The Corpus Callosum

Corpus Callosum Has Gone To Seed

2006-06-09T12:00:00.000-04:00

As of now, Corpus Callosum will no longer be published on blogspot. The new location is at ScienceBlogs, sponsored by Seed Media Group, publishers of Seed Magazine.

Photo by Tennessee-Gator
Licence: Creative Commons, Attribution-NonCommercial-NoDerivs 2.0

Today's Lesson?

2006-06-08T14:45:00.000-04:00

The two big news items today are : 1) the killing of Abu Musab al-Zarqawi, and 2) the sharp decline in stock markets around the world. The two are not particularly related.

The juxtaposition of these two events creates an interesting perspective. While it is good news that Zarqawi is out of action, it is bad news that the stock markets around the world are struggling. The thing is, the good news does not have any direct effect on the quality of life here in the USA, while the bad news does have a direct domestic effect. How bad the negative effect will be remains to be seen. I'm not arguing that the economic news is dire; rather, I am saying that this juxtaposition of events may highlight the relative importance of the two. It is going to be hard for people to care about an incremental improvement in Iraq, when their own retirement funds are going in the tank.

"They Must Actually Take Their Medication"

2006-06-08T02:10:00.000-04:00

A new report indicates that treatment with calcium and vitamin D might actually reduce the incidence of hip fractures. This appears to contradict some other studies that were reported widely in the popular media.

Dr. Boonen presented results of a meta-analysis of major randomized placebo-controlled trials that analyzed the effects of vitamin D alone or in combination with calcium. The meta-analysis found that in patients getting 800 units of vitamin D and more than 1,000 mg of calcium a day, there was a 21% reduction in risk of fracture compared to placebo.

The new report was a meta-analysis, meaning that the authors pooled the results of several studies. As seen in Wikipedia:

In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. The first meta-analysis was performed by Karl Pearson in 1904, in an attempt to overcome the problem of reduced statistical power in studies with small sample sizes; analyzing the results from a group of studies can allow more accurate data analysis.

To give an idea of why the meta-analysis might be more valid than the other studies, the authors point out:

For one thing, he said, neither study had enough statistical power to find an effect. For instance, he said, the RECORD trial, looking at hip fractures, had 2,649 participants and only 93 events. By contrast, Dr. Boonen said, he and his colleagues had a patient pool of 16,978 individuals and 812 fractures.

I'm not sophisticated enough with statistics to be able to give an opinion of the validity of this particular analysis, and the report I am citing here has not yet been subjected to peer review. Therefore, the results are to be considered to be preliminary.

What is interesting is the list of reasons given, for why the meta-analysis gives results that are different than the previously-reported studies. It turns out that the positive effect is seen only in those patients who actually had a deficiency of either calcium or vitamin D. If the patient's regular diet provides enough of those nutrients, there is no effect from supplements. Some patients in the studies did not take doses that were high enough. Some did not take both the calcium and the vitamin D. Also, the prior reports included in the analysis patients who did not actually take the supplements at all:

Dr. Boonen told reporters after his presentation that clinicians need to pay attention to four factors. They must prescribe a combination of calcium and vitamin D, the doses must be high enough, the patients must be in need of the supplements, and finally they must actually take their medication.

It seems kind of obvious to say that the patients actually have to take the supplements in order to see an effect, but in daily practice, noncompliance turns out to be a common problem. Sometimes the factors that seem too obvious to even consider, are the ones that turn out to be important.

Is This One For Real?

2006-06-05T01:09:00.000-04:00

The LA Times (free registration required) has an article on the possibility of a shortage of physicians in the USA:

Physician Shortage Looms, Risking a Crisis, as Demand for Care Explodes
An aging America needs more doctors, but supply isn't keeping up. Experts fear worsening quality and dangerously long waits for appointments.
By Lisa Girion, Times Staff Writer
June 4, 2006

A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.

Twelve states — including California, Texas and Florida — report some physician shortages now or expect them within a few years. Across the country, patients are experiencing or soon will face shortages in at least a dozen physician specialties, including cardiology and radiology and several pediatric and surgical subspecialties.

The shortages are putting pressure on medical schools to boost enrollment, and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25% of the white-coated workforce.

But it may be too late to head off havoc for at least the next decade, experts say, given the long lead time to train surgeons and other specialists. [...]

The biggest issue there is the funding for medical training. It is incredibly expensive to train physicians. I recall that when I was in medical school, and students were complaining about double-digit increases in tuition, one of the administrators told us that our tuition only covered about one-third of the actual cost of training. As an historical aside:

When the Medical School first opened in 1850, students paid only a $10 registration or matriculation fee.

By 1891, the matriculation fee was $10 for Michigan residents and $25 for students from out of state. Over the next 50 years, tuition rose slowly until it was $250 in 1940. In the early part of the twentieth century, students were required to pay laboratory and demonstration fees totaling $136 over the four years. None of this takes into account room and board. The average cost of room and board in 1893 was $3-$5 a week; 1931: $12-15 a week. In 2003, tuition and fees for Michigan residents were $20,526 (out of state, $31,526) and estimated living expenses were $20,300 a year. Currently, the average student debt for someone receiving an M.D. degree from the University of Michigan is close to $100,000.

Medical schools are allowed to charge more for services, based upon the recognition of the fact that training costs are high. But the federal government has balked at these higher fees, so there have been caps. This debatable policy has made it more difficult for medical schools to expand enrollment.

There have been dire warnings of physician shortages before, but this time it seems more credible to me. The key factor is the fact that the average age of the US population is increasing. Obviously, older people require more doctoring than younger people. But there is another factor:

At the same time, younger male physicians and women — who constitute half of all medical students — are less inclined to work the slavish hours that long typified the profession. As a result, the next generation of physicians is expected to be 10% less productive, Edward Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies, told a congressional committee in May.

I expect that the trend toward fewer work hours will bring up some controversy, and possibly some resentment. Some physicians will be negatively judgmental about those who choose to work fewer hours. Others will face pressures to delay their retirement. At the same time, it will be increasingly difficult for physicians to keep up-to-date with their skills and knowledge base. Every hour spent on continuing education is an hour that is not devoted to patient care. There is a risk that the demand for more patient-care hours could lead to doctors devoting less time to continuing education, which obviously would have a detrimental effect on quality.

It seems likely that the prediction of a shortage of physicians is accurate. That will pose new challenges for physicians, in terms of managing stress. It occurs to me as I write this, that it may be desirable to make a point of educating medical students about these pressures, and how to deal with them. As soon as I figure out how to deal with them, I will post that information here.

What To Do On 6/6/6

2006-06-04T17:01:00.000-04:00

There is still time to make your plans:

Hell plans devil of a time on 6/6/06

June 4, 2006

HELL, Mich. -- They're planning a hot time in Hell on Tuesday.

The day bears the date 6/6/06 -- abbreviated as 666, it is the "number of the beast" according to the Bible's Book of Revelation, often linked to the devil or the Antichrist.

And there's not a snowball's chance in Hell the day will go unnoticed in the unincorporated hamlet 60 miles west of Detroit.

Nobody seems more fired up than John Colone, the town's self-styled mayor and owner of a souvenir shop.

''I've got '666' T-shirts and mugs. I'm only ordering 666 so once they're gone, that's it,'' said Colone, also known as Odum Plenty. ''Everyone who comes will get a letter of authenticity saying you've celebrated June 6, 2006, in Hell.''

Not all 'Hell-billies' happy

Most of Colone's wares will sell for $6.66, including deeds to one square inch of Hell.

Mike ''Smitty'' Hickey, owner of Dam Site Inn, wasn't sure what kind of clientele would show up Tuesday.

''I don't think we're going to get the cult crowd, the devil worshippers or anything like that,'' Hickey said.

Jason LeTeff, one of the town's 72 year-round residents -- or, as the mayor calls them, Hellions or Hell-billies, wasn't enthused.

''Now, here I am living in Hell, taking my kids to church and trying to teach them the right things and the town where we live is having a 6-6-6 party,'' he said.

More information on Hell, here.

War on Science Update

2006-06-04T12:51:00.000-04:00

Seed Magazine, the originator of the web's largest conversation about science, has an editorial: The American War on Science. There have been many such articles lately, but this one is different. It examines the logistical aspect of the war. By that, I mean that the author, Christopher Mims, discusses the complex issues involved in the supply of scientists, mathematicians, and engineers in the USA.

It is possible that American students' accelerating disinterest in science and engineering, coupled with a dwindling supply of foreign replacements, would set up a Peak Oil-type scenario in the US, where demand for these workers continues to grow while supply plateaus and then dwindles.

There is another issue that is peripherally related to this: The Undercover Activist Blog, a blog that allows public employees to post anonymous criticisms of their agencies and governmental activities, has posted some new information (1 2) about the industry push to get controversial pesticides approved by the FDA.

EPA scientists protest pending pesticide approvals

In a PEER-released May 24th letter to the U.S. Environmental Protection Agency, leaders from three unions representing 9,000 scientists, risk managers and other specialists are publicly objecting to imminent agency approval for a score of powerful, controversial pesticides.

The letter is in reference to an August 3, 2006 deadline for the EPA to issue final tolerance approval for 20 organophosphate and carbamate pesticides. The scientists cite “compelling evidence” which EPA leadership is choosing to ignore that these “pesticides damage the developing nervous systems of fetuses, infants and children.”

Today’s Wall Street Journal article (subscription) broke the story and cites political pressure by agency managers and pesticide-industry officials to allow the continued use of a family of pesticides that might be harmful to children, infants and fetuses. The letter asks EPA Administrator Stephen Johnson to either adopt maximum exposure protections for these agents or take them off the market.

It seems ironic that persons who advocate for a "culture of life" would want to make it legal to poison fetuses. Of course, no one is saying that these pesticides actually kill fetuses, just that they damage their brains. The real irony is that it is going to be a lot harder to keep up the supply of scientists and science teachers, if we poison their developing brains.

Cheslea Painters Art Show

2006-06-03T17:52:00.000-04:00

In Chelsea, Michigan, the Chelsea Painters are having their annual art fair. It is closed for today, but will be up again tomorrow from 10 AM to 5 PM.

It's on the grounds of Chelsea Community Hospital (map), about 20 miles west of Ann Arbor.

A Skeptic's View of "Viagra for Diabetic Women"

2006-06-02T01:34:00.000-04:00

OK, this synopsis does not contain much actual information; certainly, not enough to be useful as a basis for medical decisions. But it does provide an example to illustrate the process of skeptical thinking. It's from Medscape News (free registration required -- but it's worth the hassle).

Sildenafil May Improve Sexual Functioning in Diabetic Women

NEW YORK (Reuters Health) May 31 - Premenopausal women with type 1 diabetes with sexual dysfunction may find that sildenafil improves arousal, orgasm and sexual enjoyment and decreases pain during intercourse, results of a small pilot study suggest. [...]

To test their theory, they recruited 32 women with type 1 diabetes who in the past had experienced normal sexual desire within their heterosexual relationship, but currently experienced sexual dysfunction -- for 3.5 years on average. [...]

Sildenafil was associated with significantly improved arousal, orgasm, and enjoyment compared with baseline (p < 0.001 for each). Compared with placebo, the experience of arousal (p < 0.01) and orgasm (p < 0.05) were better during active treatment. Only desire and frequency did not change significantly in either group. [...]

Note: sildenafil is the generic name for Viagra.

The original study can be found here, but you need subscription-level access or a bunch of money (that you have no other use for) in order to read the text.

There are a couple of points that one needs to consider in interpreting a study such as this. First, as a general rule, one should not make medical decisions based upon small studies that are identified as pilot studies. Doing so, one is likely to expose patients to risks that have not been justified by sufficient research.

Second, it is important to examine critically the outcome measures used in the study. Specifically, it is necessary to look beyond the measures of statistical significance. The statistics in this study look reasonably impressive, at first glance. However, those numbers do not tell you what you really want to know. Remember, statistical significance does not necessarily translate into clinical significance.

So let's look at the numbers:

Sexual activity	Baseline	Sildenafil	Placebo	P^a	P ^b	P ^c
Desire	4 ± 1.3	3.9 ± 0.5	4.1 ± 0.6	NS	NS	NS
Arousal	2.9 ± 1.2	3.7 ± 0.5	3.2 ± 0.3	<.01	NS	<.001
Orgasm	2.8 ± 1.4	3.8 ± 0.8	3.1 ± 0.6	<.05	NS	<.001
Enjoyment	3.5 ± 1.1	4 ± 0.5	3.7 ± 0.6	NS	NS	<.001
Satisfied by frequency	3 ± 1.1	3.2 ± 0.7	3.1 ± 0.4	NS	NS	NS
Frequency of intercourse	1.8 ± 1	2.3 ± 0.5	2.4 ± 0.6	NS	<.05	<.05
Frequency of fantasies	2.1 ± 0.8	2.3 ± 0.4	2.2 ± 0.6	NS	NS	NS
Dyspareunia	2.3 ± 1.1	1.4 ± 0.8	2 ± 0.7	<.05	NS	<.05

a Sildenafil vs. placebo.
b Placebo vs. baseline.
c Sildenafil vs. baseline.

Qualitative items were answered on a 5-point Likert scale, ranging from 1, not at all, to 5, a great deal. Quantitative items were answered as 0, never; 1, less than once a week; 2, once or twice a week; 3, several times a week; 4, once a day/sometimes twice; and 5, several times a day.

To be fair, the authors of the paper are cautious about interpreting the numbers. They include all the appropriate cautions and limitations. My concern is that a newspaper could easily pick up this story and print the high points, leading to a great deal of misinterpretation among the general public.

When I get around to it, I'll put up another post with my interpretation of the numbers. In the meantime medical students and interested readers are encouraged to look at the data and think about what conclusions may be justified by the numbers.

Depending on when I do get around to it, and when the new Seedlings go live, the follow-up post may be here, or it may be at http://www.scienceblogs.com/corpuscallosum (which is not up as of this writing).

Climate Change Affects Blogs

2006-06-01T15:58:00.000-04:00

Due to the unseasonably hot weather, Corpus Callosum will not be going to Seed tomorrow. The ScienceBlog meteoblogologists inform me that they expect the new Seedlings to sprout in 10 days or less. So all those good ideas I've been saving will have to wait.

The Effect of Caffeine on Web Design

2006-05-29T14:58:00.000-04:00

From Wikipedia:

Caffeine has a significant effect on spiders,
which is reflected in their web construction.

The question is, does this apply to humans as well? After all, humans engage in web design, so it should be possible to do a direct comparison.

Here is the structure of a web site designed by a person who is not impaired at all. Here's the information about it:

Image: created by Websites as Graphics.

KEY: What do these colored dots mean?
blue: for links (the A tag)
red: for tables (TABLE, TR and TD tags)
green: for the DIV tag
violet: for images (the IMG tag)
yellow: for forms (FORM, INPUT, TEXTAREA, SELECT and OPTION tags)
orange: for linebreaks and blockquotes (BR, P, and BLOCKQUOTE tags)
black: the HTML tag, the root node
gray: all other tags

Now, what happens if a person makes a web site while drinking too much Starbucks?

Again, from Wikipedia:

Too much caffeine, especially over an extended period of time, can lead to a number of physical and mental conditions. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) states: "The 4 caffeine-induced psychiatric disorders include caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified (NOS)."

An overdose of caffeine can result in a state termed caffeine intoxication or caffeine poisoning. Its symptoms are both physiological and psychological. Symptoms of caffeine intoxication include: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, muscle twitching, rambling flow of thought and speech, paranoia, cardiac arrhythmia or tachycardia, and psychomotor agitation, gastrointestinal complaints, increased blood pressure, rapid pulse, vasoconstriction (tightening or constricting of superficial blood vessels) sometimes resulting in cold hands or fingers, increased amounts of fatty acids in the blood, and an increased production of gastric acid. In extreme cases mania, depression, lapses in judgment, disorientation, loss of social inhibition, delusions, hallucinations and psychosis may occur.^[13]

When DSM-V is published, it will expand the list of symptoms of caffeine intoxication:

Excessive use of unordered lists and bullet points
Gross failure to comply with social norms of HTML coding
Implusive, pointless linking from one post to another
Pathological refusal to use tags only for their intended purpose

This is a good illustration of an important point reagrding the categorization of medical conditions (nosology). When the expectations and demands of society change, we have to revise our system of diagnosing mental illness.

HT: Hedwig the Owl, et alia.

Update: there are over 400 websites-as-graphs on Flickr.

Generic Escitalopram

2006-05-28T23:53:00.000-04:00

This is not really big news, but it makes me stop and think. Escitalopram has been approved in generic form (5, 10, 20mg tabs, 5mg/5ml solution). Previously, it could only be obtained as the branded product, Lexapro. As of today, that leaves only one selective serotonin reuptake inhibitor (SSRI) with patent protection: Zoloft (sertraline). Zoloft is going off patent in June 2006.

