Link Roundup, random med news buffet edition

1. Do fictional diseases increase the risk of cardiovascular disease. Probably not. So Restless Leg Syndrome probably isn't a fictional disease. I get so tired of the "nobody'd ever heard of RLS until just a few years ago, but now because some drug company can make money, everybody has it!" argument. That's not to say that I don't think problems like this get over diagnosed after physicians and patients are suddenly inundated with a new possible answer to old problems, but that doesn't mean RLS isn't a real entity.
2. The NHS has just NOW apparently figured out that it's not a good idea for patients and doctors to be inserting probes into one another for procedures that they can't bill for.
   
3. Alpha-blockers for nightmares in PTSD? Will urological psychiatry become a new fellowship?
4. Glucosamine/Chondroitin Sulfate still doesn't do shit except take your money.
5. Jonathan Cohn Jonathan Cohn Jonathan Cohn. I'm going to have to read his stupid book before I go nuts hearing something new about it three times a day. He sounds sensible enough on NPR.

Fox News pisses on Kurt Vonnegut's grave

I always knew there would be a special level of hell for the folks at Fox News, but I didn't know they were going to work towards pushing that level further and further down.

Disgusting. After calling Vonnegut "irrelevant," the final lines of the obituary take the cake:

Vonnegut, who failed at suicide 23 years ago, said 34 year ago that he hoped his children wouldn't say of him when he was gone, "He made wonderful jokes, but he was such an unhappy man." So, I'll say it for them. Kurt Vonnegut was 84. In Washington, James Rosen, Fox News.

What a stupid fuck of a man.

Sympathy for Hokies

I've only been through Blacksburg once, to pick up a friend at VT on the way to church camp back in my Falwell-brainwash days, but I remember seeing a beautiful campus on a very beautiful day.

Here's hoping folks there can get back to enjoying how beautiful it is very soon. Tragedies suck. Hard.

Men do just as much work as women do (just maybe)

Joel Waldfogel tries his best to suppress some latent misogyny on his review of a survey by some economists of 25 nations measuring how much combined work, "market" work and "house" work, men and women do. The study finds, popular to common belief in sociological circles, that men and women, at least on average, and in richer nations, tend to do the same amount of work each day. The end-article caveat seems spot-on, though:

Many women with demanding careers tell me that it is women working full-time in the market, not women overall, who work more than comparable men. This study cannot settle that question because it does not report work time separately for people with and without market jobs. But if women with careers work more than men, while women overall work the same amount as men, then women without market jobs must work less than men. Men can use that argument to hit the couch in the afternoon. Or to end up there at night.

Something tells me that Waldfogel might be looking at some nights on the couch for writing this article.

It's a little disappointing that we don't get some nice reported sub-group analysis, since the research question becomes most interesting in the context of couples who work roughly equally outside the home.

Given the massive pile of laundry in the hallway, the overflowing trash can in the bathroom, and the wads of unvacuumed puppy hair on the floor, I think you can safely assume that Courtney and I do equivalent housework: not much.

Tax Returns Rise for Immigrants in U.S. Illegally

Thought this was an interesting article in the NY Times about an increase in the number of undocumented aliens paying income taxes. A lot of Americans assume that these people don't pay any taxes and just sponge off of society, but they forget that they all pay sales tax, and with the use of individual taxpayer numbers they can pay income taxes. People also forget that many of the services these populations utilize are for health care and schooling, which (in my eyes) takes a pretty big asshole to deny someone. Apparently, some link the rise to possible amnesty and other roads to citizenship that will require payment of taxes and back taxes. It's nice that when people see a road to citizenship they are encouraged to participate in the larger society.

In 2005 alone, more than $5 billion in tax liability — the total owed, including money withheld from paychecks during the year — was reported in the 2.9 million returns that listed at least one person with an ITIN, she said. And between 1996 and 2003, such filers reported nearly $50 billion of tax liability.

Sorry Zombie lovers, the McCoys were not infected with rage

Despite the fact that I'm currently reading Max Brook's oral history of the coming Zombie war, I was a bit put off by the misleading headlines last week. Imagine that, misleading headlines about medical research. The media went haywire about a report that a genetic disorder in the McCoy side of the Hatfield-McCoy might have caused all that hillbilly rage. You know, like in 28 Days Later.

