Sunday, May 27, 2018

Is there any relationship between the opioid addiction epidemic among working/middle class Americans, and the uneven gains from the economic recovery following the 2008-09 financial crisis?


'Is there any relationship between the opioid addiction epidemic among working/middle class Americans, and the uneven gains from the economic recovery following the 2008-09 financial crisis?'.

If the 2008-2009 financial crisis and its continuing fallout triggered and/or exacerbated the ongoing US opioid addiction crisis, a striking increase in opioid overdose deaths post-2008 would be expected. However, epidemiological data does not support such a premise. This answers summarizes
  • Data showing steady year-on-year increase in opioid overdose deaths from 1999 till date, overdose death rates varying widely from state to state, disproportionately affecting whites, and increasing in tandem as opioid prescribing rates rose from 1999-2010, deaths that the CDC already noted with alarm in 2006-07.
  • How starting in the 1990s aggressive opioid marketing and lobbying gestated the roots of the ongoing opioid epidemic by changing how the US medical system treats pain.
Steady Year-on-Year Increase In Opioid Overdose Deaths From 1999 Till Date
  • Opioids prescribed in the US peaked in 2010, decreasing steadily since then (see below from 1) though they're still much higher than in the rest of the world.
'CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015. ..The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015.’
  • Drug overdose deaths have steadily increased since 1999, doubling already by 2006 in 45 to 54 year olds (see second figure below from 2).
  • Drug overdose deaths vary widely from state to state, with states with rather different economic profiles such as West Virginia, New Hampshire, Ohio, Rhode Island, Pennsylvania, Massachusetts, Connecticut, Maine and Maryland experiencing substantial increases from 2010 to 2015 (see below from 3).
  • Overdose deaths disproportionately affect whites (see below from 2) though overall, black males continue to have the lowest life expectancy (see below from 4).
  • Opioid prescribing rates steadily increased 1999-2010 with overdose deaths rising in tandem (see below from 5).
  • Already in 2006-7, CDC reported alarming increases in opioid-induced overdose deaths (see below from 6).

Aggressive Opioid Marketing in the 1990s Changed How The US Medical System Treats Pain
A little known drugmaker best known in the 1980s for the painkiller MS Contin, Purdue Pharma morphed into a multi-billion dollar behemoth on the back of OxyContin, its 1990s upgrade, whose unprecedented marketing vaulted the Sackler family, owners of Purdue Pharma, into the ranks of the wealthiest Americans today.

Well worth the reading, Mike Mariani at the Pacific Standard (7) and Patrick Radden Keefe at the New Yorker (8) methodically and comprehensively unravel the process Purdue Pharma used to relentlessly lobby all manner of doctors from general practitioners to pain physicians alike to expand opioid prescription to those with all manner of chronic pain. US doctors in the incalculably innocent pre-OxyContin era tended to view opioids as 'dangerously addictive', limiting their use to those terminally ill, usually terminal cancer patients.

Mariani and Keefe recount how sheer money muscle was used to overturn this restriction in use of prescription opioids to instead render them acceptable to treat an expanding list of pain-related conditions.

In practical terms, this meant serious boots on the ground in the form of intense lobbying by the likes of the now-defunct American Pain Foundation (9), and thousands of highly paid and hence extremely motivated sales reps to relentlessly push all manner of doctors to start applying the fifth Vital signs - Wikipedia during their routine examination of patients to elicit information about their pain levels and then palliatively treat them with powerful prescription opioids (10, 11), all while repeatedly assuring them opioids weren't addictive (see below from 12, emphasis mine).
'Abbott’s relationship with Purdue and its part in building the OxyContin brand are detailed in previously secret court filings unsealed by a Welch, http://W.Va., state court judge at the request of STAT. The records were part of a case brought by the state of West Virginia against Purdue and Abbott that alleged they inappropriately marketed the drug, causing users to become addicted to the opioid. The case was settled in 2004 when Purdue agreed to pay $10 million to the state. Neither company admitted any wrongdoing.
The documents include internal Abbott and Purdue memos, as well as sales documents and marketing materials. They show that Abbott sales reps were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis. The sales reps from the two companies closely coordinated their efforts, met regularly to strategize, and shared marketing materials.'
Opioid prescribing inducements included direct payments to doctors as well. One 2017 study estimated as many as 1 in 12 US physicians and ~1 in 5 family doctors accepted payments related to opioids during the course of the 29-month study (August 2013-December 2015) (13).
Such change in prescribing was based not on carefully conducted scientific studies but one mediated by relentless lobbying and marketing, and came into place within the span of a decade from the mid-1990s to the mid-2000s so much so that in 2012, 13 states had more opioid prescriptions than even people (see below from 14, 15). Clearly, change in prescribing (demand) went hand in glove with carpeting of the entire country with a surfeit of opioids (supply).


