A drug in search of a disease, part two

A few days ago I rambled about gabapentin for pain for kids with chronic neurologic disorders. Today, it cures hot flashes!

Moving up in the world

It's nice reaching a point in your career when you can say something on a website that gets you a personal email reply from Steven D. Levitt, author of Freakonomics.

Steve has a controversial post at the Freakonomics blog: The editor of the Journal of Clinical Psychiatry needs to have his head examined. The post references a recent research report that suggests that smokers may have worse outcomes after traumatic events than non-smokers. Levitt appears to go after some low-hanging fruit in his criticism of the press release, and a portion of his criticism only holds given the information in the press release, but not in the actual article. Citing the original article, the research design appears fairly sound, although not perfect, just as no epidemiologic study is craziness-free.

A part of freakonomics is taking causal pathways assumed true based on correlational evidence and examining the plausibility of the opposite direction. Levitt and Dubner are making quite a popular career (in addition to an impressive academic career, in Levitt's case) of questioning assumptions that certainly deserve questioning. In this case, Levitt suggests that the folks who smoke are probably the ones that are helped the most by smoking in coping. He therefore finds no evidence to suggest that smoking cessation might be beneficial, and reasons that it might even be harmful.

Levitt's points make sense, but they assume that there's no significant difference in the biology of stress regulation between folks with psychiatric trauma symptoms and those who don't have them. Smoking may be a coping mechanism with calming properties in the short run, a potential effect in the long run of further dysregulating the HPA axis could plausibly account for the smoking causing worse symptoms in the smoking group.

Levitt's argument, in whole, seems to be one of biologic plausibility. It is more plausible, given the knowledge of psychology of the average well-educated person, that people who were worse off (or in this case, going to be worse off, as I would argue that effective controls are in place at the first assessment of smoking) were more likely to smoke.

But the biology of trauma, stress, and anxiety, a field outside the knowledge pool of even the average medical student, suggests that PTSD-like symptoms could certainly be modulated by smoking if smoking, a biologically stressful event in itself, modulates the HPA axis in an unhealthy way.

So in summary,
A) Press releases of medical research, in a paraphrase of one commenter, do little more than let you know which author you should be looking for on PubMed.
B) Freakonomics methodology is valuable, but it may be limited when examining fields for which specialist knowledge may be necessary. Biologic plausibility is an important aspect of epidemiologic research.
C) Steven Levitt is gracious in his emails.
D) I'm a total nerd, because I get all excited about getting an email from a University of Chicago economics professor.

Civil Rights: RI says OK to MA

Patrick C. Lynch, Rhode Island's attorney general, said that ALL marriages performed in Massachusetts should be recognized by the state of Rhode Island. Not that ground breaking you say since states have always recognized marriages performed in other states as valid. Except he's included same sex marriages. (If you are reading this Mike Cox, see that not all state attorney generals are homophobic jerks, bent on overcompensating for their small last name.) Though the Federal Marriage Amendment prohibiting same sex marriage in the US never quite passed, it's important to remember that Congress did codify discrimination into federal law when it passed, Defense of Marriage Act which defines marriage as a legal union of one man and one woman for the purpose of interpreting federal law. This was in response to Hawaii scare when lots of states were worried they were going to be forced to recognized same sex unions in Hawaii.

“This is about Rhode Island citizens who entered into a valid, legally recognized same-sex marriage and returned here to live and work,” Mr. Lynch, a Democrat, said in an interview. “There is no way, no law, no constitutional provision and, in my estimation, no right to allow the denial of basic human rights.”

Ken Ham tried to brainwash me, and now he wants to stiff arm you

Anyone who spends more than a few hours with me learns of my redneck past. That redneck past included a sort of fascist conservatism inspired by backwoods Baptist regime, and sure, I'm a little proud I escaped. In my bootcamp time at a Baptist church in northeastern Kentucky, the youth group (of which I was a rogue, because I listened to devil music like R.E.M. and the Dave Matthews Band, although even the kids who listened to Jars of Clay were given dirty looks as well) showed Ken Ham's Answers in Genesis series.

Ken Ham is an Australian guy with some made up degrees who responds to any and all questions about evolution with "Well, were you there? God was, and you weren't. So there." I can't argue with that logic. Something about the aussie accent makes it just that much more farcical. It feels like maybe this is some foreigner who is totally proud to be taking these bumpkins for a ride with his materials. But unfortunately, that's probably not the case.

