Dangers Old and New;Pertussis and H5N1

Another Rationale for Universal Health Care

More than just a pesky cough
By Shari Roan
[LA] Times Staff Writer
January 31, 2005

The chronic, spastic cough started with what appeared to be a cold. A few months later, it was ruining Zachary Graham's life. The 16-year-old Sunapee, N.H., resident was often left gasping for air, gagging and unable to sleep. During one particularly ghastly coughing spell, Betty May Graham, Zachary's mom, feared her son was about to stop breathing.

That incident led the family to a lung specialist who delivered a diagnosis that stunned the Grahams: Zachary had pertussis, also known as whooping cough, a disease far better known in the 1930s than today.

"When the doctor said whooping cough, it kind of blew my mind," the teenager says. [...]

A vaccine introduced in the 1940s sent pertussis cases in this country plummeting to a low of 1,010 in 1976. But the disease roared back in the 1990s. According to the national Centers for Disease Control and Prevention, about 10,000 cases were reported in 2003. 

About ten thousand cases of pertussis were diagnosed in the USA in 2003.  That probably is a subset of the true number of cases, since the disease often is mild in adults, and may not be diagnosed.  The disease used to cause almost 10,000 deaths per year in the USA.  We have made a lot of progress since then. 

Of course, we now face new threats.  Bird flu has been reported in 31 areas of Viet Nam, as well as in other Asian countries.  Recently, the first reported cases of human-to-human transmission were reported. 

In this post, I describe the dangers posed by pertussis and bird flu (strain H5N1) and illustrate how these and other diseases provide a rationale for universal health care.  Read the rest at The Rest of the Story. 

Is Effexor the Best Medication for Me to Be On?

Or: What Would Osler Do?

A couple of weeks ago, a patient asked me this question: "Do you think Effexor is the best medication for me to be on?"

I had to think about that for a few moments.  Honestly, it had not occurred to me to cast that question, but it seemed like an obvious and reasonable thing to ask. 

I can't recall exactly what I said, but it was something like this:

The fact is, there is no way for us to know what the best medication is for you.  Since we cannot know the answer to that question, I don't ask it.  You see, when we [the non-royal we, meaning "members of the medical profession"] think about a medication strategy, we try to build a strategy based upon questions that can be answered. 

The only way to know what the best medication for you is, would be to try them all, one at a time.  They would have to be adequate trials, which means at least six weeks each at the maximum dose.  That would take years, would be miserable to go through, and would not be ethical for me to do. 

Instead, when I think of a medication strategy, I ask, at every decision point: what is the most reasonable thing to do now?  That is a very different question than asking: what is the best thing to do now? 

You might be wondering, do I really talk like that? Yes.  There are many dialects of English.  Some people talk in newyorkerese.  Some people talk in bumperstickerese.  I talk in lecturese. 

The second point is the most important.  Base your strategy on questions that can be answered.  Of course, that assumes that you know what questions can be answered, and which cannot.  That is not always obvious. 

I've noticed, over the years, that many persons are surprised by how much is not known about medicine.  Indeed, not only is there much we don't know, there is much that cannot be known. 

What I mean, is that there are some things that we really would like to know, but for various reasons, it is impossible to know.  For example, there is much we do not know about the safety of medication during pregnancy.  This surprises people.  But think about it.  In order to really know if a medication is safe during pregnancy, we would have to get a large number of women, randomize them, have half take medication; the other half, placebo; have them all get pregnant, and see what happens in both groups.  Obviously, that would be unethical.  Therefore, the experiments will not be done.  At least not in the USA, as it currently is constituted.  Thus, we are left in the position of having to make very important, potentially life-altering decisions, knowing full well that we do not have the information we would like to have.

This does not mean that such decisions cannot be made.  Rather, it means that the process of making decisions has to be structured carefully, taking into account the fact that there are huge gaps in our knowledge.  This is one reason why William Osler wrote of aequanimitas.

The complementary "mental" virtue is aequanimitas, which is the personal quality of calmly accepting whatever comes in life.

The full text of Aequanimitas is here.

Gmail Invitations

As of now, 10:30 PM on 1/29/2005, I have four gmail invitations to give out.  Leave a comment with your email address if you would like one.  Even you you voted for Bush.

More Opinions About FDA Changes

I've been reading Scientific American since I was about 14.  I haven't keep up a subscription for years, but I check their website fairly often.  It is rare that they publish anything about the governement.  In the last issue, though, they have an article about the FDA.  Seems as though everyone is getting into the act.  Their article, though, is worthy of attention, because it has an idea that I have not seen published anywhere else. 

In this post, I review the SA article about the FDA, examine the ideas presented in the article, and present my perspective about possible changes in the regulatory and oversight functions of the federal government.  Read the rest at The Rest of the Story. 

Windows is a Particularly Tricky Horse

Our comrades at Xinhua have picked up on the latest Microsoft story: they plan to block the application of patches and updates for users running pirated copies of Microsoft Windows.  This is a matter of some interest in China, because, apparently, it is easy to get illegitimate copies of software there, and many people are reported to have done so. 

Piracy has always been a problem for huge software-factories like Microsoft Corporation, whose operating system Windows is in use on over 92% of x86 PCs by some estimates. Piracy of Windows is a particularly tricky horse for Microsoft. Their attempts at thwarting this with their Product Activation scheme has had little effect, as it is extremely easy to obtain the "Corporate" edition and a matching product key in order to completely avoid activation.

    Microsoft, however, is not giving up there. It believes the best way to fight software piracy is to make sure users recognize and receive all the benefits of genuine software. Starting in mid-2005, they will implement a validation system on their Windows Update and Download Center websites, forcing users to validate their copy of Windows before being able to download updates. [...]

    By doing so, Microsoft hopes it has struck a balance between promoting security and ensuring that people buy genuine versions of Windows.

    "Our goal is to help customers avoid the risks associated with counterfeit software, like viruses and other vulnerabilities," David Lazar, a director in Microsoft's Windows Client group, told the E-Commerce Times. "Windows Genuine Advantage will offer users greater reliability, faster access to updates and a richer Windows experience."

The tricky horse here is Microsoft.  Now, I have no qualms about them trying to protect their intellectual property.  I have two licensed copies on Windows XP myself, use the update feature, and have always kept them activated properly.  I use one copy at work; the other is installed on the computer I am using now, at home (although it crashed several months ago, and I have not bothered to revive it yet.)

So what is wrong with Microsoft's plan?  The problem is that many of the patches for Windows are security fixes.  When more and more people start running Windows without the security fixes, it will NOT help anybody "avoid the risks."  Even those with properly registered and updated copies of Windows will be exposed to greater risk.  Why? Because the more computers there are on the 'net that are insecure, the more security problems there will be for all of us. 

Chances are, many people will continue to use their pirated copies, just without the security fixes.  Those machines will be vulnerable to exploits that lead to mass-mailing worms, denial of service attacks, transmission of spam, and probably a few other problems that I haven't thought of yet. (I am not a hacker, so I don't know all the nefarious ways to make mischief with a computer.) 

