Respectful Insolence

On Friday, I expressed my irritation at the misunderstanding of science by NEWSWEEK’s science columnist Sharon Begley, in which she opines that it is those nasty basic scientists who insist on learning new science and new physiological mechanisms of disease that are devaluing translational and clinical research, in effect ghettoizing them in low impact journals, and, as I sarcastically put it, “keeping teh curez from sick babiez!!!!!”

It turns out that both Steve Novella, Mike the Mad Biologist, and Tim Kreider have also weighed in. All are worth reading.

I also thought of another thing regarding Begley’s rant. She complains how medical science’s emphasis on the novel is supposedly inhibiting the search for cures of various diseases and how the desire of scientists to publish in top journals may lead them to take more time to “get all their ducks in a row,” as Steve Novella put it, by having a mechanism for an observed effect worked out. Often, top journals won’t publish papers that don’t have evidence for a molecular, genetic, or physiological mechanism.

Castigating “the same old incremental research that has produced too few cures” and praising “risk-taking, innovative studies,” her proposal is to find a new Director of the NIH who will strongly emphasize translational research and fund riskier but potentially higher payoff research. Yet not too long ago this same Sharon Begley ripped into physicians for opposing comparative effectiveness research, which is nothing more than comparing one existing treatment against another. Now don’t get me wrong. Comparative effectiveness research (CER) could be potentially very important. There are lots of conditions for which multiple treatments exist, the relative effectiveness of each being not entirely clear. However, if there’s one form of clinical research that is about as far from “risk-taking” and “innovative,” it’s CER. Indeed, CER is about as plain and white bread as it gets, because all it does is to compare two or more treatments that are already FDA approved in order to see which one is more effective. Important information, yes, but it’s about as far from what Begley thinks we should be doing as far as translational research as it gets. Worse, given how long it does to do a typical clinical trial, it’s not hard to imagine situations in which both treatments being compared in CER have been supplanted by new therapies, making the results of the research no longer relevant by the time it’s published.

In any case, Begley is going to have a hard time having it both ways. There are only limited resources, even if the Obama administration greatly ramps up the funding for medical research. CER has a huge number of potential therapies to be compared to each other. Given the many permutations that could be tested, CER could easily expand to fill up the entire health research budget. Obviously, doing CER leads to no new treatments. Too much CER, in other words, would cause medical progress to grind to a halt (and, if Begley thinks clinical research is ghettoized in low impact factor journals now, wait until she sees the collective yawn from the top journals that would greet the results of lots of CER). On the other extreme, “risky” translational research fails far more often than it succeeds, meaning that too much of an investment in such research is likely to produce a lot of failures. After all, major breakthroughs aren’t common, and they can’t be conjured at will. Finally, as I have said many times before, translational research will grind to a halt without a steady stream of new basic science results to exploit in the pipeline. Thus, an effective medical research effort will require a careful balance between hard core basic science research, both of the careful, incremental variety and the more risky, innovative kind; translational research, both incremental and risky; and the very safe, very dull CER. Unfortunately, Begley doesn’t seem to understand that. Indeed, her view seems to shift according to whatever is politically expedient (she appears to be a big Obama supporter) or what makes for her a provocative column, even if, as in her last column, she ends up relying solely on anecdotes of disgruntled researchers who feel they were treated unfairly by the NIH and pharmaceutical companies.

It’s a good thing Sharon Begley isn’t in charge of figuring out what kind of research is funded.

Comments

  1. #1 Happeh
    June 15, 2009

    You scientists are wrong all of the time.

    “Teen Outsmarts Doctors In Science Class

    http://www.nbcbayarea.com/news/us_world/Teen-Outsmarts-Doctors-In-Sciene-Class.html?yhp=1

    A teenager trusted scientists with her health problem. They could not diagnose it properly so the teenager diagnosed her own health condition.

    A teenager had more competence than professional doctors. If those doctors were competent they would have found the teenagers disease. Now they are laughing stocks for being incompetent.

    If you listen to me now, you will save yourselves from becoming laughing stocks for incompetence in the future

    People in the future are going to talk about you, the way you talk about medieval bloodletters.
    —–

    “A new study suggests that children and teens who take stimulants like Ritalin for ADHD have an increased risk for sudden cardiac death, but the FDA says the study has major limitations and should not change the way the drugs are used.”

