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I thought of this conversation the other evening when, for what seemed like the hundredth time, I saw Pfizer's most recent TV commercial for Lyrica, a drug to treat the chronic-pain syndrome, fibromyalgia. I can tolerate Pfizer's endless ads for Lipitor, the cholesterol-lowering drug, because the ad is doing a public service. High cholesterol is a serious health problem. But watching the kindly middle-age actress interrupt the evening news to tell me that "my fibromyalgia is real" raises serious medical issues and underscores the ruthless drive of Big Pharma.

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When hosting Bill Bennett's "Morning in America" radio show last Friday, Republican National Committee Chairman Michael Steele said, "I don't need some justice up there feeling bad for my opponent because of their life circumstances or their condition and shortchanging me and my opportunity to get fair treatment under the law … I'll give you empathy. Empathize right on your behind."

It's astounding that a trait normally considered admirable -- one usually sought out in choosing personal relationships, colleagues and associates -- is now seen as synonymous with being emotional and partisan, as though being empathetic makes one less rational and reasonable. It's understandable, given the deplorable nature of partisan politics, that conservative critics would come up with a unified denouncement of whomever Obama chooses. But why settle on an argument that flies in the very face of modern cognitive science and the understanding of how our brains function?

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Unfortunately, nearly a year has passed and nothing has changed. Last week, I turned to my local PBS station, KQED, and ran headlong into yet another program of medical self-promotion. Mark Hyman, M.D., a family physician, was talking about "brain fog" and "broken minds" and how such "conditions" could be cured or prevented by using "The UltraMind Solution" -- a combination of books, DVDs and home questionnaires.

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And yet, as Thiermann was gamely trying to accept his diminished financial circumstances by handing out fliers for the weekly specials, Madoff, under house arrest and close scrutiny, was busy mailing $1 million worth of old watches to family and friends.

I suspect we all wonder what, if anything, Madoff feels when directly confronted by those he has utterly destroyed. He cooked the books and perpetually lied to his investors. He pulled off the ongoing deception with an utter insensitivity to others. If shown videos of interviews of his victims, would he wince, laugh or simply shrug dismissively and say, "There's a sucker born every minute." For me, a glimpse into Madoff's brain can shed light on the origins of how we treat each other, and perhaps most important, why we treat each other so poorly.

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Last October, a 17-year-old Montclair, N.J., linebacker collapsed following a routine tackle. A month earlier, he had sustained a mild concussion but had recovered and been cleared to play. This time, though, when he stood up on the field, he collapsed again. He died three days later of an acute brain hemorrhage.

Fortunately, such disasters are rare. In 2007, according to the National Center for Catastrophic Sports Injury at the University of North Carolina, only three deaths were attributed to head injuries among the 1.8 million U.S. teenagers playing high school football. On the other hand, it's conservatively estimated that high school and college athletes annually sustain at least 300,000 concussions, or "dings."

Add the growing number of kids playing soccer, hockey, lacrosse and extreme sports, and the concussion rate is staggering. But youth is about taking risks and proving oneself, not about trying to avoid life. Being KO'd or having your bell rung is a rite of passage, proof that you can take whatever is dished out. Parents be damned; let the games begin.

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Last week, I jokingly asked a health club acquaintance whether he would change his mind about his choice for president if presented with sufficient facts that contradicted his present beliefs. He responded with utter confidence. "Absolutely not," he said. "No new facts will change my mind because I know that these facts are correct."

I was floored. In his brief rebuttal, he blindly demonstrated overconfidence in his own ideas and the inability to consider how new facts might alter a presently cherished opinion. Worse, he seemed unaware of how irrational his response might appear to others. It's clear, I thought, that carefully constructed arguments and presentation of irrefutable evidence will not change this man's mind.

In the current presidential election, a major percentage of voters are already committed to "their candidate"; new arguments and evidence fall on deaf ears. And yet, if we, as a country, truly want change, we must be open-minded, flexible and willing to revise our opinions when new evidence warrants it. Most important, we must be able to recognize and acknowledge when we are wrong.

