The character Melinda Gordon in CBS’s fantasy TV series Ghost Whisperer, played by Jennifer Love Hewitt, is based on a real-life resident of North Royalton, Ohio. Her name is Mary Ann Winkowski, and she sports a silver Cadillac with a license plate reading “SPIRIT” (Kachuba 2007, 202). But can she really talk to ghosts?

Introduction

Winkowski does not claim to communicate with spirits who have “crossed over” to the Other Side, the purview of “mediums”; rather, she says she “can only see and talk to earthbound spirits,” claiming, “I talk to the spirits and find out who they are and why they didn’t cross over.”

Her belief in a dimension where ghosts hang out is nothing new. It is basically a version of purgatory, which in Catholic dogma is a place (or state) “where souls are purged of sin before going to heaven” (Severy 1971, 381). Not surprisingly, Winkowski was raised Catholic. And just as the faithful are urged to assist those in purgatory by prayer and penance (Stravinskas 2003, 626–627), Winkowski believes she and others can guide spirits who lag behind for whatever reason—such as being attached to a thing or place, seeking revenge, fearing judgment (for suicide or other wrongdoing), etc. (Winkowski 2007, 81–104).

She claims to have been freeing earth­bound spirits since the age of four, when her Italian grandmother began taking her to neighborhood funerals. She would “see” the dead—who are “always there, right by the casket,” she says—then envision “the White Light” and direct spirits to it. Eventually, after becoming a wife and a mother, she was so sought after that she “had to start asking for a little bit of money” and was “basically forced into making it a business” (Winkowski 2000, 11–13, 19–20, 35). In her work, she mixes Catholic and New Age practices—for example, using holy water (water blessed by a priest) to dispel malignant entities and scattering quince seeds around a house “as protection” (2000, 162–167; 2007, 228–234). By means of the power of suggestion, such actions can have a beneficial effect, at the expense of encouraging superstition.

A Question of Evidence

In her books—As Alive, So Dead (2000) and When Ghosts Speak (2007) Winkowski provides no acceptable proof of her alleged ability. Some of her evidence is laughable. One published photo, sent by a client, purportedly depicts a spirit energy but is actually the result of the flash rebounding from the camera’s wrist strap, a common phenomenon (Nick­ell 2001, 128–131). Other “spirit” photos showing orbs, mists, and shapes (Winkowski 2007, illus. fol. p. 82) have similar mundane explanations (see Nickell 2008b).

The same is true of other phenomena reported by—or to—Winkowski, including the sounds of footsteps and other noises, the effects of drafts and warm spots, and indeed almost anything: Headaches may be “a sign of a curse or negative energy,” she says, and insomnia can be a sign of “an earthbound spirit in your home” (Winkowski 2007, 198–210). Missing pieces of a board game, drained batteries, a broken toy—all may be caused by “child ghosts,” asserts Win­kowski (2007, 208). She experiences a ghostly visitation (Kachu­ba 2007, 206) that is obviously only a common “waking dream” (one that occurs in the twilight between being fully awake and asleep—see Nickell 1995, 55). She even naively relates versions of the “vanishing hitchhiker” folktale (Winkowski 2000, 189–191).

Contradictorily, she describes ghosts as “pure energy,” a life force that survives death (Winkowski 2007, 41), yet she maintains that earthbound spirits “smoke, comb their hair, change their clothes—all those things we always do, too. Only I’ve never been able to figure out where they get the stuff from” (2000, 150). Indeed, the supposed spirit-world existence of inanimate objects is revealing: apparitions of people appear fully clothed and are often accompanied by objects, just as they are in dreams, because the clothes and objects are required by the apparitional drama (Tyrrell 1973). That is to say, the source of “the stuff” that puzzles Win­kowski is the imagination.

As to her ability to talk with ghosts, Winkowski offers only anecdotal evidence, nothing constituting scientific proof. When Shakespeare’s character Glendower asserts, “I can call spirits from the vasty deep,” Hotspur counters, “Why, so can I, or so can any man; but will they come when you do call for them?” (King Henry IV, I.3.1). In fact, we know that death brings a cessation of brain function and consequently an end to the ability to think, walk, or talk. So why do Winkowski and others believe they can converse with spirits?

Fantasy-proneness

Although Winkowski distinguishes herself from both mediums and psychics (she claims no future-telling ability), she nevertheless shares much in common with them and other paranormal claimants, including alien abductees. Such persons tend to exhibit an array of traits that indicate a fantasy-prone personality. In their pioneering study, psychologists Cheryl Wilson and Theodore Barber (1983) listed several identifying characteristics of people who fantasize profoundly. Called “fantasizers,” such individuals fall within the normal range and represent an estimated 4 percent of the population.

For the past several years, I have been applying Wilson and Barber’s findings to the biographies and autobiographies of a number of contemporary and historical individuals, ranging from psychics, like Sylvia Browne and Dorothy Allison, to prophets, like Jeane Dixon and Edgar Cayce, as well as others, including many alien abductees, like Whitley Strieber. I have considered the possession of six or more of the identified characteristics to indicate fantasy- proneness. As shown by her own statements, Winkowski—like the others mentioned here—clearly fits the profile of a fantasizer.

For example, (1) as a child she had ap­parent imaginary playmates (Win­kow­ski 2000, 10–14), although she insists they were not imaginary; (2) she claims to receive special messages from paranormal entities (2000; 2007); (3) she is a good hypnotic subject and (4) through past-life regression has had fantasy identities in the form of “several lives” (2000, 28); (5) she has had hypnagogic/hypnopomic experiences, or waking dreams, with (6) classic strange imagery (Kachuba 2007, 206–207) and (7) frequently encounters apparitions (Winkowski 2000; 2007); (8) moreover, while insisting she is “not psychic—at least not in the traditional sense”—she be­lieves she channels energy, creates “White Light” and directs spirits to it, lifts curses, and so on (2000, 92, 176; 2007, 222).

Taken together, the evidence strongly indicates that Mary Ann Winkowski, “The Real Ghost Whisperer,” is only participating in elaborate encounters of her own imagination. Like “visionaries” who receive messages from the Virgin Mary or “contactees” or “abductees” who are in touch with space aliens, mediums and ghost whisperers are merely communicating with an adult version of a child’s imaginary playmate. Such fantasizers have rich imaginative lives and, often, a receptive audience, since they tap into shared hopes and fears. But they simply deceive first themselves, then others. l

Acknowledgments

I am indebted to the late psychologist Robert A. Baker for past guidance in studying fantasy-proneness. Timothy Binga, director of Center for Inquiry Libraries, assisted with research for this article.

References

Kachuba, John. 2007. The real ghost whisperer. Chapter 19 of Ghosthunters: On the Trail of Mediums, Dowsers, Spirit Seekers, and Other Investigators of America’s Paranormal World. Franklin Lakes, NJ: New Page Books.

Nickell, Joe. 1995. Entities: Angels, Spirits, Demons, and Other Alien Beings. Amherst, NY: Prometheus Books.

———. 2001. Real-Life X-Files: Investigating the Paranormal. Lexington, KY: University Press of Kentucky.

———. 2008a. Catching ghosts. Skeptical Briefs 18(2): 4–6.

———. 2008b. Photoghosts: Images of the spirit realm? Skeptical Inquirer 32(4): 54–56.

Severy, Merle, ed. 1971. Great Religions of the World. Washington, DC: National Geographic Society.

Stravinskas, Peter M.J. 2002. Catholic Dictionary. Huntington, IN: Our Sunday Visitor.

Tyrrell, G.N.M. 1973. Apparitions. London: The Society for Psychical Research.

Wilson, Cheryl C., and Theodore X. Barber. 1983. The fantasy-prone personality. In Imagery: Current Theory, Research, and Applica­tion, ed. Anees A. Sheikh, 340–387. New York: John Wiley and Sons.

Winkowski, Mary Ann. 2000. As Alive, So Dead: Investigating the Paranormal. Avon Lake, OH: Graveworm Press.

———. 2007. When Ghosts Speak: Understanding the World of Earthbound Spirits. New York: Grand Central Publishing.

Dr. David Dosa, a geriatrician, offers the remarkable notion that a Rhode Island nursing-home cat named Oscar has a predictive ability: knowing when a patient is about to die. Dosa’s book, Making Rounds with Oscar: The Extraordinary Gift of an Or­dinary Cat (2010), is based on an essay by Dosa that appeared in the New En­gland Journal of Medicine (NEJM). It alleged that since staff members adopted him two years before, Oscar has “presided over the deaths of more than 25 residents” (Dosa 2007).