    Scientists developed a drug for children to help with ADHD. But the drug kills them. And the stoopid scientists do not even know why the drug kills them.
    —-

    “First face and double-hand transplant patient dies of heart attack”

    Scientists braggged about the first face transplant and now the patient is dead. Maybe if scientists had never performed the face transplant, the patient would still be alive? But who cares right? Scientists got to brag about how good their medicine is because they can do face transplants.
    —-

    The above listing of just one days worth of science disasters proves scientists are not as smart as they think they are.

    Stop the childish ignoring games. Stop the arrogance. Stop the name calling. Start talking to people who can explain things to you that you do not know.

  2. #2 BA
    June 15, 2009

    Another Happoe?

  3. #3 flippertie
    June 16, 2009

    Please tell me its a troll. Please.

  4. #4 Dan
    June 16, 2009

    Happeh, you cannot possibly be serious. Jessica Terry’s doctors got one case wrong, so all doctors everywhere are wrong about everything? I take issue with any argument trying to draw conclusions about an entire group of people, because they are usually exaggerated and unreliable.

    Scientists developed a drug for children to help with ADHD. But the drug kills them. And the stoopid scientists do not even know why the drug kills them.

    Did you not even read the quote you yourself posted?

    “…but the FDA says the study has major limitations and should not change the way the drugs are used.”

    That should be a red flag to you, indicating that maybe you shouldn’t draw conclusions based on this one study if there’s a chance it is seriously flawed. Maybe you need to investigate it further.

    And another thing, about spelling. I’m going to give you the benefit of the doubt and assume that you’re intentionally spelling “stupid” wrong to be facetious. If that’s the case, the attempt falls flat. Personally, I find it immensely irritating and not pithy or clever in the slightest.

    The above listing of just one days worth of science disasters proves scientists are not as smart as they think they are…Stop the arrogance.

    Why, yes, pot, I am quite aware of my current sable hue. You’re the one who seems to think you have all the answers, not scientists. Scientists only claim to have the best answers currently available.

    And finally, I can define “woo” for you. Woo, in its usage on this site, refers to so-called “medicine” that has either not been proven to work, or been proven not to work, that nonetheless continues to enjoy (undeserved) support in the public domain.

  5. #5 Damien
    June 16, 2009

    Happeh, I’m just astounded at both your posting rapidity and your posting stupidity. I personally would love to find a new and interesting way of treating my masturbatory-related blindness, but my Yin Wang just needs some adjusting.

    I’m all ears for you to explain absolutely everything you’ve said with evidence.

    Blah blah, troll bait, blah blah.

  6. #6 Matthew Cline
    June 16, 2009

    @dan:

    Happeh, you cannot possibly be serious. Jessica Terry’s doctors got one case wrong, so all doctors everywhere are wrong about everything? I take issue with any argument trying to draw conclusions about an entire group of people, because they are usually exaggerated and unreliable.

    That might not be what he meant. In a thread in another forum he claims that when he says something like that, he’s engaging in hyperbole in order to wake people up to the fact that doctors aren’t infallible, since if he merely said “doctors aren’t infallible” no one would pay attention.

    And finally, I can define “woo” for you. Woo, in its usage on this site, refers to so-called “medicine”…

    Not always. Orac once did a Friday Woo post on branch of 9/11 conspiracy theorists who claim the planes that appeared to crash into the towers were actually holographic projections which concealed some missiles.

  7. #7 Matthew Cline
    June 16, 2009

    @Happeh:

    In case you missed it, I’ve left a comment on your own blog which would be rather off-topic over here.

  8. #8 Happeh
    June 16, 2009

    Dan – “Happeh, you cannot possibly be serious. Jessica Terry’s doctors got one case wrong, so all doctors everywhere are wrong about everything?”

    Hello Dan. Of course I do not mean all doctors everywhere are wrong. Just like not all alternative medicine people everywhere are wrong.

    That does not stop this blog or the people here from claiming all alternative medicine is no good. Can you see the hypocrisy of your position? You want me to behave reasonably and agree that only some doctors make mistakes, while I allow you to say that all alternative medicine is no good because maybe homeopathy is no good.

    Dan – ” “…but the FDA says the study has major limitations and should not change the way the drugs are used.” That should be a red flag to you, indicating that maybe you shouldn’t draw conclusions based on this one study if there’s a chance it is seriously flawed.”

