You could also do a Heather Mills job but I am worried about the sexism of reporting of that incident, although also curious to see the lawyer whose personal charm apparently was tremendously accentuated by having her wool wig wetted. Does moral qualm oblige me to deny myself seeking out the image? After all, it seems that the woman was assaulted.

I wonder also how much the perception “shyness” is influenced by culture. A person considered shy in America may be considered normal in Britain and annoyingly pushy in Japan. Some surveys (mostly in America) have found that the percentage of people self-describing as “shy” has increased in recent decades; I doubt that this is due to an increase in actual timidity but rather to less tolerance of shyness even in limited form.

While extreme social phobia is no doubt life-limiting, a low level of “shyness” or social reticence may have its advantages. Holding back until you have sussed out a situation can prevent you from “rushing in where angels fear to tread”. I once saw a documentary about some kind of small penguin. There were two siblings: the brother took lots of risks, the sister held back and watched. He became seal food; she survived to adulthood and had chicks of her own.

I have a mild phobia about public presentations, which means I prepare *really* well if I know I’ll have to speak in public. And shy people are often perceived by others as “nicer” than the outspoken (whether they are or not).

However, I will certainly henceforth be substituting “energy” (in its man-in-the-street sense”) with “pep”, “zip”, “get up and go” or “bushy-tailed-ness”.

Personally, whenever I hear the Alt-oids talking vaguely about “energy” I am always reminded of Star Trek, where Mr Spock was forever telling Capt. Kirk things like “It appears to be some form of energy field, Captain”.

Perhaps my distant youth watching such things explains why I tend to view mysterious “energies” as the stuff of fiction…

There is a simple solution. We adopt a different word. Ben’s ‘welly’ is good, but I propose instead we borrow the word ‘genki’ from the Japanese. Roughly translated as ‘bright-eyed and bushy tailed’, it is used in the greeting “O-genki desu ka?” or “are you genki?”.

Would Boots be prepared to issue their press release if it was written as edited below?

“Boots believe that this product is the ideal solution for those who are not genki due to decreased CoQ10 levels, especially when combined with the Boots money back guarantee for anyone who takes Kaneka CoQ10 once a day but doesn’t feel a boost to their genki-ness within just one week.”

Using this, there is no evidence for the theory “…those who are not genki due to decreased CoQ10 levels…” hence the rest is tosh.

Re. what the anonymous biochemist said (last post): One of the big semi-respectable sales pitches for CoQ10 is that people who take statins should chomp CoQ10 to “combat the CoQ10-lowering effects of taking statins” (statins inhibit a key biosynthetic pathway that leads to both CoQ10 and cholesterol). However, as I read the reviews in the actual scientific lit, CoQ10 supplementation, while raising plasma CoQ10, doesn’t seem to raise CoQ10 levels in target tissues like muscle. Which sounds entirely consistent with what Ben’s friendly biochemist just said.

Coracle has a nice post about statins and Q10 here.

Dear Ben Goldacre,

As a regular reader of “Bad science”, I was particularly interested in
your piece on ubiquinone (often sold as a health supplement as
Coenzyme Q10), having worked in Lars Ernster”s laboratory in
Stockholm in the early 1960s. There, I had carried out many
measurements of ubiquinone levels in the mitochondria of several
tissues, as one of the several components of the chain determining the
regulation of oxidative phosphorylation leading to the production (or
not) of ATP.

After reading your piece, I re-read the review by L. Ernster and G.
Dallner on the biochemistry of ubiquinone, cited by Boots in promoting
the sale of Coenzyme Q10. It is especially ironical that the company
refers to this review, which deals mainly with the biochemistry of
ubiquinone, since at the end of their article they mention briefly
anything about this substance as a supplement for human consumption.
Despite many claims over several decades about its magical properties,
the two authors conclude that exogenous ubiquinone accumulates in the
blood and in the lysosomes in the liver lysosomes, the latter being
the route for disposal or degradation of harmful substances!

I look forward to further “Bad science” articles from you, which I
find, simultaneously entertaining and alarming.

Best wishes

There is also the question of scale. I believe that the number of people completely at ease in all social situations is zero. The market for an effective treatment for ‘social anxiety’ is probably bigger than that for weight loss. Alcohol is just one example of self-medicating here.

