Saturday, April 30, 2005

You Will Not Retire Into Poverty...Not!

I'll keep this short, since a lot already has been said about Mr. Bush's recent press conference. According to the official transcript, he said this:
By providing more generous benefits for low-income retirees, we'll make this commitment: If you work hard and pay into Social Security your entire life, you will not retire into poverty.
That sounds good, but is obviously false. Someone who works their entire life at the same job, but who works at or near minimum wage, is already living in poverty. If Social Security replaces 49% of their income, as the current plan calls for, they certainly will retire into poverty.

The only way the President's "commitment" could be kept, would be to specify that Social Security would pay the equivalent of a living wage.

The Blogosphere is Flat!

Somebody visited Corpus Callosum using a Blogwise link.  I had forgotten about Blogwise.  It is one of those sites where people can register their blogs, to get added a directory of blogs.  Anyway, I went there and discovered something novel:

The Blogwise blog mapping service uses the GeoURL data that some of us have in our blog templates, then it plots those data on a map from Google Maps, to create a map of blogs that are close to each other.

To be included, the blog must have GeoURL meta tags as follows:

<META name="ICBM" content="XXX.XXXXX, XXX.XXXXX">
<META name="DC.title" content="THE NAME OF YOUR SITE">

Or Geo Tags like this:
<META name="geo.position" content="42.27;-83.73">
<META name="geo.region" content="US-MI">
<META name="geo.placename" content="Ann Arbor">

And it must be listed on Blogwise. 

It is easy to get the right tags.  Both the GeoURL site and the Geo Tag site have the capacity to generate these tags for you, although you have to insert the tags into your blog template yourself.  So far, there are only ten blogs around Ann Arbor that have the correct meta tags and are listed on Blogwise.  Needless to say, it would be pretty cool if everyone did this.

Killing Any That Display Human-like Behavior;
More Pointless Complaining About Science Journalism

I often have been critical of journalists who write badly about science.  Perhaps I've been too harsh at times.  After all, it must be difficult to write a good story about a topic that is both complex and unfamiliar, whilst facing a deadline.  Some deficiency is to be expected.  Even so, it should be possible to anticipate certain kinds of problems that are especially likely in science writing.  Once the problems are anticipated, it should be possible to avoid them. 

One problem that is fairly common occurs when the journalist writes a sentence that only leaves the reader wondering what was meant by the sentence, yet is not followed by any explanation. Of course, the writer cannot explain everything, otherwise all such articles would turn into textbooks.  Some things, though, either should be explained more thoroughly, or should be left out entirely.  Here is one example:
Genetic Mingling Mixes Human, Animal Cells
By PAUL ELIAS, AP Biotechnology Writer
Fri Apr 29, 8:44 PM ET

[...] In the past two years, scientists have created pigs with human blood, fused rabbit eggs with human DNA and injected human stem cells to make paralyzed mice walk.

Particularly worrisome to some scientists are the nightmare scenarios that could arise from the mixing of brain cells: What if a human mind somehow got trapped inside a sheep's head?

The "idea that human neuronal cells might participate in 'higher order' brain functions in a nonhuman animal, however unlikely that may be, raises concerns that need to be considered," the academies report warned.

In January, an informal ethics committee at Stanford University endorsed a proposal to create mice with brains nearly completely made of human brain cells. Stem cell scientist Irving Weissman said his experiment could provide unparalleled insight into how the human brain develops and how degenerative brain diseases like Parkinson's progress.

Stanford law professor Hank Greely, who chaired the ethics committee, said the board was satisfied that the size and shape of the mouse brain would prevent the human cells from creating any traits of humanity. Just in case, Greely said, the committee recommended closely monitoring the mice's behavior and immediately killing any that display human-like behavior. [...]

Personally, I think that the typical media outlets like to publish stories about chimeras because they think people will be shocked by the idea of mixing human and animal cells.  The fact that nobody seems to care, is lost on them. 

The article quoted here describes some recent experiments involving such chimeras, with the point being that various organizations are establishing ethical guidelines for such experiments.  That all makes sense.  But the last sentence in the blockquote leaves the reader wondering: exactly what "human-like" behavior" might occur, that would warrant euthanasia?

Imagine the shock of the lowly post-doc who goes into the lab in the morning, only to find lab mice chatting on their cell phones, playing Nintendo, eating mouse chow with silverware, or applying nail polish to their little claws.  Or, since the committee included some lawyers, perhaps we could imagine lab mice filing lawsuits against the scientists.  I mean, really, what exactly would the mice be doing that would constitute "human-like" behavior? 

Thursday, April 28, 2005

Direct-to-Consumer Advertisement of Antidepressants

Direct-to-Consumer Advertisement of  Antidepressants; or, Why Doctors Should Remember Bayes' Theorem

In the latest (4/27/2005) issue of the Journal of the American Medical Association, there is a research paper entitled Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants.  The intent of the authors was to investigate the effect of patient's requests for antidepressants on the prescribing practices of primary care physicians.  The study was conducted by having actors go to doctor's offices and simulate a patient encounter.  They arrive at the unsurprising conclusion that direct-to-consumer (DTC) advertising of antidepressants can have an effect upon the prescribing practices of primary care physicians.

This is one of those studies, that, after reading it, one has the impression that the researchers have proven something...although it is not clear exactly what was proved.

The idea is this: simulated patients went to doctor's offices and mentioned a list of symptoms.  In some cases, the list was intended to mimic Adjustment Disorder; in others, Major Depression.  In both types of simulated encounter, actors presented one of three scenarios.  In some, they mentioned having seen an advertisement for a particular antidepressant; in others, they made a general request for an antidepressant, without mentioning a specific drug; in the third scenario, they did not mention a specific drug and did not request an antidepressant.  Thus, there were six types of simulated encounters.  The numbers in each cell indicate the percentage of times that an antidepressant prescription was written. 

