Mar 25, 2006

Towards a new test of general relativity 

"Scientists funded by the European Space Agency have measured the gravitational equivalent of a magnetic field for the first time in a laboratory. Under certain special conditions the effect is much larger than expected from general relativity and could help physicists to make a significant step towards the long-sought-after quantum theory of gravity." (PhysOrg)

9:51 AM   •  

Bias 

• List of cognitive biases


• Logical fallacies


• Self-deception


• Statistical bias


• Media bias


• True-believer syndrome


• Wishful thinking


• Doublethink

Want to see things in true perspective instead? Or at least become more realistic? (wikipedia)

9:02 AM   •  

Glacier National Park might soon need a new name 

Glaciers Disappear in Before & After Photos. "The Montana park has 26 named glaciers today, down from 150 in 1850. Those that remain are typically mere remnants of their former frozen selves, a new gallery of before and after images reveals." (Yahoo! News)

1:37 AM   •  

The Ground Zero Grassy Knoll 

A New Generation of Conspiracy Theorists are at Work on the Secret History of 9/11 — Mark Jacobson (New York Magazine)

1:25 AM   •  

Annals of Emerging Disease (cont'd.) 

Tackling the Animal-to-Human Link in Illness: “Stronger ties between veterinarians and physicians are needed to prevent further outbreaks of the animal diseases that have caused deaths and serious illness among humans in many countries in recent years, international health officials said at a meeting here.” (New York Times)

Technorati tags: zoonoses infectious_disease veterinarians epidemiology

1:18 AM   •  

Mar 24, 2006

Eating oily fish may not be so healthy 

"...[A] report published in the British Medical Journal this week has thrown doubt on the health promoting properties of omega 3." (Telegraph.UK)

11:35 PM   •  

'L'Etat C'est Moi' Dept. (cont'd.) 

Bush shuns Patriot Act requirement. In signing the renewal of the USA PATRIOT Act, Bush stipulated that he did not feel bound by the requirement in the law that he inform Congress of the FBI's use of its expanded powers. (Boston Globe) Chilling enough, but it is part of an enraging and ominous — and seemingly unstoppable — trend, when placed in the context of other recent events. Consider his continued assertion that he can ignore the requirement that the government obtain warrants for wiretaps when he deems it necessary; and the 'signing statement' he included when reluctantly forced to accept the bill forbidding torture of any US detainee declaring he could bypass the law when in his judgment it was necessary for national security. We are talking about imperial power, about contempt for or ignorance of basic principles of the structure and function of the American government learned in elementary school civics classes. We are in for a new civics lesson — how easy it appears to be to bully oneself into a brazen Presidential power grab beyond the pale of what is allowed; how utterly unopposable it seems to be if someone in the Presidency is willing to be completely criminal; how the only recourse is not to elect someone so transparently an inept and unscrupulous fool, a faith-based airhead, in the first place.

Listen to any emphatic public statement he makes to the American people. In every case, his rationale for a nomination, a policy pronouncement, a war, is nothing but an insistence we should support it because of his conviction and his conviction alone, because he knows that such and such a nominee is a good man, because he knows that such and such represents a threat to national security, because he know that such and such is the right thing to do. Such omnipotent self-referential assertions without any reasoned argument to back them up are the province of those operating on an infantile level in which there is no distinction between wish, fantasy and reality, between belief and knowledge — yes, the province of the faith-based fundamentalist. Bush is, as Sidney Blumenthal points out in echoing Kevin Phillips, the founder of the first American religious party, institutionalizing his cognitive deficits. It is both our interactions with our significant others and our education that occasion a developmental leap away from that infantile omniscience. One can only speculate on the twisted influence growing up with his parents imposed; insofar as educational influences go, it has long been clear that he slept through most of his schooling. Let us hope the American people do not sleep through this civics lesson, or that they awaken by the first Tuesday in November...

