Reverend Caleb Pitkin, an aspiring rationalist and United Methodist Minister, wrote an article about combining religion and rationality which was recently published on the Intentional Insights blog. He's the only Minister I know who is also an aspiring rationalist, so I thought it would be an interesting piece for Less Wrong as well. Besides, it prompted an interesting discussion on the Less Wrong Facebook group, so I thought some people here who don't look at the Facebook group might be interested in checking it out as well. Caleb does not have enough karma to post, so I am posting it on his behalf, but he will engage with the comments.

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Religious and Rational?

“Wisdom shouts in the street; in the public square she raises her voice.”

Proverbs 1:20 Common English Bible

The Biblical book of Proverbs is full of imagery of wisdom personified as a woman calling and extorting people to come to her and listen.  The wisdom contained in Proverbs is not just spiritual wisdom but also contains a large amount of practical wisdom and advice.  What might the wisdom of Proverbs and rationality have in common?  The wisdom literature in scripture was meant to help people make better and more effective decisions.  In today’s complex and rapidly changing world we have the same need for tools and resources to help us make good decisions.  One great source of wisdom is methods of better thinking that are informed by science.  

Now, not everyone would agree with comparing the wisdom of Proverbs with scientific insights.  Doing so may not sit well with some in the secular rationality community who view all religion as inherently irrational and hindering clear thinking. It also might not sit well with some in my own religious community who are suspicious of scientific thinking as undermining traditional faith.  While it would take a much longer piece to try to completely defend either religion or secular rationality I’m going to try and demonstrate some ways that rationality is useful  for a religious person.

The first way that rationality can be useful for a religious person is in the living of our daily lives.  We are faced with tasks and decisions each day that we try to do our best in.  Learning to recognize common logical fallacies or other biases, like those that cause us to fail to understand other people, will improve our decision making as much as it improves the thinking of non-religious people. For example, a mother driving her kids to Sunday School might benefit from avoiding thinking that the person who cuts her off is definitely a jerk, one common type of thinking error.  Some doing volunteer work for their church could be more effective if they avoid problematic communication with other volunteers. This use of rationality to lead our daily lives in the best way is one that most would find fairly unobjectionable.  It’s easy to say that the way we all achieve our personal goals and objectives could be improved, and we can all gain greater agency.

Rationality can also be of use in theological commentary and discourse.  Many of the theological and religious greats used the available philosophical and intellectual tools of their day to examine their faith. Examples of this include John Wesley, Thomas Aquinas and even the Apostle Paul when he debated Epicurean and Stoic Philosophers.   They also made sure that their theologies were internally, rational and logical.  This means that, from the perspective of a religious person, keeping up with rationality can help with the pursuit of a deeper understanding of our faith.  For a secular person acknowledging the ways in which religious people use rationality within their worldview may be difficult, but it can help to build common ground. The starting point is different.  Secular people start with the faith that they can trust their sensory experience.  Religious people start with conceptions of the divine.  Yet, after each starting point, both seek to proceed in a rational logical manner.

It is not just our personal lives that can be improved by rationality, it’s also the ways in which we interact with communities.  One of the goals of many religious communities is to make a positive impact on the world around them.  When we work to do good in community we want that work to be as effective as possible.  Often when we work in community we find that we are not meeting our goals or having the kind of significant impact that we wish to have.  It is my experience this is often a failure to really examine and gather the facts on the ground.  We set off full of good intentions but with limited resources and time.  Rational examination helps us to figure out how to match our good intentions with our limited resources in the most effective way possible.  For example as the Pastor of two small churches money and people power can be in short supply.  So when we examine all the needs of our community we have to acknowledge we cannot begin to meet all or even most of them.  So we take one issue, hunger, and devote our time and resources to having one big impact on that issue.  As opposed to trying to be a little bit to alleviate a lot of problems.

One other way that rationality can inform our work in the community is to recognize that part of what a scarcity of resources means is that we need to work together with others in our community.  The inter-faith movement has done a lot of good work in bringing together people of faith to work on common goals.  This has meant setting aside traditional differences for the sake of shared goals.  Let us examine the world we live in today though. The amount of nonreligious people is on the rise and there is every indication that it will continue to do so.  On the other hand religion does not seem to be going anywhere either.  Which is good news for a pastor.  Looking at this situation, the rational thing to do is to work together, for religious people to build bridges toward the non-religious and vice versa.

Wisdom still stands on the street calling and imploring us to be improved--not in the form of rationalist street preachers, though that idea has a certain appeal-- but in the form of the growing number of tools being offered to help us improve our capacity for logic, for reasoning, and for the tools that will enable us take part in the world we live in.  

Everyone wants to make good decisions.  This means that everyone tries to make rational decisions.  We all try but we don’t always hit the mark.  Religious people seek to achieve their goals and make good decisions.  Secular people seek to achieve their goals and make good decisions.  Yes, we have different starting points and it’s important to acknowledge that.  Yet, there are similarities in what each group wants out of their lives and maybe we have more in common than we think we do.

On a final note it is my belief that what religious people and what non-religious people fear about each other is the same thing.  The non-religious look at the religious and say God could ask them to do anything... scary.  The religious look at the non-religious and say without God they could do anything... scary.  If we remember though that most people are rational and want to live a good life we have less to be scared of, and are more likely to find common ground.

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Bio: Caleb Pitkin is a Provisional Elder with the United Methodist Church appointed to Signal Mountain United Methodist Church. Caleb is a huge fan of the theology of John Wesley, which ask that Christians use reason in their faith journey.  This helped lead Caleb to Rationality and participation in Columbus Rationality, a Less Wrong meetup that is part of the Humanist Community of Central Ohio. Through that, Caleb got involved with Intentional Insights. Caleb spends his time trying to live a faithful and rational life. 

If you are a person who finds it difficult to tell "no" to their friends, this one weird trick may save you a lot of time!

Scenario 1

Alice: "Hi Bob! You are a programmer, right?"

Bob: "Hi Alice! Yes, I am."

Alice: "I have this cool idea, but I need someone to help me. I am not good with computers, and I need someone smart whom I could trust, so they wouldn't steal my idea. Would you have a moment to listen to me?"

Alice explains to Bob her idea that would completely change the world. Well, at the least the world of bicycle shopping.

Instead of having many shops for bicycles, there could be one huge e-shop that would collect all the information about bicycles from all the existing shops. The customers would specify what kind of a bike they want (and where they live), and the system would find all bikes that fit the specification, and display them ordered by lowest price, including the price of delivery; then it would redirect them to the specific page of the specific vendor. Customers would love to use this one website, instead of having to visit multiple shops and compare. And the vendors would have to use this shop, because that's where the customers would be. Taking a fraction of a percent from the sales could make Alice (and also Bob, if he helps her) incredibly rich.

Bob is skeptical about it. The project suffers from the obvious chicken-and-egg problem: without vendors already there, the customers will not come (and if they come by accident, they will quickly leave, never to return again); and without customers already there, there is no reason for the vendors to cooperate. There are a few ways how to approach this problem, but the fact that Alice didn't even think about it is a red flag. She also has no idea who are the big players in the world of bicycle selling; and generally she didn't do her homework. But after pointing out all these objections, Alice still remains super enthusiastic about the project. She promises she will take care about everything -- she just cannot write code, and she needs Bob's help for this part.

Bob believes strongly in the division of labor, and that friends should help each other. He considers Alice his friend, and he will likely need some help from her in the future. Fact is, with perfect specification, he could make the webpage in a week or two. But he considers bicycles to be an extremely boring topic, so he wants to spend as little time as possible on this project. Finally, he has an idea:

"Okay, Alice, I will make the website for you. But first I need to know exactly how the page will look like, so that I don't have to keep changing it over and over again. So here is the homework for you -- take a pen and paper, and make a sketch of how exactly the web will look like. All the dialogs, all the buttons. Don't forget logging in and logging out, editing the customer profile, and everything else that is necessary for the website to work as intended. Just look at the papers and imagine that you are the customer: where exactly would you click to register, and to find the bicycle you want? Same for the vendor. And possibly a site administrator. Also give me the list of criteria people will use to find the bike they want. Size, weight, color, radius of wheels, what else? And when you have it all ready, I will make the first version of the website. But until then, I am not writing any code."

Alice leaves, satisfied with the outcome.

This happened a year ago.

No, Alice doesn't have the design ready, yet. Once in a while, when she meets Bob, she smiles at him and apologizes that she didn't have the time to start working on the design. Bob smiles back and says it's okay, he'll wait. Then they change the topic.

Scenario 2

Cyril: "Hi Diana! You speak Spanish, right?"

Diana: "Hi Cyril! Yes, I do."

Cyril: "You know, I think Spanish is the most cool language ever, and I would really love to learn it! Could you please give me some Spanish lessons, once in a while? I totally want to become fluent in Spanish, so I could travel to Spanish-speaking countries and experience their culture and food. Would you please help me?"

Diana is happy that someone takes interest in her favorite hobby. It would be nice to have someone around she could practice Spanish conversation with. The first instinct is to say yes.

