Thursday, September 29, 2005

Drug Approved to Help Alcoholism Also Effective Against Tinnitus

This is the kind of thing that I love about pharmacology.  Acamprosate (Campral ®) was released earlier this year as a drug that reduces craving in persons with alcoholism.  My earlier post reviews the pharmacology of the substance.   Now comes a study that shows possible benefit for sufferers of tinnitus.  
Drug Approved to Help Alcoholism Also Effective Against Tinnitus

Newswise — On July 29, 2004, The U.S. Food and Drug Administration has approved the drug acamprosate, marketed under the brand name Campral®, for treating alcohol dependent individuals seeking to continue to remain alcohol-free after they have stopped drinking. Two Brazilian researchers believe that the drug is also effective in treating tinnitus, a disorder that affects 12 million Americans with noises in their ears.

Acamprosate (calcium acetylhomotaurine), an analog of homotaurine, and a GABA-ergic agonist, stimulates inhibitory GABA-ergic neurotransmission in the brain and antagonizes the effects of certain excitatory amino acids, such as Glutamate. Since acamprosate activates postsynaptic GABA B receptors (but not GABA A receptors) in vitro and decreases electrical excitability, but does not change membrane potential, the researchers set out to evaluate the acamprosate efficacy and safety as a treatment for sensorineural tinnitus, with a double blind study.
At first glance, tinnitus does not appear to be a serious problem.  It is the sort of think that does not attract a lot of research effort; few centers will get a multimillion dollar grant to study it.  Usually, it is a minor nuisance, but some people have it so bad that they are disabled by it.  

Certainly, there is no obvious connection between alcoholism and tinnitus.  Likewise, there is no obvious reason to think that a drug that would help with one condition would help with the other.  Granted, the results were not spectacular:
In this study, those taking the drug registered a significant overall improvement rate (86.9 percent) and 47.8 percent of the cases reporting improvement better than 50 percent. Additionally, a decrease in was noted in the tinnitus discomfort rate when compared from the initial rate in the period of 90 days.
Only half the patients had an improvement of greater than 50%.  However, for many patients, even a modest improvement would be extremely helpful.  Especially since there really aren't a lot of alternatives.

Although alcoholism and tinnitus have nothing to do with each other, in terms of symptoms, or ultimate cause, the pathophysiology of the two conditions appear to share a common pathway.  Understanding of that pathway is what led to this discovery.  This study shows how a thorough understanding of the basic pathophysiology of a problem can lead to ideas for a solution.  It is a good example of why preclinical research is worthwhile.  It also illustrates how efforts to direct funding mainly to solving practical problems can be a misguided strategy.  

Bipartisan Support: No Problem!

Here is something that should have bipartisan support, with no problem at all:
Rep. Waxman and Leader Pelosi Introduce Anti-Cronyism Bill

Tuesday, September 27, 2005 -- Rep. Henry A. Waxman and House Democratic Leader Nancy Pelosi introduce the Anti-Cronyism and Public Safety Act, which would prohibit the President from appointing unqualified individuals to critical public safety positions in the government.
Certainly, both major political parties in the USA have been guilty of cronyism, although the Brown/FEMA case was particularly egregious.  Another such case is pending right now: Julie Myers, President Bush's nominee for head of the U.S. Immigration and Customs Enforcement agency.  Main St. USA has a list of other prominent political appointees who appear to have been unqualified for their jobs.  

Cronyism is a form of corruption.  In addition to be wasteful of public resources, it can lead to misplaced priorities among government officials.  It is a sad commentary on our political system, that legislation to prohibit this practices would even be needed.

UPDATE: and let's not forgot the assignment of Karl Rove to direct the NOLA reconstruction efforts!

Tuesday, September 27, 2005

More Protest Notes

I haven't yet uploaded the pictures I took at the rally, but I have collected some from around the 'net.  John Conyer's blog pointed to this collection.  Other Flickr collections are here and here.  Another collection is here.  The C-Span video is here: ANSWER Coalition Rally Against War in Iraq (09/24/2005) -- but it would not work for me, giving a page not found error.  

Some pro-war sites have pictures as well: here, here, and here.  Global Cop has more here; Global Cop was liveblogging, so you have to go to his several posts from 9/25/2005 to find the pictures.  There are photos from the LA protest here.  

 Naturally, I cannot merely find, organize, and post links.  My right hemisphere demands equal time.  Accordingly, I am going to respond to a comment left here, by Callimachus (Done With Mirrors, The Sciolist).  Continue reading here.

Black and Red Marker

Black and red marker, scrawled upon cardboard.
No Blood For Oil, the protester chants.
Under the cardboard, pregnancy shows.
Preparing for birth, the breast tissue swells,
preparing to nourish our next generation.

But what kind of turmoil
will greet her fine child?
Will our planet offer
nutrition for all?
What kind of world
can we create?

Do people have power
in a form to be used?
Do we have courage
needed for change?

Sunday, September 25, 2005

Finally! Someone did it...

I Need To Get Me One of These

Flying Spaghetti Monster Car Plaque, available soon from Ring of Fire Enterprises.

Drive proud, Pastafarians!
Finally!  Someone did it.  I think I'll get one.  HT to Tilde.

Psychology Notes:
Introversion and Extroversion

In the category of Things Found While Looking For Other Things, I found a post entitled How to Go From Introvert to Extrovert, by Steve Pavlina.  (I got to that page by looking in Rebecca's Pocket [9/22/05] for her post on Trickle Up Economics [9/23/05].)

Unlike a lot of self-helpy kinds of posts, Pavlina's is actually quite good.  The author detials his own transition from being introverted, to being extroverted.  His type, as assessed by the Myers-Briggs Type Indicator, changed accordingly.

I thought that was intesting, because the MBTI usually shows me to be an introvert, but on occasion it has branded me an extrovert.  Looking at the individual items, it turns out my score there is almost perfectly split.  So the whim of answering a single item one way or the other makes the difference.  