The way this affects other users is this: a hacker gets into several unsecured computers.  He/she sets up those unsecured computers to send out mass mailings, or to repeatedly request service from some legitimate site, such as Amazon.  Those mass mailings clog up the system from everybody.  Those requests for service, if frequent enough, can cause the legitimate computer to become overloaded, so it no longer can function as intended. 

These are not problems that threaten world peace, but they can cause significant economic harm. 

Not to sound like a proselytizer, but the solution is to get everyone to stop using pirated copies of Windows, and start using Linux.  Linux is inherently more secure, and it is easy to keep it secure.   Some distros even have an automatic update feature, that works as well as the one that Microsoft has.  

If China is concerned about their information infrastructure, they would be well advised to cooperate with Microsoft, and get people to stop using pirated software.  But there is no reason for them to take the next step on that tricky horse.  Get off the horse and onto the lizard: change quadrupeds, even if you are in the middle of a stream:

OK, perhaps SuSE is not the best distro for the average Chinese user.  Probably, that would be Red Flag or Asianux.  Asianux is being developed by Red Flag, Miracle (Japan), and Haansoft (South Korea.)  There are others, of course: Hiweed, Chinese 2000, Co-CreateLinux, MagicLinux; there even is a distro that is designed solely for the purpose of teaching and playing the game of Go (Wei Qi).  Although it (Hikarunix) is developed in Japan, I suspect many Chinese and
Korean computer users will be interested in it. 

Personally, I think Microsoft's plan will backfire, twice.  First, it will make the Internet less secure for everyone; second, it will hasten the migration to open-source software. 

Quote of the Day

Actually, it was many days ago; but it still is relevant:

Bush Sought ‘Way’ To Invade Iraq?
Jan. 11, 2004

During the campaign, candidate Bush had criticized the Clinton-Gore Administration for being too interventionist: "If we don't stop extending our troops all around the world in nation-building missions, then we're going to have a serious problem coming down the road. And I'm going to prevent that."

This refers to the 2000 campaign, obviously.  Yet in the very first meeting of the National Security Council -- on February 1, 2001 -- one of the topics discussed was "Plan for Post-Saddam Iraq."  As far as I know, the details of that plan have not been released to the general public.  Even so, the article cited above makes note of part of the plan:

He obtained one Pentagon document, dated March 5, 2001, and entitled "Foreign Suitors for Iraqi Oilfield contracts," which includes a map of potential areas for exploration.

“It talks about contractors around the world from, you know, 30-40 countries. And which ones have what intentions,” says Suskind. “On oil in Iraq.”

Four years later, all Mr. Bush can talk about is how we are spreading freedom around the world.  More freedom for "foreign suitors," at least.

Perspective on the FDA

The US Food and Drug Administration has been in the spotlight lately.  The one article that is likely to have the most influence is the one posted by the New England Journal of Medicine recently.  It is not open access, but here are some excerpts.

Today's FDA
Eve E. Slater, M.D.
January 20, 2005

The Food and Drug Administration (FDA) is responsible for the safety and efficacy of most food products and all human and veterinary drugs, biologic products, medical devices, cosmetics, and products emitting radiation that are sold within U.S. borders — a list that accounts for an estimated 20 percent of consumer spending, valued at approximately $1.5 trillion. [...] 

That gives us the background, highlighting the enormous significance of the work of the Agency.  Dr. Slater goes on to mention the impact of the the Prescription Drug User Fee Act (of 1992), the FDA Modernization Act of (1997), and the Public Health Security and Bioterrorism Preparedness and Response Act of (2002).  She notes also the fact that the agency has almost doubled in size since 1992, and that about 18% of their funding now comes from user fees.  She points out that the agency has made progress in reducing the time required for premarketing review and approval of new medications.  Despite this, the time that elapses, on average, between the discovery of a new drug, and its subsequent marketing, has increased.  This is due to scientific and technical issues; not regulation. 

Dr. Slater informs us that there has not been stability of leadership at the FDA:

Evolving FDA regulations have prompted the pharmaceutical industry to develop a powerful infrastructure in order to allow timely compliance in a highly competitive environment, whereas the growth in infrastructure at the FDA has lagged behind. This has often resulted in an imbalance when the FDA has attempted to counter industry assertions during negotiations over the approval or labeling of drugs. The problem has been seemingly compounded by several interruptions in FDA leadership. Since 1980, the FDA commissioner has been appointed by the president, subject to confirmation by the Senate. Almost two years have elapsed between the tenures of the past three commissioners, each with distinguished credentials, and the position has been vacant since March 2004 — a problem that is reflective of the political process and stands in contrast to certain overseas regulatory bodies in which heads of agencies serve fixed terms. Thus, the FDA has lacked a continuous voice to articulate policy, advise Congress, and inform the public.

In simpler terms, what she is saying is that the FDA sometimes has problems in negotiations with industry regarding the marketing of drugs.  Many people do not know how much negotiation takes place.  For example, the FDA may recommend a particular warning, or want more testing.  The pharmaceutical company will listen to the proposal, and come back with a counterproposal, and basically they duke it out until some kind of compromise is reached.  Since industry has a bigger team, with more money, the FDA may have difficulty conducting these negotiations from a position of strength.  Also, she implies that there is a problem with the fact that the office of the FDA commissioner is filled by political appointment.  Despite the key role of the office, it has been vacant now for almost a year!

Dr. Slater concludes with commentary about post-marketing surveillance (monitoring for problems, after a drug is released on the market), dissemination of information about risk, and the potential role of the FDA in managing the cost of pharmaceutical prices.  She also includes some recommendations, which seem like good ideas.  Specifically, she would like to see improved post-marketing surveillance, better data collection for public health purposes, and improvements in systems to reduce medication errors:

[T]he FDA has available to it a wealth of information from placebo control groups, which, if compiled, could provide one of the largest comparative epidemiologic databases. The announced transition to nationwide computer-assisted prescribing of bar-coded medications must proceed promptly to provide an electronic template for the rapid linking of events to prescriptions. Finally, the FDA must more readily prosecute lapses in the reporting of adverse events and enforce penalties for failure to complete post-approval studies.

Although there would be substantial costs involved in implementing these suggestions, she points out that there would be significant savings as well.  Her conclusion:

Debate about the relationship between the FDA and the pharmaceutical industry is healthy, but the discussion should expand to consider the true potential of the FDA. It is not merely a matter of too fast or too slow, of too many or too few regulations, or of Democrat or Republican solutions. We must envision the FDA as more than a counterpart to the pharmaceutical industry. It is time for the agency to realize its full potential as both protector and promoter of the public health.

Of course, the notion that any reforms could take place in a nonpartisan effort probably is unrealistic.  I just hope that if some of these reforms are debated in Congress, that the industry representatives could exercise some restraint in their lobbying efforts.  The industry must have a voice, to be sure, but these issues are too important to let any one group dictate the terms of the debate. 