But then she remembers (she knows Cyril for some time; they have a lot of friends in common, so they meet quite regularly) that Cyril is always super enthusiastic about something he is totally going to do... but when she meets him next time, he is super enthusiastic about something completely different; and she never heard about him doing anything serious about his previous dreams.

Also, Cyril seems to seriously underestimate how much time does it take to learn a foreign language fluently. Some lessons, once in a while will not do it. He also needs to study on his own. Preferably every day, but twice a week is probably a minimum, if he hopes to speak the language fluently within a year. Diana would be happy to teach someone Spanish, but not if her effort will most likely be wasted.

Diana: "Cyril, there is this great website called Duolingo, where you can learn Spanish online completely free. If you give it about ten minutes every day, maybe after a few months you will be able to speak fluently. And anytime we meet, we can practice the vocabulary you have already learned."

This would be the best option for Diana. No work, and another opportunity to practice. But Cyril insists:

"It's not the same without the live teacher. When I read something from the textbook, I cannot ask additional questions. The words that are taught are often unrelated to the topics I am interested in. I am afraid I will just get stuck with the... whatever was the website that you mentioned."

For Diana this feels like a red flag. Sure, textbooks are not optimal. They contain many words that the student will not use frequently, and will soon forget them. On the other hand, the grammar is always useful; and Diana doesn't want to waste her time explaining the basic grammar that any textbook could explain instead. If Cyril learns the grammar and some basic vocabulary, then she can teach him all the specialized vocabulary he is interested in. But now it feels like Cyril wants to avoid all work. She has to draw a line:

"Cyril, this is the address of the website." She takes his notebook and writes 'www.duolingo.com'. "You register there, choose Spanish, and click on the first lesson. It is interactive, and it will not take you more than ten minutes. If you get stuck there, write here what exactly it was that you didn't understand; I will explain it when we meet. If there is no problem, continue with the second lesson, and so on. When we meet next time, tell me which lessons you have completed, and we will talk about them. Okay?"

Cyril nods reluctantly.

This happened a year ago.

Cyril and Diana have met repeatedly during the year, but Cyril never brought up the topic of Spanish language again.

Scenario 3

Erika: "Filip, would you give me a massage?"

Filip: "Yeah, sure. The lotion is in the next room; bring it to me!"

Erika brings the massage lotion and lies on the bed. Filip massages her back. Then they make out and have sex.

This happened a year ago. Erika and Filip are still a happy couple.

Filip's previous relationships didn't work well, in long term. In retrospect, they all followed a similar scenario. At the beginning, everything seemed great. Then at some moment the girl started acting... unreasonably?... asking Filip to do various things for her, and then acting annoyed when Filip did exactly what he was asked to do. This happened more and more frequently, and at some moment she broke up with him. Sometimes she provided explanation for breaking up that Filip was unable to decipher.

Filip has a friend who is a successful salesman. Successful both professionally and with women. When Filip admitted to himself that he is unable to solve the problem on his own, he asked his friend for advice.

"It's because you're a f***ing doormat," said the friend. "The moment a woman asks you to do anything, you immediately jump and do it, like a well-trained puppy. Puppies are cute, but not attractive. Have you ready any of those books I sent you, like, ten years ago? I bet you didn't. Well, it's all there."

Filip sighed: "Look, I'm not trying to become a pick-up artist. Or a salesman. Or anything. No offense, but I'm not like you, personality-wise, I never have been, and I don't want to become your - or anyone else's - copy. Even if it would mean greater success in anything. I prefer to treat other people just like I would want them to treat me. Most people reciprocate nice behavior; and those who don't, well, I avoid them as much as possible. This works well with my friends. It also works with the girls... at the beginning... but then somehow... uhm... Anyway, all your books are about manipulating people, which is ethically unacceptable for me. Isn't there some other way?"

"All human interaction is manipulation; the choice is between doing it right or wrong, acting consciously or driven by your old habits..." started the friend, but then he gave up. "Okay, I see you're not interested. Just let me show you the most obvious mistake you make. You believe that when you are nice to people, they will perceive you as nice, and most of them will reciprocate. And when you act like an asshole, it's the other way round. That's correct, on some level; and in a perfect world this would be the whole truth. But on a different level, people also perceive nice behavior as weakness; especially if you do it habitually, as if you don't have any other option. And being an asshole obviously signals strength: you are not afraid to make other people angry. Also, in long term, people become used to your behavior, good or bad. The nice people don't seem so nice anymore, but they still seem weak. Then, ironicaly, if the person well-known to be nice refuses to do something once, people become really angry, because their expectations were violated. And if the asshole decides to do something nice once, they will praise him, because he surprised them pleasantly. You should be an asshole once in a while, to make people see that you have a choice, so they won't take your niceness for granted. Or if your girlfriend wants something from you, sometimes just say no, even if you could have done it. She will respect you more, and then she will enjoy more the things you do for her."

Filip: "Well, I... probably couldn't do that. I mean, what you say seems to make sense, however much I hate to admit it. But I can't imagine doing it myself, especially to a person I love. It's just... uhm... wrong."

"Then, I guess, the very least you could do is to ask her to do something for you first. Even if it's symbolic, that doesn't matter; human relationships are mostly about role-playing anyway. Don't jump immediately when you are told to; always make her jump first, if only a little. That will demonstrate strength without hurting anyone. Could you do that?"

Filip wasn't sure, but at the next opportunity he tried it, and it worked. And it kept working. Maybe it was all just a coincidence, maybe it was a placebo effect, but Filip doesn't mind. At first it felt kinda artificial, but then it became natural. And later, to his surprise, Filip realized that practicing these symbolic demands actually makes it easier to ask when he really needed something. (In which case sometimes he was asked to do something first, because his girlfriend -- knowingly or not? he never had the courage to ask -- copied the pattern; or maybe she has already known it long before. But he didn't mind that either.)

The lesson is: If you find yourself repeatedly in situations where people ask you to do something for them, but at the end they don't seem to appreciate what you did for them, or don't even care about the thing they asked you to do... and yet you find it difficult to say "no"... ask them to contribute to the project first.

This will help you get rid of the projects they don't care about (including the ones they think they care about in far mode, but do not care about enough to actually work on them in near mode) without being the one who refuses cooperation. Also, the act of asking the other person to contribute, after being asked to do something for them, mitigates the status loss inherent in working for them.

Thanks to the reaction to this article and some conversations, I'm convinced that it's worth trying to renovate and restore LW. Eliezer, Nate, and Matt Fallshaw are all on board and have empowered me as an editor to see what we can do about reshaping LW to meet what the community currently needs. This involves a combination of technical changes and social changes, which we'll try to make transparently and non-intrusively.

There's a lot of data and research on what makes people successful at online dating, but I don't know anyone who actually tried to wholeheartedly apply this to themselves. I decided to be that person: I implemented lessons from data, economics, game theory and of course rationality in my profile and strategy and OkCupid. Shockingly, it worked! I got a lot of great dates, learned a ton and found the love of my life. I didn't expect dating to be my "rationalist win", but it happened.

Here's the first part of the story, I hope you'll find some useful tips and maybe a dollop of inspiration among all the silly jokes.

P.S.

Does anyone know who curates the "Latest on rationality blogs" toolbar? What are the requirements to be included?

Summary:

• Chronic Fatigue and Fibromyalgia look very like Hypothyroidism.
• Thyroid Patients aren't happy with either the diagnosis or treatment of Hypothyroidism.
• It is possible that lots of FMS/CFS cases are 'something wrong with the thyroid system that doesn't show up on laboratory hormone level tests'.
• It's possible that it's not too difficult to fix these CFS/FMS cases with thyroid hormones.
• I believe that there may have been a stupendous cock-up that's hurt millions.
• Less Wrong should be interested, because it could be a real example of how bad inference can cause the sciences to come to false conclusions, as well as a good practice problem for the things we really care about.

Edit:

I found a possible answer here:
http://lesswrong.com/lw/nbm/thyroid_hormones_chronic_fatigue_and_fibromyalgia/
I do not believe it, because I do not understand it, but contemplation of it seems to be enlightening. In particular, the problem is much broader than I originally thought.

A summary of the argument in the first two posts, together with links to lots of evidence in the literature:

http://lesswrong.com/r/discussion/lw/nef/the_thyroid_madness_core_argument_evidence/

And this is pretty much proof, I think:

http://lesswrong.com/lw/nhs/the_thyroid_madness_two_apparently_contradictory/

At this point, I think I'm as confident as I can be without some sort of formal trial (so 25% maybe?)

But certainly, if you're suffering from Chronic Fatigue Syndrome/Fibromyalgia/Major Depression/Irritable Bowel Syndrome, or any of the many similar disorders which just seem to be different names for 'hypothyroidism with normal TSH', I reckon this is worth trying!

I have done, and it worked for me. For about four months now...

Original Post:

I believe that I've come across a genuine puzzle, and I wonder if you can help me solve it. This problem is complicated, and subtle, and has confounded and defeated good people for forty years. And yet there are huge and obvious clues. No-one seems to have conducted the simple experiments which the clues suggest, even though many clever people have thought hard about it, and the answer to the problem would be very valuable. And so I wonder what it is that I am missing.

