Lithium

Lithium is a drug, also used in batteries, but the drug lithium has had significant impact on the field of bipolar disorders. The book by Brown, Lithium[1], is a wonderful history of the discovery of lithium as a therapeutic for manic-depression, the earlier name for bi-polar disorders. Cade, the investigator who established its efficacy and effectiveness, was an example of the lone researcher, no funding, and using himself as the Phase I test subject to determine if it were even safe.

I first saw bi-polar disorder in the mid-1950s in a relative. The patient would swing from a normal state, to a depressed state, sometimes exacerbated by alcohol, then rapidly swing to a manic state. The manic state would involve extremes of behavior, avoiding any base in reality, often attempts at life changing actions totally inconsistent with the patient's capabilities. For example, the patient would suddenly want to enter the wholesale fish business, then buy a truck, fill it with fish, and then collapse into a depressive state. Needless to say, the fish were left unattended.

In those days the remedies were limited. There was Bellevue Hospital in New York, a short term critical care facility and then the city mental hospital on Ward's Island. Some patients underwent shock therapy but for many it was just a wait and see. Extreme manic states could be medicated and then electro convulsed.

I saw several other patients during that period, thanks to my grandmother's friend from Medical School days, Dr. Louise Despert, a prominent New York psychiatrist. She dealt with many children and this was often a significant ailment. It was not till the late 1960s that in visits to McLean Hospital, a Harvard affiliate in Belmont MA that I saw the large number of bipolar patients, but by this time various medications were becoming available, lithium amongst them. From 1968 to 1978, the patients in Massachusetts psychiatric facilities went from some 20,000 to less than 2,000, due mainly to the increase in various therapeutics. Many bi-polar patients could now live a normal, as best as possible, life.

Lithium was one of the key therapeutics used. Brown thus details this tale of Cade, returning from WW II, working at an Australian psychiatric hospital, and personally and individually exploring the use of lithium, in a salt form. Cade eventually writes this up and slowly gets some notice, not so much in the 1950s but more so in the 1960s. It is a tale of a researcher focused on a specific disorder with a target medication then facing the world of the professional researchers, some believers and many deniers.  Brown does a superb task in relating the times and the nature of others looking into this disorder, those accepting and those rejecting. Much of what Cade did was before the time of well-structured clinical trials and his approach would not even be allowed in today's world, but Brown shows how quickly Cade was able to demonstrate effectiveness and efficacy, albeit limited.

Brown then continues with the acceptance by the psychiatric community of lithium and how it made life much more acceptable to those with bi-polar disorder. Overall this is a wonderful book showing the dedication and brilliance of Cade and then showing the complexity of getting a new approach accepted by a complex medical community. This is a superb book and worthy of a read.

My only criticism, and this is quite limited, is that a better understanding of the bi-polar patients and their plights. For almost all, they have no control of their often extreme and bizarre behavior. Also, as with many therapeutics, pharmaceuticals, the side effects can be quite severe and limits the drug's effectiveness. Most people have limited exposure to bi-polar disorders, but they are more common than one thinks and this book sheds light on these facts.

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[1] https://www.amazon.com/gp/product/1631491997/ref=ppx_yo_dt_b_asin_title_o03_s00?ie=UTF8&psc=1

Writing

Real Clear Markets provides advice, modified by me, on writing[1]:

1. Scarcity: Time is a scarce resource, especially the time of a student. Thus, there is no reason to tell the student everything you know, albeit organized in some fashion.

2. Specialization: There is a great difference between a professional paper for a select group, often critical, and what one writes for a student.

3. Preparation: Some writers can write with ease, yet organize with difficulty and others the opposite. The skill of good organization and good clear writing is critical.

4. Clarity: All too often one sees an author set for a complex equation with no details as to what any of the terms mean. There may be the compulsory figure but no nexus.

5. Efficiency: Deal with the principles, define them clearly, keep notation simple but complete, and never assume.

6. Skimming: Write in a manner where the key facts are evident, do not make the reader search for a key element that you have hidden elsewhere.

7. Competition: There are many other writers who want to convey their understanding of what one is writing about. The writer must understand that they are in a competitive market and who the customer is and how to meet the customer's needs. All too often one sees the "one star" review which states, "my instructor made us buy this book but none of use could understand it."

8. Individuality: Writing so as to clearly convey one's understanding and at the same time one's intent to convey it to the reader. The document should be a written lecture, engaging the reader not terrifying them.

9. Punchlines: The classic approach of telling what you will say, say it, then tell what you said has merit. Framing and outlining what and where you mean to take the reader is essential.

10. Knowledge: Understand your reader and what they may or may not know. Balance the presentation and avoid assuming facts not in evidence.

11. Responsibility: Ultimately the writer is responsible for the document.

12. Feedback: If you are fortunate to have critical readers that can be the most useful tool available. Having someone say, "what does this mean" opens doors to explanations that not only help the reader but also the writer.

13. Editors: There are good editors and bad editors. A good editor can take your book and give you visibility to its weak points. The improvement is up to you. The bad editor tells you how to write.

14. Self-Assessment: It is easy often to be critical of others while being blind to our own poor attempts. I can go back over my books and tell you what are good and what are not so good. The real question is; what does the reader think. Any form of self-assessment must be grounded in the old dictum; "if all else fails listen to the customer".