Beyond the Purple Heart

This week's New England Journal of Medicine has an article about the fate of soldiers wounded in Iraq. You need a subscription for full access, but the intro will suffice for my purposes today:

Beyond the Purple Heart - Continuity of Care for the Wounded in Iraq
January 20, 2005
James B. Peake, M.D.

You can hear the usual hum of the emergency room, and all the familiar beeps of monitors in the operating room provide a backdrop for medical teams boasting the usual collection of skills and following the typical team approach to injured patients. But beyond the generic hospital buzz, the background noises are unusual. The whoosh and explosion of incoming mortars and the loud whine of the turbo engines of Blackhawk helicopters bringing patients, often directly from the point of wounding, distinguish the military combat support hospitals and forward surgical teams in Iraq from the ERs and ORs back home. Different also are the spectrum of patients seen here and the frequency of major penetrating traumas. Many of these patients are U.S. soldiers who have sustained devastating injuries from high-velocity gunshots or fragments from explosions. Thus far, during the war in Iraq, the Army has awarded more than 5000 Purple Hearts for injuries sustained in combat. [...]

Five thousand Purple Hearts.  Surely, nobody is going to argue that the soldiers deserve at least some recognition.  Also, they deserve significant compensation, such as free medical care for the rest of their lives.  One of my father's rare dinner-table lectures, when I was maybe ten years old, had to do with government cutbacks in VA Hospital benefits.  He made it very clear that wounded veterans should get all the care they need.

I can't help but wonder about one thing, though.  Thirty years from now, will any of the soldiers wounded in Iraq be running for public office?  If so, how many will have their honor besmirched by politically-motivated hatchet men?

Grammar Patrol Alert

Yesterday I closed a post with the sentence:

They serve whomever pays their bills.

In the shower this morning, I started to wonder about that.  Not that I think about blogging a lot while in the shower, but, you know, sometimes blogging is kind of addictive...

When I was in high school, I knew a lot about grammatical rules.  Now, however, I just know what "sounds right."  Since They serve him sounds right, I figure that They serve whomever... should be right.  But Him pays their bills sounds wrong; thus, Whomever pays their bills should be wrong. 

I'm sure someone out there can tell me which is correct: They serve whomever pays their bills; or, They serve whoever pays their bills. 

I suppose I should just can the whole sentence, and start over.

The FDA seems to owe allegiance to whatever persons or groups give money to the FDA.

The Seductive Allure of the Platonic Ideal

Or, How Brain Chemistry Tempts Us To Do Dumb Things

Warning: this is a rambling-armchair-musing kind of post.

I learned in a seminar on psychoanalysis that the original meaning of the word seduce was: to traduce from duty, meaning that something is seductive if it pulls you away from what you ought to be doing. 

I learned in high school Humanities class about the concept of Platonic Ideals.  Of course, since most ideas are connected to most other ideas, in some way; and most ideas have been written aobut somewhere on the Internet, there is a paper about the Historical Context of Cognitive Therapy (135 Kb PDF) that you can read if you are snowed in or otherwise inclined to burn up a few clock cycles in your brain.  The paper explains how Plato's concept of Ideal Forms is part of the foundation of psychotherapy. 

In this post, I engage in idle, unsubstantiated speculation about the neurochemical basis for our enthrallment by the Platonic Ideal, and speculate about how this may lead us to draw false conclusions, and, basically, do dumb things.  Read the rest at The Rest of the Story. 

Speaking of Seduction...

It has been said that the recent changes in the FDA have led to some deleterious unintended consequences.  As the agency has evolved to get more and more of their funding directly from industry, they have spent more time of getting drugs approved rapidly, and less on monitoring safety.

Now, we learn that a similar thing has happened in the Patent and Trademark Office.  In 1982, the agency was restructured, such that most of their funding comes from application and maintenance fees -- also direct from industry.  This has been beneficial for large corporations:

The U.S. Congress set us on this road in 1982, when it created a centralized appellate court for patent cases called the U.S. Court of Appeals for the Federal Circuit. A decade later, Congress ordered that the U.S. Patent and Trademark Office (PTO), which up until then had been funded by tax revenues, instead fund itself through application and maintenance fees. Both changes were described as administrative and procedural rather than substantive.

But now, after still another decade, it is apparent that together these changes have resulted in the most profound transformation in U.S. patent policy and practice since the Patent Act of 1836. They make it easier to obtain patents, to enforce patents against others, and to extract large financial awards from such enforcement but harder for those accused of infringing patents to challenge the patents' validity.

What's more, the changes increase the risks associated with innovation—and not just for U.S. companies and inventors. Of the 169 028 U.S. patents issued in 2003, nearly half were issued to foreign entities.

This is illustrated by the following:

ALBIE'S FOODS INC., a small grocery and catering company in Gaylord, Mich., received an unusual letter in 2001 from the law firm representing jelly giant J.M. Smucker Co. The letter accused Albie's—which sells pastries and sandwiches in northern Michigan—of violating Smucker's intellectual property by selling crustless peanut butter and jelly sandwiches.

In particular, Smucker's claimed that Albie's had infringed Smucker's recently granted U.S. Patent No. 6004596, which gives the Orrville, Ohio, company broad protection on its "sealed crustless sandwich." In a move that undoubtedly surprised the jam magnates, Albie's decided to defend itself in federal court. Albie's law firm noted in its filings that the "pasty"—a meat pie with crimped edges—has been popular fare in northern Michigan since the immigration of copper and iron miners from Cornwall, England, in the 19th century.

Gee, I would like to have a patent on the pasty, too.  And collect back royalties from the six zillion businesses in Michigan that have sold them for decades.

Clearly, the notion of having federal agencies derive their funding from industry, is misguided.   It seems like a good idea: make the government run more like a business.  It fits the Platonic Ideal of efficiency.  (We all know that businesses inevitably find the most efficient ways to do things.) Also, it lowers the burden on the taxpayers.  But it seems to alter their priorities as well. 

They serve whomever pays their bills.

Don't Ask

Ask not what your country can do for you.
-- Robert F. Kennedy

I have known for years that I should not ask what my country can do for me.  I just never thought I would have to ask my country to stop doing it to me.

Headline that Startles Reader

Hallucinogen may reduce alcohol cravings, reads one of the headlines on one of the sites that I go to regularly.  Hmmm.  Treat an alcohol problem by administering an hallucinogen?  Seems to no make sense.  Thinking that it must be a joke, but realizing that the site never publishes jokes, and also thinking that perhaps the headline was one of those that only makes sense when you know what the story is about, but which otherwise seems to mean something else, I satisfied my curiosity by clicking on the link.  It turns out that it is not a joke, and that the headline means exactly what it appears to mean. 