To insert myself into this picture, I think this was about the time I was 16, and still a full-court press creationist. I was taking AP Biology, and I wasn't quite convinced that evolution (or macroevolution, as the ID folks like to specifiy) really made sense. I'd learned enough of the internal logic to have an intelligent debate about evolution with other creationist folk. Sadly, there was no one at my church with a substantial science background to have an intelligent debate (Josh Hearne was only 14... so I'll give him a break), so I was roughly left alone, except for the one associate pastor who trained at Liberty University (that's Jerry Falwell's brainwash camp, for the uninitiated). Between Ken Ham's terrible logic, and David whose-last-name-I-can't-remember's complete disregard for the actual definition of the second law of thermodynamics that solidified me as somebody who would be proud to say that Creationism was a whole bunch of bullshit meant to try to get smart kids like me to stop asking all the right questions.

But I digress...

One of the great projects of the AiG folk has been to build a zillion-dollar creationist museum at Big Bone Lick State Park in northern Kentucky, just a skip down from Cincinnati.

I blog this now because Mark at BluegrassReport has a nice little tidbit:

Administrators of Answers in Genesis's Creation Museum in Petersburg, Ky. have asked Gov. Ernie Fletcher to grant special police powers to their onsite security force.

Museum officials say they need the gubernatorial action so their 10- to 20-person security team can gain access to better training and equipment to ensure they can handle the crowds and traffic anticipated when the facility opens May 28.

Construction is nearing completion on the $25 million museum, which provides detailed views of the creationist's argument that the earth was created in six days about 6,000 years ago, as opposed to the multibillion year process that evolutionists espouse.

Now, I won't pretend to know why these folks think they need some sort of special privileges. Maybe this is standard procedure, maybe they're afraid that the less-enlightened of the anti-creationists would be interested in vandalism or protest.

But I sorta doubt it. It's creepy, and its certainly consistent with the authoritarian world view Ken Ham and his Army of the Gullible endorse. It's better to run your institution as a police state than to risk someone asking the wrong question.

So remember: Adam and Eve lived with the dinosaurs. And if you don't think so, we'd be happy to show you to the door using only the necessary force for which we are authorized by Governor Fletcher.

202 Chemicals Linked To ADHD, Autism

Researchers have identified 202 industrial chemicals and compounds that may be linked to the rise in autism and ADHD. What do you think?

A drug in search of a disease now pestering kids

Gabapentin, jack of all trades (epilepsy, chronic pain, migraines, mood stabilization, and pizza topping), master of none:

may improve the irritability seen in certain children with neurologic impairments, researchers report in the journal Pediatrics.

"Irritability may represent abnormal signaling of the...nervous system," lead investigator Dr. Julie M. Hauer told Reuters Health. The present study suggests pain in the gastrointestinal tract is "a plausible source of chronic irritability in neurologically impaired children."

Hauer, who is currently at Children's Hospital Boston, and colleagues point out that neurologically impaired children have higher than normal rates of chronic pain and irritability that persist in children despite thorough medical examination and treatment of possible pain sources. Parents commonly identify the gastrointestinal tract as a source of pain in these children.

Folks always made jokes about putting prozac in the water, but it seems like Neurontin would be so much better a choice. Interestingly enough, I expected a headline of "anti-seizure drug calms irritable kids" to address the off-label (and only mildly supported) use of neurontin as an adjunct mood stabilizer, but instead we're directed to neurontin's most fortuitous property, which is its ability to partially address chronic neuropathic pain. Just never know where this thing is gonna go.

Neurontin. What's one more pill?

SSRIs and suicide

Mankiw links a paper from the National Bureau of Economic Research on the cost effectiveness of SSRIs in decreasing mortality from suicidal behavior.

We find that an increase in SSRI sales of 1 pill per capita (about a 12 percent increase over 2000 sales levels) is associated with a decline in suicide mortality of around 5 percent. These estimates imply a cost per statistical life far below most other government interventions to improve health outcomes.

The paper doesn't do anything to distinguish who might be at risk for a personally increased risk of suicide, but it does help us keep SSRIs in perspective: they do a lot more good than they do harm. The question remains, of course, how to reduce that harm.

Fake drug, fake illness, real art

For when you've really gotta havidol.

