SPARKGRASS.COMmunity

at 11:40 AM

So Tom Cruise apologizes to Brook Shields for playing (anti-)psychiatrist without a license. And then his douchebag mouthpiece has this to say:

"(But) he has not changed his position about anti-depressants, which as evidenced by the black label warnings issued by the FDA on these types of drugs, are unhealthy."

The following is a list of other medications (maintained by Joyce Generali at Kansas Med) which must be unhealthy as well, as they carry FDA black box warnings:

Point taken, I'm sure. That is all.

at 9:35 AM

“In carefully selected patients, neurostimulation of the subthalamic nucleus is a powerful treatment that alleviates the burden of advanced Parkinson’s disease,” wrote the team, led by Gunther Deuschl of Christian Albrechts University in Kiel, Germany.

A lot of neuroscientists are going to be pretty flustered if the next wave of neuroscience is psychomotor neurosurgery rather than psychopharmacology. So it blows.

at 6:11 PM

Mark at BlueGrassReport is giving excellent coverage of all info developing re: the crash this AM. I've already received an email from at least one friend who has been affected by a death in the crash.

The running theory right now is that the pilot somehow used the wrong runway, the shorter of two, when the longer one would have been required for a safe takeoff. People in medicine are obsessed with system error over human error, but this sounds like a pretty terrible example of one or the other, likely the former. One survivor is in critical condition at UK Hospital. The other 49 folks didn't fare so well.

Sadness.

at 2:12 PM

Hours worked on General Medicine Sub-I = 297, only 92.8% of what's allowed maximum under law for residents! Now, had my senior been mean and actually made me take call this weekend, I would have bumped up to 328, so I only stayed legal by the grace of a benevolent resident. Finis Est!

at 7:57 AM

The Good: Plan B going over the counter

The Bad: Pluto is just a dog now

The Ugly: Charges dismissed against Ernie Fletcher after settlement

at 11:03 AM

The FDA has become trigger-happy with its cute little black box warnings. Here's a sample from one of their latest meetings.

FDA wanker 1: Oh know! People shouldn't take these really important psychiatric medications! It might have a 1 in 100,000 chance of making them piss themselves on Tuesday nights! And I'm basing this statement off really lousy data, but it's better than we had for Vioxx!

FDA wanker 2: I know! I mean, Johnny might have a 1 in 50 chance of blowing his brains out with his dad's Glock, but if he takes this anti-depressant, he'll have a 1 in 50,000 chance of thinking about shooting himself more than he would have!

FDA wanker 3: And fuck stimulants. God knows that people with ADHD are just lazy assholes who should learn how to drink coffee like the rest of us!

FDA wanker 2: Any new ideas on how to osbtruct plan B?

FDA wanker 1: They should have to shoot their babies with Glocks like the rest of us instead of getting to avoid the consequences of being dumb enough to get raped. That girl should have known better than to walk around the streets at 7pm without her burka on...

FDA wanker 3: Sorry, I wasn't paying attention. What did you say? Oh, look at the bird in the tree!

I'm all for informing patients (and parents of patients) about the reality of being on psychotropic medications. Sure, stimulants are overused by primary care docs who have rich white patients who are getting B+'s instead of A-'s and only got a 1900 on their SAT because they couldn't pay attention well enough to study after playing World of Warcraft for six hours every night.

However, scaring patients is not the same thing as educating them. If the FDA is going to add a black-box label to a psychiatric medication, it should say a little more than "Abandon hope, all ye who enter here!"

Patients are okay at saying that they don't want to take lisinopril to lower their blood pressure if it might wipe out their last little bit of kidney function. Patients are okay at saying they don't want to take their coumadin to keep from having a stroke if it means that when they fall next week they're going to bleed to death.

But parents aren't good at saying, "Well, if my child isn't on this medication, they might wind up flunking out of high school and smoking crack, but if they are, they have this theoretical risk of a heart problem. Hmm." Parents are scared of giving their kids ANYTHING with a risk, because if a kid gets hurt by a disease, that's the disease's fault. If a kid gets hurt by a drug, that's the doctor and the parent's fault for letting the kid take the drug.