Actor mentions specific drug Actor makes general request for drug Actor makes no request
Actors mimicking depression 53% 76% 31%
Actors mimicking adjustment disorder
55% 39% 10%

There are limitations to the study.  One major methodological problem is that the study was not a double-blind study.  The actors knew that they were not real patients, although the doctors did not know that the simulated patients were actors.  (The doctors did know that some of the patients that they would be seeing during the study period would be actors, but not which ones.)  Another limitation is the type of control.  The control in this study is provided by the encounters in which patients mimicked a condition similar, but not identical, to depression.  The intent was to show what would happen if the "patients" could not really benefit from an antidepressant, but asked for one anyway.  The fact is, some patients with adjustment disorder might benefit from a prescription. 

The patients who mimicked having adjustment disorder had been instructed to report symptoms of low back pain, feeling stressed, and having occasional insomnia.  Those are all nonspecific symptoms, but a patient with depression very well might present in the office with exactly those symptoms.  Those asked to mimic depression had been told to report wrist pain and feeling “down” for a month or so, loss of interest in activities, fatigue, low energy, poor appetite and poor sleep.  That is a more specific list of symptoms, but is not necessarily conclusive.  Thus, the doctors were were in the position of having to distinguish between two shades of gray, which is more difficult than distinguishing black from white. 

The most obvious conclusion from the numbers is that people who ask for a drug are much more likely to get one than those who do not.  What is mentioned in the report, but not shown in the table, is that most of time, when actors mimicked depression, they got an appropriate intervention: any combination of an antidepressant, mental health referral, or follow-up within 2 weeks.  Interestingly, the rate of appropriate intervention was a bit lower (90%) in the instances in which a specific request was made, compared to 98% in the instances in which a general request was made. Somewhat disappointing is the fact that only 56% of the instances in which depression was simulated, but no drug request was made, there was not appropriate intervention.  In my opinion, that is one of the major findings of the study, even though it was not one of the objectives.

The other really interesting finding is that the pseudo-depressed actors were more likely to get a prescription if they made a general request, rather than asking for a particular drug; the opposite was true for the pseudo-adjustment-disorder actors.

The authors' conclusions were as follows:
Conclusions  Patients’ requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.
I actually agree with these conclusions, although I am not sure that the study really proves the point.

The study has been picked up by several mainstream news organizations and some specialty services (1  2  3  4  5), and at least one blogger.  The LAT article mentions one point, in particular, that I would like to amplify.
"There's a whole lot of medicine that is practiced in the gray zone," where social influences matter as much as clinical findings, said Dr. Richard Kravitz, a professor of medicine at UC Davis and lead author of the study.

Depression can be difficult to diagnose, and many people resist the possibility that an illness may be mental. A openness to trying an antidepressant appeared to be an important cue to the physicians, Kravitz said.
I'm not sure what the author meant; the second paragraph contains a confusing mix of messages.  The last sentence, though, is the important one.  Here's why: When the doctor is trying to decide what to do, he or she first will formulate an hypothesis, then test the hypothesis.  Some of the testing is conscious; some not.  Once the doctor starts thinking 'maybe this patient is depressed,' she or he will then sift through the patient's presentation and look for clues.  On a conscious level, such clues would include the symptoms that the patient reported.  Perhaps, on an unconscious level, the fact that the patient asked for an antidepressant makes the diagnosis seem more likely.  I am not aware that this has been studied, specifically, but I suspect rather strongly that if it were tested, it would be found to be true.  That is, if you videotaped a zillion real patient encounters, and looked to see if the patients who asked for an antidepressant were more likely to be depressed, I think you would find that it is the case.  Unfortunately, the influence of DTC advertising of pharmaceuticals may degrade the usefulness of that as a diagnostic criterion.  Person who are really interested in this concept may be interested in an explanation of the mathematical basis for this phenomenon: An Intuitive Explanation of Bayesian Reasoning:
100 out of 10,000 women at age forty who participate in routine screening have breast cancer.  80 of every 100 women with breast cancer will get a positive mammography.  950 out of  9,900 women without breast cancer will also get a positive mammography.  If 10,000 women in this age group undergo a routine screening, about what fraction of women with positive mammographies will actually have breast cancer?

The correct answer is 7.8%, obtained as follows:  Out of 10,000 women, 100 have breast cancer; 80 of those 100 have positive mammographies.  From the same 10,000 women, 9,900 will not have breast cancer and of those 9,900 women, 950 will also get positive mammographies.  This makes the total number of women with positive mammographies 950+80 or 1,030.  Of those 1,030 women with positive mammographies, 80 will have cancer.  Expressed as a proportion, this is 80/1,030 or 0.07767 or 7.8%.
In my opinion, the authors may want to study this next:

Are the patients who come to the office and report symptoms of depression and ask for an antidepressant more likely to have depression than those who come to the office and report the symptoms, but don't ask for an antidepressant? 

If so, does the presence of DTC advertising affect the predictive value of the presence or absence of the request?

Why is this more interesting to me, than the study they actually did?  It is more interesting because it would be more useful.  It is very useful, clinically, to know which observations have predictive value, and to know what factors affect that predictive value.  It is less useful to know whether DTC advertising affects the prescribing habits of doctors.  (Of course it does; that is why the drug companies do it!)

How could the study that was actually done help a clinician?  If a patient comes in and asks for a specific drug, perhaps the doctor could take a few extra minutes to ask some questions that would facilitate a correct diagnosis.  Sure, but shouldn't that be done anyway?