I'm still not entirely sure when generic sertraline will be available. There has been a lot of convoluted legal wrangling over the subject, a discussed in this court ruling (82 KB PDF). When it does occur, though, there will be no SSRIs under patent protection. Effexor (venlafaxine) and Cymbalta (duloxetine) will be the only popular antidepressants that are patented. (The Emsam (selegiline) patch was approved recently, but it remains to be seen how popular it will turn out to be.)

For many years, antidepressants have been a major contributor to the cost of prescription drug insurance coverage. Clearly, that is changing.

I suppose we can all expect our insurance to get cheaper now.

On the Recursive Nature of Pride

2006-05-28T19:40:00.000-04:00

Pride is one of the seven deadly sins. The others are greed and sloth and a few others I can't remember. Pride is the one I remember best, because of its curious mathematical properties. Things with unexpected properties are easier to remember than ordinary things like greed and sloth and so forth.

The thing about pride is this: once a person becomes aware of it, he or she tends to recognize that it is a sin. That person then takes steps to banish the pride. Then the person is proud for having banished the sin, thus becoming a paragon of virtue. Rather naturally, the person then realizes that excessive pride in one's own virtue is itself a sin. Then the whole thing starts over again.

Some people do manage to get little bit wiser with each iteration. Others do not.

I have never been able to figure out what makes the difference. Nor have I been able to find an objective way to determine if I am one of the ones who is getting wiser.

New Banner

2006-05-28T13:55:00.000-04:00

Getting ready for the transition to ScienceBlogs, I've gone ahead an designed a new banner. (I had help with the techincal aspects, but the design was my idea.) I'm a little worried that they are redesigning the layout, so it is possible that the size will be wrong or the colors won't match, but I decided to do it anyway. It should be simple enough to change, if that turns out to be necessary.

The image on the left is a macro photo of an Intel 486-DX2 processor; the image on the right is an illustration from the 1918 edition of Gray's Anatomy. Both are in the public domain. I found the images on Wikipedia. The text is in a font known as Ringbearer, which I downloaded from a free font site. I suppose I should mention the site, but I can't recall the name of the site. If you search for "Ringbearer font" you will find several sites that have it.

The banner was made using GIMP, the Gnu Image Processor, which is an open-source program. Although it started as a Linux program, there are version for Mac and Windows.

Using GIMP on a Mac, image from the GIMP.org site.

Knoppix Screenshots

2006-05-27T21:26:00.000-04:00

These are pictures of Knoppix, a kind of Linux, in use. See the previous post for the context. The images are from the O'Reilly site, OSDir.com.

Knoppix, showing the browser. Firefox is also available, but not shown here.

With Knoppix, you click on the lower-left icon to open the main menu, as shown.

Accelerated Knoppix

2006-05-27T21:05:00.000-04:00

I know I've written about this before, so if you've read one of my prior posts on the topic, or if you already are familiar with the concept of a live CD, just skip to the bottom line for the info that is specific to Accelerated Knoppix.

    We affirm that the world's magnificence
    has been enriched by a new beauty:
    the beauty of speed.

Filippo Tommaso Marinetti - Manifesto of Futurism -

That quote is on the homepage for the Accelerated Knoppix project. What that means is that computer users can boot from the CD and get a complete operating system and a complex set of applications, ready to use. It boots if the hard drive has crashed. It even boots if there is no hard drive in the computer at all.

There are several uses for a live CD. Probably the most obvious is that it enables a user to try an operating system or an application without having to install the application on the hard drive. So if you've never used Linux before, and want to give it a try, you can use alive CD to try it out, with minimal effort, and with no risk of messing anything up. Or, if you've heard about OpenOffice -- the free alternative to Microsoft Office -- and want to see if it really will open your Word documents, and see if it really is as easy to use as Microsoft Word, you can do so easily.

Another use for a live CD is for emergency use. If your computer crashes and you HAVE TO check your email, you can do it quickly with a live CD. (It can't configure a dial-up connection automatically, but it can and will recognize and use a broadband or ethernet connection without specific user intervention.) Likewise, if your system won't boot, you might be able to recover data using a live CD.

A more obscure use of a live CD could be to use it for anonymous browsing. lxnay dEsigN is planning to develop a live CD (actually a DVD) that uses TOR servers to obscure your internet usage. Plus, being on an unwritable medium, there would be no cookies, no browsing history, or other traces that could be recovered later.

Finally, some folks have used Knoppix to figure out how to configure their Linux systems. I've done that myself. When I was first learning to do intermediate-level configuration, I somehow messed up my XF86Config file (one of the files that says "Please do not edit this file" at the top.) I booted from Knoppix and saw how Knoppix autoconfigured the file, saved it to a USB flash drive, and fixed the problem that way.

By the way, there are live CD's for operating systems other than Linux. I've never used any of them, though.

The bottom line: one disadvantage of a live CD is that it can take a couple of minutes to boot. Accelerated Knoppix uses a new technology to speed up the boot process. I did not time it, but it seemed to boot in less than a minute.

In the spirit of open-source software, the developers of Acclerated Linux have made available their "LCAT" (Live CD Acceleration Toolkit). If you want to convert your favorite Live CD distro to an accelerated version.

The one trick to this distribution is that the default language is Japanese. In order to get English menus, you have to type

Knoppix
lang=US

when it first starts.

So, I will now keep a copy of this at home and at my various offices, just for emergency recovery.

No New Taxes...

2006-05-27T14:34:00.000-04:00

...except on people who are not very influential.

It was publicized pretty well, when the Administration increased taxes on teenagers. This has been discussed elsewhere, so I won't go into it very much. I just learned, however, that there has been another tax increase, again affecting Americans who have little influence. And like the one that affects teenagers saving for college, this one could have serious negative consequences.

U.S. tax law sends expatriates reeling
By Keith Bradsher and David Cay Johnston
The New York Times

FRIDAY, MAY 26, 2006

HONG KONG The sudden, and retroactive, imposition by the U.S. Congress last week of much higher taxes on Americans living abroad has left individuals and companies scrambling to regroup, while many executives and entrepreneurs assert that the move could backfire by hurting U.S. business interests at home and abroad.

The $69 billion tax cut signed into law May 17 raises taxes on Americans living overseas by $2.1 billion over the coming decade. [...]

To put this in perspective, consider that the additional revenue represents the cost of only a two weeks of fighting the war in Iraq (which does not include reconstruction costs). If it hurts international trade, it obviously wouldn't be worth it.

Note that this increase is not only a violation of one of Bush's campaign pledges, but it also increases the complexity of the tax code:

Last year the law allowed most overseas Americans to exclude $80,000 of foreign earned income from income taxed in the United States. The new law adjusts the exclusion for inflation to $82,400, but it raises taxes by adding complex new provisions on how the exclusion is calculated.

Oddly, this article shows up on the International Herald Tribune site, but not on the New York Times website, despite the fact that it was written by NYT reporters.

War On Science Update

2006-05-27T02:09:00.000-04:00

I can't tell you how glad I am to see this:

In Speech to Medical Graduates, Bloomberg Diverges From G.O.P. Line
By DIANE CARDWELL
Published: May 26, 2006

Distancing himself from national Republicans and the Bush administration, Mayor Michael R. Bloomberg yesterday urged an end to the political manipulation of science, which he said had been used to discredit the threat of global warming and undermine medical advancements in areas like stem-cell research.

In a speech to graduating students of Johns Hopkins University School of Medicine in Baltimore, Mr. Bloomberg railed against what he sees as ideologically motivated arguments that have fueled debate over hot-button issues like teaching evolution in public schools and the Terri Schiavo case.

"Today, we are seeing hundreds of years of scientific discovery being challenged by people who simply disregard facts that don't happen to agree with their agenda," Mr. Bloomberg said. "Some call it pseudoscience, others call it faith-based science, but when you notice where this negligence tends to take place, you might as well call it 'political science.' " [...]

Bloomberg only cited global warming, stem cells, Terri Schiavo, and Intelligent Design. There is a lot more that he could have mentioned, but I am sure the new graduates appreciate the fact that he didn't go on at encyclopedic length.

In his speech, Bloomberg clearly acknowledged the systematic nature of the war on science.

From time to time, I have wondered, momentarily, if scientists are defensive about their field, imagining they are under attack, much as a subset of conservative Christians feel there is a war on Christmas. I never think that for more than a few seconds, though.

At other times, I wonder why scientists worry about the war on science. After all, science will endure. Presidents come and go, religions come and go, but science marches on. Surely scientists can find other things to work on, at those times that petty power struggles give rise to temporary impediments. Then, when the heat dies down, they can get back to whatever it was that the politicians or theocrats were meddling in.

But then I remember that science is actually important, now.

Nature is Full of Surprises

2006-05-25T23:45:00.000-04:00

From Nature News, we hear of another twist in the story of inheritance:

Mutant mice challenge rules of genetic inheritance
DNA's cousin, RNA, may also pass information down the generations.

Helen Pearson

In a discovery that rips up the rulebook of genetics, researchers in France have shown that RNA, rather than its more famous cousin DNA, might be able to ferry information from one generation of mice to the next.

DNA has long been credited with the job of passing traits from parent to child. Sperm and egg deliver that DNA to the embryo, where it ultimately decides much of our looks and personality.

The new study in Nature1 thrusts RNA, DNA's sidekick, into the limelight. It suggests that sperm and eggs of mammals, perhaps including humans, can carry a cargo of RNA molecules into the embryo - and that these can change that generation and subsequent ones.

"It's a very exciting possibility," says Emma Whitelaw who studies patterns of inheritance at Queensland Institute of Medical Research in Brisbane, Australia. "DNA is certainly not all you inherit from your parents." [...]

We already knew that mitochondrial DNA could play a role, albeit a small
role, in the process of inheritance.

Spotty mice flout genetics laws, on the BBC site, is another article on the same topic. The Washington Post has a version, here.

When I hear of things like this, I am reminded of how little we know about the details of the functioning of even fairly simple processes in biology. Think about inheritance, which is the transfer of a defined set of information. Then think about the operation of the human brain, which has something like 10¹⁵ synaptic connections.

Now, I am going to write something very un-scientific.

Proponents of Intelligent Design might look at the subtleties of inheritance, or the vast complexity of the brain, and take those observations as evidence for their proposition. As far as I can tell, though, their only argument is that the origin of species via evolution just doesn't seem right; it doesn't mesh with their intuition. My intuition apparently works differently. What I see is that scientists start out with a bunch of complex, seemingly-inexplicable phenomena, then one by one, make discoveries that explain more and more of what previously was inexplicable. What my intuition tells me is that, eventually, science will come up with mundane (complex, perhaps, but still mundane) explanations for an ever-increasing percentage of things that formerly were awe-inspiring. From that, I conclude that the mere existence of seemingly-miraculous things can only be taken as evidence of limitation in our knowledge and understanding. It does not mean anything more.

Nice Picture

2006-05-25T00:44:00.000-04:00

This is a smoke plume from a volcano in the Aleutian Islands, as photographed from the International Space Station; it's from the NASA Earth Observatory site.

Astronaut photograph ISS013-E-24184 was acquired May 23, 2006, with a Kodak 760C digital camera using an 800 mm lens, and is provided by the ISS Crew Earth Observations experiment and the Image Science & Analysis Group, Johnson Space Center. The image in this article has been cropped and enhanced to improve contrast. Lens artifacts have been removed. The International Space Station Program supports the laboratory to help astronauts take pictures of Earth that will be of the greatest value to scientists and the public, and to make those images freely available on the Internet. Additional images taken by astronauts and cosmonauts can be viewed at the NASA/JSC Gateway to Astronaut Photography of Earth.

Penguin Power

2006-05-24T19:46:00.000-04:00

After messing around with XGL -- the most advanced graphical user interface there is for a computer operating system, I've now been using a much older and simpler interface: FVWM. What is FVWM? The answer, from their FAQ:

1.1 What does FVWM stand for?

A: "Fill_in_the_blank_with_whatever_f_word_you_like_
 at_the_time Virtual Window Manager". Rob Nation 
 (the original Author of FVWM, doesn't really remember 
 what the F stood for originally ...

I suppose that one tires of all the fancy do-dads after a while. Or maybe it is just a desire for something different. After all, different things always have a certain appeal.

Speaking of that appeal, it has been determined that we now have a "new" species of penguin:

The eyebrows have it for new penguin species
By John Lichfield in Paris
Published: 24 May 2006

In a world full of disappearing or threatened species, here is some good news at last. The planet is about to welcome a new species of penguin.

The birds - a few thousand small penguins on the French islands of Amsterdam and St Paul in the southern Indian Ocean - resemble millions of rockhopper penguins found all around the northern fringe of the Antarctic.

And thanks to the stubborn research of a French ornithologist, they have been declared a species in their own right.

Pierre Jouventin, scientist and film-maker and one of the world's foremost experts on penguins, first claimed that the Amsterdam and St Paul rockhoppers were a separate species 25 years ago. [...]

His claims were dismissed by other ornithologists. Now, two years before his retirement, Mr Jouventin, 63, has been vindicated. In a forthcoming article in the magazine Molecular Ecology he will reveal DNA tests which show that the Amsterdam and St Paul rockhoppers are a distinct species. [...]

Eudyptes moseleyi

This is a nice illustration of the power of close observation, combined with a little intuition, and a lot of perseverance.

Grand Rounds 2:35 is Up

2006-05-24T01:04:00.000-04:00

Dr. Emer has posted the latest Grand Rounds. He even came up with a nifty logo for it. As always, he has a nice layout/design.

At first, I was going to list a few posts that I found particularly interesting, but that proved to be too difficult. I will say that it is good to see nonmedical persons participating.

Update: shortly after posting this, I realized that Coturnix has the new Tangled Bank up.

This is an astonishing array of science writing; I find it inspiring. In fact, it is almost enough to make me wish I had become a real scientist.

XGL Eyecandy

2006-05-23T00:21:00.000-04:00

I do think that XGL has promise, but it needs a few things. First, it has to be more stable. With it, I cannot run Firefox in KDE, unless I run it as root, which I am loathe to do; or, unless I open another session and use Gnome or FVWM. Also, ideally, it would be possible to customize mouse gestures, so that awkward keyboard commands are not necessary.

I must say that the performance is decent. I expected the system to be more sluggish, but any decrement is not noticeable.

Some of the commands really are useless, such as the "rain" command:

I suppose there is a use: it shows a potential that somebody, some day, might find a real use for. But why would I want the effect of raindrops splashing on the screen?

Also, I cannot resist this comment. Everyone keeps referring to the "cube." It is not a cube. (Unless you have a square monitor.) It is a square cuboid: The top and bottom are square, but the sides are non-square rectangles.

Huh? Botox for Depression?

2006-05-21T00:38:00.000-04:00

Medscape News has an interesting item: Botox Injections May Be Useful for Major Depression (free registration required).

Botox Injections May Be Useful for Major Depression
Laurie Barclay, MD

May 16, 2006 — Botulinum toxin A injections can treat major depression, according to the results of a small case series reported in the May issue of Dermatologic Surgery.

"Major depression is a common and serious disease that may be resistant to routine pharmacologic and psychotherapeutic treatment approaches," write Eric Finzi, MD, PhD, and Erik A. Wasserman, PhD, from Dermatology and Cosmetic Surgery Associates in Greenbelt, Maryland, and Chevy Chase Cosmetic Center in Maryland. "There is a body of evidence that suggests that the facial expression of emotion may play a causal role in the subjective experience of emotion. We initiated a small open pilot trial to determine whether inhibiting the expression of facial frowning commonly associated with depression could help ameliorate depressive symptoms."

This was an extremely small study, involving only ten patients, without, and with double- or single-blind condition. That means that it is not possible to draw any valid conclusions, other that to say that a larger, double-blind, placebo-controlled study might be worthwhile.

The idea is not without precedent. It is known that people with anxiety tend to be overly vigilant concerning somatic symptoms that are correlated with anxiety. When they notice such symptoms, it tends to increase their anxiety, which increases the symptoms: a classic positive feedback loop. Sometimes, patients with anxiety disorders can learn to interrupt the feedback loop, resulting in clinical improvement. As far as I know, nobody has tried anything like that with mood disorders, until now.

A total of 10 patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for ongoing major depression refractory to pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory II (BDI-II) before receiving botulinum toxin A to their glabellar frown lines.

Two months later, all patients were reevaluated clinically and with the BDI-II. Nine of 10 patients were no longer depressed, and the 10th patient had an improvement in mood.

"These findings are very promising and show that Botox has the ability to work in ways we don't expect," Alastair Carruthers, MD, president-elect of the American Society for Dermatologic Surgery and head of Carruthers Dermatology in Vancouver, British Columbia, Canada, says in a news release.