Bottomline of this angry ramble: Yes, psychiatric medications have significant and important medical risks. But, yes, untreated psychiatric disease can be fatal in and of itself and has immense functional consequences for the future. Psych meds for serious psychopathology are no more "optional" than are antihypertensives for folks with high blood pressure.

We owe our patients, and especially their parents in the case of kids, a full education concerning the benefits and risks of putting their kids with real psychopathology on powerful medications that haven't been studied as well as we'd all like. I don't care if the rich, white B+ students get their Concerta or not. But I'm scared to death that a poorly educated parent could make a completely uninformed decision about their children's future because the FDA wants to freak them out with a big black box.

Bad FDA. No Plan B for you.

at 8:35 AM

As reported in this month's issue of JAMA, there is some indication that routine circumicision of all African men "could prevent 2 million new HIV infections and avert 300,000 deaths over the next 10 years". Why could this be? Well, Australian researchers have discovered that Langerhans cells on the inner surface of foreskin have a thinner keratin layer that may be more susceptible to the virus.

at 4:07 PM

Excellent NPR segment on some research at CHA looking at school-based interventions for children with serious behavior problems, and the cost (so far, about 2k per kid) and benefits (so far, a lot more than that, in improved attendance, fewer distractions, et al.) of interventions.

at 12:47 PM

Random survey results amok in the news today:

Unlikely: High school kids aren't doing it as much. Doesn't assess oral or anal or DVDA.

Maybe: Zogby says 80% of dems nationwide were happy to see the Putz defeated in CT, support Lamont. For some reason I can't get the details to pop up about sampling procedures, but that's surprising to me.

No shit: Out of 34 countries surveyed, only the Turks were more ignorant with regards to evolution than Americans. Beautiful quote included:

“American Protestantism is more fundamentalist than anybody except perhaps the Islamic fundamentalist, which is why Turkey and we are so close,” said study co-author Jon Miller of Michigan State University.

SMACK!!!

at 11:08 AM

Thank you, Onion.

at 4:48 PM

After reading a few zillion convoluted analyses of Ned Lamont sticking his thumb up Joe Lieberman's ass, I figured I'd break it down for everybody into its most fundamental portions.

#1: Joe Lieberman is a selfish douche bag.

#2: Joe Lieberman is a selfish douche bag who votes as a Democrat for setting senatorial agenda and committee membership.

#3: The Democratic party needs senatorial votes.

#4: Ned Lamont is a hippy opportunist, who, unlike Lieberman, at least pretends to not support pure evil superficially, while remaining willfully ignorant of the way the bloated American legislative branch works to the point of being as useless as a blind mohel.

#5: Ned Lamont could not possibly win a general election if Joe Lieberman were running as an independent.

#6: Joe Lieberman will run as an independent because he is a selfish douche bag who takes his foreign policy notes from twenty-year old neocons smoking clove cigarettes in coffee shops in New Haven. And from his mother, that told him to protect Israel even if Israel decided to throw flaming shit at its neighbors because somebody sneezed across the Gaza border without using a tissue.

#7: Welcome to the Senate, Mr. Republican from Connecticut, even if 79% of the state thinks you suck matzo, and didn't vote for you the last three times you failed to win a seat in Congress.

That is all. Save your time for important articles about Lindsay Lohan wanting to blow up Iraqis for funsies.

Update: If for some strange reason you require more nuance than the Sparkgrass 7 points, Jacob Weisberg's take, as well as an MSNBC article on how Republicans will now be able to paint Dems as pansies, should round out your education.

at 6:57 PM

Twenty-five years ago, on Aug. 3, 1981, more than 12,000 members of the Professional Air Traffic Controllers Organization walked off the job, setting off a chain of events that would redefine labor relations in America.

In response to the walkout, President Ronald Reagan issued one of the defining statements of his presidency. He said the striking air-traffic controllers were in violation of the law; if they did not report to work within 48 hours, their jobs would be terminated.

Reagan carried out his threat.

I was just a few days old when Reagan decided to fuck labor in the ass for all time.

NPR covers the 25 year anniversary of the greatest single blow of destruction to progressive economics in my generation.

at 4:52 PM

Teens whose iPods are full of music with raunchy, sexual lyrics start having sex sooner than those who prefer other songs, a study found.