I suspect that the authors of the study intended it to contribute to the public debate about the value and problems associated with DTC advertising.  It does that, but it also serves another purpose.  It reminds clinicians that Bayes' Theorem is a critical part of the diagnostic process, and it works best when it is considered on a conscious level.

Tuesday, April 26, 2005

The Leg Bone is Connected to the Jaw Bone

Found via Psychiatry Source, here is an article that indicates a possible connection between the hormonal changes associated with depression, and loss of bone mineral density.  It was a small study, consisting of 19 humans, and it is not sufficiently detailed to allow clinically meaningful conclusions.  Thus, it is of interest more from a basic science perspective than a medical perspective:
The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density
Biological Psychiatry, Volume 57, Issue 8, Pages 911-917 (15 April 2005)
Patricia M. Furlan, Tom Ten Have, Mark Cary, Babette Zemel, Felix Wehrli, Ira R. Katz, David R. Gettes, Dwight L. Evans

This study was designed to test the hypothesis that cortisol mediates the relationship between bone density and depression in postmenopausal women.

Nineteen women aged 52–79 who had been assessed for bone mineral density by dual-energy x-ray absorptiometer (DEXA) were evaluated for depression and anxiety. Diurnal and stress-induced measures of salivary cortisol were obtained during the following week and at a laboratory session involving a speech task.

Nine volunteers reported depression while 10 were never depressed. Ever depressed women had significantly lower total lumbar and right femur DEXA Z scores than never depressed (t(17) = 2.5, p = .019 and t(17) = 2.06, p = .05, respectively). Ever depressed women demonstrated a significant increase in salivary cortisol (area under the curve (AUC) = 27.83, SD = 37.64) compared to never depressed women (AUC = -13.34, SD = 19.55) (t(17) = -3.041, p = .007) during a psychological challenge. There were significant inverse relationships between salivary cortisol AUC values and bone density Z scores at every measured bone site. Mediation analyses suggest that 51 – 67% of the association between depression and bone density could be attributed to stress-induced changes in cortisol.

Cortisol hypersecretion in response to stress may, in part, explain the impact of depression on bone density in post-menopausal women.

Although there are numerous potentially-confounding variables, this study shows that depression is a complex phenomenon.  For those who may be tempted to think it is "all in the head," please realize that this is not the case.  We can't be sure that it is the changes in cortisol regulation that result in changes in bone mineral density, but we can be sure that depression is associated with changes in the endocrine and skeletal systems. 

Ubuntu-Kubuntu Mini-Review

Ubuntu appears to be gaining momentum in the Linux world.  For several weeks now, it has led the hits-per-day list at Distrowatch.  I actually installed Ubuntu several months ago, but did not care for its Gnome-centric interface.  Kubuntu, though, is Ubuntu with a KDE interface. 

Linux, for those who do not know, but who might care, at least a little, is a computer operating system.  You can get Linux for free, or you can pay for it.  If you pay for it, you get technical support.  If you get it for free, you have to use the Internet or call a friend to get support.

In this post, I provide an informal description of my first experiences with Kubuntu.  Not content to leave it at that, I provide some information about Linux in general, which may be of interest to someone who is curious about it, and is considering trying it at home.  I also provide links that can be followed to actually get Linux.  Don't be put off by the technical jargon.  In the last two paragraphs, I tell you how you can try Linux at home with little or no technical knowledge, without risking your current system.  Read the rest at The Rest of the Story.

Monday, April 25, 2005

School Fined for Not Reporting Sex Abuse

In among all the crummy news today, there is this item:

click for their homepage
School Fined for Not Reporting Sex Abuse
US News
Monday, April 25, 2005

CAMBRIDGE, Mass. (AP) - The elite Groton School pleaded guilty Monday to failing to report students' sexual abuse complaints to the state.

Groton officials entered the plea on the day the case was scheduled to go to trial. The school was fined $1,250 and avoided a public airing of damaging testimony. [...]
I don't know the state law in Massachusetts, but it probably is similar to the law in Michigan.  Here, all suspected abuse must be reported, even if there is "not enough information."  In this post, I remind or inform readers of the circumstances in which it is legally required to make a report, and show why there are no excuses.  I also let people know how to make a report, at least if they live in Michigan; the process should be similar in all states.  Continue reading here.

Sunday, April 24, 2005

Heterosexual-Affirming Therapy Endorsed by Insurance Behemoth

Heterosexual-Affirming Therapy Endorsed by Insurance Behemoth...despite lack of empirical support.

I started to write about the lawsuit threatened by the Thomas More Law Center against the Gull Lake school district, near Kalamazoo, Michigan.  The TMLC decided to come to the aid of two teachers who had been barred from teaching Intelligent Design (1  2  3). I'm sure, though, that others will write about this, and I probably don't have much to add. 

The TMLC site included a separate news release that I noticed, which deserves a little more attention:
Health Board Reinstates Controversial Therapist
Fri, Apr 22, 2005

(CNSNews.com) - After booting a controversial Christian therapist from its advisory council in February, the nation's largest behavioral health services company this week confirmed it had invited him to participate once again.

A press release from Magellan Health Services on Wednesday announced that Dr. Warren Throckmorton, a psychologist and counselor who advocates what he calls "heterosexual-affirming therapy," will serve on the company's advisory council.

Throckmorton advocates a type of counseling intended to change the orientation of homosexuals who feel uneasy about their sexual preference. [...]
Magellan is an insurance company that contracts with other insurance companies to manage (i.e. restrict) mental health benefits.  In this post, I review the events pertaining to his dismissal and reappointment, an examine the scientific basis for the treatment that he advocates.  It is a treatment that has been denounced, not only by gay/lesbian advocacy groups, but by leading professional organization.  Continue reading here.

Friday, April 22, 2005

Sitemeter Reveals

Note to the person who searched for "Neurontin recreational": I have the same advice as I gave the person who searched for "neuroscience income".  Forget it.  There's nothing there.