I am going to tell a story which rather extravagantly privileges a hypothesis that I have concocted from many different sources, but a large part of it is from the work of the late Doctor John C Lowe, an American chiropractor who claimed that he could cure Fibromyalgia.

I myself am drowning in confirmation bias to the point where I doubt my own sanity. Every time I look for evidence to disconfirm my hypothesis, I find only new reasons to believe. But I am utterly unqualified to judge. Three months ago I didn't know what an amino acid was. And so I appeal to wiser heads for help.

Crocker's Rules on this. I suspect that I am being the most spectacular fool, but I can't see why, and I'd like to know.

Setting the Scene

Chronic Fatigue Syndrome, Myalgic Encephalitis, and Fibromyalgia are 'new diseases'. There is considerable dispute as to whether they even exist, and if so how to diagnose them. They all seem to have a large number of possible symptoms, and in any given case, these symptoms may or may not occur with varying severity.

As far as I can tell, if someone claims that they're 'Tired All The Time', then a competent doctor will first of all check that they're getting enough sleep and are not unduly stressed, then rule out all of the known diseases that cause fatigue (there are a very lot!), and finally diagnose one of the three 'by exclusion', which means that there doesn't appear to be anything wrong, except that you're ill.

If widespread pain is one of the symptoms, it's Fibromyalgia Syndrome (FMS). If there's no pain, then it's CFS or ME. These may or may not be the same thing, but Myalgic Encephalitis is preferred by patients because it's greek and so sounds like a disease. Unfortunately Myalgic Encephalitis means 'hurty muscles brain inflammation', and if one had hurty muscles, it would be Fibromyalgia, and if one had brain inflammation, it would be something else entirely.

Despite the widespread belief that these are 'somatoform' diseases (all in the mind), the severity of them ranges from relatively mild (tired all the time, can't think straight), to devastating (wheelchair bound, can't leave the house, can't open one eye because the pain is too great).

All three seem to have come spontaneously into existence in the 1970s, and yet searches for the responsible infective agent have proved fruitless. Neither have palliative measures been discovered, apart from the tried and true method of telling the sufferers that it's all in their heads.

The only treatments that have proved effective are Cognitive Behavioural Therapy / Graded Exercise. A Cochrane Review reckoned that they do around 15% over placebo in producing a measurable alleviation of symptoms. I'm not very impressed. CBT/GE sound a lot like 'sports coaching', and I'm pretty sure that if we thought of 'Not Being Very Good at Rowing' as a somatoform disorder, then I could produce an improvement over placebo in a measurable outcome in ten percent of my victims without too much trouble.

But any book on CFS will tell you that the disease was well known to the Victorians, under the name of neurasthenia. The hypothesis that God lifted the curse of neurasthenia from the people of the Earth as a reward for their courage during the wars of the early twentieth century, while well supported by the clinical evidence, has a low prior probability.

We face therefore something of a mystery, and in the traditional manner of my people, a mystery requires a Just-So Story:

How It Was In The Beginning

In the dark days of Victoria, the brilliant physician William Miller Ord noticed large numbers of mainly female patients suffering from late-onset cretinism.

These patients, exhausted, tired, stupid, sad, cold, fat and emotional, declined steeply, and invariably died.

As any man of decent curiosity would, Dr Ord cut their corpses apart, and in the midst of the carnage noticed that the thyroid, a small butterfly-shaped gland in the throat, was wasted and shrunken.

One imagines that he may have thought to himself: "What has killed them may cure them."

After a few false starts and a brilliant shot in the dark by the brave George Redmayne Murray, Dr Ord secured a supply of animal thyroid glands (cheaply available at any butcher, sautée with nutmeg and basil) and fed them to his remaining patients, who were presumably by this time too weak to resist.

They recovered miraculously, and completely.

I'm not sure why Dr Ord isn't better known, since this appears to have been the first time in recorded history that something a doctor did had a positive effect.

Dr Ord's syndrome was named Ord's Thyroiditis, and it is now known to be an autoimmune disease where the patient's own antibodies attack and destroy the thyroid gland. In Ord's thyroiditis, there is no goiter.

A similar disease, where the thyroid swells to form a disfiguring deformity of the neck (goiter), was described by Hakaru Hashimoto in 1912 (who rather charmingly published in German), and as part of the war reparations of 1946 it was decided to confuse the two diseases under the single name of Hashimoto's Thyroiditis. Apart from the goiter, both conditions share a characteristic set of symptoms, and were easily treated with animal thyroid gland, with no complications.

Many years before, in 1835, a fourth physician, Robert James Graves, had described a different syndrome, now known as Graves' Disease, which has as its characteristic symptoms irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhoea, and weight loss. Unfortunately Dr Graves could not think how to cure his eponymous horror, and so the disease is still named after him.

The Horror Spreads

Victorian medicine being what it was, we can assume that animal glands were sprayed over and into any wealthy person unwise enough to be remotely ill in the vicinity of a doctor. I seem to remember a number of jokes about "monkey glands" in PG Wodehouse, and indeed a man might be tempted to assume that chimpanzee parts would be a good substitute for humans. Supply issues seem to have limited monkey glands to a few millionaires worried about impotence, and it may be that the corresponding procedure inflicted on their wives has come down to us as Hormone Replacement Therapy.

Certainly anyone looking a bit cold, tired, fat, stupid, sad or emotional is going to have been eating thyroids. We can assume that in a certain number of cases, this was just the thing, and I think it may also be safe to assume that a fair number of people who had nothing wrong with them at all died as a result of treatment, although the fact that animal thyroid is still part of the human food chain suggests it can't be that dangerous.

I mean seriously, these people use high pressure hoses to recover the last scraps of meat from the floors of slaughterhouses, they're not going to carefully remove all the nasty gristly throat-bits before they make ready meals, are they?

The Armour Sausage company, owner of extensive meat-packing facilities in Chicago, Illinois, and thus in possession of a large number of pig thyroids which, if not quite surplus to requirements, at the very least faced a market sluggish to non-existent as foodstuffs, brilliantly decided to sell them in freeze-dried form as a cure for whatever ails you.

Some Sort of Sanity Emerges, in a Decade not Noted for its Sanity

Around the time of the second world war, doctors became interested in whether their treatments actually helped, and an effort was made to determine what was going on with thyroids and the constellation of sadness that I will henceforth call 'hypometabolism', which is the set of symptoms associated with Ord's thyroiditis. Jumping the gun a little, I shall also define 'hypermetabolism' as the set of symptoms associated with Graves' disease.

The thyroid gland appeared to be some sort of metabolic regulator, in some ways analogous to a thermostat. In hypometabolism, every system of the body is running slow, and so it produces a vast range of bad effects, affecting almost every organ. Different sufferers can have very different symptoms, and so diagnosis is very difficult.

Dr Broda Barnes decided that the key symptom of hypometabolism was a low core body temperature. By careful experiment he established that in patients with no symptoms of hypometabolism the average temperature of the armpit on waking was 98 degrees Fahrenheit (or 36.6 Celsius). He believed that temperature variation of +/- 0.2 degrees Fahrenheit was unusual enough to merit diagnosis. He also seems to have believed, in the manner of the proverbial man with a hammer, that all human ailments without exception were caused by hypometabolism, and to have given freeze-dried thyroid to almost everyone he came into contact with, to see if it helped. A true scientist. Doctor Barnes became convinced that fully 40% of the population of America suffered from hypometabolism, and recommended Armour's Freeze Dried Pig Thyroid to cure America's ills.

In a brilliant stroke, Freeze Dried Pig's Thyroid was renamed 'Natural Desiccated Thyroid', which almost sounds like the sort of thing you might take in sound mind. I love marketing. It's so clever.

America being infested with religious lunatics, and Chicago being infested with nasty useless gristly bits of cow's throat, led almost inevitably to a second form of 'Natural Desiccated Thyroid' on the market.

Dr Barnes' hypometabolism test never seems to have caught on. There are several ways your temperature can go outside his 'normal' range, including fever (too hot), starvation (too cold), alcohol (too hot), sleeping under too many duvets (too hot), sleeping under too few duvets (too cold). Also mercury thermometers are a complete pain in the neck, and take ten minutes to get a sensible reading, which is a long time to lie around in bed carefully doing nothing so that you don't inadvertently raise your body temperature. To make the situation even worse, while men's temperature is reasonably constant, the body temperature of healthy young women goes up and down like the Assyrian Empire.

Several other tests were proposed. One of the most interesting is the speed of the Achilles Tendon Reflex, which is apparently super-fast in hypermetabolism, and either weirdly slow or has a freaky pause in it if you're running a bit cold. Drawbacks of this test include 'It's completely subjective, give me something with numbers in it', and 'I don't seem to have one, where am I supposed to tap the hammer-thing again?'.

By this time, neurasthenia was no longer a thing. In the same way that spiritualism was no longer a thing, and the British Empire was no longer a thing.

