Group items matching

in title, tags, annotations or url

DJ: Of the basic values of French liberalism—liberty, equality, and fraternity—the last, fraternity, always seems to get short shrift. Your book, by contrast, argues that religious tolerance and liberalism in general can only flourish if people cultivate active respect, civility, and civic friendship with their fellow citizens. If this is so crucial, why do traditional liberals fail to make it more central to their program?

MN: I think liberals associate the cultivation of public emotion with fascism and other illiberal ideologies. But if they study history more closely they will find many instances in which emotions are deliberately cultivated in the service of liberal ideals. My next book, Political Emotions, will study all of this in great detail. Any political principles that ask people to go beyond their own self-interest for the sake of justice requires the cultivation of emotion.

we should confront sexism by argument and persuasion, and that to render all practices that objectify women illegal would be both too difficult (who would judge?) and too tyrannical.

critics of the burqa typically look at the practices of others and find sexism and “objectification” of women there, while failing to look at the practices of the dominant culture, which are certainly suffused with sexism and objectification. I was one of the feminist philosophers who wrote about objectification as a fundamental problem, and what we were talking about was the portrayal of women as commodities for male use and control in violent pornography, in a great deal of our media culture, and in other cultural practices, such as plastic surgery. I would say that this type of objectification is not on the retreat but may even be growing. Go to a high school dance—even at a high-brow school such as the John Dewey Laboratory School on our campus [at the University of Chicago]—and you will see highly individual and intelligent teenage girls marketing themselves for male consumption in indistinguishable microskirts, prior to engaging in a form of group dancing that mimes sex, and effaces their individuality. (Boys wear regular and not particularly sexy clothing.)

Lots of bad things are and will remain legal: unkindness, emotional blackmail, selfishness. And though I think the culture of pornographic objectification does great damage to personal relations, I don’t think that legal bans are the answer.

In the history of philosophy this was well understood, and figures as diverse as [Jean-Jacques] Rousseau, [Johann Gottfried von] Herder, [Giuseppe] Mazzini, Auguste Comte, John Stuart Mill, and John Rawls had a lot to say about the issue. In Mill’s case, he set about solving the problem posed by the confluence of liberalism and emotion: how can a society that cultivates emotion to support its political principles also preserve enough space for dissent, critique, and experimentation? My own proposal in the forthcoming book follows the lead of Mill—and, in India, of Rabindranath Tagore—and tries to show how a public culture of emotions, supporting the stability of good political principles, can also be liberal and protective of dissent. Some of the historical figures I study in this regard are Franklin Delano Roosevelt, Martin Luther King, Jr., Gandhi, and Nehru.

the Palin reaction was a whole lot better than the standard reaction in Europe, which is that we should just ban things that we fear. It is really unbelievable, having just lectured on this topic here in Germany: my views, which are pretty mainstream in America, are found “extreme” and even “offensive” in Germany, and all sorts of quite refined people think that Islam poses a unique problem and that the law should be dragged in to protect the culture.

The problem with these Europeans is that they don’t want to ban platform shoes or spike heels either; they just want to ban practices of others which they have never tried to understand.

Even doctors—those whose business is to treat others humanely— can remain disengaged from the minds of their patients, particularly when those patients are easily seen as different from the doctors themselves. Until the early 1990s, for instance, it was routine practice for infants to undergo surgery without anesthesia. Why? Because at the time, doctors did not believe that infants were able to experience pain, a fundamental capacity of the human mind.

Your sixth sense functions only when you engage it. When you do not, you may fail to recognize a fully human mind that is right before your eyes.

Although it is indeed true that the ability to read the minds of others exists along a spectrum with stable individual differences, I believe that the more useful knowledge comes from understanding the moment-to-moment, situational influences that can lead even the most social person—yes, even you and me—to treat others as mindless animals or objects.

None of the cases described in this chapter so far involve people with chronic and stable personality disorders. Instead, they all come from predictable contexts in which people’s sixth sense remained disengaged for one fundamental reason: distance.

This three-part chain—sharing attention, imitating action, and imitation creating experience—shows one way in which your sixth sense works through your physical senses. More important, it also shows how your sixth sense could remain disengaged, leaving you disconnected from the minds of others. Close your eyes, look away, plug your ears, stand too far away to see or hear, or simply focus your attention elsewhere, and your sixth sense may not be triggered.