Thursday, April 21, 2005

Square Picture

Wednesday, April 20, 2005

Why My Old Post Is Wrong

On March 30 of this year I wrote On the Uselessness of Intuition; An Untestable Hypothesis to Explain Creationism.  In it, I posited my own definition of intuition: Intuition may be defined as the practice of drawing conclusions based upon untestable propositions.  Of course that is not really wrong.  Because of the fact that it is my own definition, it is correct, by definition.  But I have to admit that it is not the definition that everyone else uses.  In this post, I ramble on about intuition, take detours to the Southwestern USA and the University of Paris, and end up almost-proving that intuition, far from being useless, is in fact a necessary part of daily life.  Continue reading here.


One of my pet theories is the notion, that a great deal of human anxiety is caused by a failure to accept the necessity of intuition.  My reasoning goes like this: The perfect antidote to anxiety is certainty.  Certainty requires proof.  Outside the realm of pure logic, no real proof exists; therefore, in the world beyond pure logic, it never will be possible to attain that perfect antidote.  I see a lot of people who attempt to manage their anxiety by trying to prove things that cannot be proven.  It does not work very well.  That topic is worth a post or two.

Power is based upon knowledge, and knowledge is based upon guesswork; therefore, the basis of power is guesswork, and all power is questionable.  This is why those individuals who are the most narcissistic also are the most insecure.

Monday, April 18, 2005

Dogs are Killed More Humanely than Humans

The April 16, 2005 issue of The Lancet contains a fast-track Research Letter entitled Inadequate anaesthesia in lethal injection for execution, and an editorial entitled Medical collusion in the death penalty: an American atrocity.  It was the latter title that really got my attention.  Although it is not unusual for the leading British medical journal editorials to be critical of American policy, it is not common for them to use so strong of a word as atrocity.  It turns out, though, that their choice of words is no mere attention-getting gimmick; what they report really is an atrocity.  It this post, I review the Research Letter and the Editorial, to explain why it really is an atrocity.  Indeed, it is an embarrassment to our nation.  Continue reading here.

(Updated 4/19/2005)

Sunday, April 17, 2005

Intensity in One City;
The Nuge Does Houston

The epicenter of liberal media bias, the Houston Chronicle, has several articles on the recent NRA convention, which was held in Houston this month.  The featured speaker was our good buddy Tom DeLay.  Not everyone was happy to see him, as the picture illustrates.  Another prominent speaker was the former rock star, Ted Nugent.  In this post, I relay what has been reported about the The Hammer and The Nuge, then show how some advocates of gun ownership are rotten role models for the rest of us.  Continue reading here.

Saturday, April 16, 2005

Yet Another Horse Picture

Here, April and Champie are running together.  This was the first time that Champ was out of the stall.  He was four days old at the time.  By then, I had already used up most of my film.  The only film I had left was supposed to have been developed by May 2002, but I couldn't miss this, so I used it anyway.  I had to use GIMP to adjust the color balance, and the contrast is a little too high, but I still love this picture.

World Voice Day

vocal cord examApril 16th is a special day.  Aside from being the day after taxes are due, is is World Voice Day.  I learned about this from the University of Michigan Health System news release web site.  About ten thousand new cases of laryngeal cancer are diagnosed each year, and each year brings 3,770 deaths from the disease.  Those are not big numbers, in context, compared to lung, intestinal, and breast cancer.  However, there is a very good reason for designating a day to remind people of this illness.  The reason is that many early cases are overlooked.  Obviously, the medical profession is very interested in anything that can lead to early case detection. 

In cases of laryngeal cancer, early detection can be simple. The most frequent early symptom is hoarseness.  Although hoarseness is a nonspecifica symptom, and the vast majority of instances of hoarseness are not due to cancer, it is important to take the symptom seriously if it persists for more than a few days, particularly if ther are no associated symptoms to suggest an upper respiratory tract infection.  This is especially true if the person has risk factors.  Smoking tobacco, and heavy drinking, are the biggest risk factors.  Smoking and drinking are particularly bad when they occur together. 

The diagnosis involves a medical exam, during which the vocal cords are examined visually.  This is not easy to do, so it often means a referral to a specialist.  In the Ann Arbor area, we happen to have very good ENT departments at the UM hospital, and at St. Joseph Mercy.

Friday, April 15, 2005

Phil Gramm Corrected

A while back, I made a snarky comment about a quote from Phil Gramm, a former Senator from Texas. 
Has anyone ever noticed that we live in the only country in the world where all the poor people are fat?" -- Phil Gramm, during his first Senate campaign
I'm not sure why, exactly, but the comment bothered me.  Today, I read in the New England Journal of Medicine (subscription required) that Mr. Gramm was wrong:
A Nutrition Paradox — Underweight and Obesity in Developing Countries
Benjamin Caballero, M.D., Ph.D.

[...] Among countries at an intermediate level of development (middle-income countries, with a per capita gross national product [GNP] of about $3,000 per year), overweight ranks fifth among the top 10 causes of disease burden — right below underweight. This is the same position held by overweight as a cause of disease burden in the developed world. [...]

Separation of Clinic and State?

The separation of Church and State is mandated by the federal Constitution.  Would it also make sense to require a separation between politics and medial practice?  Probably not.  Religion does not have the same potential to be lethal when used improperly (unless you count war and all those other nasty things people do using religious fervor or righteousness as a false pretense.)

Then sometimes you run across things like this:
A federal judge in Utah today struck down the federal government's ban on the dietary supplement ephedra, which was pulled from the market last year after it was linked to more than 100 deaths.