Investigative reporting suggests regulator-opioid maker revolving door also helped grease the wheels.
  • A Los Angeles Times report by Harriet Ryan, Lisa Girion, Scott Glover (16) uncovers how Dr. Curtis Wright, the FDA bureaucrat who led its medical review of Purdue Pharma's OxyContin application in 1995 left the FDA shortly after it approved it and within 2 years began working for Purdue.
  • A piece in the Milwaukee Journal Sentinel by John Fauber suggests (see below from 17, emphasis mine) beefing up pain advisory councils with opioid maker-friendly voices also helped smooth the way in expanding usage of opioids in pain treatment,
'Federal health industry regulators and executives of companies that make pain drugs have held private meetings at expensive hotels at least once a year since 2002 through an organization funded by the drug companies, according to emails obtained through public records requests and provided to the Journal Sentinel/MedPage Today.
Each year a handful of drug companies have paid up to $35,000 each to send a representative to meetings of IMMPACT, where they could discuss clinical trial testing procedures with officials from the U.S. Food and Drug Administration and other government agencies. IMMPACT's stated goal is to improve the design of clinical trials conducted to develop new pain treatments.’
  • Such meetings appear to have favored opioid makers even as recently as 2013 (see below from 18, emphasis mine).
'The Food and Drug Administration is under enormous pressure to change its mind about a powerful new prescription painkiller. Forty-two public health groups are urging the FDA to withdraw its support of Zohydro. The drug is similar to Oxycontin, except it comes in significantly higher doses. The FDA approved Zohydro last year, despite its own advisory panel voting against it. And critics are, among other things, raising questions about that approval process.’
  • As late in the US opioid crisis as January 2016, a federal government pain advisory panel of 18 had at least 5 with financial ties to opioid makers, connections that came to light (see below from 19),
'...after the committee last month bashed a federal plan to recommend doctors scale back on prescribing painkillers for chronic pain. The guidelines by the Centers for Disease Control and Prevention are intended to curb deadly overdoses tied to powerful but highly-addictive opioid drugs, including Percocet and Vicodin.'
The Center for Public Integrity - Wikipedia also uncovered evidence of opioid maker lobbying of Congress and state legislatures (20), efforts estimated by Mother Jones to be 8X that of the gun lobby and 200X that of those advocating stricter opioid prescription rules (21).

Raw numbers reflect the spectacular success of such unprecedented marketing and lobbying. In 1996, annual OxyContin sales were $48 million. For OxyContin's inaugural marketing alone, Purdue doubled its sales force to 600 and spent $207 million, so much so that already by 2000, OxyContin sales grew 23-fold to ~$1.1 billion (22).

Already by 2001, OxyContin had become the most frequently prescribed brand name opioid for treating moderate to severe pain in the US, with so much overprescribing that the US GAO issued a 58-page report warning about it all the way back in December 2003 (23).

In recent years, other opioid makers such as Insys Therapeutics Inc. (24) and Mallinckrodt Pharmaceuticals (25) have also come under the public spotlight for their aggressive sales practices, tactics that also applied to antidote makers such as Reckitt Benckiser (26).

Like a burst dam, such intense marketing and lobbying ended up transforming how US doctors treat pain, replacing wholesale old true and tried methods that erred on the side of caution to an approach where it suddenly became acceptable to treat any and all pain with extremely powerful opioids (1, 5, 27, 28), a change that a 2016 study (29) suggests had US family doctors and general practitioners at the forefront.

Could one seriously argue that from the years 1996 onwards, physical pain and/or existential angst increased so much among the US population as to justify such an increase in opioid sales and consumption? Obviously not. Instead, the US opioid epidemic is inextricably linked to an unprecedented medical culture change in how US doctors were carefully and relentlessly persuaded by opioid makers, their lobbyists and sales reps to treat all manner of pain, not just terminal, late stage cancer pain, with highly powerful opioids.