Personally, I would be astonished if this turned out to work in a large, randomized, double-blind, placebo-controlled study. On the other hand, it would be pretty neat if it did work. What is more likely is that it either will not pan out at all; or it will turn out to be of great benefit to a few people, partial benefit to a few more, and no benefit to everyone else. Even so, stranger things have happened. The first discovery of antidepressant medication occurred when an antitubercular antibiotic, iproniazid, was found to relieve melancholia in patients being treated for tuberculosis.

None of this indicates that Botox is likely to work for treatment of depression, but it shows that it is, at least, remotely possible.

Update: The Washington Post picked up the story, and has a testimonial from one patient. From a scientific standpoint, one testimonial is meaningless. What it does do, though, is give you an idea of what the experience is like from the patient's point of view.

Serotonin and Depression: A Disconnect

2006-05-20T18:48:00.000-04:00

This is sort of a follow-up to a recent post, in which I discussed the correlation between administration of fluoxetine, and neurogenesis in the hippocampus. In that post, I mentioned that skeptics of psychopharmacology are fond of pointing out the lack of a well-defined connection between the inhibition of serotonin reuptake, and the clinical effects of the serotonin reuptake inhibitors.

The hypothesis that there is a connection between serotonin and depression is a refinement of the monoamine hypothesis of depression. That hypothesis states that there may be a connection between relative underactivity of brain monoamines (serotonin, norepinepherine, dopamine) and depression. It is an old idea, derived in part from studies such as this one: Antagonism to reserpine induced depression by imipramine, related psychoactive drugs, and some autonomic agents. Sigg EB, Gyermek L, Hill RT. Psychopharmacologia. 1965 Feb 15;7(2):144-9.

Obviously, we have learned a lot since 1965, so the monoamine hypothesis is significant mainly as an historical relic. Even the refinement -- the serotonin hypothesis -- is ancient. Since then, ample evidence has been found, showing that the serotonin hypothesis is, at best, a gross oversimplification. There is no strict correlation between serotonin activity and any defined mental illness.

The lack of a strict correlation means that the action of antidepressant medication is not fully understood; nobody I know will dispute that. But the thing is, harping on that string is pointless. It is like pointing out that there is not a strict correlation between the noise of an automobile engine, and the motion of he automobile. It is true that sometimes an automobile moves without the engine making noise; and sometimes the engine makes noise without moving. Sometimes there is a significant lag between the time the engine starts making noise, and the time the automobile starts to move. With the correct instruments, it would even be possible to show that none of the energy that goes into the production of noise has anything to do with the movement of the automobile. True, all of it. But can we conclude that there is no connection between the noise of the automobile, and the motion?

Perhaps the serotonin boost is not at all related to the clinical effect. It could be an epiphenomenon. Physicians generally know about epiphenomena, and are cautious about overinterpreting them. Pointing out the fact, that there is not necessarily a causal connection, is tiresome. Thus, when a skeptic takes pains to point it out, it merely shows that the skeptic is not aware of how obvious it is to medically-educated people.

As an aside, it occurs to me that epiphenomena are roughly analogous to spandrels. If I felt like getting tediously philosophical, I could write a post outlining that analogy. Another time, perhaps. (A hint: just as a feature that evolves as a spandrel can turn out to be useful, sometimes side effects of mediation can be useful.)

Sometimes it is difficult to avoid getting tediously philosophical. Oh well. It occurs to me also that this is an example of how a good understanding of evolutionary theory can be helpful in understanding medicine, as Orac is fond of pointing out. (As is my former residency director, Randy Nesse.) This is true regardless of whether you believe that evolution is responsible for the origin of species.

Putting that aside aside, and getting back to the point: Because it is tiresome to hear skeptics harp on that string (the lack of a fully-delineated connection between serotonin and depression) I was surprised to see this article in a well-regarded journal:
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature, by Jeffrey R. Lacasse and Jonathan Leo.

Illustration: Margaret Shear, Public Library of Science

I was surprised to see this, because it is, to me, a new twist on the old theme. The authors do not imply that antidepressant medication does not work; nor do they argue that psychopharmacology is suspect.

To equate the impressive recent achievements of neuroscience with support for the serotonin hypothesis is a mistake.

Rather, they argue that it is inappropriate for pharmaceutical companies to base advertising campaigns upon the presumed link between serotonin and depression.

In the US, the FDA monitors and regulates DTCA. The FDA requires that advertisements “cannot be false or misleading” and “must present information that is not inconsistent with the product label” [27]. Pharmaceutical companies that disseminate advertising incompatible with these requirements can receive warning letters and can be sanctioned. The Irish equivalent of the FDA, the Irish Medical Board, recently banned GlaxoSmithKline from claiming that paroxetine corrects a chemical imbalance even in their patient information leaflets [29]. Should the FDA take similar action against consumer advertisements of SSRIs?

Curiously, the authors devote several paragraphs to debunking the serotonin hypothesis, even though, in my opinion, their purpose could have been served with one or two citations. What is even more curious is that they do not go on to draw a specific conclusion that answers the question they pose: they never answer directly the question about whether the FDA should take action against the pharmaceutical companies that refer to the serotonin hypothesis in their advertisements.

In fact, they do make a good case against the pharmaceutical companies, and I happen to agree. It appears to be true, based upon their argument, that pharmaceutical companies are not following FDA regulations regarding DTC advertisements. Moreover, the authors make several other good points, such as this one:

Patients who are convinced they are suffering from a neurotransmitter defect are likely to request a prescription for antidepressants, and may be skeptical of physicians who suggest other interventions, such as cognitive-behavioral therapy [48], evidence-based or not.

I personally have spent a lot of time in the office, with patients, trying to undo the misinformation contained in DTCA. It bothers me that I have to do that. I would much rather spend the time providing good education, not undoing bad education. I would prefer to not have to deal with direct-to-consumer advertising at all; but if we have to have it, companies really ought to be held to the standards that exist to ensure balance and accuracy.

Impeachment Update

2006-05-20T02:32:00.000-04:00

Howard Kurtz, writing on the Washington Post column, Media Notes, has an update on the brewing impeachment issue. It turns out that some Republican strategists have been hyping the threat of impeachment. Apparently, they believe that the possibility of impeachment of the President might motivate some voters to go to the polls and vote for Republican congressional candidates.

Personally, I do not see the problem with impeachment hearings, even looking at it from the Republican perspective. After all, with regard to the domestic spying operations, the Administration keeps telling us that if we haven't done anything wrong, we have nothing to fear. Certainly, the same principle applies to the Administration itself.

Neurogenesis Promoted By Fluoxetine

2006-05-18T23:36:00.000-04:00

Browsing on the Scientific American site, I came across a reference to a new study: Fluoxetine targets early progenitor cells in the adult brain. In was written by Juan M. Encinas, Anne Vaahtokari, and Grigori Enikolopov; it was published online ahead of print in PNAS on May 15, 2006. The abstract is here; the PDF (2.8MB), which is freely available, is here.

Fluoxetine targets early progenitor cells in the adult brain
Juan M. Encinas, Anne Vaahtokari, and Grigori Enikolopov
Published online before print May 15, 2006
Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0601992103

Chronic treatment with antidepressants increases neurogenesis in the adult hippocampus. This increase in the production of new neurons may be required for the behavioral effects of antidepressants. However, it is not known which class of cells within the neuronal differentiation cascade is targeted by the drugs. We have generated a reporter mouse line, which allows identification and classification of early neuronal progenitors. It also allows accurate quantitation of changes induced by neurogenic agents in these distinct subclasses of neuronal precursors. We use this line to demonstrate that the selective serotonin reuptake inhibitor antidepressant fluoxetine does not affect division of stem-like cells in the dentate gyrus but increases symmetric divisions of an early progenitor cell class. We further demonstrate that these cells are the sole class of neuronal progenitors targeted by fluoxetine in the adult brain and suggest that the fluoxetine-induced increase in new neurons arises as a result of the expansion of this cell class. This finding defines a cellular target for antidepressant drug therapies.

This particular study is interesting to neuroscientists, mainly because it outlines a technique for studying what happens in the brain when certain medications are given. For nonspecialists, there are several points of interest. The Scientific American article points out one:

By isolating the step in neuron development that fluoxetine influences, the scientists have identified a new target for antidepressants that may have fewer side effects. The research also unveils the links in the chain leading from stem cells to new neurons as well as provides an animal tailor-made to investigate the mechanisms of other medicines and treatments, permitting a ray of hope into the darker regions of brain dysfunction.

I suppose that is true; we might someday develop a new treatment, based upon this research. That is not guaranteed, though; even if it does turn out to be the case, it would take decades to get a marketable product out of it. Perhaps what is more interesting is what is tells us about the mechanism of action of antidepressant medication, and how the reality of what these drugs do compares with popular misconceptions.

Fluoxetine is the generic name for Prozac, the first selective serotonin reuptake inhibitor marketed in the USA. Much has been made of the fact that fluoxetine boosts the amount of serotonin in the neuronal synapse. That effect is commonly thought of as the mechanism of action of the drug. Skeptics of psychopharmacology are fond of pointing out a problem with this hypothesis. The problem is that the serotonin boost occurs within hours of taking the medication, but the therapeutic effect takes weeks to develop. The article by Encinas et. al. shows that the time course for the development of new neurons takes about a month (in mice). (On page 3 of the PDF file, there is an illustration showing the progression from quiescent neural progenitor cells to mature granule cells.)

The thing is, one often starts to see clinical improvement about two weeks after the drug is started. That is well after the serotonin boost, but before any new neurons are fully developed. This makes it seem unlikely that neurogenesis is, by itself, responsible for the therapeutic effect. Of course, the validity of that line of reasoning is based upon the assumption that neurogenesis in humans is no faster than that in mice.

The demonstration of the existence of neurogenesis, and the time course, refutes the popular notion that the serotonin boost is the main mechanism of action. There is little doubt that the serotonin boost is an important part of how the drug works, but it clearly is not the whole story. The existence of neurogenesis also suggests that the notion, that antidepressants are basically "uppers" or a "quick fix," is misguided. Unlike the case with stimulants, people who take antidepressants do not notice anything immediately, except for side effects. Moreover, the action of an antidepressant drug takes place in three phases. In the first two weeks, we tend to see side effects, but little clinical effect. After two to eight weeks, there is reduction in symptoms. Over subsequent months, there is a reduction in the frequency of relapse. If the drug is stopped during the first several months of treatment, there is a high probability of relapse. That probability drops with each successive month, out for about nine to twelve months. It is possible that the relapse-reduction effect has a different neuronal basis than the immediate and intermediate effects.

It will be a while before we have a full understanding of all the effects of antidepressant medication. It will take even longer for us to map each of those neural effects to the clinical effects. I am tempted to speculate, at this point, that neurogenesis in not responsible for the clinical improvement that is seen in the first few weeks of treatment. It may, however, play a role in the reduced frequency of relapses.

Note: the images are public-domain, from Wikipedia. Click on them to go to the respective Wikipedia pages.

Video Game Boost?

2006-05-18T00:40:00.000-04:00

Extremetech informs us that video games had a big impact on the economy last year:

Video Games Had $18B Impact On U.S. Economy

The video game industry, which supported 144,000 full-time jobs and accounted for more than $8 billion in game sales in 2004, had an $18 billion impact on the U.S. economy that year, according to a new study to be released on Wednesday.

What they don't tell you, is that the economic impact of video games was all negative.

It Has Been A While...

2006-05-17T20:51:00.000-04:00

...since I've posted anything satirical. This one isn't even my own idea, but I wish it were:

Bush Demands That Iran Halt Production of Long Letters Posted on May 12, 2006 By Andy Borowitz

Days after receiving an 18-page letter from Iranian president Mahmoud Ahmadinejad, President George W. Bush called the lengthy missive "an act of war" and demanded that Iran halt its production of long letters at once.

At the White House, aides said that writing a letter of such length to President Bush, who is known for his extreme distaste for reading, was the most provocative act Mr. Ahmadinejad could have possibly committed. [...]

In the realm of US popular culture, there are TV shows and movies that contain no good people. All the the characters are unlikeable. It is hard to believe that such shows even exist. But somebody must like them, or else they would just go away.

The current situation with Iran is like that. No good guys. It is hard to believe that our government is acting the way it is, but someone in Washington must like it, or else they would stop. And like popular culture, this is not going to go away.

War on Science, Chapter MMVI

2006-05-17T01:29:00.000-04:00

Under the guise of fiscal responsibility, Washington has proposed eliminating $2 million from the budget for maintaining libraries run by the Environmental Protection Agency. According the the Washington Post:

Budget Cut Would Shutter EPA Libraries
By Christopher Lee
Washington Post Staff Writer
Monday, May 15, 2006; Page A15

Proposed budget cuts could cripple a nationwide system of Environmental Protection Agency libraries that government researchers and others depend on for hard-to-find technical information, library advocates say.

The $2 million cut sought by the White House would reduce the 35-year-old EPA Library Network's budget by 80 percent and force many of its 10 regional libraries to close, according to the advocates and internal agency documents.

That, in turn, would dramatically reduce access to certain EPA reports, guidance and technical documents that are used by the agency's scientific and enforcement staff as well as private businesses and citizens, they say.

In the obligatory fair-and-balanced way, WaPo informs us of the defense offered by an EPA spokesperson:

EPA spokeswoman Jennifer Wood said it was "premature" to talk of mass closings among the regional libraries, although the one in Chicago already is shutting down. Wood said that 15 other EPA libraries, many of them attached to federal laboratories, will not be affected by the budget cuts.

She said the agency plans to save money and operate more efficiently by making EPA materials in the regional libraries available electronically. Many documents that exist only on paper will continue to be available through interlibrary loans, Wood said.

It would seem that if you cut the budget by 80%, there would have to be a serious impact. Also, it seems that if they really plan to convert to electronically-stored documents, they should do that before they close the libraries that have the hard copies. Critics point out that it will be much more difficult for environmental advocates to do the research necessary for their efforts. See the blog post by the Public Employees for Environmental Responsibility (PEER) for additional links on the subject.

The physical collections, many of which are sole source documents, will simply be shuttered up, as the agency has no funds to relocate or digitize these records. The EPA Region 2 library is the principal research resource for regulators, academics and researchers in the New York and New Jersey area.

Environmental advocates point out that this is not the only effort to limit the agency's effectiveness. Internal budget changes are steering funds away from programs that protect children's health, toward other programs that are dedicated to homeland security. According to PEER, as reported by YubaNet:

At the same time these new security functions are being expanded, EPA's overall budget is being cut. The budgetary axe is falling on traditional environmental programs, such as those designed to improve water quality. EPA is also closing most of its libraries as a cost-saving measure.

Programs that affect children's health have also been particularly hard-hit. This fall, Johnson announced the elimination of EPA's Office of Children's Health Protection, an entity dedicated to ensure that the special vulnerability of children is safeguarded in environmental standard-setting, enforcement and prevention efforts. The Office of Children's Health Protection was collapsed into the Office of Environmental Education, considered one of EPA's lowest priority programs.

Later in the article, they refer specifically to programs designed to protect children from pesticides. The efforts were found to be inadequate, but rather than correct the problem, they cut the funding even more:

In January, the EPA Office of Inspector General issued a report criticizing serious inadequacies in the agency's ability to assess the effects of pesticides on fetuses, infants, toddlers, and youngsters. The agency claims that it lacks funding to collect data, conduct cumulative effect analyses and develop standards for determining the developmental neurotoxicity of the pesticides that EPA is approving for commercial use. Significantly, EPA is overdue in producing a plan for corrective actions that address the material weaknesses identified by the Inspector General.

Homeland security is all well and good; we do need to prevent terrorists from poisoning us. Of course, with these changes, the terrorists don't have to poison us. Our own industries are doing it for them, and we are letting them get away with it.

Is this post merely a rant? No, I actually have an idea to offer. If the government thinks it cannot afford to digitize the EPA library, why not ask Google to do it for them? They'd probably do it for free.

Corpus Callosum Is Going To SEED

2006-05-16T00:44:00.000-04:00

photo of Pusteblume by dyzzy -- some rights reserved

Scales of Flowers

2006-05-14T22:16:00.000-04:00

Here are two pictures of flowers. In case you care, I'll let you know that these flowers can be found on the north side of the Michigan Union, on the University of Michigan campus. You might also want to know what kind of flowers they are, but you will have to wait.

I studied anthropology and zoology, not botany, so don't ask me the name of the flowers. I can't answer that question. So I will move on to a different question.

Notice that one picture was taken from about two feet away; the other, from just a few inches. So which is the better picture?

I did not study art, so I cannot answer that question. But I can say what I like...

The closer-up one is more appealing to me, when looking at it on the computer monitor. However, it occurred to me, that if I were to get one of the pictures printed and framed and hung on the wall, I would rather have the one that shows the whole bunch.

If I had printed the picture that gave me the best impression at first, I would have ended up with the wrong one on the wall.