Australian artist Justine Cooper created the marketing campaign for a non-existent drug called Havidol for Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD), which she also invented.

But the multi-media exhibit at the Daneyal Mahmood Gallery in New York, which includes a Web site, mock television and print advertisements and billboards is so convincing people think it is authentic.

The theme of the art sort of rubs me just a bit funny, seeing as many of the drugs to which this "campaign" refers are good drugs for real illnesses that have been manipulated into lifestyle enhancers by clever marketing campaigns. I'm not sure if folks have, for example, really been able to develop the nuance that, for example, SSRIs have a place for folks with a real illness of depression, or that some people's health is greatly suffering from an inability to maximize their sleep hygiene, etc.

But I won't over-intellectualize this too much for the moment. The thing's damn funny, either way.

And don't miss the Zing Self Assessment Tool.

Mitch Albom Responds

Mitch Albom, who along with Alan Shore (character on "Boston Legal") is one of my favorite people, wrote this column in response to Tim Hardaway's comments about having a gay teammate.

All of this started, in case you've been living under a rock, when John Amaechi, a retired NBA player, came out on ESPN and in his new book. Ever since then reporters have been asking various coaches and players how they would respond if someone came out while still actively playing in the NBA. 99% of people have spoken tolerance (who knows how they'd actually react), but Tim Hardaway decided to show his true colors on the matter.

Mitch, you're so amazing... keep you witty humor and pointed insight - it's perfect!

Gay Football Player

ESPN ran a nice article about a gay football player who choose to come out DURING his playing career. Granted, he plays for a division 3 program, but still! And the best part, he plays for my alma mater: Washington University in St. Louis!! Go Bears!!! :)

Students rally against discrimination

Students at Spring Arbor University in Detroit, MI have rallied in support of a teacher who claims she was fired after revealing that she is a transsexual. It's great to see that students who attend Christian schools aren't as thick headed and narrow minded as those school's administration.

Tagged and unwilling... so I say

I am told that failing to blog a response once you've been tagged (thanks, Josh) is like throwing up on the Japanese Premiere's shoes. So here it goes:

A - Available or Married? Married
B - Best Moment? I'm way too sour to figure that one out.
C - Cake or Pie? Cake
D - Drink of choice? Diet Sunkist
E - Essential Item? Breath mints.
F - Favorite Colour? Blue
G - Gummi Bears or Worms? Bears.
H - Hometown? Ashland, Ky
I - Indulgence? Taco Bell
J - January or February? March.
K - Kids & names? Derby and Julep, retriever mutts.
L - Life is incomplete without? Sleep.
M - Marriage Date? July 10, 2004.
N - Number of Siblings? 0. I drowned them all.
O - Oranges or apples? Oranges, but they're too damn messy.
P - Phobias/Fears: Pea soup. That gooey stuff they use to glue fake credit cards to paper.
Q - Favorite Quotation? "The mass of men lead lives of quiet desperation" -Thoreau; "Mr. Plow, that's my name! That name again is Mr. Plow." -Homer.
R - Reason to Smile? Dogs in bed each morning.
S - Season? Fall.
T - Tag three people! Matz, Geoff, and... well Josh already tagged Kyle...
U - Unknown fact about me: Indie rock star in a previous life. I think my redneck conserva-nazi Rush Limbaugh fandom past is well documented.
V - Vegetable you hate? Olives.
W - Worst habit? Google reader.
Y - Your favorite food? Giovanni's Pizza.
Z - Zodiac? Capricorn.

Counting the homeless

For those of you interested in the homeless or in the difficulty of epidemiology field studies, this NPR report on a bunch of NYU students bouncing around New York until 5 AM every night yields the appropriate amount of non-insight. Winter or summer? Sidewalks, restaurants, and private property?

Lost is Found

Besides the fact that Ben would die within 12 hours of meningitis due to the ridiculously unsterile surgery, Lost beats 24 this week. And I've never been able to say that before. Lost is found. Three cheers for cheesy puns.

Boston Legal goes Pro-Gay

Did anyone else watch Boston Legal last night? One of the judges sued a religious organization that promised to cure him of his Same Sex Attraction Disorder (SSAD, aka homosexuality) with reparative therapy. It didn't work (shocker!). Alan Shore, who defended the judge, went on a 2 minute tirade against heterosexism in America. It was priceless!