The question I have, that the author does not answer, is this: So we know how to make an introvert turn into an extrovert, but why should we want to?  The whole point of the personality types as described in Gifts Differing, is that one type is not necessarily better than another.  Like the assigment of strength points in the construction of a charater in an adventure game, there is a way to win the game regardless of the type of charater played.  Likewise, in life, there are ways to construct a good life, regardless of your personality type.  Unlike an adverture game, in real life there is no guarantee that any given character can win.  But in life, you do not have to win, with the state of winning having been defined by someone else.  In fact, it helps to not think in terms of winning or loosing.  Rather, it is more adaptive to think in terms of making the most of what you have.  

Anyway, all you introverts out there can go check out his advice.  Just remember that it probably is a side trip that does not actually get you any closer to winning, whatever that is.

Corrective Emotional Experience

Looking through the photos that are available, so far, from the 9/24/2005 peace rally in Washington DC, it appears that three basic themes predominate.  One is the size of the crowd; another, the intensity of expressed emotion; the third, the incidence of people who dressed funny.   The problem is, those three categories of photo do not convey the core of the experience of being there; nor do they capture what, to me, is the area of greatest human interest.

The crowd was massive.  But early in the morning, the crowd was not so dense as to preclude freedom of movement.  It even was possible for individuals and small groups to have moments of relative privacy.  I noticed that people in general were aware when others were having an emotional moment, and respected the appropriateness of privacy and boundaries.  

There were a lot of individuals who ended up having moments of intense feelings.  I did not photograph any of those.  Even if I had, I would not post them.  

Those of you who have had emotional reactions, based upon the photos posted online so far, may be in need of a corrective emotional experience.  Actually, come to think of it, that is not exactly the correct term to convey what I am trying to convey.  It is not a formal term (yet), but I guess what I am thinking is that people may need a supplementary emotional experience.  So here are three pictures to supplement what has been posted elsewhere.  Continue reading here.

Why The Antiwar Rally Went Well

First, I want to let everyone know that the peace rally in Washington DC went well on 9/24/2005.  It is still going on, but I left at about 4:30PM yesterday, and have nothing to say about what has happened since then.

I've seen widely varying estimates for the size of the crowd.  Most seem to think there were about a quarter of a million.  I lost count as follows: one, two, three, MANY.

Police reports indicate that one temporary fence was knocked down, and a newspaper vending machine was damaged.  There were three arrests.  But how many people are arrested in D.C. on an average Saturday?  Surely, more than three.  Probably MANY.

How can you get hundreds of thousands of people together in one place, and have it be peaceful?  It helps if you only invite peaceful people.

Then again, a little extra insurance is always good.  Therefore, on Friday, a palliative offering was made to the Flying Spaghetti Monster.  We wanted to be sure that He did not think we were tampering with His Creation.

Ragu Offering

Items: Ragu traditional old world style spaghetti sauce, Western Digital Caviar hard drive, scented candles, books that convey His True Values, peace sign armband.  

In retrospect, the fake plant on the left...that was a mistake.  (Sorry, Great One.)  Maybe that is why the newspaper vending machine was broken.  On the other hand, maybe it was the Errant Ways of the Washington Post itself that resulted in its fall from grace.

Initial Responses to Antiwar Rally in D.C.

First, the observations, then the hypotheses; the conclusions follow.

The rally/march/concert/speeches were mainly sponsored and organized by radical groups.  However most of the attendees were not radicals.  The antiwar aspect of the rally was merely the focal point, since the Iraq war was the most egregious of the alleged offenses perpetrated by the Administration. 

Several speakers at the rally before the march commented specifically on the diversity of the crowd, and made the explicit point that people do not all need to have the same slogan in order to get together for a common cause.  Several attendees made it clear that they had agendas of their own.

The MSM and Blogosphere already are peppered with reactions to the rally.  My responses are documented here.

Wednesday, September 21, 2005

Sleep Apnea Updates

There are three: one from WebMD; the other two, from the WebMD professional companion site, Medscape (free reg. req.).  I used to post fairly often on medical topics that show that illness are often much more complex processes that they appear to be.  Today, I stick to more practical "clinical pearl" matters, giving some examples of the act of extracting one or two important points from a possibly lengthy and complex bit in the scientific literature.  Continue reading here.

Tangled Bank is Available!

Tangled Bank is Available!
Tony at milkriverblog writes;

Have a sweet tooth? Well we’ve got some sweet writing to satisfy your craving. It’s over at milkriverblog in the 37th edition of The Tangled Bank. Check it out!

The Tangled Bank

The next edition of this fine collection of the best science, medical and nature blog writing will be hosted by Living the Scientific Life on October 5th. Be sure to send submissions by October 4th to PZ Myers, The Tangled Bank host [at] tangledbank [dot] net or to GirlScientist.

For a faster response, write Tangled Bank submission in the subject line. NOTE: All submissions will be acknowledged via email. If you do not receive an email response within 24 hours, please resubmit your article.
Milkriverblog is worthwhile reading anyway, even better now with tangles on the banks.  

I know better than to speculate about the change from Grrl to Girl.

In Case You Missed It:
John Bolton Edition

The British Medical Journal had published an item that is not really news, but is worth mentioning.  
Goals to reduce poverty and infant mortality will be missed
Owen Dyer

Published on the eve of the United Nations summit in New York this week, the UN's 2005 Human Development Report finds that progress on human development, public health, and education is slowing or stagnating in many parts of the world.

The report predicts that the UN's millennium development goals?a commitment made by 189 nations to reduce infant mortality and extreme poverty and to improve maternal health, primary education, and sex equality?are in many cases further from realisation today than they were in 1990. [...]

India and China are singled out as two countries with booming economies that have failed to produce commensurate improvements in social development. Progress on child mortality in these countries has slowed even as the economy has gathered steam, the UN says. Yet their vastly poorer neighbours, Vietnam and Bangladesh, have made great strides over the same period, proving the value of government intervention. [...]
What is interesting about this?  The performance of our new ambassador to the UN: John Bolton.  Mr. Bolton was appointed over the objection of many US Senators.  The Administration insisted he was just the right man for the job.  So how is he doing so far?