In other news, people who think food taste good are more likely to get fat. And people who like to lick tables at McDonalds are more likely to get sick. And people who do really horrible research and make a career getting published by being political hack douchebags producing unnuanced research with pitifully obvious conclusions based on poorly collected correlational data will enter a special level of hell where they will be forced to read colorless statistical manuals until their ocular globes rupture.

Maybe it's just me, but the Rand Corporation looks like a scary group of folk. Condi Rice interned there.

at 12:05 AM

You've been waiting for it for years. A short history of lobotomy.

As an extra bonus: I really appreciated the Google link from below all about how much of a creep Dick DeVos is.

at 9:02 PM

Maximum number of hours a resident can work each week before program gets into trouble = 80.

Maximum number of hours a student can work each week before program gets into trouble = 168.

So, with precisely four weeks scheduled for my general medicine sub-internship this month (07.31 - 08.27), I just want to track whether I'll make it under the resident cap.

28 days, minus four days off, so 24 days, working an average of 13 hours and 20 minutes a day, would do the trick. Right now, I'm right on track.

To be clear, I'm not complaining. That's what a sub-internship is, and I don't think I could have hand-picked a more pleasant team to be paired with. But no matter how Panglossian I get describing the experience, it's no vacation. It's also by no means even one of the worse sub-internships that a fourth year medical student could take, and there are worse things to be doing than tucking sick people into their hospital care.

Watching FoxNews, for example. Or being constipated. Those things are much worse. I could also be on the rectal exam service with my GI/Liver colleagues. I prefer to stick that finger into my nose rather than a sick person's ass. A healthy person, that's a different story. But these people have blood in their asses. Ew!

I'll keep updating this everday, for those random folks who might care. If I can get one person randomly googling into Sparkgrass to go to cooking school instead of medical school, I will have done my job.

07.31 0830 - 1730 9 hours
08.01 0630 - 1600 9.5 hours
08.02 0630 - 2400 17.5 hours
08.03 0000 - 1430 14.5 hours
08.04 0600 - 1830 12.5 hours
08.05 0000 - 0000 Day off!
08.06 0600 - 2400 18 hours
08.07 0000 - 1300 13 hours
08.08 0600 - 1800 12 hours
08.09 0630 - 1500 8.5 hours
08.10 0600 - 2400 18 hours
08.11 0000 - 1500 15 hours
08.12 0600 - 1100 5 hours
08.13 0000 - 0000 Day off!
08.14 0600 - 2400 18 hours
08.15 0000 - 1300 13 hours
08.16 0630 - 0630 12 hours
08.17 0630 - 1500 8.5 hours
08.18 0600 - 2400 18 hours
08.19 0000 - 1400 14 hours
08.20 0630 - 1530 9 hours
08.21 0000 - 0000 Day off!
08.22 0600 - 2400 18 hours
08.23 0000 - 1300 13 hours
08.24 0630 - 1830 12 hours
08.25 0630 - 1530 9 hours
08.26 0000 - 0000 Switch Weekend
08.27 0000 - 0000 Switch Weekend
Total 297 / 320 (92.8% max)

at 11:51 AM

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

at 7:34 AM

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.

WHAT???

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.

at 1:42 PM

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

at 11:24 PM

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)

at 8:36 PM

at 10:38 PM

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.

at 10:49 PM

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.

at 4:08 PM

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!

at 7:38 AM

I'm sure a few of you have gotten emails from scammers in Africa offering you millions of dollars if you help them "transfer funds." These people ruin the lives of a lot of people. Mostly elderly people who think they are doing good deeds for people in dire need only to have their entire life savings wiped clean. Some people who have went to Africa to get their money back from the scammer get seriously beaten or sometimes even murdered.

