Medicine: Counseling better than Lunesta for insomnia in old folks

As reported in the Journal of the American Medical Association, the researchers assessed sleepooutcomes in 46 insomnia patients, at least 55 years of age, who were randomly assigned to CBT, zopiclone or a placebo. The subjects were treated for 6 weeks and were followed for up to 6 months.

The features of CBT, which was conducted in weekly 50-minute sessions, included education about lifestyle factors that influence sleep, such as the importance of maintaining a strict sleep schedule and using the bedroom only when sleepy. The subjects were also taught to recognize and correct sleep misconceptions and how to perform progressive relaxation techniques.

After CBT, the percentage of time in bed actually spent sleeping, also referred to as sleep efficiency, increased from 81.4 percent at the beginning of the study to 90.1 percent at 6-month follow-up. By contrast, with zopiclone treatment, sleep efficiency actually worsened slightly, dropping from 82.3 percent to 81.9 percent.

As I've NEVER seen Lunesta prescribed, and only rarely see Ambien or Sonata being offered over trazodone, seroquel, or even benadryl, I thought I'd try to figure out why. Turns out Lunesta is just the S-enantiomer of zoplicone, and Wikipedia supplies me with all of the anti-corporate info I need to feel satisfied:

Zopiclone, as traditionally sold worldwide, is a racemic mixture of two stereoisomers, only one of which is active. In 2005, the pharmaceutical company Sepracor began marketing the active stereoisomer eszopiclone under the name Lunesta in the United States. This had the consequence of placing what is a generic drug in most of the world under patent control in the United States. Apart from the difference in dosage (eszopiclone dosages are exactly one-half that of equivalent Zopiclone dosages), the two drugs are identical in effect.

Smells like Lexapro with its statistically insignificant advantages over Celexa.

And the last line of the article is even more interesting:

They also suggest that future studies should try to identify the factors in the CBT regimen that produce the best results and if CBT sessions need to be repeated to maintain the improvements.

Engineering more exact CBT for particular problems would be a medical economist's wet dream, and a drug company's dry nightmare. Which is why, of course, that research won't actually be done any time soon.

Medicine: beta-blockers blocked by Brits?

In this week's edition of Everything You Learned In Med School Was Wrong, a division of the NHS, the National Institute for Clinical Excellence (NICE), is recommending that beta-blockers no longer be prescribed as first-line hypertension therapy. Their recs:

Patients aged 55 and over and those of African or Caribbean descent should be given a calcium channel blocker or a thiazide-type diuretic initially. Those under 55 should be given an ACE inhibitor or an angiotensin receptor blocker.

The argument, which isn't bad, is that beta-blockers come with far too many side-effects: increased risk of type II DM, loss of energy, libido, and "enjoyment of life" (interesting side-effect).

I'm not sure why the cardioprotective properties of beta-blockers vs. calcium channel blockers isn't factoring in here, mainly because this is a nice article for the lay public and not the slightly less lay-med psychiatrist-to-be. And this is the Brits. But wowsers.

Medicine: More Biological Basis of Homosexuality

A study from our friends up North says that having older biological brothers raises the chances of a male homosexual orientation by a statistically significant rate.

"Only biological older brothers, and not any other sibling characteristic, including nonbiological older brothers, predicted men's sexual orientation, regardless of the amount of time reared with these siblings," Bogaert said."

These results provide evidence that a prenatal mechanism, and not social and/or rearing factors, affects men's sexual orientation development."

One possible explanation, he said, was that the mother's immune system builds up antibodies in response to carrying male babies, thus affecting the developing brain of a later male baby and having a bearing on his sexuality.

The argument feels significantly more compelling when reading the entire article. There is something disturbing that homosexuality would be attributed to a faulty immune response in utero, and while the immune response theory is plausible, it is anything but the only explanation for an effect on one of the most complicated (and most impossible to study) systems in all science, that of human development in the womb.

As always, these studies only identify biological factors for male homosexuals. To my knowledge, no good research has supplied a good explanation for female homosexuality. However, that's probably because, even in research of homosexuality, misogyny reigns supreme.

The Cruzin Cooler!

Check out this dude and his dingo.