Distance keeps your sixth sense disengaged for at least two reasons. First, your ability to understand the minds of others can be triggered by your physical senses. When you’re too far away in physical space, those triggers do not get pulled. Second, your ability to understand the minds of others is also engaged by your cognitive inferences. Too far away in psychological space—too different, too foreign, too other—and those triggers, again, do not get pulled

For psychologists, distance is not just physical space. It is also psychological space, the degree to which you feel closely connected to someone else. You are describing psychological distance when you say that you feel “distant” from your spouse, “out of touch” with your kids’ lives, “worlds apart” from a neighbor’s politics, or “separated” from your employees. You don’t mean that you are physically distant from other people; you mean that you feel psychologically distant from them in some way

Interviews with U.S. soldiers in World War II found that only 15 to 20 percent were able to discharge their weapons at the enemy in close firefights. Even when they did shoot, soldiers found it hard to hit their human targets. In the U.S. Civil War, muskets were capable of hitting a pie plate at 70 yards and soldiers could typically reload anywhere from 4 to 5 times per minute. Theoretically, a regiment of 200 soldiers firing at a wall of enemy soldiers 100 feet wide should be able to kill 120 on the first volley. And yet the kill rate during the Civil War was closer to 1 to 2 men per minute, with the average distance of engagement being only 30 yards.

Modern armies now know that they have to overcome these empathic urges, so soldiers undergo relentless training that desensitizes them to close combat, so that they can do their jobs. Modern technology also allows armies to kill more easily because it enables killing at such a great physical distance. Much of the killing by U.S. soldiers now comes through the hands of drone pilots watching a screen from a trailer in Nevada, with their sixth sense almost completely disengaged.

Other people obviously do not need to be standing right in front of you for you to imagine what they are thinking or feeling or planning. You can simply close your eyes and imagine it.

The MPFC and a handful of other brain regions undergird the inferential component of your sixth sense. When this network of brain regions is engaged, you are thinking about others’ minds. Failing to engage this region when thinking about other people is then a solid indication that you’re overlooking their minds.

Research confirms that the MPFC is engaged more when you’re thinking about yourself, your close friends and family, and others who have beliefs similar to your own. It is activated when you care enough about others to care what they are thinking, and not when you are indifferent to others

As people become more and more different from us, or more distant from our immediate social networks, they become less and less likely to engage our MPFC. When we don’t engage this region, others appear relatively mindless, something less than fully human.

The mistake that can arise when you fail to engage with the minds of others is that you may come to think of them as relatively mindless. That is, you may come to think that these others have less going on between their ears than, say, you do.

It’s not only free will that other minds might seem to lack. This lesser minds effect has many manifestations, including what appears to be a universal tendency to assume that others’ minds are less sophisticated and more superficial than one’s own. Members of distant out-groups, ranging from terrorists to poor hurricane victims to political opponents, are also rated as less able to experience complicated emotions, such as shame, pride, embarassment, and guilt than close members of one’s own group.

The international team has found more than 4,000 "enhancers" in the mouse genome that appear to play a role in facial appearance.

"In the mouse embryos we can see where exactly, as the face develops, this switch turns on the gene that it controls.

"These mice looked pretty normal, but it is really hard for humans to see differences in the face of mice," explained Prof Visel.

"What this really tells us is that this particular switch also plays a role in development of the skull and can affect what exactly the skull looks like," he explained.

Understanding this could also help to reveal why and how things can go wrong as embryos develop in the womb, leading to facial birth defects.

"And they have severe implications for the kids that are affected. They affect feeding, speech, breathing, they can require extensive surgery and they have psychological implications."

Professor Visel added that scientists were just at the beginning of understanding the processes that shape the face, but their early results suggested it was an extremely complex process.

“The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”

Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time.

if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials.

He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals

Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable.

In two nonfiction books, scheduled to be published in January, technology experts examine similar consumer-ranking techniques already in widespread use.

While a federal law called the Fair Credit Reporting Act requires consumer reporting agencies to provide individuals with copies of their credit reports on request, many other companies are free to keep their proprietary consumer scores to themselves.

Befitting the founder of a firm that markets reputation management, Mr. Fertik contends that individuals have some power to influence commercial scoring systems.

