drug therapy

CSGnet Archive CSG1995
1

[From Bill Powers (950825.0945 MDT)]

Martin Taylor (950825.11:00) --

     Not having been privy to those conversations, I am unclear as to
     why you think the use of drugs is inconsistent with PCT. I would
     have thought there was a good case for presuming that some kinds of
     drug would be useful for helping to correct pathologies that can
     afflict a hierarchic control system.

My reason is quite simple; you mention it yourself at the end of your
post:

     And I grant that, from a PCT viewpoint, the effects of no drug is
     yet known.

The human system is a _system_, not a bag full of fragmentary cause-
effect relationships. There are and can be no simple direct connections
between putting a highly active biochemical into the bloodstream and a
change in the way the control systems of the nervous system, or those of
the biochemical system, are working. The medical approach, particularly
in the hands of practitioners rather than basic researchers, has always
been and is still oriented around a superficial treatment of superficial
symptoms, with essentially no grasp of why any given drug treatment has,
or fails to have, a given effect.

It's not just from the standpoint of PCT that the effects of drugs are
unknown. It's from any standpoint you care to mention. People use drugs
because, through some unexplained pathway, they sometimes make people
feel better. Some of them very often make people feel better: alcohol,
heroin, prozac, methamphetamines, valium, steriods, PCP, ritalin,
aspirin, cocaine, cannabis, and so on. However, as we know, "feeling
better" is a very deceptive state; it can arise from stimulating
internal receptors associated with a good state; it can arise from
masking pain and despair with overpoweringly pleasant sensations; it can
arise from numbing one's senses; it can arise from dulling
consciousness; it can arise from shutting down higher mental facilities.
The one thing we know about this kind of feeling better is that there is
a vanishingly low chance that the chemical effects of the drug have
actually fixed anything that has gone wrong. What such drugs do is to
stop the complaint.

All drugs also produce "side-effects." The side effects are major shifts
in the functioning of the system that are downplayed because they aren't
the effect that is wanted or advertised. When you buy a prescription
drug, you get a little slip of paper listing precautions, dosages, and a
few other things. But if your doctor gives you an unopened sample of
that same drug, you will find that this slip of paper is half of a
larger slip, the other hand normally being torn off before the customer
gets what's left (there are instructions to the pharmacist to that
effect). On this other half, there is a far more detailed description of
side-effects and contraindications, and more often than not a statement
saying that the other effects of this drug and its mode of operation are
"unknown." Some of the side-effects listed are rather alarming: the
description of Theophilin (I believe) is one that lists "sudden death"
as a side-effect that has been observed. Not, of course, on the
customer's half of the slip. That might cut into sales by unduly
alarming the public.

All that having been said, it is still possible to make a case for the
use of drugs and other treatments justified on a purely empirical basis.
The usual case is simple: we don't know what else to do, and the
situation is so bad that something clearly has to be done. The impulse
is to help, and the hope is that what we do to help doesn't cause more
harm than benefit. In the absence of science (that is, knowledge about
how the system works), this is how people have always acted. You try
something; if it makes matters worse you don't do it any more; if it
makes matters better, you remember it for the next time you run into
what looks like the same situation. This elementary approach can be
dressed up in all sort of impressive phraseology and made to look highly
scientific by the use of formalisms and technology, but it's still
basically not much more advanced than the method by which E. coli gets
around.

What we need, of course, is a systems approach, both to biochememistry
and to brain organization. The systems approach means understanding, not
guessing, how the system works. It means seeing the system as a whole,
not through a series of tiny peepholes. It means building up a model
that can be used to predict not only "main" effects but "side" effects
-- in other words, to predict what the actual effects will be on the
whole system.

PCT is a start toward a systems approach to human and animal
functioning. It entails building up a model of the whole system, bit by
bit, and testing it in all ways possible, including both behavioral
tests and examination of actual internal organization wherever possible.
The parts of the model that have survived the test are not stashed away
for a rainy day in case the same situation arises again; they become
part of the model that is used in ALL cases. We are not building one
model for this situation and another one for that situation. We are
building one coherent model of the entire human system, and we expect
the parts of the model that we accept as correct to be part of every
behavioral situation.

The existing methods of chemical and psychological therapy are not based
on any conception of a whole system. They are based on piecemeal
collections of unrelated observations, with no basic model to tie them
together. What is unfortunate from my point of view is that the
conventional approach has become so embedded and self-justifying that it
uses up all the resources that might otherwise go toward true systems
research. There is tremendous social and financial pressure not only to
continue the old scattered empirical approach, but to build it up to
appear as the only proper approach. In order to do this, the failures
have to be minimized and the successes exaggerated. The result is to
paint a picture of the current state of affairs as the best that can be
done, the top of the line, the state of the art. So what happens to the
motivation to find a better way?