There are also hundreds of variations of social phobia. One person might be afraid of eye contact whilst another might dislike speaking out in front of groups, another afraid of confronting people etc.

The chances of a drug being able to target solely these individual variations is zero. It’s no coincidence that Prozac has been promoted for social anxiety as well as other anxieties, depression and numerous other DSV IV classifications.

DSM IV classifications are quite arbitrary then.

This kept me amused all day but I had to search hard at work for someone who got the joke…

My favourite is the one where the Placebo group beat the CoQ10 supplemented group.

This is more a “push economy” issue where they have a solution and want the largest possible group of people to use it regardless of whether it plausibly addresses their underlying issue.

Negative affect and fatigue are both gross categories with many different underlying causes and effective treatments, so I think push strategies can be perilous for vulnerable consumers.

Part of the problem with psychiatry is the assumption that everything should be divided into ‘normal’ and ‘abnormal’ and the ‘normal’ people told to fuck off. It is obviously rather more of a continuum and telling people that their distress is part of the ‘normal spectrum’ is not helpful.

That doesn’t mean we should be dishing SSRIs out to every person that comes into a GP’s surgery feeling a bit low for a few days, but nor does it mean turning away people with serious distress because we think it is ‘normal’.

Personally I think a major depressive disorder is probably a totally ‘normal’ response to childhood abuse, but that doesn’t mean we don’t try and find ways to alleviate or ameliorate the suffering involved.

“…[Arguably] a subgroup of the people diagnosed “mildly to moderately depressed” and given SSRIs… are… sad, rather than depressed. …”

“Subgroup” is clearly not all.

Re. sadness and depression, for an insightful blogpost by a blogging consultant psychiatrist that I think gets to the nub of some of this, see here. Here’s a question: do we really believe that a GP seeing a patient like the one described would never give them an SSRI?

BTW, I am old enough to remember the pre-SSRI era and the early media buzz around Prozac. In their early years (late 80s and early 90s) SSRIs were far more than medicines – they were truly a snowballing cultural (as well as medical) phenomenon. I don’t blame the PharmaCos – everyone was part of it. The patients wanted “miracle pills”, the doctors wanted something to give the patients, the Pharmas wanted to sell boatloads of pills and the media ate it up. It has latterly been “recast” as PharmaCo dirty dealing, but that was not how it ran and played at the time.

Turning to social anxiety disorder, there I find it hard not to believe that we are looking at some “medicalising shyness”. The prevalence that some psychiatrists believe in seems so enormous that it is clearly “diagnosing deficit” in vast swathes of the population. Take, for instance, an editorial in the BMJ a few years ago which offered the view that:

“studies in Europe and N America… found a 7-12% lifetime prevalence [of social anxiety disorder] in the community and higher rates in primary care samples”.

This is saying that they think nearly one in every eight people is going to have a treatable “Social anxiety disorder” in their lifetime. One in eight?! If that isn’t “medicalising the normal spectrum” then I don’t really know what is.

To make a bond releases energy and to break one requires energy input.

It is only the overall reaction of respiration that releases energy ie the energy released in making new bonds is greater than that used by breaking existing ones.

I was prescribed anti-depressants and sleeping tablets, neither of which have I used, practically the moment I walked into a surgery looking for advice on couselling. It was in vain that I protested that of course I was anxious and depressed but that this was because I had reason to be and was surely not a clinical condition. I was basically told that the pills would help; quite why a doctor thought that giving sleeping pills to a woman with the sole care of four kids was a good idea, I don’t know. Why a doctor thought that my not being happy because my life had turned to shit required medication, I don’t know either.

A few weeks later, I can’t say I’m ecstatic, but I’m coping far better than I was, starting to look to the future, and I’m certainly no longer depressed.

Now if they had a drug for anger…:)

“it is hard to escape the conclusion that a highly significant subgroup of the people diagnosed “mildly to moderately depressed” and given SSRIs each year are indeed sad, rather than depressed.”

“Sleep and exercise have a much better evidence base for tiredness.”

Exercise helps you sleep, and cycling to work is a great way of getting exercise without investing much time [except during UK winters]. Cycling with kids to school has helped my wife gain fitness and lose weight with minimal time investment.