Mostly for the non-medical folk who read this blog:

McCoy descendants have been found to have a high number of cases of Von Hippel-Lindau Syndrome (VHL). On my week of neurosurgery last year, I met a patient with VHL, and believe me, they weren't chasing me around the table, infected with rage. VHL doesn't cause rage. It causes tumors in lots of places, usually around rich vascular supplies, because of an autosomal dominant lack of a certain binding protein. One of the tumors that are common in certain subtypes of VHL are pheochromocytomas, adrenal gland tumors. Pheos present clinically with sudden episodes of sweating, crazy high blood pressure, etc., from basically a big dumping of catecholamines (like adrenaline) into the blood stream. Anyone who's watching 24 this season knows what happens when you inject people, like presidents, with shots of adrenaline. They start pretending to drop nuclear bombs on unnamed Arabic nations.

Pheochromocytomas are rare, but for some reason are classically represented on boards exams, so every medical student on earth can pick out a pheo on a standardized test from 20 miles away. But because they're so rare, and typically not as interesting as in the above test, non-medical folk just don't know anything about them.

Pheochromocytomas are also most commonly not related to VHL, although they are a hallmark of several of the multiple endocrine neoplasia syndromes. Again, boards questions for medical students, rarely obscure for non-medical folks.

Of course, my question immediately becomes, has there been an episode of CSI about a pheochromocytoma? Has there been an episode of House? If not, I bet you won't have to wait much longer.

Lithium cuts suicide risk in recurrent depression

The overall rate of suicidal acts was 1.48 percent annually among those not given lithium compared with 0.17 percent per year among those treated with lithium -- an 88.5 percent reduction in risk.

For better or worse, current thought among the medical community is that SSRIs are so safe, a monkey could prescribe them. Just above monkeys, of course, are psychiatrists, family docs, and nurse practitioners. Psychologists typically gain the most support for their petitions for prescribing rights on the safety of SSRIs.

But lithium is something altogether scarier, again, for better or worse. Psychiatrists prescribe lithium. Nobody else does. And now there's evidence that, at least in the population defined in this study, the attributable benefit of lithium could be about 8/9 for suicide prevention. So some questions immediately arise (some maybe because I just haven't got around to looking at the original article yet):

1) What patients with depression (since most depression is undoubtedly recurrent depression) would benefit from lithium? I don't know what it feels like to be on lithium, but from Kay Redfield Jamison's An Unquiet Mind, it doesn't sound like the most benign drug. Thus, balancing the way lithium makes patients feel, in addition to all the long term nephrotoxicity and such, with the benefit of less death by suicide will be quite an important endeavor. Will that be an endeavor for psychiatrists, or for the larger mental health practitioner community?

2) Do all of these patients suddenly need psychiatrists to prescribe their lithium, or would non-psychiatrists become more comfortable prescribing lithium, at least as a depression adjuvant, which would likely be a far less complex endeavor than managing bipolar disorder?

3) Does this strengthen or weaken the case for prescribing rights for psychologists? After all, this paper is proposing a change to our current care model that could cause a dramatic increase in the need for more specialized mental health services. Of course, this assumes that the answer to question 2) is that non-psychiatrists would not become more comfortable prescribing lithium adjuvant therapy for depression.

4) And of course, if one mood stabilizer decreases the risk of death by suicide for folks with recurrent depression, what would the others do? Now that some atypical antipsychotics have been approved as mood stabilizers, where do they fit into this picture?

5) Do SSRIs remain relevant to the treatment of recurrent depression? Not to be too cynical, but all but Lexapro are off patent.

On a parallel note, check out The Last Psychiatrist's take on new evidence that adjuvant SSRI therapy adds nothing to patients with bipolar disorder already on a mood stabilizer. Especially relevant to question 5).

Goodbye, Blue Monday

When my radio alarm woke me up this morning, I caught "he survived the firebombing of Dresden, and much of his early work dealt with atrocities..."

Holy Shit.