The NEJM piece was an essay and in no sense a scientific article, which raises questions about why it was published. If we expected the book to provide something resembling scientific evidence, we are again disappointed. Dosa seems primarily motivated to produce a sympathetic, insightful account about dementia patients, and there is nothing wrong—indeed, everything right—with that. (As one whose mother had Alzheimer’s, I am, unfortunately, all too familiar with the heartbreaking issues involved, including the toll on family members. Until her death, I used my allotments of vacation time to travel across four states to be with my mother and invariably left the visits with tears streaming down my face.)

Enter Oscar the cat. Few would dispute that pets can provide therapeutic benefits to patients and family members. And there is little harm in ascribing human feelings and motives to the animal: a woman maintaining a vigil for her dying mother said, “[Oscar] was really there for me” (Dosa 2010, 188). (This ascription of human traits or feelings to objects, deities, or, in this case, animals, is known as anthropomorphism.)

However, it is another matter to ascribe magical powers to animals. A patient told Dosa, “Animals have this sixth sense and they can communicate with us if we understand their language.” She claimed her own cat “always knew whenever I was sick or my arthritis was acting up. He would jump on my bed and just sit with me” (21, 22). A woman whose father died said of Oscar, “This beautiful creature was sending us a sign” (149).

Dosa ventures possible explanations for the supposed phenomenon (68):

When you consider it from a scientific point of view it’s easy to shrug off suggestions that a cat can predict death. It’s so much easier to say that he’s just sitting with those patients because of the activity—the gathering of family, the holding of hands, the saying of good-byes. It just makes more sense. Or maybe he just likes to hang out with dying people because they don’t bother him. Most cats sleep two thirds of the day anyway, so chances are a cat is going to be found on a warm bed somewhere.

Again, Dosa observes (217–218):

As cells die, carbohydrates are de­graded into many oxygenated compounds, including various types of ketones—chemical mixtures known for their fragrant aroma.... Could it be that Oscar simply smells an elevated level of a chemical compound released prior to death? It is certainly clear that animals have a refined sense of smell that goes well beyond that of the ordinary human.

However, he adds, “I like to think of Oscar as more than a ketone early-warning system.”

Here we should note the cautionary principle known as Hyman’s Categorical Imperative (after distinguished skeptic Ray Hyman [Alcock 1994, 89]): “Do not try to explain something until you are sure there is something to be explained.” In the case of Oscar, the prescient cat, that certainty is far from having been established, as we shall see.

Dosa’s thinking about Oscar was influenced by a nurse named Mary: “Nothing happens on the unit,” he says, “without her knowing about it. Even her supervisors have been known to defer to her” (3). She possesses “intuition” and “always seems to know who actually needs the most attention” (6)—a quality projected onto Oscar. Throughout the book Mary declares her belief that “Oscar only spends time with patients who are about to die” (8), although some family members believe Oscar is there not for the dying but for the living. “I think he was there for me,” one said. “In fact, I’m sure of it” (182).

Mary admits she also would “like to think” that there is something more to Oscar’s alleged ability than, say, smell (64). Dosa reports that she “hated my I’m a scientist talk” (68) and that she concedes, “I’m a dyed-in-the-wool animal lover. It’s not like I’m objective” (190). Yet Dosa singles her out in his acknowledgments, saying that it was she “who helped me collect many of the stories that appear in this book” (224).

Dosa’s use of the word stories is instructive. His evidence is the kind disparaged in science as anecdotal. That is, it is based on personal narratives that may be affected by mistaken perceptions, faulty memory, folkloric influences, and many other faults.

Hearsay may creep in (as it has done regarding Oscar [e.g., 213]). Biased selection is a very real problem: there is a natural tendency for believers in some phenomenon to collect stories supporting it, just as there is for disbelievers to collect stories discrediting it. In 225 pages of text (relating some sixteen of Oscar’s supposed successes), Dosa fails to mention a single instance of Oscar failing to predict death correctly; yet in a beginning note he begs readers to “forgive the occasional mistakes” the cat “makes from time to time.”

Oscar’s purported ability was first noted when he was just a kitten and jumped onto the bed of a patient who died later that day. But Oscar often came and went (and was generally characterized as going “in and out” of patients’ rooms [181, 182]). Never-the­less, once people began “talking about Oscar,” staff began collecting—even manipulating—the evidence. In at least one instance, the kitten was actually placed in the bed of a dying man (67). (Reportedly, Oscar ran away, only to return a day and a half later when the man really died.) One wonders, was Oscar placed or coaxed into rooms of other dying patients?

Moreover, Dosa admits that “for narrative purposes” he has “made some changes that depart from actual events” and that “some of the characters that appear in this book are composites of multiple patients” (v). In other words, there is no point in trying to evaluate the anecdotal evidence: it has been manipulated—in the interest of telling a good story, of course—so it is scientifically worthless.

Although Oscar takes his place among other alleged animal prodigies (Nickell 2002)—like the dog that supposedly knew when her owner was coming home (Wiseman et al. 1998)—Dosa’s own assessment at the end of his suggestive book is quite equivocal (219):

I don’t really pretend to know the nature of Oscar’s special gift—I am not an animal behaviorist nor have I rigorously studied the why and how of his behavior. Whether he is motivated by a refined sense of smell, a special empathy, or something en­tirely different—your guess is as good as mine.

Oh, I didn’t know we were just guessing. My guess is that Oscar is a magnet for fuzzy thinking. l

Acknowledgments

I am grateful for research assistance from CFI Libraries Director Tim Binga, as well as my wife, Diana Harris.

References

Alcock, James. 1994. An analysis of psychic sleuths’ claims. Afterword to Nickell 1994, 172–190.

Dosa, David. 2007. A day in the life of Oscar the cat. New England Journal of Medicine 357(4): 328–329.

———. 2010. Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat. New York: Hyperion.

Nickell, Joe, ed. 1994. Psychic Sleuths: ESP and Sensational Cases. Buffalo, NY: Prometheus Books.

———. 2002. Psychic pets and pet psychics. Skeptical Inquirer 26(6): 12–15, 18.

Wiseman, Richard, Matthew Smith, and Julie Milton. 1998. Can animals detect when their owners are returning home? An experimental test of the “psychic pet” phenomenon. British Journal of Psychology 89: 453–462.

In the late 1980s and early 1990s, one pharmaceutical company was named the world’s “most admired” company by Fortune magazine seven years in a row. During those years, the pharmaceutical industry was widely recognized for its integrity and productivity. What more noble activity is there than curing or preventing disease? Much of the progress in the pharmaceutical industry was based on foundational biological science performed by academicians and government scientists.

However, for the last ten years, there has been intense criticism of the research pharmaceutical industry over questionable practices (see table 1) (Angell 2004, 2008; Relman 2008; Steinbrook 2009). Although the industry argues that many of these practices are actually positive (e.g., direct-to-consumer advertising “educates” the public), the consensus of those outside the pharmaceutical industry is that these practices are, on balance, harmful. In fact, although there are many well-documented flagrant examples in newspapers, magazines, and books, it is extremely difficult to obtain quantitative data on the frequency of these practices. However, in general, I agree with these criticisms (see table 1). The industry has also been criticized for the lack of research and development productivity considering the amount of money spent.

But to obtain a balanced view of pharmaceutical progress (or lack thereof), we need to step back, define a few terms and concepts, and make explicit certain assumptions. Only then can we evaluate the “good” done by new pharmaceutical products over the last thirty years versus the abuses in table 1. I will refer to drugs by their chemical names and use generic (off patent) examples as much as possible, since generics are generally much cheaper and in many cases as good as or better than brand name drugs in their class.

Obviously, pharmaceutical agents, including vaccines, should prolong life or significantly decrease clinical disease and its attendant pain and suffering with minimal or no side effects. In other words, the risk/benefit ratio should favor the patient and the costs should be reasonable.

Generally, in thinking about prevention and treatment, we divide prevention of disease into two categories: primary and secondary. Primary prevention is treatment in high-risk persons to prevent disease; secondary prevention is treatment to prevent further disease. Examples of primary prevention are vaccines to prevent disease or the use of a now generic statin (e.g., simva­statin) to prevent heart attacks and strokes in high-risk persons. With simvastatin, secondary prevention would prevent deaths and further heart attacks and/or strokes in patients with previous episodes (see below). Treatment is the use of drugs to ameliorate disease—sometimes with a curative intent.

To prove the value of preventatives (including vaccines) and treatments, the European Medicines Agency and the U.S. FDA have rigorous “gold standard” criteria discussed in the Method­ological and Statistical section of a recent article in the Skeptical Inquirer and other publications (Spector 2009; Spector and Vesell 2006a). Generally, this involves doing two large (i.e., thousands of patients) randomized blinded trials of the drug versus a placebo (or comparator agent) that both show statistically significant results (Spector and Vesell 2006a). These studies are carried out after dose-finding studies in which the correct dose is determined. Ideally, the endpoint of such trials should be the number of deaths or events (e.g., heart attacks), but sometimes surrogate markers are accepted (e.g., lowering blood pressure or cholesterol) (Spector and Vesell 2006a).