Opinion: "Miami Terror Arrests"

Seven homeless guys were arrested in the Liberty City area of Miami. Now, I don't know much about counter-terrorism, but I have played my fair share of Grand Theft Auto: Vice City. What I can tell you is that the slums of South Beach are fertile breeding grounds for terrorist cells--especially ones with guys that all look like Bob Marley.

This was a small victory in the war against terror, coinciding with several other recent events (the death of al-Zarcawi and the finding of WMDs in Iraq). But remember this: the enemy could be ANYBODY. You should be real fuckin' scared. I think these arrests just go to show that we need to spy on Americans. Now I know what you're thinking, and it seems reasonable. "We just tried spying on Americans, and it caused quite an uproar." That's true. But I believe that this bust gives us carte blanche in our methods for protecting America.

Update:

CNN is now calling this group al-Qaeda 2.0. They weren't an al-Qaeda group, but rather a small pack of pennyless civilians inspired by the work and fundamentalist message of al-Qaeda. Brilliant!

Balance: They make it too easy sometimes

The DCCC fills my hotmail box regularly, but I did get a kick of the most recent email from John Murtha:

...Karl Rove talking about "cutting and running" while he sits on his big, fat backside-saying "stay the course."

...While the Republicans have been busy name calling, the situation in Iraq has only gotten worse.

Now, you know I wouldn't defend Karl Rove in any fashion. But COME ON. Doesn't the DCCC have some sort of email editor?

FOX News interview backfires: James Fetzer on H&C

Here is what was supposed to happen:

Colmes: Joining us is Dr. James Fetzer, founder of Scholars for 9/11 Truth and University of Minnesota professor. Dr. Fetzer, isn't it true that several major universities are offering some courses about 9/11 conspiracy theories?

Fetzer: Yes Alan, we believe that...(interrupted)

Then the melee begins with the usual "liberal professors, poisoning young minds, etc."

But instead, this happened.
WMV format, 4:11 running time

The amazing thing is, both of them shut up long enough to let him really stick the key points in. At one point, North interjects with a feckless retort of "Osama bin Laden himself claims that, I mean, they didn't manufacture those tapes." Was he referring to this tape? Fetzer counters with the FBI's own recent admission that bin Laden is not officially connected to 9/11 because of lack of hard evidence. And then, as if some guy in a dark control room had ordered it, Colmes jumps in and cuts it off before any more damage is done. Surprising--they usually deliver when it comes to guest control.

Medicine: Can a psychiatrist really tell what's wrong with you

A thoughtful article from Slate on the problems with (and headlong improvements in) psychiatric diagnosis, specifically since the famously subversive Rosenhan experiments.

Blog Crisis: Update

Yesterday morning when only a few certain liberal political blogs seemed to be blocked on Kentucky state computers, we had something to firebomb about. In the interest of some semblance of balance, I'll point you towards our conserva-buddy Bo for his take on the matter. Right now it's the top post, I can't figure out how to link to his individual post.

If the state department wants to block all blogs, personal, political, or what have you, then there's a un-biased consistency that, while annoying, isn't particularly even newsworthy. Commentary worthy, sure, but it'd be nice to minimize the freak-out if there's nothing to really freak out about. Sure, effective blogging is largely liberal, and blocking blogs disproportionately blocks liberal commentary. But that's not the hard and fast reasoning that can go against "you shouldn't be looking at personal sites at work."

Of course, the timing of the blocking, the day after Mark at BGR had a quote in the NYT criticizing the Fletcher administration. If not for that temporal relationship, things wouldn't have looked quite so fishy.

Medicine: The Crisis in Emergency Medicine

A recent series of reports from the Institute of Medicine (one of my favorite Institutes) evaluates the current state of Emergency Medicine in the US and also Pediatric Emergency Medicine. The report is available to read free online, but some of the key findings include:

• Demand for emergency care has been growing fast—
emergency department (ED) visits grew by 26 percent
between 1993 and 2003.
• But over the same period, the number of EDs declined
by 425, and the number of hospital beds declined by
198,000.
• ED crowding is a hospital-wide problem—patients
back up in the ED because they can not get admitted to
inpatient beds.
• As a result, patients are often “boarded”—held in the
ED until an inpatient bed becomes available—for 48
hours or more.
• Three quarters of hospitals report difficulty finding
specialists to take emergency and trauma calls.
• Children make up 27 percent of all ED visits, but only
6 percent of EDs in the U.S. have all of the necessary
supplies for pediatric emergencies.

