Sunday, July 30, 2006

Comedy: the Axis of Evil Comedy Tour

More than worth a listen. An Egyptian, a Palestinian, and an Iranian walk into a bar, and make fun of you.

Saturday, July 29, 2006

Politics: Minimum Wage Whiskey Tango Foxtrot

Republicans muscled the first minimum wage increase in a decade through the House of Representatives early Saturday after pairing it with a cut in inheritance taxes on multimillion-dollar estates.

Harry Reid calls it blackmail. Generally, when Harry Reid calls something blackmail, I scoff at him. He's a little histrionic.

If I needed any one instance to demonstrate everything about the Republican party that is wrong for America, I now have it.
"Just think of what it is to have a bill that says to minimum wage workers, 'We'll raise your minimum wage but only if we can give an estate tax cut to the 7,500 wealthiest families in America,"' said Minority Leader Nancy Pelosi, a Democrat.
Again, when Nancy Pelosi opens her mouth, I usually roll my eyes, knowing that I probably agree with her in principle, but that she'll try to figure out a way to make liberalism sound even whinier than it did before.

But this time, right on, Nancy. Fight the disgusting F-tards.

Thursday, July 27, 2006

Medicine: Teenagers bagging mothballs

Since asking about huffing isn't enough anymore. Mothballs. Yuck.

Wednesday, July 26, 2006

Medicine: drunken mice and serotonin

From Nature Neuroscience:

We all know that consumption of alcohol can lead to changes in mood, cognition and motor behaviour, but how ethanol affects neuronal function is not so well understood. A new study shows that ethanol inhibits clearance of the neurotransmitter serotonin (5-HT) from the extracellular fluid in the mouse hippocampus, and that, surprisingly, this occurs through a mechanism that is independent of the serotonin transporter (5-HTT).
Beyond just being interesting for the exact cellular mechanisms of alcohol intoxication (which have amazingly eluded researchers for the most part), it's dually interesting that increasing serotonin concentrations with more alcohol produces a CNS depressive effect, which seems paradoxical in the light of SSRIs. Further in the the study, fluvoxamine was found to have similar effects acutely on the hippocampal serotonergic neurons. Of course, being an SSRI probably has nothing to do with being an antidepressant in the short run.

The serotonin transporter doesn't tell us the whole story, but does offer at least some clue as to part of the genetic basis of alcoholism, as the ability to clear 5HT (which attributes at least somewhat to intoxicating effects) gives a mechanism for subjective differences in experience. The study does not address changes in regulation of the 5HTT chronically with alcohol abuse, but we could speculate that, most importantly, there could be genetic differences predisposing some to more maladaptive physiology.

But the 5HT transporter isn't the whole story, as a hippocampal NE-T might contribute. Imagine that, no clean mechanisms.
This work clearly establishes that blocking the removal of 5-HT underlies, at least in part, the effects of ethanol in the brain. It remains to be determined exactly how ethanol inhibits 5-HT removal from the extracellular fluid. The noradrenaline transporter, which also transports serotonin and is expressed in the hippocampus, is one candidate site of action. However, more work will be required to confirm a role for this transporter in the influence of alcohol on neuronal function and behaviour. These findings could help to explain the positive association between a polymorphism in the promoter region of human 5-HTT, which confers low-expression of 5-HTT, and alcoholism.
With alcoholism, our primitive understanding has continued to limit our therapeutic approaches to a problem that, intuitively, an outsider would expect wouldn't be all that terribly difficult to hash out.

My undergrad research PI sent me the article, making me nostalgic for my invertebrate neurotransmitter research days. Sigh.

(Note: the other Sparks GM with the ophthy article from 1967 obviously isn't me)

Monday, July 24, 2006

Wednesday, July 19, 2006

MedPol: Bush uses first veto on stem cells, will trade get out of jail free card for immunity on Water Works for three turns

I have nothing to say about Bush vetoing federal funding for stem cell research. Nothing polite, anyway.

I just wonder why he didn't just sign it with a signing statement reading, "NOT!"

In more positive Bush news, John Dickerson laments that Bush doesn't swear more. He sounds so much more nuanced when cursing. In his convo with Blair, he actually sounded like someone with a vested interest in foreign policy and, more importantly, in the role of the UN in international diplomacy.