The judge, Tena Campbell of the United States District Court in Salt Lake City, said that ephedra was a dietary supplement and that under rules of the Food and Drug Administration it was the government's burden to prove whether the supplement was harmful if taken in dosages recommended by the manufacturer. In this case, the judge said, the government had failed to do so.
...and you wish Government would just get out of the medical business altogether.  I don't know about the legal merit of her argument, but from a medical standpoint, the decision is almost a parody of libertarian principles.  It seems obvious that you need something like the FDA to impose regulation on a product that is so dangerous, with no valid redeeming qualities.  But what one branch of government can take away, apparently another branch can restore. 

If the ephedra case does have merit, then the FDA regulations should be changed.  I've long thought that they are too loose in the area of "dietary supplements," anyway.  Some of those products have enough pharmacological activity that they should be regulated as stringently as pharmaceuticals.  Clearly, the FDA should be able to designate some herbal products as drugs instead of foods, thereby enabling regulation using the more stringent guidelines.

Closer to home, and illustrating another wrinkle in the governmental role in the regulation of medical practice, is this story from The Pleiad, Albion College's student newspaper:
They want it now
Protests stem from doctor’s comments
April 8, 2005
Carolyn Widman
Senior Writer

Shouts of “What do we want? EC! When do we want it? Now!” echoed across the quad on Wednesday morning, March 31. Students working on bringing emergency contraception to campus gathered outside the Student Health Services building at 8 a.m. to protest the decision to not dispense or prescribe emergency contraception, such as Plan B.

Ken Powell, Midland senior, has been collecting signatures for a petition to bring emergency contraception to the Health Center since February. He and Ryan Sebolt, Lansing senior, organized the demonstration.

Throughout the past three weeks, Powell and co-presidents of POWER Lauren Duthie, Dearborn sophomore, and Amanda Boundy, Eben Junction sophomore, have been in meetings with Sally Walker, vice president of Student Affairs and dean of Students, Cindy Magness, RN, director of the Health Center, and Dr. Martin Holmes, the Health Center’s medical director.

Legally, Holmes is responsible for deciding what gets prescribed to students. He has stated that his reasons for not allowing emergency contraception at the Health Center are based on both medical and personal beliefs.
I actually know Dr. Holmes, and I respect him, and I want to agree with him, although in this particular case I do not.  Even though I disagree with his decision, I can't come up with a good argument for a governmental regulation that would compel him to prescribe emergency contraception.

On the other hand, there is this recent development (from Medscape - free registration required):
U.S. Bill Would Enforce Contraceptive Access in Pharmacies
Todd Zwillich

April 14, 2005 — Washington lawmakers introduced a bill Thursday making it illegal for pharmacies to refuse to fill prescriptions for birth control, fueling a growing controversy over whether pharmacists have the right to withhold oral contraceptives from patients with valid prescriptions.

Under the "Access to Legal Pharmaceuticals Act," introduced by Democrats in the House and Senate, pharmacists who refuse to fill any prescription because of "personal beliefs" must ensure that another dispenses the drugs. Pharmacies that do not stock a drug must order it immediately at the patient's request, it states.

[...] While the bill applies to all prescriptions and does not specifically mention contraception, supporters made it clear that it was intended to head off a growing number of pharmacists who are refusing to fill prescriptions for birth control and emergency contraceptives because of moral objections. [...]
This is superficially similar -- but fundamentally quite different -- than the case above, in which a physician refuses to prescribe emergency contraception.  There are times that pregnancy is medically hazardous, so that emergency contraception could be a lifesaving intervention.  While the physician is in a position to know whether a given patient is in this category, the pharmacist is not.  It is difficult to image a moral framework that would justify withholding a lifesaving medication under any circumstances, except for those that believe that all medical intervention is wrong. 

Clearly, there are no pharmacists who believe that all medical intervention is wrong, so that exception is a moot point.

Now, in actual practice, I don't know if the Access to Legal Pharmaceuticals Act would be effective in all circumstances.  Emergency contraception has to be taken within 72 hours of unprotected coitus to be reliable.  Compelling the pharmacy to order the medication would not assure that it would arrive in time.

Even if the legislation does not always produce the desired outcome, it would have an interesting effect upon the pharmaceutical profession.  Those pharmacists who insist on sticking to their principles would have to know that they might not always be able to do so, legally.  They then would have to decide if they believe in their principles so strongly that they will risk prosecution, or change to a different profession. 

Obviously, the big corporate pharmacies will not want to risk the heavy fines called for in the legislation, and will keep the product in stock. 

I guess I can't make an argument that there should be complete separation of clinic and state, even though it sounds attractive sometimes.

Thursday, April 14, 2005

Filibuster Irony

Julie Saltman has a nice roundup of opinions on the Senate filibuster rule, and proposed changes.  I won't get in to that.  It just occurs to me how ironic it is, that the same people who complain about "judicial activism" want to eliminate one of the few mechanisms in place to prevent it.

Unitarian Jihad Gains Momentum

My Unitarian Jihad Name is: Brother Venerable Chakram of Grace. What's yours?

Thank the French:
Here Comes Souchard's Global Postural Re-education

Back pain is the most rapidly rising source of occupational disability in the USA.  It has a yearly prevalence of 15-20% of the working adult population.  The economic impact is considerable.  Depending upon the methodology, estimates range from 20 to 50 billion dollars per year.

Much medical research that is reported in the Blogosphere is the high-tech stuff.  Every once in a while, though, there is an important finding that is remarkable because it is so simple.  From Medscape (free registration required):
French Physical Therapy Technique Effective in Patients With Refractory Chronic Back Pain
Paula Moyer, MA

April 14, 2005 (Miami Beach) — A physical therapy technique known as Souchard's global postural re-education (GPR) restores most people to complete activities of daily living and therefore produces results that are superior to other conservative interventions or surgery, according to a team of Argentine investigators whose findings were presented here today at the 57th annual meeting of the American Academy of Neurology.