“This will happen whether or not you want to participate, and these scores will be used by others to make major decisions about your life, such as whether to hire, insure, or even date you,”

“Important corporate actors have unprecedented knowledge of the minutiae of our daily lives,” he writes in “The Black Box Society: The Secret Algorithms That Control Money and Information” (Harvard University Press), “while we know little to nothing about how they use this knowledge to influence important decisions that we — and they — make.”

Data brokers amass dossiers with thousands of details about individual consumers, like age, religion, ethnicity, profession, mortgage size, social networks, estimated income and health concerns such as impotence and irritable bowel syndrome. Then analytics engines can compare patterns in those variables against computer forecasting models. Algorithms are used to assign consumers scores — and to recommend offering, or withholding, particular products, services or fees — based on predictions about their behavior.

It’s a fictional forecast of a data-deterministic culture in which computer algorithms constantly analyze consumers’ profiles, issuing individuals numeric rankings that may benefit or hinder them.

Think of this technique as reputation engine optimization. If an algorithm incorrectly pegs you as physically unfit, for instance, the book suggests that you can try to mitigate the wrong. You can buy a Fitbit fitness tracker, for instance, and upload the exercise data to a public profile — or even “snap that Fitbit to your dog” and “you’ll quickly be the fittest person in your town.”

Professor Pasquale offers a more downbeat reading. Companies, he says, are using such a wide variety of numerical rating systems that it would be impossible for average people to significantly influence their scores.

“Corporations depend on automated judgments that may be wrong, biased or destructive,” Professor Pasquale writes. “Faulty data, invalid assumptions and defective models can’t be corrected when they are hidden.”

Moreover, trying to influence scoring systems could backfire. If a person attached a fitness device to a dog and tried to claim the resulting exercise log, he suggests, an algorithm might be able to tell the difference and issue that person a high score for propensity toward fraudulent activity.

“People shouldn’t think they can outwit corporations with hundreds of millions of dollars,” Professor Pasquale said in a phone interview.Consumers would have more control, he argues, if Congress extended the right to see and correct credit reports to other kinds of rankings.

It is unethical to deceive patients by prescribing fake treatments, of course. But there is evidence that people with some conditions benefit even if they know they are taking placebos. In a 2014 study that followed 459 migraine attacks in 66 patients, honestly labeled placebos provided significantly more pain relief than no treatment, and were nearly half as effective as the painkiller Maxalt.

With placebo responses in pain so high — and the risks of drugs so severe — why not prescribe a course of “honest” placebos for those who wish to try it, before proceeding, if necessary, to an active drug?

Another option is to employ alternative therapies, which through placebo responses can benefit patients even when there is no physical mode of action.

Taking a placebo painkiller dampens activity in pain-related areas of the brain and spinal cord, and triggers the release of endorphins, the natural pain-relieving chemicals that opioid drugs are designed to mimic. Even when we take a real painkiller, a big chunk of its effect is delivered not by any direct chemical action, but by our expectation that the drug will work. Studies show that widely used painkillers like morphine, buprenorphine and tramadol are markedly less effective if we don’t know we’re taking them.

Individual attitudes and experiences are important, as are cultural factors. Placebo effects are getting stronger in the United States, for example, though not elsewhere.

Likely explanations include a growing cultural belief in the effectiveness of painkillers — a result of direct-to-consumer advertising (illegal in most other countries) and perhaps the fact that so many Americans have taken these drugs in the past.

Trials show, for example, that strengthening patients’ positive expectations and reducing their anxiety during a variety of procedures, including minimally invasive surgery, while still being honest, can reduce the dose of painkillers required and cut complications.

Placebo studies also reveal the value of social interaction as a treatment for pain. Harvard researchers studied patients in pain from irritable bowel syndrome and found that 44 percent of those given sham acupuncture had adequate relief from their symptoms. If the person who performed the acupuncture was extra supportive and empathetic, however, that figure jumped to 62 percent.

Placebos tell us that pain is a complex mix of biological, psychological and social factors. We need to develop better drugs to treat it, but let’s also take more seriously the idea of relieving pain without them.

“What companies are looking for,” says Mary Jo King, the president of the National Résumé Writers’ Association, “is someone who can be all, do all, and pivot on a dime to solve any problem.”