    What it tells me is that the FDA is in the pocket of the Pharma companies, and so as to not hurt ADHD drug sales, they make certain they tell parents to continue to buy drugs that could kill their child.

    Dan – “I’m going to give you the benefit of the doubt and assume that you’re intentionally spelling “stupid” wrong to be facetious. If that’s the case, the attempt falls flat. Personally, I find it immensely irritating and not pithy or clever in the slightest.”

    I find it irritating to be called crazy, insane, told that what I say is woo, or called a woo meister. No one cares. Are you saying I should care about your feelings? Is that more hypocrisy?

    Dan – “You’re the one who seems to think you have all the answers, not scientists. ”

    No I don’t. People here do not want to speak to me because they feel conventional science is best and I know nothing. That forces me to prove that conventional science does not know best. Something that is very easy to prove. Hopefully the chagrin that scientist might feel at being shown how many mistakes they make, might make them more open to alternative opinions about the health of the human body.
    ——-

    Damien – “Happeh, I’m just astounded at both your posting rapidity”

    You never met one of those types of geniuses huh? The kind that talk a mile a minute? You should watch a movie called “Real Genius”. There is a girl in there sort of like me. She never stops talking because her brain is working at 100 miles an hour.

    It is a good movie too.

  9. #9 Happeh
    June 16, 2009

    Please lord let this individual be capable of continuing on with a thought. ;)

    Dan – “Woo, in its usage on this site, refers to so-called “medicine” that has either not been proven to work, or been proven not to work, that nonetheless continues to enjoy (undeserved) support in the public domain.”

    Why did you or whoever it was choose the word “woo” to describe what is described above?

    Why not some other word?

  10. #10 Richard Eis
    June 16, 2009

    -Why did you or whoever it was choose the word “woo” to describe what is described above? Why not some other word?-

    We have lots of words for people that have as much arrogance as ignorance. Woo is merely more polite.

  11. #11 Ranson
    June 16, 2009

    I can’t believe I’m engaging here.

    Happeh,

    As I understand it, the term “woo” originated with James Randi. “Woo” is actually a shortened version of “woo-woo”, which is alternately an onomotopeia for either the traditional spooky sound of a “ghost” or the instrument called a theremin, which was often used to generate sound effects in early science fiction and horror movies. Thus, “woo” is used derisively as shorthand for foolish mysticism and/or pseudoscience.

  12. #12 #1 Dinosaur
    June 16, 2009

    “First face and double-hand transplant patient dies of heart attack”

    Scientists bragged about the first face transplant and now the patient is dead. Maybe if scientists had never performed the face transplant, the patient would still be alive? But who cares right? Scientists got to brag about how good their medicine is because they can do face transplants.

    I know someone who had a face lift who then died in a car accident. If she hadn’t had the operation, maybe she’d still be alive. That surgery KILLED her!!

    Srsly; WTF??

  13. #13 Orac
    June 16, 2009

    Everyone:

    May I suggest that you all resist the temptation to feed the troll?

  14. #14 Happeh
    June 16, 2009

    Gotcha!

    Ranson – “As I understand it, the term “woo” originated with James Randi. “Woo” is actually a shortened version of “woo-woo”,”

    Oh great scientists. What is the phrase “woo – woo” described in scientific terms? Mystified by the request? Why? You are scientists. How can an alternative medicine guy mystify you? You should be able to think rings around the stupid alternative medicine guy.

    “Woo – Woo” is a waveform. WOO woo. WOO Up woo Down.

    Now. Since you are all so certain you are smart, why is it that you chose a phrase that looks like a waveform to describe the things that alternative medicine says?

    Come on. I know you can do it. Don’t disappoint me. I want to see that raw intelligence of yours that needs no study to tell it what to do.
    ———

    Orac – “May I suggest that you all resist the temptation to feed the troll?”

    Come on Orac. You are man enough to author a hit piece on Happeh Theory. Then when Happeh shows up on your doorstep to talk to you about your hit piece, you tell people to ignore him.

    Why aren’t you man enough to take Happeh on face to face?

    Woman?

  15. #15 Marcus Ranum
    June 16, 2009

    Happeh writes:
    Start talking to people who can explain things to you that you do not know.