What this demonstrates, is that one picture is better for one particular purpose, while the other is better for a different purpose. Yet is is almost automatic, to ask ourselves: "which one is better?" We conclude that something is good or bad, better or worse; then, we base our subsequent decisions on that conclusion. In the process, we forget what observations led us to the conclusion in the first place.

That is one way that we end up making the wrong choices. We base our decisions on intermediate conclusions; then we forget the original observations.

Often, when we consider a bunch of observations, then draw some kind of conclusion, we think we have gained new information. That is not the case. Conclusions tend to obscure information, not generate new information.

Politicians know this. That is why they so often try to get us to draw conclusions prematurely. They try to get us to form a positive impression of them, based on vague niceties. We draw a conclusion, and feel good about ourselves, thinking we have figured something out. We often don't bother to notice when subsequent observations don't fit with our nice little conclusion. After we form that initial impression, we tend to disregard the little details. After all, why go through the effort of noticing and/or remembering all those little details, when you already know what your conclusion is?

Well, the reason is this: you might end up with the wrong picture on the wall.

Chantix (varenicline tartrate) For Smoking Cessation

2006-05-12T23:41:00.000-04:00

Both the New York Times (link) and the Washington Post (link) carried an article about the new smoking-cessation pill from Pfizer. The brand name for the product is Chantix; the generic name is varenicline tartrate.

Varenicline tartrate was the Prous Scientific Molecule of the Month for March 2006.

Chantix (varenicline tartrate)

Chantix is a partial agonist for a particular type of nicotine receptor. The term partial agonist refers to a chemical that activates the receptor, but is not able activate the receptor to its full extent.

In the case of Chantix, it acts on a subtype of nicotine receptor called the α4β2 (alpha4beta2 nicotinic receptors). Chantix activates these receptors, providing an effect similar to that of a low to medium amount of nicotine. However, because it is a partial agonist, it is not possible to get as strong an effect as one would get with a high dose of nicotine. In fact, the presence of Chantix would make it impossible for the receptors to be activated fully, even in the presence of a high dose of nicotine.

As a result, the patient gets relief from nicotine craving, but only to a certain extent. Smoking a cigarette while taking Chantix would not result in increased activation of the receptors.

The behavioral theory here, is that it will be much easier to quit smoking, once the behavior of smoking is not coupled with a reward. That is, it is no longer positively reinforced.

Likewise, the negative reinforcement is eliminated. Once the behavior of smoking no longer results in a relief from craving, there is not so much of a reason to keep doing it.

Note that the mechanism of action of Chantix is analogous to that of Subutex and Suboxone (buprenorphine).

One of the reasons that addiction is such a nasty problem, is that the addictive behavior is reinforced both positively and negatively. Not only does the behavior lead to something positive, but it also avoids a negative consequence. In the case of addiction, the negative consequence is the withdrawal syndrome. See this e-Medicine page for on overview of the problem of nicotine addiction.

Of course, addiction is a complex phenomenon. Simple behavioral models are not perfect. It follows, then, that the results of the treatment are less than perfect. According to the Washington Post:

Several studies conducted in Europe on about 2,000 smokers and presented in November at an American Heart Association conference showed that a year after initial treatment with varenicline, abstinence rates were 22 percent, versus 16 percent among those given Zyban. Just 8 percent of those given dummy medicines had stopped after a year.

A success rate of 22% may not sound impressive. However, smoking is so prevalent and so damaging, that even a small success rate could have a large impact on public health.

Another thing to keep in mind, when interpreting the success rate, is this: many people have already quit smoking. Presumably, the ones who continue to smoke are those who have the greatest difficulty in quitting. It is likely that most of the people who participated in the studies were people who already had tried to quit several times. Therefore, any improvement seen with the drug is all the more impressive.

Tenkile Conservation Alliance

2006-05-11T22:23:00.000-04:00

Papua New Guinea (PNG) is home to a number of threatened and endangered species; one of these is the tenkile (Dendrolagus scottae; Scott's Tree Kangaroo). According to the Tenkile Conservation Alliance:

The Tenkile Conservation Alliance (TCA) aims to save the critically endangered Tenkile, or Scott's Tree Kangaroo (Dendrolagus scottae), from becoming extinct.

The Tenkile is one of the most endangered mammal species in the world with as few as one hundred individuals remaining. So it is really now or never to save the Tenkile. TCA works in the Torricelli Mountains of Papua New Guinea researching the animal, providing education to the schools and helping the community.

Tenkile are tree kangaroos; they are marsupials, typically about 10kg (22 pounds). They are vegetarian, with a diurnal activity pattern. Most sightings these days are of single individuals. Historically, they have been observed to live in families of four. There are listed as "critically endangered," having about 100 surviving individuals, and a range of only 50 square kilometers.

What is interesting about the TCA's effort is the way they are helping to reduce predation of tenkiles. The local humans traditionally have hunted the tenkile. The TCA has introduced rabbits to breed, and is teaching the people to raise the rabbits and make use of them. The idea is that people can eat rabbit meat, instead of hunting tenkiles.

The environment in Papua New Guinea is not conducive to rabbit breeding; consequently, there is little concern about the possibility of rabbits escaping and causing environmental damage.

TCA does not limit its activities to conservation of tenkiles. The have started a local educational radio program. They conduct educational programs in local schools.

Students learn about the discovery of Tenkile, the establishment of a hunting moratorium and Tenkile Conservation Alliance.

They also teach children about zoology, ecology, and general conservation principles. (Perhaps in their spare time, they could come to the US and teach our adults a few of these things, too.)

There are adult education courses in the local villages. Local people learn about nutrition. They also participate in a drama program that has a educational purpose, as well as being a form of entertainment and community-building.

The clever aspect to the TCA's operation, is the way in which the workers have integrated themselves into the community. This gives them credibility among the people. Moreover, they do not merely go in and tell people what not to do; rather, they provide a practical alternative.

this photo by Paul Downey; others courtesy of Jim and Jean

If you are so inclined, you can contribute to the Tenkile Conservation Alliance here.

In Case You Were Wondering...

2006-05-10T19:23:00.000-04:00

...about my bumper sticker, this explains it:

PROSPECT for Survivial

2006-05-07T12:50:00.000-04:00

The NIMH sposored a study, called the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). PROSPECT ran from 1999 to 2005, and has resulted in three papers, plus one abstract.

Bruce ML, Ten Have TR, Reynolds CF 3rd, Katz II, Schulberg HC, Mulsant BH, Brown GK, McAvay GJ, Pearson JL, Alexopoulos GS. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004 Mar 3;291(9):1081-91.

Alexopoulos GS, Katz IR, Bruce ML, Heo M, Ten Have T, Raue P, Bogner HR, Schulberg HC, Mulsant BH, Reynolds CF 3rd; PROSPECT Group. Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry. 2005 Apr;162(4):718-24.

Gallo JJ, Bogner HR, Morales KH, Post EP, Ten Have T, Bruce ML. Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients. Am J Geriatr Psychiatry. 2005 Sep;13(9):748-55.

The abstract I mentioned was just presented at the annual meeting of the American Geriatrics Society, and is reported on Medscape News (free registration required). None of the papers mention that they were successful in reducing the risk of suicide, although the later reports indicate that suicidal thinking was reduced.

The interesting thing is that the patients in the intervention group tended to live longer, as reported in the AGS abstract.

"We found that depressed older adults in the intervention practices were less likely to die over a 4-year follow-up period compared to not-depressed older adults in the usual-care practices," Dr. Bogner said. She noted that her findings reached statistical significance.

The intervention was simple. They assigned patients randomly to receive either usual care, or to receive intervention by primary care physicians who were assisted by a "masters level depression specialist."

The study method involved deploying a masters level depression specialist to collaborate with the patient's primary care physician (PCP) with the goal of improving patient adherence to medical therapy for depression. The specialist also educated both the PCP and the patient's family about the issues involved. A "depression care manager" provided general treatment recommendations for all study patients. The manager did not make specific recommendations for individual patients.

Notice that the intervention is the sort of thing that could be done easily almost anywhere, at little cost. However, notice also that it would be difficult to find someone to pay for the intervention.

Eye Candy From the Deep

2006-05-06T07:25:00.000-04:00

News@Nature has a collection of six photographs from the Census of Marine Zooplankton, illustrating odd creatures from the deep sea.

This intricately formed tunicate seems to be curled around its young.

Evolution and Drug Development

2006-05-06T07:15:00.000-04:00

After reading this article about the antibiotic drug-development pipeline, I had a thought.

The Antibiotic Pipeline — Challenges, Costs, and Values
Richard P. Wenzel, M.D.
NEJM 351:523-526

In 2004, there are few antibacterial agents in the pipeline. Recall that in the 1930s and 1940s, four new classes of antibiotics were approved, each with novel antibacterial targets: sulfonamides, beta-lactams, aminoglycosides, and chloramphenicol. In the 1950s and 1960s, six more new classes became available (tetracycline, macrolides, glycopeptides, rifamycins, quinolones, and trimethoprim). In the 1970s, 1980s, and 1990s, however, no novel classes were licensed, and all the new drugs that became available were derivatives of existing classes. Since 2000, two new classes of antibiotics have been approved for the treatment of gram-positive bacteria: the oxazolidinones (linezolid) and the cyclic lipopeptides (daptomycin).

A relatively unfavorable return on investment is apparently deterring large pharmaceutical companies from engaging in antibiotic-drug discovery [...]

Drug companies generate candidates for drug development in a variety of ways. Some of the candidates are developed by making random changes to existing drugs, then testing them. As the candidates proceed through the pipeline, various economic models are used to determine which ones are worthy of additional investment.

What occurred to me is something that might already be obvious to others; but for me, it is a new idea. The idea is that the process of drug development could be modeled using evolutionary principles: mutation, founder effect, natural selection, and the probable mutation effect.

The NEJM article (cited above) contains a discussion of the way in which economic models influence drug development. This is kind of obvious: if the anticipated return on investment is low, then the incentive for developing new classes of drugs is going to be low. However, this does not always fit with health policy priorities. For example, we need new classes of antibiotics a lot more than we need new classes of insomnia drugs, but we currently are seeing a lot more new drugs for insomnia than for serious infections.

From the perspective of public health, it would be desirable to rearrange the incentives in drug development.

I am wondering if a really sophisticated analysis of the drug pipeline, using evolutionary principles, could lead to some modifications of health policy. The goal would be to modify the incentives for drug development in a way that would promote the development of drugs to meet high public-heath priorities.

New Use For Old Drug

2006-05-06T06:41:00.000-04:00

I always like to see this kind of a thing:

Aspirin shows promise in combating a common, antibiotic-induced hearing loss

University of Michigan, Chinese hospital find high success rate at preserving hearing when aspirin is paired with widely used antibiotic

ANN ARBOR, MI –Around the world, inexpensive antibiotics known as aminoglycosides have been used for the past 60 years in the battles against acute infections and tuberculosis, as antibacterial prophylaxis in cystic fibrosis patients, and other conditions. But for all of the good they do, the drugs also have been widely linked to irreversible hearing loss. [...]

The researchers studied [link to extract] 195 patients in China who received 80 to 160 milligrams of gentamicin (a type of aminoglycoside) intravenously twice daily, typically for five to seven days. Of those, 89 patients were given aspirin along with the antibiotic, and 106 were given placebos along with the antibiotic. The results were dramatic: The incidence of hearing loss in the group that was given placebos was 13 percent, while in the aspirin group it was just 3 percent, or 75 percent lower.

“We would like to see the word get around to the medical community around the world that you can take some precautions to minimize the risk to your patients. Aspirin is available everywhere, and it’s cheap,” says senior author Schacht, professor of biological chemistry in otolaryngology at the University of Michigan Medical School and director of the U-M Health System’s Kresge Hearing Research Institute. Gentamicin is not commonly used in the United States. [...]

This is a nice bit of work that could have significant implications for health in developing countries. Even in the US, aminoglycosides are used often enough that the findings could be important here, too.

Feeding Time

2006-05-05T21:23:00.000-04:00

Chicago Tribute Sports Pix of the Week
Brother Derek tries to get hold of the helmet of Angel Rangel as groomer Rafael Martinez washes him down following Kentucky Derby workouts at Churchill Downs on Monday in Louisville, Ky.
(Lexington Herald-Leader photo by Mark Cornelison) May. 1, 2006

I don't know why, but I felt like posting this photo.

Junk Science Revealed, and Other Stories

2006-05-05T01:51:00.000-04:00

Scienceblog.com has a nice little post about the war on science. There are a couple of particularly good links. One link goes to an article that gives examples of the use of the term "sound science" as a propaganda ploy.

"Sound science is whatever somebody likes," Kennedy said. "It's essentially a politically useful term, but it doesn't have any normative meaning whatsoever. My science is sound science, and the science of my enemies is junk science."

In other science news, CIDRAP reports on the federal plan for management of a bird flu epidemic:

The White House today released a lengthy new plan describing how the government intends to cope with an influenza pandemic, but officials continued to stress their standard message that states and communities will have to rely mainly on themselves in that situation, with the federal government in an advisory role.

I don't think many people in the post-Katrina USA ever thought otherwise.

"Local communities will have to address the medical and non-medical effects of the pandemic with available resources," the document says. "This means that it is essential for communities, tribes, states, and regions to have plans in place to support the full spectrum of their needs over the course of weeks or months, and for the Federal Government to provide clear guidance on the manner in which these needs can be met."

I am happy that they notice that tribes, in particular will have to be self-sufficient. At least the federal government has not totally forgotten how badly Native Americans were affected by the diseases brought by settlers. On the other hand (LA Times; free registration required)...

But in a budget-cutting proposal that has set off protests and indignation among Indians from Los Angeles to New York and several smaller cities in between, the Bush administration has proposed eliminating funds for these clinics, which served about 106,000 Indians last year.

I guess that just proves their point about self-reliance.

Speaking of threatened populations, National Geographic has a photo gallery of some of the species that have been added to the list of threatened species. The list includes polar bears and hippos, for the first time.

XGL on Linux

2006-05-04T00:37:00.000-04:00

XGL on Linux is pretty flashy. After I finally got it working, I found out that I did not know the commands to use. In the event that someone is trying to find them, I just made it a little easier to find them.

These instructions are for SuSE 10.1, which is still at the release-candidate stage. I am using XGL on RR4, and I find that there are some differences. For example, I cannot rotate the cube by moving the cursor to the edge of the screen; I have to use the keyboard shortcuts. I also find that it is the F-12 key, not the F-11 key, that actuates the scale mode for switching windows.

Is any of this really useful? It is hard to say, because sometimes utility is not obvious at first. I do like the scale mode, and find it useful when I have a lot of open windows. I also think the zoom mode will turn out to be useful. Some of the other features might just be eye candy. On the other hand, different user interfaces are good for different people. If a particular interface is a good fit for your particular style of intuition, then it will be easy for you to use.

The following table is from SuSE's site, here.

XGL Shortcuts

Some of the features of XGL are executed when you perform certain functions. Mostly, this is some kind of key combination on your keyboard in addition to some button press and/or movement of your mouse. Below, I have provided a table with the different XGL options and how to execute each one.

Window Operations
Move Window	ALT + Left-Click and Drag
Move Window - Snap to screen	CTRL + ALT + Left-Click and Drag
Resize Window	ALT + Right-Click and Drag
Switch Windows	ALT + TAB
Switch Windows (Scale Mode)	F11
Wobbly Windows	Left-Click Window and Drag
Translucency	ALT + Mouse Up / Mouse Down
Cube
Rotate Cube - Next Desktop	CTRL + ALT + Left or Right Arrow
Rotate Cube - Next Desktop	Move Mouse cursor to extreme edge of desktop
Rotate Cube - Take Active Window	CTRL + SHIFT + ALT + Left or Right Arrow
Manually Rotate Cube	CTRL + SHIFT + Left-Click on Desktop and Drag
Zoom
Zoom Once	Super-Key (Windows Key)
Zoom In Manually	Mouse Wheel Scroll Up + Super-Key (Windows Key)
Zoom Out Manually	Mouse Wheel Scroll Down + Super-Key (Windows Key)

Addendum: it turns out that on my instance of Suse 10.1, the scale mode is not activated by pressing F11. Instead, it is activated by moving the mouse cursor to the upper right-hand corner of the screen. That is actually a better arrangement, in my opinion. Also, I noticed that pressing control-alt down-arrow shows a triptych with a minature version of the current cube facet, flanked by minature versions of the two flanking facets.

Also, if you simply move the mouse cursor to the edge of the screen, nothing happens. You do not get the cube to rotate that way. But if you click on a window and drag it toward either the left or right edge, the cube rotates, and the window you are dragging slides over the next facet.

Please leave a comment if you know of any other XGL function that is not listed here.

