Unintentional Comedy
I have been really enjoying your magazine since I started reading it last year.

In the “Humor in the Brain” sidebar in “Laughing Matters,” by Steve Ayan, the picture of the brain with eyeballs actually looks pretty hilarious. I keep visualizing Slinky-style springs behind the eyeballs going “Sproing!”

Anyway, keep up the good work.
Meghan O’Connell
via e-mail

Risks and Rewards
I feel that “Knowing Your Chances,” by Gerd Gigerenzer, Wolfgang Gaissmaier, Elke Kurz-Milcke, Lisa M. Schwartz and Steven Woloshin, is a very important article. As a physician, I know it is often difficult to follow through with scientific recommendations. This difficulty results in part from a fear—justified or not—that runs through the medical community: if you do not do everything possible for a patient, no matter how small the benefit, you will be sued. The saying is, “No one is ever sued for overtreatment.” As acknowledged in the article, patients want certainty. They want to feel like everything that can be done has been done. This may not be the best physical approach, but it can be mentally reassuring to a patient and the family.
“akaamd”
adapted from a comment at www.ScientificAmerican.com/Mind-and-Brain

“Knowing Your Chances” is a very good article. Although the authors touched on drug efficacy, I am sur­­­­­-prised they did not invoke the concept of “number needed to treat,” or NNT. This statistic indicates how many people would have to take a particular drug to achieve the desired results in one individual.

For instance, note the NNT of 35 for statins (cholesterol-lowering drugs) in the primary prevention (avoiding a first-time event) of any bad thing (such as a heart attack), according to a table provided by the journal Bandolier, found at http://tinyurl.com/mrxngz. [Editor’s note: the URL has been shortened to make it easier to type into a browser.] Your doctor may advise you to take a statin if your cholesterol is slightly elevated, but he or she probably will not tell you that out of 35 people taking the drug for four years, only one person will actually benefit from it in terms of avoiding a coronary event or another bad outcome. I wonder how many people with slightly elevated cholesterol would feel this rather minimal risk reduction to be worth the cost and the potentially bad side effects of taking this type of drug for the rest of their lives.
“MikeB”
adapted from a comment at www.ScientificAmerican.com/Mind-and-Brain

Notes on Depression
As a biological anthropologist and someone who has been through postpartum depression, it worries me to see too much eagerness to slap an adaptive explanation onto PPD, as anthropologist Edward H. Hagan does in “Ask the Brains.” As scientists, it is our responsibility to acknowledge that we cannot explain everything and that not everything has a purpose.

Sometimes things are coincidental—and sometimes they are the result of maladaptive traits being tagged onto adaptive ones. Perhaps the hormonal shifts themselves are highly adaptive, but their ability to completely throw a new mother’s mind out of whack is not.

Assuming that everything is an adaptation—or failing to present the possibility that there are good scientific explanations besides adaptive ones for certain phenomena—ultimately undermines our credibility with those who do not wish to believe the adaptive explanations for which we do have good evidence. The scientific community (including myself, Hagan and Scientific American Mind) has a responsibility to the public to avoid simply providing stimulating or fascinating potential explanations using evolutionary theory. We also need to provide sound, proven explan­ations for phenomena that are only potentially evolutionary in origin.
“beak3chimps”
adapted from a comment atwww.ScientificAmerican.com/Mind-and-Brain