I'll work on finding a youtube clip and post it. Everyone deserves the opportunity to enjoy that rant as much as I did!

Edit: Found it!! See the comment for the link :)

Ted Haggard "completely heterosexual"???

Ted Haggard, the ousted Colorado mega church leader, has returned from 3 weeks (yes, 3 whole weeks) of intensive therapy to declare himself "completely heterosexual." Perhaps the three weeks of therapy involved hypnotism where he forgot about the 3 YEAR long affair he had with a man. Or maybe this is just his way of saving face so he can get back to the lucrative and ego boosting job of leading another mega church. Shame on him for thinking that three weeks of talk therapy can change his identity - but I guess that's just another lie he's telling himself.

Ding Dong! The Wendy's is dead!

The U-M hospital will no longer be polluting its patrons with Frosty goodness! That means I'll probably lose about seven pounds between now and graduation.

Q: Why did we choose to replace Wendy’s?

A: We chose to replace Wendy’s for a variety of reasons. The first was based on feedback from faculty and staff during an employee survey conducted in August 2006. We learned that there was a desire for greater variety of “quick-service” menu items and that people wanted value, convenience and healthier food options. In addition, as a health care institution, we feel that it is our duty to promote and empower our employees, patients and the community to make healthier lifestyle choices. By replacing Wendy’s with Einstein Bros. Bagels and Fresh and Healthy Express, we feel we are aligning ourselves more closely with that goal.

What the hell is the Fresh and Healthy Express? Google doesn't seem to have heard of it. I hope it's not some sort of Aramark attempt at further monopolization of our dietary options.

Obama Up in Smoke Update

Said Obama: "I've got an ironclad demand from my wife that in the stresses of the campaign I don't succumb. I've been chewing Nicorette strenuously."

When do we get a "Here's what Obama could be doing to stop smoking" article, sponsored by Zyban?

Psychiatry can only fix so much

A beautiful article from Richard Friedman (Psychiatry, Cornell) about how, while psychiatry can do a lot for mental illness, it can't fix somebody who is just flat out mean.

The "yes, but's" are the critical portions of articles like these. Friedman isn't saying that psychopathology doesn't affect how people behave towards their fellow humans, and that there aren't organic reasons for being an asshole:

Don’t get me wrong. There is plenty of undesirable human behavior that falls well within the rightful domain of psychiatry to understand and treat. But must we turn everything we don’t like about our fellow humans into a form of psychopathology?

A year or two ago, I might have found Friedman, to use a Tom Cruise word, a bit glib. That's probably a good thing. You don't want psychiatrists-in-training to have much else besides positive regard for folks with mental illness until they are mature enough in their understanding of psychopathology to begin to parse it away from normalcy.

I'm certainly not there yet, and so its probably good that I continue, at least for the time being, to view folks with mental illness as people who would be good folks if not for the misfortune of illness. I'll keep the fact that there's no necessary truth in that stance in my back pocket until I can figure out how to make sense of it. Folks with mental illness can be nice folk or jackasses, just like folks without mental illness.

A few years ago, I would have read Friedman's article as anti-mental illness and anti-patient. But part of becoming a psychiatrist has to include the process of realizing that folks with mental illness are normal people with a devastating illness that just makes them look like they aren't normal people to the untrained eye. Blaming the victim doesn't help anybody, but deeming the victim blameless removes the humanity from those who suffer from mental illness.

And physicians simply do not have the right, professionally or morally, to take away their patients' humanity.

Youth suicides rise as antidepressant use diminishes

A disturbing, new study... shows a sharp jump in the number of young Americans committing suicide. Almost 2,000 young people age 19 and under killed themselves in 2004. That's an increase of more than 18 percent in the rate of teen suicide from the year before. . . The alarming, new suicide figures have some child psychiatrists worried that these black box warning labels on antidepressants may be keeping them from getting to the children that need them the most. After a decade of steady decline, teen suicides spiked sharply in 2004 -- the very same year that the FDA man mandated that the antidepressants come with warning labels, about a possible link to suicidal thoughts in adolescents and children. The warnings led to a 20-percent drop in antidepressant prescriptions for those under 18.

It's only one point of data with circumstantial association but it does seem to make sense and a lot of psychiatrists have been worried about this exact scenario. The question now becomes, will wacky parents swing the other way and demand antidepressants for their slightly mopey kids? If only the public could understand a message slightly more complicated than "pill = bad" or "pill = good".

