Sally Satel is a staff psychiatrist with Partners in Drug Abuse Rehabilitation Counseling (PIDARC), and a resident scholar at the American Enterprise Institute (AEI). Dr. Satel was educated at Cornell University, the University of Chicago, and Brown University, where she received her M.D. degree. She has taught at Yale University and has served as a member of the National Advisory Council for the Center for Mental Health Services and as a policy fellow with the U.S. Senate Labor and Human Resources Committee. She has published widely in academic journals and has authored, co-authored, or co-edited many books, including P.C., M.D.: How Political Correctness Is Corrupting Medicine (Basic Books, 2000) and most recently Brainwashed: The Seductive Appeal of Mindless Neuroscience, with Scott O. Lilienfeld (Basic Books, 2013). Visit Dr. Satel’s web site for more information about her work.
TheBestSchools: Thank you very much for agreeing to participate in TheBestSchools Interviews, an ongoing series of interviews with prominent contemporary thinkers who are impacting American society for the better.
You have just published a wonderful book, Brainwashed, which we feel may represent a watershed in terms of the way in which neuroscience is viewed by the layman, and we want to discuss the book with you in depth. First, though, we would like for you to share with our readers some information about your background, to enable them to get a better sense of who you are as a person.
Sally Satel: I was born in New York City and grew up in Queens. My parents were Jewish but we were only mildly observant. I am an only child and my family was probably middle class. I went to public schools. My parents were Democrats, but were not very politically involved. I never met a Republican until I was 34. I do not consider myself to be conservative, but being critical of political correctness and affirmative action seems to put one on the right (as opposed to left) side of the spectrum. Basically the common thread in my work is the idea that patients benefit when they are self-determining (serious exceptions need to be made for psychotic individuals). The field tends to be infantilizing, too often, and does not expect much from patients. We see this in the granting of disability payments and other entitlements to too many patients who should be self-supporting (which is by no means to deny that some patients are so debilitated as to require intensive support).
I feel strongly that work is the best therapy. Without it, people lose the sense of purpose work gives (or at least the distraction from depressive rumination it provides), the daily structure it affords, and the opportunity for socializing and cultivating friendships. The longer someone is unemployed, the more his confidence in his ability and motivation to work erodes and his skills atrophy. Once a patient is caught in such a downward spiral of invalidism, it can be hard to throttle back out. What’s more, compensation contingent upon being sick often creates a perverse incentive to remain sick. Many helping policies are enacted with the best of intentions, but they end up undermining patient flourishing. In my post-academic career, I have tried to translate these principles into policy recommendations.
TBS: What are the pluses and minuses of being an author and, increasingly, a public intellectual, as opposed to being a professor or a psychiatrist in private practice?
SS: The advantages of publishing books and writing in the press are the opportunities to disseminate your ideas, get people thinking, fuel public debate, and, ideally, spark change (if you are promoting a policy reform). I do know that my articles on organ donation have spurred some people to donate kidneys to strangers. Their letters to me telling me of their decision are probably the most palpable evidence of having starkly influenced life and death matters through my writing—or my life, for that matter. (Granted, I believe I have helped patients as a psychiatrist, but never clearly saved anyone’s life.) On the basis of public writing, I have been invited to give talks, appear on radio and TV, and, several times, testify at Congressional hearings. Without writing, I would never be at a think tank, nor would I have been able to participate in public dialogue about issues related to my expertise. On the down side, one gets hate mail (but, of course, it’s part of the job).
TBS: You are a resident scholar with the American Enterprise Institute (AEI), which is generally described as a “conservative” think tank. Is this a description you embrace? What, to you, does it mean to be a conservative and/or a libertarian (in the political sense)?
SS: I would describe myself as a “classical liberal.” That is, I value above all else free speech, free thought, freely made exchanges between knowledgeable parties, meritocracies, and government safety nets. I think the conditions in prison are a disgrace and that legal representation for low-income people is unforgivably shoddy. I think everyone deserves quality healthcare and I endorsed a tripartite health reform strategy of insurance mandates, subsidized catastrophic insurance for those who cannot afford any plan at all, and even more public health clinics. Politically speaking, I consider myself moderate. I also like the term “humane utilitarian.”