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One way to distinguish the effects of nature from nurture would be to look at brain regions believed by neuro-anatomists to be fully formed at birth and impervious to subsequent environmental effects, both physical and psychological. Focusing on such brain regions, a research team at the Karolinska Institute in Stockholm, Sweden, headed by neuroscientist Ivanka Savic, obtained MRIs for 90 adult volunteers -- 25 straight men, 25 straight women, 20 gay men and 20 lesbians. Using the latest quantitative techniques for assessing cerebral symmetry and functional connections between various areas of brain, Savic was able to demonstrate highly statistically significant differences between straight and gay brains. Gay and lesbian brains more closely resembled the brains of straight volunteers of the opposite sex than the brains of heterosexual members of the same sex.

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The popular glucosamine is only a tip of the complementary and alternative medicine (CAM) iceberg. Health-conscious consumers now spend more than $30 billion a year on CAM therapies. But as a growing body of medical research and the convincing recent book, "Snake-Oil Science: The Truth About Complementary and Alternative Medicine," by R. Barker Bausell, former research director of the National Institutes of Health-funded National Center for Complementary and Alternative Medicine, point out, the primary benefit of CAM therapies is a result of placebo.

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Before the neurologist in me can voice an objection, the doctor, Daniel Amen, is being interviewed by on-air station (KQED) host Greg Sherwood. Sherwood is wildly enthusiastic. After reading Amen's book, "Change Your Brain, Change Your Life," Sherwood says, "The first thing I wanted to do was to get a brain scan." He turns to Amen. "You could start taking care 10 years in advance of ever having a symptom and prevent Alzheimer's disease," he says. "Yes, prevent Alzheimer's disease," Amen chimes in.

Wait a minute. Prevent Alzheimer's disease? Is he kidding? But Sherwood is already holding up Amen's package of DVDs on learning your risk factors for A.D., as well as his book with a section titled "Preventing Alzheimer's." Then, as though offering a landmark insight into a tragic disease -- and encouraging viewers to pledge money to the station -- Sherwood beams and says, "This is the kind of program that you've come to expect from PBS."

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It's certainly true that good health practices, physical and mental exercise, and stress reduction are associated with lower rates of mental decline. But do brain fitness programs add any additional specific benefits? The optimistic answer is they might. The realistic answer is that it's hard to know. Despite what the makers of the games claim, there isn't a reasonably foolproof way to measure a program's specific effects on mental performance. In other words, buyer beware.

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But why? Is this simply a matter of stubbornness, arrogance or misguided thinking, or is the problem more deeply rooted in brain biology? Since my early days in neurology training, I have been puzzled by this most basic of cognitive problems: What does it mean to be convinced? This question might sound foolish. You study the evidence, weigh the pros and cons, and make a decision. If the evidence is strong enough, you are convinced there is no other reasonable answer. Your resulting sense of certainty feels like the only logical and justifiable conclusion to a conscious and deliberate line of reasoning.

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Such patients are easy to mock; some less than sympathetic journalists have dubbed BDD the "imagined ugliness syndrome." However, to the sufferers, every bodily deviation from perceived perfection is both real and profoundly disturbing. Many become socially isolated, have difficulty holding jobs and suffer from serious depression. In a prospective study, over 50 percent of patients with BDD admitted to thoughts of suicide, with an attempted suicide rate of 2 to 3 percent per year, and an overall suicide rate of greater than 20 percent.

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I am stuck in rush-hour traffic. Maybe I can find a decent radio program to distract myself from the blasting horns, angry looks and cussing behind rolled-up windows. But the radio is worse than the traffic. On NPR, a Washington think tank guru is arguing that "my 30-plus years of studying the Middle East has convinced me that democracy is more appropriate for some cultures than others." A second NPR station is airing a debate on the medical rights of "illegal aliens." On Fox, Bill O'Reilly is talking about a recent dinner in Harlem, N.Y., with Al Sharpton: "I couldn't get over the fact that there was no difference between Sylvia's restaurant and any other restaurant in New York City. I mean, it was exactly the same, even though it's run by blacks."

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Their extraordinary conclusions are beyond provocative; they raise profound questions about the very notion of consciousness. What's more, they could throw thousands of families and doctors into utter turmoil. As with the Terri Schiavo controversy, patient advocacy groups, self-serving lawyers and politicians with personal agendas could use the study's stamp of certainty as a given.

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