As far as we know, Chronic Fatigue Syndrome was not a thing either, and neither was Fibromyalgia (which is just Chronic Fatigue Syndrome but it hurts), nor Myalgic Encephalitis. There was something called 'Myalgic Neurasthenia' in 1934, but it seems to have been a painful infectious disease and they thought it was polio.

Finally, Science

It turned out that the purpose of the thyroid gland is to make hormones which control the metabolism. It takes in the amino acid tyrosine, and it takes in iodine. It releases Thyroglobulin, mono-iodo-tyrosine (MIT), di-iodo-tyrosine (DIT), thyroxine (T4) and triiodothyronine (T3) into the blood. The chemistry is interesting but too complicated to explain in a just-so story.

I believe that we currently think that thyroglobulin, MIT and DIT are simply by-products of the process that makes T3 and T4.

T3 is the hormone. It seems to control the rate of metabolism in all cells. T4 has something of the same effect, but is much less active, and called a 'prohormone'. Its main purpose seems to be to be deiodinated to make more T3. This happens outside the thyroid gland, in the other parts of the body ('peripheral conversion'). I believe mainly in the liver, but to some extent in all cells.

Our forefathers knew about thyroxine (T4, or thyronine-with-four-iodines-attached), and triiodothyronine (T3, or thyronine-with-three-iodines-attached)

It seems to me that just from the names, thyroxine was the first one to be discovered. But I'm not sure about that. You try finding a history-of-endocrinology website. At any rate they seem to have known about T4 and T3 fairly early on.

The mystery of Graves', Ord's and Hashimoto's thyroid diseases was explained.

Ord's and Hashimoto's are diseases where the thryoid gland under-produces (hypothyroidism). The metabolism of all cells slows down. As might be expected, this causes a huge number of effects, which seem to manifest differently in different sufferers.

Graves' disease is caused by the thyroid gland over-producing (hyperthyroidism). The metabolism of all cells speeds up. Again, there are a lot of possible symptoms.

All three are thought to be autoimmune diseases. Some people think that they may be different manifestations of the same disease. They are all fairly common.

Desiccated thryoid cures hypothyroidism because the ground-up thyroids contain T4 and T3, as well as lots of thyroglobulin, MIT and DIT, and they are absorbed by the stomach. They get into the blood and speed up the metabolism of all cells. By titrating the dose carefully you can restore roughly the correct levels of the thyroid hormones in all tissues, and the patient gets better. (Titration is where you change something carefully until you get it right)

The theory has considerable explanatory power. It explains cretinism, which is caused either by a genetic disease, or by iodine deficiency in childhood. If you grow up in an iodine deficient area, then your growth is stunted, your brain doesn't develop properly, and your thyroid gland may become hugely enlarged. Presumably because the brain is desperately trying to get it to produce more thyroid hormones, and it responds by swelling.

Once upon a time, this swelling (goitre) was called 'Derbyshire Neck'. I grew up near Derbyshire, and I remember an old rhyme: "Derbyshire born, Derbyshire bred, strong in the arm, and weak in the head". I always thought it was just an insult. Maybe not. Cretinism was also popular in the Alps, and there is a story of an English traveller in Switzerland of whom it was remarked that he would have been quite handsome if only he had had a goitre. So it must have been very common there.

But at this point I am *extremely suspicious*. The thyroid/metabolic regulation system is ancient (universal in vertebrates, I believe), crucial to life, and it really shouldn't just go wrong. We should suspect either an infectious cause, or a recent environmental influence which we haven't had time to adjust to, an evolved defence against an infectious disease, or just possibly, a recently evolved but as yet imperfect defence against a less recent environmental change.

(Cretinism in particular is very strange. Presumably animals in iodine-deficient areas aren't cretinous, and yet they should be. Perhaps a change to a farming from a hunter-gatherer lifestyle has increased our dependency on iodine from crops, which crops have sucked what little iodine occurs naturally out of the soil?)

It's also not entirely clear to me what the thyroid system is *for*. If there's just a particular rate that cells are supposed to run at, then why do they need a control signal to tell them that? I could believe that it was a literal thermostat, designed to keep the body temperature constant at the best speed for the various biological reactions, but it's universal in *vertebrates*. There are plenty of vertebrates which don't keep a constant temperature.

The Fall of Desiccated Thyroid

There turned out to be some problems with Natural Desiccated Thyroid (NDT).

Firstly, there were many competing brands and types, and even if you stuck to one brand the quality control wasn't great, so the dose you'd be taking would have been a bit variable.

Secondly, it's fucking pig's thyroid from an abattoir. It could have all sorts of nasty things in it. Also, ick.

Thirdly, it turned out that pigs made quite a lot more T3 in their thyroids than humans do. It also seems that T3 is better absorbed by the gut than T4 is, so someone taking NDT to compensate for their own underproduction will have too much of the active hormone compared to the prohormone. That may not be good news.

With the discovery of 'peripheral conversion', and the possibility of cheap clean synthesis, it was decided that modern scientific thyroid treatment would henceforth be by synthetic T4 (thyroxine) alone. The body would make its own T3 from the T4 supply.

Alarm bells should be ringing at this point. Apart from the above points, I'm not aware of any great reason for the switch from NDT to thyroxine in the treatment of hypothyroidism, but it seems to have been pretty much universal, and it seems to have worked.

Aware of the lack of T3, doctors compensated by giving people more T4 than was in their pig-thyroid doses. And there don't seem to have been any complaints.

Over the years, NDT seems to have become a crazy fringe treatment despite there not being any evidence against it. It's still a legal prescription drug, but in America it's only prescribed by eccentrics. In England a doctor prescribing it would be, at the very least, summoned to explain himself before the GMC.

However, since it was (a) sold over the counter for so many years, and (b) part of the food chain, it is still perfectly legal to sell as a food supplement in both countries, as long as you don't make any medical claims for it. And the internet being what it is, the prescription-only synthetic hormones T3 and T4 are easily obtained without a prescription. These are extremely powerful hormones which have an effect on metabolism. If 'body-builders' and sports cheats aren't consuming all three in vast quantities, I am a Dutchman.

The Clinical Diagnosis of Hypothyroidism

We pass now to the beginning of the 1970s.

Hypothyroidism is ferociously difficult to diagnose. People complain of 'Tired All The Time' well, ... all the time, and it has literally hundreds of causes.

And it must be diagnosed correctly! If you miss a case of hypothyroidism, your patient is likely to collapse and possibly die at some point in the medium-term future. If you diagnose hypothyroidism where it isn't, you'll start giving the poor bugger powerful hormones which he doesn't need and *cause* hypermetabolism.

The last word in 'diagnosis by symptoms' was the absolutely excellent paper:

Statistical Methods Applied To The Diagnosis Of Hypothyroidism

by W. Z. Billewicz, R. S. Chapman, J. Crooks, M. E. Day, J. Gossage, Sir Edward Wayne, and J. A. Young

Connoisseurs will note the clever and careful application of 'machine learning' techniques, before there were machines to learn!

One important thing to note is that this is a way of separating hypothyroid cases from other cases of tiredness at the point where people have been referred by their GP to a specialist at a hospital on suspicion of hypothyroidism. That changes the statistics remarkably. This is *not* a way of diagnosing hypothyroidism in the general population. But if someone's been to their GP (general practitioner, the doctor that a British person likely makes first contact with) and their GP has suspected their thryoid function might be inadequate, this test should probably still work.

For instance, they consider Physical Tiredness, Mental Lethargy, Slow Cerebration, Dry Hair, and Muscle Pain, the classic symptoms of hypothyroidism, present in most cases, to be indications *against* the disease.

That's because if you didn't have these things, you likely wouldn't have got that far. So in the population they're seeing (of people whose doctor suspects they might be hypothyroid), they're not of great value either way, but their presence is likely the reason why the person's GP has referred them even though they've really got iron-deficiency anaemia or one of the other causes of fatigue.

In their population, the strongest indicators are 'Ankle Jerk' and 'Slow Movements', subtle hypothyroid symptoms which aren't likely to be present in people who are fatigued for other reasons.

But this absolutely isn't a test you should use for population screening! In the general population, the classic symptoms are strong indicators of hypothyroidism.

Probability Theory is weird, huh?

Luckily, there were lab tests for hypothyroidism too, but they were expensive, complicated, annoying and difficult to interpret. Billewicz et al used them to calibrate their test, and recommend them for the difficult cases where their test doesn't give a clear answer.

And of course, the final test is to give them thyroid treatment and see whether they get better. If you're not sure, go slow, watch very carefully and look for hyper symptoms.

Overconfidence is definitely the way to go. If you don't diagnose it and it is, that's catastrophe. If it isn't, but you diagnose it anyway, then as long as you're paying attention the hyper symptoms are easy enough to spot, and you can pull back with little harm done.

A Better Way

It should be obvious from the above that the diagnosis of hypothyroidism by symptoms is absolutely fraught with complexity, and very easy to get wrong, and if you get it wrong the bad way, it's a disaster. Doctors were absolutely screaming for a decisive way to test for hypothyroidism.