    That sounds like a good idea. Would you be interested in looking at some photographs of people that I know, then applying “happeh theory” to them, and telling me what you are able to determine? That would be a weak but interesting test of the predictive power of “happeh theory.” Post facto reasoning is easy; being able to use a theory predictively is a good argument that there’s some objective reality behind it. So – put up or shut up.

  16. #16 Happeh
    June 16, 2009

    Sure Marcus. I am who I say I am. I will look anyone in the face and defend my claims.

    I don’t say things and then run and hide like Orac does.

  17. #17 Marcus Ranum
    June 17, 2009

    OK. I’ve uploaded pictures of 3 people that I know very well. One woman, and 2 guys. I know a lot about them and their personalities and habits, including gender preferences, how often they do/don’t masturbate, etc. Why don’t you take a look at:
    http://www.ranum.com/happeh/
    and tell me what happeh theory predicts about them, based on the photos. Let’s see how you do!

    The only changes I made to the images is cropping and downsampling them in photoshop.

  18. #18 Chris
    June 18, 2009

    Marcus, please read comment #13.

  19. #19 Marcus Ranum
    June 18, 2009

    @Chris #18
    I read just fine; I chose to ignore it.

  20. #20 Chris
    June 18, 2009

    Ah, well… trolls tend to starve if you ignore them. I guess I’ll add you to the list.

  21. #21 Happeh
    June 19, 2009

    Marcus. Are you completely certain that you know about the masturbation habits of these individuals? Many people will tell something other than the truth because masturbation embarrasses them.

    Also, I think Chris wants you to stop because you are going to find out there is something to what I say. That is why they make so much trouble about me. If anyone actually looks at what I say, it is easy to see and believe. They need to stop that possibility at all costs.
    ——————

    Picture #1 – This woman shows signs of changes to the body predicted by Happeh Theory. Because I have only talked about masturbation changing the body, people might initially think that since I said her body shows Happeh Theory signs, then I am saying the woman masturbates.

    I would guess the woman shows Happeh Theory signs because of her dancing, if she does dance. Excessive exercise can cause some of the same symptoms exhibited by excessive masturbators. The reasoning is simple. Masturbation is an exercise. Excessive masturbation is Excessive exercise, so it is no surprise that a person who exercises heavily would show some of the signs predicted by Happeh Theory.

    If you are curious what signs I am talking about, the woman has what Happeh Theory calls “Anorexia Dent” on her right side. That is why her right leg is lifted upwards and crossed over in front of her body.

    If you have good eyesight, the right side of the woman’s face is thinner than the left side. The eyesight in her right eye will be different than the eyesight in her left eye

    Please notice the common factor. Right eye bad. Right leg lifted and moved across body. Anorexia Dent on right side of body. Everything is on the right. The Anorexia Dent changes the entire right side of her body.
    ————-

    Picture 02 – If this is not a faked photograph of some kind, this man is an excessive masturbator. He shows all of the symptoms that Happeh Theory says masturbation will cause.

    His head is thrown back to his right. His right eye is barely visible. His right arm is raised and bent, with the hand curled around something like a hand curled around a penis. His left leg is raised upwards and his left hand is in his pocket.

    All of those signs indicate this man is an excessive masturbator with his right hand. Again notice the common factor. Right hand masturbation. Head thrown back to right. Right eye barely visible. Right arm lifted and bent.

    The raised left leg is not an anomaly. The raised left leg is part of the normal pattern of right hand masturbation caused changes to a human body.
    ————

    Picture 03 – This picture bothers me because it looks faked. Maybe you removed the background? I need to repeat that I hope you are not pulling shenanigans.

    The man in picture 03 shows mild signs of right hand masturbation. His entire body very slightly leans back to his left, like he is pulling his weight up off of his right leg. His right chest is smaller than his left chest. The right shoulder is slightly higher and a slightly different shape than the left shoulder.

    I hope you can see it, because this man has masturbation damage to his right eye. The right side of his face is clearly thinner than the left side of his face.

    Again there is the same factor. Right hand masturbation. Right side chest smaller. Right side face thinner. Right eye damaged. Right shoulder shape change.
    ———-

    I am for real Marcus. If I could find someone who other people will listen to, and who can understand what I say, what I say could make that person famous.

    Don’t you think the news would want to talk to people who claimed masturbation makes you blind and crippled? With easily visible proof that anyone can verify?

