When doctors can’t tell you what’s wrong (updated)

Some number of people feel ill, and they have no doubt that they feel ill, yet their doctors claim to find nothing wrong with them.

Not uncommonly, the medicos will infer that “it’s all in the head”, and prescribe tranquilizers or placebos or the like. Sometimes they pretend to know what’s going on and offer a diagnosis that sounds technical and knowledgeable, like “irritable bowel syndrome” or “chronic fatigue syndrome”, but offer similarly non-specific treatment: sedatives, placebos, “avoid spicy foods”, “get plenty of rest”, etc.

On TV, House featured a doctor who specialized in diagnosing difficult cases, obscure conditions. In real life, it may be that patients need to do the work for themselves.

This blog post was stimulated by the experience of a friend’s daughter, “N”, a highly intelligent, capable, productive lawyer, who had began to experience episodes of pain, seizures, mental confusion. Local doctors couldn’t help. The renowned Mayo Clinic was also unable to diagnose and cure. So N herself researched the literature. The upshot is that she suffers from a very rare disorder, Hashimoto’s Encephalopathy (eventually confirmed at the University of Illinois Medical Center in Chicago), about which there is the typical official inconclusiveness: Does it really exist? What symptoms define it? Are there effective treatments?

Hashimoto’s Encephalopathy is also known as Steroid Responsive Encephalopathy Associated with Thyroiditis or Autoimmune Encephalopathy — illustrating again the essential uncertainties about this. People who believe that they may have this condition can now turn to a patient-organized website  which is about to publish a book of case studies, personal accounts, and relevant scientific papers.

The wife of an acquaintance of mine, another lawyer, “T”, also enormously productive, came down a few years ago with what seemed like chronic fatigue syndrome. Again the official medical route did not bring help. Eventually T and her husband decided that the problem was Chronic Lyme Disease. Again there is controversy: Does this condition really exist? Doctors who have treated such patients with very long-term courses of antibiotics have sometimes been excoriated by the medical profession or even charged with malpractice — see Medicine isn’t science — nor should it be.

Even with comparatively well-defined conditions, it behooves us to take responsibility ourselves for evaluating what our doctors tell us, by getting as much other information as possible. An example that I’ve noted before is M. Aziz’s research on vitamin D (Evidence-based medicine? Wishful thinking).  After all, most doctors only know what official sources and drug companies tell them, and that has become increasingly untrustworthy  — see e.g. “Don’t take a pill if you’re not ill”, “Everyone is sick?”, and the several posts on this blog about statins and cholesterol.

Drug-based medicine is inescapably medicine for profit. No matter their propaganda and spin, pharmaceutical companies are motivated first and foremost by the need to make profits. They want to sell as much as possible at as high a price as possible, and therefore pay little attention to rarer conditions or to medications that would be used only for short periods, like antibiotics. They are on the lookout for “blockbusters” — drugs that people can be persuaded to take lifelong, like statins, anti-arthritics, breathing helpers for asthmatics and COPD patients, and most recently vaccines, which can potentially be administered to everyone (Deadly vaccines; Beyond Belief: Deadly vaccines for Africa and Asia).

Many people do in fact take responsibility when they make us of “alternative medicine”, but the same caution is called for here, because most vitamins and other supplements are described and sold by individuals or companies who make their living from such sales. There are not many disinterested sources of information about alternative medicine. One such resource, an attempt to evaluate in an unbiased and evidence-based way, is Alternative Medicine — The Christian Handbook by Dónal O’Mathúna (research chemist) & Walt Larimore (MD), Zondervan (2001, updated 2006, Kindle ed. 2010).

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Déjà vu all over again

Many voices have been raised in many places for many years, about the many things that are badly wrong with drug-based medical practices. 

Dozens of books  by well informed individuals have exposed the nefarious actions of drug companies, the lack of appropriate regulations and oversight, the damaging prevalence of conflicts of interest, the inadequacy of clinical trials, the failure to monitor drug safety and efficacy following approval and marketing, the disastrously inappropriate use of biomarkers as purported surrogates for clinical condition and prognosis . . .

Yet nothing changes. Or rather, things keep getting worse because nothing changes, and they will continue to get worse unless drastic, revolutionary actions are somehow brought about. More dangerous drugs will be prescribed to more people, harming them physically and mentally at increasingly exorbitant financial cost.