TBS: We all know that the contemporary academic establishment is dominated by “liberals” (in the corrupted sense of “supporters of state intervention in the economy and society”). Have you found your public identification as a conservative to be a handicap when it comes to being taken seriously in academia? If so, what do you recommend to other scholars in your position to do to mitigate this problem?
SS: If anything, I think some of the ultra-liberal members of the medical establishment take me too seriously. I don’t have enough power to be a threat, but I’m flattered! When President Bush was in office, I was imagined to have clout. It was amusing—if only it were true!
In medical schools, over all, the PC police are not as well-armed as they are in the rest of the academy. (I am not talking here about health reform, writ large, as in “ObamaCare.” That said, the hostility directed towards pharmaceutical companies and their interactions with physicians is unduly harsh. Now that rules about undue influence are in place, there seems to be a willing blindness to the difference between conflict of interest and confluence of interest.) Face it, treating people and saving lives on a day-to-day basis demands practicality. I’ve gotten some unwelcome reaction to my writing about veterans, but when I explain how current policies can harm veterans there is considerable calming of nerves. When I talk about race in medicine as a version of population genetics, ruffled feathers seem to flatten out.
But, yes, I do think that some academics have been biased against me reflexively because of my being at AEI. Every now and then, I have been told by colleagues that they wanted to invite me to speak at their medical schools, but were outvoted. I suppose one never knows how often that happens, but I feel, on balance, that I have had many opportunities to speak—and not just at the invitation of like-minded institutions.
Then again, I am not in a league with Charles Murray or Steve Pinker or Camille Paglia. All of whom are among my intellectual heroes and have taken serious anti-PC blowback from time to time, handling it brilliantly. In the end, first-rate work that is respectful of other views, even if in disagreement with them, is hard to dismiss—even in the academy. Though, of course, it is deeply unfair when unpopular views distract colleagues from attention to the careful reasoning behind those views.
Sometimes, you can pair up (in a pro & con commentary) with someone on the other side of an issue and model a civil debate. In my view, the quieter students who truly want to understand the nuances of a subject are almost always in the majority, but it’s easy to forget that because the hostile folks are generally loud. It’s the silent majority you are talking to—and, I hope, emboldening—by giving them the arguments to defend themselves. And when you write outside the walls of academia, you’ll find considerable receptivity to counter-intuitive essays and articles, in my experience. And if you lean right, then, by definition your thoughts will run against the grain of the mainstream. If your tone is good-natured and you can show the paradoxical harm in liberal (or for that matter right-wing) pieties, then editors seem intrigued.
My specific advice would be to stay away from obvious third-rail topics while still a trainee (such as IQ or particular, though not all, aspects of race). It can be a nice bonus if you can co-author with someone whose work is of high quality and is known to be sympathetic to the “other” side—whichever side is ideologically different from yours—assuming each of you has something unique to contribute to the paper.
TBS: You have testified before Congress on many occasions on a variety of topics. What was it like? Did you feel that your testimony was comprehended? That it was listened to? That it made a positive difference? Do you have any suggestions about ways in which the political process of seeking expert opinion from scientists might be improved?
SS: In all but one case, I felt that my comments were understood and, in most cases, listened to. In one specific case, I saw one or two of my suggestions actually incorporated into legislation. Whether that bill will pass Congress is an altogether different matter, though. In my experience, academics are treated with respect. People from think tanks—no matter the placement on the political spectrum, I think—are fairer game in the eyes of committee members than are people whose sole affiliation is a university. The latter are considered more “pure” in their expertise. This may or may not be fair, but it is my observation.
TBS: One of the many policy areas you have written about is organ transplants. You yourself have received a kidney transplant. Would you please briefly explain the reason for your controversial opinion that we should create a legal market for organs? How, if at all, do you think your personal experience has affected the development of your policy views on this subject?
SS: Today, 118,000 people await a kidney, liver, lung, or heart. Eighteen of them will die tomorrow because they could not survive the wait for a donated organ. Current law (1984 National Organ Transplant Act) demands that organs are given as “gifts,” an act of selfless generosity. A beautiful sentiment, yes. But for those without a willing loved one to donate, or years to wait on an ever-growing list, altruism can be a lethal prescription. (Full disclosure: in 2006, I got a kidney from a friend. If not for her, I would have spent many miserable years on dialysis.)