How the US Drug Safety System Should Be Changed

2006-05-02T23:45:00.000-04:00

The Journal of the American Medical Association has published a commentary article about proposed changes to the FDA. The author is Brian L. Strom, MD, MPH, a professor at the University of Pennsylvania School of Medicine. The article itself is subscription-only, but Penn's website has an article about the article:

Commentary on How the US Drug Safety System Should Be Changed
MAY 2, 2006

In the May 3 issue of the Journal of the American Medical Association, Brian L. Strom, MD, MPH, Professor of Public Health and Preventive Medicine and Chair of the Department of Biostatistics and Epidemiology at the University of Pennsylvania School of Medicine, analyzes the limitations of the current system of drug-safety monitoring and proposes a solution that addresses overly aggressive early marketing practices; an absence of incentives to complete post-marketing safety studies; direct-to-consumer (DTC) advertising that can promote non-critical use of "blockbuster" drugs; the current trend toward delaying drug approval; and public misunderstanding about the safety of drugs. [...]

Strom proposes an alternative approach with three elements: conditional approval, an empowered US Food and Drug Administration (FDA), and a complementary nongovernmental organization. [...]

Dr. Strom explains that any new drug should have a two-step approval. When it is first released on the market, it would be sold under a conditional approval. This would be like a probationary period. During this period, the drug would carry extra warnings, and direct-to-consumer (DTC) advertising would be limited. In order to get rid of the extra warnings, the pharmaceutical company would have to comply with required post-marketing safety studies.

His other two recommendations are good ideas, but they have been promoted before by others, and I won't discuss them now. It is the first recommendation that caught my interest.

It would seem that pharmaceutical companies would resist the notice of a two-tiered approval, at least at first. After investing all that money on a new drug, they want to recoup their investment as quickly as possible. Advocates of small government might oppose the idea, because it would generate a new level of regulation and an awful lot of paperwork, and a small army of government employees to handle all that paperwork.

However, the fact is, pharmaceutical companies have not been doing as much post-marketing safety testing as they are supposed to do. The FDA does not really have any way of compelling them to do so. By using a two-tiered approval process, they would have some incentive to offer.

Another possible benefit to the two-tiered process, could be a reduction in liability exposure for the company.

Regarding the potential objection over increasing the size of government, it would seem that there are times when a bigger government is called for. The issues regarding drug safety are getting more complex, as exotic new medications are developed. At the second stage of approval, it should be possible to get input from a wider variety of professionals, who actually have experience prescribing and studying the drug. It would allow for a more detailed assessment of the product. During the first stage of approval, it may be difficult for the agency to know what questions they should be asking. After the drug has been on the market for a while, there would be more specific hypotheses to be tested.

Overhaul of the FDA is overdue. Getting it to actually happen in today's political climate will not be easy.

Speaking Truth to Teflon®

2006-05-02T01:34:00.000-04:00

This is pure armchair musing. There has been a lot of talk lately about the brazen performance by Stephen Colbert at the White House Correspondent's Dinner's a couple of days ago (YouTube video here).

This got me to thinking, again, about the willingness of the media to print, broadcast, or otherwise acknowledge criticism of the President. Back in the 1980's liberal persons were amazed by the "Teflon President," Ronald Reagan. He did all kinds of terrible things, it seemed, and nothing ever stuck. I am sure that conservatives thought the same about Clinton.

During Bush 43's first term, the same thing seemed to be happening. Abu Ghraib is perhaps the best example, but there are many. More recently, things definitely have changed.

Joseph Lowery
Harry Taylor
Harry Reid
John Murtha
John Conyers
Cindy Sheehan
Stephen Colbert

I am sure there have been more, but those are the names that come to mind, of people whose criticisms of the President have been taken seriously by the media.

All of these persons have been outspoken in opposition to Mr. Bush and his policies. I have not done any real research into this, other than just thinking about it, but it seems to me that the first person on that list to get any respect in the media was Cindy Sheehan. Once the media covered her and her story, it became acceptable for the media in the USA to report on criticisms of the President.

It strikes me that this is a significant development. I would like to understand more about what happened to crack the Teflon coating of the Presidency. I know it was not just Sheehan who caused this. The Downing Street Memo, Katrina, and the indictment of Scooter Libby all caused spikes in the mention of the word "impeachment," according to Blogpulse. Unfortunately, their system only allows tracking back for six months, so right now the only spike you can see is the one caused by the Libby indictment; but I have been following this. Since then, there has been a steady simmer, but no big spike. Still, it is clear that it now is acceptable for the media to report on criticism of the President. Something has changed. The Teflon is gone.

Perhaps some historian will be able to go back someday, and look at the blogs, and the data collected by services such as Blogpulse and Technorati, and figure out exactly what happened to scrub away the Teflon.

We Cover the News

2006-04-30T16:56:00.000-04:00

NYC Protest
Originally uploaded by mollydobkin.

We cover the news, so the MSM doesn't have to.

Also see the Flickr photo pool of the event.

BIG Moose

2006-04-30T13:06:00.000-04:00

Information
A junction in the northern part of Sweden, a destination for people all over the world, a monument dedicated to wilderness, nature and the king of the forest. Our goal is for this giant moose to be "born" before the end of 2006.

Situated on top of the mountain "Vithatten"

2 legs in the district of Arvidsjaur and region "Norrbotten".

2 legs in the district of Skellefteå and region "Västerbotten."

Construction completely made of gluelam wood with steeltubes in the legs and in the "pinetree".

Approx. 47 m long, 12 m wide, 35 m on the back, ca 45 m on the antlers. The antlers incl. tines approx. 100 m².

The moose will bite onto a pinetree, inside the pine an elevator will lift people up to enter the moose through the mouth. The branches from the pine will serve as an umbrella over the antlers.

The exterior will be made from heat-preparated wood, which makes it possible to decide colour by using different temperatures.

A track will be made for those who rather want to walk to the top.

Inside the moose there will be 3 floors with a total size of approx. 1500 m² and a floor in the throat with a size of 250 m².

Done by December 2006.

The interior will contain a concert hall, dining hall, and conference center. There also will be galleries for artists to sell their creative works.

Governor Grandholm should take note of this for her "cool cities" concept. Maybe Ann Arbor could build a huge Wolverine, and put a football field inside. Next thing you know, Los Angeles will build a giant Trojan Horse.

Another One Bites the Dust

2006-04-29T13:27:00.000-04:00

How many times have you heard a phrase in the form of: "humans are the only animals that X," where X is some kind of cognition or behavior? We hear that a lot less than we did a few decades ago, because scientists keep finding animals that do things that we used to think that only humans did. Now comes a report about yet another presumptive myth:

The Birds and the B’s Challenging Chomsky, Starlings Learn ‘Human-Only’ Syntax Patterns By Inga Kiderra April 26, 2006 The European starling – long known as a virtuoso songbird and as an expert mimic too – may also soon gain a reputation as something of a “grammar-marm.” This three-ounce bird, new research shows, can learn syntactic patterns formerly thought to be the exclusive province of humans. Led by Timothy Q. Gentner, assistant professor of psychology at the University of California, San Diego, a study published in the April 27 issue of Nature demonstrates that starlings have the capacity to classify acoustic sequences defined by recursive, center-embedded grammars. Recursive center-embedding refers to the common characteristic of human grammars that allows for the creation of new (and grammatically correct) utterances by inserting words and clauses within sentences – theoretically, without limit. So, for example, “Oedipus ruled Thebes” can become “Oedipus, who killed his father, ruled Thebes” or “Oedipus, who killed his father, whom he met on the road from Delphi, ruled Thebes,” and so on. Chomskian linguists have held that this recursive center-embedding is a universal feature of human language and, moreover, that the ability to process it forms the computational core of a uniquely human language facility. “Our research is a refutation of the canonical position that what makes human language unique is a singular ability to comprehend these kinds of patterns,” Gentner said. “If birds can learn these patterning rules, then their use does not explain the uniqueness of human language.”

One thing remains unique about humans: We are the only creatures that can raise the price of oil by merely starting a rumor about attacking another country. The original article is in Nature, here.

Klingon National Anthem

2006-04-29T07:34:00.000-04:00

I decided to try to translate the Star Spangled Banner into Klingon, but it was too much work, and it would not have been very funny, anway. And it would have been a bear to try to sing it.

Speaking of insolence, the hackers at OnMac.net have succeeded in getting an Intel Mac to triple-boot Mac Os, Win XP, and Linux. I am not sure why, but they did.

Now, this is really insolent: Anheuser-Busch admitted in the Wall Street Journal that it has changed the recipe of Budweiser and Bud Light! Not that I care; I'm one of those people who think that Budweiser is not really beer. But it is America's Beer. Now why isn't Bush complaining about that in the Rose Garden? It's a lot more heretical than a Spanish-version national anthem.

Baloney Detection Kit: Political Version

2006-04-28T00:07:00.000-04:00

Regular readers know that one of my pet peeves is propaganda in the mass media. Since this is Friday, when bloggers traditionally blog about their pets, I thought I would write about my pet peeve.

In this case, however, I am please to report that a journalist was using his Baloney Detection Kit (term © Borac) and actually wrote an article that dispels a common myth that is ensconced in American psyche.

As a little ironic twist, the author's name is Alister Bull.

Rags-to-riches dream an illusion: study
Wed Apr 26, 2006 11:40pm ET
by: Alister Bull

WASHINGTON (Reuters) - America may still think of itself as the land of opportunity, but the chances of living a rags-to-riches life are a lot lower than elsewhere in the world, according to a new study published on Wednesday.

The likelihood that a child born into a poor family will make it into the top five percent is just one percent, according to "Understanding Mobility in America", a study by economist Tom Hertz from American University.

By contrast, a child born rich had a 22 percent chance of being rich as an adult, he said.

"In other words, the chances of getting rich are about 20 times higher if you are born rich than if you are born in a low-income family," he told an audience at the Center for American Progress, a liberal think-tank sponsoring the work. [link added]

He also found the United States had one of the lowest levels of inter-generational mobility in the wealthy world, on a par with Britain but way behind most of Europe. [emphasis added]

This, of course, is a corollary of the principle that the rich get richer, and the poor get poorer. Despite all the talk about developing an "ownership society," the fact is that the income gap in the USA is getting wider.

33rd Skeptic's CircleAnd More

2006-04-27T13:22:00.000-04:00

The 33rd Skeptic's Circle, a biweekly carnival of skepticism, has been posted by Borac at Science and Politics. It is nicely organized, with an entertaining, whimsical overtone. Running a carnival takes a lot of work; thanks to Borac for putting this together.

Also, I notice that Sine.Qua.Non Journal is collecting what will be a virtual clearinghouse for articles and links pertaining to the US involvement in torture, at Torture, Abuse & Detainee Database. They are looking for contributions, so if anyone has blog posts, or links to articles or other information on the subject, please consider dropping them a line at sinequanonblog [@] yahoo.com. (The email address is obscured as an anti-spam measure; just take out the spaces and the square brackets to get the real email address.

I am hopeful that they can build up an impressive collection to help keep this important issue bright on the American political radar screen.

Banks Won't Make Pizza

2006-04-27T00:25:00.000-04:00

I forget where I first saw this sign: "We have a deal with the bank. We won't cash checks, and the bank won't make pizza." It probably was in a pizza place, perhaps the Cottage Inn on William St. in downtown Ann Arbor. If that is where it was, it is not there any more. But I have seen signs like that elsewhere. It is still a good idea. Banks should limit what they do to areas in which they have expertise.

In the latest edition of the medical journal, The Lancet, there is an article about the World Bank and its efforts to address the problem of malaria in developing nations.

The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment
The Lancet Early Online Publication, 25 April 2006
DOI:10.1016/S0140-6736(06)68545-0

The World Bank has an annual budget of US$20 billion, and is the largest organisation operating with a mission to reduce poverty worldwide. Malaria destroys about 1 million lives a year; the disease is the leading parasitic cause of death for Africa's children and impoverishment for their families. Here we examine how these factors meet in the new Global Strategy & Booster Program, which is the Bank's plan for controlling that disease in 2005–10.

We believe this plan is inadequate to reverse the Bank's troubling history of neglect for malaria. In the past 5 years, the Bank has failed to uphold a pledge to increase funding for malaria control in Africa, has claimed success in its malaria programmes by promulgating false epidemiological statistics, and has approved clinically obsolete treatments for a potentially deadly form of malaria. Crucially, the Bank also downsized its malaria staff, so that it cannot swiftly execute the restoration it plans under the Global Strategy & Booster Program. We summarise the evidence, show that the Bank possesses demonstrably little expertise in malaria, and argue that the Bank should relinquish its funding to other agencies better placed to control the disease. [...]

The article is made available freely to the general public, something which Elsevier generally is loathe to do; the fact that it is freely available is an indication that the editors think it is a pretty important matter. And so it is:

The Bank's secrecy and technical errors combine dangerously when we look at malaria treatment. Our investigations suggest that the Bank wasted money and lives on ineffective medicines.

The authors go on to provide abundant evidence of profound mismanagement. The more you read, the worse it sounds, despite the fact that it was written in a dispassionate and objective style. If anything, they are too gentle. After stating that their investigations "suggest" that the Bank wasted money and lives, they document six instances of exactly that.

Upon reading the article, one is left to wonder what the World Bank is doing. Is it merely a political showcase, rather that an humanitarian institution?

They would have been better off if they had decided to spend hundreds of millions of dollars making pizza instead of running a medical program.

Healthcare Initiatives Fall Short

2006-04-26T01:17:00.000-04:00

Massachusetts recently began a program that would expand health care coverage to almost everyone. Now, U.S. Rep. Pete Hoekstra has introduced a bill (Communities Building Access Act) that would try the same kind of thing. It would be more modest, but cover the entire country.

The bill Introduced Tuesday in Congress would set aside $45 million in federal grants over seven years as seed money for communities to design and implement local programs to provide health insurance or health care services to the uninsured. There are 1.1 million uninsured people in Michigan.

"As we all know, there are way too many Americans who do not have access to health insurance and therefore they do not have access to health coverage," said U.S. Rep. Pete Hoekstra, R-Holland, the bill's main sponsor.

"We also know that as we face this issue in health care, there's not a silver bullet to address these concerns. We need to be doing a lot of things in a lot of different areas."

Inspired by Muskegon's Access Health insurance program, the Communities Building Access Act would allow communities to leverage federal grants to create local health insurance cooperatives where the cost of care is shared by the local government, employers and employees.

The money also could be used to create volunteer specialty provider networks, in which providers discount their services to care for low-income members of the network. CareNet of Toledo/Lucas County, Ohio, is the most prominent example of such a network.

Vondie Woodbury, director of the Muskegon Community Health Project, said that these community-based solutions are appealing to the business community, which has been reluctant to embrace national solutions for fear they would be costly and require too much red tape.

As commendable as these initiative may seem, they suffer from a serious flaw. They rely on an unreliable patchwork of solutions. The specifics vary from place to place, and change from time to time. As a result, healthcare providers will have a hard time understanding exactly what benefits are available, where, when, and for whom. This will make it difficult for providers to formulate treatment plans for their patients.

I understand what Woodbury said about the business community being reluctant to embrace national solutions. They are afraid it would be costly and require too much red tape. The solution is not to create additional programs that add on to the programs that are already available. It does not make any sense to think that such an approach will reduce costs and avoid red tape. The opposite is true. It is inevitable that creating more programs will crate more overhead costs. The only was to both increase overhead and decrease costs, is to limit the care that is provided. The thing is, nobody wants to come right out and say the truth. The truth is, it would cost a lot of money to provide unlimited health care. The only alternative is to ration the care in some way. But nobody wants to talk about rationing health care.

So instead, what we have done, as a society, is to build a massively inefficient, complex system that limits access to health care by being so inaccessible and inscrutable that health care is effectively rationed, without anyone having to say that it is rationed.

The only sensible approach is to have a universal system that provides basic health care. If people want more, than what we, as a collective, decide we can afford, then that can go out and pay for it themselves. If we want to expand what is covered in the basic package, then we have to decide to pay for it. But the key is to keep the basic system as efficient as possible, with as little paper-shuffling as possible.

If people want to pay others to move paper from one stack to another, they are free to do so, but they have to pay for it themselves. There is no reason to use collective funds to pay for that.

Some of these issues are discussed here, specifically regarding the Massachusetts plan.

Mozilla RIP

2006-04-25T02:54:00.000-04:00

Remember when you had to pay to get Netscape? I think it was about $25 or so, although I never actually paid for it. I got it for free when I became an early user of Physicians On Line (POL). That was around 1995. POL is gone now (merged with Medscape) and Netscape is not being developed. The latest version of Netscape (8) is actually pretty nice, but hardly anybody uses it.

I just learned that the open-source version, Mozilla, is not going to be developed any further, either. Instead, the offbeat branch is going to become the main branch. That is, Firefox is going to be the only actively-developed browser out of the original code base.