There are private clinics in the Caribbean and Mexico that use an hallucinogen to treat addictions.  It turns out, though, that the treatment is not really the point of the article.  Rather, the article is about the mechanism by which the drug acts, and how that might sometime lead to a treatment for addiction that is credible and clinically useful. 

Regular readers know that I always am skeptical of such claims.  Even so, the article is interesting, even if the claim of clinical relevance is an exaggeration.  Read the rest at The Rest of the Story.

'Evil twin' hotspots

'Evil twin' hotspots are a new menace for Wi-Fi Internet users
PhysOrg
January 20, 2005

'Evil Twin' hotspots: the latest security threat to web users, according to wireless internet and cyber crime experts at Cranfield University, academic partner of the Defence Academy of the UK.  "So-called ‘Evil Twin’ hotspots present a hidden danger for web users," explained Dr Nobles.  In essence, users think they’ve logged on to a wireless hotspot connection when, in fact, they’ve been tricked to connect to the attacker’s unauthorised base station. The latter jams the connection to a legitimate base station by sending a stronger signal within close proximity to the wireless client – thereby turning itself into an ‘Evil Twin’.

There are many free hotspots around Ann Arbor, and I have visited many of them.  But I use an old notebook computer that does not have any sensitive information on it.  I probably would use the hotspots more, if I could justify buying one of those new thin/light computers, but the security problems are such that I would not want to use it for anything important. 

I've heard of physician's offices that have wireless networks, and all the doctors carry tablet PC's.  Sounds nice, but I would not want my medical records broadcast over WiFi.  And I don't even have anything embarrassing in my records. 

XP13512: Drug Development News

Most often, when you see articles about drugs with names such as XP13512, chances are that the drug never will sit on a pharmacy shelf.

In an earlier life, I was told that in some relatively nonindustrialized cultures, infants were not given names at birth. Infant mortality was so high, that the parents would wait until the child attained an age that gave a good chance of survival. Only then was it considered safe to give the child a name.

People in the drug development business will say that bringing a drug to market is a lot like giving birth. Except it takes a lot longer. Like the nonindustrialized peoples, the drug companies think it is bad luck to give real names to compounds that might not make it. So, they come up with names that imply no emotional attachment, names like XP13512.

XP13512 has a pretty good chance of making it, despite having no real name. In this post, I discuss the pharmacology of XP13512, and compare it to similar drugs that it will be in competition with. I also review some of the marketing intrigue that will arise. Read the rest at The Rest of the Story.

Quiz: Corruption Lite

Some ideas transcend political parties.  The concepts of equality and free enterprise are examples.  Perhaps there are some on the far left that might oppose free enterprise, and some on the far right who might oppose equality; but for the most part, Democrats and Republicans both would agree that equality and free enterprise are virtues.  There are times, though, when the almighty dollar transcends even those virtues. 

Now for the quiz: Who said this, where, and about what?

He appealed to the idea of free competition [...] and claimed that Villanueva's bill "breaches the principles of equality before the law, that of nondiscrimination and the right of free private enterprise, freedom of industry and of contract, protected by the Constitution."

Hints: The person who said that was supported by an American ambassador.  It was in somewhere in South America.  He was talking about software.

In this post, I describe a way in which international corporations try to influence governments to act contrary to the interest of the people whom they govern.  Read the rest at The Rest of the Story. 

What Cherry Tree?

Two Sides of Foreign Policy

WHEN George Bush is sworn in this Thursday for a second term in office, he will use his inauguration speech to emphasise his belief that "liberty is powerful and freedom is peace".

The citation above is from today's issue of The Scotsman.  And writing at the invitation of Foreign Policy magazine, outgoing Secretary of State Colin Powell wrote:

The United States cannot win the war on terrorism unless we confront the social and political roots of poverty. We want to bring people to justice if they commit acts of terrorism, but we also want to bring justice to people. We want to help others achieve representative government that provides opportunity and fairness. We want to unshackle the human spirit so that entrepreneurship, investment, and trade can flourish. This goal is the indispensable social and political precondition for sustainable development; it is the means by which we will uproot the social support structures of terrorism.

President Bush and Secretary Powell have voiced some powerful ideas.  Furthermore, there are actions to back up these voices.  The United States of America has had some successes in the area of foreign policy.  The victory in Afghanistan is one example, ...and when I think of a second example, I'll let you know.

Is there any reason to think that the US is really going to act in such a way as to promote the humanitarian ideals of freedom, health, and prosperity?  Perhaps.  But there are two sides to foreign policy: the good side and the bad side.  Looking at it another way, there is the outside policy: the way our country relates to other countries; and the inside, the way our country regulates the behavior of its citizens and corporations that interact with other countries.  In this post, I show that the USA is taking steps to improve one of these, but not the other.  Read the rest at The Rest of the Story. 

Campus Suicide Prevention in the News

The Washington Post has an article about the problem of student suicides on college campuses.  The article focuses on campuses in the Washington D.C. area, but it seems applicable to pretty much any college.  It article mentions a resource that I had forgotten about: the US Air Force Suicide Prevention Program.  (links: summary, full (2Mb) PDF file)  This is one of the very few programs that has some evidence that it actually works.  Interestingly, they looked -- not only at factors that increase risk -- but also at factors that decrease risk:

— Social support and interconnectedness
— Individual coping skills
— Cultural norms that promote and protect responsible help-seeking behavior

The summary of the document poses the question:  Is the Air Force Program Transferable to Civilian Communities?  They speculate that it can; although what is not known, is whether the program could be demonstrated to be effective in other settings.  That is, the essential elements of the program could be adapted to a nonmilitary setting, such as a college campus.  But would it be possible to prove that it works?  This raises a number of interesting methodological questions, which I won't go into now.  Perhaps more important is the policy question:  If it cannot be proved effective, is it worth funding? 

Currently, the trend in government agencies is to demand proof in order for funding to continue.  At first glance, it seems hard to argue with that.  After all, funding is scarce, competing demands are great, and fiscal responsibility generally is a good thing.  But in life-or-death situations, is it wise to demand proof?  And what if a statistically analysis shows that, not only is there no proof, but that such proof will not be possible?  What if the methodological problems are too great to overcome.  Given the the number of variables, the low incidence of suicide on any given campus, and the variation from one campus to another, it is possible that there is no study design that would provide adequate statistical power to resolve the question. 

My suggestion, then, is this: if anyone plans to try to study this, do not set a reduction of the rate of suicide as the only goal of the program.  If you can demonstrate that the program has related benefits, that might be sufficient to ensure continued funding.  For example, if you can show that the program increases campus-community involvement, enhances individual coping skills, etc., those outcomes might be deemed worthy of continued funding.

US Biodefense Crossing the Line?

A recent report published on TheScientist.com pertains to developments in the biodefense program in the United States of America.  Apparently, we are planning to spend about $1.7 billion dollars to expand the amount of Biosafety Level Four labs in the country.  They add:

[...] Critics immediately condemned the plans, charging they would violate international bioweapons treaties and may set off a global biological arms race. For example, the new lab will genetically alter bioweapon diseases and package them so they can be dispersed as weapons.