Implicit in these standards is the definition of an ideal drug or vaccine (see table 2) (Spector 2002). Note that ideal drugs and vaccines must also stand the “test of time.” Table 3 shows examples of ideal (or near ideal) drugs discovered, developed, and marketed in the last thirty years. There is now nearly universal agreement (because of the large number of controlled trials) that moderate doses of statins not only lower blood cholesterol but substantially decrease death (secondary prevention) by about 30 percent and heart attacks and strokes by 30 to 50 percent (Scandinavian Simvastatin Survival Study [4S] 1994). To show the quantitative importance of these results, based on data from the 4S trial in patients with stable heart disease or angina, 12 percent died on placebo and only 8 percent died on simvastatin in five years. This 4 percentage point differential (assuming there are ten million U.S. patients with stable coronary heart disease [CHD], a conservative estimate, who took simvastatin) amounts to four hundred thousand fewer deaths due to the drug in five years. Aspirin, beta-blockers, and angiotensin converting enzyme (ACE) inhibitors or sartans (see below) each save about 5 to 15 percent of lives in such patients. When statins are appropriately combined with these drugs, there is probably about a 50 percent improvement in survival, or six hundred thousand lives (per ten million) saved in CHD patients over five years (Baker et al. 2009). In primary prevention, statins decrease heart attacks, strokes, and procedures by 20 to 50 percent depending on the population (Baigent et al. 2005; Brugts et al. 2009). The side effects and cost of moderate doses of statins (now generic) are generally not issues. Notwithstanding these impressive results, there is obviously more work to be done.

The now generic ACE inhibitors and the newer sartans effectively lower blood pressure with minimal side effects and decrease strokes, heart failure, and kidney damage (see table 3) (Spector and Vesell 2006b).

Proton pump inhibitors (PPI), which block stomach acid secretion, have had a huge impact on common stomach and esophageal disorders—disorders, in large part, due to stomach acid—including dyspepsia, ulcer, gastritis, and esophagitis due to acid reflux. Moreover, stomach operations for the complications of stomach and duodenal ulceration (perforation, obstruction, bleeding, and intractable pain) since the marketing of histamine blockers and especially PPI have decreased dramatically. Millions of Americans with these problems have been cured or have had their symptoms controlled with a safe daily pill or two—and no surgery (Spector and Vesell 2006c). Helicobacter pylori, a bacterium that often plays a contributory role in stomach ulceration, is also eliminable with antibiotics (Spector and Vesell 2006c). (This latter work led to a Nobel Prize.)

Certain newer antibacterial agents, including penems and ceftriaxone, save lives with minimal side effects. The penems have a very broad spectrum and kill bacteria (i.e., they are bacteriocidal). Similarly, ceftriaxone is generally bacteriocidal and needs to be given parenterally (i.e., by injection) only once daily—thus allowing for outpatient therapy of serious bacterial infections.

The vaccines listed in table 3, marketed over the last thirty years, are remarkably effective and safe. These vaccines are over 95 percent effective in preventing clinically significant disease (Offit 2008). One exception is the varicella vaccine, after which mild cases can still occur.

Finally, table 3 contains three examples of cancer chemo-preventatives. Hepatitis B, which in the past has infected hundreds of millions of people, can be eliminated by vaccination, with an attendant decline in liver cancer—a consequence of chronic hepatitis B infection (Offit 2008). Similarly, the current papilloma virus vaccines prevent infection with virus types 16 and 18, reducing cervical cancer in women by about 70 percent. And 5-alpha-reductase inhibitors can decrease cancer of the prostate by about 20 percent. These three examples are one of the few bright spots in the war on cancer (see below).

Examples of moderately useful drugs are shown in table 4. Before the mid-1990s, there were no useful, nonhormonal drugs for the treatment and prevention of osteoporosis and fractures—a huge clinical problem. Now, bisphosphonates can prevent approximately 50 percent of vertebral fractures and 25 percent of hip fractures—a good but obviously imperfect result. Moreover, they can be taken orally once weekly, once monthly, or intravenously once yearly (Spector and Vesell 2006b).

The new calcium channel blockers are effective agents in the treatment of high blood pressure but cause edema (swelling) in 5 to 15 percent of users. They do, however, prevent strokes, renal damage, and heart failure more than placebo.

The H-2 histamine blockers inhibit histamine-stimulated acid production by the stomach but are not as effective as the PPI discussed in table 2. However, for the treatment of milder acid-induced stomach disorders (heartburn, dyspepsia, esophageal reflux), they are useful, safe, and very inexpensive.

The tumor necrosis factor alpha (TNF a) blockers are the first of the biotechnology drugs useful in crippling rheumatoid arthritis (RA) and psoriasis. However, they have substantial and serious side effects, placing some patients at risk of severe infectious diseases. Their ability to slow or stop the relentless progression of RA puts the risk/benefit ratio in most patients’ favor, but these patented drugs are also expensive.

Finally, the SSRIs (see table 4) have a complex developmental history in the treatment of depression and generalized anxiety, but what is now clear is that the SSRIs are barely better than placebo in patients with mild depression (Mayer 2008). In severe depression, however, they are unequivocally useful with acceptable side effects. Severe depression is a devastating disease that ruins lives and can lead to suicide and other dire consequences. The SSRIs are helpful in these patients but by no means generally curative (Mayer 2008).

The three vaccines listed in table 4 (which were developed in the last twenty years) prevent shingles, childhood pneumococcal infections, and influenza, respectively, in 25 to 75 percent of vaccinated subjects. Specifically, the shingles vaccine prevents 75 percent of severe cases of shingles and 50 percent of total cases. Severe cases of shingles can affect the eye, causing terrible pain and damage to the cornea with loss of vision; more commonly, shingles can cause a severe chronic pain syndrome in the affected area that, on occasion, can drive people to suicide. The problem with the influenza vaccine is that it is formulated and manufactured before the flu season and thus sometimes the current formulation is ineffective against the current strain (compare the unexpected outbreak of “swine” flu in 2009).

Shown in table 5 are examples of FDA-approved drugs that are barely better than placebo on the average (P<.05 in two studies, although there were also negative studies) (Spector and Vesell 2002; 2006a). For example, loratadine is about 12 percent better than placebo (on the average) in relieving symptoms of allergic rhinitis; montelukast is even worse (about 6 percent), according to the company’s own label. To me, it seems outrageous to pay around $3 for a tablet of montelukast for a 6 percent chance of effect, when safe generic drugs yield a 20 to 60 percent response and are cheaper. In my view, the wide use of montelukast for allergic rhinitis is an example of the power of noncomparative direct-to-consumer advertising (see table 1). Similarly, 4 mg of tolteradine daily (for overactive bladder) gives (net of placebo) a less than 10 percent decrease in trips to the bathroom (micturations) and a less than 20 percent decrease in “accidents” (incontinence). Tol­teradine also has side effects (e.g., dry mouth, urinary retention) and contraindications to its use. Finally, tacrine is liver-toxic, and it has never been established that tacrine has clinical utility.

I would place many of the newer cancer drugs, especially the biotechnology agents, in table 5. In fact, in a recent thoughtful analysis of cancer therapy, Gina Kolata (2009) of The New York Times pointed out the minimal progress (with a few notable exceptions, like the treatment of chronic myelogenous leukemia with Gleevac) in the “war against cancer.” She points out that we are only 5 percent better off today than we were in 1950, notwithstanding billions of dollars spent on cancer research and treatments. Alas, there has been little progress against the major cancers (e.g., lung, stomach, pancreas, brain, breast, renal, etc.) when surgeons cannot totally remove it. (For more, see Kolata’s piece and my article “The War on Cancer: A Progress Report for Skeptics,” SI, January/February 2010.) This is in stark contrast to the tremendous progress against heart disease and stroke.

Discussion

As a society, where should we go from here with the problems outlined in table 1? Notwithstanding the hundreds of articles and books (see, for example, Angell’s work in 2004 and 2008), as noted above, it is difficult to assess quantitatively the magnitude of the questionable practices in table 1. In fact, though we have all seen fancy mainstream drug advertising that contains no quantitative data (e.g., how much improvement there is on the average) or important comparative data (e.g., in allergic rhinitis ads), there are some advertisements that are accurate and informative. But clearly misleading direct-to-consumer ads should be stopped.

There is also no doubt that some companies have flagrantly covered up negative data. In some cases, after being “caught” the companies paid hundreds of millions of dollars in fines or, in one recent case, settled with harmed patients for $5 billion (Singer 2009).