BLOG CRISIS: BluegrassReport.org Being BLOCKED By Kentucky State Government

Melodrama? Maybe. But, dude, this is some messed up-edness.

Also blocked: our sister blog, which I used to contribute to frequently, BlueGrassRoots! Also, our NKU buddy, Daniel Solzman's Kentucky Democrat.

BluegrassReport.org is updating too much for me to cover, but man, this sounds hardcore thus far. Ben Chandler is throwing a fit. As are Kos, Atrios, TPM, MyDD, Wonkette, etc.

MedPol: The Pentagon offering the best intelligence 1973 has to offer

A pentagon document listing retirement and discharge policies still has homosexuality listed with all of their other mental disorders.

Mary Cheney: Gutless bitch

NPR preface:

Dick Cheney's daughter was a campaign aide for her father during the 2000 and 2004 elections. The fact that she is a lesbian put a distinctive spin on the experience. She has a new memoir: Now It's My Turn.

This is an audio interview.

The interesting point of this discordant interview is her inability to handle questions regarding gay rights without sounding like a gutless bitch. But she assures us that it was for good cause--to elect the administration that will keep America safe. Solid gold.

EnviroPol: A Convenient Review

The best review I've seen so far covering Gore's new flick, including a few factual errors that do not detract from the overall point: "we in the United States have the technological and institutional ability to have a significant impact on the future trajectory of climate change." Fair enough.

Dern Libruls: Kentucky school board enters the common era, falls back into dark ages

From NPR:

Morning Edition, June 15, 2006 · Kentucky's state school board approved a plan to teach a secular alternative to the calendar abbreviations B.C. and A.D. In April, the board adopted "Before Common Era" as part of the curriculum. Some religious conservatives complained that BCE did not mention Christ. When the board members' terms expired, the governor appointed new members, who have voted unanimously to undo the policy.

Listen to the story (linked on the page) for the full comedic impact.

My Latin teachers in podunk taught BCE and CE, because, well, they were educated outside of podunk. And considering most scholarship points to somewhere between 6 and 4 BC(E) as the likely date of the birth of the Christ, should we all be ashamed how silly those drunken monks were with their sloppy research? Shouldn't we allow those dumbass monks to move out of purgatory through the pearly gates? We could always just sell indulgences to their descendants.

Thanks to Courtney for the incessant NPR listening.

Politics: Top 10 Signs of the Impending U.S. Police State

Alternet does a pretty convincing job dissecting the current administration's totalitarian impulses. The info on signing statements is particularly troublesome.

MedPol: Frist the Cat-Killer

I never miss out on the opportunity to point out a good article on Bill Frist killing pet cats in medical school in the supposed guise of contraband research.

Medica: EW's 25 most controversial movies

I suspected Last Temptation of Christ at no.1, but alas, Passion was no. 1. My colleagues down in the psychiatric emergency room point out Taxi Driver and Hostel as strange omissions. Also, no Disclosure, Showgirls, or Vietnam movies. And that cruelty-to-animals saga, Milo and Otis. Others?

Apocalypse Now: Sparkgrass praising Senator Man-on-Dog for Anti-Coulter remarks

From The Huffington Post:

Rick Santorum actually said something mega-laudable on Michael Smerconish's Philadelphia radio show:

MICHAEL SMERCONISH: With regard to a certain group of 9/11 widows Ann Coulter in her new book says, ‘I’ve never seen people enjoying their husbands’ deaths so much.’ I’m appalled by that. Are you appalled by that?

SEN. SANTORUM: Probably more then you are. I mean this is ridiculous. I mean Ann is what? Ann is someone who is out there trying to sell books and, you know appeal to a certain audience and I guess she’s doing it.

SMERCONISH: But you’re not in that audience to which she’s appealing?

SANTORUM: No, no, I don’t consider myself, I’m not a part of that audience at all that’s really on the edge as far as I’m concerned, maybe over the edge.

SMERCONISH: Yes, over the edge. I applaud you, I applaud you for saying that.

Senator Santorum, we might never say this again, but kudos, sir. Kudos.