Last month John Bolton, the United States' ambassador to the United Nations, called into question the very existence of the millennium development goals, when he presented a long list of objections to a draft document that is due to be presented at this week's UN summit.

Mr Bolton denied that the US had ever signed up to the goals, although President Bush has endorsed both the 2000 millennium declaration, which included the goals, and the Monterrey consensus, an agreement that urged wealthy countries to "make concrete efforts towards the target of 0.7% of gross national product" in foreign assistance.

Mr Bolton eventually accepted the reference to the goals in the summit document, but as the BMJ went to press he was still rejecting the annex setting the 0.7% aid target, and prospects for agreement looked far from certain.
The guy doesn't know what he is doing.

Monday, September 19, 2005


Every once in a while, things get confusing. We cannot figure them out. It helps to try to keep both feet on the ground.

Thursday, September 15, 2005

Buprenorphine Explainer:
Subutex and Suboxone

As I go about my days, I get the impression that there is a lot of confusion out there about the treatment of opiate abuse and dependence.  Wes Clark (not that Wes Clark, the other one) has written an article to help us understand this nettlesome issue.  First, I summarize some point from his article, and a few others, then add a few bits of my own.  Continue reading at The Rest of the Story.

Categories: Science, neurochemistry
Tags: , ,

Our Agenda

In case anyone was wondering about the agenda for the little get-together in Washington D.C., someone has kindly put up some information, telling us what our agenda is.

With mind-reading abilities like this person obviously has, he or she really ought to be good at playing poker.


I sure hope GOP Vixen is there.

NLM Provides Access to Environmental Health Information Following Hurricane Katrina

The National Library of Medicine's Specialized Information Services (SIS) Division has compiled a new Hurricane Katrina resource page at http://sis.nlm.nih.gov/enviro/hurricane.html. This page has toxic chemical and environmental health information resources for health workers and the interested public. SIS has also included links to information on chemicals that may be released as a result of the Katrina disaster and on environmental health concerns following the wind and flood damage.

The page also links to WISER, the Wireless Information System for Emergency Responders, at http://wiser.nlm.nih.gov. First responders may download the WISER set of information on 400 toxic chemicals and hazardous materials to a Palm, Pocket PC, or laptop/desktop computer that uses Microsoft Windows. WISER is designed to help identify unknown substances and gives ready access to basic emergency haz-mat information.

Links to TOXMAP (http://toxmap.nlm.nih.gov) identify and map locations of facilities that use or transport significant levels of toxic chemicals, and lists the chemicals for each facility. Maps are included for the Katrina-affected states as well as for New Orleans, Biloxi, and Gulfport.

To contact Specialized Information Services for information on toxicology and environmental health:
Customer Service: tehip@teh.nlm.nih.gov

Categories: Science

Wednesday, September 14, 2005

Contemplate This

National Geographic

No.  Don't read this yet.  Look at the picture some more.  Contemplate.  

Imagine why a reality-based, slightly left-of center regular guy, who reserves the right to be highly irregular, might post this picture and ask that you look at it.  Three times.  

The photo is from the National Geographic "Best Mountain Photographs of 2005."  It's a pine tree next to a mountain.  Small, insignificant, mostly unseen.  But the sun is shining on it.  The mountain is in shadow.

Usually I give nature photographs a green background, which denotes a "Science" post.  

Clue #1: This one is in blue, for "Politics".
Clue #2: I'm listening to Patti Smith, quite a bit louder than usual. ("outside of society")
Clue #3: I'm going to Washington DC next week.

That shadowy mountain: preaches a culture of life, yet practices policies of death; preaches from The Bible, yet practices from Niccolo Machiavelli's The Prince; claims to take full responsibility, yet unleashes an avalanche at any criticism; has a really annoying voice.

The pine tree: preaches nothing, yet whispers in the wind; takes only what the land can reasonably give, and leaves the rest; takes responsibility for the few square yards it covers, and allows others to be responsible for themselves; has a really beautiful profile.  

I sometimes wish I could model myself after the pine tree, but I can no longer.

Any beautiful profile I may have had once, was lost years ago.  I prefer to whisper in the wind, but sometimes I speak out loudly.  I've read the Bible, but I've also read Machiavelli.  I like to think that I know when to practice which.

I do not fear the mountain.  Let the avalanche come.  Under the light of the Sun, the avalanche will melt away; yet me and my kind will only grow stronger, and taller.  

Categories: politics, rants

No Worries

Regular readers do not need to worry that Corpus Callosum will trouble them, with poetry that does not make any sense unless you know why it was written.

A healthy relationship is not like a salt crystal, in which the only choices are rigid bonding and total dissolution.  It's more like a carboxylic acid in a mostly lipophilic solution, in which the proton can come and go, according to rules that the atoms have agreed to follow.

The difference is that, in organic chemistry, the atoms always follow the same rules.  In a healthy relationship, the people have some freedom to set their own rules.  There are conventions, of course, which ought to be respected.  But there is some room for flexibility.

I guess there is one other difference.  Ideally, the society in which the couple is finds itself, is not too lipophilic.  

Tuesday, September 13, 2005

Creativity and Emotion

Some people use their emotions to drive their creativity.  Others use their creativity to find their emotions.

two kinds of atoms
infinite orthogonal matrix
ionic bonds are the most powerful kind
the atoms are locked in place

along comes the water
dissolving the bonds
increasing entropy to maximum
atoms within tears

are those our choices:
crystals or tears?
unlocking creativity
we find other ways


Categories: ?
Tags: none

Monday, September 12, 2005

Time for Investigative Journalism?