The segment ended, I poked Courtney, and she listened to the last bit with me, still too asleep to process that all the verbs were in the past tense. She ran to the computer and popped up the news, and there it was. Kurt Vonnegut dies at 84.

You're not supposed to cry when people die whom you never met. But damn, I can hardly even type right now. I was okay, until I entered that title above, and then it just broke. Goodbye, Blue Monday. It's like the god damn Velveteen Rabbit all over again.

People either get Vonnegut, or they don't. Few people who get Vonnegut don't have a period of their life where they start voraciously consuming his novels as fast as they can read for at least a few months. You change during those months. I think I was 16. People talk about great writers, but Vonnegut was an important writer. He was important because he's often the first writer that existential dysthymic teenagers run across who is so interested in something that, however nebulously, you have to call truth.

Vonnegut, like the other main artistic force in my personal development, R.E.M., wasn't doing anything nowadays to add to his legacy. A Man Without A Country was a guilty pleasure, and quintessential Vonnegut, but it wasn't a book, and it was clear to all of us that he wasn't going to write another book. Timequake wasn't even supposed to happen, and plenty of people wish it hadn't. But Kurt Vonnegut had a series of seven novels, each of which incrementally dealt further with his time in Dresden, leading to his eventual release from its grasp on his artistic psyche in Breakfast of Champions.

He was old, and the fact that he didn't die of lung cancer might be a small miracle unto itself. But these days come. And these days are devastating.

On the top of one of my bookshelves, every Vonnegut book published (except for a few of the random nonfiction ones that have popped up over the past ten years or so, mostly collections of previous stuff), is lined up in a nice dusty row. Several of them have more than one copy, due to the merging of my and Courtney's book collection. I imagine the two or three that have managed to avoid being read for all these years will find that streak coming to an end very soon.

Funny, I just mentioned to Courtney that we watched Slaughterhouse Five on DVD the night of our first kiss.

Poo-tee-weet.

A well-intentioned white southerner's education on racism

Please understand that I'm not being sarcastic here, because if I were reading this post, I think I would think it was sarcastic in parts.

I grew up in northeastern Kentucky around a bunch of white people and a handful of Asian doctors' kids. I think there were some black kids in some of the neighboring school systems, but I don't think any stayed at Russell for more than a few years. I didn't really know any of them. So sure, I was ignorant about race in the classical sense. I wasn't exposed to race issues personally in any meaningful way, and the little I knew about race issues came from books and TV and bad jokes.

So stuff I've learned this year:
-The world 'articulate' has some sort of weird history (predating Barry-O) as a derogatory term for well-spoken folks who are African American. Didn't know that.
-Tar-baby from Song of the South, which I knew in its situational context, has a racial context as well. Didn't know that. I remember singing Zip-A-Dee-Do-Da a lot when I was kid, because it was a catchy tune. I knew Brer Rabbit was a rabbit, Brer Bear a bear, Brer Fox a fox, and Uncle Remus, well, somebody's uncle, and a farmer. Black sharecropper didn't really mean anything different than the farmer in the dell. And Song of the South really wasn't something on the forefront of my brain to really reconsider.
-Nappy refers to, according to wiki, the texture of African hair which has not been altered chemically. I knew that nappy hair was similar to hair that was in dreads, and I guess I knew
that dreads had African roots. But I don't think I necessarily understood that there was a necessarily negative connection there. And when I first read the whole Imus thing, I don't think I really understood that his "nappy-headed ho" comment was really any more inflammatory than the entirely disgusting and uncalled-for stuff he says every day.

My wife asked me why I was even writing this post, what I possibly hoped to accomplish by a) painting myself as a dumb hick, b) risking giving the impression that I somehow tolerated things that other folks found hurtful, c) rambling.

A) My thesis is not that white southerners are dumb hicks, but that some aspects of the white southern experience differ meaningfully than that of folks who grew up in relatively progressive urban environments, and can easily include minimal exposure to race issues in a meaningful way. I think it's non-obvious to folks who have only lived in progressive areas that reasonably intelligent and even well-intentioned people can be ignorant about the finer points of race issues due simply to lack of exposure.
B) Each of the three controversial points above could elude a well-intentioned person with minimal exposure to race issues. My initial reaction to all three was generally dismissive until I saw that reasonably mainstream folks with more direct experience with race issues could find the usages undesirable. I'm not convinced that "articulate" and "tar-baby" are inherently racist words, but I am convinced that it's probably not worth using them in these contexts, because there are intelligent folk who could reasonably feel marginalized by their usage.
C) Well, yeah.