Netscape used to have a browser, an email client, and an HTML editor, all in one application. Now, we have the browser (Firefox), the mail (Thunderbird), and the editor (NVu) being developed as separate applications. I actually preferred the old way, from a usability standpoint. But I must admit, there has been a lot more innovation using the new model. Having three separate applications does mean more downloading and more disk space being used. But since downloading is pretty fast these days, and disk space is cheap, that is not much of an issue.

Windows is finally going to introduce some of the innovations we have seen in Firefox, when they release Explorer 7. But now, assuming it comes out with Vista, that won't be until 2007. By then, it will be a little hard to think of them as "innovations."

I just fired up Mozilla and used Composer to write this, just for old times' sake. Still works fine, but how many browsers do we need? What we need is innovation, and Firefox right now is where the innovation is taking place.

U.S. Military Orders Human-trafficking Reforms in Iraq

2006-04-24T00:04:00.000-04:00

The Chicago Tribune published a series of investigative articles, Pipeline to Peril (free registration required), in October 2005. Among their findings, they determined that US-based contractors were engaging in illegal human trafficking to supply laborers in Iraq.

Now, the Tribune reports that General Casey has ordered the implementation of reforms, confirming that the abuses did in fact occur.

The memos, including an order dated April 4 and titled "Subject: Prevention of Trafficking in Persons in MNF-I," or Multinational Forces-Iraq, say the military also confirmed a host of other abuses during an inspection of contracting activities supporting the U.S. military in Iraq. They include deceptive hiring practices; excessive fees charged by overseas job brokers who lure workers into Iraq; substandard living conditions once laborers arrive; violations of Iraqi immigration laws; and a lack of mandatory "awareness training" on U.S. bases concerning human trafficking.

That quote does not make it sound too bad, but the rest of the article details some overtly abusive practices:

Those workers and others suffered from a chain of exploitation that began in their home countries, where families often assumed huge debts to pay fees demanded by brokers, to Iraq. Even after discovering they'd been deceived, workers felt compelled to head into the war zone, or remain in danger for much longer than they desired, just to pay those debts.

The Tribune also found evidence that subcontractors and brokers routinely seized workers' passports, deceived them about their safety or contract terms and, in at least one case, allegedly tried to force terrified men into Iraq under the threat of cutting off their food and water.

I have two things to say about this. First, it is absolutely disgusting that we would essentially enslave people, all in the service of "liberating" Iraq. Second, it is unbelievably stupid to import labor, when the unemployment rate in Iraq is so high. All it does is alienate the local people. What are they to think, when they see jobs going to foreigners, while their own people are going without jobs?

Oh. That's Great.

2006-04-23T20:40:00.000-04:00

Russia has decided to escalate rebuilding its nuclear arsenal, in response to our nuclear policy. That is really something, isn't it?

Read the article in Foreign Affairs, by Keir A. Lieber and Daryl G. Press, here.

PTSD May Persist in Combat Veterans for Decades

2006-04-23T02:00:00.000-04:00

The April 2006 edition of the American Journal of Psychiatry has an article about the longitudinal course of Posttraumatic Stress Disorder. The abstract is here; the full version is here, but requires a subscription. Additionally, there is a Medscape article based upon the original paper, here (free registration required).

In this post, I describe the key findings of the study, then comment on the implications for veterans and civilians. Contnue reading here.

Arrrgh! Not Another Online Quiz!

2006-04-22T20:49:00.000-04:00

Actually, it is a serious online quiz. It measures a person's implicit bias, with regard to some particular set of concepts. Implicit bias can be measured using, among other instruments, the Implicit Association Test (IAT). You can take this test here. It appears to select a topic for you, either at random, or perhaps according to an internal protocol of some sort.

My results were as follows:

Your data suggest a strong automatic preference for Open-Source compared to Microsoft.

While that is not what I would call an earth-shattering result, it was kind of fun to take the test. Specifically, it was fun to try to figure out why the test works the way it does.

The results of this particular iteration of the test did not result in any new knowledge. I suppose it must happen occasionally that people get results that they don't expect. In fact, before you take the test, you are alerted to the possibility that you might find the results to be objectionable. If that possibility bothers you, you are supposed to stop immediately.

Important disclaimer: In reporting to you results of any IAT that you take, we will mention possible interpretations that have a basis in research done at the University of Washington, University of Virginia, Harvard University, and Yale University. However, these Universities, as well as the individual researchers who have contributed to this site, make no claim for the validity of these suggested interpretations. If you are unprepared to encounter interpretations that you might find objectionable, please do not proceed further.

That would be common sense. My question for tonight is this: What is the opposite of common sense? Is it absurdity?

Having no mental handicap herself, she had to ask George what the latest sound had been.

"Sounded like somebody hitting a milk bottle with a ball peen hammer," said George.

--Kurt Vonnegut, in Welcome To the Monkey House

Trillium

2006-04-22T16:34:00.000-04:00

From a stroll at Country Farm Park in Ann Arbor, Michigan.

Nichols Arboretum

2006-04-20T19:12:00.000-04:00

Pictures from a stroll in Nichols Arboretum, Ann Arbor, Michigan.

A Peaceful Call to Arms?

2006-04-20T18:28:00.000-04:00

The New York Times today printed an opinion piece by Paul Kane, who is described as: "a Marine who served in Iraq and a fellow at the Kennedy School of Government, [who] is writing a book about national service and sacrifice." I found the article by following a link from the new blog, Manging the Atom: Iran News.

A Peaceful Call to Arms

By PAUL KANE
Published: April 20, 2006

THE American public needs to be prepared for what is shaping up to be a clash of colossal proportions between the West and Iran.

President Franklin D. Roosevelt masterfully prepared Americans before the United States entered World War II by initiating a peacetime draft under the Selective Training and Service Act of 1940.

Now, President Bush and Congress should reinstitute selective service under a lottery without any deferments.

This single action will send a strong message to three constituencies in the crisis over Iran's nuclear intentions — Iran, outside powers like China and Russia and Americans at home — and perhaps lead to a peaceful resolution. [...]

Last year, when I first noticed the propaganda that seemed to be preparing the US public for war with Iran, one of my first thoughts was 'There would have to be a draft. The American Public would not stand for that.' I suppose I was trying to reassure myself.

I also tried to reassure myself myself by remembering that Bush promised, I think during the third debate, that he would not institute a draft. I knew, though, that such a promise is worth nothing. In the current Administration, war seems to be an all-purpose excuse.

Resurrecting the draft is a terrible idea. The only way it could contribute to peace is if it so enraged the population that people would threaten an uprising or a general strike in response to the draft. Kane is right about one thing. The American public does need to be prepared for a clash of colossal proportions. But the clash would be a clash between sensible persons, who see that Iran still does not have the capacity to threaten us, and a subset of sensless persons who fail to see that we cannot simultaneously prevent and prepare for war.

To add a little of that most unwelcome spice -- nuance -- I would add that there is a difference between maintaining a credible deterrence, and actually preparing for war. The question is, where is the line between the two?

Rove Question

2006-04-20T03:41:00.000-04:00

In some ways, this is a routine, expected news item, but it does raise one question.

Rove Is Giving Up Daily Policy Post to Focus on Vote

By ELISABETH BUMILLER
Published: April 20, 2006

WASHINGTON, April 19 — The overhaul of the White House staff intensified on Wednesday as Karl Rove, one of the president's most powerful and feared advisers, gave up day-to-day control over the administration's domestic policy to concentrate on the midterm elections. Scott McClellan, the White House press secretary, said he was stepping down. [...]

What I want to know is this: if this guy's job is to "concentrate on the midterm elections," then why is he drawing a government salary?

Attention CPAP Slackers!

2006-04-17T21:44:00.000-04:00

It has come to my attention that there are many people out there who have CPAP machines, but are not using them.

Remember, there is no shame in wearing a mask at night. Even Tom Cruise wore a mask at night, in Eyes Wide Shut.

Granted, his was a little more stylish than the ones used for CPAP. But really, medical devices are gaining in popularity. Within several decades, everyone will be seen on the street wearing some kind of medical device. You will just be a little bit ahead of the fashion curve.

Plus, there is a good reason to wear it when you are supposed to. According to Medscape (free registration required):

Sleep Apnea Increases Cardiac Arrhythmia Risk

By Will Boggs. MD

NEW YORK (Reuters Health) Apr 17 - Sleep-disordered breathing (SDB) is associated with an increased risk for complex cardiac arrhythmias, according to a report in the April 15th issue of the American Journal of Respiratory and Critical Care Medicine.

This study, "suggests increased vulnerability for nocturnal cardiac arrhythmias in those with SDB," Dr. Reena Mehra from Case Western Reserve University, Cleveland, Ohio told Reuters Health. However, "the potential relationships of these arrhythmias and sudden nocturnal cardiac death in patients with SDB remain to be determined."

Dr. Mehra and colleagues compared the prevalence of arrhythmias in 228 patients with SDB and in 338 matched controls without SDB.

Atrial fibrillation, nonsustained ventricular tachycardia, complex ventricular ectopy, bigeminy, and quadrigeminy were significantly more common among SDB patients than among controls, the authors report. [...]

Wearing medical devices will be stylish someday, but quadrigeminy never will be stylish.

Better LEDs, Better Investment

2006-04-16T22:54:00.000-04:00

Scientific American reports on a new generation of white LEDs. Developed at the University of Michigan and the University of Southern California, they produce 25 lumens per watt. That is 67% better than the 15 lumens per watt we get from incandescent bulbs.

Electrical engineer Stephen Forrest of the University of Michigan, chemist Mark Thompson of the University of Southern California and their colleagues created the so-called organic LED by combining two layers of phosphorescent diodes--to release green and red wavelength light--and one layer of a fluorescent diode to supply blue wavelength light.

This is a bit of a curiosity: the device uses both fluorescence and phosphorescence. The article implies that the only remaining technological obstacle is that they have to figure out what kind of coating to put on it, to keep moisture out. That is not expected to be a big obstacle. Lighting accounts for 22% of the electricity used in buildings. These devices would reduce that by 60%. Savings actually would be greater, in those buildings that are cooled by air conditioning.

Reducing energy consumption is the best thing we can do to make our country safer. It almost does not matter what it costs. We're spending about $150 million on day on the Iraq war. Getting better lights would be a better investment.

Bush Leaks Cartoons

2006-04-16T13:32:00.000-04:00

See this page for a collection of Leaker-in-Chief cartoons.

More Good News

2006-04-16T04:10:00.000-04:00

Chris Richards for The New York Times

Since they began six years ago, the Cactus Rescue Crew has rescued over 27,000 cacti and other native plants from road widening, subdivisions, golf courses and shopping malls in Arizona.

The New York Times reports that volunteers have banded together to save cactus plants, by relocating them away from areas of development.

Does Restless Legs Syndrome Exist?

2006-04-14T22:39:00.000-04:00

Those who read the essay on RLS that I linked to yesterday may find themselves wondering if RLS even exists, or if it was entirely made up by a pharmaceutical company. Curious readers may read about it on the Merck Manual, which is a generally-respected medical handbook. (Availably freely online here.)

Restless legs syndrome is a relatively common disorder that often occurs just before falling asleep, particularly among persons > 50 yr. The cause is unknown, but >= 1/3 of persons with the syndrome have a family history. Uncomfortable sensations that are difficult to describe are felt in the legs and are relieved temporarily by movement. Patient distress and sleep loss may become severe. Treatment can be difficult and often requires trying different drugs and dosage regimens. The drugs of choice are the dopamine agonists pergolide and carbidopa/levodopa. Other choices are oxycodone, carbamazepine, and gabapentin. Benzodiazepines taken at bedtime prevent awakening but not nocturnal movements.

Although Merck is a drug company, they do not have any drugs for RLS. Perhaps a more objective source, though, is Harrison's Principles of Internal Medicine. This is available online, although you have to be a medical doctor to register for it:

[...] Patients with this sensory-motor disorder report a creeping or crawling dysesthesia deep within the calves or feet, or sometimes even in the upper extemities, that is associated with an irresistible urge to move the affected limbs. For most patients with RLS, the dysesthesias and restlessness are much worse in the evening or night compared to the daytime and frequently interfere with the ability to fall asleep. The disorder is exacerbated by inactivity and temporarily relieved by movement. In contrast, paresthesias secondary to peripheral neuropathy persists with activity. The severity of this chronic disorder may wax and wane with time and can be exacerbated by sleep deprivation, caffeine, and pregnancy. The prevalence is 1 to 5% of young to middle-age adults and increases to 10 to 20% in those >60 years. There appear to be important differences in RLS prevalence among racial groups, with higher prevalence in those of Northern European ancestry. [...]

The symptoms of RLS are exquisitely sensitive to dopaminergic drugs (e.g., pramipexole 0.25 to 1.0 mg q8pm or ropinirole 0.5 to 4.0 mg q8pm), which are the treatment of choice. Narcotics, benzodiazepines, and certain anticonvulsants may also be of therapeutic value. Most patients with restless legs also experience periodic limb movements of sleep, although the reverse is not the case.[...]

Medical textbooks are not always the best source of up-to-date medical information, but Harrison's is pretty reputable, and this particular passage at least has face validity. It would appear that in the geriatric population, the reported incidence is at least as high as that reported by the company that markets ropinirole. However, it would appear that the company exaggerated the incidence, if one assumes that the rate they report, is a rate that applies to the general population.

Disease Mongering and the Calibration of Skepticism

2006-04-13T22:16:00.000-04:00

The Public Library of Medicine has a collection of essays on the topic of disease mongering. The essays were written in conjunction with an international conference on the topic. There has been a little bit of publicity on the topic; such as these news articles:

Drug firms 'hype up diseases to boost sales'
By RICHARD SHEARS, Daily Mail 08:35am 11th April 2006

Drug companies are inventing diseases to sell more of their products, it has been claimed. Scientists have accused major pharmaceutical firms of "medicalising" problems like high cholesterol or the symptoms of the menopause in a bid to increase profits.

Experts from around the world will meet in Australia today to discuss what they have labelled "disease-mongering". [...]

There are similar news articles here, here, and here.

There are many points that one could make based upon the eleven "disease mongering" essays. Today, though, I would like to focus on these, from the essay on Restless Legs Syndrome (RLS):

First, journalists should be very wary when confronted with a new or expanded disease affecting large numbers of people. If a disease is common and very bothersome, it is hard to believe that no one would have noticed it before. Prevalence estimates are easy to exaggerate by broadening the definition of disease. Journalists need to ask exactly how the disease is being defined, whether the diagnostic criteria were used appropriately, and whether the study sample truly represents the general population (e.g., patients at an insomnia clinic cannot be taken to represent the general public).

Journalists should also reflexively question whether more diagnosis is always a good thing. Simply labeling people with disease has negative consequences [21]. Similarly, journalists should question the assumption that treatment always makes sense. Medical treatments always involve trade-offs; people with mild symptoms have little to gain, and treatment may end up causing more harm than good.

Finally, instead of extreme, unrepresentative anecdotes about miracle cures, journalists should help readers understand how well the treatment works (e.g., what is the chance that I will feel better if I take the medicine versus if I do not?) and what problems it might cause (e.g., whether I might be trading less restless legs for daytime nausea, dizziness, and somnolence).

The point I would like to make is that we cannot rely on journalists to do this. Readers should be able to do this for themselves. News articles that contain glowing quotations from patients should be taking with the same degree of skepticism as celebrity endorsements. Likewise, reports of unbelievably high incidence rates should raise some questions. Plus, it is very dangerous to assume that the mere presence of an illness means that treatment is always appropriate. Some conditions are best managed by leaving them alone.

Having said that, I should also point out that it is entirely possible to take skepticism entirely too far. As it happens, there probably are a lot of people out there who have undiagnosed and untreated RLS. Many do not really need to be treated. But in the most severe cases, RLS can lead to serious problems. Persons with untreated sleep disorders may be at risk for automobile accidents. They many underperform at work, which can threaten their livelihood. They many underperform at home, which can lead to relationship problems. So, it is important that we not ignore the warnings entirely. The trick is to calibrate our skepticism the way we calibrate a laboratory test: if it is too sensitive, it generates a lot of false positives; not sensitive enough, and it misses real cases of illness.

Leaker-in-Chief, Part III

2006-04-11T00:41:00.000-04:00

I have been leaving comments around the Internet, saying that there now has been a second leak. The first was the Libby-Plame leak; the second was the Bush-Israeli Military Intelligence leak. Now, I have to amend that. There have been three high-profile leaks that have damaged intelligence operations. Hat tip to Steven J. at Radamisto, who reminds us that the Libby-Plame leak was the second. The first occurred in 2004, when the Administration blew a Pakistani-UK operation that had successfully infiltrated Al-Qaeda.