Problem is so far opioid makers haven't been held accountable for their willful recklessness (slaps on the wrist in the form of relatively piddling monetary fines obviously don't count) even as they've saturated the US market. Rather, a report in the Los Angeles Times by by Harriet Ryan, Lisa Girion, Scott Glover suggests that as their profits in the US market start to dry up, their ongoing intense lobbying around the world may end up replicating the US opioid crisis in other countries as well (30). For governments, policy makers and regulators the world over, how to avoid 'globalization of the prescription opioid epidemic' (31) thus becomes a matter of urgency.

Bibliography
1. Guy, Gery P. "Vital signs: changes in opioid prescribing in the United States, 2006–2015." MMWR. Morbidity and mortality weekly report 66 (2017). https://www.cdc.gov/mmwr/volumes...
2. Hedegaard, Holly, Margaret Warner, and Arialdi M. Miniño. "Drug overdose deaths in the United States, 1999-2015." NCHS data brief 273 (2017): 1-8. Welcome to CDC stacks
3. Rudd, Rose A. "Increases in drug and opioid-involved overdose deaths—United States, 2010–2015." MMWR. Morbidity and mortality weekly report 65 (2016). https://www.cdc.gov/mmwr/volumes...
5. Centers for Disease Control and Prevention (CDC. "Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008." MMWR. Morbidity and mortality weekly report 60.43 (2011): 1487. https://www.cdc.gov/mmwr/pdf/wk/...
7. Mike Mariani, February 23, 2015. Poison Pill
8. New Yorker, Patrick Radden Keefe, October 30, 2017. The Family That Built an Empire of Pain
9. Propublica, Charles Ornstein, Tracy Weber, December 23, 2011. The Champion of Painkillers — ProPublica
10. Tompkins, D. Andrew, J. Greg Hobelmann, and Peggy Compton. "Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma." Drug and Alcohol Dependence 173 (2017): S11-S21. http://www.sciencedirect.com/sci...
11. Harris, Matthew C., et al. "Prescription Opioids and Labor Market Pains." (2017). http://cber.haslam.utk.edu/staff...
12. Stat News, David Armstrong, September 22, 2016. Secret trove reveals Abbott's bold 'crusade' to sell OxyContin
13. Hadland, Scott E., Maxwell S. Krieger, and Brandon DL Marshall. "Industry Payments to Physicians for Opioid Products, 2013–2015." American journal of public health 107.9 (2017): 1493-1495. https://www.researchgate.net/pro...
16. The Los Angeles Times, Harriet Ryan, Lisa Girion, Scott Glover, May 5, 2016. http://www.latimes.com/projects/...
17. Milwaukee Journal Sentinel, John Fauber, October 6, 2013. Emails point to relationship between drug firms, regulators
19. Associated Press, Matthew Perrone, January 27, 2016. Federal pain panel rife with links to pharma companies
20. Public Integrity, Liz Essley Whyte, Geoff Mulvhill, Ben Wieder, September 18, 2016. Politics of pain: Drugmakers fought state opioid limits amid crisis
22. Van Zee, Art. "The promotion and marketing of oxycontin: commercial triumph, public health tragedy." American Journal of Public Health 99.2 (2009): 221-227. https://www.ncbi.nlm.nih.gov/pmc...
27. Boudreau, Denise, et al. "Trends in long‐term opioid therapy for chronic non‐cancer pain." Pharmacoepidemiology and drug safety 18.12 (2009): 1166-1175. 6 (2017). https://www.cdc.gov/mmwr/volumes...
28. Schuchat, Anne, Debra Houry, and Gery P. Guy. "New data on opioid use and prescribing in the United States." Jama 318.5 (2017): 425-426. https://www.issup.net/files/2017...
29. Chen, Jonathan H., et al. "Distribution of opioids by different types of medicare prescribers." JAMA internal medicine 176.2 (2016): 259-261. https://jamanetwork.com/journals...
30. Los Angeles Times, Harriet Ryan, Lisa Girion, Scott Glover, December 16, 2016. http://www.latimes.com/projects/...
31. Humphreys, Keith. "Avoiding globalisation of the prescription opioid epidemic." The Lancet 390.10093 (2017): 437-439.


https://www.quora.com/Is-there-any-relationship-between-the-opioid-addiction-epidemic-among-working-middle-class-Americans-and-the-uneven-gains-from-the-economic-recovery-following-the-2008-09-financial-crisis/answer/Tirumalai-Kamala


Sunday, May 20, 2018

What are some things everyone "knows" that are no longer true?


A few examples of things everyone “knows” that are no longer true.