Unfortunately, testing directly for the levels of thyroid hormones is very difficult, and the tests of the 1960s weren't accurate enough to be used for diagnosis.

The answer came from an understanding of how the thyroid regulatory system works, and the development of an accurate blood test for a crucial signalling hormone.

Three structures control the level of thyroid hormones in the blood.

The thyroid gland produces the hormones and secretes them into the blood.

Its activity is controlled by the hormone thyrotropin, or Thyroid Signalling Hormone (TSH). Lots of TSH works the thyroid hard. In the absence of TSH the thyroid relaxes but doesn't switch off entirely. However the basal level of thyroid activity in the absence of TSH is far too low.

TSH is controlled by the pituitary gland, a tiny structure attached to the brain.

The pituitary itself is controlled, via Thyroid Releasing Hormone (TRH), by the hypothalamus, which is part of the brain.

This was thought to be a classic example of a feedback control system.

hypothalamus->pituitary->thyroid

It turns out that the level of thyrotropin TSH in the blood is exquisitely sensitive to the levels of thyroid hormones in the blood.

Administer thyroid hormone to a patient and their TSH level will rapidly adjust downwards by an easily detectable amount.

So:

In hypothyroidism, where the thyroid has failed, the body will be desperately trying to produce more thyroid hormones, and the TSH level will be extremely high.

In Graves' Disease, this theory says, where the thyroid has grown too large, and the metabolism is running damagingly fast, the body will be, like a central bank trying to stimulate growth in a deflationary economy by reducing interest rates, 'pushing on a piece of string'. TSH will be undetectable.

The original TSH test was developed in 1965, by the startlingly clever method of radio-immuno-assay.

[For reasons that aren't clear to me, rather than being expressed in grams/litre, or mols/litre, the TSH test is expressed in 'international units/liter'. But I don't think that that's important]

A small number of people in whom there was no suspicion of thyroid disease were assessed, and the 'normal range' of TSH was calculated.

Again, 'endocrinology history' resources are not easy to find, but the first test was not terribly sensitive, and I think originally hyperthyroidism was thought to result in a complete absence of TSH, and that the highest value considered normal was about 4 (milli-international-units/liter).

This apparently pretty much solved the problem of diagnosing thyroid disorders.

Forgetfulness

It's no longer necessary to diagnose hypo- and hyper-thyroidism by symptoms. It was error prone anyway, and the question is easily decided by a cheap and simple test.

Natural Desiccated Thyroid is one with Nineveh and Tyre.

No doctor trained since the 1980s knows much about hypothyroid symptoms.

Medical textbooks mention them only in passing, as an unweighted list of classic symptoms. You couldn't use that for diagnosis of this famously difficult disease.

If you suspect hypothyroidism, you order a TSH test. If the value of TSH is very low, that's hyperthyroidism. If the value is very high then that's hypothyroidism. Otherwise you're 'euthyroid' (greek again, good-thyroid), and your symptoms are caused by some other problem.

The treatment for hyperthyroidism is to damage the thyroid gland. There are various ways. This often results in hypothyroidism. *For reasons that are not terribly well understood*.

The treatment for hypothyroidism is to give the patient sufficient thyroxine (T4) to cause TSH levels to come back into their normal range.

The conditions hyperthyroidism and hypothyroidism are now *defined* by TSH levels.

Hypothyroidism, in particular, a fairly common disease, is considered to be such a solved problem that it's usually treated by the GP, without involving any kind of specialist.

Present Day

It was found that the traditional amount of thyroxine (T4) administered to cure hypothyroid patients, was in fact too high. The amount of T4 that had always been used to replace the hormones that had once been produced by a thyroid gland now dead, destroyed, or surgically removed appeared now to be too much. That amount causes suppression of TSH to below its normal range. The brain, theory says, is asking for the level to be reduced.

The amount of T4 administered in such cases (there are many) has been reduced by a factor of around two, to the level where it produces 'normal' TSH levels in the blood. Treatment is now titrated to produce the normal levels of TSH.

TSH tests have improved enormously since their introduction, and are on their third or fourth generation. The accuracy of measurement is very good indeed.

It's now possible to detect the tiny remaining levels of TSH in overtly hyperthyroid patients, so hyperthyroidism is also now defined by the TSH test.

In England, the normal range is 0.35 to 5.5. This is considered to be the definition of 'euthyroidism'. If your levels are normal, you're fine.

If you have hypothyroid symptoms but a normal TSH level, then your symptoms are caused by something else. Look for Anaemia, look for Lyme Disease. There are hundreds of other possible causes. Once you rule out all the other causes, then it's the mysterious CFS/FMS/ME, for which there is no cause and no treatment.

If your doctor is very good, very careful and very paranoid, he might order tests of the levels of T4 and T3 directly. But actually the direct T4 and T3 tests, although much more accurate than they were in the 1960s, are quite badly standardised, and there's considerable controversy about what they actually measure. Different assay techniques can produce quite different readings. They're expensive. It's fairly common, and on the face of it perfectly reasonable, for a lab to refuse to conduct the T3 and T4 tests if the TSH level is normal.

It's been discovered that quite small increases in TSH actually predict hypothyroidism. Minute changes in thyroid hormone levels, which don't produce symptoms, cause detectable changes in the TSH levels. Normal, but slightly high values of TSH, especially in combination with the presence of thyroid related antibodies (there are several types), indicate a slight risk of one day developing hypothyroidism.

There's quite a lot of controversy about what the normal range for TSH actually is. Many doctors consider that the optimal range is 1-2, and target that range when administering thyroxine. Many think that just getting the value in the normal range is good enough. None of this is properly understood, to understate the case rather dramatically.

There are new categories, 'sub-clinical hypothyroidism' and 'sub-clinical hyperthyroidism', which are defined by abnormal TSH tests in the absence of symptoms. There is considerable controversy over whether it is a good idea to treat these, in order to prevent subtle hormonal imbalances which may cause difficult-to-detect long term problems.

Everyone is a little concerned about accidentally over-treating people, (remember that hyperthyroidism is now defined by TSH<0.35).

Hyperthyroidism has long been associated with Atrial Fibrillation (a heart problem), and Osteoporosis, both very nasty things. A large population study in Denmark recently revealed that there is a greater incidence of Atrial Fibrillation in sub-clinical hyperthyroidism, and that hypothyroidism actually has a 'protective effect' against Atrial Fibrillation.

It's known that TSH has a circadian rhythm, higher in the early morning, lower at night. This makes the test rather noisy, as your TSH level can be doubled or halved depending on what time of day you have the blood drawn.

But the big problems of the 1960s and 1970s are completely solved. We are just tidying up the details.

Doubt

Many hypothyroid patients complain that they suffer from 'Tired All The Time', and have some of the classic hypothyroid symptoms, even though their TSH levels have been carefully adjusted to be in the normal range.

I've no idea how many, but opinions range from 'the great majority of patients are perfectly happy' to 'around half of hypothyroid sufferers have hypothyroid symptoms even though they're being treated'.

The internet is black with people complaining about it, and there are many books and alternative medicine practitioners trying to cure them, or possibly trying to extract as much money as possible from people in desperate need of relief from an unpleasant, debilitating and inexplicable malaise.

THE PLURAL OF ANECDOTE IS DATA.

Not good data, to be sure. But if ten people mention to you in passing that the sun is shining, you are a damned fool if you think you know nothing about the weather.

It's known that TSH ranges aren't 'normally distributed' (in the sense of Gauss/the bell curve distribution) in the healthy population.

If you log-transform them, they do look a bit more normal.

The American Academy of Clinical Biochemists, in 2003, decided to settle the question once and for all. They carefully screened out anyone with even the slightest sign that there might be anything wrong with their thyroid at all, and measured their TSH very accurately.

In their report, they said (this is a direct quote):

In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L.

Many other studies disagree, and propose wider ranges for normal TSH.

But if the AACB report were taken seriously, it would lead to diagnosis of hypothyroidism in vast numbers of people who are perfectly healthy! In fact the levels of noise in the test would put people whose thyroid systems are perfectly normal in danger of being diagnosed and inappropriately treated.

For fairly obvious reasons, biochemists have been extremely, and quite properly, reluctant to take the report of their own professional body seriously. And yet it is hard to see where the AACB have gone wrong in their report.

Neurasthenia is back.

A little after the time of the introduction of the TSH test, new forms of 'Tired All The Time' were discovered.

As I said, CFS and ME are just two names for the same thing. Fibromyalgia Syndrome (FMS) is much worse, since it is CFS with constant pain, for which there is no known cause and from which there is no relief. Most drugs make it worse.

But if you combine the three things (CFS/ME/FMS), then you get a single disease, which has a large number of very non-specific symptoms.

These symptoms are the classic symptoms of 'hypometabolism'. Any doctor who has a patient who has CFS/ME/FMS and hasn't tested their thyroid function is *de facto* incompetent. I think the vast majority of medical people would agree with this statement.

And yet, when you test the TSH levels in CFS/ME/FMS sufferers, they are perfectly normal.