Something reminded me of a couple of old chapters in my life.  I've been thinking about that, and I realized that there are two stories here.  One is personal, and not very interesting to anyone who does not know me.  The other is important to everyone who lives in Michigan.  Continue reading here.

categories: rants, politics

Sunday, September 11, 2005

In Memoriam

My beloved Viewsonic A70 died last night, after eight years of faithful service.  I wish I could say that he died peacefully in his sleep, but alas, that was not to be.  I suppose, though, he went the way he would have wanted to go: in the thick of action, alternately displaying e-mail and a blog post, both with heavy content.  My only regrets are that he will never know the irony of the timing of his demise; and his replacement will never get to meet him.  I think they would have liked each other.

Some good will come of this.  The new one (a Viewsonic LCD) will use only 35 watts, instead of 200.  Some bad will come as well.  Because CRTs emit x-rays, the front glass contains lead.  That is bad for the environment.  It seems that, death often is like that.  You take the bad with the good.

Many argue the relative merits of CRTs versus LCDs.  There is no point in trying to compare them.  They both have their good and their bad points.  You cannot say that one is better than the other.  What is important to us, as humans, is that we all find a monitor that is pleasing to our senses.

There will be no viewing, as there is little point in viewing a single, bright white horizontal line across an otherwise totally-black screen.  In lieu of flowers, donations may be sent to the American Red Cross, to help refugees from Katrina.  

I happen to have two monitors connected to my computer; that is how I am able to write this.  Some argue that it is improper, unseemly, confusing, or even immoral to have two monitors at the same time.  I say that people should keep their judgments to themselves.  

At least he was happy with the arrangement.

Windows Catches Up to Linux...sort of

In my view, one of the most important advantages of Linux, when it comes to running mission-critical programs, is the ability to boot from a live CD (or DVD, or USB flash drive).  In the event of a total system crash, or boot-sector error (such as what happened to me after the last thunderstorm), it is possible to boot from the CD and have a fully functional, if somewhat slower, operating system.  

Booting from a boot floppy only gives you a command-line interface.  Booting from a Linux live CD (such as Knoppix or SLAX) gives you a graphical user interface and a good selection of programs, including web browser and office suite.  It also gives you utilities for backing up your files, which obviously is a really good idea after a catastrophic system failure.  

Now, there is a freeware program that extends the same functionality to Windows XP users.  Microsoft insists that it is not legal, although the author disagrees, and he seems to make a good case -- although I am not about to argue with Microsoft's legal team.  

I can't vouch for the program, as I have no need for it.  But Tom's Hardware, normally a reliable source, is happy with it, as described here.  The author of the program (BartPE) is Bart Lagerweij.  The home page for the program is here.  

Note that if your original Windows XP installation disk does not have SP1, you'll have to make a slipstreamed installation CD first.  Although this is not a one-click operation, it should be possible to do, for most anyone who would be reading this.

Uncle Redmond is not wild about the idea of people having fully-functional boot CD's, I guess because of the potential for non-licensed use.  Given the performance hit caused by having the OS on something other than a hard drive, this does not seem very realistic.

Can't Decide

I can't decide if my latest essay is worth posting.  I was a bit preoccupied while writing the last half.

Thursday, September 08, 2005

Nice Little Chat

I had a nice little e-mail chat with a high school student who is interested in going to medical school.  He asked for some advice, so I gave him a few pointers.  Since it is a matter of common interest, I asked his permission to post it, and he said it would be OK to do so.  Continue reading here.  

If anyone else has advice for him, check out his blog at http://bravomedic.blogspot.com.

Wednesday, September 07, 2005

Let Them Eat This

I almost went to Busch's today, to have them make one of those birthday cakes with a picture of Barbara Bush on it, with the caption "Let Them Eat This."
"And so many of the people in the arena here, you know, were underprivileged anyway, so this--this (she chuckles slightly) is working very well for them."
Does she have any idea what it means to be "underprivileged"?

By the way, I have no antipathy for those people who were filmed looting and otherwise breaking various laws in New Orleans.  It's not that I encourage lawlessness; quite to the contrary.  The reason I don't despise them is that I really believe that they, unwittingly, are finally what got the Administration into gear with a serious rescue effort.  It was so embarrassing for the Administration to have Al Jazeera broadcasting video of Americans behaving badly, that the Administration finally decided to send in enough National Guard to really get things moving.  If I'm right -- and I realize that this is an untestable hypothesis -- then it would be sad commentary that it was not compassion, but wounded pride, that led to these people getting the help they needed.

UPDATE: This would appear to confirm my hypothesis.

Categories: rants, politics

Tuesday, September 06, 2005

Something Wonderful

Something wonderful happened to me today, and I want to tell the whole world!

I dropped my father and my son off, in front of Madras Masala on Maynard Street, then went to park the car.  Just then, a car with a University of Michigan Medical School sticker on the back window pulled out of a parking spot in front of Frank's Diner.  I had a perfect parking spot, right in the middle of downtown Ann Arbor!  

This is as it should be, of course; medical students should always vacate parking spots that are needed by senior physicians.  

Then, as I was getting out of the car, I noticed a radio somewhere.  It was playing that old Doors song: "Come on baby light my fire."  Then I noticed how supple my back felt.

The night before, I had spend hours at the keyboard, working on Grand Rounds.  My back had gotten a bit stiff, despite the Aeron chair I use.  Sometimes, though, certain things have a way of making you feel young again.

(And of course I was kidding about medical students needing to be obsequious.  If anything, they need to learn to stick up for themselves.)

Grand Rounds Postscript: Thank You, Everyone!

Hosting Grand Rounds is fun.  Arduous, but fun.  I learned a lot.  What was most surprising, though, was how gracious everyone was with their emails and comments.  I really appreciate both the positive feedback, and the constructive feedback.  I also appreciate the time that people took to link to GRL, since it is those links that make the whole thing work.  

Grand Rounds is still evolving.  Anyone who wants to take an active role should go to the Google Groups page, and ask to join.

Monday, September 05, 2005

It's GRL Time!