Tuesday, July 18, 2006

MedPol: some of the good and bad of the Fletcher administration

Bo links a nice article featuring his papa's role as a policy wonk, rather than a politico, in KY governor Ernie Fletcher's administration. It's good to hear about sensible, results-driven policy work on the other side of the aisle (or either side, for that matter). The article mentions some KY medicaid reforms of which I am entirely ignorant, but I emailed to see if I can get some more info.

As far as I can tell, the simplest way to sum up conflicts between conservative and liberal economics is that liberals want to split up the pie evenly, and conservatives want to make the pie bigger, figuring that there will be enough to go around for everybody, and some leftovers (whether it matters if everyone gets a piece or not is a moral question not necessarily addressed).

But with something like the internal management of Medicaid, essentially the size of the pie is fixed. Management becomes a matter of optimization, of getting the most bang for the buck, the greatest good for the greatest number of folks. Market principals become tools to make those things happen rather than ideals to which to aspire. That's number-crunching and policy work, not necessarily politics. And that's the point where I feel comfortable posting about an article hopeful of the work of even the most arrogant Republican administration.

My understanding of Cowgill's work is obviously superficial at best; I know some friends doing advocacy work with leftist orgs were highly critical of the tax reforms mentioned in the article Bo cites for not doing enough to update KY tax laws that were horribly out of date. However, it's also noteable to say that those tax laws became absurdly out of date under the watch of multiple previous Democratic administrations that did little to address tax fairness in Kentucky. So whatever failings may have been present in KY tax reform, it seems like there was a lot less being done by Paul Patton and Brereton Jones and Co long before Fletcher's crew was faced with the task.

In an administration of so much unadulterated jack-assery, I'm happy to be able to link to some good things going on back home in the Bluegrass.

Sunday, July 16, 2006

Red State: The Things I Couldn't Make Up

As I've posted before, I follow the letter-to-the-editor page of my hometown newspaper very closely to keep a bit of a pulse on the sort of folks who shaped the first 18 years of my life. And let me tell you, 98% of what those folks had to offer was wonderful. But every once in a while, I run across a letter that reminds me that I can't go home again. Again, this was a letter written to a newspaper. I'll leave out the author name to protect this guy with too much free time.

Gordon’s actions upset NASCAR fan

This is in regards to a situation that occurred last Sunday, July 9. I am a really big NASCAR fan, and what happened when No. 24 Jeff Gordon bumped No. 17 Matt Kenseth from winning the race made me a little upset.

I think NASCAR shold make it hard for drivers like Jeff Gordon and others who will take advantage of the young guys and deny them a chance in the spotlight. Jeff Gordon needs to grow up and not be so childish.
Global warning, nothing. 24 is on a rampage, that's crisis!

Thursday, July 13, 2006

Medicine: Magic Mushrooms more than just for stomping Koopas, saving Princesses

After four days of intense vomiting and, er, vomiting the other way, I can finally blog about the new Hopkins study about the possible uses of psilocybin and other hallucinogenic goodies as pharmacotherapy and as an adjunct for intense psychotherapy. But I think Syd Barrett can probably sum up anything intelligent I might have to say on the matter.

Psychiatry has always been interested in possible uses of the psychedelic medications to allow patients to explore parts of their brains that they might have difficulty calling up without a little help. Ecstasy was still legal for use as a psychiatric adjuvant up until 1985 (Merck filed patent on MDMA in 1912). Psychedelics enhanced communication, weakened defense mechanisms, and broke down barriers against introspection.

Most of these meds are serotonergic equivalent of a nuclear warhead, and years of amazingly effective ECT has taught psychiatrists that, for some reason, stimulating the hell out of the nervous system can sometimes lead to improvements against the negative symptoms of mood and thought disorders. Neuroscientists may have all of the "how's" and "why's" figured out in the next fifty years, but all psychiatry needs to worry about right now are the "what's": what could these medications help treat along with the therapies we already have available; what bad things could happen to people taking these medications inappropriately; and what do I need to do to get some of this junk in time for the weekend?

So the Hopkins study, or at least the way the media is covering it, since I can't get the pdf to come up from home, seems to just be looking at what the hell magic mushrooms do to people without prior mental illness in a controlled environment, with some nice research design with crossover and methylphenidate controls. Their results:

According to the Baltimore team, nearly two-thirds of the volunteers said they achieved a "mystical experience" with "substantial personal meaning." One-third rated the psilocybin experience as "the single most spiritually significant experience of his or her life," and another 38 percent placed the experience among their "top five" most spiritually significant moments.