In the event that the London Times article about the third leak becomes unavailable, I've archived a copy on Newsvine, here. To me, part of the story hear is that the US media have completely ignored the story. Despite the fact that the Libby-Plame leak is a top news event right now, nobody in the media is bothering to connect the three leaks together into a comprehensive picture of the Administrations penchant for clumsy handling of sensitive intelligence data.

I have heard that the phrase "Leaker-in-Chief" is turning out to be rather damaging to Bush. It is sticking to him just like the "flip-flopper" nickname stuck to a different aspiring politician. I think it is important, though, for us to reflect on just how appropriate the nickname is in this case.

Some of the Right have tried to diminish the impact of this, by pointing out that all Administrations use leaks for political purposes. That is true, but irrelevant. The problem with the Bush 43 Administration is not merely that it is prone to leaks. Rather, the problem is that some of the leaks damage our national security in general, and risk the lives of certain intelligence operatives in particular. It is not just one case. There are now three cases that have come to my attention.

Why does this matter? Consider this: when an intelligence operative goes into the field, he or she does so at the behest of the Administration. He or She is acting in good faith, that the Administration has a good reason for the operation, and the the Administration will not betray them. The operative then recruits people to be sources of information. The sources act on good faith, assuming that the operative will not betray them. When the Administration leaks sensitive information, it does betray them; both the operatives and their sources are put at risk. Perhaps even worse, when the Administration blows the cover off of an operation conducted by a cooperative foreign government, the betrayal has three layers: the foreign government, it's operatives, and their sources, are all put at risk. This is deadly, serious business.

In the Bush White House, loyalty only goes one way: you are expected to be loyal to the President, but that loyalty gets you nothing in return.

Leaker-in-Chief ReduxOffered Without Comment

2006-04-08T22:52:00.000-04:00

The Sunday Times

April 09, 2006

US leak of Zarqawi letter riles Israelis

ISRAELI military intelligence officials have accused President George W Bush’s administration of undermining their attempts to infiltrate Al-Qaeda’s operations in Iraq by revealing the contents of a secret letter written by Osama Bin Laden’s second-in-command, writes Uzi Mahnaimi.

Israel passed the letter — in which Ayman al-Zawahiri outlined his Middle East strategy to Abu Musab al- Zarqawi, the Al-Qaeda leader in Iraq — to Washington last October on condition of strict anonymity.

Israeli officials were dismayed, however, when John Negroponte, the US director of national intelligence, made it available in both English and its original Arabic on his office web site.

Bush then referred to it during his weekly address. “The Al-Qaeda letter points to Vietnam as a model,” the president declared. “Al-Qaeda believes that America can be made to run again. They are gravely mistaken. America will not run and we will not forget our responsibilities.”

Israeli intelligence sources said officials who had worked on “Operation Tiramisu” inside Iraq took emergency steps to protect their sources, but it was not clear how successful they had been in averting the damage to their intelligence network.

They said Bush’s indiscretion had undone months of painstaking effort.

Candidate's Forum

2006-04-07T00:31:00.000-04:00

This is a quick report on the Washtenaw County Democracy for America Candidates Forum, held on April 5, 2006, at the Superior Township hall. The purpose of the Forum was to have Democratic Party candidates for State of Michigan offices answer questions about themselves and their campaigns. This forum was small; there were three candidates there, two for the Attorney General spot, and one for the Secretary of State (SoS). They invited three attorney general candidates, but only two agreed to come. Scott Bowen is the one who did not come. Amos Williams and Alexander "Sandy" Lipsey did come. Geoffrey Fieger also may be running, but nobody even mentioned him. Continue reading here.

Collateral Damage in the War on TerrorismMedical Ethics in Inaction

2006-04-05T00:07:00.000-04:00

This post is about the case of a patient with Duchenne Muscular Dystrophy, whose life-prolonging medication was intercepted at the border by Homeland Security agents. The post includes a long excerpt from the Grand Rapids Press. I would not ordinarily excerpt so much of an article, but I think the article will disappear behind a firewall in a couple of weeks. Continue reading here.

Absolutely Blistering

2006-04-04T21:34:00.000-04:00

The United States of America is a young country. So young, in fact, that one may reasonably doubt whether it has any institutions that legitimately can be called "venerable," given that part of the definition of something that is venerable, is that it must must be old. If, however, one allows that this young whippersnapper of a country can indeed have something that is venerable, then certainly, the New England Journal of Medicine would qualify. It was founded by Dr. John Collins Warren in 1812 as a quarterly called The New England Journal of Medicine and Surgery.

The history of medicine is replete with time-honored traditions. Among these is included a certain elusive quality of pretentiousness that is somehow acceptable, despite the air of exclusivity it engenders. This is true because, as irritating as pretentiousness is, it does not sink to the level of a deadly sin, when it subserves a truly noble purpose.

A quick examination of their website confirms this nobility of purpose. There are no advertisements, although it is quite likely that there would be many suitors. The editors chose to spurn that quick profit, in return for both the perception of impartiality, and some editorial freedom. Editorial freedom, after all, is a valuable commodity. It is somewhat surprising, perhaps, that despite that freedom, the authors seem to make use of such freedom only rarely. It is even more rare, that they turn their editorial blunderbusses toward the federal government. After all, the Journal is penned by academic physicians. Federal research grants are their lifeblood, even though the government doles out the grants like tiny flecks of gold leaf, being given to a young apprentice at an artisan's guild. "That's all you get, now run along and make something worthwhile out of it!"

Imagine, if you can, the depth and breadth of my astonishment, when I read the following in those venerable pages:

Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation. Proponents of the first explanation suggest that Medicare and its private insurers were not ready for the millions of applicants and hundreds of millions of prescriptions that poured in early in January, in a flood that they were ill prepared to handle. The layer of insurance companies inserted into the process in the name of efficiency exacerbated the confusion. An administration and Congress guided by Ronald Reagan's principle that "government is not the solution to our problem; government is the problem" put his vision into practice in a chillingly convincing way.

Oh my. "Chillingly convincing." That is from a Perspective article about the new Medicare Part D prescription drug benefit. Read the whole thing. It is available to the public here.

Tom DeLay Won't Seek Re-Election

2006-04-04T00:15:00.000-04:00

I'm sure most of you have seen this already, but Tom DeLay is planning to resign from Congress, and won't seek re-election. I am so thrilled I just had to write about it. The news is here, here, and here. There is speculation that he would not be doing this unless he knew he is in serious trouble with Travis County District Attorney Ronnie Earle. We all can hope that this puts a serious dent in the culture of corruption.

Expectation Of Laughter Boosts Endorphins

2006-04-03T23:48:00.000-04:00

Tipped off by a post at Crumb Trail, I saw this report on the effects of the anticipation of "mirthful laughter" on stress:

Just the expectation of a mirthful laughter experience boosts endorphins 27 percent, HGH 87 percent
Public release date: 3-Apr-2006
American Physiological Society

SAN FRANCISCO – There's no doubt that laughter feels good, but is there real neurophysiology behind it and what can you do about it?

In a paper being presented in an American Physiological Society session at Experimental Biology 2006, Lee S. Berk of Loma Linda University, reports that not only is there real science and psychophysiology, but just the anticipation of the "mirthful laughter" involved in watching your favorite funny movie has some very surprising and significant neuroendocrine/hormone effects.

According to Berk: "The blood drawn from experimental subjects just before they watched the video had 27% more beta-endorphins and 87% more human growth hormone, compared to blood from the control group, which didn't anticipate the watching of a humorous video. Between blood pulls, the control group stayed in a waiting room and could choose from a wide variety of magazines," he explained. [...]

The article goes on to explain that they also found beneficial effects on the immune response, suggesting that there could be benefit for those with autoimmune diseases. It's just an armchair-musing kind of speculation, but since the effect is seen with mere anticipation of something positive, I wonder if it is related to the placebo effect?

RR4 (32-bit) XGL Version

2006-04-03T23:30:00.000-04:00

RR4 Linux 3.0b0 XGL edition is unofficially out, available on bittorrent at Linux Tracker. For those of you longing for the sweet smell of mouthwatering eye candy, it is only a 2.52GB download away.

This is still in beta, so I would not recommend it for general use yet. Should be fun to play with, though. RR4 and RR64 are turning out to be quite popular, climbing up to the 23rd spot on the Distrowatch most-clicks-per-day chart.

Post-Hoc Vindication?

2006-04-03T22:50:00.000-04:00

Yesterday's Wall Street Journal contains an article about some recently-released documents pertaining to terrorist links with Saddam Hussein's government. The documents were discovered during and after the invasion on Iraq. Some of the documents are described as evidence that there were, in fact, links between the Iraqi government and terrorist organizations. The author, on the WSJ article, Ms. Mylroie, concludes:

Many more documents are to be released in the coming months. Quite possibly, they will vindicate the decision to undertake the Iraq war; help maintain public support for fighting it; and radically change our understanding of Saddam's role in international terrorism.

I can't help but comment on this. First of all, you can't justify starting a war based upon documents found after the war started. The decision to go to war has to be judged based according to the information that was available at the time the decision was made. Second, the webstie containing the documents states plainly that:

The US Government has made no determination regarding the authenticity of the documents, validity or factual accuracy of the information contained therein, or the quality of any translations, when available.

Vindication of the war may be desirable, but it is a serious matter. Making such a judgment based upon unverified documents would be rash, at best. A much more thorough analysis would be called for.

Universal Health Care

2006-04-03T00:06:00.000-04:00

A local non-medical blogger comments on universal health care. With any luck, the issue will gain greater visibility, and become more important in the upcoming election cycle. Note that health care was considered an important issue in the last election, ranking in the top five in the polls. The problem was, the top issue (national security) seemed to trump everything else. That was, frankly, a reflection of the narrow-mindedness of the electorate. Health care policy is going to affect more lives than the war on terrorism ever will, so it really is a part of the security issue. I mean, the whole point of national security is to prevent premature death. That happens to be the whole point of the health care system, too.

Fundamental Principles of Design

2006-04-02T23:58:00.000-04:00

There is an article in Seed about the influence of science on modern Architecture:

No shift in architectural practice in recent times has been more fruitful or astonishing than the profession's current embrace of scientific models and ideas. While the Modern movement of the last century famously incorporated the latest advances in technology and industry, there were remarkably few attempts to come to terms with the more radical scientific developments of the era, such as relativity or quantum mechanics.

Today's architect, however, is increasingly schooled in cutting-edge developments in science and mathematics, from neuroscience and computation, to complexity theory and embryology. Indeed, there has been a surprising turn in architectural thinking during the last 15 years that has brought it far from its ancient roots in mechanics—say from the post-and-lintel methods that remained nearly unchallenged for 3,000 years—to what one might call a biological habit of mind. Today's architect is more likely to study problems of form in the natural world than those within the history of his or her own discipline. [...]

The article got me to thinking that I should share with the world all that I know about design. I learned this from my brother-in-law, an architect and web designer, who used to make furniture. I learned that the application of scientific principles in design can not only lead to improvements in form and function, but can have significant practical implications as well. Understanding of these principles can be intellectually enriching.

Before he married my sister, my brother-in-law used to make furniture out of concrete. Yes, concrete. The heavy stuff. When my sister graduated from MSU, she had concrete furniture in her apartment. There was a lot to be learned from that furniture:

Use of unconventional materials adds visual and tactile interest
Interesting design stimulates interesting thought processes
Concrete furniture is cool to the touch, which is beneficial in warm climates
Concrete furniture has high thermal mass, which promotes energy conservation
Bold, geometrical designs can be integrated successfully with traditional design elements

Elaborating on the theme of geometry, the Seed article discusses the importance of geometry in the evolution of architectural principles:

While building science remained essentially the artful deployment of columns and beams, the Greeks could not help but add exquisite refinements such as the famous entases--the artificial bulges near the middles of columns that counteract the concaving effects of vision. This beguiling idea was derived from complex calculation systems based in geometry. Later, the Age of the (Gothic) Cathedrals would bring an unprecedented virtuosity and expressiveness to bear on the production of architecture, as well as new techniques of templating stones in order to master the very subtle mathematics required for progressively-changing angles and massing of material.

The thing is, when my sister graduated, it was time to move that furniture. Her husband-to-be conveniently had to be somewhere else. So, it was I who had to move that concrete furniture. This leads to the final principle of design:

If you make furniture that weighs hundreds of pounds, get someone else to move it for you

Illegals: Just Get Rid Of Them

2006-04-02T10:21:00.000-04:00

No, not undocumented Mexican immigrants. They are welcome to stay, as far as I am concerned. What we need to get rid of are the illegal factories:

Report: Most U.S. factories violate Clean Water Act
The Ithaca Journal reports in this weekend's paper on the latest study of Clean Water Act compliance by the US Public Interest Research Group.

Among the alarming details:• Nationally, more than 3,700 major facilities (62%) exceeded their Clean Water Act permit limits at least once between July 1, 2003 and December 31, 2004. [...]

One of the arguments used to advocate for the deportation of illegal immigrants is that they are "illegal." They are breaking the law. Perhaps the knowledge, that law-breaking is actually normal in corporate America, will put this argument in a new light.

HT: Daniel Rhoades, A Concerned Scientist.

In other news:

Gross domestic income: profit growth swamps labor income
Today's data release from the Bureau of Economic Analysis (BEA) shows that the share of corporate profits in gross domestic income (GDI) reached the highest level since the 4th quarter of 1968. In the corporate sector, the current recovery has seen the largest swing from labor incomes to corporate profits of any recovery since World War II. Read EPI's new Snapshot for a full analysis.

Amusing Link For Today

2006-04-02T09:30:00.000-04:00

An exercise in the archeology of popular culture:

Notes on a Strange World
The Walrus Was Paul!

Massimo Polidoro
Skeptical Inquirer
2006, Volume 30 1, Jan/Feb

Did you know that Paul McCartney, the ex-Beatle, never actually left the band because . . . he died in 1966 and was then replaced by a lookalike? It sounds bizarre, and it is. The “Paul is dead” myth is one of the most popular myths set in the world of rock music and perhaps the most fun to follow up. [...]

I find it amusing to think back at how seriously some people took this at the time.

Brain imaging can predict effectiveness of CBT

2006-04-02T01:26:00.000-05:00

In the 1980's there was some attention interest in being able to figure out if a given case of depression was "psychological" or "biological" in origin. The idea was, that if you could show that a person was depressed for psychological reasons, then you also would know that the patient should receive treatment with psychotherapy. Likewise, a case of depression with a biological cause should be treated with medication.

Nothing ever came of that. In fact, what happened was that practitioners came to think that there is no meaningful difference. Even if we find some replicable way to distinguish between depression with a biological cause and depression with a psychological cause, there is no particular reason to think that knowing the cause would enable us to predict which treatment would be more likely to be effective.

Still, there are some interesting ideas there to explore, even if the exploration cannot necessarily be expected to lead to improved treatment matching.

Now we see a study that offers just such an exploration. Some folks over at the University of Pittsburgh School of Medicine have done fMRI studies of depressed people, compared to control subjects, then looked to see if there were any findings that correlated with later response to cognitive-behavioral therapy. They report that there were two findings that did tend to correlate with responsiveness to CBT. The treatment responders were more likely to have decreased activity in the subgenual cingulate cortex. They also were found to have "increased activity after reading negative words in a brain region called the amygdala."

This would be more exciting if they had a larger sample size. There were only 14 depressed patients in the study, and 21 controls. So at this point, it is fun to think about what the study means, but we certainly can't go around changing our clinical practice -- or our belief systems -- based upon the results.

Stories that could be pranks - but aren't

2006-04-02T00:54:00.000-05:00

6. A Belgian police training manual which aims to help recruits understand body language has caused a row by likening George Bush's facial expressions to a chimpanzee's.

That's from a list of news items that are said to sound like April fool items, but are not.

Got Fish?

2006-04-01T15:40:00.000-05:00

Mike Scanlon and the "Wackos"

2006-03-31T23:32:00.000-05:00

Project for the Old American Century has posted a PDF ( large: 26 MB) containing memos from the Abramoff trial. One of the memos contains the following information (page 119) about one of their strategies for increasing voter turnout to support their cause:

Mobilization

We plan to use three forms of communication to mobilize and win these battles. Phones, mail, and Christian radio. We believe that if you are on TV you are generally loosing battles like this. Our mission is to get specifically selected groups of individuals to the polls to speak out AGAINST something.

To that end, your money is best spent finding them and communicating with them using the modes they are most likely to respond to. Sinply put we want to bring out the wackos to vote against something and make sure the rest of the public lets the whole thing slip right past them. The wackos get their information form [sic] the Chistrian right, Christian radio, mail, the internet, and telephone trees.

The memo was written by Michael Scanlon; it pertains to their efforts to get people to vote against certain gambling operations. Apparently, the idea was to get certain persons out to vote against the proposal, while not even raising the issue with those who might take the opposite position. I assume that is why he wants to avoid the use of television ads: the ads cannot be targeted narrowly enough.