The only solution is more organs. We need a regulated system in which compensation is provided by a third party (government, a charity, or insurance) to well-informed, healthy donors. Rewards such as contributions to retirement funds, tax breaks, loan repayments, tuition vouchers for children, and so on, would not attract people who might otherwise rush to donate on the promise of a large sum of instant cash in their pockets.
With private buying kept unlawful, available organs would be distributed not to the highest bidder, but to the next needy person according to a transparent algorithm. For organs that come only from deceased donors, such as hearts, or those that are less often given by loved ones, like livers and lungs, a pilot trial of government-paid or charity-financed funerals makes sense.
My opinion about the importance of studying the virtues of incentives is really not that controversial. I refer to the majority of polls taken on the issue: most lay people are receptive to a trial of in-kind benefits made available by a third party (either the government or an approved charity). Unfortunately, the leadership in the “transplant community” is behind the the curve of public opinion and, with some notable exceptions, prefer to stick with the status quo. Sadly, that is a deadly choice that kills 18 people a day (who die because they can’t live long enough to receive an organ) while fostering a thriving black market in organs overseas.
It would sound odd, I’m sure, if I said that my situation as a kidney recipient has not fueled the passion behind my efforts to persuade Congress to allow pilot trials, but as a matter of policy I’ve always been in favor of private, enforceable contracts between willing and informed people. What’s more, the over-wrought paternalism, emotionalism, and sheer arrogance expressed by many of the opponents—within the fields of medicine and bioethics—is enough to frustrate anyone committed to rational policy debate.
TBS: You have also been very active as a writer and a public advocate in the field of drug addiction treatment. You maintain that drug addicts retain the ability to respond rationally to ordinary incentives—rewards and punishments—in spite of the evidence that their brains have been physically altered. We will return to the philosophical implications of this claim below, but for now, could you please enlarge on exactly what the empirical studies show?
SS: The brain changes associated with addiction do not prevent addicts’ behavior from being shaped by consequences. Contingency management—the technical term for the practice of adjusting consequences, including incentives—often succeeds with people who face serious losses, such as their livelihood, professional identity, or reputation. When addicted physicians come under the surveillance of their state medical boards and are subject to random urine testing, unannounced workplace visits, and frequent employer evaluations, they fare well: 70% to 90% are employed with their licenses intact five years later. Likewise, scores of clinical trials show that addicts who know they will receive a reward, such as cash, gift certificates, or services, are nearly two to three times more likely to submit drug-free urine samples as addicts not offered rewards.
Unfortunately, treatment programs are rarely in a position to offer cash or costly rewards. But the criminal justice system has an ample supply of incentives at its disposal and has been using such leverage for years. One of the most promising demonstrations of contingency management comes from Honolulu in the form of Project HOPE: Hawaii’s Opportunity Probation with Enforcement. Project HOPE includes frequent random drug testing of offenders on probation. Those who test positive are subject to immediate and brief incarceration. Sanctions are fair and transparent: All offenders are treated equally, and everyone knows what will happen in case of an infraction. The judges express a heartfelt faith in offenders’ ability to succeed. These basic elements of HOPE’s contingency administration—swiftness, sureness, transparency, and fairness, combined with expectation for achievement—are a potent prescription for behavior change in just about anyone.
Indeed, after one year of enrollment in Project HOPE, participants fared considerably better than probationers in a group who served as a comparison. They were 55% less likely to be arrested for a new crime and 53% less likely to have had their probation revoked. These results are even more impressive in light of the participants’ criminal histories and their heavy, chronic exposure to methamphetamine, which can impair aspects of cognitive function.
These findings join a vast body of experimental data attesting to the power of incentives to override the lure of drugs.
TBS: What is your opinion of some of the more successful forms of addiction treatment that are currently available? We are thinking of things like mindfulness-based cognitive/behavioral therapy and AA. Are there other forms of treatment you would recommend?
SS: I am a pragmatist. Whatever works is what I support. What I don’t support are unproven or disproven approaches masquerading as “effective” treatments. As for mindfulness and cognitive behavioral therapy (including relapse prevention), they have been shown to help. AA is a lifesaver for some and simply because the “higher power” or other religious overtones may not resonate with some clinician, is an unacceptable rationale for failing to suggest the option to patients. The best therapy, however, is contingency management alone or paired with other interventions.
TBS: What does the relative success of these approaches tell us about the claims of the “neuromaniacs” (to use Raymond Tallis’s term) that we have no control over our brains?