[...] GPR consists of a series of maneuvers in which the patient is in the supine, sitting, and standing positions. The physical therapist's maneuvers involve stretching the paraspinal muscles and those of the abdominal wall so that the joints are relieved of the compression that is typically the source of their pain. The technique is named after the French physical therapist who developed it, Philippe Souchard, and was originally intended as a treatment for scoliosis. Treatment is typically at least four months in duration, with two to four sessions or more the first week, depending on the severity of the patient's condition, and then once weekly thereafter. [...]
Perhaps it is not the sort of earth-shattering, groundbreaking stuff that you usually read about.  But hey, if it cuts the economic impact of back pain by even 10 or 20%, that's real money.

Wednesday, April 13, 2005

Bush, Cheney and Rumsfeld are now species of slime-mold beetles

Bush, Cheney and Rumsfeld are now species of slime-mold beetles

U.S. President George Bush, Vice President Dick Cheney and Secretary of Defense Donald Rumsfeld may not all get a library, airport or highway named after them. But each has a slime-mold beetle named in his honor. Two former Cornell University entomologists who recently had the job of naming 65 new species of slime-mold beetles named three species that are new to science in the genus Agathidium for members of the U.S. administration. They are A. bushi Miller and Wheeler, A. cheneyi Miller and Wheeler and A. rumsfeldi Miller and Wheeler.

Israel presents aerial photos of Iran nuclear sites to Bush

Israel presents aerial photos of Iran nuclear sites to Bush
JERUSALEM (AFP) Apr 12, 2005

Ariel Sharon's military attache presented aerial photos of Iranian nuclear installations during the Israeli prime minister's summit with US President George W. Bush, Israeli public radio reported Tuesday.

General Yoav Gallan, who accompanied Sharon to Monday's talks at Bush's Texas ranch, presented the photos as well as information gathered by the Israeli intelligence services on Tehran's nuclear programme.

The radio, which did not give details on how the photos were taken, said the images proved that the Iranian nuclear programme was at a "very advanced" stage.

White House spokesman Scott McClellan confirmed the two leaders had "talked about their shared concern about Iran's intentions with their nuclear programme" but denied they had discussed the possibility of a preemptive military strike by Israel, aimed at ensuring Iran does not acquire atomic weapons.

This seems odd to me.  Surely intelligence agencies trade information all the time.  Usually it is not reported in the news.  Surely this information could have been exchanged in such a way that it would not be common knowledge.  So what are these people up to?  Who has what agenda?  Who wants whom to think what?

All I know is someone's playing games, and I don't like it.

Tuesday, April 12, 2005

RNC Endorses Affirmative Action!

In a stunning about-face, the republican National Committee has officially endorsed the concept of Affirmative Action. 

Ken Mehlman did not really say thisAccording to Party chair Ken Mehlman, "We decided that, in the spirit of the republican Party's Big Tent® philosophy, that Affirmative Action is duly meritorious and should be a plank in the republican Party's platform." 

Alarmed by the findings that most Universities have mostly Democratic faculty members, and that many prominent Universities are major donors to the Democratic Party, the republican Party has decided that Universities should embark on an aggressive campaign to recruit and retain republican supporters to top faculty positions. 

Mehlman explained that the Party initially pinned it's hopes on charter schools and tougher academic testing to raise the performance of republican offspring, thereby rectifying the liberal bias in academia.  However, the prominent republican, Jeb Bush, has conceded that this is not working in Florida.  Arnold Schwartznegger has terminated California's contract with 60 charter schools.  Even in Texas, the adopted home state of the "Education President,"  the only way to get report positive results from No Child Left Behind was to leave the truth behind while writing the reports. 

Even Dick Cheney has chimed in: "This is a matter of National Security."  He states that the problem is so severe, that it would be appropriate for Universities to lower their standards in order to let a few more republicans get tenure.  He says that it would be a big sacrifice, but a necessary one: "I know it's tough to work with someone who can't pronounce "nuclear" properly, but you kinda get used to it, after a few years."

CC acknowledges David M for finding some of the links.

Sunday, April 10, 2005

Video Clip of Champie

On Sony's Imagestation, I've uploaded more pictures of Champ, including a short video clip, at www.imagestation.com.  Unfortunately, you have to endure free registration to view the albums.  Then you need to search for Member jyaroch, and select the Album, Champie.  The video is about 2.5 megabytes, so it takes a long time to load over a modem.

If anyone knows of a free video hosting service that does not require users to register, just to watch  the pictures, please let me know in the comments.


When I was in high school, one day, one of my teachers, Mr. Harrison, the Biology teacher (and wrestling coach) decided he needed to refocus everyone's attention.  He did this by having a contest of sorts.  Everyone had to write down, on a little slip of paper, the one thing that he or she wanted the most.  He collected them all and read them off.  We then voted on them.  The person who got the most votes was a girl named Priscilla; she wanted a horse farm.  Nobody voted for mine, which was to know everything.

Here I am thirty years later:  I have a horse farm; I have no idea whether Priscilla ever got her wish.  Probably not.  I didn't get my wish, either.  In fact, I keep getting farther from it.  As Oscar Wilde said:
"I am not young enough to know everything"

When I was in college, one of my favorite albums was Horses.  I wanted to see Patti Smith in concert.  Thirty years later, I still like the album, but I have not seen Patti Smith.  She's still around, although I don't know if she does concerts any more.  I did buy her retrospective set, Land 1975-2002, which includes sleeve notes by the late Susan Sontag

My wife does not particularly care for Patti Smith, but she does care for horses.  She grew up on a farm, used to ride horses bareback when she was four years old.  She also sang in a rock band when she was a teenager.

