Melissa James are thankfully rare.

2. There is more to the oral contraceptive pill than just the risk of strokes. The oral contraceptive pill has a number of other potential complications, and each form of contraception needs to be matched correctly to the woman who’ll be taking it. This is why the pill remains on prescription in Australia (and most other countries), not sold off the shelf at the pharmacy or the supermarket. If you have any concerns about your risk from the pill, or any other method of contraception, see your GP for a full assessment.

References

[1]        Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. The New England journal of medicine 2012 Jun 14;366(24):2257-66.
[2]        Izadi M, Alemzadeh-Ansari MJ, Kazemisaleh D, Moshkani-Farahani M, Shafiee A. Do pregnant women have a higher risk for venous thromboembolism following air travel? Advanced biomedical research 2015;4:60.
[3]        Centers for Disease Control and Prevention. CDC Health Information for International Travel 2014. New York: Oxford University Press, 2014.

Declaration: For the record, I declare no conflict of interest in the publication of this post. I do not receive payment, commission, or any kind of gratuity, from Bayer, or any pharmaceutical company. I do not directly own shares in Bayer or any other pharmaceutical company. Nor do I have any professional links to any pharmaceutical company. I wrote this post to promote rational use of medicine, not to specifically promote or defend one particular brand of medication.

Different strokes for different folks? Why vaccinations don’t lead to mini-strokes

Screen Shot 2015-05-31 at 4.46.48 pmOne of my Facebook friends messaged me a link the other day. It was to an article that had been popping up on his Facebook feed, originally published by Health Impact News (http://goo.gl/V3A5Mb).

The article is a report by John P. Thomas, building on the previous work of Andrew Moulden. Moulden failed his medical residency in Canada (http://goo.gl/BBKG5z), but used his doctorate in psychology to promote himself as a doctor.

Moulden believed that “Multiple factors can work together to trigger a single type of reaction in the body, which can then produce various sets of symptoms. Even though there were different sets of symptoms and different disease names given to each one, they were actually all part of a spectrum of diseases that he called Moulden Anoxia Spectrum Syndromes. Learning disabilities, autism, Alzheimer’s, irritable bowel disease, Crohn’s disease, colitis, food allergies, shaken baby syndrome, sudden infant death, idiopathic seizure disorders, Gulf War syndrome, Gardasil adverse reactions, schizophrenia, Tourette’s syndrome, chronic fatigue syndrome, fibromyalgia, expressive aphasia, impaired speech skills, attention deficit disorders, silent ischemic strokes, blood clots, idiopathic thrombocytopenia purpura, Parkinson’s disease, and other modern neurodevelopmental disorders are closely related in many ways, and are part of a larger syndrome.” (http://goo.gl/kTNRMV)

Moulden Anoxia Spectrum Syndromes isn’t found in any medical textbook, and there is no evidence that Autism, Alzheimer’s, Gulf War Syndrome, food allergies and Shaken Baby Syndrome are at all causally related.

Besides, the term ‘anoxia’ is a medical term meaning ‘without oxygen’. Moulden is obviously suggesting that every one of those disparate conditions is fundamentally caused by a lack of oxygen to somewhere, and while his logic has many flaws, this is the fatal one. Food allergies are not related to lack of oxygen. Neither are reactions to the Gardasil vaccine. And we know that Autism is defined by structural and functional changes in the brain that occur in the womb, and can be detected as early as a month after birth [1]. Autism is primarily genetic – autistic brains have excess numbers of dysfunctional nerve cells that are unable to form the correct synaptic scaffolding, leaving a brain that’s large [2, 3], but out-of-sync. There is nothing about autism that’s related to low oxygen. ADHD is similarly genetic and neurodevelopmental in origin [4]. The only thing suffering from lack of oxygen is Moulden’s theories.

Thomas then tries to extend this already tenuous medical hypothesis by claiming that vaccines cause damage to capillaries in ‘watershed’ areas which, according to his definition (not the medical definition), are “very small areas of tissue (groups of cells) that are served by a single blood vessel called a capillary” (http://goo.gl/4IlUI7) He suggests that certain cranial nerves are vulnerable to these ‘watershed’ injuries, which then result in changes in the way the face moves.