11:32 PM   •  

Mar 23, 2006

Sleep Deprivation: The Great American Myth 

A six-year study of more than a million subjects headed by psychiatrist Daniel Kripke establishes that those who sleep an average of 6-7 hours a night function no worse and have no added health consequences than those getting the mythical 8 hours a night. Indeed, the mild sleep deprivation may extend their life, as well as making them more productive. The myth that we are a nation of zombies walking around bleary-eyed, making more mistakes, having more accidents and showing more emotional instability may be mostly a sales pitch for the lucrative pharmaceutical trade in hypnotics (sleeping pills). (Yahoo! News)

I routinely sleep more like 6 hours a night than 8 during the week, and (although you might argue that I would be the last to know) I don't feel I suffer for it. If I get down to 4-5 hours, I do see the difference, especially in terms of irritability and especially if I do so for several nights in the same week. (There's also no such thing as making up a cumulative sleep deficit by sleeping in on the weekend, I am convinced...)

And, in my psychiatric practice, both because of physiological addictiveness and the risk of rebound insomnia, I strictly adhere to the practice of only prescribing sleeping pills for my patients for acute use (less than about two weeks at a stretch, better if used intermittently than consistently). Because of the development of physiological tolerance, most of the medications lose their effectiveness if used for longer anyway, although patients become psychologically dependent on them and physicians often renew their prescriptions indefinitely. If the patient ever tries to go off the medication, indeed they have trouble sleeping and they never sustain their abstention for long, concluding that the drug-free trial confirmed their ongoing need for sleeping medication. However, all it really shows is the phenomenon of rebound insomnia, which would probably abate if they remained drug-free for long enough. And "a poor night's sleep never killed anyone..."

Newer sleeping pills are marketed as less addictive and effective for lengthier use, but don't believe it. There are few free lunches in brain chemistry. Zolpidem (Ambien®) and the others are really not very different from the benzodiazepine sleep aids (Halcion®, Dalmane® etc.) they are supplanting, in my opinion. Medications that interact with the benzodiazepine receptor — which all of these medications do — interfere with the acquisition of new learnng while under their influence and, at high doses, can cause the somnambulist activities so much in the news these days, such as "sleep driving" and "sleep eating". There is nothing special about Ambien in this regard except that it is now so broadly prescribed. Other hypnotic medications do the same thing. At high doses, especially in combination with alcohol, they are respiratory suppressants (read: lethal in overdose), and they accumulate to high levels in the systems of those with impaired ability to metabolize them, such as the medically ill and the elderly. Not benign at all...

But, of course, we can try to compensate for all these hypnotic effects with the daytime-alertness drug that is all the rage these days, modafinil (Provigil®), right?

6:40 PM   •  

No Head for Numbers 

New Insight into How We Count: A recent functional MRI study gives us a new appreciation for the fact that specific brain circuitry underlies processing 'how many' (and that it is different from how we process 'how much'). The intraparietal sulcus lights up with the former taks but not the latter when they are cleverly distinguished by the study design. The region may be involved with the learning disorder called dyscalculia, which affects perhaps 6% of the public and involves difficulty envisioning numerical sequences and even distinguishing which of two numbers is bigger. Dyscalculia is not the only way in which someone might have difficulty with calculation and other mathematics, but it is the most severe. (Yahoo! News)

6:34 PM   •  

The Hillary juggernaut 

"The rank and file may be against her, but numbers (and dollars) don't lie. Why Clinton may already be unstoppable." (Salon)

That would be about as exciting a Democratic choice as the last two were, and probably less effective.

6:23 PM   •  

Mar 22, 2006

When Law and Ethics Collide 

Why Physicians Participate in Executions. An opinion piece by Atul Gawande, one of my favorite physician-writers. Hopefully of interest to non-MDs as well.

"States have affirmed that physicians and nurses — including those who are prison employees — have a right to refuse to participate in any way in executions. Yet they have found physicians and nurses who are willing to participate. Who are these people? And why do they do it?"

Gawande interviews several physician-executioners, all but one cloaked by anonymity, pointedly examining the slippery slope that led each one to their induction into the role, and their ethical qualms, such as they are. Gawande himself takes pains to note that he is not an opponent of the death penalty, although one of the physicians he interviews, who has so far participated in six executions, is. Interestingly, ironically, troublingly, this MD sees his role as akin to not abandoning any other patient with a terminal illness in their final moments. Gawande isn't buying that argument, and comes down on the side of advocating a legal ban on the participation of physicians and nurses in performing executions. (New England Journal of Medicine)

6:59 PM   •  

Supreme Court Limits Police Searches of Homes 

"A bitterly split Supreme Court, ruling in a case that arose from a marriage gone bad, today narrowed the circumstances under which the police can enter and search a home without a warrant....