Almost everyone outside the industry feels an excessive amount of money is spent on misleading advertising—especially for drugs like those in table 5 that would not “sell themselves.” Also, the use of ghost writers and excessive payments to thought leaders, florid conflicts of interest, and payments to practicing physicians to encourage specific drug use clearly occur (see table 1). These practices should be outlawed (Stein­brook 2009).

Finally, scientifically worthless seeding studies (i.e., studies that do not test a hypothesis but are meant to familiarize physicians with the drug with the intent of increasing sales) may be on the wane, as is publishing only positive data and encouraging biased talks and literature. The press, academicians, journals, and public have wisely cracked down and lampooned such practices endlessly.

However, I submit that incredible good has been done by the drugs and vaccines in tables 3 and 4 (and many others not mentioned because of space limitations, like erythropoetin for certain types of anemia). As I discussed above, generic statins, ACE inhibitors, beta-blockers, and aspirin used in patients with coronary heart disease (CHD) save hundreds of thousands of lives yearly worldwide. Moreover, these drugs, when used optimally in patients with stable CHD, are as effective as invasive surgical procedures (e.g., coronary artery stenting) in most patients (Boden et al. 2007). Great progress against fatal heart disease (64 percent decline since 1950) and fatal stroke (74 percent decline since 1950) has been made in the face of increasing obesity and diabetes mellitus—two problems that exacerbate CHD and stroke (Kolata 2009). The drugs in table 3 and old drugs like beta-blockers and aspirin have made these tremendous advances possible.

The vaccines in table 3 basically eliminate the diseases (primary prevention) at which they are aimed. The harm done by hepatitis B alone—in the hundreds of millions—is now in principle eliminable with universal vaccination (Offit 2008). Hepatitis B is often a dreadful clinical problem and, as noted above, can lead to liver cancer (Offit 2008).

However, the failed war on cancer (Kolata 2009) and the lack of progress against Alzheimer’s and Parkinson’s diseases and many other chronic disabling diseases, unlike the tremendous progress made against heart disease and stroke, are very discouraging.

I would note that the drugs and vaccines in table 4, al­though not ideal, are also very useful; the risk/benefit ratio is clearly in the patient’s favor.

We should encourage the discovery and development of drugs and vaccines like those in table 3—especially against unsolved medical problems like cancer and Alzheimer’s and Parkinson’s diseases. Equally important, we should bridle or stop the abuses in table 1 and demand honest advertising of the drugs in table 5 (i.e., quantitative differences from placebo and comparative efficacy results). The abuses in table 1 could be eliminated by the combined and concerted efforts of the FDA, Securities and Exchange Commission, universities, journals, and medical societies. The FDA should also allow easier access to unpublished negative studies, as has been done with antidepressants (SSRI), allowing their “true efficacy” to be calculated (Mayer 2008).

Finally, the old saw that efficacy data must be clinically im­por­tant and not just statistically significant (Spector and Vesell 2006a; Spector 2009) must never be forgotten. Unbiased and objective experts, beholden to the public good, should discourage the pharmaceutical industry from marketing drugs that are statistically better than placebo but have no clinically meaningful efficacy. The FDA does not do this; they approve drugs but do not generally make comparative judgments.

In summary, over the past thirty years the pharmaceutical industry has made tremendous progress leading to greatly improved health and longer life spans with a substantial and correct focus on primary and secondary prevention, not just treatment, notwithstanding its failures (e.g., against cancer, Alzheimer’s and Parkinson’s diseases). In my view the future is bright with the steady march of new scientific progress. The problems in table 1 need work, but the solutions are obvious and should be relatively easily corrected. l

Acknowledgments

I wish to thank Michiko Spector for her help in the preparation of this manuscript.

References

Angell, M. 2004. The Truth about the Drug Companies: How They Deceive Us and What to Do About It. New York: Random House.

———. 2008. Industry-sponsored clinical research: A broken system. Journal of the American Medical Association 300: 1069–1071.

Baigent, C., et al. 2005. Cholesterol Treatment Trailists’ (CTT) collaboration. The Lancet 366: 1267–1278.

Baker, W.L., et al. 2009. Systematic review: Comparative effectiveness of angiotensin-converting enzyme inhibitors or angiotensin II–receptor blockers for ischemic heart disease. Annals of Internal Medicine 151: 861–871.

Brugts, J.J., et al. 2009. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: Meta-analysis of randomized controlled trials. British Medical Journal 338(301): b2376, June 30.

Boden, W.E., et al. 2007. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine 356: 1503–1516.

Kolata, G. 2009. In long drive to cure cancer, advances have been elusive. The New York Times. April 24, p.A1, A17.

Mayor, S. 2008. Study shows difference between antidepressants and placebo is significant only in severe depression. British Medical Journal 336: 466.

Offit, P.A. 2008. Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases. New York: Collins.

Relman, A.S. 2008. Industry support of medical education. Journal of the American Medical Association 300: 1071–1073.

Scandinavian Simvastatin Survival Study Group. 1994. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease (4S). The Lancet 344: 1383–1389.

Singer, N. 2009. Trial puts spotlight on Merck. The New York Times, May 14 p.B1.

Spector, R. 2002. Progress in the search for ideal drugs. Pharmacology 64: 1–7.

———. 2009. Science and pseudoscience in adult nutrition and practice. Skeptical Inquirer 33(3) (May/June): 35–41.

———. 2010. The war on cancer: A progress report for skeptics. Skeptical Inquirer 34(1) (January/February): 25–31.

Spector, R., and E.S. Vesell. 2002. A rational approach to the selection of drugs for clinical practice. Pharmacology 65: 57–61.

———. 2006a. Pharmacology and statistics: Recommendations to strengthen a productive partnership. Pharmacology 78: 113–122.

———. 2006b. The heart of drug discovery and development: Rational target selection. Phamacology 77: 85–92.

———. 2006c. The power of pharmacological sciences. Pharmacology 76: 148–156.

Steinbrook, R. 2009. Controlling conflicts of interest: Proposals from the Institute of Medicine. New England Journal of Medicine 360: 2160–2165.

A: Rods are a footnote in forteana, a blip on the paranormal radar. What are they? It depends on who you talk to. Some believe they are extraterrestrial entities; others believe they are a species of unknown invisible animals. (One might think that animals, whether invisible or not, that zoom through the air at high speeds might have been noticed by now—if only because they would regularly collide with people and objects.)

Curiously—and very tellingly—rods almost invariably appear only in photographs, films, and videotapes. To an investigator, this is a big red flag suggesting that the phenomenon is a photographic artifact. In a nutshell, rods are to cryptozoology (or UFOs) what orbs are to ghosts.

The main proponent of the rod phenomenon is a man named Jose Esca­milla, who first “discovered” and publicized it in 1994. Escamilla’s rods “al­legedly zip through the air, never seeming to stop or slow down [and] have been seen almost everywhere that anyone has bothered to look for them.... The best way to spot them is to take a video or movie camera and point it at the sky. Sooner or later some little dark spot will be seen to zip across at high angular velocity, and when it does you will have a rod sighting” (Sheaffer 2000). So what might these mysterious, elongated, blurry “rods” caught on video be?

Bob DuHamel, editor of AmSky, an online amateur astronomy magazine, wrote a detailed analysis of Escamilla’s “rods.” He began by noting a photographic phenomenon “so unremarkable as to be virtually ignored”—namely that fast-moving objects appear elongated in photographs. “When a blurred streak ap­pears on a photograph most of us will see it as a fast moving object; Jose Escamilla sees [it] as an unidentified life form” (DuHamel 2000). Are the rods perhaps merely flying insects caught on film?

Doug Yanega, an entomologist at the University of California at Riverside, not­ed that a rod is “a videographic artifact based on the frame capture rate of the videocam versus the wingbeat frequency of the insects. Essentially what you see is several wingbeat cycles of the insect on each frame of the video, creating the illusion of a rod with bulges along its length. The blurred body of the insect as it moves forward forms the rod, and the oscillation of the wings up and down form[s] the bulges. Anyone with a video camera can duplicate the effect, if you shoot enough footage of flying insects from the right distance” (quoted in Carroll 2003).

Still, Escamilla is undeterred. He has created a Web site featuring pictures of his rods and a documentary film about the subject. Escamilla’s rods are a classic example of how “unexplained” phenomena often occur: someone notices something he thinks is odd or unexplainable and assumes that because he can’t understand it, it must be novel or mysterious. l

References

Carroll, Robert. 2003. Rods. The Skeptics Dictionary: A Collection of Strange Beliefs, Amusing Deceptions and Dangerous Delusions. Hoboken, NJ: John Wiley and Sons.

DuHamel, Bob. 2000. The ‘rods’ hoax. AmSky, February. Available online at www.amsky.com/ufos/rods.

Sheaffer, Robert. 2000. ET, you’ve got mail. Skeptical Inquirer 24(2).