The cause for these ‘watershed’ injuries? “The blood is being sludged up in multiple areas of the body, which is causing ischemia, damage to tissue, functional disorders, and disease. This is not genetic. It is acquired. The drop in the corner of the mouth is the result of low zeta potential and the MASS process. People with autism spectrum disorders, neurodevelopmental disorders, ADHD, and those who are having adverse effects from vaccines such as hepatitis, flu, anthrax, Gardasil, DPT, MMR, etc. are having a generic response. The body is reacting to having foreign matter put into it.”

In other words, he’s suggesting that vaccinations essentially cause strokes.

From here, the article becomes a bamboozling cacophony of legitimate but irrelevant facts, diagrams, factoids, and recommendations. For example, Thomas explains the signs of damage to the third, fourth, sixth and seventh cranial nerves, and cites the damage by actual strokes as examples. Well, that’s fine, except that real strokes don’t involve damage to capillaries, but blockage of arteries, and have nothing to do with vaccination.

He also makes statements that are simply wrong, like “The seventh cranial nerve primarily controls the lower half of the face” (actually the seventh cranial nerve, also called the facial nerve, controls the muscles of the whole face – http://goo.gl/m9S7Gd). And, “When we see seventh cranial nerve damage, we can be sure that the damage is not isolated to the seventh cranial nerve – the damage is happening everywhere” (except in Bells Palsy … and some parotid tumours … and some strokes … and lots of other things).

He also makes the ridiculous claim that autism causes facial droop without explaining why, suggests that weakness of the muscles of the eyes controlled by the sixth cranial nerve is often the first sign of vaccine damage, and that ‘watershed’ damage to the brainstem from vaccination is the cause of SIDS.

Thomas then attempts to justify his conjecture by describing the case of a single baby boy whom he claims died from sudden infant death post vaccination – “His family and his physicians watched him slowly die while the respirator did his breathing for him. Basically they were watching his brain as he went through the stages of sudden infant death after vaccine exposure”. Except that death after nineteen days is not ‘sudden’, and the description of this child’s tragic death is nothing like SIDS. And his only reference to this case? Not an official forensic report, but a ‘report’ written by Andrew Moulden, which was simply an offensive and detestable attempt to leverage the heart-wrenching death of a fifteen month old boy to push his idealistic agenda (http://goo.gl/ysoCtQ).

I could go on. There are pages of material that simply defy rational thinking. He even goes on to question germ theory, and states that “Vaccines are one of the largest triggers of excessive non-specific immune hyperstimulation, which ultimately leads to blood sludging, clotting, and loss of negative zeta. The combined effect of all these factors produce illness, disability, and death.”

There is no credible medical evidence to back up any of Thomas’s claims, nor the claims of Moulden before him. Together, they openly defy centuries of scientific knowledge, modern science, and the observations of every parent whose children have been vaccinated.

Lets face it – if vaccines really caused mini-strokes, we wouldn’t need the dubious work of Moulden and his disciples to discover it. We would have all seen it.

There are a lot of very questionable theories that get promoted on the internet as valid science. Don’t fall for it. There’s no evidence for Moulden Anoxia Spectrum Syndromes, and the only connection between conditions like Irritable Bowel Syndrome, Shaken Baby Syndrome and Chronic Fatigue Syndrome is not vaccination, but the pathetic attempt to try and connect them by pseudoscientists with an idealistic barrow to push.

References

[1]        Pierce K. Exploring the Causes of Autism – The Role of Genetics and The Environment (Keynote Symposium 11). Asia Pacific Autism Conference; 2013 10 August; Adelaide, Australia: APAC 2013; 2013.

[2]        Courchesne E, Carper R, Akshoomoff N. Evidence of brain overgrowth in the first year of life in autism. JAMA : the journal of the American Medical Association 2003 Jul 16;290(3):337-44.

[3]        Shen MD, Nordahl CW, Young GS, et al. Early brain enlargement and elevated extra-axial fluid in infants who develop autism spectrum disorder. Brain : a journal of neurology 2013 Sep;136(Pt 9):2825-35.

[4]        Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.

Dr Caroline Leaf and the organic foods fallacy

Screen Shot 2014-11-28 at 1.13.59 am

Organic foods. They are amazingly popular. More than a million Australians buy organic foods regularly, and several million more buy it occasionally. The retail value of the organic market is estimated to be more than $1 billion annually. The assumption made by most people is that because it’s so popular, organic foods must be good for you, or at least have something going for them to make them worth all the hype.

Of course, just because something’s immensely popular and has a billion-dollar turnover doesn’t necessarily mean it’s beneficial (One Direction is a case-in-point).