Grand Rounds #L, or 50, is finally here.  For newcomers, a little explanation is in order.  Grand Rounds is a creaky old tradition that doctors have.  Once a week, they get together and talk about one "case" (which is actually a person) in agonizing detail.  Then they try to impress each other by recalling incredibly obscure details about related cases (people).  

George Washington University Department of Medicine

Actually, it is not always that bad.  Sometimes it gets a little stuffy, but it is an important part of medical education.  And some people try to lighten things up a little, as seen in this real example from SUNY-Buffalo.  

Grand Rounds in the Blogosphere has evolved such that it includes things written by doctors, nurses, EMT's, scientists, and a variety of others.  Some of the posts are presentations of clinical cases (people), others are explainers about medical science, and some are human interest stories.  We always get some commentary on health policy and a few other related topics.  The schedule is always posted here, the submission guidelines are here, and the Google Group for discussion about Grand Rounds is here.  

Looking at the schedule, it appears that we could use a few volunteers to host subsequent iterations of GR. (If we don't get any, I'll be hacking into people's blogs and spreading dancing flamingos everywhere.)  

One rule about real-life Grand Rounds is that they always must start with a really boring introduction.  Now that we've gotten that out of the way, here are the cases (people):

#0 The zero entry is from your host, Joseph j7uy5.  In case you were wondering, j7uy5 was derived by randomly striking the tips of the fingers of one hand, all together, vaguely in the middle of the keyboard.  It doesn't mean anything.  

My post is about the rationale for universal health coverage in the United States of America.  Please help me accomplish my goal of having a better-informed citizenry, by taking the time to read the sources that I linked to in the post.

#1 Our first entry is from Arnold Kling, Ph.D., posting on EconLog: Grey-area Medicine and Non-monetary Costs.  The economics of health care is a complex and under-appreciated issue.  Dr. Kling does a nice job of summarizing one important point: there are costs associated with the provision of health care that are not direct monetary costs.  This, of course, is one of the reasons that the health care market operates in ways that defy traditional economic models.  

#2 The second entry comes to us from the Philippines, courtesy of Mic Agbayani, MD.  Dr. Agbayani has a good idea, proposing a brief code of ethics for medbloggers.  This actually would be a good topic to discuss in the Google Group that I linked to up above, somewhere.  There already is something called the HONcode, which is a set of guidelines for health-related websites.  The HONcode would not be appropriate for medbloggers, but it does have some ideas that we might decide to add to Dr. Agbayani's proposal.  

#3 This next one is a thought piece regarding genetics and genetic testing.  Posting on Insureblog, Henry Stern, LUTCF, discusses a study about the relationship between intelligence and Tay-Sachs disease in Ashkenazim:
The study "hypothesizes that the genetic disorders could be the unfortunate side effects of genes that facilitate intelligence." In fact, the authors of the study had some difficulty even getting it published in the first place. There is a very real concern that some in the lunatic fringe would find great joy in using the results of the study for their own nefarious goals.
This actually is not a new topic; I remember hearing about it in Anthro #4-somethingorother when I was a senior undergrad.  (That was in 1980; I'm glad to see that more progress has been made.)  The link to the Economist article on the topic is here.  What they are talking about is the concept of a balanced polymorphism.  
Buy Now
#4 Dr. Charles tries something cool in his submission, Legends of the Examining Room.  He's published a compilation of his best blogging and would like people to consider buying it.  In his e-mail to me, he called it "shameless self-promotion."  I assured him it is nothing of the sort.  Anything that promotes considered and informed discussion about health topics is sorely needed in our society.  Plus, he's going to donate 25% of profits to medical relief efforts.  For now, that will be the Katrina relief effort.

#5 Back to the realm of genetics, Hsien-Hsien Lei, PhD, presents us with an update on one of my favorite topics, Genetics of Post-Traumatic Stress Disorder.  It was Katrina that got her thinking about the subject.  I'm happy to see that Dr. Lei points out how common PTSD is, contrary to common belief.  In fact, some people do not believe that PTSD even exists.  Those people might want to take a look at one of my earlier posts on the subject.  

I'm going to take the editorial liberty of linking to another one of her posts, to be found on the July 2005 Tangled Bank:  Infectious Disease Genetics.  Why?  As we are going to learn from Katrina, massive climate change brings about a reshuffling as ecological niches.  Each shuffle of the deck brings a new opportunity for disease to spread from animal hosts to humans.  The world is going to need more scientists studying this kind of thing.  And more politicians paying attention.
Del Rio
#6 Longtime contributor and former Del Rio aficionado, Orac, displays some backbone while he serves up a sobering treatment about vertebroplasty: Avoiding scientific delusions.  Like a good medblogger, he is not content with just echoing the news: he gives us a good background on the concept of evidence-based medicine, and its practical application; he also illustrates what kind of nonsense ensues when medical practice is not based upon good evidence.  

#7 Drunken Lagomorph, who has the most hilarious "about me" page I've ever seen, has a cute story about nursing in a correctional facility.  Having spent time in one myself (on the "right" side of the bars) I can say this is probably pretty typical.

#8 Posting on the MSSP Nexus Blog, Rita Schwab puts up a tribute to those medical professionals who are helping out in Katrina's wake.  
Among the heroes of New Orleans, Biloxi, Mobile, and beyond, are the doctors, nurses, technicians, and others who stayed behind to face a devastating storm and its aftermath in order to provide care and comfort to their patients.  As we've watched events unfold this week we've come to have a new appreciation for their training, dedication, and endurance in the face of overwhelming obstacles.   
This tribute is a nice touch, since it is mostly the looters, snipers, news pundits, politicians, and other riffraff who have been getting the spotlight.  We must not forget that the majority of people involved are doing their heroic best.

#9 & #9.5 The authors have a couple of posts on the Clinical Cases and Images Blog, which is put up by a group at Case Western University.  One post is: Who Are the Medical Bloggers and Where to Find Them?  As the name suggests, the author gives suggestions on how to find medical blogs.  For one, he suggests using Technorati and searching for the tag, medicine.  