All three/two/one are appalling, crippling, terrible syndromes which ruin people's lives. They are fairly common. You almost certainly know one or two sufferers. The suffering is made worse by the fact that most people believe that they're psychosomatic, which is a polite word for 'imaginary'.

And the people suffering are mainly middle-aged women. Middle-aged women are easy to ignore. Especially stupid middle-aged women who are worried about being overweight and obviously faking their symptoms in order to get drugs which are popularly believed to induce weight loss. It's clearly their hormones. Or they're trying to scrounge up welfare benefits. Or they're trying to claim insurance. Even though there's nothing wrong with them and you've checked so carefully for everything that it could possibly be.

But it's not all middle aged women. These diseases affect men, and the young. Sometimes they affect little children. Exhaustion, stupidity, constant pain. Endless other problems as your body rots away. Lifelong. No remission and no cure.

And I have Doubts of my Own

And I can't believe that careful, numerate Billewicz and his co-authors would have made this mistake, but I can't find where the doctors of the 1970s checked for the sensitivity of the TSH test.

Specificity, yes. They tested a lot of people who hadn't got any sign of hypothyroidism for TSH levels. If you're well, then your TSH level will be in a narrow range, which may be 0-6, or it may be 1-2. Opinions are weirdly divided on this point in a hard to explain way.

But Sensitivity? Where's the bit where they checked for the other arm of the conditional?

The bit where they show that no-one who's suffering from hypometabolism, and who gets well when you give them Desiccated Thyroid, had, on first contact, TSH levels outside the normal range.

If you're trying to prove A <=> B, you can't just prove A => B and call it a day. You couldn't get that past an A-level maths student. And certainly anyone with a science degree wouldn't make that error. Surely? I mean you shouldn't be able to get that past anyone who can reason their way out of a paper bag.

I'm going to say this a third time, because I think it's important and maybe it's not obvious to everyone.

If you're trying to prove that two things are the same thing, then proving that the first one is always the second one is not good enough.

IF YOU KNOW THAT THE KING OF FRANCE IS ALWAYS FRENCH, YOU DO *NOT* KNOW THAT ANYONE WHO IS FRENCH IS KING OF FRANCE.

It's possible, of course, that I've missed this bit. As I say, 'History of Endocrinology' is not one of those popular, fashionable subjects that you can easily find out about.

I wonder if they just assumed that the thyroid system was a thermostat. The analogy is still common today.

But it doesn't look like a thermostat to me. The thyroid system with its vast numbers of hormones and transforming enzymes is insanely, incomprehensibly complicated. And very poorly understood. And evolutionarily ancient. It looks as though originally it was the system that coordinated metamorphosis. Or maybe it signalled when resources were high enough to undergo metamorphosis. But whatever it did originally in our most ancient ancestors, it looks as though the blind watchmaker has layered hack after hack after hack on top of it on the way to us.

Only the thyroid originally, controlling major changes in body plan in tiny creatures that metamorphose.

Of course, humans metamorphose too, but it's all in the womb, and who measures thyroid levels in the unborn when they still look like tiny fish?

And of course, humans undergo very rapid growth and change after we are born. Especially in the brain. Baby horses can walk seconds after they're born. Baby humans take months to learn to crawl. I wonder if that's got anything to do with cretinism.

And I'm told that baby humans have very high hormone levels. I wonder why they need to be so hot? If it's a thermostat, I mean.

But then on top of the thyroid, the pituitary. I wonder what that adds to the system? If the thyroid's just a thermostat, or just a device for keeping T4 levels constant, why can't it just do the sensing itself?

What evolutionary process created the pituitary control over the thyroid? Is that the thermostat bit?

And then the hypothalamus, controlling the pituitary. Why? Why would the brain need to set the temperature when the ideal temperature of metabolic reactions is always 37C in every animal? That's the temperature everything's designed for. Why would you dial it up or down, to a place where the chemical reactions that you are don't work properly?

I can think of reasons why. Perhaps you're hibernating. Many of our ancestors must have hibernated. Maybe it's a good idea to slow the metabolism sometimes. Perhaps to conserve your fat supplies. Your stored food.

Perhaps it's a good idea to slow the metabolism in times of famine?

Perhaps the whole calories in/calories out thing is wrong, and people whose energy expenditure goes over their calorie intake have slow metabolisms, slowly sacrificing every bodily function including immune defence in order to avoid starvation.

I wonder at the willpower that could keep an animal sane in that state. While its body does everything it can to keep its precious fat reserves high so that it can get through the famine.

And then I remember about Anorexia Nervosa, where young women who want to lose weight starve themselves to the point where they no longer feel hungry at all. Another mysterious psychological disease that's just put down to crazy females. We really need some female doctors.

And I remember about Seth Robert's Shangri-La Diet, that I tried, to see if it worked, some years ago, just because it was so weird, where by eating strange things, like tasteless oil and raw sugar, you can make your appetite disappear, and lose weight. It seemed to work pretty well, to my surprise. Seth came up with it while thinking about rats. And apparently it works on rats too. I wonder why it hasn't caught on.

It seems, my female friends tell me, that a lot of diets work well for a bit, but then after a few weeks the effect just stops. If we think of a particular diet as a meme, this would seem to be its infectious period, where the host enthusiastically spreads the idea.

And I wonder about the role of the thyronine de-iodinating enzymes, and the whole fantastically complicated process of stripping the iodines and the amino acid bits from thyroxine in various patterns that no-one understands, and what could be going on there if the thyroid system were just a simple thermostat.

And I wonder about reports I am reading where elite athletes are finding themselves suffering from hypothyroidism in numbers far too large to be credible, if it wasn't, say, a physical response to calorie intake less than calorie output.

I've been looking ever so hard to find out why the TSH test, or any of the various available thyroid blood tests are a good way to assess the function of this fantastically complicated and very poorly understood system.

But every time I look, I just come up with more reasons to believe that they don't tell you very much at all.

The Mystery

Can anyone convince me that the converse arm has been carefully checked?

That everyone who's suffering from hypometabolism, and who gets well when you give them Desiccated Thyroid, has, before you fix them, TSH levels outside the normal range.

In other words, that we haven't just thrown, though carelessness, a long standing, perfectly safe, well tested treatment, for a horrible disabling disease that often causes excruciating pain, that the Victorians knew how to cure, and that the people of the 1950s and 60s routinely cured, away.

Alice: "I just flipped a coin [large number] times. Here's the sequence I got:

(Alice presents her sequence.)

Bob: No, you didn't. The probability of having gotten that particular sequence is 1/2^[large number]. Which is basically impossible. I don't believe you.

Alice: But I had to get some sequence or other. You'd make the same claim regardless of what sequence I showed you.

Bob: True. But am I really supposed to believe you that a 1/2^[large number] event happened, just because you tell me it did, or because you showed me a video of it happening, or even if I watched it happen with my own eyes? My observations are always fallible, and if you make an event improbable enough, why shouldn't I be skeptical even if I think I observed it?

Alice: Someone usually wins the lottery. Should the person who finds out that their ticket had the winning numbers believe the opposite, because winning is so improbable?

Bob: What's the difference between finding out you've won the lottery and finding out that your neighbor is a 500 year old vampire, or that your house is haunted by real ghosts? All of these events are extremely improbable given what we know of the world.

Alice: There's improbable, and then there's impossible. 500 year old vampires and ghosts don't exist.

Bob: As far as you know. And I bet more people claim to have seen ghosts than have won more than 100 million dollars in the lottery.

Alice: I still think there's something wrong with your reasoning here.

I don't know enough math and I don't know if this is important, but in the hopes that it helps someone figure something out that they otherwise might not, I'm posting it.

In Soares & Fallenstein (2015), the authors describe the following problem:

Consider a simple two-player game, described by Slepnev (2011), played by a human and an agent which is capable of fully simulating the human and which acts according to the prescriptions of UDT. The game works as follows: each player must write down an integer between 0 and 10. If both numbers sum to 10 or less, then each player is paid according to the number that they wrote down. Otherwise, they are paid nothing. For example, if one player writes down 4 and the other 3, then the former gets paid $4 while the latter gets paid $3. But if both players write down 6, then neither player gets paid. Say the human player reasons as follows:

"I don’t quite know how UDT works, but I remember hearing that it’s a very powerful predictor. So if I decide to write down 9, then it will predict this, and it will decide to write 1. Therefore, I can write down 9 without fear."

The human writes down 9, and UDT, predicting this, prescribes writing down 1. This result is uncomfortable, in that the agent with superior predictive power “loses” to the “dumber” agent. In this scenario, it is almost as if the human’s lack of ability to predict UDT (while using correct abstract reasoning about the UDT algorithm) gives the human an “epistemic high ground” or “first mover advantage.” It seems unsatisfactory that increased predictive power can harm an agent.

More precisely: two agents A and B must choose integers m and n with 0 ≤ m, n ≤ 10, and if m + n ≤ 10, then A receives a payoff of m dollars and B receives a payoff of n dollars, and if m + n > 10, then each agent receives a payoff of zero dollars. B has perfect predictive accuracy and A knows that B has perfect predictive accuracy.