For example:
There is no good evidence that statins are of any benefit, specifically that they stave off cardiovascular disease or stroke — as acknowledged in peer-reviewed articles and the Institute of Medicine 2010 report, Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease.
On the other hand, there is ample evidence that statins have very nasty “side” effects: mental confusion, loss of memory, weakening of muscles.

Nevertheless, august authorities continue to revise their “guidelines” and “recommendations” to increase the numbers of people being prescribed these harmful, benefit-lacking substances. The latest initiative would double the number of Americans buying statins:
“The number of Americans taking cholesterol-lowering statin drugs is set to double under new guidelines unveiled Tuesday by the American College of Cardiology and the American Heart Assn.
The goal of prescribing statins to as many as 70 million people is to reduce the incidence of heart attacks and strokes in the United States, not merely to get patient’s LDL cholesterol – the ‘bad’ kind that’s most closely linked to disease risk – into an ideal range, experts said.”
But the peer-reviewed literature does not support the notion that statins “reduce the incidence of heart attacks and strokes” .

These revised guidelines do benefit the drug companies, as Marcia Angell pointed out in the New York Times:
“The Bottom Line? Often the Drug Companies’
[A]s is often the case with specialty societies, the groups behind these new proposals, the American College of Cardiology and the American Heart Association, are heavily dependent on financial support by drug companies to support their meetings. Moreover, members of their guideline committees often work as paid consultants or speakers for companies whose sales will be affected by the guidelines. About half the members of the committee that wrote the cholesterol guidelines had financial ties to the makers of statins . . . .
Conflicts of interest are not just a matter of form; they do matter.
Another problem: Instead of targeting cholesterol levels, the new cardiac guidelines target all risk factors that together would predict at least a 7.5 percent chance of a heart attack or stroke in 10 years – including age, smoking and high blood pressure. Thus, you might be subject to statin treatment even if your ‘bad’ cholesterol is quite low.
But why take a drug designed to lower cholesterol if that’s not your problem? That seems nonsensical, unless there is very good evidence that statins have other, relevant effects. And that gets to the heart of the matter.
Far-reaching guidelines should be based on strong scientific evidence from randomized controlled clinical trials. Without it, all we have is the opinion of a group that, even though expert, has a financial conflict of interest.
The only sure benefit of doubling the market for statins is to the bottom line of the drug companies” [emphases added].

In this modern, “scientific” age, one believes any and all official pronouncements on matters of science and medicine at one’s peril; see Dogmatism in Science and Medicine  as well as the many books about what’s wrong with present-day medicine.

The solution has to be systemic: the whole system of drug research and approval and monitoring and marketing and prescribing has to be drastically altered, because what’s wrong is systemic, it is not the fault of any identifiable individuals or groups.

Angell was quite right to point to conflicts of interest as a source of damage. But conflicts of interest are widely misunderstood: it’s generally assumed that conflicts of interest are harmful only if individual subject to them behave unethically by not resisting temptation. That’s a mistaken view (read the excellent discussion by Andrew Stark, Conflict of Interest in American Public Life, Harvard University Press, 2000).

Conflicts of interest exert a statistically significant effect even if no one deliberately does anything unethical. I’ve used before the example of doctors who have financial interests in clinical labs prescribing more lab tests than doctors who don’t have such financial interests. But it is perfectly possible that the belief in the value of lab tests came first, and the financial investment later, so that the financial conflict of interest is not responsible for increased prescribing of tests. Nevertheless, the conflict of interest shows that a bias exists toward more testing.

As to consultantships, research grants, and support for “medical education” by drug companies: The overriding effect is that there are congenial interactions among researchers, physicians, and drug-company personnel. Congenial interactions conduce to a sort of team feeling. Researchers and physicians come to regard drug-company personnel as nice people who are doing their jobs honestly and properly. That researchers and physicians with conflicts of interest associated with drug companies vote to approve drugs more often than people without those conflicts of interest merely reflects attitudes no more reprehensible than feeling like an integral part of an enterprise, being loyal to one’s group, “my country right or wrong” — attitudes that may be based on mistaken interpretations but that are in no way reprehensible, whereas it would be reprehensible to do for personal gain things understood to be bad.