While a DHS spokeswoman later characterized this research as necessary to learn how to counter such weapons, three veteran US biological arms control experts strongly disagreed. The DHS plans "may constitute [prohibited weapon] development in the guise of threat assessment, and they certainly will be interpreted that way" by other countries, wrote James Leonard, Milton Leitenberg, and Richard Spertzel in the journal Politics and the Life Sciences in May. [...]

It was not obvious, immediately, what the criticism was about.  Turning to the article cited, Biodefense Crossing the Line, we get some more specific information.  We learn that the US is planning research on genetically-modified pathogens.  Some of the criticism implies that it is not always possible to distinguish between research that is purely defensive, and that which could lead to offensive capability.  Read the rest at The Rest of the Story. 

Free Concert in Ann Arbor

Life Sciences Orchestra to play Jan. 15
The nation's only Life Sciences Orchestra, made up of faculty, staff, students, alumni and others from the U-M health, medical and science community, will kick off its fifth season on Saturday, Jan. 15 with a concert of Mozart and Mahler. Coincidentally, the LSO will play Mahler's "Titan" symphony the day after the landing of the first space probe on Titan, a moon of Saturn.

The free concert will begin at 8 p.m. on Saturday, Jan. 15 at Hill Auditorium, and will be introduced by U-M Medical School Dean Allen S. Lichter, M.D.

It will be the first concert under the baton of new LSO music director John Goodell, a graduate of the noted orchestral conducting program at the U-M School of Music.

The concert will open with the Symphony No. 29 in A Major by Wolfgang Amadeus Mozart, written in 1774 when Mozart was just 18 years old. The second half of the program will be the Symphony No. 1, “Titan,” by Gustav Mahler, composed in 1888.

Coincidentally, this performance of the “Titan” symphony will come on the day after a joint American-European space mission hopes to land a probe on Titan, the largest moon of the planet Saturn.

The concert is free and open to the general public. For more information, visit www.umich.edu/~lsorch, e-mail orchestra@umich.edu, or call (734) 936-ARTS.

Thomas More Law CenterArgues for Intelligent Design Instruction

Ann Arbor's own Thomas More Law Center made the news, although not in a manner that reflects positively upon the city.  From the website, Live Science:

District Loosens 'Intelligent Design' Rule
By Martha Raffaele
Associated Press
posted: 07 January 2005
10:13 pm ET
   
HARRISBURG, Pa. (AP) -- A school district that required science teachers to read a statement about alternatives to the theory of evolution decided Friday that teachers can choose not to read it, but their classes will still hear it. [...]

Tom Scott, an attorney representing the Pennsylvania State Education Association, said the teachers' union was satisfied with the decision. He said teachers had objected because intelligent design "is not science.''

"Unfortunately, the school board and the superintendent can put anything they want to in front of the students, but we are not going to be their messenger,'' Scott said.

"The Dover faculty have no right to opt out of a legal directive,'' said Richard Thompson, president and chief counsel of the Thomas More Law Center in Ann Arbor, Mich., which is defending the school district. "Having said that, because there is pending litigation ... we are going to accommodate their request.''

I won't bother to argue the demerits of the Creationist/ID movement here; anyone who wants to know about the issue, can go to Panda's Thumb (link in sidebar) to get an update. 

I mention the topic only as an introduction to a question that has been bugging me for several months: Why is it that Christian groups and not up in arms about this, disavowing any connection to the Intelligent Design proponents?

It seems plainly obvious that the ID proponents are liars (saying it is not about religion, when in fact it is), and that such dishonesty really should not be associated with Christianity.  I mean, if someone went around trying to sell a pack of lies under the name of some ethnic group to which I belonged, it would bother me, and I would disavow any connection to them.  And if the ethnic group to which I belonged was proud -- especially proud -- of their honesty, I would be terribly upset. 

Of course, maybe there are groups making such disavowals, and I have not encountered them.  If so, they need to speak up a little more. 

And as I think about it some more, I realize that it is a bit presumptuous of me to be telling other people what they should be upset about.  Still, it perplexes me that there isn't some kind of protest.  I find it so perplexing, in fact, that I worry that I must be missing something, some key aspect to the whole debate.  If so, I just called a bunch of people liars, some or all of whom might not deserve it, which would be, like, embarrassing.  But part of this blog is supposed to be about spontaneity, and spontaneity necessitates risk, and one of those risks is that a person might embarrass himself. 

More Bad Apples

The prisoner abuse scandal keeps getting worse.  Alberto "Torture Al" Gonzales probably will be the next Attorney General of the United States of America.  Low-level grunts are getting punished, but there appears to be no interest in the Administration for fingering higher level authorities. 

To makes matters worse, through some bizarre, contorted logic, the Administration feels that the Commander-in-Chief has the authority to abrogate international treaties, condone torture, yet not take responsibility.  The media seem content to let them get away with this.  Even the medical profession has colluded with this, although some are speaking out.  The New England Journal of Medicine has published another commentary about the role of medical personnel in the scandal.  Read the rest at The Rest of the Story. 

Rather Ironic

NYT, among numerous others, reports on the fallout from the Ra^thergate episode.  From this, we can conclude that it is a serious matter when you take action based upon faulty information.  Especially when that action results in important people getting embarrassed. 

On the other hand, if you start a war based upon faulty information, and that war kills 100,000 unimportant people, you get reelected.

The Two Crises Facing Health Care

The two crises are these: managing medical information, and manging costs.  Of course, the two are related.  Management of information will cost money, although properly done, it can save a lot more than it costs to implement.  We cannot expect information management to solve the cost problem, though.  Although the potential savings are considerable, they could not possibly offset the cost increases that are projected currently.

In this post, I look at what pundits have to say about these issues, and examine the policy implications.  Read the rest at The Rest of the Story. 

A World Without Israel?

This evening, I went into Border's on Liberty St., after dining at the Madras Masala.  I had parked in the parking structure, but had no money in my wallet, for some reason. (I had given it to my teenage son, for a wild night on the town.)  I needed to get the parking stub validated.  Otherwise I would be embarrassed at the ticket booth.

On the magazine rack, there was a copy of Foreign Policy.  FP, by the way, is one of the most influential publications in the world.  The cover was rather startling:

Now, Foreign Policy is not something I profess to understand.  But I had though it was a field populated by serious scholars, not science fiction writers.  In the SF genre, one often encounters "future histories," basically "what if..." stories: projections about what the world would be like, if such and such either happened, or did not happen.  So the title story is something one would expect in SF, but not FP.

In this post, I provide a review of the lead FP article, and conclude with my own thoughts about its significance for American security.  Read the rest at The Rest of the Story. 