You can readily find computer and network security courses in most computer science departments, but it may be overly ambitious to call computer security a science. The profession certainly has aspects of an art, and it is fair to call much of the work engineering, but it lacks the rigor and objectivity of a science when put into practice. We highly desire security metrics to objectively measure the effectiveness of security technologies and to give the field this extra rigor, but they are difficult to come by. In fact, developing objective security metrics is considered one of the grand challenges of the field (INFOSEC Research Council 2005).

Part of the problem is the difficulty of quantifying risk in this field. Often, qualitative analysis is given with what are arguably somewhat arbitrary mappings to quantitative values (Schneier and Ranum 2008). It is even harder to calculate the return on investment that managers need in order to make decisions about how to mitigate a risk. How much value do you give to your reputation, and how do you estimate the cost of loss of reputation due to a kind of cyber attack that has never occurred before? Also, we have too little data on how often various industries suffer from different types of intrusions. Until recent laws were passed, companies would conceal most instances of attack even from law enforcement if they could (Schneier 2006). These factors make it hard to make rational decisions about how to address the different threats from cyber attackers.

If the computer security industry had a good handle on these problems, you would expect to see the major insurance companies offering policies that allow one to transfer these risks. This is what we see with automobile safety, natural disasters, and physical theft. If there were a way to reliably calculate these risks, the insurance companies would create standards of practice for cyber security and commonly sell insurance to cover losses due to such threats, as they have done for other industries. However, it is very difficult to calculate the likelihood of an attack in such a rapidly changing landscape and even harder to estimate the true cost of such an incident. Therefore, cyber security insurance is just now beginning to appear—though not from major players—and is far from common practice.

Fear, Uncertainty, and Doubt

Without solid risk analysis, FUD (fear, uncertainty, and doubt) often fills its place when justifying a particular security countermeasure. It is easier and often more effective to raise fear in people’s minds than to argue with them that they need to spend time or money on some security mechanism. This has presented enough of a problem that the statement of ethics for the major information security certification, the CISSP, specifically states that security professionals should avoid raising unnecessary FUD ([ISC]2 2008).

Raising fear, uncertainty, and doubt is not unique to computer security professionals. It is used by governments to justify exercising extraordinary powers (Electronic Frontier Foundation 2003), especially in times of crisis. It is used by agencies within the government to grab power (Shachtman 2008; Poulsen 2009), and it has been used to bring funding to pet projects (Meserve 2007). Vendors of security products also use FUD to sell their tools. This kind of FUD often comes in the form of scary and misleading statistics (Winder 2007).

In addition to not effectively informing people how to spend resources on security, FUD is dangerous for another reason. Its overuse makes people numb to real, but less dramatic, threats. This constant “crying wolf” can be dangerous because it can lead to inaction when a large, serious threat must be dealt with quickly in the future.

Insecurity at the Airport

Bruce Schneier coined the very apt term security theater (Schneier 2003). Once exposed to the concept, one sees it everywhere. Security theater is security done just for show or just to make people feel better. It is the placebo of the field. A great example can be seen in the public safety films shown to schoolchildren during the Cold War era. These films showed children hiding under their desks for atomic bomb drills. There could hardly be a less effective countermeasure, but that wasn’t the point. The point was to empower people so they felt like they could do something.

A more modern example of security theater costs us time at the airport and presumably man-hours for Transportation Security Administration agents and information technology staff. It is the “No-Fly” list. The goal of this list is to keep “bad” people off of planes, or at least people with names similar to those of “bad” people (Goo 2004; Moore 2007). It works by checking the name against a database containing the blacklisted non-flyers when tickets are purchased. The problem is that checks at the airport are very easy to bypass even if the list is accurate and specific—a precarious assumption (Bowers 2005).

The War on Photography

One interesting case is what has been called the “War on Photography” (Schneier 2008b). In recent years, people have been arrested, had their cameras confiscated, and been hassled by law enforcement for photographing particular targets (Davis 2007a, 2007b). Examples include photographing an ATM, police, and even tourist landmarks (Becker 2009; Davis 2007b; Fisher 2005; Shattuck 2008; Electronic Frontier Foundation 2003). There often isn’t legislation to indicate what is illegal to photograph, and it is often instigated by reports from overzealous citizens or police who do not like to be photographed.

The main problem with this approach is that while police may catch a terrorist photographing something, there are far more tourists taking pictures of landmarks and curious people with cell phones taking pictures of things they don’t frequently see—like an open ATM machine. This is simply because there are so few terrorists compared to non-terrorists. The signal to noise ratio of this approach is too high to be useful or efficient.

Furthermore, in this case there is likely nothing that can be done if law enforcement finds a terrorist taking pictures, as that alone is merely circumstantial evidence of terrorist activities. Usually, people are not taking pictures of anything illegally unless they are trespassing—in which case there are established laws to handle the situation. Add to this the decrease in police accountability if citizens are not allowed to photograph or record officers, and the trade-offs do not look so good. We likely harass and infringe upon the liberties of far more innocents for every terrorist encountered. And even then, confiscating the camera would not get the terrorist off the street or stop him from having a comrade take the photo later or from using Google Street View. To be useful, the false positive rate would have to be much, much smaller.

Back to Cyber Security

A common theme among these examples is that security is a trade-off. Even for effective measures, there are costs—if only of convenience and time. If we are not just propping up security theater as a substitute for real security, we are usually making a trade-off between usability and security. Furthermore, security is not all or nothing. Nothing is ever 100 percent secure, and therefore security comes down to using the best information available to balance costs versus benefits.

Let’s look at desktop computer antivirus technology. Everyone should run antivirus software on his or her computers, right? The landscape was very different in the late 1980s and early 1990s when signature-based virus detection was created: there were few viruses, they used known and old exploits, and they spread slowly. Most often, the viruses spread by floppy disk and not over networks because most home PCs were not connected (Bloor 2006).

Much of this has changed now. First, viruses are often polymorphic or use encryption techniques to thwart signature-based detection, which fails at detecting as much as 80 percent of new malware (Tung 2008; Kotadia 2006). These techniques of obfuscation create one virus with a million different perfect disguises, which makes it difficult for any signature-based technique to match a virus. There is what we call “zero day exploits,” unknown vulnerabilities used by the malware writers to spread their code quickly across the Internet before a signature can even be created and distributed. Finally, the signature databases have become huge—with millions of signatures—and they are growing exponentially (Leydon 2008). This uses significant resources on all but the newest PCs. For a long time the exponential growth in computational power kept antivirus technology in pace with the exponential growth of the number of viruses, but that has begun to level off (Dauger 2007). Signature-based antivirus is simply an untenable approach to handle malware on computers today.

Lest it be said that I am arguing against a straw man, I recognize that antivirus software has begun to try more behavioral-based approaches to look for misbehaving software. Unfortunately, this technology is still immature and often burdens users with cryptic messages. The fact is that even fully patched machines with the latest antivirus updates can still be infected. It appears that the “good guys” are currently the losers in this arms race until better techniques than the blacklisting approach of handling malware are developed. In fact, it may even make sense to consider white lists of allowable programs since there are more pieces of software people do not want running than those they do (Tung 2008).

The point is not to say “do not run antivirus on desktop PCs” but that enough has changed that one must really analyze the costs and benefits. Since keeping a machine patched and practicing good behaviors is so much more effective at preventing infection, and because signature-based antivirus software consumes a significant percentage of a computer’s resources, I lean toward not running it. The tipping point was when it became so easy to restore a machine to a previous clean state with the advent of virtual machines. This allows you to freeze the exact state of a machine, do something that may risk infection of your computer, and revert back to that clean state afterwards and know that your machine is not infected.

Firewalls

Another thing people are told they must have is a firewall, even if they don’t know what it is or how to properly configure it. Furthermore, there is a good chance that their Internet Service Provider (ISP) or office network already employs one. Host-based firewalls—ones that run on your local machine—can be great if you understand the messages. They will alert anytime a new piece of software wants to connect to the network, something almost all modern malware does.

Unfortunately, the average user does not know what programs should and should not run on their systems. For example, many users would see a message such as the one in figure 1 and not know what to do with it. In this case, it is necessary to allow a service pack to be downloaded, but how is the user supposed to know that? Furthermore, even if the alert says the name of the software is “iTunes,” the creator of the malware can call it anything he or she wants. This often makes host-based firewalls very unusable, and users tend to just allow everything, effectively negating the benefit a firewall could bring.

So it comes back to trade-offs. Here we can potentially get more protection, but at the cost of usability if users unwittingly block necessary software. If they allow everything, they get no additional protection.

Password Mythology

One of the most common security mantras is to never write down one’s password. Is this good advice? It depends upon who we are concerned might misuse the password. Writing down a password will not make it more or less likely for an online adversary to compromise the account. However, put­ting a password on a Post-it note underneath your keyboard at your office makes you vulnerable to the threat of a nosy coworker. What if you put passwords on a Post-it in your wallet? Presumably, you already put sensitive information such as credit cards in your wallet. You have to think realistically about the threats you are exposing yourself to and weigh the trade-offs.