Thats where "scambaiting" comes in. It's where you reply to them and act like a gullible westerner wanting to help them out. The object is to waste their time and their money (they use internet cafes there and have to pay fees to use the internet) and to get them to take stupid pictures of themselves and sometimes long journies to London or where ever to "pick up the money in person"

I'm not going to spoil the entire post here, but I'll assure you that it gets better. Especially if you're having a bad day and need to shoot somebody in the face with an RPG.

at 10:08 PM

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.

at 6:00 PM

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.

at 9:03 AM

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!

at 7:31 AM

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.

at 9:23 AM

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!

at 9:17 AM

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!

at 9:17 PM

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.

at 9:29 PM

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.

at 10:59 AM

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!!

at 10:20 AM

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.

at 4:45 PM

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.

at 10:33 AM

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.

at 8:49 AM

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.

at 1:44 PM

Check out this dude and his dingo.

at 2:33 AM

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!

at 3:18 PM

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?

at 3:27 AM

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.

at 1:57 PM

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

at 9:13 AM

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.

at 10:06 PM

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.

at 5:52 PM

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.

at 9:37 AM

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

at 2:40 AM

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.

at 12:03 AM

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.

at 9:41 PM

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.

at 12:16 PM

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

at 9:14 AM

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.

at 10:22 AM

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?

at 8:11 PM

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.

at 1:26 PM

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.

at 10:36 AM

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!

at 5:42 AM

Is it too late for "666" humor?

Check it.

at 7:36 PM

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

at 10:25 AM

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.

at 8:48 AM

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.

at 9:23 AM

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.

at 10:16 PM

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]}

at 8:19 AM

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

at 11:30 AM

William Saletan likes meat, but he recognizes the moral conundra it poses:

Shrinks call this "cognitive dissonance." You munch a strip of bacon then pet your dog. You wince at the sight of a crippled horse but continue chewing your burger. Three weeks ago, I took my kids to a sheep and wool festival. They petted lambs; I nibbled a lamb sausage. That's the thing about humans: We're half-evolved beasts. We love animals, but we love meat, too. We don't want to have to choose. And maybe we don't have to. Maybe, thanks to biotechnology, we can now grow meat instead of butchering it.

Saletan's solution? We're close to being able to grow meat instead of killing it.

By growing meat in labs, the way we grow tissue from stem cells. That's the great thing about cells: They're programmed to multiply. You just have to figure out what chemical and structural environment they need to do their thing. Researchers in Holland and the United States are working on the problem. They've grown and sautéed fish that smelled like dinner, though FDA rules didn't allow them to taste it. Now they're working on pork. The short-term goal is sausage, ground beef, and chicken nuggets. Steaks will be more difficult. Three Dutch universities and a nonprofit consortium called New Harvest are involved. They need money. A fraction of what we spend on cattle subsidies would help.

Growing meat like this will be good for us in lots of ways. We'll be able to make beef with no fat, or with good fat transplanted from fish. We'll avoid bird flu, mad-cow disease, and salmonella. We'll scale back the land consumption and pollution involved in cattle farming. But 300 years from now, when our descendants look back at slaughterhouses the way we look back at slavery, they won't remember the benefits to us, any more than they'll remember our dried-up tears for a horse. They'll want to know whether we saw the moral calling of our age. If we do, it's time to pony up.

Of course, Saletan doesn't particularly explore the fact that most people would probably be freaked out by lab-grown meat, even though it doesn't pose near the ecological difficulties that biotechnology agriculture does. And I can't see the ingredients on the side of a lab-grown beef package reading merely: beef. There are a few zillion chemicals that will probably sneak in there as well, not that real beef probably doesn't contain a zillion environmental toxins anyway.

I don't think the evangelicals would freak out too badly; I don't recall anything in Revelations that would suggest that lab-grown chicken nuggets signal the end-times.

I'm not holding my breath, but I'll cross my fingers. I do sorta miss barbecue ribs.

at 10:24 AM

For those with taste for fine sci-fi, any news of Ridley Scott's 1982 adaptation of Philip K. Dick's Do Androids Dream of Electric Sheep? is certainly blogworthy.

at 1:31 PM

You Are Bert

Extremely serious and a little eccentric, people find you loveable - even if you don't love them!