Don't crack your knuckles. You'll develop arthritis” (Cracking joints - Wikipedia). Scientific evidence doesn't support the idea.
  • A 1990 study confirmed this in a controlled study of 300 knuckle crackers and 226 non-knuckle crackers (1), though it did conclude knuckle crackers ended up with swollen hands and lower grip strength.
  • A prior 1975 study on 28 elderly residents in a home for the aged had also found no correlation between knuckle cracking and osteoarthritis (2).
  • A quirky case study with an n of 1 consisted of the author, a rheumatologist, who for 50 years consistently and daily cracked twice a day the knuckles of only his left hand, leaving uncracked those on the right as controls. Fifty years later and left hand knuckles cracked some 36500 times, no arthritis in either hand and no apparent differences between the two hands (3).
  • Subsequent reviews and studies only concluded more of the same, no arthritis from knuckle cracking (4, 5, 6).
  • Use of better methodology and more sensitive technology found no evidence either that knuckle cracking led to hand swelling or lowered grip strength (7).
  • Losing the ability to crack knuckles might even be emotionally distressing for some, according to a study on patients with end-stage renal disease (8). It appeared habitual knuckle crackers in this group of patients had lost their ability to do so, apparently a result of hyperparathyroidism, a secondary feature of their kidney disease. Surgical removal, parathyroidectomy, restored this ability, bringing back “great satisfaction from the emotional relief from what appeared to be habitual knuckle cracking”.
Get cold, catch cold”. Hundreds of years old this superstition and yet controlled studies on volunteers repeatedly failed to prove exposure to cold led to increased risk of catching a 'cold' (9, 10, 11).

Five-second rule - Wikipedia, drop food or cutlery and they still remain safe enough to eat or use if picked up within five seconds. Several scientific studies have by now thoroughly debunked this myth.

Shaving hair makes it come back thicker and faster”. Hmm, sounds like a surefire cure for baldness so bald people remain so by choice, eh?

Bibliography
1. Castellanos, Jorge, and David Axelrod. "Effect of habitual knuckle cracking on hand function." Annals of the rheumatic diseases 49.5 (1990): 308-309. http://ard.bmj.com/content/annrh...
2. Swezey, Robert L., and Stuart E. Swezey. "The consequences of habitual knuckle cracking." Western Journal of Medicine 122.5 (1975): 377. https://www.ncbi.nlm.nih.gov/pmc...
3. Unger, Donald L. "Does knuckle cracking lead to arthritis of the fingers?." Arthritis & Rheumatology 41.5 (1998): 949-950. Does knuckle cracking lead to arthritis of the fingers?
4. Gaetano, John. "Cracking the Cracked Knuckle: A Medical Student’s Take." The Journal of rheumatology 36.11 (2009): 2624-2624. http://citeseerx.ist.psu.edu/vie...;
5. Olszewski, Mariusz, and Rebecca Ortolano. "Knuckle cracking and hand osteoarthritis." The Journal of the American Board of Family Medicine 24.2 (2011): 169-174. Knuckle Cracking and Hand Osteoarthritis
6. Powers, Tye, Gary Kelsberg, and Sarah Safranek. "Does knuckle popping lead to arthritis?." (2016). https://mospace.umsystem.edu/xml...
7. Yildizgören, M. T., et al. "Effects of habitual knuckle cracking on metacarpal cartilage thickness and grip strength." Hand Surgery and Rehabilitation 36.1 (2017): 41-43. https://ac.els-cdn.com/S24681229...
8. Ross, Edward A., Jennifer L. Paugh-Miller, and Robert W. Nappo. "Knuckle cracking: secondary hyperparathyroidism and what your mother did not tell you." Clinical kidney journal 6.6 (2013): 671-673. https://pdfs.semanticscholar.org...
9. Andrewes, Christopher Howard. "Adventures Among Viruses. III. The Puzzle of the Common Cold." Reviews of infectious diseases 11.6 (1989): 1022-1028.
10. Dowling, Harry F., et al. "Transmission of the common cold to volunteers under controlled conditions. III. The effect of chilling of the subjects upon susceptibility." American journal of hygiene 68.1 (1958): 59-65.
11. Douglas Jr, R. Gordon, Keith M. Lindgren, and Robert B. Couch. "Exposure to cold environment and rhinovirus common cold: failure to demonstrate effect." New England Journal of Medicine 279.14 (1968): 742-747.


https://www.quora.com/What-are-some-things-everyone-knows-that-are-no-longer-true/answer/Tirumalai-Kamala


Sunday, May 13, 2018

What are some examples of cultural variance in the results of behavioral economics research?