Medicine: Dieting With Dog Helps People Lose Weight

The Dog Diet:

While on the dog diet, participants cannot eat food that smells good or makes noise. Plastic packaging is noisy, and the kind of food in it is usually not good for you or your pet, Lawson said. "You cannot open a potato chip bag without those four paws coming running into the kitchen," said Lawson. Lawson replaced noisy, unhealthy foods with quieter foods such as salads. "I wanted something that Sadie wouldn't be attracted to and that was also odorless and quiet," said Lawson. Many experts believe one reason we overeat is to comfort ourselves. That's where the dog comes in again. "If somebody has a pet it can be extremely comforting. I can pet the dog, I can sit here and enjoy and I'm not putting anything into my mouth," said Bonci.

Politics: Ky. Governor to Be Arraigned on Friday

The first few lines of the article sum up so much:

Gov. Ernie Fletcher is vacationing in Florida, but the first step in the criminal prosecution against him is set to begin back home.

Blatant politically-motivated investigation versus blatant misconduct. What drama!

Religion: My New Tattoo

Is it too late for "666" humor?

Check it.

Flush(ed): Online gambling banned in Washington state

Beginning next month, Washington residents who play poker or make most other types of wagers on the Internet will be committing a Class C felony, equivalent under the law to possessing child pornography, threatening the governor or torturing an animal.

Gambling Commission Director Rick Day and Prentice, who sponsored the legislation, said the law is necessary, partly to protect the gamblers themselves.

Online poker games invite organized crime and money laundering, they said, and it's easier for dishonest players to collude against unsuspecting opponents. And when online gambling operators refuse to pay winners their proceeds, some gamblers have said there is little recourse.

It's also as addictive as other forms of gambling, they add, and more accessible to minors.

If I were a television producer, I might jump on the next big series. It's an organized crime drama run by 17-year-old online poker mafiosos. They have to battle the Washington state police and the big poker sites' anti-collusion software. Instead of guns and knives, they use weapons like poker-playing bots and IP spoofers. Maybe the title of the show would be El33t C4rd Sh4rkz

Politics: With Dems like this, who needs the GOP?

Gov. Kathleen Blanco was expected to sign a strict abortion ban into law after the Senate on Monday gave the measure final legislative approval...

Under the measure, doctors found guilty of performing abortions would face up to 10 years in prison and fines of $100,000.

Originally, the bill would have allowed abortions only to save the life of the mother, with no exceptions for victims of rape or incest. The House added a provision to allow abortions in cases where the mother's health faces permanent harm.

That's a pretty weak "provision." Does that include mental health? Now, maybe Blanco just doesn't want to lose her job and is banking that Roe will be upheld by the Roberts court relatively intact. Obviously a democrat in a red state has to choose her battles, and the abortion fight is not one that she could win--she'd simply be voted out next term along with pro-lifers in the state senate, and the whole state would be mired in the conservative swamp.

But all those apologetics don't particularly make me think Blanco isn't a pretty disgusting politico right now.

Baseball: Rocket comes to Lexington

Not to kick into overly sentimental baseball mode, but I think two figures right now really sum quite a bit about our country's character. Of course, there's Barry Bonds, who has made us all ambivalent about the value of home runs and hitting a lot of them with steroids. He's four thousand years old and falling apart, and nobody in the country actually wants the jerk to hit another anything. We all want him kicked out of any record books he's ever entered, and that's probably sad, since he's obviously an amazing player who, even without steroids, did some pretty amazing things. Enough for the Hall, anyway. His steals as a young'un, back when he was relatively waify and not spouting roid rage, were pretty impressive for a dude hitting home runs more occasionally, but consistently.

And then there's Roger Clemens, who grew from jerk-in-his-hey-day to superman-in-his-twilight, the antithesis of Bonds, a guy who, even if we didn't like him as a Yankee or a Red Sox player, we can cheer for when he strikes out six guys on a A-farm team with his son playing third base (and one of those strikeouts in the third inning earned every fan free windshield-wiper fluid).

From The Herald-Leader:

What was neat about all this was that after the past few days, it was like we were watching one of our own.

Clemens didn't helicopter in. He arrived last Thursday. He hung out with his kid. He worked out. He went on an electronics shopping spree. He refurbished the Legends' clubhouse. (Roger Clemens, decorator. Who knew?) He's staying three more days before heading back to Texas. We should adopt the guy.

