The most interesting thing about the Nobel Prize in Medicine is its predictable irrelevance to major health problems. Year after year, the prize-winning work has failed to reduce heart disease, cancer, depression, stroke, diabetes, schizophrenia, and so on. Another interesting thing about the Nobel Prize in Medicine is that Eric Kandel, a Columbia Medical School professor, managed to win one. In 1986, a book called Explorers of the Black Box: The Search for the Cellular Basis of Memory by Susan Allport told how Kandel tried to take credit for other people’s discoveries. Not a pretty picture. Yet in 2000 he won a Nobel Prize for those or very similar discoveries. Did Allport exaggerate? Did her sources deceive her? Did Kandel — contrary to what Allport’s book seems to say — deserve a Nobel Prize?
I can’t answer these questions. However, a recent article by Kandel (“A New Science of Mind”) in the New York Times sheds light on how well he understands medicine and neuroscience. Not well, it turns out. He writes:
We are nowhere near understanding [psychiatric disorders] as well as we understand disorders of the liver or the heart.
Actually, our understanding of liver and heart disorders is close to zero, matching our understanding of psychiatric disorders. If we had some understanding of heart disease, for example, we would know why heart disease is much rarer in Japan than in the United States.
Kandel goes on to say “the prefrontal cortex . . . is the seat of executive function and self-esteem.” The self-esteem claim is apparently based on this study. Okay, people with low self-esteem may be more sensitive to feedback than people with high self-esteem. That one region in the brain exhibits such a difference doesn’t show it is “the seat of self-esteem” — whatever that means. Perhaps other regions also show such an effect. It would make as much sense (none) to say the prefrontal cortex is “the seat of feedback”. In addition, Kandel apparently fails to realize how often these imaging studies yield false positives. One imaging study is not enough to conclude anything.
Kandel makes a big deal of one particular study:
In a recent study of people with depression, Professor Mayberg gave each person one of two types of treatment: cognitive behavioral therapy, a form of psychotherapy that trains people to view their feelings in more positive terms, or an antidepressant medication. She found that people who started with below-average baseline activity in the right anterior insula responded well to cognitive behavioral therapy, but not to the antidepressant. People with above-average activity responded to the antidepressant, but not to cognitive behavioral therapy. Thus, Professor Mayberg found that she could predict [emphasis added] a depressed person’s response to specific treatments from the baseline activity in the right anterior insula.
Mayberg looked at many brain areas (how many is unclear from the abstract). Maybe 30 areas. Fromh those 30 areas, she picked the region that best discriminated responses to the two types of therapy. This means little. If you look at enough brain regions, you will always find one that, purely by chance, discriminates rather well. Mayberg did not show that the particular region she emphasized (the right anterior insula) has any predictive power. She did not do a second study to make sure her results were not pure chance. The abstract emphasizes this (“if verified with prospective testing . . .”). Contrary to Kandel, Mayberg correctly predicted nothing.
Mayberg’s study could not be weaker, yet Kandel places great weight on it.
These results show us four very important things about the biology of mental disorders. First, the neural circuits disturbed by psychiatric disorders are likely to be very complex. [The results, which are relatively simple, do not show this.]
Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication. [Biomarker means biological correlate. The study was not about biological correlates of depression. It was about predictors of treatment response. Those predictors were measured before treatment, when all subjects were depressed. They were not measured after treatment.]
Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does. [In Mayberg’s study, “brain glucose metabolism was measured with positron emission tomography prior to treatment.” As I said, it wasn’t measured after treatment, so the study could not provide evidence that psychotherapy changed the brain.]
And fourth, the effects of psychotherapy can be studied empirically. [We already knew this. There have been thousands of empirical studies of psychotherapy.]
What a mess.
The article goes on to say impenetrable stuff like this:
This new science of mind is based on the principle that our mind and our brain are inseparable. The brain is a complex biological organ possessing immense computational capability: it constructs our sensory experience, regulates our thoughts and emotions, and controls our actions. . . . Our mind is a set of operations carried out by our brain. The same principle of unity applies to mental disorders. In years to come [emphasis added] this increased understanding of the physical workings of our brain will provide us with important insight into brain disorders, whether psychiatric or neurological. But if we persevere, it will do even more: it will give us new insights into who we are as human beings.
This is in the grand Nobel Prize in Medicine tradition. The honored work, we are told by the press release, will be terribly useful in the future, although it was done twenty years ago and so far hasn’t been useful at all.
I asked Kandel for comment. He did not reply. Whether Kandel’s understanding was ever better than this, I don’t know.