Link Roundup, Baseball and Robots edition

Baseball's "hitting slump" probably isn't due to de-juiced balls or steroid deterrents, but about the ever-widening strike zone. Which makes sense, since the vast majority of baseball hits are not homeruns. And anybody that's watched Barry Bonds work the count has to wonder if anything that doesn't hit Barry's bat would ever be called a strike.

And more on the neuropsychology of hitting a baseball. Nerdy, but essential for the baseball-watching neuro-fan.

Check out the Top 10 80's Robots (We Expected to Exist By Now). Embarrass-your-self-at-work funny for the people who found link 2 interesting.

Darshak Sanghavi takes Jerome Groopman to task in Slate's book club for his focus on the efforts of individuals in improving health care, which has become an inherently systems-based practice. Groopman's been on a handful of NPR segments to blast doctors for being arrogant and tunnelvisioned, but I've struggled to really put my finger on what about Groopman's arguments really bugged me. Sanghavi proves why he gets to write on Slate, and I get to write on Sparkgrass.

And, from the somebody-had-to-do-the-study department, having a gun at home increases the risk for a death by suicide.

For the med student sequel of Harold and Kumar go to White Castle

Check out Matt (our own Matz) and Kags in Ghana. Matt reads enough Bill Bryson to insure that he's at least familiar with the travelogue genre, with a creative writing degree to boot. Not to say that he's necessarily aiming for his masterpiece under such circumstances, but chances are these guys will make fools of themselves plenty of times.

Matt and Kags will begin residencies in emergency medicine in July, at Brown and UofMichigan, respectively.

Throwing grapes at the Detroit school board

I don't usually watch local news, but we didn't turn from channel 7 after Lost on Wednesday. The first story was some crazy women chucking grapes from the audience at a school board meeting because Detroit schools are hemorrhaging cash, and some unfortunate closings were necessary.DPS police officers arrested

Agnes Hitchcock, leader of the Call 'Em Out Coalition, a local advocacy group known for harsh political comments. As she was being arrested, she was asked what she had thrown, and Hitchcock yelled, "Grapes! I hit her right here," and pointed to her forehead. It was unclear whether Hitchcock was released from custody Wednesday night.

Hayes-Giles said she was struck in the chest and plans to press charges.

"It was hard. It startled me because quite frankly, I didn't know what it was," Hayes-Giles said of the incident. "It was unacceptable behavior. You can disagree with the vote someone takes, but that gives her no right to assault anyone."

Some things don't even need commentary.

Was the Dharma Initiative a UofM psychology project?

I knew there was something fishy about this place.

Exiting the panic room

I've tried to avoid turning Sparkgrass into a basketball blog, as others do that much better, but I'll just state my extreme satisfaction with Billy Gillispie as a super choice to lead the Wildcats helm. He wanted the job as soon as his name was mentioned, and he wins fast. Of course, the latter worries me that a bunch of NCAA violations will pop up, since it's a little unreal that he could turn UTEP and Texas A&M each into strong programs in the twinkle of an eye. But if this guy's for real (and he probably is), we're all in for some fun times. And maybe, just maybe, a Kentucky-Florida rivalry will be restored with the stakes even so much higher.

The Kentucky job is still one of the top 5 in college basketball. But the top 5 jobs in college basketball are no longer so much better than the top 20 jobs in college basketball to expect someone to leave one of those posts. Roy Williams left Kansas for Carolina because he was a Carolina kid at heart, the same reason that Bob Huggins made yet a bigger ass of himself and left KSU for West Virginia. Huggins is a Mountaineer and a douche nozzle at heart, and so he left all of his promises to his #2 recruiting class in the nation to go home. Heck, Ben Howland left a sweet job at Pitt for UCLA not just because the UCLA is a top 5 job, and the Pitt job is a top 25 job, but because he was a UCLA kid at heart.