Consider a variant of the aforementioned decision problem in which the same two agents A and B must choose integers m and n with 0 ≤ m, n ≤ 3; if m + n ≤ 3, then {A, B} receives a payoff of {m, n} dollars; if m + n > 3, then {A, B} receives a payoff of zero dollars. This variant is similar to a variant of the Prisoner's Dilemma with a slightly modified payoff matrix:

Likewise, A reasons as follows:

If I cooperate, then B will predict that I will cooperate, and B will defect. If I defect, then B will predict that I will defect, and B will cooperate. Therefore, I defect.

And B:

I predict that A will defect. Therefore, I cooperate.

I figure it's good to have multiple takes on a problem if possible, and that this particular take might be especially valuable, what with all of the attention that seems to get put on the Prisoner's Dilemma and its variants.

I am curious on the perspective of a rationalist discussion board (this seems like a good start) on the practice of magic. I introduce the novel, genius concept of "rationalist magic", i.e. magic practiced by rationalists.

Why would rationalists practice magic? That makes no sense!!

It's the logical conclusion to Making Peace with Belief, Engineering Religion and the self-help threads.

What would that look like?

Good question. Here are some possible considerations to make:

• It's given low probability that magic is more than purely mental phenomena. The practice is called "placebomancy" to make it clear that such an explanation is favoured.
• It is practiced as a way to gain placebons.
• A cult of rationalist magic, the Cult of Rationatron, should be formed to compete against worse (anti-rationality, anti-science, violent) cults.
• Rationalist groups can retain more members due to abundance of placebons.
• The ultimate goal is to use rationality to devise a logically optimal system of magic with which to build the Philosopher's Stone and fix the world like in HPMOR. (Just kidding, magic isn't real.)

I looked into magical literature and compiled a few placebo techniques/exercises, along with their informal instructions. These might be used as a starting point. If there are any scientific errors these can eventually be corrected. I favoured techniques that can be done with little to no preparation and provide some results. Of course, professional assistance (e.g. yoga classes) can also be helpful.

1. Mindfulness Meditation

• (Optional) Do 1-3 deep mouth-exhales to relax.
• Find a good position.
• Begin by being aware of breath.
• (Optional) Move on to calmly observing different parts of the body, vision, the other senses, thoughts, mandala visualization, and so on.
• (Optional) Compare the experience to teachings of buddhism.
• (Optional) Say "bud-" for each inhale and "-dho" for each exhale; alternatively, count them from 1 to 10 and reset each time.

Note that trying to focus on not focusing isn't always helpful. Hence the common technique is that of focusing on a single thing, or rather, simply being passively aware of it. The goal is to discipline the mind and develop one-pointedness.

2. Astral Projection (OBE)

• Lay on a bed, relax.
• Try out some of the tips from the previous exercise.
• Stay there for 30-60 minutes until you reach the hypnagogic state (a state where the mind is awake but the body is sleeping) and try to (a) feel your astral body and grab a rope, (b) feel vibrations in your body, (c) roll out of the body, (d) (...).

Astral Projection can be thought of as a very vivid stage of dreaming. Some authors have more detailed exercises related to this[7]. It might take many tries to do this exercise right.

3. Mantras

You can borrow an eastern mantra such as "om mani padme hum", "om namah shivaya" and "hare kṛiṣhṇa hare kṛiṣhṇa / kṛiṣhṇa kṛiṣhṇa hare hare / hare rāma hare rāma / rāma rāma hare hare" or make up some phrase. Whatever works for you.

Chanting mantras is a form of sensory excitation. Both sensory excitation and deprivation can induce trance. This can be used along with exercise 1.

(Optional) Find one of these.

4. Contemplation

• Take a moment to contemplate the harmony of the universe and/or have love towards some/all beings.

5. Idol Worship

• Make a shrine dedicated to Rationatron, god of rationality.

This and this are possible forms of Rationatron.

6. Minimal Spellcasting

• Make a wish.
• Clear your mind.
• Take a deep, long breath imagining that as you exhale the wish is being registered into the universe by Rationatron.

• Forget about the wish.

Magicians claim it's more magically effective to forget about the wish after casting the spell (fourth step) and let your subconscious act than to use the repeat-your-wish-every-day method.

This is, as far as I know, the simplest spellcasting technique. It can be complicated further by the addition of rituals, sigils, poses[6], and stronger methods of inducing trance in the second step.

7. Deity Generator

• Take any arbitrary concept or amalgam of concepts.
• (Optional) Associate it to a colour.
• (Optional) Make it a new deity.

For one reason or another, spiritualists love doing this.

This exercise can make arbitrary "powers" or "deities" for use in other exercises. For example, the association "yellow - wealth" is a "power" for exercise 6, or you might imagine yourself as a "deity" in that same exercise to induce some emotion.

8. Tulpa Making

This is a technique found in Tibetan buddhism lore[5] as one ability held by bodhisattvas and used by Buddha to multiply himself. This was adopted by communities of westerners in the internet who generally don't attribute mystical properties to the practice and made detailed tutorials (tulpa.info).

The technique uses your subconscious to create a companion. It consists in visualizing and talking to a being in your imagination until it eventually produces unexpected thoughts.

You might be asking, "can I model this companion after a cartoon?" The answer is yes.

Note: some of the following techniques might require further examination.

9. Aura Sight

Some authors[1,2,4] give exercises attributed to peripheral vision or meditation. If anyone finds out how to see auras, please confirm.

10. Invoking and Banishing Ritual of Truth

• Imagine a circle of protection surrounding you.
• (Invoking) "I open/invoke the powers of p, q, ¬p, ¬q."
• (Banishing) "I close/revoke/banish the powers of ¬q, ¬p, q, p."
• (Optional) This can be performed solely in the imagination through visualization or with more realism added to different degrees inbetween (e.g. by making a real circle, pointing a sword or your hand to the four directions).

This has been used for different purposes; as an introduction to ritual work or simply as routine.

The common formulation of this exercise uses a pentagram, holy names, the elements, planets and a bunch of other nonsense. Why do I have to remember all this roleplaying? Do they think this is D&D? Therefore, I designed a more efficient version of the technique that also replaces the magical symbolism with superior logic symbolism.

Note: these are roughly analogous[3] to the simpler placebo techniques known as shielding (imagining a shield), centering (regaining focus by being aware of the solar plexus/heart area) and grounding (putting your feet on the ground to receive/release energy from/to the ground).

11. Demonic Mirror Summoning

Call upon Dark Lord Voldemort and say the "avada kedavra" mantra 7+ times in front of a mirror in a dimly lit room until a demon pops up and/or your appearance gets distorted.

Some individuals report holding a conversation with their mirror self through mirror exercises.

FAQ

What is the purpose of this?

It's about time someone made an atheist religion.

Why not follow the Flying Spaggheti Monster religion instead?

It doesn't provide placebo techniques. It only functions as a point in argumentation.

Do I have to do all of the exercises?

No, only those that you personally deem helpful. However, the first exercise (meditation) is generally recommended by health research. It's also a pre-requisite to many other exercises. Note: although meditation is generally recommended, some caution, common sense and preparation is advised (specially for exercises 2-3).

What are the teachings?

It's acknowledged that rational people can sometimes get to different conclusions. Therefore, there is no mandatory teachings. However, it uses "rationality" as a starting point to distinguish it from other cults meaning that "placebo" is used as the default model of magic and that both logic and the use of such techniques is encouraged. It can be used as a gathering of placebo techniques for atheists and as a blank slate from the dogma of already existing cults on the nature of magic.

What is the pantheon of this religion?

The "official" pantheon is that of the universe itself (Einstein's pantheism; it's used in exercises 4 and 6), Rationatron (a deity of rationality) and Dark Lord Voldemort (the opposer). They fulfill different god-roles. More gods can be created with the Deity Generator exercise or borrowed.

Can I worship Eris, Cthullu or Horus/Isis/Odin...?

Yes, see above answer.

Wait, Dark Lord Voldemort? Really?

Christianity had lazier ways to come up with their demons and nobody noticed. Zing.

Aren't some of those techniques irrational?

Only when used by superstitious people. Once used by rationalists, they become super-rational.

What about black magic? Can I cast hexes?

They aren't going to work because magic is not real.

References

1. frater, ud. high magick. A good overview on different kinds of magic.

2. hine, phil. spirit guides. Another overview.

3. hine, phil. modern shamanism pt1-2. Overview for shamans.

4. samuel sagan. awakening the third eye.

5. alexandra david-neel. magic and mystery in tibet. A book on buddhist lore.

6. crowley. liber o.

7. robert bruce. mastering astral projection.

What is your opinion on rationality-promoting articles by Gleb Tsipursky / Intentional Insights? Here is what I think:

Tl;dr: Articles on LW are, if unchecked (for now by you), heavily distorting a useful view (yours) on what matters.

[This is (though in part only) a five-year update to Patrissimo’s article Self-Improvement or Shiny Distraction: Why Less Wrong is anti-Instrumental Rationality. However, I wrote most of this article before I became aware of its predecessor. Then again, this reinforces both our articles' main critique.]