Personally, I've started using the tag medblogger, which hardly anyone else uses, and which seems less likely to attract spam posts.  

ClinicalCases' second entry is this: Calculate Your Life Expectancy.  The idea of having people calculate their life expectancy is a clever way to point out to people what impact their lifestyle has on their mortality.  Anything that might encourage salubrious lifestyle changes is welcome.  

#10 Kim McAllister, an ED RN, sent her first GR submission: Backpack Your Way Through a Disaster.  The Katrina disaster got her to thinking that, since she lives on a geological fault line, she ought to get an emergency preparedness kit for herself.  She provides tips on where to get the necessary supplies, and what to include.

#11 David Williams, MBA, posting on Health Business Blog, has some advice for Delivering Operational Excellence.  This is a good reminder that professionals outside of the health care area do have something to offer.  In this case, he discusses lessons learned from the Institute for Healthcare Improvement.

#12 Medpundit presents a postmortem of the emergency preparedness planning and its failures in the aftermath of Katrina.  Like most autopsies, this one is not fun, but it is necessary.

#13 & 13.5 Elisa Camahort, last week's GR host, somehow had the stamina to submit two entries from her Worker Bees blog, Healthy Concerns.  First, she gives a good example of bureaucratic inefficiency, that takes place in an organization that is supposedly one of the more efficient around.  She then makes the point:
It seems so inefficient. What a waste of paper, of stamps, of administrative effort. Multiply that by the thousands and you begin to understand why tort reform is not the biggest part of increases in health care costs, administrative costs and overhead are.
She's absolutely right about that, as we shall see later.  Her second entry echoes one of my own concerns, that of political influence inside the FDA: You Wonder if it's Political?  This pertains to the seemingly-endless delays in the approval of OTC status for emergency contraception.  

I know I've posted this before, but here is the info for circumventing the bureaucratic stonewall:
Meanwhile, women who find themselves in need of EC can call 888-NOT-2-LATE or go to www.themorningafterpill.net.
#14 Hospital Impact submitted a post: Recent Deluge of coverage on physicians saying "I'm Sorry".  
As most of you have seen, a lot has been written recently on the "the power of apology" from physicians. This is an overdue & healthy development that could make a huge impact. It's a shame that it took data "that it pays to be honest" to get people's attention. But hey, regardless, this is better for the patient, better for the physician, and better for our healthcare system. [...]
Tony reviews some of the posts my other medbloggers, as well as a book, and some news articles.  Well done.

#15 Dr. Tony (a different Tony than the one above) provides us with a dramatic-but-true story of rescue (nothing to do with Katrina).
I don't think we pay our emergency services personnel nearly enough. These folks are true heroes. Thank you.
#16 Dr. Emer happens to have been one of the first people ever to visit Corpus Callosum (other than family and friends).  He makes a return visit with Baking 'Human Body Parts'.  One of the things I really like about medicine is that you can never say "Now I've seen it all."  Just when you think you couldn't possibly be surprised by whatever comes along next, something totally unexpected comes along.  (Note: it isn't really as bad as it sounds.)

#17 Another first-time GR participant, Ruth Schaffer, MS, submitted a nice basic science article (we should get more of these, in my opinion):  GRN163L: Drug Candidate Against Lung Adenocarcinoma.  She gives us some information about why cancer cells can divide indefinitely, and what can be done about it.  

#18 Mike, posting at Interested-Participant, brings us all some relief with news of a study that fails to find a link between cell phone use and brain cancer.  
This is obviously good news in the interim before the results of another study indicate differently, which seems to happen with regularity.
#19 Dr. Andrew MacGinnitie, posting on Dr. Andy, provides us with a good basic-->applied science post: Graft versus Leukemia.  It's all about bone marrow transplants.  He gives us some hope-inspiring news:
Oncologists are now trying to take advantage of this graft versus tumor effect and expanding it from blood cancers to solid tumors (that primarily arise from internal organs).
This is far from being ready for routine clinical use.  However, in light of the progress made in transplant medicine and oncology in the past thirty years, I suspect that we will see some significant progress here, too.

#20 Red State Moron (obviously, he's actually quite bright) chimes in with some information about VBAC: vaginal birth after a C-section.  He gives a thoughtful perspective on this controversial topic.  

#21 Medmusings ponders volunteering to help survivors of Katrina:  
What's been most convincing are the firsthand accounts of nurses at medscape's blog

Now, for some entries that I nominated myself.  

# Dr. Deborah Serani has a post that outlines psychological reactions to disaster.  She also tells us what to do about it.  

# Dr. Mark Kleiman links to a paper he wrote for the Congressional Research Service on the implications of the terrorist threat for drug policy.

#Anthony Cox, at Black Triangle, tells us about the unfortunate effects of a shortage of diamorphine in the UK.  This illustrates the enormity of the problem of opiate dependence.

# Continuing with the drug theme, Dr. Mike Lee informs us of an option for the treatment of opiate addiction: Suboxone.  Suboxone is a combination of buprenorphine hydrochloride and naloxone hydrochloride.  A similar drug, Subutex, has buprenorphine without naloxone.  Subutex also is used for treatment of chronic pain.  For many people, it is a better choice that methadone etc., although it takes a bit of expertise to prescribe it safely.  Perhaps I'll expand on this topic at some point.  Until then, see the FDA page for more information.

# Finally, I would like to introduce a group blog, put up mostly by U of Michigan med students: The Sparkgrass Community.  Sort of like CC, they tend to post about political issues that are of interest to medical folks.  Oh, and they seem a bit left of center.  And humanistic, too.  Just what the world needs...

Categories: science, medicine
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Grand Rounds #49

(Postdated to stay at top while pertinent)

Grand Rounds

OK, I got my self-imposed quota for Grand Rounds #50 submissions, and GRL will be up later tonight.  I will still accept some submissions, and tack them on as time allows.  

Not to make it seem like bribery, or anything, but I've decided that the earlier submissions will be featured earlier in Grand Rounds, which means they'll get more hits.