The issue before the justices was one that has long caused confusion in state courts: whether the police can search a home without a warrant if one occupant gives consent but another occupant, who is physically present, says 'no.' The majority held today that at least under some circumstances, such a search is invalid....

Justice Souter, [writing for the majority,] said a finding for Mr. Randolph — in the specific circumstances that marked this case, Georgia v. Randolph, No. 04-1067 — was compelled by Fourth Amendment principles against unreasonable searches and seizures. But Chief Justice John G. Roberts Jr., the main dissenter, bitterly disagreed, as he and Justice Souter exchanged darts in writing." (New York Times )

Even though the case went (IMHO) the right way, the heated disputation does not bode well for some of the other contentious issues facing the Roberts Court, especially as Alito (who was not on the Court when this arguments in this case were heard) begins to join the deliberations.

6:25 PM   •  

Mar 21, 2006

Revisiting Schizophrenia Diagnosis 

Are Drugs Always Needed? "The only responsible way to manage schizophrenia, most psychiatrists have long insisted, is to treat its symptoms when they first surface with antipsychotic drugs, which help dissolve hallucinations and quiet imaginary voices. Delaying treatment, some researchers say, may damage the brain.

But a report appearing next month in one of the field's premier journals suggests that when some people first develop psychosis they can function without medication — or with far less than is typically prescribed — as well as they can with the drugs. And the long-term advantage of treating first psychotic episodes with antipsychotics, the report found, was not clear. The analysis, based on a review of six studies carried out from 1959 to 2003, exposes deep divisions in the field that are rarely discussed in public." (New York Times )

In typically melodramatic fashion, the journalist feels he has exposed "deep divisions" because he has gotten quotes on both sides of the issue. The unfortunate reality is that there is too little division over the issue of the necessity of medication in a psychiatric profession in the hip pocket of the pharmaceutical industry. The divisions tend to fall between the medical practitioners (psychiatrists) and the non-medical mental health caregivers; the author of the current study is a pforessor of social work. In making the cse for a portion of the schizophrenic population who do not need antipsychotic medication, he speculates that perhaps they have a milder form of the disease. I think it is even more likely that they do not have schizophrenia at all. Psychiatry has labored mightily to establish a credible diagnostic schema but few realize that it is a work in progress and deeply flawed.

Part of the problem is that the research edifice requires slavish adherence to the diagnostic system to conduct studies. This leads to a misplaced sense of concreteness. "If I say the patient is a schizophrenic (carries the diagnosis of schizophrenia), then they have the disease of schizophrenia..." In other words, making the diagnosis implies, and I would say falsely, that all subjects who share a diagnosis have something meaningful in common, so that research findings on that class of individuals are meaningful. But if you are really lumping together unlikes, the research findings will either be trivial, coincidental, or inconclusive. As an example, if a researcher set out to measure, say, the citric acid content in the fruits he called "oranges", and included the oranges with the thick pockmarked orange skins as well as those with the smooth thin red skins (more commonly known as "apples"), his findings would be meaningless. If we were uncertain about the distinctions between apples and oranges, in other words, we would be comparing apples and oranges.

It may not be immediately obvious to the public, even the erudite readers of the New York Times, that diagnoses are not etched in stone. There are problems with diagnostic clarity elsewhere in medicine, of course, but none as severe as in psychiatry, where we peer into the 'black box' that is the workings of the brain and mind. The situation is particularly acute with schizophrenia, which I find to be a wastebasket diagnosis among the members of which class I discern patients with several distinct clinical entities varying along a number of dimensions including medication-responsiveness. In a less tortured diagnostic system, many of them should not be called schizophrenic at all. Compounding the imprecision of the diagnostic system is the fact that clinicians and researchers vary in the acumen with which they make diagnoses. While particularly egregious with the schizophrenic diagnosis, this is a problem throughout the field of psychiatric diagnosis. Patients who are not responding to treatment x are often referred to me with diagnosis y, for which treatment x would be totally appropriate, only I do not find them to have diagnosis y. There is another factor as well, which becomes most clear when one studies the history of psychiatric classification over the last century or century and a half. The world of psychopathology is parsed up into different diagnoses in an everchanging way. Styles of classification change; we are more inclusivist or exclusivist, more 'lumpers' or 'splitters' in different eras. Vastly different numbers of patients, different proportions of those with mental illness, were diagnosed with schizophrenia, for example, at some times than at others. Given diagnostic categories expand or contract over time, bumping up against both 'normals' and other diagnostic categories. There is a sort of Darwinian competition for niches in the mental health ecology; diagnoses are always trying to maximize their 'fitness'.