Most also said they became better, gentler people in the following two months. "We don't think that's delusional, because we also interviewed family members and friends by telephone, and they confirmed these kinds of claims," Griffiths said.
My wife's initial response: "Dude, how did these people get to be in this trial? Sign me up." Basically, with results like that. But mysticism isn't exactly a primary end-point for a therapeutic trial, and I'm sure if there were safe recreational uses of medications like this, the free market would be more than happy enough to cover the expenses of the trials.

But of course, hitting shrooms is illegal for a reason: because the government doesn't want you to have any fun. Well, that, and the fact that they might be really dangerous. But that dangerousness is as least as unclear as potential therapeutic effects, and that's where the study leaves us with our proper cautionary tale:
Even though the candidates for the landmark study were carefully screened to reduce their vulnerability and closely monitored during the trial, "We still had 30 percent of them reporting periods of very significant fear or anxiety which could easily escalate into panic and dangerous behavior if this were given in any other kind of circumstances," Griffiths said.

"We simply don't know what causes a 'bad trip,' " he added, "and we can't forecast who'll have a difficult time and who won't."
Especially at a club, driving down the highway, or while operating heavy machinery.

The results of the study aren't surprising and its conclusions filled with the standard mantra of what needs to be studied further, i.e., everything. But the fact that this study was actually done, and that Bill Frist or Tom Cruise haven't been holding cats hostage or jumping on couches, says so much more. And (I absolutely speculate) it's Hopkins, so they can keep playing with Schedule 1 all they want. Not many politicians would have the nerve to fight with God's Hospital right across the Potomac, lest they wind up admitted there for a stubbed toe and leave straight from the ICU to the funeral home.

Of course, this means Hopkins jumps up a little higher on the residency match list, if only so my wife and I could be test subjects.

Tuesday, July 11, 2006

Politics: Lessons Learned

This one has been mocked elsewhere, including DailyKos and Think Progress, but it's too funny not to repeat. The National Journal has an article out today listing the salaries of the President's official aides. It's no surprise that those familiar faces who making the top dollar (now at $165,200 per year) hold the title of "Assistant to the President", but some of the lower positions might surprise you. My personal favorite is Stuart Baker, who gets paid $106,641 of the taxpayers' dollars per year to be the "Director for Lessons Learned."

I wonder how much his assistant, "Chief Advisor for 'My Bad!'", makes.

In all seriousness though, how come there isn't more scrutiny of the President's staff? Sure, we all hear the pundits going on and on whenever Bush shuffles around the Chief of Staff or whatnot, but what about the lower positions? It seems to me that it would be pretty easy to reward your political cronies with some trumped-up fake directorship, then hand them a 6-figure a year salary for watching their ass widen. Does nobody actually investigate who these people are and what the hell they're actually doing?

Oh right, I forgot that Republicans have become the party of big government and nobody cares.

Lesson learned.

Monday, July 10, 2006

Health: An HIV Breakthrough?

I'm not sure which is more amazing: the fact that we're on the cusp of having a single pill, once daily dosing for triple drug treatment of HIV, or the fact that two different drug companies came together to collaborate on the project with success.

Either way, it's a win for the millions world-wide with HIV--let's all cheer to that!

Saturday, July 8, 2006

LGBT: Giving up royalty for ones sexual identity

Here is an interesting and heart-warming story of an Indian price who has given up his place in the royal family (translation - a lot of money in inheritance) to be at peace with himself and come out of the closet. I only wish the Indian government wasn't even more narrow-minded than our own and would strike down their law against homosexuality. Too many people with AIDS are dying needlessly because they are afraid to get proper treatment as this will likely out them and put them at risk for arrest/jail.

Friday, July 7, 2006

LGBT: Some reasonable Catholics (and former governors too)

Here is a nice article from the Dunn County paper (somewhere in Wisconsin) about a few former Wisconsin governors (who happen to be Catholic) strongly defending the tradition of amending the constitution only for the purposes of expanding rights, not limiting them. My favorite quote, from former governors Pat Lucey (an 88 year old Catholic): "I just can‚’t believe any rational human being would want to put that kind of thing in the Constitution."

Good for him--I hope his fellow residents listen!