He also could not have been classier. Example: Having completed his pre-game warmup pitches in the Legends' bullpen down the right-field line, Clemens walked to the Lexington dugout. There standing were the 7- and 8-year-olds of the Southwest Lexington Little League Reds, waiting for their ceremonial dash onto the field with the Legends during player introductions. Clemens stopped and shook each Little Leaguer's hand, one by one.

Then, after 8-year-old Brandon Stewart belted out the national anthem, Clemens knelt and signed a ball for the Little Leaguer who had accompanied him to the mound.

"When I saw him do that I started bawling like a baby," said Alan Stein, the Legends' chief executive. "That's what this night was about. It was about fathers and sons. Roger wouldn't have been here were it not for Koby."

For us, the night was about getting to watch a real-life Legend work. History. Once-in-a-lifetime.

Sappy? Sure. But by God, if we can't be sappy about baseball, the terrorists have won!

The Lexington Legends are a Houston Astros farm team that have been playing in Applebee Park in Lexington since 2001.

Medicine: Antipsychotic usage in kids quintuples from 1993 to 2002

Articles like this are given alarmist headlines, which entirely obscures the legitimate debate that should accompany them, and to which is only vaguely alluded throughout the text. Of course antipsychotic prescriptions have gone up with the atypicals. When you have a better hammer, it makes sense to try to hit nails that you might not have tried before. The article certainly implies that drug profits and marketing, rather than advances in the field, account for increased usage of atypicals.

Bottomline: hell yes, we should be careful about giving kids mind-blasting drugs without good research as to their long term effects or even efficacy. but hell no, we shouldn't apologize for the cases in which children who would otherwise be sneaking into their younger brother's crib with a butcher knife are made safer with the use of drugs.

It's pretty sick that the final quote of the article comes with a bone to pick:

"If you're going to put children on three or four different drugs, now you've got a potpourri of target symptoms and side effects," said Dr. Julie Magno Zito, an associate professor of pharmacy and medicine at the University of Maryland. She added, "How do you even know who the kid is anymore?"

Well, apparently when we knew who the kids were, we were scared for our lives. I'm not sure if she was really linking polypharmacy specifically, which isn't going anywhere in the land of psych med augmentation, to zonking kids out, or if that was just the spoon-bending of the article author, but the old "I want my kid to be my kid" adage is worn out (even if it's certainly valid if care is not given appropriately--but we're, presumably, not talking about bad care here.)

I don't want to undermine a good debate, and obviously kids need drug-cautious advocates to make sure that kids are given their best shot at developing in a healthy matter. But alarmist prosetylizers don't add any more to the debate than do profit-hungry drug companies.

Beyond Fact Checking: Olbermann RIPS O'Reilly on Countdown

Keith was pretty fired up about this in case you missed it.

addendum: Basically, Olbermann blasts O'Reilly for his two discrete instances of claiming that American forces massacred surrendered Nazi forces in WWII at Malmedy, and for using that instance as some sort of justification for the abuses at Abu Ghraib. And all of this in an argument with General Wes Clark, as if an MPA from the Kennedy School lets you even hold the jock strap of a retired four-star army general. Olbermann plays the "disgusting" card very effectively.

Wikipedia has the same info [available 06.06.06]:

In late May 2006, O'Reilly caused controversy when he accused American soldiers of committing the WWII Belgium Malmedy massacre when discussing the recent firestorm over the alleged Haditha massacre.[38] This is the second time that O'Reilly had made the same accusation, and the Fox News Channel edited the transcript to allegedly cover up the fact that O'Reilly had made the same comments twice. To date, O'Reilly has offered neither a retraction of, nor apology for, the matter.[39] On his show Countdown, rival cable news host Keith Olbermann administered O'Reilly a verbal scolding in response to the matter. Video and transcript of the Olbermann segment are available here. On Monday, June 5 2006, Paul Rieckhoff, executive director and founder of Iraq and Afghanistan Veterans of America asked O’Reilly to apologize for his erroneous comments on Haditha.^{[citation needed]}

Camping

74% of Sparkgrass' posting volume will be trying to not get eaten by bears at Tawas Point State Park this weekend.