    I can’t do it though. I am nobody so they wouldn’t listen to me. I am also too honest to be on TV. I say what I think which always seems to make people unhappy.

    A smooth talking person with credentials that a news organization would approve of could go places with what I know. All I want is accreditation. And of course a cut of the profits if you start making money with my discovery.

  22. #22 snerd
    June 19, 2009

    Hrm. It occurs to me that if we saw a picture of Happeh, we could apply the heuristics of his Theory to that picture.

    Also; sorry Orac, kind of a whack-a-mole thing happening here.

  23. #23 Marcus Ranum
    June 19, 2009

    @Chris:
    Ah, well… trolls tend to starve if you ignore them. I guess I’ll add you to the list.

    If I gave a shit about what you think, that would really make me cry. It must be difficult, trying to act as if the internet is your personal playground and wanting to blot out everything that annoys you; it’s probably hard on your blood pressure, isn’t it?

  24. #24 Happeh
    June 19, 2009

    “Hrm. It occurs to me that if we saw a picture of Happeh, we could apply the heuristics of his Theory to that picture.”

    Of course. Last time I checked my body was human.

  25. #25 Marcus Ranum
    June 19, 2009

    happeh:
    Are you completely certain that you know about the masturbation habits of these individuals?

    I am. One of them is myself, one of my sweetheart, and the other is a friend of mine.

    I have a super-busy day today; I’ll be back later or tomorrow.

  26. #26 Marcus Ranum
    June 20, 2009

    @Happeh:
    Also, I think Chris wants you to stop because you are going to find out there is something to what I say.

    No; I think it’s just some random person who isn’t interested in the conversation and, rather than ignore it, prefers to be in the silly position of shouting “QUIET!!!!”

    Are you completely certain that you know about the masturbation habits of these individuals? Many people will tell something other than the truth because masturbation embarrasses them

    That’s why I used the photos that I used. I know all 3 of our habits quite well. I shot all 3 of those photos myself, in my studio and the only post-work I did on them was resizing them.

    Now, let me deconstruct your responses on the images, in sequence:
    I would guess the woman shows Happeh Theory signs because of her dancing, if she does dance. Excessive exercise can cause some of the same symptoms exhibited by excessive masturbators. The reasoning is simple. Masturbation is an exercise. Excessive masturbation is Excessive exercise, so it is no surprise that a person who exercises heavily would show some of the signs predicted by Happeh Theory.

    Your response here reminds me of a professional palm-reader’s. “She may masturbate but then again, she may not.” “She may show signs of dancing bu then again, she may not.” Or perhaps she shows signs of anorexia but then again, she may not. The probability that you’ll take any 20-something female and find one who neither dances, diets, or masturbates are… what? Especially when, as you say, muscular activity affects your physique.

    Note: I still haven’t said anything about whether she’s a dancer, masturbator, or anorexic. And, neither have you.

    If you are curious what signs I am talking about, the woman has what Happeh Theory calls “Anorexia Dent” on her right side. That is why her right leg is lifted upwards and crossed over in front of her body.

    It’s called “contraposto” and it’s a popular fashion model’s posing technique. It involves putting all the weight on one hip to accentuate the waist; the other leg is raised slightly to shorten it, then the front knee is crunched over in front of the one supporting the weight, to make the pose look somewhat balanced. The model, in this instance, was posing that way because I asked her to. I didn’t shoot this just for you; it’s an image I selected from a series we shot in my studio last month.

    If you have good eyesight, the right side of the woman’s face is thinner than the left side. The eyesight in her right eye will be different than the eyesight in her left eye

    Interesting.

    I notice that once again you cover yourself: “The eyesight in her right eye will be different than the eyesight in her left eye” doesn’t say which is better or which is worse. So it’s a win/win guess. That’s how palm readers and psychics work, too.

    I will state that the model did have eye surgery to correct vision, several years ago.

    Please notice the common factor. Right eye bad. Right leg lifted and moved across body. Anorexia Dent on right side of body. Everything is on the right. The Anorexia Dent changes the entire right side of her body.

    Here’s where I am fascinated; you appear to have noticed a few things about the model (some right, some wrong) and then appear to be post-facto fitting them to the “anorexia dent” You did not say whether she is/was an anorexic. Or a masturbator, or a dancer. She could be all, some, or none of those and, at various times in her life. So you haven’t got a 1-in-3 guess; it’s more complicated than that.

