Why do we keep stalking bears, when we only find scat in the woods?

Hans Ormel’s contribution to psychosomatic scatology

James C. Coyne, PhDProfessor Emeritus, University of Pennsylvania

Professor, University of Groningen, University Medical Center Groningen (UMCG), The Netherlands

“Discovery” -> Disappointment -> Decline.

Recurring cycles of premature, exaggerated, and simply false “discoveries” concerning negative emotion and health.

Hans Ormel’s work can be used to set a higher threshold for future declarations of “discoveries.”

John Snow and the Broad Street Pump Handle

  

For over half a century, researchers in psychosomatic medicine have stalked an elusive trophy bear, a modifiable connection between negative emotion and morbidity and mortality.

Claims of finding one have attract considerable attention again and again, only to lead to embarrassing disconfirmations.

Depressive symptoms linked to

Death, dementia, coronary artery disease, cancer, asthma, diabetes, Parkinson’s disease, COPD, headaches, insomnia, acne, health problems after pregnancy, lower back pain, anorgasmia, premature ejaculation, impotence, hypertension, HIV viral load, poor glycemic control, constipation, diarrhea, nausea, chronic pelvic pain, incontinence, …and flatulence.

Just as many oncologists now view pain as a symptom to be treated, they should also consider depression a symptom to be treated to improve quality of—and possibly extend—life.

The National Heart Lung and Blood Institute ENRICH-D trial was an expensive attempt to show we could save cardiac patients from re-infarction and death by improving the outcome of their depression.

Clinical depression was the identified bear.

But in hindsight, ENRICH-D does not seem to have been on the trail of a bear. Maybe was just making too much of scat in the woods.

Bear Scat

ENRICH-D presumed clinical depression was the long sought bear-modifiable risk factor. 

Target may only have been scat on the trail—uniformative risk marker. 

Shooting scat does not reduce mortality.

Coyne JC, van Sonderen E: The Hospital Anxiety and Depression Scale (HADS) is dead, but like Elvis, there will still be citings. Journal of Psychosomatic Research. 73:77-78.

Meehl (1990) applied “crud factor” to the broader tendency of self-reported negative factors to be correlated in ways that cannot readily be unambiguously differentiated. 

Ketterer MW, Denollet J, Goldberg AD, McCullough PA, John S, Farha AJ, et al. The big mush: psychometric measures are confounded and non-independent in their association with age at initial diagnosis of Ischaemic Coronary Heart Disease. J Cardiovasc Risk 2002; 9(1): 41-48.

Lesperance and Frasure-Smith

Denollet et al. added a new term – the distressed personality (Type D) – to a field congested with related concepts including type A personality, anger and hostility, psychological stress, vital exhaustion, major depression, depressive symptoms, and social isolation. Each of these concepts enjoyed a period of prime time exposure following publication of one or more epidemiological reports linking it to mortality in patients with CHD and then declined in popularity.…

John Ioannidis

Most “discoveries” in biomedical literature are premature, exaggerated, or simply false.

Apparent discoveries are created and perpetuated by a combination of confirmatory bias, flexible rules of design, data analysis and reporting, and significance chasing.

Beware of unexpected large findings from small samples.

The psychological sciences may be particularly susceptible because many of the psychological variables and outcomes measured and analyzed are often convoluted, complex, and highly correlated.

There is large flexibility in definitions, uses of cut-offs, modeling, and statistical handling of the data, hence large room for exploratory analyses.

John Ioannidis (2012)

Obliged replication: Proponents of dominant view are so strong in controlling the publication venues that they can largely select and mold the results, wording, and interpretation of studies eventually published.

John MacLeod and George Davey Smith

Challenge of distinguishing causal influence of negative affect from other negative environmental and physical health variables.

 High likelihood of noncausal relationships generated by confounding between self-reported negative affect and physical health outcomes.

 Residual confounding often impossible to rule out.

Plausible biological mechanism can almost always be cited, so not a good way of excluding spurious findings.

Hans Ormel -- Neuroticism: a non-informative marker of vulnerability

Broad set of items describing anxiety, insecurity, irritability, anger, hostility, worry, depression, frustration, self-consciousness, emotionality, sensitivity to criticism, stress reactivity, and impulsiveness.

Hans Ormel -- Neuroticism: a non-informative marker of vulnerability

Prospective studies of associations of neuroticism with mental health outcomes are basically futile, and largely tautological since scores on any characteristic with substantial within-subject stability will predict, by definition, that characteristic and related variables at later points in time.

Hans Ormel

What about hard biomedical outcomes…like death?

Need to rule out antecedent and concurrent associations with known risk factors.

Persons with physical conditions register their malaise on measures of negative emotion.

“Negative emotion predicts survival”

Another unexpected large effect from small study?

Flexible rules of collecting, analyzing interpreting data?

Spurious association convincingly ruled out?

Only that negative emotion?

Risk factor or uninformative risk indicator?

What’s wrong with continuing to stalk the bear?

Continued embarrassment, decreased credibility

Squandering of research and clinical resources

Denigrating of genuine accomplishments of behavioral medicine in terms of reducing behavioral risk factors

AvaIIable distorted by obliged replication Bad message to junior scientists