In this case, there can be some very bad trade-offs, especially if not writing down passwords forces you to use simpler passwords or reuse them for multiple accounts. It is hard enough to remember a few good passwords, let alone dozens. Simple passwords can be easily cracked by computer software using variations of what are called dictionary attacks (Null 2007). A dictionary attack is an unsophisticated but effective attack that simply tries millions of combinations of words from some dictionary in an increasing order of likelihood as the password in question. Because people do not use truly random passwords, these attacks are very effective. Poor security practices at another site can expose that password, letting the attacker try it for accounts in other domains. This is a problem we frequently face in the supercomputing community (Nixon 2006), where passwords are harvested at one site and reused at a collaborating site to get a foothold on new systems. This is often out of the user’s control, too. Password reuse allows a small breach to more easily become a large one.

The best defense against these problems is to use many distinct, random passwords. Because of the limitations of human memory, this usually requires writing some of them down or using one of the many great password management tools,1 which encrypt your passwords with one strong password and even allow you to carry them with you on a USB flash drive. However, this goes against the often-recited warning about writing down passwords.

Web Site Security

You will often see advertisements on Web sites, especially if they are selling something, that they are “hacker proof” or use “128 bit encryption.” Ignoring the fact that not all 128 bit ciphers are equal (Vaudenay and Vuagnoux 2007), anyone can set up a Web site that uses encryption. If they are willing to spend a couple hundred dollars, they can even get a certificate so that the visitors’ Web browsers will show a nice little lock icon “proving” their connection is secure.

Few people, however, really know what that lock icon means. You should ask, “Who am I trusting and to say what?” In this case, you are trusting that a certificate authority, like Xramp Global Certification, has done some sort of check that the owner of the domain (e.g., example.com if you are visiting www.example.com) is the one running that Web site. Further­more, you are trusting that your Web browser is correctly communicating with this Web site in a way that prevents others from eavesdropping on the conversation between your Web browser software and the Web server. While there may be reasonable doubts about whether this is good (e.g., “Who is Xramp Global Certification, and why should I trust them?”), this in itself is not so bad. The problem is that the lock icon does not assert what people often assume it does.

Several questions remain unanswered even if you have a “secure connection” to a Web site and see that nice lock icon. For example, how are the data handled on the retailer’s network after the Web server processes it? Is the credit card information stored on these systems and, if so, is it encrypted and protected adequately? How does the business handle its back­up tapes that contain the consumer’s data, and how does it prevent theft or loss? With whom do they share the consumer’s data and for what purposes? All of these things could be answered in various ways regardless of whether or not that one communication channel between the Web browser and the retailer’s Web server is secure.

The problem is that people must still trust the retailer to implement good security measures. This is probably not a terrible step to take if you are visiting Wal-Mart’s Web site or Amazon.com. However, it is likely to be of little help if you want to do business with the owners of cheapjunk.biz.2 The security that comes with that little lock icon proves to be necessary but hardly sufficient for a secure online transaction.

Why Do We Make Bad Trade-offs?

It is clear that we often make poor security trade-offs, but the question is: why? While this is outside the main point of this article, I present some of the more popular hypotheses. Bruce Schneier, a leading applied cryptography researcher, brings up a point I find particularly suited to explain much of our inability for reasoned risk analysis (Schneier 2008). There is a mental mechanism psychologists call the “availability heuristic,” which states: “We assess the frequency of a class or the probability of an event by the ease with which instances or occurrences can be brought to mind.” A corollary of this is that we are swayed more by vivid, personal experience than statistics. It certainly makes sense that we would evolve such a heuristic and that it would work well with the simpler risk analysis faced by hunter-gatherers tens of thousands of years ago. Further, it is just as easy to see how it falls apart in the modern world of twenty-four-hour news channels. Coverage and over-coverage of rare events naturally increases the ease with which a rare occurrence can be brought to mind, thus skewing our perceptions of the probability of specific events.

Another problem faced by politicians, security officers, and anyone who makes decisions about what security mechanisms to implement is that no one wants to be a scapegoat. This leads to a lot of CYA (cover your ass) security, as it is called in the trade. A government official could reasonably say that he believes a lot of people are on the No-Fly list wrongly but probably not want to be the one to take a person off the list. The fallout if someone taken off the list later hijacks a plane is something you would not risk, even if it were a low-probability event. In fact, it is so hard to get a name off of the No-Fly list that it took three weeks to remove the late Senator Edward M. Kennedy (Goo 2004).

Furthermore, fear, uncertainty, and doubt taps into deep emotions, especially when the protection of children is involved. We will make all sorts of silly and even dangerous arguments when we think children may be threatened (Lemos 2007). With such an effective motivator to get a security mechanism implemented, few wish to take the much harder route of reason and analysis, especially when they often cannot assign hard quantitative numbers to the risk.

Conclusion

In a field wrought with fear, uncertainty, doubt, and poorly justified solutions, a consumer or citizen should ask many questions. Be skeptical if promised 100 percent security or hacker-proof services. Be skeptical if promotional materials for a product are primarily based on FUD. Be skeptical if presented an all-or-nothing choice—a false dichotomy. In that case, ask several questions. Are there hidden or non-monetary costs to this security measure? Is this just something to make us feel safer? What are all the trade-offs? Are they reasonable? Here, we must balance the competing needs of security and usability, letting neither our fear nor desire for convenience win. Does this security precaution still make sense in today’s landscape, or are we just doing it out of habit? Are we just doing this because everyone else does or says it is necessary? Who are all the parties being trusted, and what are they actually being trusted to do?

Many of these are the same sorts of questions skeptics ask of any claim. Similarly, security is not the only realm that touches on deep needs and emotions that cloud critical thinking. In that sense, it is no different from any other field. However, it is a challenging place to apply critical thought—one where it is far too commonly not applied at all. l

Acknowledgments

I thank Von Welch and Jim Basney of the National Center for Supercomputing Applications for their input and feedback, and I thank the James Randi Educational Foundation for the opportunity to present the original paper upon which this article is based at The Amaz!ng Meeting 7.

Notes

1. http://passwordsafe.sourceforge.net/.

2. Cheapjunk.biz did not exist at the time this article was written. It proved exceptionally difficult to find a name on that theme that was not already registered.

References

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Becker, Shane. 2009.

Arrested for taking photo of ATM. INFOWARS.COM, May 12. Available online at www.infowars.com/arrested-for-taking-photo-of-atm/ (accessed August 19, 2009).

Bloor, Robin. 2006. Anti-virus is dead: The advent of the graylist approach to computer protection. TechRepublic, September 1. Available online at http://whitepapers.techrepublic.com.com/abstract.aspx?assetid=881470&node=2094&docid=395435 (accessed August 19, 2009).

Bowers, Andy. 2005. A dangerous loophole in airport security. Slate Magazine, February 7. Available online at http://slate.msn.com/id/2113157/fr/rss/ (accessed August 25, 2009).

Dauger, Dean. 2007. Multicore eroding Moore’s Law. MacResearch, October 9. Available online at www.macresearch.org/multicore_eroding_moores_
law (accessed August 19, 2009).

Davis, Kathleen. 2007a. The crime of photographing (or reporting) a crime. PopPhoto Flash, September 21. Available online at http://flash.popphoto.com/blog/2007/09/the-crime-of-ph.html (accessed August 19, 2009).

———. 2007b. The crime of photography: Rewarded! PopPhoto Flash, November 19. Available online at http://flash.popphoto.com/blog/2007/11/the-crime-of-ph.html (accessed August 19, 2009).

Electronic Frontier Foundation. 2003. EFF: Patriot ACT II analysis. Electronic Frontier Foundation, January 9. Available online at http://w2.eff.org/Censorship/Terrorism_militias/patriot-act-II-analysis.php (accessed August 19, 2009).

Fisher, Marc. 2005. Union Station photo follies. The Washington Post, May 20. Available online at http://blog.washingtonpost.com/rawfisher/2008/05/
union_station_photo_follies. html (accessed August 19, 2009).