You are usually feeling: Logical - you rarely let your emotions rule you

You are famous for: Being smart, a total neat freak, and maybe just a little evil

How you life your life: With passion, even if your odd passions (like bottle caps and pigeons) are baffling to others

The Sesame Street Personality Quiz

at 8:48 AM

A decision on the provision of emergency contraception over the counter has been stalled by the FDA (originally due Jan 2005), which is currently being sued by the Center for Reproductive Rights. There's a lot of politics, religion, morality, and stigma involved, but a recent article in the Annals of Emergency Medicine does a good job of covering the pro's, con's, history, and possible impact on ED's. Right now many people who have condom breakages, etc. have to visit ED's for PlanB prescriptions. Making it over the counter might reduce these visits and help with the incredibly crowded state of our ED's.

at 12:06 PM

You are a
Social Liberal
(68% permissive)

and an...
Economic Liberal
(25% permissive)

You are best described as a:

Democrat

Link: The Politics Test on OkCupid Free Online Dating
Also: The OkCupid Dating Persona Test

at 10:30 AM

Cartoon from Clay Jones, from Slate's cartoons.

at 10:09 AM

Apparently Lexapro was the number 2 seller behind Zoloft, which is quasi-shocking to me. I'm wondering if this actually represents the number of prescriptions for escitalopram versus sertraline, or Lexapro versus Zoloft, i.e. what "brand name" drugs are being sold the most. I'd imagine that generic sertraline (Zoloft) and citalopram (Celexa, and the racemic mixture of Lexapro), would blow the more-expensive and probably-no-better-tolerated Lexapro out of the water.

For those not in the know, among the class of drugs wrongfully called SSRIs, since the fact that they are SSRIs probably has nothing to do with their efficacy, sertraline and citalopram are the two antidepressants that play most nicely with other drugs, which of course becomes important for folks taking 20 other meds.

at 8:22 AM

Fact or fiction?

Women who eat a vegan diet -- a strict vegetarian diet that excludes all animal
products including milk -- are one-fifth as likely as other women to have twins, a U.S. researcher reported on Saturday.

The reason may be hormones given to cattle to boost their milk and meat production, said Dr. Gary Steinman, an obstetrician specializing in multiple-birth pregnancies at Long Island Jewish Medical Center in New Hyde Park, New York.

This might, at first, seem like a semi-condemnation of veganism, and is of course the way that the general public would take a headline like that, thinking "oh, vegans aren't healthy enough to carry twins, which are obviously cooler than singles!"

Except that's of course a load of crap, since a twin pregnancy is, by definition, a high-risk pregnancy. But regardless, this entirely retrospective, correlational study can't a) prove causation, or b) figure out if it's because milk is healthy, or because we're doping cows up with exogenous hormone, IGF, to make them produce more milk. Now, milk would of course contain some cow IGF anyway, which might be stimulating human ovaries. Or, maybe it's the crap we throw into milk. I'm wondering, for example, if there would be enough of an organic milk drinker subset to hash this out. Doubtful, since widespread availability of organic milk is a little on the new side.

Twins are cute, but do you really want them to moo at you?

Well, sure, that'd be awfully cute. If the kids would really moo at you, that'd be awesome. But they wouldn't really. Not to say that there's even anything particularly dangerous about exogenous IGF transferred from moo cows, but there's obviously a slight creepy factor.

Unfortunately, articles likes this would undermine a slightly more serious matter, that of vegan mothers receiving proper nutrition throughout their pregnancies. Proper nutrition for vegans is not a given, but certainly very possible (and, if done properly, probably beneficial) for a pregnant mom and her baby. But no, we'll have to have fights of Silk vs. milk, because its more fun to bash vegans. That's great public health. Sure.

at 7:30 AM

Ever wondered who spends the most time on the internet googling terms like "porn" or "vibrator"? Well, now we have an answer: Elmhurst, IL!!

All I can say is keep up the good work!!!

at 12:50 AM

So this is supposed to be the video that puts all 9/11 conspiracy theories to rest, the media is reporting. The addition of a mere, blurry frame offers absolute proof of the events on the Pentagon lawn. Watch it. Stare at it for hours like one of those flash-in-the-pan popular stereograms. Why can't we see the other videos taken from the nearby gas station and hotel which were confiscated immediately following the attack? The people at Flight77.info are trying to obtain these, but I think they may just be wasting their time.

Update:

Here is a link to the photo of the single frame everyone is buzzing about.

at 10:05 PM

Post rated PG-13 for mature themes, baseless anger, dirty words, and the desecration of all humanity by Seattle Grace

If only my wife would quit watching it and exiling me from the living room into the bedroom or computer room, where I can't help but listen to its inane bullshit.

