Breast cancer and cognitive deficits: a lesson in what isn’t being studied

Trigger warning: if you are on an estrogen lowering regime after initial breast cancer treatment, you may want to know that I’m going to describe a possible side effect that is apparently not studied at all in breast cancer research. The effect has little or nothing to do with longevity, recurrence or known hazards, such as bone loss. But it is probably important to quality of life. The side effect is a significant decrease in dopamine, with attendant problems from that.
Please see my REQUEST below if you don’t read through the post.

Here’s what we know:

1. 65-75 percent of breast cancers are estrogen positive; that is, estrogen is used in their growth.
2. Anti-estrogen measures are commonly used in such cases; before menopause these may include, e.g., removal of one’s ovaries, and after menopause there are a number of meds that will limit the production of estrogen in one’s body. The typical times for using these drugs is at least 5 years.
3. estrogen is a key factor in the production and use of dopamine.
4. dopamine is very important for memory, executing complicated actions, types of learning, sleep regulation and much more.
5. The loss of dopamine may be implicated in cognitive problems resulting from breast cancer treatment.

What is not studied at all, as far as several weeks of researching and writing to researchers indicates to me, is the move from 2 to 5. In fact, if you look at a very central breast cancer info site on a prime class of drugs for reducing estrogen, aromatase inhibitors, cognitive decline is not mentioned at all. The first publication that I could find that clearly warns of cognitive decline was published in early 2011. It was recommended to me at a leading edge cancer center, MD Anderson in Houston, that I take the meds in late 2011. Nothing was said about cognitive decline.

What sort of cognitive declines? And how could I, a philosopher, have discovered something that dedicated cancer researchers have not? The two go together. I have been interested in dopamine for years; it was picked out as a very important ingredient in the genesis of action and in learning by Sejnowski, Dayan and Montague in a 1996 article. And Montague had fabulous labs a few miles away from my office at UH, at Baylor College of Medicine. And Baylor was a very dynamic place to be, so I went over there occasionally. In December 2014 I was writing on dopamine for a series of posts on the brain blog. Then on Dec. 17th, after my appointment at MD Anderson, I stopped taking Femara, an aromatase inhibitor, which is anti-estrogen, on a trial basis. Within several days, there were dramatic changes in my actions. One was that I came home, tired after shopping for the holidays and a pilates lesson, and unpacked seven bags of groceries and put them away. I hadn’t performed such an extended, relatively intricate action for over 2.5 years. At best I’d get half the groceries in. Then I might perform a later action of getting the next half in, etc, etc. With any luck, my partner would show up and do what might take me three or four hours. And in a day or two I discovered that all the novels written recently were not boring; in fact, I started enjoying novel-reading for the first time in years. Before the aromatase inhibitors I was almost always reading a novel. I now think that the absence of dopamine meant that I couldn’t remember characters and plot vividly enough to sustain interest.

Let me mention that Montague says that, among other things, dopamine acts like a “hot-cold” signal of the sort that occurs in children’s games, as kids tell a child with eyes covered that they’re nearer or farther from a goal. I’d get half the groceries in and the signals would go missing.

It took me a few more days to realize fully that the effects I experienced might well be due to a reentry of dopamine. So I looked at the relationship between dopamine and estrogen. And it was immediately clear that a good hypothesis was that my dopamine levels had dropped significantly. I’ve been looking off and on for 8 weeks since then for whether there’s been any research on this. I can’t find any.

So why wouldn’t there be research? One reason may be that dopamine is subtle in a lot of its actions, and though one might notice that one is not performing complex actions as well as before, this may well be to be due to fatigue, one thinks. In general, the cognitive deficits caused by aromatase inhibitors have not received a lot of attention, and one prominent researcher suggests that that’s because women’s complaints were not taken very seriously. After all, they’ve had precious bits cut off and they’re depressed.

Finally, even for those who have started studying cognitive deficits, dopamine is not on their radar. I’ve been told that’s because neuroscientists aren’t really working in the area.

One important gap is that there are ways to increase dopamine in one’s system, and a lot of it is yummy food. And of course exercise. ADHD medications might also help.