And once I get twenty submissions, I'll turn off that annoying NOTICE:, and get rid of the flamingo.

This is late notice, but Grand Rounds #49 was posted yesterday at Healthy Concerns. There were many interesting submissions this week. Check out the rest of the blog while you are there. Grand Rounds #50 will be here, at Corpus Callosum, the day after Labor Day, 9/6/2005. I've already started getting submissions, which I appreciate. The "deadline" is going to be 9PM Monday night. General submission guidelines are here.

Remember, non-medical people are welcome to send submissions, so long as they pertain to medicine. If you have even the slightest interest in writing a medical post, just read the submission guidelines to get an idea of what we are looking for, and possibly to generate ideas about a subject for your post.

Medical students, even the busy ones in Ann Arbor, are particularly encouraged to participate.

I plan to post a review of an essay promoting universal health coverage in the United States of America.

Posting might be less dense than usual here, as I review the submissions.  Let's keep 'em rolling in to: joseph dot j7uy5 at gmail dot com.

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Sunday, September 04, 2005


What we have seen and heard over these past few days has been horrible.  For the next twelve hours, I am going to focus on my sense of touch.  Nothing else.

Well, I did not last for twelve hours, but I did manage to relax.

Students Break Boring Dormitory Look

There's got to be some good news out there, somewhere.  Or at least, something lighthearted.  From everyone's favorite newspaper, the Montréal Gazette, we learn about this topical, fascinating subject:
Students Break Boring Dormitory Look
Sheri Block
CanWest News Service
Sunday, September 04, 2005

Laura (Lola) Carnegie is not content to live in a dorm room with bare walls, standardized book shelves and uninspiring bed linens.

The second-year student at the Southern Albert Institute of Technology (SAIT) has added a number of personal touches to her room to reflect her personality and make it feel like home.

"It's important (to decorate) because otherwise it just looks like every other apartment in the (residence) it just makes everyone love your room and want to hang out there," says Carnegie, who is studying information management at SAIT. [...]

"I've got a lot of pictures of Marilyn Monroe and Mae West because I just think they're beautiful and really stylish and I've got a lot of flowers and things like that," says Carnegie. [...]

Decorating the dreary old school residence has grown in popularity in recent years, thanks to the inspiration of the home-decorating TV show craze. [...]
We also learn that the Gazette is going to start reprinting Calvin and Hobbes!  

Elsewhere, we learn that Maclean is: the most mysterious of residence halls.

No Useful Purpose

The vast majority of judgments that people make about other people serve no useful purpose.  I find that it is very difficult to keep this in mind, but it is very important.  After all, it was a rush to judgment (indeed, the glorification of judgment)  that led to the Dark Ages.  Here is perhaps the most self-disclosing and least modest essay I've ever posted.  

It was inspired by one of my favorite sources.  

Having said that, though, there are times when judgment is appropriate.  What is important, though, is that we exercise independent judgment.  No automaticity, as they say at the UN.  

I never liked George W. Bush.  But at first, I did not judge him.  After all, he initially ran as a moderate; he positioned himself as a better moderate that the good moderate, Al Gore.  But things happened.  Tax cuts for the rich.  Increased disparity of wealth distribution.  Corporate welfare.  ("When poor people ask for government handouts, we call them bums.  When rich people ask for government handouts, we call them entrepreneurs.")  

In the first meeting of the National Security Council, the third item on the agenda was "plans for post-Saddam Iraq."  that was in February 2001.  Then 9-11.  Then Afghanistan, which nobody complained about.  Then the Downing Street Memos, vaporware WMDs, nonexistent links to terrorism.  Then Iraq, Abu Ghraib, Gitmo.  Alberto "Torture Memo" Gonzalez.  Colin Powell sacked.  Poverty goes up.  Bush boasts that home ownership is up, fails to mention that poverty and homelessness also are up.  More people go without health insurance.  Lies about Social Security.  Valerie Plame.  Black box voting.  

Now, we learn that a $250 million investment in infrastructure might have prevented our nation's worst natural disaster ever.  The pressure for tax cuts and war led to a $250 million gamble that has cost at least $10 billion, and cost thousands of lives.  

OK, I'm ready to make a judgment.

Usually, I link all the crucial facts in my argument, but this time, no links.  Look them up yourself, then make your own judgment.

Categories: armchair musings, politics
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Saturday, September 03, 2005

Saturday Brother-In-Law Blogging


Open Format Victory!

I'm working feverishly on the Grand Rounds submissions, but I just had to take a break and put this up:
Massachusetts mandates open-format docs, edges toward Linux
Sep. 01, 2005

The state of Massachusetts will revamp its digital output during the next 16 months to create only open-format documents and is increasing its use of Linux and free and open source software (FOSS) among its workers, the state's chief information officer told DesktopLinux.com Thursday in a conference call.

CIO Peter Quinn challenged Microsoft and other companies who sell software that uses proprietary document formats to consider enabling open-format options as soon as possible. Quinn said that "government is creating history at a rapidly increasing rate, and all documents we save must be accessible to everybody, without having to use 'closed' software to open them now and in the future." [...]

"Microsoft has remade the desktop world," Quinn said. "But if you've watched history, there's a slag heap of proprietary companies who have fallen by the wayside because they were stuck in their ways. Just look at the minicomputer business, for example. The world is about open standards and open source. I can't understand why anybody would want to continue making closed-format documents anymore."
[emphasis added]
I've been using OpenOffice in my own office for years, and have never had a problem with it.  I've taken documents back and forth from that office to others, alternately editing them using OpenOffice and Microsoft Word, Excel, and Powerpoint.  That has included some rather complex forms.  No problem.  

Friday, September 02, 2005

Rare Cheetahs Caught In Camera Trap

Photograph courtesy I.R. Iran DOE/CACP/WCS 

More Photos in the News


Tips For Emergency Preparedness

This one is for you, Mr. Bush.  Bloggers everywhere have been critical for the failure to plan adequately for Katrina, alleging that you basically gambled by cutting funding for civil engineering projects in order to finance the war and the tax cuts.  You saved hundreds of millions of dollars, but it ended up costing billions.  Oh well, you knew it was a gamble.