Attenace: Upcoming Treatment Option For ADHD

For decades, the options for pharmacological treatment of ADHD have been limited to methylphenidate (Ritalin), various forms of amphetamine, atomoxetine (Strattera), and pemoline (Cylert).  Methylphenidate and amphetamine are Schedule-II drugs, meaning that they are designated as having a high potential for abuse.  Pemoline has been associated with liver damage, so it is not a first-line option.  There have been recent reports of liver damage with Strattera as well.  Although it remains to be seen how widespread the atomoxetine problem is, it is difficult to be enthusiastic about atomoxetine until that question is resolved.  Other options, such as bupropion and tricyclic antidepressants, have limited efficacy.  Therefore, there is a need for a better option.  See CNS Spectrums Apr 2003, 8(4) p253-8 for a review of nonstimulant treatment options for ADHD. 

Read the rest at The Rest of the Story. 

CCL3L1: Genetic Factor in Determining HIV/AIDS Risk

Researchers have reported finding a genetic factor that influences the risk of HIV/AIDS.  The effect is twofold: it alters the risk of contracting HIV infection; and it alters the risk that HIV with progress to AIDS in a given period of time.  The factor that was studied turns out to be a subtle one.  The human genome contains a gene called CCL3L1.  A person can have more than one copy of this gene.  The more copies, the lower the risk. 

The study was reported on Science Express, the online version of Science Magazine that is used for early reporting of important findings, before the print version comes out.  I don't have a subscription, which is required, even to view the abstract.  However, there are reports on News@Nature.com and on the NIH website.  From the NIH report:

The study focused on the gene that encodes CCL3L1, a potent HIV-blocking protein that interacts with CCR5 — a major receptor protein that HIV uses as a doorway to enter and infect cells. The senior authors are Sunil K. Ahuja, M.D., of the University of Texas Health Science Center and the Veterans Administration Center for AIDS and HIV-1 Infection in San Antonio, and Matthew J. Dolan, M.D., of the U.S. Air Force’s Wilford Hall Medical Center and Brooks City-Base in San Antonio.

The researchers analyzed blood samples from more than 4,300 HIV-positive and -negative people of different ancestral origins to determine the average number of CCL3L1 gene copies in each group. They found that, for example, HIV-negative African-American adults had an average of four CCL3L1 copies, while HIV-negative European- and Hispanic-American adults averaged two and three copies, respectively.

This does not mean that European Americans are more prone to HIV/AIDS than other populations. Rather, using the average CCL3L1 gene copy number as a reference point for each group, the authors found that individuals with fewer CCL3L1 copies than their population’s average were more susceptible to HIV infection and rapid progression to AIDS. People with greater-than-average CCL3L1 gene copies, in contrast, were less prone to infection by HIV or to rapid progression to AIDS.

Depending on the study population, each additional CCL3L1 copy lowered the risk of acquiring HIV by between 4.5 and 10.5 percent. Additionally, below-average CCL3L1 copy numbers were associated with a 39 to 260 percent higher risk of rapid progression to AIDS.

The Nature report adds some background.  The author explains more about the role of CCR5, and the interactions between the CCL3L1 protein and the CCR5 receptor.  She also reports on an interview with a geneticist, Mary Carrington.  Dr. Carrington talks about the potential clinical application of the findings.  Patients could be advised to follow a more aggressive medication regimen, if their genetic disposition puts them at higher risk.  Also interviewed was a infectious disease specialist, Michael Lederman.  Dr. Lederman points out that patients in clinical trials for HIV vaccines could be divided into groups based upon their genetic makeup.  This could help researchers find out who is most likely to respond to a vaccine. 

Although the clinical applications are not great, at this point, the HIV/AIDS problem is so great, that any finding is welcome. 

An interesting aspect of the study is that the variation in CCR5 and CCL3L1 together account for about 40% of the variance in the risk of HIV infection.  That means, of course, that there are other factors, perhaps more important, that remain to be elucidated. 

Social Integration Predicts Suicide Over and Above Mental Disorders

This is another one of those posts that I have been meaning to write for a while.  As fate would have it, I encountered the following two items at about the same time.  They were written a month apart, but time does funny things in cyberspace:

Item #1 -- from PsychiatrySource.com

Social integration predicts suicide over and above mental disorders
24 Nov 2004
The association between family and social involvement and the risk of suicide is robust and largely independent of the presence of mental disorders, report US investigators, who say their findings could enhance the identification and treatment of vulnerable individuals.

To determine whether poor social integration amplifies the risk of suicide after taking into account the effects of mental disorders and employment status, the researchers, from the University of Rochester Medical Center in New York, compared 86 individuals who had attempted suicide and 86 people who had not, all of whom were aged 50 years or older.

Multivariate analysis showed that people who had attempted suicide were less likely than those who had not to have ever been married, to have had children, and to be living with their family.

With regard to social integration, participants with suicidal behavior were less involved in religion, showed less interaction with a social network, and had a low engagement in community activities, compared with individuals who were not suicidal. [...]

Item #2 -- from Mousemusings:

Place to Be
December 22, 2004

[...] That’s the first part: The suicides I have known have almost all been about love promised and not delivered. Let me be very clear: It is not the fault of the lover who could not love him or her enough. It is the fault of the entire community and culture for being unable and unwilling to support revolutionary love. The suicides I have known have mostly been in Gringolandia, where there is no support for love, where “the problem club” recruits daily, where the “self help” and addictionology industries prey on weak gringo minds selling the bullshit that a human being is a nation-state, that the human has “borders” or “boundaries” and has to “set those boundaries.” The "professionals" who peddle those inhuman theories have their fingers on the trigger, too. [...]

Statistics show that the lowest rates of suicide occur among Black women and Latinas.  Among Hispanics, the highest rates are for the elderly, followed by the group from ages 10-34; it is much higher for Latinos than Latinas. (link)  It is very high among gay and lesbian youth of any ethnicity. (link)

What this shows is that social factors are more important that mental illness diagnosis.  It suggests, but does not prove, that the role of medication in the prevention of suicide is very limited.  I can imagine that antidepressant medication might even be perceived by the person as an intervention that misses the point -- potentially increasing the sense of alienation. 

That's one of those hypotheses that seems plausible, but would be difficult to test.  In fact, I'm having a hard time coming up with a way to design a study that would 1) test the hypothesis adequately, and 2) be ethical to conduct, not to mention 3) be feasible without a multi-million-dollar grant. 

Another problem with trying to study it would be this: what would you do with the results.  There are interventions that can reduce the effect of social isolation, but they are very expensive to operate.  It is doubtful that anyone could figure out how to fund such a thing.  Insurance companies don't want to pay for interventions that are not biomedically-based; the government sure isn't going to do it, and most churches or other community organizations don't have the expertise. 

I guess what it boils down to is this: if we want to have a real impact on suicide rates, we are just going to have to try to be nice to each other.  Concepts such as tolerance and diversity are more that nice ideas.  Such values could save lives.

Another Update on Cloning

The latest issue of the New England Journal of Medicine has an article that clarifies some of the science, as well as the ethical issues, regarding human cloning. 