Goo, Sara Kehaulani. 2004. Sen. Kennedy flagged by No-Fly list. The Washington Post, August 20. Available online at www.washington
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Kotadia, Munir. 2006. Eighty percent of new malware defeats antivirus. ZDNet Australia, July 19. Available online at www.zdnet.com.au/news/
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Lemos, Robert. 2007. Amero case spawns effort to educate. The Register, June 20. Available online at www.theregister.co.uk/2007/06/20/julie_amero_
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Leydon, John. 2008. Malware still malingering for up-to-date anti-virus users. Channel Register, April 11. Available online at www.channelregister.co.uk/
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Recent tests by the Belgian skeptical organization SKEPP have confirmed that the “facilitated communication” (FC) with Rom Hou­ben, a Belgian man who was allegedly trapped in his paralyzed body for twenty-three years, was fictional (see “Miracle Coma Patient’s Story Told via Facilitated Communication,” SI, May­/June 2010). Neurologist Steven Lau­reys of the University of Liège and his team, who presented Houben’s case to the international press in November 2009, seem to have rushed to premature conclusions. Bearing in mind FC’s de­servedly bad reputation, they should have known better.

The Miraculous Case of Rom Houben

In November 2009, the miracle story of Rom Houben, forty-six, made international headlines. In 1983 Houben was involved in a car accident, and his brain was deprived of oxygen for several minutes. Doctors had diagnosed Houben as being in a persistent vegetative state (PVS), a classification used for patients who are wakeful yet suffer from severe brain damage and show no signs of conscious awareness. However, on PET scans of Houben’s brain taken three years ago, his treating neurologist Laureys claimed to have found signs of consciousness. Laureys, who has published research in the New England Journal of Medicine (NEJM) and BMC Neurology, is an ac­claimed expert in coma and disorders of consciousness. In his latest study published in NEJM, Laureys and his colleagues (Monti et al. 2010) have shown that a small percentage of patients diagnosed as being in a persistent vegetative state still show forms of preserved cognition under the scanner.

Ever since the PET scans of Houben’s brain, Laureys’s team has tried several methods to establish contact with him. At first, according to Laureys, Houben was able to answer simple yes or no questions by pushing buttons with his toes, which were not completely paralyzed. Due to his spastic paralysis, however, the method proved unreliable. Afterwards, still ac­cording to Laureys, Houben learned to type on a simple keyboard and was eventually able to fully express his thoughts and type elaborate sentences with the help of a so-called “facilitator.” This is a trained assistant who guides the patient’s hand along a keyboard, trying to feel and amplify his or her minute willful movements. All over the world video footage showed Houben and his facilitator jointly typing elaborate messages with one of Houben’s fingers.

However, the method of FC has long been discredited. Controlled experiments have consistently demonstrated that not the patient but the facilitator is directing the “conversation” (Wheeler et al. 1993; Felce 1994; Twachtman-Cullen 1997). FC has in the past been used to tap into the minds of autistic or mentally retarded children, but this led to false allegations of abuse and other unfortunate complications. In 1994, the American Psychiatric Association issued a statement denying the scientific validity of FC, stating that “facilitated communication is a controversial and un­proved communicative procedure with no scientifically demonstrated support for its efficacy.”

Skeptical Reactions

On the basis of FC’s dubious reputation, as well as the distributed video footage of Houben, skeptics and scientific authorities all over the world immediately expressed strong doubts about the case. For example, on his blog Neuro­logica, Yale neurologist Steven Novella noted that “it seems impossible that someone with his level of paralysis, and years of inactivity, would be able to type so quickly with just a little ‘support.’” More­over, Houben was hardly looking in the direction of the keyboard, and on some videos it is clear his eyes were completely closed. Not even a fully conscious person with no neurological damage can blind-type whole sentences with one finger. Experiments have shown that experts in blind-typing can orientate themselves on a keyboard only if they use at least two fingers. That is why keyboards have little nibs on some of the keys to give typists reference points. On the video footage of Houben’s FC, however, his hand was in a brace, which leaves him with little or no sensory feedback.

In brief, the spectacular story was completely implausible on its face, even after a cursory examination of the basic facts and the available video footage. More­over, a straightforward and simple experiment would have sufficed to check this out, as SKEPP and other critics im­mediately pointed out.

However, Laureys assured the international press that the method was reliable. For example, in The Times of Lon­don (November 25) Laureys claimed that while initially skeptical, he had convinced himself of FC’s reliability by a series of controlled tests: “I showed [Houben] objects when I was alone with him in the room and then, later, with his aide, he was able to give the right answers.... It is true.” On the same day in Der Spiegel, Laureys commented that “naturally, I tested him to rule out the possibility that it’s actually the speech therapist doing the writing.” A few days later, when skeptics and scientific authorities all over the world had already questioned the case, Laureys backtracked somewhat, distancing himself from FC and telling the press that “further tests were required.” By then, however, the news of Houben’s miraculous rebirth after twenty-three years had already circulated the globe.

Controlled Tests with SKEPP

At the request of the medical institution where Houben is cared for, on February 4, 2010, a SKEPP delegation (W. Betz and J. Torfs) was present to advise at a long overdue test of FC. We also conducted our own tests. We were surprised to learn from the institute’s staff that over a period of two years all attempts to establish any form of communication with the patient by detecting and coding minute movements of the eyes or any other body part had failed.

Houben’s habitual facilitator, Linda W., featured in the video footage in November, was not available for the test. Consequently, the director of a Flemish institute for “alternative communication” (Anne C.), who trained several facilitators working with Houben, acted as the facilitator ad interim. Interestingly, Laureys told the media afterwards that when he asked Houben (through Linda W.) whether he was willing to cooperate in a test, (s)he always gave the same reply: “I don’t trust you [scientists].” After looking for another facilitator for a year and a half (which raises the question of how Laureys performed tests in November 2009), Laureys and his team finally found Anne C. Through her “facilitation,” Houben suddenly changed his mind and agreed to put FC to the test. If there had been any lack of reasons for skepticism, this observation alone would have sufficed to discredit the whole affair.

At the beginning and at the end of our trials, we tried to make normal conversation with Houben, and the FC seemed to work perfectly fine, producing intelligible and sometimes even elaborate sentences. In one test, we asked the facilitator to leave the room while we showed Houben a large printed word, which we read aloud to him several times. The facilitator was then allowed to return and assist Mr. Houben in giving the word back to us. Although a well-formed word, the resulting answer was completely wrong. We tried the same test with a large and simple drawing, which yielded identical results. In another test, we shielded the keyboard from the facilitator’s view in the midst of an answer. Immediately, the typing changed into gibberish and soon halted completely. After the tests by SKEPP, a psychologist and assistant of Laureys gave Houben a set of headphones and asked him to type the words he alone could hear. The results were uniformly negative: the FC method was not tapping the thoughts of the patient at all but only the imagination and expectations of the facilitator.

The Psychology of FC

Facilitators typically express the strong conviction that the patient is the true author of communication in FC. After the failed tests, Linda W. retained faith in the method, arguing that FC often produced information that she was unaware of and that Houben sometimes engaged in philosophical discussions with visiting friends that she could not even understand. It seems unlikely that facilitators like Linda W. are all lying, and there might be more subtle psychological mechanisms at work here.

Psychologists have found that the apparent communication by means of FC is an artifact of “action projection,” in which the self-deceived facilitator is attributing his own unconscious movements to the patient. In a study into the psychological aspects of FC, Wegner, Sparrow, and Fuller (2003) subsume this effect under the phenomenon of “un­controlled intelligence.” This refers to the production of intelligent acts in the absence of any conscious intention to do so, or even contrary to one’s own intentions. In one experiment, subjects who were instructed to answer a set of questions in an entirely random fashion still tended to give correct answers and afterward denied the influence of their knowledge.

According to Wegner et al., the mere fact that the facilitator’s subtle movements coincide with possible movements of the patient suffices to significantly reduce the sense of personal authorship. In addition, the physical proximity to the patient further blurs the distinction between self and other. To be sure, facilitators still receive sensory feedback for their own finger movements, yet this is insufficient to compensate for the illusion that the patient is directing the communication. Researchers also found that an increased belief in the effectiveness of FC enhanced the projection of authorship to the communicator. They argue that, for facilitators, belief in FC provides a context for interpreting the effects of “uncontrolled intelligence.”

In another experiment, Wegner et al. provided both facilitators and (healthy) communicators with headphones but asked questions only to the facilitators. Despite the fact that the communicators could not hear anything, communication performances still rose above the chance level. Moreover, easy questions were answered correctly more often than difficult questions, which is consistent with the hypothesis of (unconscious) intelligent action.

Facilitators often unconsciously draw from knowledge they have developed about their patients through their intimate relationships with them. Inter­estingly, many facilitators do admit that they sometimes intervene deliberately in the process of communication (Twacht­man-Cullen 1997). Sometimes they start to type the first letters of a word to “get the patient going” or finish a sentence because they “get the gist already.” By doing so, facilitators may eventually produce elaborate sentences while still retaining the conviction that none other than the patient is doing the communication.