Within drug companies, specialization of roles also means that bad things happen even though no individuals do bad things deliberately. Managers naturally ask researchers to work on projects that are likely to bring the largest sales. Those conducting clinical trials believe reasonably enough that researchers have good reason to think their product is likely to be beneficial. Marketing staff rely on the expertise of the scientific personnel and can be enthusiastic about selling the drugs. So bias pervades the system, always in the favor of drugs and against looking with determined skepticism into actual efficacy and safety. The result is that over the last two or three decades, “blockbuster” drugs have increasingly turned out to be harmful rather than beneficial: see a list in Wikipedia  and pp. 238-42 in Dogmatism in Science and Medicine.

The evils of modern drug-based medical practice can only be undone by a thoroughgoing overhaul of the whole system, including — for a start — banning direct-to-consumer advertising of prescription drugs and the restricting of “accelerated approval” to what it was originally designed for, genuine life-threatening emergencies.

The Science Bubble

Even good and admirable things can become damaging liabilities if taken to excess. More is not necessarily better. More food than we need to keep our best weight can be quite damaging. More power corrupts absolutely more.

Economic growth is taken to be good, yet a number of innovations that stimulated growth turned out to be very damaging when taken over by “irrational exuberance”. The derivatives/sub-prime mortgages bubble that burst not so long ago continues a series of such bubble-burstings in financial matters, nicely recounted and explained in Galbraith’s A Short History of Financial Euphoria [1].

The largely unrecognized reason is that when a useful activity expands, at some stage it may become quite a different thing. In the case of science, there is no question that “modern science”, a very good thing indeed in its time and place, has expanded tremendously during its lifetime of half a millennium — expanded exponentially, as Derek Price showed [2]. It remains largely unrecognized that this lifetime of five centuries has seen at least three distinguishable eras, in the last of which “science” is nothing like what it was in the first era, in particular through the hegemony of ill-founded dogmas on matters of great public importance [3].

That science has gone badly astray in certain fields and certain respects may not remain much longer secret since it has been noted in the much-respected The Economist [4]: “modern scientists are doing too much trusting and not enough verifying — to the detriment of the whole of science, and of humanity. . . . shoddy experiments . . . poor analysis” . . . half of published research cannot be replicated . . . . [Only] six of 53 ‘landmark’ studies in cancer research. . . . just a quarter of 67 similarly important papers. . . . three-quarters of papers in . . . [computer science] are bunk. . . . roughly 80,000 patients took part in clinical trials based on research that was later retracted because of mistakes or improprieties”.

Competitiveness is one of the reasons. Just after World War II, the world had a few hundred thousand scientists; now there are 6-7 million. . . . “publish or perish” . . . . “Every year six freshly minted PhDs vie for every academic post. . . . The hallowed process of peer review is not all it is cracked up to be”.

None of this is new to me, or to readers of my books and blogs, but it is quite novel to see these points made in a respected periodical of wide circulation. Suggestions for amelioration, however, miss the main point, since they don’t address the central issue of competitiveness.

A companion article [5] to this Economist Editorial offers a few more examples. “’I see a train wreck looming’, warned Daniel Kahneman, an eminent psychologist, in an open letter last year” about research on “priming”, which suggested that apparently irrelevant matters just before a decision could influence that decision. “There is no cost to getting things wrong . . . . The cost is not getting them published”. Incompetent statistics is a huge problem in many fields. But once again the suggested solutions miss the point:

“Journals must do more to enforce standards. . . Budding scientists must be taught technical skills, including statistics, and must be imbued with skepticism towards their own results and those of others. Researchers ought to be judged on the basis of the quality, not the quantity, of their work. Funding agencies should encourage replications . . . .”

None of those can fix what’s wrong, because what’s wrong resides in the traditional culture of science — seeking new knowledge — which has become dysfunctional owing to the enormous growth of the enterprise. As with bubbles in other human activities, the Science Bubble will have to burst before reform can be effective. There is too much “research”, done by too many not very competent people motivated not by truth-seeking but by self-interested careerism.