This is very similar to the strategy involving gay marriage.

I have a few comments on this. First, note how the strategy subverts the democratic process: Rather than promote honest and open debate, they use private channels to manipulate people. I guess there is no news there, but I find it noteworthy, if not newsworthy.

Second, I suspect that all political operations use strategies like this. The take-home message is that we all need to be careful when we are the recipients of targeted political messages. Such messages should be viewed with a critical eye, since they are likely to be worded in such a way as to be manipulative.

Third, it is ironic that the very technologies that could be used to create a global village also can be used to do the exact opposite. Internet sites, email, and special-interest cable and broadcast media can be used to divide the population into groups that receive only a narrow subset of information, rather that getting the whole picture. Rather than bringing us together, such propaganda splits us apart. Sometimes, these messages seem compelling, in part because the recipient may feel that he or she is getting inside information. Being the recipient of inside information can boost one's self-esteem, because it can make the recipient feel special. The recipient might have an altogether different feeling, if he or she knew that the person who concocted the message thought of the recipient as a "whacko."

Intelligence Redo Is Harshly Judged

2006-03-31T13:12:00.000-05:00

Intelligence Redo Is Harshly Judged
A Judge Critiques 9/11 Overhaul, and Finds It Top-Heavy

By Walter Pincus
Washington Post Staff Writer
Friday, March 31, 2006; Page A17

U.S. Court of Appeals Judge Richard A. Posner sharply criticized the restructuring of U.S. intelligence agencies last week, telling CIA lawyers that the overhaul has done nothing to rectify flaws exposed by al-Qaeda's Sept. 11, 2001, attacks and that the changes "in the end . . . will amount to rather little." [...]

Posner has a book coming out on the subject, but it does not sound as though he was trying to solicit publicity for the book when he made that statement. His main concern is this:

In Posner's analysis, the director of national intelligence (DNI), created by Congress to be the president's top intelligence adviser, was given too much to do. DNI John D. Negroponte oversees the CIA and 15 other intelligence agencies, including those at the Pentagon. Negroponte's staff, which has grown to about 1,000, "has become a new bureaucracy layered on top of the intelligence community," Posner said.

As I recall, that was one of the major concerns that was raised when the reorganization was planned. It sounds as though that concern was justified.

National Sleep Awareness Week

2006-03-29T21:57:00.000-05:00

National Sleep Awareness Week

This week (March 27, 2006 - April 2, 2006) is National Sleep Awareness Week. So, I assume that Circadiana will get a lot of hits this week. Perhaps if you all link to it.

So there you have it. Bora reminds us that this is National Sleep Awareness Week. Check the link for interesting tidbits of information, including some little-recognized clues to the possible presence of a sleep disorder. If I can stay awake long enough, I will get into the spirit and post some on some sleep-related topic.

ZZZZZ...

OK, here's one. Researchers have found a strong correlation between CSF levels of hypocretin, and the occurrence of excessive daytime sleepiness:

Hypocretin Deficiency Associated With Excessive Daytime Sleepiness

NEW YORK (Reuters Health) Mar 29 - Hypocretin deficiency is associated with excessive daytime sleepiness in patients with narcolepsy with cataplexy, according to a report by researchers in Zurich. [...]

Dr. Baumann and colleagues investigated the relationship between CSF hypocretin levels and clinical findings in 18 patients with narcolepsy with definite cataplexy.

Twelve patients had undetectable levels of hypocretin in the CSF, three patients had low levels, and three patients had normal levels, the researchers report in the March issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

Multiple sleep latencies were significantly shorter in patients with undetectable hypocretin levels than in patients with detectable hypocretin, the authors report. [...]

Hypocretin is a neurotransmitter that is produced by a small clump of neurons in the hypothalamus. The association between loss of hypocretin-secreting cells and narcolepsy is old news. The new study refines that finding a little bit, by showing a strong correlation between low hypocretin levels and one of the cardinal symptoms of narcolepsy: excessive daytime sleepiness. The outcome of the study is no surprise; but of course, in science, you can't skip doing the study just because you think you already know what the results are going to be.

Crazy Cat Terrorizes Connecticut Town

2006-03-29T19:13:00.000-05:00

Crazy Cat Terrorizes Connecticut Town
March 29, 2006 10:15 a.m. EST

Nidhi Sharma - All Headline News Contributor

Fairfield, Conn (AHN) - Residents of the neighborhood of Sunset Circle say they have been terrorized by a crazy cat named Lewis, The Associated Press reports.

Lewis, for his part, has been uniquely cited, personally issued a restraining order by the town's animal control officer.

Janet Kettman, a neighbor said Monday, "He looks like Felix the Cat and has six toes on each foot, each with a long claw. They are formidable weapons."

The neighbors said those weapons, along with catlike stealth, have allowed Lewis to attack at least a half dozen people and ambush the Avon lady as she was getting out of her car.

Some of those who were bitten and scratched ended up seeking treatment at area hospitals. It was the first time such an action was taken against a cat in Fairfield.

In effect, Lewis is under house arrest, forbidden to leave his home. The cat's owner, Ruth Cisero, was also arrested on charges of failing to comply with the restraining order and reckless endangerment.

Sounds familiar.

Free On-line CME from MedPage

2006-03-28T21:40:00.000-05:00

MedPage Today has free online continuing medical education articles. Each one only provides 0.25 credits, and there are not enough articles for this to be sufficient as the only source of CME. Even so, it does not cost anything, and it can be a good supplement to other CME sources.

One thing I noticed about MedPage CME articles is that a lot of them focus on improving communication with patients. That is not something I have seen in other CME courses.

Patients these days often come to the office with questions about medical topics that have been in the news. Many of the MedPage articles seem to be aimed at educating physicians about the science that underlies the news items. This serves two purposes. For one, it is a decent source of background information that has some direct clinical utility. Secondly, it prepares physicians to give their patients useful answers to their questions.

Old News

2006-03-27T22:04:00.000-05:00

Sometimes it is instructive to take a new look at old news:

Larry Lindsey: A "top economic adviser" to Bush who was ousted when he revealed to a newspaper that a war with Iraq could cost $200 billion. Fired, December 2002.

Of course, it is now well past that figure, but apparently even the lowball estimate was too much for the Administration to handle.

Medical Schools Must Get Down To Business

2006-03-27T21:28:00.000-05:00

An item at the UM Medical School news site caught my attention:

Medical Schools must get down to business (03/27/06)
Medical School leaders nationally must manage their institutions more like a business. The U-M Medical School is leading the way.

The reason it caught my attention is that I have a strong negative visceral reaction to the use of the phrase "run like a business." The phrase was used often here in Michigan by the former governor, John Engler. It that context, it meant to ignore humanistic values, maximize profits, and specifically to ignore the plight of the underprivileged. Obviously, none of that would be appropriate for a medical school.

Besides, I learned in a high school Business Management class that something like 80% of new businesses go out of business within the first three years. I don't recall the exact figures, but is was something like that. The point is, that in empirical terms, to run something like a business means to adopt practices that are almost certain to fail within a short period of time. The fact is, most businesses are not successful.

The article is about the new CFO of the University of Michigan Medical School, William Elger. For what it is worth, it does not provide a direct quote of him saying that the Medical School should be run like a business. Instead, it talks about some sophisticated mathematical models he has developed to help understand what is happening with the School's financial status. I have no problem with that; obviously, it helps to have a clear idea of what is going on. It helps to be able to model various "what-if" scenarios, to anticipate problems before they occur, etc.

“Medical schools must have rapid-fire, up-to-date information on measurable, critical success factors, including market share, expenditures and revenue sources. We face eroding federal and state support for medical research and education, so it is essential that we understand existing resources and identify the ones we need to grow as an organization,” Elger says. “Without the metrics to assess key performance measures, we won’t be top medical schools down the road.”

I would have been happier to see a clear statement of the need to balance the harsh financial realities with the mission of the School, which has to be fundamentally humanistic in nature. But I won't be too critical, since that is not what the article was about, anyway. (The article was about an article that Elger wrote in the latest issue of Academic Medicine.)

Still, I hope that the School does not focus too much on "market share, expenditures and revenue sources." They do need to strive for the appropriate balance between financial security and fulfilling their missions of patient care, teaching, and research.

Or, as some would say, research, teaching, and patient care.

Blogworthy Articles in NEJM

2006-03-26T21:37:00.000-05:00

The most recent (3/25/06) issue of the New England Journal of Medicine contains several items that deserve a mention here at Corpus Callosum. It is worth noting that there are three items related to psychopharmacology; this degree of attention is unusual in a general medical journal. All require a subscription for the full text.

There are two papers that report on results from the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) project. One study shows what happens when patients are switched from one antidepressant that is not working for them, to a different one. The other shows what happens when a second drug is added to the first one. The third paper discusses what is known about the cardiovascular risk of stimulant medications used to treat ADHD. Continue reading here.

Sunday Loose Association Blogging

2006-03-26T10:48:00.000-05:00

Ambling around the Internet, following links from fellow Ann Arbor bloggers at Mousemusings and An Empire Wilderness, plus a few tangents, I came across the following pair of related ideas:

From Common Dreams, about the Academic Bill of Rights:

"In Baxley's bill -- which is really the Horowitz bill -- students are customers, whose tastes and prejudices must be accommodated. Professors are likened to vendors who must take care not to offend or disturb those who have come to purchase their wares."

"It's like the Wal-Mart model: Maybe they can import holographic images of professors made in China, attractive classroom automatons who can be programmed to present marketable and politically acceptable material," she said dryly.

From Neil Bush's Ignite! Learning:

Dear Teachers,
Ignite! Learning is thrilled to introduce you to The COW (Curriculum On Wheels), a program designed to let you deliver lessons in the same way professional presenters do.

The COW (including computer, projector, and speakers) comes pre-loaded with all of Ignite!'s Science or Social Studies courses. You just plug it in and start teaching!

Please contact us to learn how to get The COW for your classroom.

Context: Barbara Bush made a "generous" donation to the Katrina relief fund, but earmarked the funds, so that they had to be used for the purchase of curriculum materials from her son's software company.

This is as good of an example as you can get, of the Culture of Corruption.

Just a Question

2006-03-25T21:24:00.001-05:00

I just ate the first solid food I've had since Wednesday night. (That is not typical for me.) My brain still is not up to speed, still have a fever, cough, etc. I find that it is much easier to think about politics than about science. What does this mean?

Marcinkowski for Congress

2006-03-25T21:24:00.000-05:00

I don't live in Michigan's 8th Congressional district, but if I did, I would vote for this guy.

Online gamer punished with virtual crucifixion

2006-03-25T19:01:00.000-05:00

Banning online players for in-game offenses is common, but a new multiplayer game has gone a step further. Roma Victor, a game set in Roman-controlled Britain, has virtually crucified a player for killing other players repeatedly. Cynewulf, a character played by a Flint Michigan resident, will hang in a public square for seven days. Other players have been stopping by to watch and even taunt Cynewulf.

I saw this on Tom's Hardware. It is a sign of the times.

You Have To Wonder About This

2006-03-25T13:42:00.000-05:00

Courtesy of American Samizdat, we learn that the screening of shipping containers for radioactive materials has been outsourced to a Hong Kong company.

Courtesy of Think Progress, we learn that screening of all containers would cost about $400 million. Yet a budget amendment that would have appropriated that amount was defeated. Sure, there are difficult decisions to be made in any budget, but the budget also calls for an extra $1.7 billion for missile defense.

Is there anyone who seriously thinks that the missile defense program is more important? And does it make sense to spend so much on something that does not work, in favor of something that will work?

It's just corporate welfare, that's what it is.

Muddle Machine

2006-03-25T12:48:00.000-05:00

OK, so I sometimes miss the story and end up behind the times.

There is a topic that I have been meaning to write about for the past two weeks. Then, when I got to writing, I did a Google blog search, and found that 15 others have already posted on the subject. Some of the posts are almost a year old. Plus, over 60 people have linked to the article on del.icio.us. So it is hardly a new subject, and it already has gotten a fair amount of attention. But I decided just now to go ahead and write about it anyway, partly just to see if I could find a new perspective.

A couple of weeks ago, I noticed a post on the curiously-named blog, Notional Slurry. Tozier pointed out an article on Edutopia entitled The Muddle Machine. The article reveals that many high school textbooks actually are written by a committee; the author of record may not have had anything to do with the actual writing.

I won't get into the details; the original article does a fine job on its own. The main points are these: a lot of money is wasted on high school textbooks; also, the process of creating the textbook all but guarantees mediocrity.

I have two thoughts about this.

First, high school textbooks are written specifically to avoid controversy. At first glance, this may seem like a sort of institutionalized political correctness. It is not. The idea behind political correctness is that it is a good idea to go out of your way to avoid offending people. That is not the same as avoiding controversy. There is nothing about political correctness that says you shouldn't express an idea that someone might object to. Indeed, if that were the case, it would never be politically correct to say anything. No, the point of political correctness is to be aware of the potential impact of what you say, and to take reasonable steps to make sure it is no more offensive than it needs to be.

Second, it occurs to me that part of our national agenda, right now, is to encourage the growth of the creative class, to foster innovation, to capitalize on one of our Country's few remaining strengths. Writing insipid textbook is hardly the way to accomplish that.

UPDATE: Dr. Free-Ride has a nice post that shows that the duty to teach well is a serious matter, with important ethical prinicples involved.

What makes life hard for the folks interviewed for this story is that they recognize their duty to provide a quality education to the students in Arkansas schools. If they're charged with teaching science, they have a duty actually to teach science and not to omit important bits because they might upset some people.

It is an interesting and informative perspective.

Rolling Downhill

2006-03-22T21:36:00.000-05:00

This is one of those studies that reaches a conclusion that seems so obvious, it is hard to know why the study was even done:

Study: Workplace abuse can trickle down

A Georgia State University study suggests supervisors who believe they've been unjustly treated might vent their resentment by abusing their duties.

Researchers found that supervisors engage in more abusive behavior when they perceive their employer is using unfair decision-making to allocate valued resources.

For example, if a company doesn't seem neutral or respectful when distributing benefits and other attractive incentives, the boss may become rude, assign blame, or publicly ridicule those that report to him or her.

In practice, though, it often is a good idea to actually do a study, even if the conclusion seems perfectly obvious. Every once in a while, the results are different than what one would expect.

Reading more closely, it turns out that the results of the study are not really the same as what is implied in the title: "Study: Workplace abuse can trickle down." What the study actually says, it that supervisors who perceive themselves as being treated unjustly are more likely to be abusive to subordinates. That appears to be the case, regardless of whether the perception is accurate. That suggests that top-level managers might be able to reduce the incidence of the propagation of abusive practices by making sure that supervisors understand the rationale for decisions pertaining to the allocation of resources.

Of course, that is what is really interesting: once we figure out how this kind of thing happens, we then have to figure out how to stop it.

We May Have To Change the Constitution, Then

2006-03-20T20:15:00.000-05:00

This is a very serious issue, outlined in the LA Times (free registration required) :

Justices May Further Restrict Domestic Violence Testimony
By David G. Savage, Times Staff Writer
March 20, 2006

WASHINGTON — The Supreme Court appears poised to make it far harder to prosecute cases of domestic violence when victims are unwilling or unable to testify in court.

Today, the high court will hear the appeals of two men who were convicted of assaulting women based, in one case, on a recorded 911 call, and in the other, on a police officer's testimony of what the victim told him.

Over the last two decades, prosecutors in domestic violence and child abuse cases have relied heavily on testimony by police officers and counselors who interviewed the alleged victims when they could not or would not appear in court.

But those prosecutions have a formidable foe in Justice Antonin Scalia. He insists the Constitution guarantees all defendants a right to confront their accusers in court, and sees no basis for an exception in cases of domestic violence or child abuse. [...]

I understand that changing the Constitution is a serious matter, but it is essential to the well-being of our nation and our people that these prosecutions procede without impediment.

Antiwar Update

2006-03-19T22:30:00.000-05:00

As expected, I was not able to go to the peace rally and march, earlier today. However, two local Flickrites have already posted photos. Argusmaniac has a set here. Peter Honeyman has a few also. [UPDATE] Bob Goodsell has a couple of photos on his blog, too. [UPDATE] More Flickr photos by Jacques Strappe and Boston Fan in Michigan.

one of Peter Honeyman's photos

In non-local news, King of Zembla has posted about the Pentagon's practice of sending troops back into combat after treatment for depression and/or anxiety disorders. I would take that as a sign of desperation. The article says that the troops involved often are eager to go back. That may be so, but I can't help but think that it is a really bad idea to send them back.

Antiwar Protest

2006-03-18T22:13:00.000-05:00

This is a photo of the peace march that was held in San Francisco today, one of many around the world. The protest in Ann Arbor will be held tomorrow. I won't be able to go, but I except that many will. There should be a lot of young people, finally.