The Aftermath

When conducting our experiments in February, our intent was not to test Houben but to test FC. As anyone familiar with the reputation of FC ex­pected, the results were completely negative. This is not to deny that Houben may have some limited consciousness. If so, it must have been very frustrating for him to hear all the bogus messages being produced in his name without being able to protest. After our test, SKEPP chairman Willem Betz had a long conversation with Laureys, who insisted that we needed to test more facilitators before jumping to conclusions. We declined and advised Laureys to clearly distance himself from the FC sham. Still, out of respect for the family and to allow the institution time to discuss the results with the dedicated staff, we agreed on a two-week embargo before making our results public. Ten days later, Laureys finally backtracked on the FC part of the story, claiming that new tests with Houben had failed to validate the method.

Of course, the failed test does not definitely rule out that Houben may be able to communicate somehow with the outside world. Understandably, Houben’s mother still believes in FC because she thinks it has produced answers that the facilitator had “no way of knowing.” She still hopes to establish a line of communication with her son some day.

Laureys’s request for “more tests with more facilitators,” at a time when the miraculous story was giving relatives of coma patients all over the world false hope, was clearly off the mark. More tests should have been conducted before launching the story in the international press in the first place. Why did Laureys need more than a year to debunk this spurious method when skeptics had pointed out to him that a controlled test could be performed in a matter of minutes?

Moreover, Laureys repeated to the media that “from the start, I did not prescribe this technique,” which is somewhat disingenuous given his earlier statements in Der Spiegel and The Times. We wonder what world-shaking news there would have been to communicate if it had not been for the spectacular finding about the typing coma patient, validated by his treating neurologist, a renowned expert of consciousness disorders. Moreover, to this day Laureys maintains that FC proved successful with another patient of his, but he refuses to provide the details of the case, claiming that he will present them in due time in a proper scientific outlet. Consequently, he has refused to sign the resolution of the Behavior Analysis Association of Michigan (BAAM) on the scientific evidence against the validity of facilitated communication.

Naturally, this does not affect the fMRI research that Laureys and his colleagues published in NEJM (Monti et al. 2010), in which they showed that a small percentage of patients initially classified as being in a PVS show signs of preserved cognition under the scanner. Still, to what extent these traces of meaningful cognitive activity indicate that there is still “someone in there” remains debatable. In interviews Laureys claimed that his scans showed that up to 40 percent of patients previously diagnosed as being in a PVS were trapped in a paralyzed body and could be “released.” But this is a premature conclusion. As neurologist Alan Ropper (2010) writes in an editorial for the NEJM, “cortical activity does not provide evidence of an internal ‘stream of thought.’” The findings of Monti et al. suggest that there is a twilight zone between a vegetative state and a state of minimal consciousness, and we may want to recognize degrees of consciousness.

In any case, even if some of the patients under Laureys’s scanner turn out to have a form of consciousness, FC is certainly the last method to recommend for establishing communication. The international news coverage of Houben’s case has given the advocates of this sham method an undeserved publicity boost, and the emotional impact on patient’s families cannot be underestimated. The decision to present this story before the international media was premature to say the least, and Laureys has clearly overreached in this case. He would do the scientific community and the families of coma patients all over the world a great service if he would finally distance himself completely from the follies of FC. l

References

Felce, D. 1994. Facilitated communication: Results from a number of recently published evaluations. British Journal of Learning Disabilities 22(4): 122–126.

Monti, M.M., A. Vanhaudenhuyse, M.R. Cole­man, et al. 2010. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 362(7): 579–589.

Ropper, A.H. 2010. Cogito ergo sum by MRI. New England Journal of Medicine 362(7): 648–649.

Twachtman-Cullen, D. 1997. A Passion to Believe: Autism and the Facilitated Communication Phenomenon. Oxford: Westview Press.

Wegner, D.M., V.A. Fuller, and B. Sparrow. 2003. Clever hands: Uncontrolled intelligence in facilitated communication. Journal of Person­ality and Social Psychology 85(1): 5–19.

Wheeler, D.L., J.W. Jacobson, R.A. Paglieri, and A.A. Schwartz. 1993. An experimental assessment of facilitated communication. Mental Retardation 31(1): 49–59.

At CICAP, the Italian Committee for the Investigation of Claims of the Paranormal, every year we receive a few dozen requests from people claiming to possess some kind of psychic power. Many disappear after we ask for more details. Of those who remain, we almost always find that they are sincere and honest people who really believe they possess the powers they claim. Very rarely does someone try to deceive or cheat us.

Some time ago, we received a letter from a woman, R.G., who claimed she can peer inside sealed boxes with some sort of X-ray vision and describe what is inside with a 60 to 70 percent rate of success. She wanted us to test and verify her powers. In letters and phone calls she explained that we could use any kind of box and any object we liked.

We gladly accepted her proposal and invited her to the University of Pavia, where, with the help of colleagues such as chemist Luigi Garlaschelli and physicist Adalberto Piazzoli, we have often tested psychics.

Once in Pavia, she agreed that the testing situation was ideal, that the people there were not hostile, and that she was confident she would succeed. It is very important to establish this beforehand to prevent excuses if the test fails. She read the protocol for the experiment that we had prepared in advance according to her claims, and she signed it.

No ‘Fitting’ Allowed

We had previously selected twelve objects, each one different from the others in shape, color, and material. These objects were taken to a different room from the one where the test was taking place and randomly numbered from 1 to 12. An experimenter then chose a random number, picked up the corresponding object, wrapped it in paper in order to avoid any clues from sound (the psychic confirmed beforehand that paper didn’t block her visions), put it in a wooden box kept firm by two rubber bands, and finally brought the box within view of R.G. (The experimenter who placed the objects inside the box had to stay away from R.G. in order to avoid any involuntary nonverbal communication.) This procedure took place for each object, and each object was chosen only once.

When R.G. saw the box for the first time, she asked us to remove the rubber bands around it because they could confuse her images. We agreed on the condition that nobody could touch or get close to the box after it was placed on a table.

We then gave R.G. a list of the twelve objects in order to help her decide. She had to concentrate on the box and then indicate on the list the object that best matched her visions. This was done to av­oid “fitting” a general description to more than one object; her vision could match one, and only one, object on the list. If she wished, she could switch one guess for another before the end of the test.

The correct answers would be given only at the end of the session. As usual, we videotaped the whole test.

‘I See Something Square....’

Sitting six feet away from the box with her husband beside her, R.G. concentrated for a few seconds and then described her perceptions: “I see something square... a bit thick... something dark... straight...” She then pointed to the rubber stamp on the list.

The test went on until she reached the last object: “It’s something rigid,” she said. “Straight but... not a cube. It has only one color... looks like a pen, a tube... could be the key.”

At the end of the test, we compared R.G.’s guesses to a list of the objects in the order in which they were presented. Out of twelve objects, she got only one match—exactly what one would expect by chance.

R.G. tried to justify her unsuccessful performance by saying that the conditions (to which she had previously agreed) were not the ones she was accustomed to. She then tried to accommodate her descriptions to the objects actually presented. For example, the object that she had indicated was a key turned out to be a mirror. “Well, I was right after all,” she said. “It was something straight, not a cube and only had one color.” The lady seemed to have forgotten that she also had said the object looked “like a pen, a tube.”

There’s No Place Like Home

We had designed our protocol on the basis of what R.G. said she could do (and in conditions under which she said she could succeed). We had tried to accommodate her needs. However, the failure bothered her, and she insisted that this was not the procedure she used at home. Usually, she said, she needed two series of objects: one for the test, the other to be kept in front of her so that she could compare her visions with a replica of the actual object and not with a word on a list. This was the first time she said something of the kind to us.

So, even though the official test was over, we agreed to perform an informal trial. We looked for twelve double objects in the laboratory and proceeded as before. Again, the result was quite clear: one hit in twelve trials.

Still, R.G. was unconvinced and repeated that, at home, she would usually get six or seven objects out of ten and proceeded to indicate two more differences with our test. At home, her husband could use the same object more than once, and this gave her more freedom of choice. Furthermore, she needed some encouragement; she needed to know if she was right or wrong immediately after her guess.

Some of us were against the idea of performing a new test and changing the protocol again. However, after clearly stating on camera that the test was not to be considered a proper, scientific test and that it was done only as another informal trial, in view of future tests, we decided to try.

Since this demonstration proved to be very quick to prepare, we did twenty-eight trials with a choice of the same seven objects for each trial. R.G. was right on six cases. Even this demonstration was not considered significant (in order to have a minimum of significance, p=0.02, with seven objects and twenty-eight trials, nine to ten hits are re­quired).

At the end of our meeting, we suggested that R.G. repeat the test as we had performed it that day at home. This way, we thought, maybe she would realize that once the possibility of adapting one’s “visions” to the correct object in the box is ruled out, the results can be only random (unless she really possessed psychic powers, obviously). We said that we would invite her back if, following this procedure, she could still obtain a 60 to 70 percent success rate.

A few years have passed now, but we have never heard from her again.