Lovely interview, Owen. So glad you're out there sharing your story and working for quality public health messaging. And this hit home: "the road to hell is paved with great ideas for what you should do for yourself, and so I try not to be my own doctor to the degree possible".
As both a patient and a physician, Dr. Muir provides a great example of a collaborative relationship between a doctor and a patient that is based on mutual respect and trust. Interestingly, he also experiences that collaboration within himself as an individual who is simultaneously an insightful doctor and an insightful patient. Because certified peer support specialists today have such an influential role in mental health policy in my community, one that is sometimes frustrating to me as a parent caregiver for an adult living with schizophrenia, it is this combination that I would like to see more often: Replace the disrespect, distrust, and unawareness I too often hear in contentious arguments about treatment and civil rights with true collaboration. Bravo, Dr. Muir!
"There is little I can imagine relating to more? I have a relationship with whatever bipolar disorder is. It is complicated. I’ve written about it before. I think any common condition when we’re talking about neuropsychiatric illness, exists in the population because those same underlying genetics provide an advantage. It might not be an advantage to the person at the moment, but there is a definite advantage to the gene pool for having some people around who have bipolar disorder. That’s a scientific way of saying we need each other. And we need some people who have big ideas. And sometimes, people who are prone to big ideas can go off the deep end. And then we need to support those people on the way back. Because without them, we don’t have any big ideas. We also need people who support, are even-keeled, and are cautious. It’s that teamwork of humanity that I relate to the most."
This is what I was getting at with a comment to an earlier post. There are lots of philosophers and enthusiastic tech-bros who are totally on board with eugenics, as long as we don't actually murder people. But they want to eradicate "bad genes" from the gene pool, like "mental illness genes".
This is bad. And it is NOT the same thing (as someone claimed in response to me) as inventing new vaccines, medications or other treatment methods.
Wonderful interview, loved getting to know Dr. Muir's story.
> To give you an example, the randomized control trial of fMRI guided SAINT was halted at an interim analysis by the institutional review board because it showed a large effect size and it would’ve been unethical to continue withholding this highly effective treatment from suffering people.
Is it widely accepted the observed effect size in unbiased and free from magnitude errors? I'm curious if there are any arguments of such a nature that have been well received amongst clinicians.
It's depends who is in your trial and the rate of placebo response in that population.
In the case of Saint, they enrolled highly treatment or Factory individuals and had a vanishing low placebo response (sham is the term in device trials)
It's not ethical to study parachute versus sham parachute, because the rate of death is 100%. In the framing of any question, you end up with a similar issue.
Lovely interview, Owen. So glad you're out there sharing your story and working for quality public health messaging. And this hit home: "the road to hell is paved with great ideas for what you should do for yourself, and so I try not to be my own doctor to the degree possible".
Thanks Carl. Appreciate it from you, especially
As both a patient and a physician, Dr. Muir provides a great example of a collaborative relationship between a doctor and a patient that is based on mutual respect and trust. Interestingly, he also experiences that collaboration within himself as an individual who is simultaneously an insightful doctor and an insightful patient. Because certified peer support specialists today have such an influential role in mental health policy in my community, one that is sometimes frustrating to me as a parent caregiver for an adult living with schizophrenia, it is this combination that I would like to see more often: Replace the disrespect, distrust, and unawareness I too often hear in contentious arguments about treatment and civil rights with true collaboration. Bravo, Dr. Muir!
Thanks so much!
"There is little I can imagine relating to more? I have a relationship with whatever bipolar disorder is. It is complicated. I’ve written about it before. I think any common condition when we’re talking about neuropsychiatric illness, exists in the population because those same underlying genetics provide an advantage. It might not be an advantage to the person at the moment, but there is a definite advantage to the gene pool for having some people around who have bipolar disorder. That’s a scientific way of saying we need each other. And we need some people who have big ideas. And sometimes, people who are prone to big ideas can go off the deep end. And then we need to support those people on the way back. Because without them, we don’t have any big ideas. We also need people who support, are even-keeled, and are cautious. It’s that teamwork of humanity that I relate to the most."
This is what I was getting at with a comment to an earlier post. There are lots of philosophers and enthusiastic tech-bros who are totally on board with eugenics, as long as we don't actually murder people. But they want to eradicate "bad genes" from the gene pool, like "mental illness genes".
This is bad. And it is NOT the same thing (as someone claimed in response to me) as inventing new vaccines, medications or other treatment methods.
Wonderful interview, loved getting to know Dr. Muir's story.
> To give you an example, the randomized control trial of fMRI guided SAINT was halted at an interim analysis by the institutional review board because it showed a large effect size and it would’ve been unethical to continue withholding this highly effective treatment from suffering people.
Is it widely accepted the observed effect size in unbiased and free from magnitude errors? I'm curious if there are any arguments of such a nature that have been well received amongst clinicians.
It's depends who is in your trial and the rate of placebo response in that population.
In the case of Saint, they enrolled highly treatment or Factory individuals and had a vanishing low placebo response (sham is the term in device trials)
It's not ethical to study parachute versus sham parachute, because the rate of death is 100%. In the framing of any question, you end up with a similar issue.