The phenomenon is sped by automation, which usurps routine tasks, leaving employees to handle the nonroutine and unanticipated—and the continued advance of which throws the skills employers value into flux

Or, for that matter, on the relevance of the question What do you want to be when you grow up?

By 2020, a 2016 World Economic Forum report predicted, “more than one-third of the desired core skill sets of most occupations” will not have been seen as crucial to the job when the report was published

I asked John Sullivan, a prominent Silicon Valley talent adviser, why should anyone take the time to master anything at all? “You shouldn’t!” he replied.

Minimal manning—and the evolution of the economy more generally—requires a different kind of worker, with not only different acquired skills but different inherent abilities

It has implications for the nature and utility of a college education, for the path of careers, for inequality and employability—even for the generational divide.

Then, in 2001, Donald Rumsfeld arrived at the Pentagon. The new secretary of defense carried with him a briefcase full of ideas from the corporate world: downsizing, reengineering, “transformational” technologies. Almost immediately, what had been an experimental concept became an article of faith

But once cadets got into actual command environments, which tend to be fluid and full of surprises, a different picture emerged. “Psychological hardiness”—a construct that includes, among other things, a willingness to explore “multiple possible response alternatives,” a tendency to “see all experience as interesting and meaningful,” and a strong sense of self-confidence—was a better predictor of leadership ability in officers after three years in the field.

Because there really is no such thing as multitasking—just a rapid switching of attention—I began to feel overstrained, put upon, and finally irked by the impossible set of concurrent demands. Shouldn’t someone be giving me a hand here? This, Hambrick explained, meant I was hitting the limits of working memory—basically, raw processing power—which is an important aspect of “fluid intelligence” and peaks in your early 20s. This is distinct from “crystallized intelligence”—the accumulated facts and know-how on your hard drive—which peaks in your 50

Others noticed the change but continued to devote equal attention to all four tasks. Their scores fell. This group, Hambrick found, was high in “conscientiousness”—a trait that’s normally an overwhelming predictor of positive job performance. We like conscientious people because they can be trusted to show up early, double-check the math, fill the gap in the presentation, and return your car gassed up even though the tank was nowhere near empty to begin with. What struck Hambrick as counterintuitive and interesting was that conscientiousness here seemed to correlate with poor performance.

he discovered another correlation in his test: The people who did best tended to score high on “openness to new experience”—a personality trait that is normally not a major job-performance predictor and that, in certain contexts, roughly translates to “distractibility.”

To borrow the management expert Peter Drucker’s formulation, people with this trait are less focused on doing things right, and more likely to wonder whether they’re doing the right things.

High in fluid intelligence, low in experience, not terribly conscientious, open to potential distraction—this is not the classic profile of a winning job candidate. But what if it is the profile of the winning job candidate of the future?

One concerns “grit”—a mind-set, much vaunted these days in educational and professional circles, that allows people to commit tenaciously to doing one thing well

These ideas are inherently appealing; they suggest that dedication can be more important than raw talent, that the dogged and conscientious will be rewarded in the end.

he studied West Point students and graduates.

Traditional measures such as SAT scores and high-school class rank “predicted leader performance in the stable, highly regulated environment of West Point” itself.

It would be supremely ironic if the advance of the knowledge economy had the effect of devaluing knowledge. But that’s what I heard, recurrentl

“Fluid, learning-intensive environments are going to require different traits than classical business environments,” I was told by Frida Polli, a co-founder of an AI-powered hiring platform called Pymetrics. “And they’re going to be things like ability to learn quickly from mistakes, use of trial and error, and comfort with ambiguity.”

“We’re starting to see a big shift,” says Guy Halfteck, a people-analytics expert. “Employers are looking less at what you know and more and more at your hidden potential” to learn new things

advice to employers? Stop hiring people based on their work experience. Because in these environments, expertise can become an obstacle.

“The Curse of Expertise.” The more we invest in building and embellishing a system of knowledge, they found, the more averse we become to unbuilding it.

All too often experts, like the mechanic in LePine’s garage, fail to inspect their knowledge structure for signs of decay. “It just didn’t occur to him,” LePine said, “that he was repeating the same mistake over and over.

The devaluation of expertise opens up ample room for different sorts of mistakes—and sometimes creates a kind of helplessness.