SS: My new book, with Emory psychologist Scott Lilienfeld, has focused on the extent to which brain science, and brain imaging in particular, can explain human behavior. Non-experts are at risk of being seduced into believing that brain science, and brain imaging in particular, can unlock the secrets of human nature. Media outlets tend to purvey information about studies of the brain in uncritical ways, which foster mis-impressions of brain science’s capabilities to reveal the working of the mind.
We talk about “losing the mind in the age of brain science.” We mean that brain-based levels of explanation are regarded as the most authentic and valued way of explaining human behavior. Sometimes, this is the proper way to go (when we want to uncover the workings of the brain for clinical purposes or to achieve new insight about the mechanisms of memory, learning, emotion, and so on). But if we want to understand people in the context of their lives—their desires, intentions, attitudes, feelings, and so on—the best way is to ask them, not their brains.
To clarify, all subjective experience, from a frisson of excitement to the ache of longing, corresponds to physical events in the brain. Scientists have made great strides in reducing the organizational complexity of the brain from the intact organ to its constituent neurons, the proteins they contain, genes, and so on. Just as one obtains differing perspectives on the layout of a sprawling city while ascending in a skyscraper’s glass elevator, we can gather different insights into human behavior at different levels of analysis.
With this template, we can see how human thought and action unfold at a number of explanatory levels, working upward from the most basic elements. A major point we make in Brainwashed is that problems arise when we ascribe too much importance to the brain-based explanations and not enough to psychological or social ones.
TBS: Do you see any connection between the decline of religion—and traditional education in general—with their emphasis on character-building and virtue, and the sharp rise in drug addiction rates we have seen in recent years?
SS: The rise in rates relates to prescription drugs, not illicit drugs. In general, I steer clear of causal questions about social phenomena because too many variables are involved and causal direction is not always clear. Natural experiments are nice ways to learn something, for example, when a locality implements a new, discrete policy so that before and after effects can be measured. So, I will answer this question obliquely in terms of the process it implies (the difficulty of studying such trends), rather than directly. That is, I don’t know.
TBS: Before your new book came out, you were perhaps best known to the general public for your earlier book, P.C., M.D.: How Political Correctness Is Corrupting Medicine. Everyone knows that American medicine suffers from a variety of ills, but being PC is not usually mentioned as one of them. So, could you please tell our readers a little bit about the sorts of problems you discussed in that book?
SS: In short, the book exposed ways in which the teaching of medicine and public health, and also its practice, are distorted by political agendas surrounding the issue of victimization—in particular, the notion that the poor health of minority populations (e.g., ethnic minorities, severely mentally ill people, women) is due to social oppression. In P.C., M.D. and The Health Disparities Myth, for example, I show that despite insistent claims that racially biased doctors are a cause of poor minority health, there are no data to support this.
Politicized medicine (which is different than PC medicine) can come from both directions: the left and the right. For example, pro-life advocates exaggerate the extent to which abortion leads to depression and misrepresent aspects of the stem cell debate.
TBS: Let us now turn to the book you have just published, Brainwashed: The Seductive Appeal of Mindless Neuroscience (co-authored with Scott O. Lilienfeld). We believe it is destined to become a classic in its field, which might be defined as books that push back against “scientism.” By this, we mean the claim that neuroscience, genetics, evolutionary biology, and the natural sciences in general have finally succeeded in “unmasking” our ordinary, commonsense understanding of the human person—as a being capable of making free choices on the basis of moral judgments—as an illusion or a myth, and that therefore science must now replace philosophy, religion, the arts, the humanities, and even the social sciences as our master narrative of what it means to be a human being.
This topic is so vast it is hard to know where to begin. Let’s start with the hard science, and work our way out toward the more philosophical issues. Could you please briefly explain what fMRI technology actually does, and why you think it is being misused, or at least misinterpreted?
SS: Thank you for the kind words about the book. First, bear in mind that Technicolor brain scans are not anything remotely like photographs of the brain in action in real time. Scientists can’t just look “in” the brain and see what it does. They cannot “read” minds. More accurately, scans produced by functional magnetic resonance imaging (fMRI) tell us which areas in the brain are working the hardest, as measured by increased oxygen consumption, when a subject performs a task such as reading a passage or reacting to stimuli, such as pictures or sounds. The problem is that almost all regions of the brain have not just one but several job descriptions, which can make interpretation of scans a challenge.
