Thursday, March 26, 2015

"Negative Reinforcement" is like "Inconceivable" - I do not think it means what you think it means.

When I ask most people what the term "Negative Reinforcement"  means most of them say something like:

"It's when you want someone to stop doing something so you do something negative so they'll stop. Like yelling at them or grounding them or insulting them."

That is actually the EXACT OPPOSITE of Negative Reinforcement.  That example is actually : Positive Punishment.

Let me explain. (no there is too much, let me sum up):

POSITIVE: Do Something or Give Something
NEGATIVE: Stop Doing Something or Take Something Away

REINFORCEMENT: Increases a behavior
PUNISHMENT: Decreases a behavior


EXAMPLE: You want your kid to take out the trash

When they take out the trash, you praise them or give them a reward, and then they take it out more often

When they take out the trash, you stop nagging them, and then they take it out more often

Your kid refuses to take out the trash, you spank them, they stop refusing.
OR your kid refuses to take out the trash, you give them $5, they stop refusing.

Your kid refuses to take out the trash, you stop giving them allowance, they stop refusing.

The important thing to remember is that NONE OF THESE TERMS refer to moral judgments or preferences.

Punishment, by definition, decreases a behavior.  It could be very enjoyable and nice, if it decreases the behavior it is a punishment.  You could give someone ice cream, and if it stopped them from cussing you out, then it is by definition a punishment of cussing.  (if it made them cuss you out more so they'd get ice cream then it became reinforcing...oops)

Positive means "you do something" so spanking and cussing out your kids is in this sense "positive" because are DOING something.
Negative means "take something away or stop doing something."  It doesn't mean it's aversive or unpleasant

THIS is positive punishment:

ie: Sunscreen works through negative reinforcement.  When you put on sunscreen, you decrease or take away a sunburn, and then sunscreen is put on more often.  The behavior is done more often, because something was taken away.

Parents often think that if something is unpleasant it is a punishment.  Well, if your kid is smoking marijuana and coming home late, and you take away their cell phone - then they smoke more and come home late more often - THEN you have reinforced them.
You used NEGATIVE REINFORCEMENT.  You took something away, and it increased the behavior (smoking and staying out late).

If they were smoking and coming home late and you took them to a minor league baseball game and spent more time with them, and they stopped smoking and staying out late, THEN you have POSITIVELY PUNISHED them.  You did something, and the behavior decreased. 

Clear as mud?

Sunday, March 22, 2015

Christ was Abused by his Parents

I mean that.  As a fact.

Christ watched his father beat his mother, and then Christ was beaten too.  He sat hungry in the corner, crying, wishing He had a different family.

He watched his father go to prison and his mother get strung out on meth as He entered the foster care system.  He got just enough birthday cards to keep his hopes up of having a family again - only to have those hopes crushed time and time again.

Christ was insulted in front of his entire school.
He was rejected, and felt so terrible inside He cut his arms with razor blades.
He got his girlfriend pregnant and didn't know how to tell his parents...or hers.

He decided they should abort the baby, and He lived with that knowledge the rest of his life.

He was fired from his job the week before a family vacation and had to tell his kids they couldn't go.
He cheated on his wife and slept next to her every night with guilt in his heart.

He was addicted to pornography.  He got hooked on weed, and heroin, and LSD.
He felt the pain of crashing when coming down off drugs, and was also convicted of DUI.  He has murdered millions of people, cussed out and beat his own kids, and He has lived with the never ending agony and guilt and pain of every single one of those moments and decisions.

When Christ was suffering in the garden of Gethsemane and later on the cross, He wasn't just paying for our sins.  He felt every grief, every pain, every ounce of guilt, shame, hate, self-loathing, regret, loneliness, fear and doubt.  As Isaiah said: "Surely He hath borne our griefs and carried our sorrows."

Christ never sinned.  He never did any of those things I said.  But when He was in Gethsemane He wasn't imagining what it would feel like.  He wasn't pretending or feeling sorry for us.
He felt all of it for real.  He went from never feeling shame, to feeling the shame of being Hitler or Stalin.  He suddenly had to experience all our sorrows, exactly as we feel them.

Christ had to have one mortal parent and one immortal parent, otherwise He couldn't have done it.  Any human being who experiences that much physical and emotional pain can't handle it.  We would pass out and die. 

Christ reached that point.  He reached the point of such severe pain that his brain should have shut off.  But He was the literal son of God, and as such He could choose to continue suffering when any human would have died.  He made that choice a few billion times.  He felt every moment of anguish for every human being who has ever lived on this planet.  He cried out to God: "O my Father, if it be possible, let this cup pass from me: nevertheless not as I will, but as thou wilt."