I claim that rational discussions in person, conferences, forums, social media, and blogs suffer from adverse selection and promote unwished-for phenomena such as the availability heuristic. Bluntly stated, they do (as all other discussions) have a tendency to support ever worse, unimportant, or wrong opinions and articles. More importantly, articles of high relevancy regarding some topics are conspicuously missing. This can be also observed on Less Wrong. It is not the purpose of this article to determine the exact extent of this problem. It shall merely bring to attention that “what you get is not what you should see." However, I am afraid this effect is largely undervalued.

This result is by design and therefore to be expected. A rational agent will, by definition, post incorrect, incomplete, or not at all in the following instances:

• Cost-benefit analysis: A rational agent will not post information that reduces his utility by enabling others to compete better and, more importantly, by causing him any effort unless some gain (status, monetary, happiness,…) offsets the former effect. Example: Have you seen articles by Mark Zuckerberg? But I also argue that for random John Doe the personal cost-benefit-analysis from posting an article is negative. Even more, the value of your time should approach infinity if you really drink the LW Kool-Aid, however, this shall be the topic of a subsequent article. I suspect the theme of this article may also be restated as a free-riding problem as it postulates the non-production or under-production of valuable articles and other contributions.
• Conflicting with law: Topics like drugs (in the western world) and maybe politics or sexuality in other parts of the world are biased due to the risk of persecution, punishment, extortion, etc. And many topics such as in the spheres of rationality, transhumanism, effective altruism, are at least highly sensitive, especially when you continue arguing until you reach their moral extremes.
• Inconvenience of disagreement: Due to the effort of posting truly anonymously (which currently requires a truly anonymous e-mail address and so forth), disagreeing posts will be avoided, particularly when the original poster is of high status and the risk to rub off on one’s other articles thus increased. This is obviously even truer for personal interactions. Side note: The reverse situation may also apply: more agreement (likes) with high status.
• Dark knowledge: Even if I know how to acquire a sniper gun that cannot be traced, I will not share this knowledge (as for all other reasons, there are substantially better examples, but I do not want to make spreading dark knowledge a focus of this article).
• Signaling: Seriously, would you discuss your affiliation to LW in a job interview?! Or tell your friends that you are afraid we live in a simulation? (If you don’t see my point, your rationality is totally off base, see the next point). LW user “Timtyler” commented before: “I also found myself wondering why people remained puzzled about the high observed levels of disagreement. It seems obvious to me that people are poor approximations of truth-seeking agents—and instead promote their own interests. If you understand that, then the existence of many real-world disagreements is explained: people disagree in order to manipulate the opinions and actions of others for their own benefit.”
• WEIRD-M-LW: It is a known problem that articles on LW are going to be written by authors that are in the overwhelming majority western, educated, industrialized, rich, democratic, and male. The LW surveys show distinctly that there are most likely many further attributes in which the population on LW differs from the rest of the world. LW user “Jpet” argued in a comment very nicely: “But assuming that the other party is in fact totally rational is just silly. We know we're talking to other flawed human beings, and either or both of us might just be totally off base, even if we're hanging around on a rationality discussion board.” LW could certainly use more diversity. Personal anecdote: I was dumbfounded by the current discussion around LW T-shirts sporting slogans such as "Growing Mentally Stronger" which seemed to me intuitively highly counterproductive. I then asked my wife who is far more into fashion and not at all into LW. Her comment (Crocker's warning): “They are great! You should definitely buy one for your son if you want him to go to high school and to be all for himself for the next couple of years; that is, except for the mobbing, maybe.”
• Genes, minds, hormones & personal history: (Even) rational agents are highly influenced by those factors. This fact seems underappreciated. Think of SSC's "What universal human experiences are you missing without realizing it?" Think of inferential distances and the typical mind fallacy. Think of slight changes in beliefs after drinking coffee, been working out, deeply in love for the first time/seen your child born, being extremely hungry, wanting to and standing on the top of the mountain (especially Mt. Everest). Russell pointed out the interesting and strong effect of Schopenhauer’s and Nietzsche’s personal history on their misogyny. However, it would be a stretch to simply call them irrational. In every discussion, you have to start somewhere, but finding a starting point is a lot more difficult when the discussion partners are more diverse. All factors may not result in direct misinformation on LW but certainly shape the conversation (see also the next point).
• Priorities: Specific “darlings” of the LW sphere such as Newcomb’s paradox or MW are regularly discussed. Just one moment of not paying bias attention, and you may assume they are really relevant. For those of us currently not programming FAI, they aren’t and steal attention from more important issues.
• Other beliefs/goals: Close to selfishness, but not quite the same. If an agent’s beliefs and goals differ from most others, the discussion would benefit from your post. Even so, that by itself may not be a sufficient reason for an agent to post. Example: Imagine somebody like Ben Goertzel. His beliefs on AI, for instance, differed from the mainstream on LW. This did not necessarily result in him posting an article on LW. And to my knowledge, he won’t, at least not directly. Plus, LW may try to slow him down as he seems less concerned about the F of FAI.
• Vanity: Considering the amount of self-help threads, nerdiness, and alike on LW, it may be suspected that some refrain from posting due to self-respect. E.g. I do not want to signal myself that I belong to this tribe. This may sound outlandish but then again, have a look at the Facebook groups of LW and other rationalists where people ask frequently how they can be more interesting, or how “they can train how to pause for two seconds before they speak to increase their charisma." Again, if this sounds perfectly fine to you, that may be bad news.
• Barriers to entry: Your first post requires creating an account. Karma that signals the quality of your post is still absent. An aspiring author may question the relative importance of his opinion (especially for highly complex topics), his understanding of the problem, the quality of his writing, and if his research on the chosen topic is sufficient.
• Nothing new under the sun: Writing an article requires the bold assumption that its marginal utility is significantly above zero. The likelihood of which probably decreases with the number of posts, which is, as of now, quite impressive. Patrissimo‘s article (footnote [10]) addresses the same point, others mention being afraid of "reinventing the wheel."
• Error: I should point out that most of the reasons brought forward in this list talk about deliberate misinformation. In many cases, an article will just be wrong which the author does not realize. Examples: facts (the earth is flat), predications (planes cannot fly), and, seriously underestimated, horizon effects (if more information is provided the rational agent realizes that his action did not yield the desired outcome, e.g. ban of plastic bags).
• Protection of the group: Opinions though being important may not be discussed to protect the group or its image to outsiders. See “is LW a c***” and Roko’s ***." This argument can also be brought forward much more subtle: an agent may, for example, hold the opinion that rationality concepts are information hazards by nature if they reduce the happiness of the otherwise blissfully unaware.
• Topicality: This is a problem specific to LW. Many of the great posts as well as the sequences have originated about five to ten years ago. While the interest in AI has now reached mainstream awareness, the solid intellectual basis (centered around a few individuals) which LW offered seems to break away gradually and rationality topics experience their diaspora. What remains is a less balanced account of important topics in the sphere of rationality and new authors are discouraged to enter the conversation.
• Russell’s antinomy: Is the contribution that states its futility ever expressed? Random example article title: “Writing articles on LW is useless because only nerds will read them."
• +Redundancy: If any of the above reasons apply, I may choose not to post. However, I also expect a rational agent with sufficiently close knowledge to attain the same knowledge himself so it is at the same time not absolutely necessary to post. An article will “only” speed up the time required to understand a new concept and reduce the likelihood of rationalists diverting due to disagreement (if Aumann is ignored) or faulty argumentation.

This list is not exhaustive. If you do not find a factor in this list that you expect to accounts for much of the effect, I will appreciate a hint in the comments.

There are a few outstanding examples pointing in the opposite direction. They appear to provide uncensored accounts of their way of thinking and take arguments to their logical extremes when necessary. Most notably Bostrom and Gwern, but then again, feel free to read the latter’s posts on endured extortion attempts.

A somewhat flippant conclusion (more in a FB than LW voice): After reading the article from 2010, I cannot expect this article (or the ones possibly following that have already been written) to have a serious impact. It thus can be concluded that it should not have been written. Then again, observing our own thinking patterns, we can identify influences of many thinkers who may have suspected the same (hubris not intended). And step by step, we will be standing on the shoulders of giants. At the same time, keep in mind that articles from LW won’t get you there. They represent only a small piece of the jigsaw. You may want to read some, observe how instrumental rationality works in the “real world," and, finally, you have to draw the critical conclusions for yourself. Nobody truly rational will lay them out for you. LW is great if you have an IQ of 140 and are tired of superficial discussions with the hairstylist in your village X. But keep in mind that the instrumental rationality of your hairstylist may still surpass yours, and I don’t even need to say much about the one of your president, business leader, and club Casanova. And yet, they may be literally dead wrong, because they have overlooked AI and SENS.

A final personal note: Kudos to the giants for building this great website and starting point for rationalists and the real-life progress in the last couple of years! This is a rather skeptical article to start with, but it does have its specific purpose of laying out why I, and I suspect many others, almost refrained from posting.