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[1] John Kenneth Galbraith, A Short History of Financial Euphoria, Whittle Books/Penguin 1993
[2] Derek de Solla Price, Little Science, Big Science . . . and Beyond,  Columbia University Press 1986; Science Since Babylon, Yale University Press 1975 (enlarged from 1961 edition)
[3] Henry H. Bauer, Dogmatism  in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth, McFarland 2012
[4] Leaders: How science goes wrong, The Economist, 19 October 2013, p. 13
[5] Briefing: Unreliable research: Trouble at the lab, The Economist, 19 October 2013, pp. 26-30

 

Mainstream propaganda by the BBC about denialism and global warming

A BBC documentary entitled “Science Under Attack” was broadcast in the UK on 24th January 2011. It is a superb piece of propaganda masquerading as a scientific documentary. Among other things, it seeks to quench any doubts that emissions of carbon dioxide are greatly speeding up global warming. A secondary aim seems to be to safeguard any and all pronouncements from the Scientific Establishment against criticism from outsiders.

Outside the UK, the program is not available from the BCC website, but on 1 April 2013 it was on YouTube for a short time before being purged for copyright reasons. An earlier YouTube posting had also been removed, as had the 7 sections of the program posted by TheChipsnbeer66.

“Science Under Attack” relied on two unstated presumptions, both of which are unsustainable: That a scientific consensus at any given moment should be taken as correct, and that computer models can accurately make predictions about something as complex as climate.

I call the program superb because it masks its propaganda so subtly:

First through being narrated by Sir Paul Nurse, president of the Royal Society, a disarmingly amiable man who recounts how he has enjoyed thoroughly his lifelong work in science, along conventional lines but ably enough to bring a Nobel Prize. There is no trace of haughty arrogance in Nurse. When he says, ”Call me Paul”, it is obviously meant wholeheartedly, it is a straightforward, genuine and unassuming meeting card as he begins conversations with people who question the conventional view on global warming, HIV/AIDS, or the safety of genetically modified plants and foods. Even as I find the program deviously misleading, I continue to find Nurse wholly likable. Many likable people are wrong about all sorts of things, and many scientists are wrong about the reliability of contemporary scientific consensuses.

Second, “Science Under Attack” implies evenhandedness by allowing questioners to appear and to be treated in courteous, friendly fashion by Nurse.

Third, the very title of the program already makes its case subliminally. Surely science must actually be under attack if a program is devoted to the matter? Details might be arguable, say, the reasons why it is under attack, but surely the title couldn’t be entirely misleading, could it?
But of course it is. “Science” is not under attack by anyone. It’s just that in quite a number of fields, those in power are suppressing the views of competent peers. It is unwarranted mainstream dogmas that are under attack by a minority of largely ignored experts and informed observers [1].

Fourth, a vast range of relevant stuff is ignored. Perhaps the most important — and the least understood — is that whenever the significance of science outside its own domain is concerned, namely, the consideration of potential applications of scientific knowledge, and in particular any applications that impinge on public policies, scientists (very much including Nobelists like Nurse) are not the experts. Indeed, they are rarely knowledgeable at all. Most relevant here is that the history of science is a continuing story of mainstream consensus being found wrong and needing to be replaced. But most scientists — and many others too — still believe that scientists use a scientific method that automatically produces trustworthy results; they are not only lamentably ignorant but often downright misinformed about the history of science, the philosophy and sociology of science, the psychology of scientists. Scientists qua scientists are not reliable advisors on matters of public policy [2].

An important specific omission comes early in the BBC program, when Nurse cites a letter published in Science in which 250 climate scientists deplore the manner in which they are accused, in intemperate language, of fudging their data. Those cry-babies have nothing to complain of by comparison with how they themselves treat their own peers who happen to take a different view, as when Bjørn Lomborg — who doesn’t even question human-caused global warming, only the purported efficacy of Kyoto-type ameliorations — was compared to a Holocaust denier in a book review published in Nature (414 [2001] 149-50). Dissenters from the consensus are denied research funds, publication in leading journals, inclusion in conferences [1]. The cry-babies had their letter published in Science, but letters from those who dissent from a mainstream consensus and protest the lack of attention to the actual evidence are routinely refused publication in Science and Nature and the Lancet and the New England Journal of Medicine [3].

The program misleads by stating that the so-called attack on science comes from the lay public, vested ideological interests, and hapless media. In point of fact it is well qualified experts, insiders of the scientific specialty, who question the consensus [4]. Excluded from and shunned by their own professional forums, they can only turn to the public and the media in attempting to get some sort of hearing for their case.