Aboard littoral combat ships, the crew lacks the expertise to carry out some important tasks, and instead has to rely on civilian help

Meanwhile, the modular “plug and fight” configuration was not panning out as hoped. Converting a ship from sub-hunter to minesweeper or minesweeper to surface combatant, it turned out, was a logistical nightmare

So in 2016 the concept of interchangeability was scuttled for a “one ship, one mission” approach, in which the extra 20-plus sailors became permanent crew members

“As equipment breaks, [sailors] are required to fix it without any training,” a Defense Department Test and Evaluation employee told Congress. “Those are not my words. Those are the words of the sailors who were doing the best they could to try to accomplish the missions we gave them in testing.”

These results were, perhaps, predictable given the Navy’s initial, full-throttle approach to minimal manning—and are an object lesson on the dangers of embracing any radical concept without thinking hard enough about the downsides

a world in which mental agility and raw cognitive speed eclipse hard-won expertise is a world of greater exclusion: of older workers, slower learners, and the less socially adept.

if you keep going down this road, you end up with one really expensive ship with just a few people on it who are geniuses … That’s not a future we want to see, because you need a large enough crew to conduct multiple tasks in combat.

hat does all this mean for those of us in the workforce, and those of us planning to enter it? It would be wrong to say that the 10,000-hours-of-deliberate-practice idea doesn’t hold up at all. In some situations, it clearly does

A spinal surgery will not be performed by a brilliant dermatologist. A criminal-defense team will not be headed by a tax attorney. And in tech, the demand for specialized skills will continue to reward expertise handsomely.

But in many fields, the path to success isn’t so clear. The rules keep changing, which means that highly focused practice has a much lower return

In uncertain environments, Hambrick told me, “specialization is no longer the coin of the realm.”

It leaves us with lifelong learning,

I found myself the target of career suggestions. “You need to be a video guy, an audio guy!” the Silicon Valley talent adviser John Sullivan told me, alluding to the demise of print media

I found the prospect of starting over just plain exhausting. Building a professional identity takes a lot of resources—money, time, energy. After it’s built, we expect to reap gains from our investment, and—let’s be honest—even do a bit of coasting. Are we equipped to continually return to apprentice mode? Will this burn us out?

Everybody I met on the Giffords seemed to share that mentality. They regarded every minute on board—even during a routine transit back to port in San Diego Harbor—as a chance to learn something new.

Revisiting your youth culture when your own youth has mostly fled is an exercise in estrangement and mild humiliation, like running into your therapist at Victoria’s Secret.

“We didn’t know what it was going to be,” the journalist and activist Kevin Powell, one of the original roommates, says in the first episode of “Homecoming.” “We were just ourselves.”

by agreeing to the constant presence of producers and cameras, were the harbingers of today’s culture, in which self-image is shaped in the expectation of a lens and personhood collates with brand identity.

Moon Frye seems to have known every other child star in Los Angeles and its outlying counties: Sara Gilbert, Emmanuel Lewis, Brian Austin Green, Mark-Paul Gosselaar, Joey Lawrence, Jenny Lewis (hilarious) and at least a dozen more.

These were children valued less for who they were and more for the fandom and ads they could generate, the tickets they could sell

Today, that’s everyone with an Instagram account, potentially.

“Kid 90” also reminds us that until pretty recently, the dumb things teenagers wore and the dumber things they did and said didn’t have an afterlife, because there were few ways to record them and even fewer ways to disseminate those recordings.

I was, unconvincingly, so many people as a teenager — a rebel, a sophisticate, a drama nerd, a go-getter, a witch.

The comedy of adolescence is that it’s practice for adulthood. The tragedy is that adolescents practice on one another

I’m unutterably grateful that my own mortifications — lines like, “I’m not a feminist, I’m really more like a humanist,”

Moon Frye seems to have also struggled with her image and with how the industry treated her when her body began to diverge from Punky’s

In an agonizing section of the documentary, she talks about going through puberty, developing breasts and being seen, at 13 and 14 years old, only for bimbo-esque roles.

Peers called her Punky Boobster.

“It’s hard when you’ve got boobs and you can’t work in this business,”

What if the business is the problem and not children’s bodies?

She wanted serious roles, so at 15, she had breast reduction surgery.

A crucial aspect of adolescence is performance

I could try on a persona for size and then return it, tags on

There was no social media then and no one wanted me on any reality series, so I never had to curate a self before I had one.

What would I have done for likes? What would that have made me?