Human Cloning — The Science and Ethics of Nuclear Transplantation
Rudolf Jaenisch, M.D.
Volume 351:2787-2791         December 30, 2004         Number 27

In addition to the moral argument against the use of somatic-cell nuclear transfer for the creation of a child ("reproductive cloning"), there are overwhelming scientific reasons to oppose this practice. In contrast, many believe that the practice of somatic-cell nuclear transfer with the goal of generating an embryonic stem-cell line (sometimes referred to as "therapeutic cloning") is justified, because it holds the promise of yielding new ways of studying and treating a number of diseases. Once isolated from a patient, an embryonic stem cell thus derived would be "customized" to the needs of the patient who had served as the nuclear donor and thus would obviate the need for immunosuppressive treatment as part of a therapeutic application. In addition, because embryonic stem cells can generate most, if not all, types of cells in vitro, a stem cell isolated from a patient with a complex genetic disease could be used to study the pathogenesis of the disease in culture. [...]

Unfortunately, this article was not published on an open-access basis.  I'm not sure why not; often, they provide open access to editorials of public interest.  On the other hand, it is such a technical article, that it might not be very informative to nonscientists.

Dr. Jaenisch discusses, in detail, the reasons that reproductive cloning is not feasible for the reproduction of humans.  He then discussed the distinction between reproductive cloning and therapeutic cloning.  The latter technique, therapeutic cloning, is more accurately called somatic-cell nuclear transfer (SCNT).  In this post,  I review what Dr. Jaenisch has to say on the topic, and use this to illustrate why it is so important to understand some of the science in order to make an informed judgment about the ethics of stem cell technology.  Read the rest at The Rest of the Story. 

Best of (X) Roundup

Space.com has put up its "Best Images of 2004" collection.  It contains many really neat pictures from space, and some from Mars. 

Science Magazine has a list of their "Best of the Web" sites.  Most are rather specialized.  For example, the first one listed under Medicine/Diseases is

RESOURCES: Inside the Milk Gland
Science 306: 2009b.
The eclectic Biology of the Mammary Gland site is aimed at developmental biologists, cancer researchers, and physiologists. The site, from Lothar Hennighausen's lab at the National Institute of Diabetes and Digestive and Kidney Diseases, includes everything from technical tips to pathology slides, mainly on mice.

A histology atlas brims with images of normal and unhealthy tissues. Visitors can track development of the mammary glands in mice from birth to pregnancy and compare the process in, say, mice lacking the estrogen receptor. Pages on techniques explain how to prepare and stain tissue, insert genes into mammary cells, and more. The reviews section includes slide shows, short backgrounders, and audio lectures on topics such as the physiology of milk secretion and breast cancer diagnosis. Above, branching milk-producing ducts from a 4-week-old mouse.

mammary.nih.gov

New Scientist has a listed of the top ten science stories of 2004, as rated by their readers:

1. Mysterious signals from light years away
2. Petite skull reopens human ancestry debate
3. Sweeping stun guns to target crowds
4. Cassini finds a mystery in Saturn's rippling rings
5. Hawking cracks black hole paradox
6. Speed of light may have changed recently
7. Scientists stirred to ridicule ice age claims
8. Photo recognition software gives location
9. 'Anomalies' in first private spaceflight revealed
10. Mysterious virus may thwart HIV

The National Press Photographer's Association has put up their Best of Still Photojournalism 2004 site. 

Finally, Intelliseek's BlogPulse has a compilation of the most blogged about items in 2004. 

Health Care, Tax Policy, and Misleading the Public

Never try to solve a problem using an indirect method, when a direct method will do the job.  That is one of those maxims that sounds obvious, so obvious as to no need saying.  But sometimes we go astray, with the best of intentions.  And sometimes people pose indirect methods of solving problems when their intentions are not good.  The indirectness serves to obfuscate the true agenda. 

I am not an economist.  I read about the subject in my spare time in high school, but not since.  That makes me a perpetual sophomore in the subject. 

Sometimes, though, despite my sophomoric "wisdom," I read economic policy and get bewildered.  It is like trying to figure out a Rube Goldberg device.  Tax policy tends to affect me like that. 

Today, I encountered a post at Brad DeLong's site: Jon Gruber Thinks About Tax Policy for Health Insurance.

Despite a $140 billion existing tax break for employer-provided health insurance, tax policy remains the tool of choice for many policy-makers in addressing the problem of the uninsured.

This is a good example of how to not follow the advice in the beginning of this post.  Now, it would seem to me, that if you want to provide health care for the uninsured, the default policy would be to set up a program to do exactly that.  The idea is that the simplest, most direct approach probably is going to turn out to be the best solution. 

Of course, it is possible that a more complex solution could turn out to be better, or more efficient.  After all, automobile engines these days are much better that those of 50 years ago.  Yes, they are more expensive, and vastly more complex.  But they are much more reliable, and much more efficient.   I haven't seen figures on this, but I imagine that the total cost of ownership is much lower for a new engine that an old one.  So it is possible for complex solutions to be better, but those cases are the exceptions.

The idea behind changing tax policy to affect changes in the health care system is this: the government changes policy, to change incentives.  People respond to those incentives by doing what someone predicts they will do.  What they do then, will have other effects, which, with luck, will at some point, downstream, produce the desired outcome.  It seems pretty obvious that the success of such a method depends upon the accuracy with which one is able to predict human behavior in complex systems.  That always is a suspect proposition.  And the longer the chain of events becomes, the less reliable the predictions become. 

Also, it seems that the people who come up with these ideas always seem to assume that nobody is going to try to subvert the system.  They expect everyone to act in good faith.  Of course, by that logic, Communism would be the perfect system. 

As I said, I am not an economist, so I will not get into the specifics about the health care tax proposals.  Instead, I will use the tax scheme to illustrate a few points of interest to me. 

How is it that the Government could propose an indirect solution to a problem, and have it seem, superficially, to be a good idea?  Is it not obvious that indirect solutions generally are inferior to direct ones?  The answer is: usually, but not always.  It is possible, through the deft use of propaganda, to make an indirect solution appear to be a direct solution. 

First you have to set up a propaganda machine.  Then you start repeating certain phrases over and over again.  "Smaller government."  "Tax cuts work." etc.

Once these maxims are established firmly enough in enough minds, the people who believe them stop seeing what is going on.  If you believe that people always do what tax policy appears to provide incentive for them to do, you no longer see that as a iffy proposition.  The fact that it is based upon a string of tenuous suppositions simply does not register.  So the idea that:

if you do X (and expected outcome A occurs, and expected consequence B ensues, and nobody does C, D, E, or F) then Y happens

Looks like:

if you do X, then Y happens.

As a result, it looks like a direct solution, when in fact it is not. 