15. Endings: I have mixed feelings on endings. On the one hand they may be a summary, on the other a discussion of trends, what you did not cover, or even opportunities for future research. Often few read the endings, yet they can be a platform for new ideas.

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[1] https://www.realclearmarkets.com/articles/2019/08/28/how_the_aspiring_can_learn_to_write_like_economists_103883.html

Pyramids for Pharaohs

The recent tales of woe from the MIT Media Lab have raised concerns over funding of universities, I believe in general. In a NY Times article the writer states:

Epstein’s infiltration of M.I.T. shouldn’t even be much of a surprise; from the Kochs to the Sacklers to the Saudis to sundry endowed chairs and fancy corporate institutes, American higher education has long been hooked on billionaires. The billionaires aren’t dumb — they go after the universities because our idea factories have proven to be susceptible to all their wealth. Giving money to higher education amplifies a billionaire’s legacy. The money greases hiring decisions and shapes curriculums, and it can ricochet across the wider culture for decades, even after the billionaire himself has shuffled off this mortal coil. Note how Charles and David Koch used higher-education philanthropy to push a libertarian intellectual agenda that influenced policy wonk circles across the country. The Sacklers, meanwhile, used their opioid-derived loot to insulate the family name from the horrors that the family business was wreaking across the country.

Now I will suggest there is a great deal more here than meets the eye. Before that one should read the MIT Tech, the student newspaper, which had a piece by a person affiliated with the Media Lab, the Poetry Project, who preceded the Times writer by a couple of days, and who noted:

But billionaires don't deserve to have the final say on arts and science funding in the first place. They don’t deserve to be the people after whom libraries, art wings, or cancer research centers are named. Big donors are a tiny subset of the population — and terrifyingly skewed in terms of race, gender, and age — and it does our research no favors to be beholden to a funding structure that requires catering to their impulses. In fact, most billionaires don’t deserve their status at all, considering how the livelihoods of the 1 percent have been built on the backs of slavery, oppression, and tax evasion. Even the billionaires who aren’t convicted criminals are guilty of the crime of being too rich in a country where around 40 million people live in poverty. We have become too used to seeing billionaire names plastered in large font across our hospitals, our theaters, our parks. The next time we walk past them, let us remember the staggering injustices these big names represent.

First perhaps some history. In 1986 I was head of R&D for NYNEX, now Verizon, and in that position provided a great deal of funds to the new Media Lab. My focus was on Multimedia Communications, a melding of computers, communications and media in the broadest sense. In 1989 I taught the first course in Multimedia Communications, at MIT, a reference still apparently in demand. I tried to meld EECS and the Media Lab, but it was oil and water. The Media Lab was famous for demos, whereas the EECS Department did fundamental research in a wide variety of areas and focused on more classic approaches. Thus a cultural divide, deeper than anything I could see. Thus, I have some modicum of bona fides in the area.

Funding then was primarily by grants and Government contracts but commercial entities also provided some. But it was clear that anything NYNEX gave would be used in a manner solely determined by the researcher and not control of direction could be given. The theme was; give us the money and then go away. That was even true for the Media Lab. In fact given the funds I provided them over the early years NYNEX to my knowledge never even received a thank you note. But that was the way academics worked.

Now as to the above allegations. Take money influencing hiring. I would strongly disagree. Faculty make those decisions. Faculty select those who they like, it is a self-replicating group think, which may from time to time be stultifying, but it never appeared to me that any money could influence that. Now as to the Koch donation, I again doubt that the Koch's demanded cancer research be politically correct in accord with their principles. In fact, I hazard to guess that there are few if any Republicans in the building, no less hard-core conservatives. Self-selection at work. Further the Kochs would not have a clue as to how to direct cancer research, no less than Whitehead or Broad. They equally funded a broad-based facility for Cancer research which gets its day to day project funding from a variety of sources, many being NIH, NCI and others.

Next the animosity towards billionaires is rather senseless. Rockefeller Institute is a major foundation contributing to major insights in a wide variety of medical areas, none of which were directed by John D. The funding often is for edifices and infrastructure, facilities wherein research is performed.

Now this is not all benign. I have argued that MIT has allowed for a restructuring of its EECS Department into what I shall call a Pyramid, named for a pharaoh, who donated or made to be donated some billion dollars. Thus, my alma mater may no longer be MIT but some pyramid for some pharaoh.

There are now lots of these pyramids being built around the country and many billionaire pharaohs paying for them and in turn having them named for them for posterity. Fundamentally this is not a problem. What is the insidious problem is that these new edifices demand significant finds to maintain? Funds for research are just that, funds for the people and specific research facilities. It may include an overhead and if one has lots of pyramids on the campus the overhead explodes. Thus, funding becomes more limited and tuition explodes. The alleged good works of the pharaohs and their pyramids is overridden by the explosion of costs to maintain the pyramids. The Egyptian pharaohs just died and closed off the pyramid, there were no maintenance costs.

When I was a grad student and junior faculty member, we had old Building 20, the remnants of the WW II Rad Lab, a broken down wooden edifice, infested with mice, leaky and God knows what else. It was not a pyramid and its was named Building 20, that's all.

Perhaps we should consider returning to that, Course VI in Building 20. No pharaohs, no pyramids.

Happy Labor Day