"They always say that transplant patients bounce back quick, but wow!"

No, they don't. Transplants, especially heart transplants, are hellacious ordeals. What the HELL are these overly made-up dufus bitch doctors talking about? I think the University of Washington should sue the shit out of the producers of this show for even associating the piss-poor dickheaded medical melodrama of Grey's with the Seattle area. Hell, Starbucks should bring out a drink, the "We have nothing to do with that piece of shit show" Mocha.

I'm truly appalled of the medical folks who actually watch this show with some sort of forgiveness for its atrocious crap. All female medical students, that I know of. And the entire OBGYN staff. I pretended that I liked the show on OBGYN, I admit, so I'd have something to talk about with some of the residents. True, I had been forced to listen to the "Code Black" episode, and by unwilling osmosis, I did know some of the plot twists that a few of the residents were dying to get to their Tivo's to watch.

I think all of my other postings outline very well my feminist nature, but feminism doesn't say anything about taste. Guys still like a lot of shitty action movies that aren't any good. And Girls still like a lot of shitty romance melodramas that aren't any good. And sure, there's overlap, but society is one strong monkey, and the gender monkey isn't getting off our backs any time soon.

So here it is: I blame heterosexual female medical students for allowing Grey's Anatomy to exist!!! Curse you all!!!

I'm glad Courtney doesn't watch House.

And what's worst, poor ER, still a good show, has to share the small screen with this crap.

It's a commercial. Courtney has the TV on mute. My blood pressure slowly drifts downwards... must... hit... publish... post... now.

Update: Grey's has been moved to Thursday nights at 9:00, against CSI and the O.C. and some new big deal thing from NBC. Since nobody watches TV except on Thursdays, and nobody wants to watch more than show.

at 8:36 PM

A pair of CNN military mental health articles have come out over the past few days:

Report: Mentally ill troops forced into combat:
Military not following own rules on deployment, paper says

More veterans may need extra help for post-combat stress:
Fewer than a quarter of returning troops get mental health referrals

The articles detail several dangerous situations, including troops being pulled out only briefly, slapped on an antidepressant, and thrown back into combat without any sort of therapy or even further evaluation--this for a population in which everyone has ready access to firearms. Apparently suicides have accounted for about one-fifth of the total noncombat deaths in the current conflict.

Some of the problem seems to stem from the fact that military commanders, rather than medical personnel, make the decision as to whether someone is fit for duty. And since "be all you can be" doesn't allow room for being depressed, unfit soldiers are stigmatized and placed back into positions where they are dangerous to themselves and others.

Of course, difficulties with keeping military enrollment at desired levels produces undue stress on commanders to keep their troops in the field, crossing their fingers that the ship holds.

And after watching Jarhead this past weekend, all of this seems perfectly in place.

at 10:51 PM

Short, terse, unfriendly,
Yet sometimes quite emotive;
I am the Haiku.

What Poetry Form Are You?

What Video Game Character Are You? I am a Scorched Earth Tank.

I am a Scorched Earth Tank.

When I have a mission, it consumes me; I will not be satisfied until the job is done. I have a strong sense of duty, and a strong sense of direction. Changes in the tide don't phase me - I always know which way the wind blows, and I know how to compensate for it. I get on poorly with people like myself. What Video Game Character Are You?

at 11:31 PM

I've been worried recently about so called "conscience clauses" that allow insurers to refuse to cover services they find ethically objectionable--abortion, birth control, in vitro for gay couples. You might ask, why can't insurers do that already when they setup a plan? Well, most states have laws (and under the federal rubric of division of powers states get to regulate insurance) that mandate minimum coverage. Well, now Congress has decided that states aren't acting fast enough to undermine citizen protections and have proposed legislation to allow businesses and insurers to refuse to cover services for pretty much any damn reason they want (who needs religious outrage?). And their argument: By lowering what insurers can offer, more people will be insured.

Sponsor Sen. Mike Enzi R-Wyo. predicts that most businesses will stick with the policies they currently offer rather than switch to a less comprehensive benefit and only those businesses without any coverage would choose to add the crappy coverage. (Remember to downplay the number of employees that are being screwed and the number of businesses that will make money off this act of betrayal whenever you are proposing legislation to allow businesses to screw their employees.)