For example, according to one “neuro-marketer,” people “love” their iPhones. He concluded this based on the fact that brain scans of smart phone users listening to their personal ring tones showed a “flurry of activation” in the insula, a prune-sized area of the brain. But in another study, researchers at UCLA claimed that photos of former presidential candidate John Edwards provoked feelings of “disgust” because they “lit up” . . . the insula!
The insula plays a role in a broad range of psychological experiences, including empathy and disgust, but also sudden insight, uncertainty, and the awareness of bodily sensations, such as pain, hunger, and thirst. With such a broad physiological portfolio, it is no surprise that the insula is activated in many fMRI studies. The same holds true for other brain areas. The amygdala, for instance, shows increased activation when one experiences fear, but it also springs to life when one encounters novel or unexpected stimuli.
The multi-functionality of most brain areas renders reasoning backwards from neural activation depicted by a scan to the subjective experience of the brain’s owner a dubious strategy. Formally, this logically suspect approach is called “reverse inference,” and when crudely applied it functions much like a high-tech Rorschach test, inviting interpreters to read what they want into largely ambiguous findings.
In fact, researchers are now using techniques that measure the nature of brain activity in more informative ways. Increasingly, they are moving away from the time-honored approach of examining which discrete brain areas “light up,” and toward the study of the brain as it operates in nature: as the electrical crackling of crosstalk among numerous regions as they are strung together in specialized neural circuits that work in parallel to produce our thoughts and feelings.
Brain imaging is surely the most media-genic of neuroscientific tools—and, indeed, it is an invaluable part of a technological arsenal aimed at discovering the workings of the brain. Through these tools, scientists will develop next-generation treatments for crippling illnesses, such as schizophrenia and Alzheimer’s Disease. Novel insights into the biology of memory, learning, decision-making, and emotion are also forthcoming.
But we must remember that brain images have their limits. Since they are better suited for generating promising hypotheses than for confirming them, they should be a starting point, not a finish line. Unless we are careful, pretty pictures of the brain can seduce us into drawing simplistic conclusions, leading us to ask more of these images than they can possibly deliver.
TBS: We have already discussed the fact that even though drug addiction alters the brain, it does not obliterate the ordinary motivational system of rewards and punishments upon which much of human behavior (and animal behavior, for that matter) is based. This raises the issue of the relation of the brain to the whole person, often known as the “mind/body” problem. We know this is an enormous question; but in a nutshell, what is your viewpoint on how the human person and his or her brain are related to each other?
After all, isn’t it the case that all that we think and feel is somehow embodied in the brain, and that therefore everything we experience changes the brain? If that is so, then why do you think we must nevertheless view the human person as more than the sum total of his or her synaptic connections?
SS: There is a lot of confusion here. Sometimes, I’ve found, neuroscientists do not use a vocabulary that is sufficiently subtle. Take the idea that the brain and the mind are “different.” Does this necessarily mean that the two are materially separate domains? Virtually all psychologists, psychiatrists, and neuroscientists, me included, certainly don’t think so. Every subjective experience, from the pang of nostalgia to the thrill of a Christmas morning, corresponds to physical events in the brain. The mind—the realm of feelings, desires, ideas, memories, intentions, and subjective experience—is produced by the action of neurons and brain circuits. How else could it work? Yet, as New York Times columnist David Brooks observed, the mind is not identical with the matter that produces it. So, to say that the brain and the mind are different is not necessarily evidence of scientific ignorance. It means simply that one cannot use the physical rules from the cellular level to completely predict activity at the psychological or behavioral level.
As an analogy, consider the words Shakespeare wrote on a page. They are, of course, “material,” but one could not capture the meaning of his plays by conducting a chemical analysis of the ink in which the letters of his words were written. The brain and the mind are different levels of explanation of the same phenomenon; when we talk about the brain, we talk about mechanisms underlying perception, emotion, and cognition. When we talk about mind, we talk about awareness and meaning. Because brain and mind are different levels of description, they have different properties. This position, which we endorse, is called “property dualism.”