Like Moon Frye and a lot of girls with big feelings and poetic inclinations, I kept diaries as a teenager. I’ve never gone back and read them. Why? I’m afraid that I might be embarrassed by my younger self or that she might be embarrassed by boring, wine-mom me

But I hope we’d get along. And then we could take a kiss-face selfie together, filter it, Facetune it, post it with some cute caption and watch the little hearts roll in.

when it comes to mistaken judgments and unfortunate decisions, there is another type of error that attracts far less attention: noise.

To see the difference between bias and noise, consider your bathroom scale. If on average the readings it gives are too high (or too low), the scale is biased

It is hard to escape the conclusion that sentencing is in part a lottery, because the punishment can vary by many years depending on which judge is assigned to the case and on the judge’s state of mind on that day. The judicial system is unacceptably noisy.

While bias is the average of errors, noise is their variability.

Although it is often ignored, noise is a large source of malfunction in society.

The average difference between the sentences that two randomly chosen judges gave for the same crime was more than 3.5 years. Considering that the mean sentence was seven years, that was a disconcerting amount of noise.

If it shows different readings when you step on it several times in quick succession, the scale is noisy.

How much of a difference would you expect to find between the premium values that two competent underwriters assigned to the same risk?

Executives in the insurance company said they expected about a 10 percent difference.

But the typical difference we found between two underwriters was an astonishing 55 percent of their average premium — more than five times as large as the executives had expected.

Many other studies demonstrate noise in professional judgments. Radiologists disagree on their readings of images and cardiologists on their surgery decisions

Wherever there is judgment, there is noise — and more of it than you think.

Noise causes error, as does bias, but the two kinds of error are separate and independent.

A company’s hiring decisions could be unbiased overall if some of its recruiters favor men and others favor women. However, its hiring decisions would be noisy, and the company would make many bad choices

Where does noise come from?

There is much evidence that irrelevant circumstances can affect judgments.

for instance, a judge’s mood, fatigue and even the weather can all have modest but detectable effects on judicial decisions.

people can have different general tendencies. Judges often vary in the severity of the sentences they mete out: There are “hanging” judges and lenient ones.

People can have not only different general tendencies (say, whether they are harsh or lenient) but also different patterns of assessment (say, which types of cases they believe merit being harsh or lenient about).

Underwriters differ in their views of what is risky, and doctors in their views of which ailments require treatment.

Once you become aware of noise, you can look for ways to reduce it.

independent judgments from a number of people can be averaged (a frequent practice in forecasting)

Guidelines, such as those often used in medicine, can help professionals reach better and more uniform decisions

imposing structure and discipline in interviews and other forms of assessment tends to improve judgments of job candidates.

No noise-reduction techniques will be deployed, however, if we do not first recognize the existence of noise.

Organizations and institutions, public and private, will make better decisions if they take noise seriously.

The left cerebral hemisphere is to the “right-brained” poet or novelist as the hamstrings and quadriceps are to a competitive sprinter

Because the ability to understand and produce language is focused in the left side of the brain in almost everyone, caricaturing these creative types as using their right brain more than their left brain is silly.

visual-spatial abilities—localized to the right cerebral hemisphere—are skills that are absolutely critical for “left-brained” talents like science or engineering.

But much of our obsession with the brain’s left and right cerebral hemispheres may have started with studies of split brain patients in the ‘50s. During this time, people who suffered multiple seizures a day underwent intense surgery to treat their epilepsy.

To calm the electrical storms that ravaged these patients’ brains, the nerve fibers connecting the left and right hemispheres of the brain were cut. These fibers are collectively known as the corpus callosum

Once the corpus callosum is severed on the operating table, the new split brain patient appears astonishingly normal at first glance

But careful experiments reveal that this person is really two persons, two streams of consciousness in one body

only the left hemisphere can speak

The right hemisphere cannot speak, but it can point to words like “yes” or “no” to answer a question

Each hemisphere, it seems, maintains independent beliefs and personalities, challenging the notion that we are each an indivisible “self.”

We are all “brain-ambidextrous.”

"I could do open heart surgery right now. My hands are steady, my eyes are good," Wareham said. "My blood pressure is 117. I have noticed no deterioration in my mental ability with my age. If you gave me something to memorize, I would memorize it now just as quickly as when I was 20."