And the best part is, this bill is merely an attempt to cover the uninsured: "They have no insurance right now, so this would be an improvement," Enzi said. This is a great solution, when presented with a huge number of people who don't have health insurance (and thus don't have access to basic services) just redefine what constitutes a basic service.

Insurers say the state mandates (such as mammograms, immunizations, and child health exams) are driving up the cost of policies, and the ranks of the uninsured. Additionally, some states have increased the age at which insurers must cover unmarried dependents to 25 and 30 years old. Why are they doing this? Perhaps it's because so many of those unmarried dependents are (you guessed it) uninsured.

Forty-six states also require coverage for treatment and screening of diabetics, as well as the cost of their insulin. First of all, which four states DON'T require coverage for insulin? And, as Lawrence Smith, president of the American Diabetes Association points out, "The need for diabetes care will not diminish simply because coverage shrinks . . . it will be our emergency rooms and Medicaid system that are forced to pay, thus overburdening an already strapped public health infrastructure."

at 11:17 PM

This is from an Australian Newspaper, but some of the issues are relevant here as well:

TEACHING of basic anatomy in Australia's medical schools is so inadequate that students are increasingly unable to locate important body parts - and in some cases even confuse one vital organ with another.

"Teaching hours for anatomy have been slashed by 80 per cent in some medical schools to make way for "touchy-feely" subjects such as "cultural sensitivity", communication and ethics.

Several senior consultants have told The Weekend Australian they have been "horrified" to encounter final-year medical students who do not know where the prostate gland is, or what a healthy liver feels like.

When asked by a cardiac surgeon during a live operation to identify a part of the heart that he was pointing to, one group of final-year students thought it was the patient's liver.

But many students are also unhappy about core science training. One group of students wrote anonymously to two noted academics last year, saying they were "sick of being asked, 'Didn't you study anatomy?"' by consultants amazed by the gaps in their knowledge. "How can we learn if we are not taught the basics?" they wrote.

"It's part of the new educational dictums - 'don't put any stress on them (students) ... it doesn't matter if they don't know anything'."

Okay, so the article is alarmist and kind of takes things out of context (anyone who has spent several hours retracting during a surgery has had a moment where they looked at what was below them and thought: What the hell is that?). I mean, is it really important to understand what a healthy liver "feels like"? Additionally there's a lot of other stuff to learn that squeezes anatomy out, like new diagnostics, genetics, treatment, etc. And apparently Aussie med schools are pretty cushy because I've never heard anyone say "don't put any stress on them". But when the going get tough, the Aussie med students handle things much like American med students . . . blame the administration and bitch about the curriculum.

at 6:11 PM

Kids born in spring or early summer have a 17% higher chance of committing suicide, says a new study, in contrast to schizophrenic babies, which are born more often in late winter, early spring. Last year, other research found that summer sunlight triggers a seasonal rise in suicides.

Another new study compared a 500-calorie diet vs gastric banding surgery. After six months, both the surgery patients and the low-calorie dieters lost an average of 14% of their starting weight. After two years, the gastric band patients lost 22% of their starting weight. That was about 87% of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life. At the end of two years, the dieters had regained much of their lost weight but were still 5.5% below their starting weight. They had lost 22% of their excess weight, or about 12 pounds.

A consumer group wants gatifloxacin banned, because even though Bristol-Squibb discontinued production of the drug, stores that docs could prescribe still exist. The fluoroquinolone reaks havoc on blood sugar levels, but it also is the drug least associated with agranulocytosis, which made it a key portion of the treatment of one of my AIDS patients at the VA this past year. Gati isn't exactly first-line, but with growing fluoroquinolone resistance, I don't know why the FDA would deem it necessary to remove yet another tool from the infectious disease toolbox, especially in the in-patient setting, where blood sugar levels can be closely moniotored.

A UofChicago survey, not surprisingly reported by Fox News, says that physicians really don't mind talking about religion with their patients. Actually, that's not at all what it says, but that's what the headline implies. Really, there's just no consensus on how religion can be appropriately integrated into the therapeutic relationship. I'd like to see a breakdown by specialty.

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