Similarly, one cannot rely on the brain alone to predict or understand everything important about human subjectivity or behavior. This is because many psychological phenomena are emergent properties of lower-order constituents such as neural circuits, neurons, proteins, and genes. “Constitutive” reductionism—reducing complex entities to the sum of their component parts to facilitate study—is not controversial in the scientific community. But, radical or “eliminative” reductionists go a crucial, and questionable, step further. They insist that everything mental will ultimately be explained fully at the material level of analysis. This variant of reductionism ultimately eliminates the need for the psychological level of analysis, not to mention all other levels—social, cultural, and so on.
TBS: Your last chapter on free will and moral responsibility is one of the most interesting in your book. In this chapter, you assume that compatibilism (the idea that hard determinism is true, but we are morally responsible for our actions anyway) is the only game in town. However, as I am sure you know, Immanuel Kant called compatibilism a “wretched subterfuge,” and hard determinists (who dismiss moral responsibility as a superstition) certainly seem more consistent. In any case, it seems to us that compatibilism is an unstable position, and as long as determinism holds the intellectual field, moral responsibility will continue its disorderly retreat.
But there is an alternative. On p. 131, you seem to accept Patricia Churchland’s definition of libertarianism (in the philosophical sense—the doctrine which holds that both free will and moral responsibility really exist). She says that libertarians believe action takes place in a “causal vacuum.” This implies that if our actions are not causally determined in the same way as the trajectories of billiard balls, then they happen for no reason at all. And of course that is silly.
However, Churchland was attacking a straw man. Most libertarians (in the philosophical sense) claim simply that the reasons which motivate our actions are irreducible to causes in the mechanistic billiard-ball sense. They posit a separate category of “agent causation,” which amounts to the claim that our minds are in control of our desires and passions, authorizing action when they approve of our transient motives in the light of either enlightened self-interest or some higher ideal, and refraining from action when they disapprove.
In other words, on the libertarian view, we are truly the authors of our own actions, and therefore morally responsible for them. Would you care to comment?
SS: Our minds are in control of our desires and passions—I believe. I also believe that our behavior is caused—but I also agree with those who say that certain kinds of freedoms are still open to us. The longstanding debate, of course, is about the kind of freedom that is necessary. I agree with those (typically called “compatibilists”) who contend that we can be held accountable, as long as we are able to engage in conscious deliberation, follow rules, and generally control ourselves.
Others, like Stanford neuroscientist Robert Sapolsky, disagree, insisting that our deliberations and decisions do not make us free because they are dictated by neuronal circumstances. They say that, as we come to understand the mechanical workings of our brains, we’ll be compelled to adopt a strictly utilitarian model of justice in which criminals are “punished” solely as a way to change their behavior, not because they truly deserve blame.
Although it’s cloaked in neuroscientific garb, this free will question remains one of the great conceptual impasses of all time, far beyond the capacity of brain science to resolve. Unless, that is, investigators can show something truly spectacular: that people are not conscious beings whose actions flow from reasons and who are responsive to reason. True, we do not exert as much conscious control over our actions as we think we do. Every student of the mind, beginning most notably with William James and Sigmund Freud, knows this. But it doesn’t mean we are powerless.
TBS: These issues can get very complicated very quickly. Some would say they are too complex to leave to ordinary people like legislators, judges, and jurors to decide. Why, then, shouldn’t we let the experts (meaning, the scientists) decide these difficult questions for us?
SS: Because they can’t, either.
TBS: In Brave New World, Aldous Huxley described a world in which scientist-leaders make all the decisions for us, and human beings are reduced to the condition of being contented servants of the state—contented because they are allowed (indeed compelled) to have all the food and drugs and sex and other distractions they want. Some see the Brave New World scenario as a nightmare, while others look at it and say: “What’s not to like?” (I know because I used to poll my students!) Some of us see Huxley as incredibly prescient and the danger as real and present, while others make fun of our paranoia.
What do you think?
SS: I don’t worry too much about that scenario. Most scientists are horrified at the thought of directing society (they just want more lab funding and exciting discoveries!). The people who are the problem are the ones who think science can guide policy, let alone should.
Of course, data should inform the way a society seeks to fulfill its shared values. But the idea that science can guide policy is naïve because the scientific method cannot investigate what we should do. But the reason I am not too worried about the rise of the scientistic-leaders is because they will fail and a democracy won’t tolerate repeated failures. In fact, the Brave New World cohort will probably end up tarnishing the deserved respect that the scientific enterprise now enjoys.
TBS: Thank you very much for sharing your time and your insights with our readers.