He didn't want to feel the pain anymore.  It was too much, too hard, too overwhelming.  But Christ wasn't going to do what He wanted, He was going to do what God wanted - so He kept suffering.  

He suffered until finally He had felt it all, suffered it all, been through every single experience of every single child of God.  Then He could finally say "It is finished" and let himself die.

That is the atonement.  That is what Christ gave us.  He not only gave us the gift of resurrection and salvation and forgiveness of sins, but also of perfect empathy.

I thank God for His Son, and for the immeasurable gift He has given me.

Friday, March 20, 2015

Book Review: Food, A Love Story

Grade: D+

I really wanted to love this book.  Jim Gaffigan is one of the funniest comedians I have ever heard.  I bust up when I watch his videos: Mr. Universe, Beyond the Pale, and Obsessed.  I watch YouTube clips and I constantly quote his material.

He is a comedic genius.  He is hilariously self deprecating and he knows what the audience is thinking.  His timing is precise and his delivery is practiced and polished and perfect.

And his book is a re-run.

I listened to the audio tape.  It is 7 hours of rehashed material I have heard before - with boring descriptions of the food across America mixed in.

I loved "Hot Pockets" the first time I heard it.  I also loved "Kale" and so many others... and I heard them all again.  ALL.  Repeated.  Slower, and much less funny.

This book is a sad money grab.  It is not original.  It is not new.  It is not worth the time or money. 

Go on Netflix and watch his specials.  Laugh so hard you cry - and then skip this book.  You'll thank me.

Monday, February 23, 2015

Book Review: Deadly Medicines and Organized Crime

Grade: A

Mind Blown! I mean it.  I've been skeptical of the pharmaceutical industry for many years, but I don't know of anything as impressive as this book.
This book is not written by some anti-drug hack.  Dr. Peter Gotzsche co-founded the Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year.
I first heard about the Cochrane Collaboration in my high school debate class when my teacher was discussing the greatest collection and analyses of medical knowledge in the world.
Yeah - the author of this book helped found it and he has worked in medical research and meta-analysis of data for most of his life.  He became Professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen.
Basically - this guy knows what he is talking about. He is a physician who has prescribed medications, he has been a "drug rep" and helped sell medications, and he has since analyzed more studies than any researcher I've read.
The only reason this book doesn't get an A+ is because it is so amazingly heavy on research and medical terminology that it is unlikely to be read by the general public.

This book meticulously and methodically shows how deeply entrenched the pharmaceutical industry is in EVERY level of medicine.
I knew they offered free lunches, free drug samples, and they paid for speakers at medical conferences.  I knew they used to give out free pens and paper, and toys, and clocks.  I even knew they had some pull at the FDA.  I had no idea about all the rest.
This was the part that scared me the most. 
The BMJ (British Medical Journal)'s former editor said "medical journals are an extension of the marketing arm of the pharmaceutical companies." - p. 64
WHAT?!  Medical journals are where I get my trustworthy information.  It's where I can find double blind randomized control trials that have been peer-reviewed.  They are the gold standard for research!
Journals are where I proudly hang my hat.  I don't need to listen to drug reps - I read the New England Journal of Medicine.  The best in the world!

It turns out journal editors can be bought off - just like everyone else.  Even the best medical journals in the world - New England Journal of Medicine, Lancet, BMJ, Annals of Internal Medicine and JAMA - have all accepted drug money to publish misleading information or bad studies.
The New England Journal of Medicine (likely the most respected medical journal in the world) is as guilty as the rest.  32% of all trials published in their journal were solely funded by drug companies.
NEJM even changed their policy in 2002 to allow authors to write about products in which they had a financial interest.
Journals make HUGE money from advertisements and reprints.  If they publish a study beneficial to a drug company - that company promises to buy reprints in order to show them to physicians.
The Lancet made over £1.5 million on orders for a reprint of just one of their editions.  - p. 65
The Annals of Internal Medicine lost over $1 million in advertising revenue after it published a study that was critical of industry advertisements. - p. 65
Journals have a financial interest in making their article abstracts sound beneficial for new drugs.  Reprints will be ordered.  The more they allow a study to minimize or hide side effects - the more money they'll make.
Journal corruption is just one small chapter in this book.  Gotzsche also details corruption in clinical trials, seeding trials, TV ads, the FDA, patents, professional organizations, and even CME (Continuing Medical Education.)