Equally true is that there are cross-cultural differences. The rates of classification with given diagnoses vary significantly between European and American practitioners, even when they are seeing the same patients, as in one famous study where diagnosticians were brought across the Atlantic to compare their skills and styles.

One of the reasons diagnostic categories expand and contract is the development of new medications. If the only tool you have is a hammer, it pays to see everything as if it is a nail, I am fond of saying. The most dramatic example of this was the expansion in those who were seen to be bipolar (manic depressive) after the introduction of lithium, the first effective modern mood stabilizer, in the '50's. Most of the newly-recognized manic depressives would have been called schizophrenics previously, when in essence the distinction had not mattered as much. But one has to be wary of arguing that the new diagnostic distinction is driven entirely by newfound utility. The refinements in diagnostic classification are by no means inevitably improvements. It is equally likely, and more worrisome, that change is driven by marketing pressures to sell the new drug. We have seen something similar with depressive diagnoses since the development of the SSRI antidepressants, and their descendants, in the last two decades. No only do the antidepressants reach more depressed people, but more people are defined as having a depressive condition in order to be eligible for medications. No one is doing this consciously, but it happens inexorably nonetheless. Furthermore, as psychiatrists scramble for market share in the face of competition from competing nonmedical mental health professionals, it pays to expand the definitions of medication-responsive diagnoses so they have more people to treat.

This leads me to subscribe to a "one-third" rule, almost regardless of diagnosis. One third of patients diagnosed with a given disorder will respond to the appropriate treatment; one third will be poor responders; and one-third would get better regardless of, or without, treatment. Part, but not all, of this is based on the diagnostic issues I have discussed above (for example, do the one third who would respond anyway, as the 'schizophrenics' in the study under current consideration, really have the condition in question? In essence, is the treatment wrong for the diagnosis or is the diagnosis wrong for the treatment? We ignore either wing of this quandary at our peril.).

As I grow older, I become much more of a diagnostic nihilist, finding the misplaced concreteness of the system and of my colleagues increasingly painful to bear. At least as far as my professional work as a psychiatrist goes, the older I get, the less I know. The important question: does that make me of more or less help to my patients?

6:52 AM   •  

Mar 20, 2006

How to spot a baby conservative 

"Whiny children, claims a new study, tend to grow up rigid and traditional. Future liberals, on the other hand ..." (Toronto Star)

10:39 PM   •  

Catastrophic immune response may have caused drug trial horror 

"A catastrophic over-stimulation of the immune system may have caused the horrific reactions suffered by six men taking part in the first human clinical trial of an experimental drug.

An investigation by New Scientist suggests the drug may have caused a super-immune response – sending white blood cells called T cells rampaging through the body destroying its own tissues."

8:50 PM   •  

Hip to Be Square 

Via the null device, this Guardian piece about the latest rock revival genre: soft rock, believe it or not.

2:09 PM   •  

World's Funniest Joke? 

Okay, the joke is funny, but the more intriguing discussion in this old CNN article is about cultural differences in what is found to be funny, especially between American and European humor:

"One intriguing result was that Germans -- not renowned for their sense of humour -- found just about everything funny and did not express a strong preference for any type of joke.

People from the Republic of Ireland, the UK, Australia and New Zealand most enjoyed jokes involving word plays.

Many European countries, such as France, Denmark and Belgium, displayed a penchant for off-beat surreal humour, while Americans and Canadians preferred jokes where there was a strong sense of superiority -- either because a character looks stupid or is made to look stupid by someone else.

Europeans also enjoyed jokes that involved making light of topics that make people feel anxious, such as death, illness and marriage."

I had previously blinked to the world's funniest joke article but revisited it after reading this recent Ask MetaFilter thread asking people to post their funniest joke that is not offensive to any class of people. Some of them are to laugh out loud over.

2:02 PM   •  

Money Changes Everything 

What is to become of NPR now that it has some resources? (New York Times )

2:00 PM   •  

It's Official: 

Intel-based Mac boots Windows XP

1:59 PM   •