The human brain is wired to look for shortcuts, and to use them.  Professional magicians know this; that is how sleight of hand works.   Professional politicians know this too.   That is how they get the general public to act in ways that are contrary to their best interests.  They feed them maxims, pretend they are truisms, then lead them merrily down the garden path. 

-------------

Update Slate Magazine has an easier-to-read summary of Gruber's findings regarding the cost-effectiveness of various tax schemes, compared to the straightforward approach of simply giving insurance to poor people. The simple approach is cheaper and covers more people.

Arrrgh! Not Another Internet Quiz

From time to time, we see these Internet quizzes making the rounds.  Most of them are pretty silly; some are amusing; a few are slightly informative.  I just encountered one that actually is serious:

Philosophical Health Check
Check your Tension Quotient!

To take the philosophical health check (PHC), go through the statements below, selecting for each one 'agree' or 'disagree'. If not sure, select the response which is closest to your opinion. When you have answered all the questions, click the 'submit' button and the results of your check will be generated.

The test does not really test your "philosophical health;" that would require some sort of value judgment about the validity of your philosophical tenets.  Rather, it tests your values for internal consistency. 

---

Tension Quotient Score

Tension Quotient = 13%

The average player of this activity to date has a Tension Quotient of 29%.

---

I don't know that that the result is particularly meaningful, although I was a bit gratified, on a narcissistic level, to find that my responses have greater internal consistency than average.  I also was pleased to see that I am not 100% consistent.  As much as I like computers, I do not want to be one.

It probably is an error to equate internal consistency with philosophical health.  However, it is interesting, and possibly even useful, to check one's beliefs for internal consistency, and think about the conflicts that are revealed. 

Last Minute ThoughtsAlcohol Abuse, Acamprosate, and Hope

It seems that there has not been a lot of reason for hope, in the last month of the year.  I've been digging around on the Internet for the past hour or so, looking for something positive to say.  When everyone sobers up and gets back to life in cyberspace, perhaps some of them will find encouraging news here.

News #1:

Nov. 5, 2004 -- No. 541

New brain cells develop during alcohol
abstinence, UNC study shows

By LESLIE H. LANG
UNC School of Medicine

CHAPEL HILL -- University of North Carolina at Chapel Hill scientists have reported – for the first time – a burst in new brain cell development during abstinence from chronic alcohol consumption.

The UNC findings, from research at UNC’s Bowles Center for Alcohol Studies, were based on an animal model of chronic alcohol dependence, in which adult rats were given alcohol over four days in amounts that produced alcohol dependency. The study is in the Oct. 27 issue of the Journal of Neuroscience.

In 2002, Dr. Fulton T. Crews, Bowles Center director, and Bowles Center research associate Dr. Kim Nixon were the first to report that alcohol, during intoxication, has a detrimental effect on the formation of new neurons in the adult rat hippocampus. This brain region is important for learning and memory – in animals and humans – and is linked to psychiatric disorders, particularly depression.

"When used in excess, alcohol damages brain structure and function. Alcoholics have impairments in the ability to reason, plan or remember," said Crews, also professor of pharmacology and psychiatry in UNC’s School of Medicine. "A variety of psychological tests show alcoholics have a difficulty in ability to understand negative consequences."

In the new study, senior co-author Crews and co-author Nixon found inhibition of neurogenesis, or brain cell development, during alcohol dependency, followed by a pronounced increase in new neuron formation in the hippocampus within four-to-five weeks of abstinence. This included a twofold burst in brain cell proliferation at day seven of abstinence. [...]

News #2

Health Notes
Monday, December 6, 2004
Compiled by Anne Hart

New Year's little helper

Makers of a new drug to help drinkers stay on the wagon is expected to be available in time for New Year's festivities, Time magazine reports.

Campral is the first new drug approved by the Food and Drug Administration in almost a decade for helping drinkers remain abstinent.

Taken as part of alcohol-treatment program that includes psychosocial support, Campral helped 16 to 38 percent of alcoholics who had already stopped drinking avoid imbibing for up to four months, Time reports

Unlike current abstinence aids, Campral works by restoring the nerve activity in the brain's pleasure center that is altered by too much alcohol.

Those interested in Campral can find a little more information at the manufacturer's product website.  According to their package insert (PI), chronic alcohol abuse is thought to "alter the normal balance between neuronal excitation and inhibition."  They add, "acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and [that] has led to the hypothesis that acamprosate restores this balance.

If that is all geek to you, I will translate.  Most systems in biology are regulated via two opposing forces.   Very broadly speaking, there are two kinds of chemical messengers in the brain: those that increase nerve cell activity, and those that decrease it.  Glutamate is a widely-distributed excitatory transmitter; GABA is a widely-distributed inhibitory transmitter.  It appears that chronic alcohol use causes the brain to decrease the overall amount of inhibitory transmitter activity, and increase the activity of excitatory transmitters.  This is adaptive, since it helps the brain counteract the effects of alcohol.  But when there is no alcohol, the compensated brain has too much glutamate activity; not enough GABA.  This, in addition to making the person very uncomfortable, makes the person have all kinds of nasty symptoms.  In severe cases, it can cause hallucinations, seizures, and death.  The discomfort, though, is what leads to craving, which increases the risk of relapse.

The idea is that Campral might help stabilize the balance between excitatory and inhibitory activity in the brain, thus reducing craving, thus reducing relapse.  Notable, it does not act like Antabuse.  Antabuse causes the patient to become violently ill after consuming alcohol.  That can be dangerous, so it cannot be used in people who have not established some degree of sobriety already.  Also significant is the finding that Campral has no appreciable anticonvulsant activity.  That means it cannot be used to make alcohol withdrawal safer.  People who need to be detoxified from alcohol still will need to take something like Librium, Serax, or phenobarbital. 

Does Campral work?  It is too early to say how useful it will be in actual practice.  Even if it is only moderately effective, that will be a very good thing.  To illustrate: even if it only leads to sobriety in 10% of persons addicted to alcohol, if all alcoholics took it, it would help over a million people in the USA alone.  So the fact is, it does not have to be very effective, in order to have a huge public health impact.  Are there are risks? Who cares? Really: who cares?.  I can guarantee this: it is not as dangerous as alcohol. 

I'll close with this snippet from the NYT article on the New Year celebration:

News #3

Miss Trixie, a transsexual who said she was an actress between jobs, was on Avenue of the Americas in Greenwich Village talking about how she had been sober for 49 days and was determined to make it 50. She said she was returning to Brooklyn as soon as she finished hustling for small change.

"Old people and old places," she said about Times Square, a veneer of 5 o'clock shadow showing through her made-up face. "People and places you want to stay away from.

"My goal in 2005 is to be a productive citizen in society working for some establishment in New York City."

She rattled her Taco Bell cup as people walked by .

You take your hope wherever you can find it.

Here's Some Help

To help all those blogs that are struggling for recognition, I am going to link to them right now.  All at once, liberal, conservative, authoritarian, libertarian, factual, personal...whatever:

http://*.*

There.  That should boost your standings.