Wareham passed away last year, at the age of 104. Like 10% of the Adventist community, Wareham was a vegan. Another 30% are lacto-ovo vegetarians who eat dairy and eggs, while another 8% eat fish but not other meat. Vegetarianism is so prevalent that no meat can be purchased at the cafeterias at the university and medical center.

Other key factors to longevity: Only 1% of the Seventh-day Adventist community in the study smokes. Little to no alcohol is consumed. Daily exercise out in the fresh air of nature is the norm. The church advocates a life of service, so dedication to volunteering, humanitarian and mission work is typical, which contributes to a sense of community.

"The bulk of evidence suggests that changing a few simple lifestyle factors can have a profound difference in the risk of major diseases and the likelihood of living a long life," Orlich said. "The body has an amazing ability to, um, you know, heal itself to some degree.

Not only is this tied to weight gain, especially in the belly, but it also leaves you with cravings. Aspartame is 200 times sweeter than table sugar. Serious drinkers are so used to the super-sweet taste that everything else seems bland in comparison.

Coca-Cola has a different take on what people refer to as an addiction. “Food and beverages, like chocolate, for example, can trigger what scientists call ‘reward centers’ in the brain, but so can other things like music or laughter,” said Daphne Dickerson, a spokeswoman for Coca-Cola. “Regularly consuming food and beverages that taste good and that you enjoy is not the same as being addicted to them.”

In September 2020, Ms. Beller was diagnosed with breast cancer. She didn’t quit Diet Coke until after surgery, when doctors found more cancer and she realized she’d have to undergo chemotherapy.

She used the Quitzilla app, a habit breaker and sobriety counter, which tracked her progress. “Every time I had a craving, just looking at the app did something good in my brain,” she said. She didn’t have a lot of physical side effects, but she did long for the drink. She credits the app with helping her stay on track.

There is no such thing as a trans child. Mermaids passionately advocates for the availability of puberty blockers for kids, despite the growing bank of evidence that they can cause a multitude of harms. The vast majority of those prescribed blockers go to take cross-sex hormones further down the line.

In the dim and distant past, lobotomies were performed on those with mental illness and psychosis, and today distressed children are being fed the line that they are trapped in the wrong body and that drugs and surgery is the solution. When and how did it become acceptable to pump kids full of harmful hormones and remove healthy body parts as opposed to offering them therapy?

I was in court during the cross examination of Mermaids and its supporter, and heard loud and clear its dismissal of the fact that sex is immutable. As far as Mermaids and its lackeys are concerned, all that is necessary to identify and live as the opposite sex is an inner ‘feeling’ of gender identity. The witnesses declared that trans men are men, and trans women, women. They were seemingly unconcerned when presented with the fact that there has been a 4000-plus per cent increase in girls presenting at clinics such as the Tavistock GIDS, claiming to be trans boys.

A recent interim report on the Tavistock GIDs recommended that it be closed down in due course, and that much of the ‘treatment’ at the clinic was focused solely on affirming a child’s trans identity and not scrutinising related issues such as mental health issues, autistic disorders, and abuse within the family home.

I first contacted Mermaids in 2003, when investigating the notion of ‘trans children’ and was given the cold shoulder. Many other individuals and organisations that have grave concerns about its practices have spoken out, and as a result have been labelled bigots and transphobes. That we are now about to be validated is little comfort, bearing in mind the number of lives ruined by irreversible medical intervention on children who, if supported therapeutically, would likely have grown up to be lesbian or gay.

As a result of its spiteful attempt to discredit LGB Alliance, it seems the practice and ideology of Mermaids is now being exposed. In my view it is an organisation led by dangerous ideology that promotes medical intervention to kids that simply need to be supported in who they are and in the bodies they were born with. I believe it deserves to be shut down.

agents will open up many more learning opportunities.

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past

Productivity

copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

before the sophisticated agents I’m describing become a reality, we need to confront a number of questions about the technology and how we’ll use it.

Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it.

I don’t think any single company will dominate the agents business--there will be many different AI engines available.

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

They’ll replace word processors, spreadsheets, and other productivity apps.

Education

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans.

Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

A shock wave in the tech industry

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you

they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter.

Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people

The ramifications for the software business and for society will be profound.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

onic constipation, a functional bowel disorder, affects approximately 14% of adults worldwide [1]. Slow transit constipation (STC) is the major cause of chronic constipation which is characterized by markedly prolonged colonic transit time as a result of the colonic motility function disorde

Usually, patients with STC suffer from a common sense of abdominal pain, nausea, depression and sickness, which seriously influence their social ability and health-related quality of life [4–6

Current clinical treatments include cathartics, prokinetics and aggressive surgery which can increase bowel movement frequency to a certain degree.

However, pharmacological interventions is prone to drug dependency and relapse after drug withdrawal [3]

Surgical treatments such as subtotal colectomy and total colectomy in STC patients may adversely affect the quality of life due to the risk of postoperative diarrhea or incontinence, and result in a heavy healthcare burden

The enteric nervous system (ENS), located in the intestinal wall, regulates various functions including contraction of intestine, homeostasis and blood flow [10]. As the ‘second brain’, the ENS contains large amounts of neurons working independently from the central nervous system [11]. Researches have identified that STCs are mostly caused by disorders of the relevant nerves, especially the ENS [12,13].

McCallum et al. [35] found that gastric electrical stimulation in combination with pharmacological treatment could also enhance emptying in patients with gastroparesis. Especially, gastric electrical stimulation has been approved as a clinical therapy method for gastroparesis and obesity in European and American countries [36].

we employed pulse train stimulation and implanted electrodes at the proximal colon in dogs.

After CES treatment, we observed the colonic transit time of the sham treatment group was longer than that of CES treatment and control groups, and electrical stimulation significantly enhanced the colonic electromyogram (EMG) signal.

histopathology and TEM analysis showed increased ganglia and synaptic vesicles existing in the colon myenteric plexus of the CES treatment group as compared with that of the sham CES group

Our results suggested that CES might reduce the degeneration of the myenteric plexus neurons, thereby contributing to the therapeutic effect on STC beagles.

the defecating frequency and the feces characteristics of STC beagles returned to normal after CES treatment. The result indicated that CES could improve the symptoms of STC.

The colonic EMG signal was strongly promoted by CES

Especially, the colonic EMG signal of the beagles with STC was remarkably enhanced by CES (Figure 3), indicating that CES could not only improve the colonic content emptying, but also enhance the EMG signal to promote colonic motility.

Colonic electrical stimulation (CES), a valuable alternative for the treatment of STC, was reported to improve the colon motility by adjusting the bioelectrical activity in animal models or patients with STC [17]. However, little report focuses on the underlying nervous mechanism to normalize the delayed colonic emptying and relieve symptoms. We hypothesized that CES may also repair the disorders of the relevant nerves and then improve the colonic motility.

The first study regarding the CES to modulate colonic motility was performed by Hughes et al. [37]. Since then, many researchers employed short-pulse CES in canine descending colon or pig cecum [20,21,38]. Researchers also applied long-pulse CES to stimulate the colon of human or animals [39]

Recently, studies showed that the prokinetic effect of pulse train CES is better than that of short-pulse CES or long-pulse CES [25]

Our study indicated that CES could enhance the colonic motility, and then accelerate the colonic content emptying. Thereafter, we investigated the underlying mechanism and presumed that CES might improve the STC symptom through the repairment of the ENS.

The neuropathy in ENS is considered to be responsible for various kinds of disordered motility including STC and the related pathophysiologic symptoms [40]. In agreement with this view, our study discovered the decreased number of ganglia in the myenteric plexus, as well as the destruction of the enteric nerve axon terminals and synaptic vesicles in the sham CES group beagles

The present study proves that CES with pulse trains has curative effects on the colonic motility and content emptying in STC beagles. The up-regulation of intestinal nerve related proteins such as SYP, PGP9.5, CAD and S-100B in the colonic myenteric plexus suggests that CES might reduce the degeneration of the myenteric plexus neurons, thereby producing the therapeutic effect on STC beagles. Further investigation for the underlying mechanism of nerve regeneration is necessary to better understand how CES promotes the recovery of delayed colonic motility induced by STC.

Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis

ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."

"There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.

On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.

"What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.

"It's a redundant name, real medicine is functional."

Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).

Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.

As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.

"If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.

GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…

"Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.

Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.

"The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."

"There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.

"Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."

GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.

"It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.

"I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.

"Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."

Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."

For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.

"Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.

l What are the principles?

"There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."

He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.

Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.

"My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises