Wednesday, October 31, 2007

Another Drug Rep

Drug reps are hired for their looks and personality, not their knowledge. Lots of people are influenced by a charming personality instead of common sense. That is why advertising succeeds and the earth is drowning in useless garbage. Manipulating people pays better than informing them.

The Problem with Experts

If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance. - Orville Wright

Education can be a wonderful thing as long as it is not just pepetuating false assumptions.

Dr Ioannidis began his study by reviewing 49 research articles printed in widely read medical journals between 1990 and 2003. Each of these articles had been cited by other scientists in their own papers 1,000 times or more. However, 14 of them—almost a third—were later refuted by other work. Having established the reality of his point, he then designed a mathematical model that tried to take into account and quantify sources of error. Again, these are well known in the field.

One is an unsophisticated reliance on “statistical significance”. To qualify a result as statistically significant, the probability that it is the result of pure coincidence should be smaler than 1:20. But, as Dr Ioannidis points out, adhering to this standard means that simply examining 20 different hypotheses at random is likely to give you one statistically significant result. In fields where thousands of possibilities have to be examined, such as the search for genes that contribute to a particular disease, many seemingly meaningful results are bound to be wrong just by chance.

In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance.

When Dr Ioannidis ran the numbers through a simulation, his model predicted that even a large, well-designed study with little researcher bias has only an 85% chance of being right. An underpowered, poorly performed drug trial with researcher bias has but a 17% chance of producing true conclusions. Overall, the model predicts that more than 50% of all published research is probably wrong.
- Read whole article here.

Because the educated professionals have invested a lot of time and money in studying current thinking, they are reluctant to discard any of it. This is despite the fact that modern medicine really has very few accomplishments to take credit for and diseases that have been around for centuries will probably be attacking future generations.

This is an incomplete list of incurable diseases:
Acute Lymphocytic Leukemia
Acute Myeloid Leukemia
Acquired Immune Defficiency Syndrome (AIDS) see also HIV
Adrenoleukodystrophy (ALD)
Alzheimer disease
Amyotrophic Lateral Sclerosis (ALS,Lou Gehrig's disease)
Attention Deficit Disorder (ADD)
Avian Influenza
Batten disease (Juvenile Neuronal Ceroid Lipofuscinosis)
Bovine Spongiform Encephalopathy (BSE, "Mad Cow" disease)
Bipolar disorder (Manic-depression)
Chronic lymphocytic leukemia (CLL)
Chronic myeloid leukemia (CML)
Creutzfeldt-Jakob Disease (CJD) see also Bovine Spongiform Encephalopathy and Kuru
Common Cold
chicken pox aka Herpes Zoster aka varicella-zoster aka Shingles
Currarino Triad
Cystic Fibrosis
Dysmyelogenic leukodystrophy (DMD a.k.a. Alexander disease)
Emphysema (C.O.P.D.)
Farber disease
Fatal Familial Insomnia
Fibrodysplasia ossificans progressiva
Galactosialidosis (Goldberg syndrome)
Gaucher disease
GM1 Gangliodsidosis
Hairy cell leukemia
Herpes Zoster aka varicella-zoster aka chicken pox
Hopeless Astrocytoma (Brain Cancer)
Hurler syndrome (includes Hurler-Scheie)
Hunter syndrome
Infantile Neuronal Ceroid Lipofuscinosis
Krabbe disease
Kuru see Creutzfeldt-Jakob Disease
Lymphocytic Lymphomas
Hodgkin Lymphoma
Non-Hodgkin lymphoma
Small lymphocytic lymphoma
Metachromatic Leukodystrophy (MLD)
Morquio A
Mucolipidosis II (I-Cell Disease)
Mucolipidosis IV
Multiple sclerosis (MS)
Niemann-Pick disease, Types A and B
Pompe disease
Pseudomyxoma peritonei
Salla disease
Sandhoff disease
Sanfilippo A
Scheie syndrome
Schindler disease
Sialidosis (Mucolipidosis I)
Sly syndrome
Spreading Adenocarcinoma
Spreading Melanoma
Takayasu's arteritis (Pulseless Disease)
Tay-Sachs disease
Wolman disease

Sunday, October 28, 2007

They are Safer on the Streets than at Home

Tales of tampered candy and others like it are based more on our unreasonable collective fears, fueled by the media and hearsay, than on factual information. The fear surrounding tainted Halloween treats goes back for decades and may have originally stemmed from an incident in 1964. A New York housewife, annoyed that many of the trick-or-treaters were too old to be asking for free candy, decided to make up packages of inedible treats to give the teens. The packages contained steel wool, dog biscuits and ant buttons. To her credit, she did clearly label the ant buttons "POISON" and cautioned the teenagers of her little prank. No one was injured, but the potential for harm was there, so the District Attorney prosecuted and she plead guilty to endangering children.
National panic about candy tampering didn’t reach an epidemic proportion however, until the New York Times ran an article in 1970 claiming that "Those Halloween goodies that children collect this weekend on their rounds of ‘trick or treating’ may bring them more horror than happiness." (NY Times, 10/28/70, pg. 56) The article went on to give specific and horrifying examples of potential tamperings. Since the Times article, the media has kept that fear alive. Even "Dear Abby" got in on the action by reminding parents of the danger that "…somebody’s child will become violently ill or die after eating poisoned candy or an apple containing a razor blade."
The truth about the dangers might not have been discovered, were it not for California researchers Joel Best and Gerald Horiuchi, who studied national crime data going back to 1958. In their 1985 published study, they found only 76 reports of any kind of tampering. Most of them turned out to be mistaken or fraudulent. Out of these 76 reports, only three incidents of children dying were reported to be tainted candy cases. In one case, the father of a Houston boy gave him arsenic laced candy to collect on a large insurance claim. In the second case, a boy stumbled across his uncle’s stash of heroin, ingested some of the drug and died. This boy’s family tried to hide the facts by sprinkling heroin over some of his other candy, but the family soon confessed to their cover-up. And in the third case, a Los Angeles girl had a fatal seizure that was first blamed on tainted candy, but later discovered to be the result of a congenital heart condition.

Contrast that with this:

According to the National Center on Child Abuse and Neglect, in 1995 about 2.9 million children in the United States were reported as abused or neglected to government agencies that investigate child abuse. Investigators substantiated abuse or neglect for more than 1 million of the children reported. Among substantiated cases, 52 percent involved physical or emotional neglect, 24.5 percent involved physical abuse, 12.6 percent involved sexual abuse, 4.5 percent involved emotional abuse, and 17.3 percent involved other abuse, such as educational neglect or abandonment. Some children experienced multiple forms of abuse.
Many researchers believe that statistics based on official reports do not accurately reflect the prevalence of child abuse. Definitions of maltreatment vary from state to state and among agencies, making such statistics unreliable. Professionals who interact with children—such as teachers, day-care workers, pediatricians, and police officers—may fail to recognize or report abuse. In addition, acts of abuse usually occur in the privacy of a family’s home and often go unreported. Surveys of families, another way of estimating abuse, indicate that 2.3 percent of children in the United States—or about 1.5 million children—experience abusive violence each year.
The U.S. Advisory Board on Child Abuse and Neglect estimates that 2000 children under the age of 18 are killed by parents or caretakers each year. Annually, more children under the age of four die from abuse and neglect than from falls, choking on food, drowning, fires, or motor vehicle accidents. More than 18,000 children suffer permanent disabilities from abuse or neglect annually.

Thursday, October 25, 2007

Sleep Deprivation

It sickens me that not only physical torture but also psychological torture of sleep deprivation, sensory deprivation (the hoods), and isolation are used by our government. To everyone who has gone for long stretches without sleeping with all the loss of judgement that goes with it, this article in Psyciatric Times is an interesting one as you are not alone:
When sleep deprivation becomes great enough, the effects mimic those of psychosis. The failure of the scientific world to recognize this is due to some extent to the folklore that has grown up around the sleepless marathon of high school student Randy Gardner in 1964.

To gain an entry into the Guiness Book of World Records, he remained awake for 264 hours (11 days). Summaries of this case usually report that Gardner suffered no hallucinations, no paranoia or other negative mood changes, and that his mental, motor and sensory abilities were quite good throughout the entire episode. This conclusion is so widespread that it has now become a stock "fact" presented in virtually any psychology or psychiatry book that has a chapter on sleep.

This conclusion seems to be based on two items of information. The first was the observation that there were no obvious lasting physical or mental problems encountered by Gardner when he began to sleep again. The second was based upon observations of researcher William Dement (Dement, 1992), who interviewed Gardner on Day 10 of the experiment. He reported that he took Gardner to a restaurant and then played pinball with him, noting that Gardner played the game well and even won. Lt. Cmdr. John J. Ross of the U.S. Navy Medical Neuropsychiatric Research Unit in San Diego, who was called in by Gardner's worried parents to monitor his condition, tells a quite different story (Ross, 1965). Gardner's symptoms that Ross reported included:

Day 2: Difficulty focusing eyes and signs of astereognosis (difficulty recognizing objects only by touch).

Day 3: Moodiness, some signs of ataxia (inability to repeat simple tongue twisters).

Day 4: Irritability and uncooperative attitude, memory lapses and difficulty concentrating. Gardner's first hallucination was that a street sign was a person, followed by a delusional episode in which he imagined that he was a famous black football player.

Day 5: More hallucinations (e.g., seeing a path extending from the room in front of him down through a quiet forest). These were sometimes described as "hypnagogic reveries" since Gardner recognized, at least after a short while, that the visions were illusionary in nature.

Day 6: Speech slowing and difficulty naming common objects.

Day 7 and 8: Irritability, speech slurring and increased memory lapses.

Day 9: Episodes of fragmented thinking; frequently beginning, but not finishing, his sentences.

Day 10: Paranoia focused on a radio show host who Gardner felt was trying to make him appear foolish because he ws having difficulty remembering some details about his vigil.

Day 11: Expressionless appearance, speech slurred and without intonation; had to be encouraged to talk to get him to respond at all. His attention span was very short and his mental abilities were diminished. In a serial sevens test, where the respondent starts with the number 100 and proceeds downward by subtracting seven each time, Gardner got back to 65 (only five subtractions) and then stopped. When asked why he had stopped he claimed that he couldn't remember what he was supposed to be doing.

In many respects Gardner's symptoms were similar to those experienced by a New York disk jockey, Peter Tripp, who endured a 200-hour sleepless marathon to raise money for the March of Dimes. During the course of his ordeal his thoughts became increasingly distorted and there were marked periods of irrationality. By the end of four days he could not successfully execute simple tests requiring focused attention. In addition, he began to have hallucinations and distorted visual perceptions. At one point Tripp became quite upset when he thought that the spots on a table were insects. He thought that there were spiders crawling around the booth and even once complained that they had spun cobwebs on his shoes.

He showed the same increasing moodiness and paranoia that Gardner did. On his last day, a neurologist was called to examine Tripp before sending him home. When Tripp looked up at this doctor in his dark, old-fashioned suit, he had the delusion that the doctor was really an undertaker who was about to bury him alive. Overtaken with fear, he let loose a scream and bolted for the door. Half-dressed, Tripp ran down the hall with doctors and psychologists in pursuit. He could no longer distinguish the difference between reality and nightmare.

This same pattern of mental deterioration that mimicks psychotic symptoms appears in several more systematic studies of sleep deprivation and extreme sleep debt. Thus, prolonged sleep deprivation does lead to the appearance of serious mental symptoms. In addition, even moderate amounts of sleep deprivation can lead to losses in mental efficiency that can threaten public and personal safety.

William Dement is regarded as the expert on sleeping and he was so wrong on this aspect. One has to question his reliability when he says that schizophrenics have the same sleep and REM patterns as normals.

The Crying Game: Male vs Female

latest study mentioned on Yahoo is that crying men and crying women are viewed very differently. I actually get quite a kick out of all the studies that try to sound profound when they are just commenting on obvious things. Anyway here is a snippet:

In a recently published study at Penn State, researchers sought to explore differing perceptions of crying in men and women, presenting their 284 subjects with a series of hypothetical vignettes.

What they found is that reactions depended on the type of crying, and who was doing it. A moist eye was viewed much more positively than open crying, and males got the most positive responses.

"Women are not making it up when they say they're damned if they do, damned if they don't," said Stephanie Shields, the psychology professor who conducted the study. "If you don't express any emotion, you're seen as not human, like Mr. Spock on 'Star Trek,'" she said. "But too much crying, or the wrong kind, and you're labeled as overemotional, out of control, and possibly irrational."

That comes as no surprise to Suzyn Waldman, a well-known broadcaster of Yankee games on New York's WCBS Radio.

Earlier this month, she choked up for several seconds on live radio after the Yankees had just been eliminated from the playoffs. She was describing the scene as manager Joe Torre's coaches choked up themselves, watching him at the podium and foreseeing the end of an era.

Her tearful report quickly became an Internet hit, and she was mocked far and wide, especially on radio, with her voice, for example, played over the song "Big Girls Don't Cry."

"This turned into something pretty ugly," Waldman said in an interview. "I don't throw around the word 'sexist,' but this was as sexist as it gets."

She also wrote a passionate editorial in Newsday defending her brief display of emotion. "While the anger and sarcasm that I can and do display is all right with people," she wrote, "the occasional tear is scary and is ridiculed. Why?"