The first flawed presumption on which the BBC program rests — unspoken but clearly entailed implicitly — is that a scientific consensus should always be accepted. This is absurd on its face, especially in conjunction with the program’s soothing assertion that the computer models of global climate are being improved all the time. This amounts to an intellectual oxymoron: If improvement is needed, obviously one shouldn’t have believed earlier claims or, by easy extension, what is now claimed. There is no guarantee that the next “improvement” will not upset the whole apple cart. To give just a couple of actual examples: It had been found that the model was diametrically wrong about the influence of clouds; and it was discovered belatedly that living plants emit significant amounts of the powerful greenhouse gas, methane.
As Michael Crichton pointed out in a splendid essay [5], the same experts whose computer models cannot predict weather with any reliability more than a few days ahead are asking that their computer models be trusted to tell us what’s coming 50 and 100 years from now. Global temperatures have cycled over a range of about 5ºC several times during the last million years. Until the computer models can simulate that record, which they presently cannot, there is no reason to pay any attention to what they predict about the future.
I suggest that when you hear “scientific consensus”, you should immediately reach for your common sense and your history of science. Moreover, many climate scientists and meteorologists are on record as disagreeing with the so-called consensus about climate change.

Crichton is also good about the second flawed presumption. Computer models can never be better than the assumptions and data fed into them. The only way to test them is to compare them with reality. No comparison based on current or past circumstances can ever validate a model for the purpose of making predictions, because the model was constructed through knowledge of those past and present circumstances, and the future might be different in some significant, unsuspected, unforeseeable way. In “Science Under Attack”, Sir Paul expresses admiration for a demonstration at NASA of how similar are the actual circumstances and those calculated by the computer; but of course the computer’s calculations reflect accurately what is happening at the present time, because that’s the knowledge that was programmed into it. Tomorrow may be another day entirely.
The NASA scientist admits that Nature itself, rebounding from the last ice age, is causing some of the warming, but asserts that the present rate of warming is greater than anything in the past. That cannot be known. Past temperatures have fluctuated mightily: over a range of about 15ºC several times during the billions of years of the Earth’s existence, over a range of about 5-6ºC seven or eight times during the last million years, but the data from those past episodes are not fine-grained enough to reveal all the fluctuations over periods as short as a century or so. We simply do not know how rapidly the global temperature rose or fell within any given century 100,000 or a million years ago. Furthermore, assessing changes — let alone rapidity of changes — of a continually fluctuating up-and-down temperature means choosing starting and ending points for calculating the change: start at the trough before a warming period and end at an apex, and the change looks large; start at a rising midpoint and end at a falling midpoint and the “change” will be negligible. The NASA man’s assertion that warming is faster now cannot be known to be true, which makes it in effect a lie, albeit perhaps an unwitting one. A very detailed analysis of Earth’s many temperature cycles, with periodicities ranging from hundreds of years to hundreds of thousands of years, can be found in David Dilley’s “Natural Climate Pulse” [6].

Sir Paul Nurse helps create superb propaganda not only because he is so affable and sincere but also because he symbolizes centuries of scientific achievement, emphasized several times in the program as he visits the Royal Society’s archives and touches volumes by Darwin and Newton. Those lauded scientists were right, therefore we scientists are right now, is the obvious message. There is no mention of Bernard Barber’s long list of now-revered scientists, household names like Einstein (relativity) and Faraday (electrochemistry) and Lister (antisepsis) and Planck (quantum theory) who were fiercely resisted by their contemporary consensus [7]; nor did Newton’s or Darwin’s works receive immediate acclamation from their contemporary peers.
George Bernard Shaw’s insights might well be recalled, that progress depends on “unreasonable” individuals, and that all professions are conspiracies against the laity. Science has been a profession for more than a century now.

The program’s simulation of evenhandedness is entirely misleading. Fred Singer is allowed to make only a single point, that there’s a strong correlation between the solar wind and Earth temperatures. Commenting later on that conversation, Sir Paul points out that one must take into account all the evidence, not just a single factor, implying that this is what Singer does. In reality, Singer in his many publications takes into account every known factor no less than do the orthodox climate scientists, and some might say he considers all the data better than the orthodoxy does. A documentary that made Singer’s case could be just as convincing as this one is, yet in the opposite direction, if 95% of the program expounded Singer’s views of “all” the evidence and if, “in fairness”, one exponent of the orthodox view were allowed to make only a single point.