In fact, despite organic foods being touted by their supporters as healthier, safer, and better for the environment than normal foods, actual scientific evidence fails to show any significant difference. I wrote about this earlier in the year (see: Borderline Narcissism and Organic Food). Since then, another large prospective trial deflated organic food’s bubble, with a British study showing no change in the incidence of cancer in women who always ate organic foods versus those who never ate organic foods [1].

The dearth of benefit from organic foods wouldn’t be so bad if they were just another guy in the line-up, something neutral and inert. Unfortunately, not only can organic produce be contaminated if farmed incorrectly [2, 3], but they come at an extraordinary premium, sometimes costing four times more than their conventional counterparts (Borderline Narcissism and Organic Food).

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. A couple of months ago, she let slip her intention to publish a book in 2015 about food. Who knows what she’ll actually say, but if today’s social media meme is anything to go by, it will likely follow the same pattern of her other teachings.

Today, she wrote, “Research shows that dark organic CHOCOLATE lowers blood pressure, improves circulation, increase HDL (“good”) cholesterol, reduce the risk of heart attack and stroke, and increases insulin … and … recent research has even suggest it may prevent weight gain!”

As I discussed recently, Dr Leaf does herself a disservice by not citing her sources. It’s very brave to write in a public forum that dark chocolate reduces the heart attack and stroke, since this could be interpreted as medical advice, which she is not qualified to give. As for the actual effects of dark chocolate, there is not a lot of quality evidence on dark chocolate on its own. A 2011 meta-analysis of general chocolate consumption on cardiovascular risk did indeed show a relative risk reduction of 37% [4]. But before you prescribe yourself two dark chocolate Lindt balls twice a day, consider that a relative risk reduction of 37% isn’t a big effect. Plus, the recommended 50 grams of 85% organic dark chocolate to attain the small benefit for your cardiovascular health contains just over 300 calories/1280 kJ (the average can of Coke contains 146 calories/ 600 kJ), and is 30% saturated fat (http://caloriecount.about.com/calories-green-blacks-organic-dark-chocolate-i110689). So any health benefit that may be associated with the poly-phenol content is likely nullified by the high saturated fat and calorie count.

What concerns me about Dr Leaf’s future foray into dietetics is that little word sitting quietly in her opening sentence: “organic”. Dr Leaf is an organic convert. But rather than act like a scientist that she claims to be, she preaches from her biases, ignoring the evidence that organic food is all hype and no substance, encouraging Christians everywhere to pay excessive amounts of money for something that’s of absolutely no benefit. Dr Leaf is welcome to eat whatever she chooses, but encouraging organic eating without clear benefit is more hindrance than help for most of her followers.

References

  1. Bradbury, K.E., et al., Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br J Cancer, 2014. 110(9): 2321-6 doi: 10.1038/bjc.2014.148
  2. Mukherjee, A., et al., Association of farm management practices with risk of Escherichia coli contamination in pre-harvest produce grown in Minnesota and Wisconsin. Int J Food Microbiol, 2007. 120(3): 296-302 doi: 10.1016/j.ijfoodmicro.2007.09.007
  3. Sample, I., E coli outbreak: German organic farm officially identified. The Guardian, London, UK, 11 June 2011 http://www.theguardian.com/world/2011/jun/10/e-coli-bean-sprouts-blamed
  4. Buitrago-Lopez, A., et al., Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ, 2011. 343: d4488 doi: 10.1136/bmj.d4488

Dr Caroline Leaf and the Two Rights Principle

Screen Shot 2014-10-02 at 9.40.13 pm

They say that two wrongs don’t make a right. And as it turns out, two rights don’t always make a right either.

Dr Caroline Leaf is a communication pathologist and a self-titled neuroscientist. Her last social media post declared, “The power of renewing the mind! Romans 12:2 We have the power to restrengthen, recover, and renormalize our brain even when it has suffered major trauma.”

Each part of her post is technically correct, with a few qualifications.

As Christians, we always accept that scripture is infallible, the inspired word of God. The interpretation of that scripture is not so infallible. Dr Leaf often quotes Romans 12:2, “And be not conformed to this world: but be ye transformed by the renewing of your mind, that ye may prove what is that good, and acceptable, and perfect, will of God.”