LGBT: Another attack on health care

Things are getting close to home once again. There is a new challenge in Lansing to prevent MSU from offering same-sex partners of University employees health benefits. Somehow people think that providing health insurance to fellow Americans is a violation or threat to traditional marriage--I still don't get it. Are these people malicious or just plain stupid? Allowing someone to get proper health care shouldn't be a threat to anyone--come on!

Wednesday, July 5, 2006

Medicine: fluoxetine doesn't help with anorexia relapses

From earlier last month, Timothy Walsh and company at Columbia found out, surprisingly and disappointedly, that Prozac is basically no better than placebo for anorexic patients without comorbid anxiety or depression. Notably, about one half of the sample dropped out, which isn't surprising at all for a disorder with such a significant denial/personality component. The news article doesn't actually address the issue of comorbidity, while the test subjects in the original research article seem to have reasonably similar prior psychiatric difficulties prior to the study, with a slight increase in depression in the fluoxetine group. The study wasn't powered to pick up sub-groups for whom fluoxetine might be beneficial, but it looks like anorexia will persist as a psychiatric illness that we're still pretty ineffective at treating.

Tuesday, July 4, 2006

Medicine: FDA approves generic Zoloft

Sertraline will be the last SSRI to go off patent, which is a good thing, since, along with citalopram (Celexa) and escitalopram (Lexapro), Zoloft plays nice with the P450 2D6 isoenzyme responsible for most drug interactions with SSRIs.

Technology: TV over phone lines? Can it fit?

Here is an interesting NYT's article about AT&T and Verizon both trying to grab some of the cable market with TV over phone lines. Just one question I have - if cable internet is already WAY faster than DSL, how do they expect to fit high quality video next to phone and internet services and make it competitive? I'm sure they have some solution - I'm just a little skeptical. But if it'll help drive down cable TV/internet prices, I'm all for it!!

Medicine: an Oath Betrayed

Andrew Sullivan writes a beautiful piece for Time reviewing the latest from medical ethicist Steven Miles, Oath Betrayed, which explores the ways in which medicine in the military has been unforgivably corrupted by the Bush-Rumsfeld machine's insistence that those who swear to heal participate in the process of torture.

Some of the medical involvement in torture defies belief. In one of the few actual logs we have of a high-level interrogation, that of Mohammed al-Qhatani (first reported in TIME), doctors were present during the long process of constant sleep deprivation over 55 days, and they induced hypothermia and the use of threatening dogs, among other techniques. According to Miles, Medics had to administer three bags of medical saline to Qhatani — while he was strapped to a chair — and aggressively treat him for hypothermia in the hospital. They then returned him to his interrogators. Elsewhere in Guantánamo, one prisoner had a gunshot wound that was left to fester during three days of interrogation before treatment, and two others were denied antibiotics for wounds. In Iraq, according to the Army surgeon general as reported by Miles, "an anesthesiologist repeatedly dropped a 2-lb. bag of intravenous fluid on a patient; a nurse deliberately delayed giving pain medication, and medical staff fed pork to Muslim patients." Doctors were also tasked at Abu Ghraib with "Dietary Manip (monitored by med)," in other words, using someone's food intake to weaken or manipulate them.

Of the 136 documented deaths of prisoners in detention, Miles found, medical death certificates were often not issued until months or even years after the actual deaths. One prisoner's corpse at Camp Cropper was kept for two weeks before his family or criminal investigators were notified. The body was then left at a local hospital with a certificate attributing death to "sudden brainstem compression." The hospital's own autopsy found that the man had died of a massive blow to the head. Another certificate claimed a 63-year-old prisoner had died of "cardiovascular disease and a buildup of fluid around his heart." According to Miles, no mention was made that the old man had been stripped naked, doused in cold water and kept outside in 40° cold for three days before cardiac arrest.

Other doctors just looked the other way, their military duty overruling the Hippocratic Oath. One at Abu Ghraib intervened to ask guards to stop beating one prisoner's wounded leg and quit hanging him from an injured shoulder. He saw it happen three times. He never reported it. In Mosul, according to Miles, one medic witnessed guards beating a prisoner and burning him by dragging him over hot stones. The prisoner was taken to the hospital, treated and then returned by doctors to his torturers. An investigation into the incidentwas closed because the medic didn't sign the medical record and so he couldn't be identified.