Due to various misfortunes, she needed something to enrich her life.  We decided to have horses here on our property, for that reason.  We can't really afford it, but sometimes you just do what you have to do. 

When I put up the most recent post with pictures of our new colt, it stuck me as odd that I was writing about Linux and digital image acquisition and manipulation, just a day or two after getting my hands dirty delivering a baby horse. 

Bits and bytes, after all, are pretty much the epitome of cleanliness.  At first glance, that is.  But then fire up a computer and connect to the Internet.  It seems so clean at first: electrons in a wire.  But look at what you see.  Death.  Deception.  War.  Betrayal.

Then watch the colt.  Two days after the birth, the mother has licked him clean of blood and amniotic fluid.  Let him out of the stall for the first time.  It is a sunny spring day.  At first he tries to canter, tentatively, perhaps stumbles a bit.  Within minutes, he and his mother are at full gallop.  Perfect unison.

For a moment, you forget to breathe.  You also forget about Death.  Deception.  War.  Betrayal.

Perhaps it is true, that cleanliness is next to godliness; but it is not always obvious, what is truly clean, and what is not.

Saturday, April 09, 2005

Use the Right Number!
What do Tom DeLay and Bextra Have in Common?

Recently, Bextra was taken off the market because there is evidence that it could increase the risk of vascular disease.  That sounds like a sensible thing.  Vascular disease is bad.  Nobody wants that.  And I will trust that the number crunchers at FDA crunched the right numbers to come up with the correct recommendation. 

However, finding the right numbers to crunch is not always a straightforward process. 

Image that I told you that a widely-used drug is likely to increase the risk of death, not only from vascular disease, but also cancer, pneumonia, HIV, and meteor strikes.  It increases the risk that the patient will die from sticking a knife into a toaster to dislodge a stuck piece of bread.  At first glance, it would seem that such a drug should be removed from the market, immediately.  But in fact, there are many such drugs on the market, and rightly so. 

You see, everyone has to die from something.  So if a drug reduces the risk of death from one cause, it automatically increases the risk of death from all other causes*.  If you do not die from heart disease, you then are more likely to die from cancer.  Therefore, in assessing the safety of a drug, it is not meaningful to say that the drug increases the risk of death from some particular cause: any drug that reduces the risk of death from one particular cause will have such an effect.  The absolute risk simply is not the right number to use in this context. 

In the recent controversy about Tom DeLay, it has been revealed that his wife and daughter have received a total of ~ $500,000 from his various campaign funds.  The Left is all up in arms about that, because $500,000 is a big number.  The Right is dismissive.  Having done the math, they say that the half-million actually amounts to only about 40 to 50 thousand dollars per person-year . 

Neither side is using the right number.  What matters is not the total amount, nor the amount per person per year.  What matters is this: how much were they making per hour of legitimate work? If they made $50,000 per year for a 40-hour workweek, 48 weeks per year, that would be reasonable.  In fact, it might indicate that they were underpaid.  But if they only did a few hours of real work per year, then the same amount could indicate something really fishy. 

In this case, neither the total amount, nor the amount per year, is the right number.

How much do the Ms. DeLay's make per hour?  Is fifty thousand dollars chicken feed to them, or real money?  Did they actually do anything substantive to earn the money?  What did they do with the money?  Donate it to charity, or buy a yacht? 

Believe me, I would love to see Mr. DeLay loose his job over an ethics scandal.  After all, he once tried to con me into donating $300 to his campaign.  (I told the staffer who called me that I would pay him $300 if he could guarantee that he would never call me again.)  However, the fact is, we cannot tell -- from what has been reported so far -- whether the half-million dollars was inappropriate.  Nobody is using the right number. 

What we really want to know is this: what would it take for the FDA to declare Tom DeLay unsafe and ineffective?
* To be obsessively accurate, this statement is true only if all causes of death are fully independent of each other, which is not really the case, but the main point still stands.

UPDATE Here's another example of the wrong number, in this case, concerning pollution. A reporter does not understand the distinction between emissions and emissions intensity.

Friday, April 08, 2005

More Pictures of Champ

These are the first scans I've made using Linux.  It was remarkably easy, even while sleep-deprived.  I plugged in the scanner (Epson Perfection 1240U photo), SuSE's YaST (Yet Another Set-up Tool) recognized it immediately and launched the setup program.  I clicked to accept the default settings, and a dialog box popped up informing me of the pertinent programs that were installed already (SANE -- Scanner Access Now Easy; GIMP -- GNU Image Manipulation Program; and Kooka -- which doesn't stand for anything).  SANE is a low-level program that communicates between the scanner and the computer.  Kooka is the front end, the program that the user interacts with, that does the scanning.  GIMP is used to touch up the photo and save it in whatever format.

Yvonne and I helped deliver this cute little thing.  This picture was taken about 15 or 20 minutes after the delivery.  Champie is trying to stand up for the first time. 

This, obviously, is immediately after the birth.  Note that part of the amniotic sac still is covering Champie's hind legs.  We had just put him down on the ground.  Once we were sure he was breathing and that his nostrils were clear, we backed off and let April take over.  April is cleaning him up for the rest of the photos. 

I'll post more later, probably on a different site. 

What War Does

God does not play dice.  But American Presidents do, so long as it is someone's else's lives and money on the line.

NPR is doing their fundraising thing this week.  Consequently, I've been listening to AM radio.  On 760 kilohertz -- WJR -- I've had the privilege of hearing Rush Limbaugh again. 

My first experience with Mr. Limbaugh occurred many years ago, late at night.  I had turned on the TV.  There was a talking head going on and on about liberals.  Literally, I though I had tuned in a late night parody, perhaps a rerun from Saturday Night Live.  After several minutes, I realized that, even as a parody, it was not really funny; the guy was just too offensive, even by SNL standards. 