REQUEST: if you have any knowledge about anyone looking at dopamine in the treatment of cancer patients please let me know. If you have any good reason for thinking I’m misguided, please, please let me know.

Jennifer Saul on women in philosophy in phil magazine

In the latest issue of Philosopher’s Magazine Jennifer Saul describes the dearth of women in philosophy, lists a number of causes and describes some remedial steps. The result is a great introduction to a very serious problen in the philosophy profession. It’s also a quick refresher course for those who’ve pick up this material in bits and pieces.

In the UK, women are 46% of undergraduate students in philosophy, but only 24% of permanent staff. Women are approximately 21% of professional philosophers in the US, but only 17% of those employed full-time. These figures are very unlike those for most fields of the humanities, in which women tend to be near or above parity with men. Indeed, they more closely resemble mathematics and physical sciences (biological sciences are much closer to parity). One recent study by Kieran Healy showed philosophy to be more male than mathematics, with only computer science, physics and engineering showing lower percentages of women.

We’re recognized a number of times in this blog that there are other features that can provoke discriminatory reactions in philosophy: disability, race, not having English as your first language, class and being in the glbt community. And no doubt more my memory is not bringing to the fore. O, and then there’s ageism, which I think we don’t discuss much. You are welcome to take note of any of these in discussion.

Oxford’s Women in the Humanities initiative

Selina Todd, a social historian at St. Hilda’s College, Oxford, relays the following anecdote that will sound pretty familiar to many philosophers:

At a recent academic conference, I stepped back in time, and not because we were all talking about history. Here was a group of men who announced they were “redefining” modern history. They swaggered through presentations – about men – asserting that only those in their charmed circle had anything of significance to say. Male speakers were introduced as great scholars – “he needs no introduction” a favourite opening – while the few female speakers were granted brief, unenthusiastic descriptions of their work. Few women asked questions; those who did were often ignored, though if a man picked up and repeated their ideas, these were then considered worthy of debate. We are all wearily used to “mansplaining” and being talked over, excluded or ignored. But this conference was a personal nadir.

On the first day I thought: is it me? We’re often told that women overreact, taking offence where none is meant. These were younger men, who’d grown up since the 1970s: wasn’t misogyny meant to disappear when they came of age? Yet, as I watched our next generation of professors perform, it was as if feminism had never happened.

On the second day, I left an overrunning session (those men sure can talk) and discovered a bunch of other women huddled around the cold coffee and curdling milk, who felt exactly the same. Something, we said, has to change.

This experience led to the formation of a new collaborative initiative at Oxford – Women in the Humanities. Todd describes the project in The Guardian in an article that includes many references to philosophy and the British Philosophical Association’s ‘Women in Philosophy’ report (as well as lots of useful information and comparisons.)

(Hat tip BW!)

Yet more on gender and citation

Political Philosop-her has a wonderful post up discussing the implications of the latest information on gender and citation in philosophy:

Almost everyone has had the chance to read the new Healy data on the citation of women. As another female philosopher has stated, a central take home point is that “women are cited. But they are only allowed to chip in to the debates–they are not allowed to be the agenda-setters.”

The question now is, what should we do about this? Increasing the diversity of those who participate in philosophy will not in and of itself change things unless we also find mechanisms to allow a more diverse range of people to “create” philosophy or to “set agendas” in philosophy, in Healy’s terms. Though it might mean some small progress, focusing on improving the citation of women’s work (for example, through a gendered-citation-campaign) will not fundamentally change things. Even if the citations of women’s work were to increase, women may still be prohibited from engaging in creative or agenda-setting philosophy.

#AskAWhiteFeminist at the Oscars

I guess we really shouldn’t look to the Oscars – or to movie or pop stars generally – for help in promoting feminism, or any other cause. Yet we do! So it was doubly disappointing that Arquette’s statement for equal pay for women turned into a really insulting argument based on the assumptions that 1) all women (or all these whose rights to equal pay are worth fighting for) are white and straight, and 2) that black and LGBT people have received sufficient support in fighting for their rights and that it’s now their turn to help (and 3 that  until now they have only fought for their own rights qua black or LGBT ?). The responses can be read on twitter under the hashtag #AskAWhiteFeminist. This page has a small selection as well as some replies from Arquette.