I won't bother listing all the other criticisms; Krugman did a nice job of that already.  I just hope you learn from your mistakes.  

Of the three biggest threats listed by FEMA before 9-11, two have already happened.  The remaining one is a major California earthquake.  If that happens, and the response is as poor as the response to Katrina, it will look very bad indeed.

However, there is one risk that the pre-9-11 FEMA could not have anticipated.  That is the risk of an avian influenza pandemic.  Now, we are being told that the CDC is not adequately prepared (Medscape, free registration required):
US Needs Better Quarantines to Fight Disease -- Study

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) Sept 02 - The current U.S. quarantine system does not do enough to keep out new killer diseases such as avian flu or unknown new bioterrorist threats, a panel of experts cautioned on Thursday.

They said the Centers for Disease Control and Prevention should be given broad new powers to set up and enforce quarantine stations and to monitor for imported infections.

Hundreds more people need to be trained to watch at ports of entry for people who may be carrying diseases, the Institute of Medicine Committee said.

"What happens if you get SARS or have a pandemic or a big outbreak occurs somewhere and you need a big capacity very quickly? That is going to require a lot more planning than is occurring today," Dr. Georges Benjamin, head of the American Public Health Association and chair of the committee that wrote the report, said in a telephone interview.

"They need a lot more resources to do this. This is really an insurance plan that is underfinanced and undersupported." [...]
The warnings are out there; the funding is not.  Are you ready for another gamble?  If you gamble and loose, the death toll will not be in the mere thousands.  It'll be millions.

Categories: Science, medicine, politics
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Thursday, September 01, 2005

Serendipity In Medical Discovery: Oleocanthal

We could be seeing another instance of serendipity aiding the efforts at drug development.  

There have been many instances of accidental discoveries.  One of the most famous was the observation that patients with tuberculosis, after treatment with iproniazid, sometimes became less depressed.  Subsequent investigation showed that iproniazid inhibits the action of an enzyme that breaks down several neurotransmitters, including serotonin.  This led to the development of the antidepressant monoamine oxidase inhibitors, as well as the antiparkinsonian drug, l-deprenyl.  

In the search for antimalarial drugs, antihistamines were discovered.  One class, the phenothiazines, turned out to have antipsychotic effects.  This led to the development of Thorazine.  Further work on phenothiazines led to the development of tricyclic antidepressants.  

Valproic acid (VPA), the active ingredient in Depakote, also was discovered by accident.  VPA was used as a solvent in the early studies on a drug that was being investigated as an anticonvulsant.  It turned out that similar, substantial improvement was seen in both the placebo group and the "active" drug group.  The improvement turned out to be due to the solvent, not the hoped-for drug.  

Several more examples are seen in the (PDF) document, Chance Favors the Prepared Mind, by Hugo Kubinyi.  That title alone could inspire another post, but I'll save that for later.

More recently, the Monell Chemical Senses Center has reported on a tantalizing discovery by one of its researchers, Gay Beauchamp.  Monell's press release (PDF) is here.  The full report (abstact only; subscription for full text) is in the journal Nature, and a summary is at News@Nature, here.

Extra-virgin olive oil mimics painkiller
Oil may help stave off cancer, as long as you stick to the good stuff.
31 August 2005

Good news for lovers of extra-virgin olive oil: besides being delicious on salads, it also contains a compound that mimics the effects of ibuprofen. So a Mediterranean-style diet might give you the supposed long-term benefits of that drug, such as a reduced cancer risk.

A daily dose of 50 g or 4 tablespoons of olive oil confers the equivalent of around 10% of the recommended ibuprofen dose for adult pain relief, say researchers led by Paul Breslin of the Monell Chemical Senses Center in Philadelphia, who discovered the effect. So although it won't cure a headache, it may give you some of the long-term benefits of repeated ibuprofen use, including helping to ward off Alzheimer's. [...]
There is an interesting aspect to this discovery, though.  Apparently, the folks at the Monell Chemical Senses Center have exquisite senses of taste and smell.  One of them noticed that there was a distinctive sharp taste to ibuprofen, and that the taste was similar to the sharpness found in certain kinds of olive oil.  The team was able to isolate the compound in olive oil that produces that distinct sharpness.  They named it oleocanthal: oleo=olive; canth=sting; al=aldehyde.  They synthesized pure oleocanthal and found that it has anti-inflammatory properties similar to ibuprofen, in that it inhibits the activity of COX-1 and COX-2.

At this point, nobody is claiming to have found a magical cure for anything.  However, it is interesting to find a new class of compounds that have anti-inflammatory activity.  This could help us understand the complex process of inflammation more thoroughly.  It also could help us understand at least one instance in which a food product turns out to have beneficial properties that would not be expected, based upon study of its main ingredients.

Categories: Science, medicine
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Battleground ’06: 2006 Mid-Term Election

Zogby has a good report regarding the 2006 mid-term elections, focused on the struggle for control of the US Senate:

The Democrats

The Democrats do have an excellent opportunity to pick up seats, but winning back the Senate will be the political equivalent of pitching a perfect game. The Democrats need to pick up six seats, defend three open seats, protect four vulnerable incumbents, and at least two more seats that could become competitive. All in all, it makes it a long shot for the Democrats. The Democrats start out having to defend open seats in...

The Republicans

The Republicans' goals in this election can range from minimizing losses to shooting for a veto proof majority. It will all depend on who has the momentum as the election draws closer, right now the wind is at the backs of the Democrats but that could easily change. Reaching a veto proof majority for the Republicans will be difficult, they first need to defend their two highly vulnerable incumbents in…

Unfortunately, you have to pay to get the fully reports as they conduct repeated polling.  Still, the summary indicates just how important this topic is.

Categories: politics