Plenty of behavioral science studies in recent decades and yet lack of data is a major problem in understanding how cultural differences impact behavior. That should have caused a double take. How could there be both abundance and scarcity of data on the same research topic? Easy. Subjects in most of the published studies are undergraduate university students, usually psychology students, all too often American undergraduate psychology students (see below from 1, emphasis mine).
'...the Western, and more specifically American, undergraduates who form the bulk of the database in the experimental branches of psychology, cognitive science, and economics, as well as allied fields (hereafter collectively labeled the “behavioral sciences”).
Talk about navel-gazing in a self-selecting group that chooses to study among other things navel-gazing!

While there was some kind of underground mumbling and grumbling about this issue for years, the true extent of this problem came into sharp relief with WEIRD. No, not the word, the acronym. This highly cited 2010 paper (1) authored by Joseph Henrich - Wikipedia, Steven Heine - Wikipedia and Ara Norenzayan coined Western, Educated, Industrialized, Rich, and Democratic (WEIRD) to describe the most commonly studied subject in behavioral science studies (2, 3). The paper reviewed the comparative database across behavioral sciences including in economics and concluded
  • Most choose to examine the same thin sliver of humanity, WEIRD.
  • However, the few experimental results that do exist across populations, many conducted by Henrich himself, suggest substantial variation in basic attributes such as visual perception, fairness, cooperation, various types of reasoning, etc.
  • Authors thus conclude results from behavioral science studies are not representative and therefore, rarely, if ever, generalizable.
See below from 1, emphasis mine.
'Abstract: Behavioral scientists routinely publish broad claims about human psychology and behavior in the world’s top journals based on samples drawn entirely from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Researchers – often implicitly – assume that either there is little variation across human populations, or that these “standard subjects” are as representative of the species as any other population. Are these assumptions justified? Here, our review of the comparative database from across the behavioral sciences suggests both that there is substantial variability in experimental results across populations and that WEIRD subjects are particularly unusual compared with the rest of the species – frequent outliers. The domains reviewed include visual perception, fairness, cooperation, spatial reasoning, categorization and inferential induction, moral reasoning, reasoning styles, self-concepts and related motivations, and the heritability of IQ. The findings suggest that members of WEIRD societies, including young children, are among the least representative populations one could find for generalizing about humans. Many of these findings involve domains that are associated with fundamental aspects of psychology, motivation, and behavior – hence, there are no obvious a priori grounds for claiming that a particular behavioral phenomenon is universal based on sampling from a single subpopulation. Overall, these empirical patterns suggests that we need to be less cavalier in addressing questions of human nature on the basis of data drawn from this particularly thin, and rather unusual, slice of humanity. We close by proposing ways to structurally re-organize the behavioral sciences to best tackle these challenges.'
Gizmodo's helpful infographic (see below from 4) digests this article whose gist is,
  • Population sampling is blatantly skewed in much behavioral science research.
  • Most WEIRDs are undergraduate psychology students.
  • Results of economic experiments such as the Ultimatum game - Wikipedia are not generalizable across cultures. Indeed, they aren't generalizable even among Americans.
  • Cross-cultural assessment of tests such as Rod and frame test - Wikipedia and Müller-Lyer illusion - Wikipedia show culture shapes perception to a previously unappreciated extent.

It would be careless to move on from this review without referring to one of its other important conclusions (1, emphasis mine),
'There are few research programs that have explicitly sought to contrast Americans with other Westerners on psychological or behavioral measures. However, those phenomena for which sufficient data are available to make cross-population comparisons reveal that American participants are exceptional even within the unusual population of Westerners – outliers among outliers.'
The review (1) found 'highly educated Americans differ from other Americans in many important respects
  • Tend to rationalize their choices more.
  • Are more individualistic.
  • Less conforming.
  • Embedded in less tightly structured social networks.
  • Less interdependent and holistic.
  • Moralize within the ethic of autonomy compared to the ethic of community and divinity used by the non-college-educated.
  • More favorable to diversity.
This much-needed jolt of reality brings to mind the almost century-old words of noted anthropologist, linguist, Edward Sapir - Wikipedia (5),
'The worlds in which different societies live are distinct worlds, not merely the same world with different words attached.'
Obviously Homo weirdus is unlikely to improve upon the by-now increasingly discredited Homo economicus. A rather embarrassing state of affairs considering the Nobels bestowed to date for Behavioral Economics research.