When Paul wrote this scripture, what did he mean when he used the word for mind? Well, I guess I can’t speak for the Apostle Paul, but I can say that the Greek word that’s translated “mind” in this verse is “nous”. In modern times we would use this word for ‘brain’ or ‘head’, especially those with a British influence in their upbringing (“use your nous” = “use your brain”). The Greek word means,
“I. the mind, comprising alike the faculties of perceiving and understanding and those of feeling, judging, determining
a. the intellectual faculty, the understanding
b. reason in the narrower sense, as the capacity for spiritual truth, the higher powers of the soul, the faculty of perceiving divine things, of recognising goodness and of hating evil
c. the power of considering and judging soberly, calmly and impartially
d. a particular mode of thinking and judging, i.e. thoughts, feelings, purposes, desires.”
(https://www.blueletterbible.org/lang/lexicon/lexicon.cfm?Strongs=G3563&t=KJV)

Hmmm … which one did Paul really mean? Did he mean just our thoughts, all of our mental faculties, or specifically to the perception of the divine? Dr Leaf never really says, although there’s a big difference between perceiving and understanding in general, and the specific capacity for spiritual truth. So Dr Leaf’s interpretation of Romans 12:2 might be correct, depending.

The other half of her post is also true, but in the most vague sense. “We have the power to restrengthen, recover, and renormalize our brain even when it has suffered major trauma” is technically true … the brain can recover from significant trauma. It does this through neuroplasticity, broadly defined as “the ability of the nervous system to modify its structural and functional organization.” (http://emedicine.medscape.com/article/324386-overview#aw2aab6b4) Neuroplasticity is a property inherent to the nervous system of every animal that has a nervous system; humans are not unique in this regard. Given the massive scale of the human nervous system (0.15 quadrillion, or 150,000,000,000,000 synapses throughout the average brain [1]), then there is massive scope for neuroplasticity-mediated regeneration, though it’s not unlimited. Neuroscience is only just starting to unlock the incredible depth of the science of our neural synapses [2], the foundation of neuroplasticity.

However, just because her two statements are separately correct in some vague sense, does not make the combination of the two more correct. If anything, combining them results in a non-sequitur type of false argument – the two separate statements don’t support each other in a logical way. A bit like saying, “My cat has four legs. A cow has four legs, therefore a cow is a cat”. Our ability to “restrengthen, recover, and renormalize our brain” is a capacity built into our nervous system that has nothing to do with “renewing our minds” in the scriptural sense. They only seem similar in the fuzziest of ways because they share a single common element, but otherwise, they really aren’t the same process.

Dr Leaf may appear to be unlocking the hidden mysteries of scripture and science, but just because her statements are vaguely true or vaguely similar doesn’t mean they explain anything … something to be aware of when reviewing Dr Leaf’s teaching.

References

  1. Sukel, K. The Synapse – A Primer. 2013 [cited 2013, 28/06/2013]; Available from: http://www.dana.org/media/detail.aspx?id=31294.
  2. Bliss, T.V., et al., Synaptic plasticity in health and disease: introduction and overview. Philos Trans R Soc Lond B Biol Sci, 2014. 369(1633): 20130129 doi: 10.1098/rstb.2013.0129

Dr Caroline Leaf and the Myth of the Blameless Brain

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When I came back to Facebook this morning, I found this from Dr Leaf on my feed,

“Don’t blame your physical brain for your decisions and actions. You control your brain!”

Dr Caroline Leaf is a Communication Pathologist and a self-titled Cognitive Neuroscientist. Her post follows her theme of the last couple of weeks, the premise that the mind is the dominant cognitive force, controlling the physical brain, and indeed, all matter. I have written about the Myth of Mind Domination in a previous blog. But Dr Leaf’s latest offering here deserves special attention.

Lets think about her statement in more detail:

“Don’t blame your physical brain for your decisions and actions.”

What Dr Leaf is really saying is that the physical brain has no role in your choices or behaviour whatsoever, because if your physical brain had a role in the decisions and actions you make, it would also carry some blame for your poor decisions and actions.

“You control your brain.”

The question to ask here is, “Which part of ‘you’ controls your brain?” Her answer would be, “Your mind”, although she never says where the mind is. Certainly not in the physical brain or even in our physical body, since “Our mind is designed to control the body, of which the brain is a part, not the other way around.” [1: p33].

So an ethereal, disembodied force is in full control of our physical body, such that our brain has no role in the decisions we make or actions we take. Even at this stage of analysis, Dr Leaf’s statement is ludicrous. But wait, there’s more.