Similarly, Sir Paul talks with Tony Lance and allows him to mention that he has been “HIV-positive” for 13 years and entirely healthy and that he saw many friends dying after taking AZT. Later Sir Paul confesses that he doesn’t understand Lance’s thinking. Of course he doesn’t, he didn’t spent the requisite time learning about all the mainstream literature Lance has accumulated that supports his interpretation. Were Sir Paul to attempt to convey his own thinking to someone else in the space of a short conversation, that other person could well remain unable to understand Sir Paul’s thinking.

It is also worth bearing in mind that Sir Paul Nurse is a biologist. On the matter of global warming, he takes on trust the purveyors of the orthodox view. This is standard practice within science: specialists in one field trust what they hear from specialists in other fields. But one can reasonably ask, why does Nurse trust the Establishment specialists rather than the at-least-equally qualified and eminent Fred Singer and the thousands of other well qualified specialists who maintain that human-caused global warming has not been proved?
A partial answer to that may be found in “The New World Order in Science”: Conflicts of interest within science and vested interests from outside science have distorted “the search for truth” to the degree that a contemporary “scientific consensus” reflects power and not truth.

“Science Under Attack”, then, is thoroughly wrongheaded and misleading, about matters large — the nature of science, the significance of a scientific consensus, the role of computer models — and about matters smaller, the specific evidence for and against human-caused global warming, HIV-caused AIDS, and the dangers of genetically modifying organisms. It is superbly convincing through the devices I’ve described. It is propaganda pure and simple, at its best — which means at its moral worst.
It would therefore be gratifying to wax furious at Sir Paul Nurse and the writers and producers of this program for their devilish ingenuity in manufacturing such a fine piece of propaganda. But the reality is even worse. We should never attribute to deliberate malice what can be explained by incompetence or ignorance, because incompetence and ignorance are really so much more common than deliberate malice [8]. In more than one place, Sir Paul asserts that science is always trying to test its theories to self-destruction, always looking to all the evidence, always empirical and open-minded. It’s clear that he genuinely believes those things, not understanding that they are ideals and that scientists fall far short of practicing those ideals, individually to some extent but chiefly collectively, because science nowadays is a collection and a hierarchy of interlocking institutions that make it enormously difficult to change any established consensus [1].

This BBC program was produced by perfectly well-intentioned true believers, whose ignorance is vast and quite unsuspected by them. They don’t know that they are cultish followers of the ideology of scientism, and they would be disbelieving, shocked, offended were that pointed out to them.

It is always worth recalling that the path to Hell is paved with good intentions.

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[1] Henry H. Bauer, Dogmatism in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth, McFarland 2012.
[2] Authoritative discussions of this point by a well-informed writer on science and politics can be found in Science, Money and Politics: Political Triumph and Ethical Erosion (2001) and Science for Sale: The Perils, Rewards, and Delusions of Campus Capitalism (2007), both by Daniel S. Greenberg, University of Chicago Press. As to the so-called scientific method, see Henry H. Bauer, Scientific Literacy and the Myth of the Scientific Method, University of Illinois Press, 1992.
[3] See “Suppression of Science Within Science”.
[4] See for instance the Science and Environmental Policy Project,  established by the distinguished scientist Fred Singer. See also my summary of why human-caused global warming should be treated with the greatest skepticism: “A politically liberal global-warming skeptic?”.
[5] Michael Crichton, “Aliens cause global warming (Caltech Michelin Lecture)”, 17 January 2003.
[6] The book can be downloaded from Dilley’s website  under “Climate Cycles” and then “Climate Pulse E-Book”. I couldn’t make the links work, so Google “David Dilley Climate” and go from there.
[7] Bernard Barber, “Resistance by scientists to scientific discovery.” Science, 134 (1961) 596-602.
[8] I believe that I first saw this expressed as one of Murphy’s Laws, which contain a huge amount of practical wisdom: Arthur Bloch, Murphy’s Law and other reasons why things go wrong; Murphy’s Law Book Two — more reasons why things go wrong; Murphy’s Law Book FourThree — wrong reasons why things go more (Price/Stern/Sloan, 1980-1982).