Doctors have to stay current.  To keep our board certification we have to log hours of continuing education.
60% of all CME is paid for and provided by drug companies - so guess what most of us are learning?  Exactly what they want us to.
Drug companies are not changing.  They get caught in their fraud and they either say it was "one bad apple" or "mea culpa: we've now changed our ways."
It's all lies.
If you look at the 3 years span from 2010-2012 you'll find these cases:

2012: Abbott paid $1.5 Billion for Medicaid fraud

2012: Johnson and Johnson fined $1.1 Billion for hiding side effects
2011: GlaxoSmithKline paid $3 Billion for illegal marketing of off-label drugs.
2010: AstraZeneca paid $520 Million for fraud
2010: Novartis paid $423 Million for illegal marketing
the list goes on...

They aren't changing.  Drug companies know how to make money - and these lawsuits are already factored in to the profit predictions.  They know that these fines are worth it.  The fraud makes them more money than they will ever be fined.

This book made me look at my life.  I'll graduate from fellowship in four months and begin my career as a Child and Adolescent Psychiatrist.

I know there are good medications.  There are caring doctors.  There are honest people working as drug reps.  There are intelligent and ethical researchers at the FDA and at pharmaceutical companies.  There are honest, discerning journal editors who want to publish the truth.

I simply don't trust drug companies to give any of these people accurate information.

Peter Gotzsche's book is heart-breakingly accurate.  I highly recommend it.

(Because of this book, I have started a facebook group for prescribers called "Doctors Without Sponsors" to help increase awareness and encourage others to decrease their reliance on drug companies' information and money.  I also recommend signing this pledge:

Tuesday, February 17, 2015

Book Review: Essentialism

Fast Read with Pearls of Wisdom
Grade: B+
 This book helps you develop more options in your life.  Push away all the clutter and figure out what you REALLY care about, and what you need to have a fulfilling life.
 It starts with a rather extreme idea - say NO to everything.  Seriously, when you are asked to do pretty much anything, say no. 
"Do you ever feel busy but not productive?" (p. 4) I do. This is because we do so many things that don't really matter to us.  We do things that we don't care about, that don't move us forward, that aren't part of our value system.  They don't advance our career or improve a relationship - yet we do them anyway.
"Live by design, not by default." (p. 7)  How many of us really choose what we do each day?  How many of us have daily goals, weekly goals, monthly goals, yearly goals?  Even if they are not written down - we know what they are and we know what we are doing each day to get us there.

"If you don’t prioritize your life, someone else will." (p. 10)  Just like your dream.  If you aren't fulfilling your own dream , someone else will pay you to help fulfill theirs.
He then gets into some other great points about our homes, our belongings, our clutter:
"We tend to value things we already own more highly than they are worth." (p. 18)  We've been taught to never throw anything away.  Which increases our number of choices, increasing our stress, decreasing our space and enjoyment.
"This book is not about going back to a simpler time.  It’s not about eschewing e-mail or disconnecting from the web or living like a hermit. " (p. 27)

This book embodies the idea of Good Better Best.  Stop doing so many things that are merely GOOD.  WE can fill out lives with "good" things and miss out on everything that is better, and even the best.

"We aren’t looking for a plethora of good things to do.  We are looking for the one where we can make our absolutely highest point of contribution." (p. 112)

We need to reevaluate the way we look at opportunities: Don’t ask “How will I feel if I miss this opportunity?” but rather, “If I did not have this opportunity, how much would I be willing to sacrifice in order to obtain it?” (p. 149)

This book took me a few days to read because it is well written.  The author gives interesting and understandable examples and it was easily applied to me daily life.  I am glad I read it.

I recommend it

Here are a few more of my favorite quotes:

Essentialism is not about how to get more things done, it’s about how to get the right things done. – p. 5

The more choices we are forced to make, the more the quality of our decisions deteriorates. – p. 15

We keep doing things we detest to buy things we don't need with money we don't have to impress people we don't like. – p. 26

Drip by drip we allow our power to be taken away until we end up becoming a function of other people’s choices – or even a function of our own past choices. – p. 39

Warren Buffet decided early in his career it would be impossible for him to make hundreds of right investment decisions, so he decided that he would invest only in the businesses that he was absolutely sure of, and then bet heavily on them. – p. 44

You cannot overestimate the unimportance of practically everything – p. 45 (John Maxwell)

There are no solutions.  There are only trade-offs. – p. 55 (Thomas Sowell)

By abolishing any chance of being bored we have also lost the time we used to have to think and process – p. 68