The following day, I looked him up.  Only then did I realize that he's for real.  Today he had something to say about the war.  It got me thinking in an abstract way.  Continue reading here.

Thursday, April 07, 2005

Champ's Vivid Image

Champ Stands for the First Time

April 6, 2005
42 minutes old

Wednesday, April 06, 2005

Pipeline Update: Eszopiclone in Pharmacies Now

Sepracor's new medication, Lunesta, was approved by the FDA last year.  I just heard that it is being shipped to pharmacies as of today.  I don't have a lot to add since my original post, although a couple more abstracts have appeared on Medline.  Also, I have a few comments about the potential for ancillary use of Lunesta in treatment of depression and chronic pain.  Continue reading here.

Familial Advanced Sleep Phase Syndrome:
Exactly What is a Disease Anyway?

Lessons in Clear Thinking About Diagnosis and Labels

The news is not making much of a splash in the Blogosphere.  Scientists at the Howard Hughes Medical Institute, working on a condition known as Familial Advanced Sleep Phase Syndrome, have discovered the cause.  It is a mutant gene known as CKIdelta.  Their press release is here

FASPS is a condition in which people tend to fall asleep early in the evening, say around 5 PM, then awaken early.  They are healthy otherwise, and they sleep a normal amount of time.  For example, the person who goes to sleep every day at 5 PM may awaken every morning at 3 AM. 

In this post, I discuss the nature of FASPS and use that as a specific example, to illustrate certain general concepts about the diagnosis of illness, then explore what a diagnosis means in medical settings, as well as in society at large.  Continue reading here.

Sunday, April 03, 2005

Lesson from History

The UK just released some formerly-secret papers regarding the activities of spies in the run up to the second World War.  I ran across the reference on the oxymoronically-named  History News Network.  They link to this story in the Financial Times:
Spy secrets failed to win Whitehall's trust
By Jimmy Burns
April 1 2005 03:00
[...]The use of spies was defended by Winston Churchill. But in remarks echoed six decades later in the controversy over the invasion of Iraq, Sir George Mounsey, secretary designate to the Ministry of Economic Warfare, challenged the value of the "sensational" information provided by agents.

"They have a secret mission and they must justify it," he said. "If nothing comes to hand for them to report, they must earn their pay for finding something." [...]
Of course, I can't claim to know the ins and outs of the spy business.  I wonder, though, if Sir George [no relation to the current White House occupant] was on to something.  Does the clandestine culture encourage -- or even permit -- people to come back and say, "I don't know, I couldn't find out."?

Welcome to Michigan

NASA Photo - visibleearth.nasa.gov

Saturday, April 02, 2005

Isn't This Cool?

From the  New York Times:

Andrew Sacks for
The New York Times

Ron Gremban modified a Toyota Prius by installing auxiliary batteries.
Andrew Sacks for
 The New York Times

Felix Kramer, left, and Ron Gremban in Ann Arbor, Mich., with an auxiliary battery charger for a converted Prius. Toyota has spent millions persuading people that the car does not need to be plugged in.

These Ann Arborites have modified a Prius in two ways: It has extra batteries, so can run farther on battery power alone; and it can be charged by plugging it in to a wall outlet.  Apparently, Toyota discourages these modifications, calling them unnecessary.  Critics point out that 60% of electrical power is generated via the burning of coal, which is more polluting than gasoline.  However, there are advantages.
[...]They were aroused by a mysterious unmarked button on their Prius and discovered that in Priuses sold in Europe and Japan, the button allows the car to drive for a mile in electric-only mode. Mr. Hermance said the feature was disabled in Priuses sold in the United States because of complications it would have created in emissions-testing rules.

Mr. Kramer said "a bunch of engineers reverse-engineered it in the United States and figured out how to hack it."

But they soon wanted to travel on batteries for more than a mile and began to collaborate through CalCars on adding batteries to the Prius that would allow for longer pure electric travel. With the help of dozens of volunteer engineers collaborating online, the group retrofitted a Prius in Mr. Gremban's garage to travel about 10 miles on nothing but battery power. [...]
This would be great for urban use: drive to the city in normal mode; in the city, use electric-only mode.  That would cut down on air pollution in the city, where it tends to be most concentrated, and causes the most health problems.

Another advantage is that the cars usually would be plugged in at night, drawing electricity at times of low demand.  What would be really cool would be a way to plug the car into a heavy outlet in the home, so that you could use the car to power the house, in case of an electrical outage. The article mentions the possibility of car owners selling electricity back to the power company, although I doubt that would be efficient enough to be worthwhile. 

Twin Research Links Genetics and Adult Spirituality -- Maybe

I ran across this on the Futurepundit weblog.  The headline, Twin Research Links Genetics and Adult Spirituality, appears on the ABC News website, along with Photos: Atlanta Courthouse Shooting, and Sony Launches Mobile PlayStation Portable.  The Atlanta courthouse shooting article is sensationalist, but not really very significant on a national level.  The Sony PlayStation article is amusing, but hardly significant.  The Genetics and Adult Spirituality article shares the virtues of the others: it is amusing, sensationalist, and hardly significant. 
To get at possible causes behind a person's degree of religiousness, Koenig examined surveys completed by 169 identical and 104 fraternal twins. All the twins were men born in Minnesota with an average age of 33 at the time of the survey. The idea was that similarities in faith between identical twins would have a stronger genetic link that those found among fraternal twins.
Of course, the first problem is that the study did not actually measure religiousness.  Since it was done by having people fill out surveys, what they actually measured was survey-filling-out behavior.  What they found is that identical twins fill out surveys the same way more often than fraternal twins do.  Continue reading here.
(Updated 4/3/05)