···

----------------------------------------------------------------------
Best,

Bill P.

2

[Martin Taylor 950825 13:30]

Bill Powers (950825.0945 MDT)

I don't think you addressed my point. Much of what you say is incontrovertible,
yet the gist seems to be opposed to your general approach to reorganization
within a hierarchy. If I read you aright (and history makes me dubious)
you seem to say:

it's still
basically not much more advanced than the method by which E. coli gets
around.

in a negative sense. Why negative? Don't you argue that this is an
effective method of learning, a good metaphor for reorganization in general?
Why is it not a good metaphor for finding out what works in general?

When one understands HPCT (as well as we now can understand it), one looks
for different observations in respect to drug effects than:

People use drugs
because, through some unexplained pathway, they sometimes make people
feel better.

For example, one would look for evidence of control where there had been none.
Is that why people "feel better?" In the situation we were discussing,
one might look for evidence of varying reference signals where the patient
seemed to have been using fixed "inappropriate" reference values. (Again
recognizing "inappropriate" is as seen by the external observer).

Who has looked from that point of view? I hazard a guess that the number
approaches zero quite closely. Are you saying that therefore nobody SHOULD
look?

All drugs also produce "side-effects." The side effects are major shifts
in the functioning of the system that are downplayed because they aren't
the effect that is wanted or advertised.

Indeed they do. An HPCT view might allow one to determine what the real
side-effects are, as opposed to their surface manifestations.

As far as I can see, nothing in your response suggests that drug therapy
is inconsistent with HPCT. I see only comments to the effect that we
don't know just what the drug is doing, and with that, I think there can
be little disagreement.

What we need, of course, is a systems approach, both to biochememistry
and to brain organization. The systems approach means understanding, not
guessing, how the system works. It means seeing the system as a whole,
not through a series of tiny peepholes. It means building up a model
that can be used to predict not only "main" effects but "side" effects
-- in other words, to predict what the actual effects will be on the
whole system.

Yep. But if there is something that seems to work, should we stop using it
because we don't know why? Should Trevethick and Watt and Stevenson not
have made steam engines because Carnot had not discovered heat efficiency
and Boltzmann had not explained the thermodynamics?

It has to be easier to figure out what normally happens if we know the
surface manifestations of effective and ineffective interventions, no
matter how distant the changes are from the causes of those changes. If
a patient becomes rational after being obsessive, a control theorist might
guess that the gain(s) of some loop(s) had been reduced, whereas a "classic"
observer would perhaps only say that the drug relaxes the patient. Wouldn't
that be an improvement? Couldn't one then expect to find more focused ways to
reduce specific gains, in future experimentation, leading to treatments with
fewer side effects?

The existing methods of chemical and psychological therapy are not based
on any conception of a whole system.

Right, but not addressing the issue.

What is unfortunate from my point of view is that the
conventional approach has become so embedded and self-justifying that it
uses up all the resources that might otherwise go toward true systems
research.

Perhaps so. What then should be done about it? A control theorist knows
WHY this happens, and perhaps might be able to propose ways that might
change it. A drug for the social pathology, perhaps :-?

The result is to
paint a picture of the current state of affairs as the best that can be
done, the top of the line, the state of the art. So what happens to the
motivation to find a better way?

All grist for the applications side of PCT. Can we use a knowledge of PCT
to affect the environmental part of the feedback loops that sustain the
current state of affairs? If we did, would the result necessarily be an
improvement?

Martin

3

[From Bill Powers (950825.1710 MDT)]

Martin Taylor (950825.1330) --

     I don't think you addressed my point. Much of what you say is
     incontrovertible, yet the gist seems to be opposed to your general
     approach to reorganization within a hierarchy.

I don't want to get into another Oxbridge argument. If you think that
the trial-and-error method is the best way for science to be conducted,
I doubt that any argument I make will sway you.

I'm trying to paint a picture of a science of life in which system
models are cumulatively proposed, tested, refined, and expanded. I
consider this approach to be far superior to the methods that have been
used in the past by the behavioral sciences and by medicine. I don't
doubt that pure empiricism coupled with pure conjecture has had its uses
and will continue to have them. But I'm just not interested in varying A
to see what happens to B, even if B is something like loop gain or the
rate of reorganization. I want to understand the _connection_ between A
and B, to have a model that makes sense of it not only behaviorally but
neurologically and biochemically. Maybe others want something else, and
maybe I won't get it, but that's what I want.

···

-----------------------------------------------------------------------
Best,

Bill P.