Dr Leaf’s statement puts her at odds with real Cognitive Neuroscientists. Professor Patrick Haggard is the Deputy Director of the Institute of Cognitive Neuroscience at the University College London. He has authored or co-authored over 350 peer-reviewed articles on the neuroscience of making choices. He writes, “Modern neuroscience rejects the traditional dualist view of volition as a causal chain from the conscious mind or ‘soul’ to the brain and body. Rather, volition involves brain networks making a series of complex, open decisions between alternative actions.” [2] Strike one for Dr Leaf.

Dr Leaf’s statement puts her at odds with herself. Two weeks ago when misinterpreting James 1:21, Dr Leaf wrote, “How you react to events and circumstances of your life is based upon your perceptions.” Perception is classically defined in neurobiology as conscious sensory experience [3: p8] although the work of cognitive neuroscientists has shown that perception can also be non-conscious [4, 5]. Either way, perception is based entirely on processing within the brain [3: p6-11]. So one week, Dr Leaf is saying that our brain determines how we behave, and then ten days later, she is telling us that our brain does not determine how we behave. Which is it? Strike two for Dr Leaf.

Finally, Dr Leaf’s statement is borderline insulting to the sufferers of congenital or acquired brain disorders. Would you tell a stroke patient that they shouldn’t blame their physical brain for their immobility, because they’re mind is in control of their brain? What about a child with Cerebral Palsy? Would you tell a mother of a child with Downs Syndrome that their child is having recurrent seizures because they aren’t using their mind properly to control their brain? Dr Leaf is doing exactly that. I find it incredible that she could be so insensitive, given her background as a speech pathologist working with patients with Acquired Brain Injury.

I imagine that her defence would be something along the lines of, “What I meant was, ‘don’t blame your normal physical brain for your decisions and actions. You control your functional brain.’” That sort of explanation would be less insulting to people with strokes or brain injuries, but it then undermines her whole premise. The hierarchy of the brain and the mind doesn’t change just because a part of the brain is damaged.

Besides, changes to brain function at any level can change the way a person thinks and behaves. The classic example was Phineas Gage, who in 1848, accidentally blasted an iron rod through his skull, damaging his left frontal lobe. History records that Gage’s well-mannered, pleasant demeanour changed suddenly into a fitful, irreverent, obstinate and capricious man whose workmates could no longer stand him [6]. Medical science has documented numerous cases of damage to the right ventromedial prefrontal cortex causing acquired sociopathy [7]. How can the mind be in control of the brain when an injury to the brain causes a sudden change in thought pattern and behaviour? Clearly one CAN blame the physical brain for one’s decisions and actions. Strike three. You’re out.

Dr Leaf is welcome to comment here. Perhaps she meant something completely different by her post, although there’s only so many ways that such a statement can be interpreted.

Ultimately, Dr Leaf’s love of posting pithy memes of dubious quality is now getting embarrassing. Being so far behind the knowledge of a subject in which she claims expertise is ignominious. Undermining her own premise and contradicting herself is just plain embarrassing. But to be so insensitive to some of the most vulnerable is poor form. I think she’d be well served by re-examining her facts and adjusting her teaching.

References

  1. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  2. Haggard, P., Human volition: towards a neuroscience of will. Nat Rev Neurosci, 2008. 9(12): 934-46 doi: 10.1038/nrn2497
  3. Goldstein, E.B., Sensation and perception. 8th ed. 2010, Wadsworth, Cengage Learning, Belmont, CA:
  4. Kouider, S. and Dehaene, S., Levels of processing during non-conscious perception: a critical review of visual masking. Philos Trans R Soc Lond B Biol Sci, 2007. 362(1481): 857-75 doi: 10.1098/rstb.2007.2093
  5. Tamietto, M. and de Gelder, B., Neural bases of the non-conscious perception of emotional signals. Nat Rev Neurosci, 2010. 11(10): 697-709 doi: 10.1038/nrn2889
  6. Fumagalli, M. and Priori, A., Functional and clinical neuroanatomy of morality. Brain, 2012. 135(Pt 7): 2006-21 doi: 10.1093/brain/awr334
  7. Mendez, M.F., The neurobiology of moral behavior: review and neuropsychiatric implications. CNS Spectr, 2009. 14(11): 608-20 http://www.ncbi.nlm.nih.gov/pubmed/20173686