    Picture 02 – If this is not a faked photograph of some kind, this man is an excessive masturbator. He shows all of the symptoms that Happeh Theory says masturbation will cause.

    It’s not a faked picture. It’s a self-portrait I shot about 6 months ago. :D I was testing a new radio remote on my camera.

    with the hand curled around something like a hand curled around a penis.

    Radio remote.

    All of those signs indicate this man is an excessive masturbator with his right hand.

    Well, I certainly have been known to. :D But I don’t know what “excessive” means. Nothing has fallen off. That’s a question I should have asked earlier: are you talking long-term or short-term with your diagnosis? Speaking for myself, there’s been considerable variation in that department over the course of my life.

    So, in photo #1 her raised right foot indicates she dances/masturbates/anorexia? and in photo #2 the raised left foot indicates excessive masturbation?

    Here’s why I used a self-portrait, there: as a kid I was deeply dyslexic. As I grew up, I adopted a strategy of using my right hand for almost everything, so my left arm is nowhere near as strong or coordinated and it might show in my build and posture. Of course, I masturbate with my right hand, too, so I’m not sure how to score you on that one.

    Picture 03 – This picture bothers me because it looks faked. Maybe you removed the background? I need to repeat that I hope you are not pulling shenanigans.

    No shenanigans; it’s called a “studio sweep” – it’s the same thing that I am standing on in photo #2 you just can’t see his feet and I had it painted grey that day.

    Again there is the same factor. Right hand masturbation. Right side chest smaller. Right side face thinner. Right eye damaged. Right shoulder shape change.

    Interesting. Did you notice the lighting? The model is standing at an angle to the camera; it’s side lit from an angle as well, and because you can’t see the position of his feet, you can’t tell.

    I picked that shot because his feet weren’t in the picture, which I thought might deny you clues that you’re using. So I left those clues in the other image (although in the one of the girl, her leg-pose altered her balance completely)

    I am for real Marcus. If I could find someone who other people will listen to, and who can understand what I say, what I say could make that person famous.

    Don’t you think the news would want to talk to people who claimed masturbation makes you blind and crippled? With easily visible proof that anyone can verify?

    Well, I’m unconvinced. You clearly believe in what you’re saying but I don’t think your performance on the 3 images I presented was particularly good. You got some stuff right and some stuff wrong and threw a couple “truth sandwiches” like the psychics and palm readers do.

    You appear to be able to determine if someone is right-handed or left-handed but your reasoning doesn’t convince me you have a good way of factoring that out.

    I you’re going to make progress with the scientific community and media, you’d need to be able to be much more impressive on much larger, better-controlled tests than the 3 images I gave you.

    One of the hallmarks of a good explanatory theory is its predictive power: if you really understand the underlying rules of something, it should be possible to use them to correctly predict. The predictive power of a theory and its accuracy go a long way toward making its case as scientific fact. I just don’t see that going on here.

    Thanks for your time,
    mjr.

  27. #27 Happeh
    June 20, 2009

    Marcus – “I you’re going to make progress with the scientific community and media, you’d need to be able to be much more impressive on much larger, better-controlled tests than the 3 images I gave you”

    My first response to this is that I will be tested by anyone who is sincere, and I will agree to be tested in any way that is reasonable. Anybody can get any people they want for the test and I will take it. I can see what I see in any human being on earth. Except. If you somehow find an Asian person or some other ethnic person who is more developed than me, I might not be able to see them. Their higher development might give them the ability to hide from me.

    Now to answer you.

    I do not want to be insulting to you, but I do not believe you are thinking very well. You can test what I say very easily. Do you still have access to the dance model?

    Get a measuring instrument and some kind of marker. Draw a straight line from the dancers chin to her waistband. Take the ruler and measure from the line on the center of her body to the outside of her torso on both sides while she is standing in a normal posture.

    Stand the dancer up against a wall in a normal posture. Take your marker and outline the curve of both sides of her torso on some paper or something held against the wall.

    Do your outline and measurements show that both sides of the models’ torso are the exact same width? If not, which side of the torso is smaller than the other side? How and where are the shapes different?

    If you do find two different size and shape sides of the torso, the next thing to do is discuss why. My reason is Anorexia Dent.