The best journalists do not simply relay information.  Their value is in discovering what really matters to people. – p. 75

Play stimulates the parts of the brain involved in both careful, logical reasoning and carefree, unbound exploration. – p. 87

“If you think you are so tough you can do anything I have a challenge for you.  If you really want to do something hard; say not to an opportunity so you can take a nap.” – p. 94

The best violinist spent more time practicing than the merely good violinists…[AND] the best violinists slept an average of 8.6 hours in every 24 hour period; about an hour longer than the average American. – p. 97

If we could be truly excellent at only one thing, what would it be? – p. 127

When people ask us to do something, we can confuse it with our relationship with them. – p. 137

Sunk Cost Bias – it explains why we’ll continue to sit through a terrible movie because we’ve already paid the price of a ticket. – p. 146

Nearly 40 percent of our choices are deeply unconscious – p. 209

Every habit is made up of a cue, a routine, and a reward – p. 209

On my worst days I have wondered if my tombstone will read “He checked e-mail” – p. 232


Sunday, February 1, 2015

How Did I Find the Dedication to Train for a Marathon? By Realizing I Am Too Lazy to Walk 100 Meters to Get to a Gym.

On January 1st I asked for some advice on what gym I should join.  I knew I wanted to get back into shape – and I wanted to train for a long race.  I didn’t know if it would be a 10K or a half Marathon – I just knew I needed to get running. 
Luckily I know myself – and I know how lazy I am.  I would only run if it were easy. 

I teach a religion class every morning and then I have a break before work starts.  I knew I would only exercise during that break if it were easy.

I debated using the University gym down the street – but I knew I’d never make it.  I refuse to pay $200 for the parking pass, and if I had to walk over 100 meters to get to the gym – I wouldn’t do it.  (This is when friends said to me - “you’re training to run a 13 mile race but you won’t walk 100 meters?”)


I then looked at the Hospital’s gym – it was gorgeous and amazing with every amenity I could ever want: treadmills, a track, classes, a pool and sauna, etc… – but the parking lot was still too far from the gym and it cost too much.

Then I found Anytime Fitness.  It was small and dinky with tiny bathrooms, only 2 showers, and very few channels on the TV.  No pool, no amazing equipment. 

AND it was only one mile from where I teach my morning class.  I could park 10 feet from the gym door and I could be running on a treadmill 30 seconds after parking my car.

What was the result?
That first week I ran 3 miles.
The next week I ran 9. 

I realized that I still like running and I can run a really long distance.  I just hate getting READY to work out.  Now, that part was easy.
The next week I ran 18 miles.  I had decided to train for a full marathon: 26 miles.

I have now scheduled my workouts for the next 6 months.  I take 3 days off per week.  I have cross training days and recovery days.  I’m still me - I want time off.  

But I have no doubt I’ll keep training for the next 5 months and I’ll run that marathon, because I'm loving my daily schedule.

Running a Marathon may be the hardest physical feat I ever complete - and the only reason I believe I can do it… is because I made it easy.

Friday, January 23, 2015

Book Review: FOCUSED

This is a perfect book. 

It's a short, simple, heartfelt autobiography of a women overcoming tragedy and defeat.  It is the story of Noelle Pikus Pace; and Olympic athlete who was #1 in the world until her leg was broken by a 1,400 pound runaway bobsled going 60 mph.

This is a story about family and faith.  Noelle tells us what it was like to have her career derailed. How she struggled to get back to the top, only to finish one tenth of a second too slow to get the bronze medal. 

She tells of the heartache of being away from her husband and children.  Her lack of focus and scattered goals while meandering through years of Olympic training.

Then her decision to take her family with her for the rest of her training.  Her realization that in order to be the athlete she wanted to be, she also needed to be the wife and mother she wanted to be.  As her focus became clear and she chose family and God, AND Skeleton racing - she was able to live the life she wanted.

She realized that she didn't need to focus on other racers, or be competitive AGAINST them.  She could be a competitive athlete, by becoming the best version of herself.

As she says in the book:
"Be fearless and love yourself for who you are and what you can offer. Share your talents, whatever they may be, with those around you. Be humble when you recognize you have a gift, and continue to develop it. Help and encourage others as they try new things and develop their talents. Don’t be afraid for them to succeed. Their success cannot diminish your talents unless you allow it to. Compliment yourself when you do something praiseworthy. Compliment others as well. Be honest with yourself about your weaknesses, and strive to make them stronger. Don’t strengthen your weakness in order to beat someone else, but strengthen them to become the best version of yourself. Finally, and most important, dare to be you!"