What the hell is this EGCG crap?

One of the least enlightening Super Bowl commercials was for some Snapple tea drink with some weird chemical in it: EGCG. A douchebag guy runs up a mountain to ask some guru what the junk is, only to be reprimanded that it's right on the side of the bottle. It might have been witty, if not for the logical suspicion that whatever this guy is asking about is a load of crap.

Well, apparently the Center for Science in the Public Interest (CSPI) thinks EGCG is a load of crap too. And that's why they're suing Coke and Nestle over its absurd marketing claims that epigalloocatechin gallate (EGCG, as above) has a negative calorie effect, which it justifies by citing one terribly done study that even the conference where the study was presented rejected.

I especially appreciate the semi-sardonic tone of the article:

David Schardt a senior nutritionist with the CSPI says there is no clear evidence that what is in Enviga will help control weight and a person would do better to give up non-diet soda or join a gym, which is in the long run less expensive than buying 3 cans of Enviga a day.

Enviga sounds a little too much like a sexually-transmitted disease for my taste.

UPDATE: The Connecticut AG calls bullshit too.

No more domestic partnership benefits?

The MI court of appeals today overtunred a trial court's opinion, now stating that state universities are NOT able to provide same-sex domestic partner benefits to their employees. This mean that numerous LGBT faculty and staff at all Michigan state universities will no longer be able to cover their same-sex partners with health insurance (among other things).

The university is actively appealing to the state supreme court... I sure the heck hope they've got some sense in them. It would be disasterous to consider the consequences for many of us who may be directly effected by such a narrow sighted and discriminatory policy.

Historical Political Travel: Assassination Vacation

I'm currently reading Assassination Vacation by Sarah Vowell (get it in the remaindered pile at your bookstore now). It's a pretty funny account of Vowell's trips to various locations associated with the past assignations of Lincoln, Garfield and McKinley; "visiting everything from grave sites and simple plaques (like the one in Buffalo that marks the place where McKinley was shot) to places like the National Museum of Health and Medicine, where fragments of Lincoln's skull are on display." The best part though is Vowell's hilarious wit as she engages in a macabre trip around the country in search of assignation paraphernalia. In the opening of the book she explains how (due to her feelings about the current administration) she can begin to understand how someone decides to kill the president, although she emphasizes that she does not wish anyone to harm Bush. Previously she viewed Booth and others as crazies, but today with animosity towards the president so high, assassination isn't such an alien possibility. And being that those who truly dislike Bush are the same liberals that won't let their kids play with guns and abhor hunting, the idea that some part of them is angry enough to sympathize with killers is off putting. Like waking up one day and saying, "Gee, I don't know why but I really feel like clubbing baby seals". Anyway, it's a fun read with lots of humor and history. Kind of like Bill Bryson meets Dave Bary meets David McCullough.

Inside the Lost writer's room...

Mary Cheney: My baby 'is not a prop'

Dick Cheney became testy last week when CNN's Wolf Blitzer asked him what he thought of conservatives who are critical of his daughter's pregnancy. Cheney told Blitzer he was "over the line."

In a brief interview with The New York Times after Wednesday's panel, Mary Cheney said she agreed that Blitzer had crossed a line. "He was trying to get a rise out of my father," she said.

Glamour editor Cindi Leive asked Cheney during the panel discussion if she had anything to say to conservatives such as James Dobson, founder of Focus on the Family, who have criticized her pregnancy, asserting that children should be raised by heterosexual married couples.

She responded, "Every piece of remotely responsible research that has been done in the last 20 years on this issue has shown there is no difference between children who are raised by same-sex parents and children who are raised by opposite-sex parents. What matters is that children are being raised in a stable, loving environment."

Note to Mary Cheney: it's not unreasonable that folks who think that lesbians actually should have all the rights of, say, other human beings should want your father, who supports a regime that obviously doesn't think that lesbians deserve the same rights as other human beings, to justify his support for folks who think your decision to be who you are (instead of who James Dobson would like you to be) is abominable.

Mary Cheney's baby is not a prop. But Mary Cheney is certainly becoming one herself if she refuses to even acknowledge the hypocrisy of the current administration and her father's tacit role in propagating anti-LGBT hatethink.