Unfortunately, even seven years on from the coining of WEIRD, apparently nothing much has changed with regard to sampling in behavioral science studies.

Bibliography
1. Henrich, J., S. J. Heine, and A. Norenzayan. "The weirdest people in the world?." The Behavioral and brain sciences 33.2-3 (2010): 61-83. http://hci.ucsd.edu/102b/reading...
2. Henrich, Joseph, Steven J. Heine, and Ara Norenzayan. "Most people are not WEIRD." Nature 466.7302 (2010): 29-29. http://www2.psych.ubc.ca/~heine/...
5. Sapir, Edward. "The status of linguistics as a science." Language (1929): 207-214. http://pubman.mpdl.mpg.de/pubman...


https://www.quora.com/What-are-some-examples-of-cultural-variance-in-the-results-of-behavioral-economics-research/answer/Tirumalai-Kamala


Sunday, May 6, 2018

What are your thoughts on the term ‘empty barrel’ to describe a person? What does it mean and what’s the origin?


'An empty barrel makes the most noise' may be a more modern derivation of older sayings about 'empty vessels'.

The 1908 book, A Dictionary of Thoughts by Tryon Edwards, features not one but two 'empty vessels' quotes, one from Plato and the other from Shakespeare. Book itself is available for free download here: https://ia800302.us.archive.org/...
A Dictionary Of Thoughts, page 560, Plato.
As empty vessels make the loudest sound, so they that have least wit are the greatest babblers.
A Dictionary Of Thoughts, page 46, Shakespeare.
The empty vessel makes the greatest sound.
Comments in a discussion thread from Did Plato say this? (see below, quotes in italics) offer several examples of 'empty vessels' usage in English over the centuries. Gist is 'all talk, no action' or 'ones who act, don't talk, those who talk, don't act'.
"I have always observed that your empty vessels sound loudest"
Jonathan Swift in "A tritical essay upon the faculties of the mind"
Published in "The Works" in 1803 by J. Johnson. (See page 270).
15 years later comes this:
"Empty vessels make the greatest sound.
The Scripture saith, A fool's voice is known by multitude of words. None more apt to boast than those who have least real worth ; least whereof justly to boast. The deepest streams flow with least noise."
 Page 71 of "A compleat collection of English proverbs of the Scotch, Italian, French, Spanish and other languages" by John Ray, published in 1818
Consider the following passage:
" Empty vessels make always the loudest sound; the less virtue, the greater report. Deep rivers pass away in silence ; profound knowledge says little ; but what a murmur and bubbling, yea, sometimes what a roaring, do they make in the shallows ! The full vessel gives you a soft answer, but sound liquor. Samson slew a lion, but he made no words of it: the greatest talkers are the least doers. As when a rabbi, little learned, and less modest, usurped all the discourse at table; one much admiring him, asked his friend in private, whether he did not take such a man for a great scholar: to whom he plainly answered, Fог aught I know he may be learned, but I never heard learning make such a noise. Religion is much heard of in our words, but it is little seen in our works. We have busy tongues, but lazy hands; and this argues but vain hearts ; we may be still empty vessels. By their unseasonable noise, men are known for empty vessels."
 Page 843 of "An Exposition Upon the Second Epistle General of St. Peter" by Thomas Adams and James Sherman, published by Henry G. Bohn in 1848.
In Shakespeare's Henry V, the character called "Boy" ends a scene with an aside about Pistol (a pompous and bombastic character) which begins as follows:
"I did never know so full a voice issue from so empty a heart: but the saying is true 'The empty vessel makes the greatest sound.' "
Shakespeare Henry V, Act IV, scene 4, line 72 (c. 1599)
pre-1430
 John Lydgate 
Pilgrimage of Man l. 15933
 A voyde vessel‥maketh outward a gret soun, Mor than‥what yt was ful.
1547
 William Baldwin
 Treatise of Moral Philosophy iv. Q4
 As emptye vesselles make the lowdest sounde: so they that haue least wyt, are the greatest babblers.
1599
 [Shakespeare, Henry V, already quoted above]
1707 
Swift Essay on Faculties of Mind I. 249 
"Empty Vessels sound loudest." [more fully quoted above]


https://www.quora.com/What-are-your-thoughts-on-the-term-%E2%80%98empty-barrel%E2%80%99-to-describe-a-person-What-does-it-mean-and-what%E2%80%99s-the-origin/answer/Tirumalai-Kamala