While Waldman notes that female anger in the clubhouse, is OK — it makes her seem tough, she says — one recent study indicates that perceptions of anger, too, differ according to gender.

"When men express anger they gain status, but when women express anger they lose status," Yale social psychologist Victoria Brescoll, who conducted three experiments on how people perceive female anger, said in an interview. Her study is to be published in the journal Psychological Science.

Tuesday, October 23, 2007


Many psychiatric disorders, "particularly ones involving emotions, seem to be linked with abnormal sleep," he added. "Traditionally people mostly thought the psychiatric disorders were contributing to the sleep abnormalities, but of course it could be the other way around. If we can find out which parts of sleep are most key to emotional stability, we already have a good range of drugs that can push and pull at these kinds of sleep and maybe help treat certain kinds of psychiatric conditions."
Read the whole article here

It has also been found that melatonin levels drop 75% suddenly just before puberty which seems very significant considering schizophrenia usually appears at about the same time in formerly healthy kids and their parents often talk about how they wander around nights.

When you factor in other victims of sleeplessness due to hypervigilance (child abuse and PTSD for example) one really has to question whether all the psych treatments are taking credit for a side effect - sleepiness. Actually the blockbuster drugs for erectile dysfunction were just a side effect of a drug designed for hypertension, ecstasy was developed to prevent excess bleeding, there are lots of examples of the side effects becoming more important than the original function.

Sunday, October 21, 2007

Medication Nation

Medication Nation by Mark White Too fat, too thin, too sad, too happy...Whatever the problem Biotech is developing a vaccine or a pill to cure us. Mark White examines the consequences of a world where all our worries can be medicated away. Here is just some of a really interesting article:

Swiss biotech company Cytos has 25 research programs underway, including its ImmunodrugTM nicotine vaccine CYT002-NicQb, along with vaccines for chronic diseases including obesity, hypertension, allergy, psoriasis and rheumatoid arthritis. The company was granted a US patent in early 2005 for vaccines against different drugs of abuse, and hopes to release its nicotine vaccine in 2010. The vaccine antibodies prevent dopamine, the chemical that leads to a feeling of pleasure, from flooding the brain. They have a half-life of 50 to 100 days, meaning the response could be a boosted by a further injection. The rewards are huge: Decision Resources estimated the 'stop smoking' market in America alone will be $1.5bn by 2007, and as China and India become richer, with more people smoking, eventually more people will want to stop smoking too.

Cystos' obesity vaccine works on a similar principle with an antibody against ghrelin, a small protein that regulates appetite. If you inject extra ghrelin into people it makes them hungrier. Fat people who lose weight develop extra ghrelin, leading to yo-yo dieting. The theory is that by stopping the uptake of ghrelin it will be easier to stick to a diet. Cytos is to be running trials with 112 obese volunteers on a six month treatment of the vaccine or a placebo, and at the same time counselling them about healthy eating and encouraging exercise. While obesity is a leading cause of preventable death in rich countries, it is also, in every sense, a growing problem, with rich nations becoming fatter and fatter, and less and less happy about it. A successful vaccine would be worth billions.

The military are in on the act, naturally, sponsoring research into drugs that will keep their soldiers awake without the jittery, glittery rush of adrenaline that follows amphetamine use. And then there are mood-enhancing drugs to combat the rise of depression, a disorder that the World Health Organisation estimates will be the biggest health problem in the industrialised world by 2020.

'Tomorrow's biotechnology offers us the chance to enrich our emotional, intellectual and, yes, spiritual capacities,' says David Pearce, a leading transhumanist philosopher (transhumanists favour using science and technology to overcome human limitations). I think there's an overriding moral urgency to eradicating suffering. This ethical goal eclipses everything else.'

There is an alternative view, explored by philosopher Carl Elliott in his essay Pursued by happiness and beaten senseless: Prozac and the American Dream, that looks at alienation in societies - the 'mismatch between the way you are living a life and the structure of meaning that tells you how to live a life... it makes some sense (though one could contest this) to say that sometimes a person should be alienated - that given certain circumstances, alienation is the proper response. Some external circumstances call for alienation.' He gives the example of Sisyphus pushing the boulder up the mountain. He may be happier on Prozac and his psychic well-being would be improved. But his predicament is not just a matter of the wellbeing of his mental health, but how he is living his life. If someone's life is making them sick, then you can make them well by cither changing how they live their life or by making them fit in with what made them sick in the first place.

The real kicker is the class of experimental drugs developed by Cortex Pharmaceuticals, known as ampakines, that boost the levels of glutamate in the brain - a neurotransmitter implicated in the consolidation of memory. The drug's obvious therapeutic use is to treat people with Alzheimer's or dementia, but why stop there? A report in New Scientist earlier this year described the effects of the Cortex Pharmaceuticals ampakine CX717 on 16 healthy male volunteers at the University of Surrrey who were kept awake all night and then put through tests. Even the smallest doses of the drug improved their performance, and the more they took the more alert they became and the better their cognitive performance. The ampakine users remained alert and with none of the jitters associated with caffeine or amphetamines.

All technologies have mission creep and unintended consequences. Chatterjee dismisses concern about drug safety with the blithe phrase 'in general, newer medications will continue to be safer', despite little evidence to that end - and recent evidence with fen-phen, Vioxx and' the hiding of negative SSRI drug data by Big Pharma pointing in the other direction. The debate is framed in such a way as to make cosmetic neurology sound like an extension of evolution, when it's about as natural as a GM tomato containing a fish gene. This kind of technological arrogance is what's dooming the ecosphere, not saving it. 'I'm not prepared to say they can't be a good thing,' wrote Elliott, by email. 'They may well be. But I guess my feeling is that while the benefits are obvious, the possible drawbacks are not, and need to be thought about more carefully. There are also a lot of people out there with a financial interest in hyping the benefits and downplaying the risks.'

Friday, October 19, 2007

This is Pretty Funny

This guy has a simple cure for all mental illness - a cuff to the side of the head. Even more absurd is the fact that one psychiatrist also recommended slapping mentally ill people.

In the 1940s and 50s, Dr. John Nathaniel Rosen developed a technique for treating schizophrenic patients that involved slapping them. In 1971, he received the Man of the Year Award from the American Academy of Psychotherapy according to this history of treatments.

Sunday, October 07, 2007

Big Price Jump

Drug's price up more than $21,000
The hike for H.P. Acthar, which treats a rare childhood disorder, has sparked debate over prescription costs.

There's one drug most doctors turn to first when babies have catastrophic seizures: a natural hormone sold under the name H.P. Acthar. It's the gold standard to stop seizures that can ruin a child's chance for a normal life.
On Aug. 27, the lone maker of that drug raised the price from $1,650 a vial to more than $23,000 a vial, sending the price for an average patient to $100,000 or more.
Experts say it is not uncommon for new drugs, especially for those that treat rare diseases, to cost more than $100,000 a year. The high price is needed, economists say, so the firm can be encouraged to enter the field.

What sets apart Acthar is that it is an old drug. The compound (Adrenocorticotropic hormone) was first synthesized in the 1940s by Armour & Co., the canned-meat firm, which harvested it from pigs' pituitary glands.

The drug, used for years to treat Infantile Spasms, was made by Rhone-Poulenc Rorer Inc. and then by its successor, Aventis. It was never a big seller, and the former owner nearly stopped making it in the mid-1990s - only to see it brought back after a storm of pediatricians complained that there was no substitute.

Monday, October 01, 2007

Risperdal and pituitary tumors

Antipsychotic Drug May Be Linked to Pituitary Tumors

No wonder people put on weight if it affects the pituitary gland significantly.

This was Interesting

The World Health Organization (WHO) estimates that there are 18 million people with Alzheimer's. Over 4 1/2 million Americans have the disease. We account for 25% of all Alzheimer's cases, even though we represent only 4.6% of the world's population. Europe is experiencing half our rate of disease. For Americans over 85 years of age, 50% are thought to have Alzheimer’s

In 1998 Julie Varner and two colleagues published research on the effects of aluminum-fluoride and sodium-fluoride on the nervous system of rats. They concluded, "Chronic administration of aluminum-fluoride and sodium-fluoride in the drinking water of rats resulted in distinct morphological alterations of the brain, including the effects on neurons and cerebrovasculature." In layman's terms, it looked like fluoride and aluminum could cause Alzheimer's.

That was not a definitive study, but they may have been onto something. Aluminum is in our drinking water, foods, and many consumer products. Adding fluoride to drinking water in the U.S. started in the 1950's. America's drinking water is now over 60% fluoridated. Fluoride appears in many processed foods and beverages made with fluoridated water. Keep in mind, Europe has half our rate of Alzheimer’s. They don't fluoridate their water supplies, but they do use fluoride supplements and dental products.
Read the whole article Alzheimer's in America.