More data on gender and citation in philosophy

Kieran Healy has provided some more fascinating information on gender and citation in philosophy, based on data taken from the ‘top four’ generalist philosophy journals (Nous, Mind, J Phil, Phil Review):

The story here is rather sobering and, if you’re familiar with the literature on citation, unsurprising. Citation counts are highly skewed. Even though these are all peer-reviewed articles published in high-prestige journals, almost a fifth of them are never cited at all, and just over half of them are cited five times or fewer. A very small number of articles are cited more than twenty or thirty times. Getting cited just twenty five times is enough to put a paper in the top decile of the distribution. (As I said, philosophers don’t cite each other much.) The top one percent of papers are cited seventy five times of more. The most-cited paper in the data has just shy of 300 citations. . .

From the co-citation analysis we already know that within the articles published in our four journals women make up just 3.5 percent of the 500 most-cited items. We don’t have a baseline for the number of potentially citeable items here in general, nor do we know whether that 3.5 percent is proportional to the number of women amongst the full count of cited items. (This was one of the motivations for wanting to code all 34,000 by gender.) For the case of the articles themselves, though, we do have a base rate: 87.5 percent of the published articles are by men, and 12.5 percent are by women. If we add up the total citations held by those articles, we find that articles written by men have 88 percent of the citations, and those by women have 12 percent of the citations. So at this level of resolution, things are proportional in the sense that the share of citations to articles by women lines up with the overall share of articles by women. On the average, articles by women are not cited less often than articles by men. It’s the very low base-rate of articles by women that’s driving things.

We’re not quite done, though. Overall, citations are proportional, given the low base rate of women in the field. At the same time, rates of citation in general are extremely skewed. It’s worth looking more closely about what these two things mean together. . .

Kieran has lots of information and very pretty pictures up on his post – and, in particular, some very revealing data about what the very top echelons of highly cited papers in philosophy look like with respect to gender. (Spoiler alert: they look very, very male.) Go check it out! (And thank you, Kieran, for doing this!)

Update on the Stubblefield sexual assault case

Those following the case of Anna Stubblefield, the Rutgers-Newark philosophy professor accused of sexually assaulting a disabled man, may be interested in the following update to the case:

Judge Siobhan Teare ruled [that a proposed expert for the defense], Rosemary Crossley, will not be allowed to testify in regard to her assessment of the alleged victim, known as D.J. The evaluation was meant to test D.J.’s ability to communicate.

The judge found Crossley’s methods were “unreliable,” because she assisted D.J. in moving a communication device during the assessment.

But Stubblefield’s attorney, James Patton, said he is still requesting that Crossley be permitted to testify at the trial about the methodology used by the state’s experts in evaluating D.J., if those experts are allowed to testify.

Those experts have determined D.J. did not have the ability to consent to the sexual activity.

Stubblefield has apparently claimed that her relationship with “D.J.” was consensual because he consented via facilitated communication. Facilitated communication is highly controversial method of communication aimed at allowing people with cognitive disabilities to communicate, even if they are not capable of written, spoken, or signed language (as in the case of “D.J.”). There appears to be very little evidence that facilitated communication is a reliable method of communication. (Indeed, there seems to be quite a lot of evidence that it is not reliable and that responses are heavily influenced by the facilitator). Nevertheless, the method continues to be championed by some disability advocates and caregivers.

Stubblefield – herself a defender and practioner of facilitated communication – is relying on the good standing of the practice for her claim that her sexual encounters with “D.J.” were consensual. She repeatedly had sexual contact with “D.J.” in her office and is claiming he consented to this via facilitated communication. But experts for the prosecution have – unsurprisingly – found that “D.J.” is incapable of consent. The judge has now ruled that there is insufficient scientific evidence to allow an advocate of facilitated communication to testify as an expert witness on behalf of Stubblefield.