Billy Donovan wasn't a Wildcat at heart. He was an assistant coach under a former coach, and an assistant coach at the same time as another assistant coach who just got pushed out of his head coach position by the psychotic wing of the Kentucky fanbase. He had a nice link, but growing up in the same conference, he'd had plenty of time for the mystique to weather. Billy Donovan can do no wrong in Florida. He'll pull a Denny Crum or a Bobby Knight. He'll win for a few more years (10-15?), and then spend his twilight years directing a mediocre program. No one will care, because he put Florida on the map. That's special, and good for Billy Donovan. Kentucky should be proud that we had something to do with developing the hottest coach in the nation, even if we can't claim him as our own.

Francis Collins, class act

Apparently, my first year of medical school was the first year in which Francis Collins didn't teach M1s medical genetics at the University of Michigan, so I never got to meet the guy. He was too firmly entrenched as director of the genome project by then, and while I'm sure lecturing me on genetics would be his second greatest achievement, honing his ninja genetics skillz at NIH makes sense too.

Collins is also famous as an evangelical Christian who makes a lot of sense when he talks. There aren't a lot of those on the national stage, and not a lot of them in the scientific community with voices loud enough to be heard.

So, some have asked, doesn't your brain explode? Can you both pursue an understanding of how life works using the tools of genetics and molecular biology, and worship a creator God? Aren't evolution and faith in God incompatible? Can a scientist believe in miracles like the resurrection?

Actually, I find no conflict here, and neither apparently do the 40 percent of working scientists who claim to be believers. Yes, evolution by descent from a common ancestor is clearly true. If there was any lingering doubt about the evidence from the fossil record, the study of DNA provides the strongest possible proof of our relatedness to all other living things.

This is a guy who is obviously interested in cutting out the bullshit. I'd like to think that it's the bullshit, and not religion itself, that scares away intellectuals and scientists.

As an almost formal rule, I don't really talk about my personal religious beliefs with anyone nowadays. I hadn't really thought about that fact, but the last time I can remember even trying to have a discussion of what I believed was during my first year of medical school.

UofMichigan Sit-In for sweatshop labor

Back in my freshman year of college at the University of Kentucky, friends of mine holed themselves up in the administration building to protest the use of sweatshop labor by university vendors.

Now, there are kids at UofM doing the same thing.

I'm no economist (even if I sometimes play one in my fantasy life), and I'm ambivalent at best nowadays about globalization (which is a dramatic shift from my extreme anti-globalization views held as recently as just the past few years). The globalization debate is a fertile one, and one in which both sides can make extremely compelling arguments that their policy preferences best serve the interests of the citizens of the world, rich and poor, at least in a long haul. So, I guess I'm not de facto supporting the fact that these motivated kids are anti-globalization, but I will support their willingness to stick out their necks because they think the world can be a better and more equal place. Their message is that, in the globalization debate, we do have to consider the holistic impact of economic policy on both human dignity and the environment. Compelling arguments, albeit slightly counterintuitive ones, assure that both human dignity and the environment will eventually benefit from globalization, even if some short term lapses appear to occur. Those arguments might also be effective only in a theoretical universe, and may fall apart when weasel corporations are involved. Lots of mights and maybes, and I'm just not able to commit to any of them.

But, props to the kids at the UofM Sit-In. They're not doing anything wrong, and they just might be doing something right.

UPDATE: Surprise! They got arrested, as seems to happen at these things. At least they didn't get manhandled, or at least it wasn't reported as such.

Link Roundup, Drug-Withdrawal edition

Pergolide, dopamine agonist used as an adjunct to L-Dopa and Carbidopa, is withdrawn voluntarily when evidence showing that the drug increases the risk of damage to heart valves puts the drug on tremulous ground. *Rimshot*

In crappier news, IBS pro-motile drug Zelnorm apparently increases the risk of pretty much everything. FDA asks Novartis nicely to please quit selling people heart attacks and strokes.

Some NIH folks figured out that when monkeys concentrate voluntarily, their prefrontal cortex is in charge, while distractions activate the parietal cortex. ADHD neuroscientists start writing new grants furiously, buying extra bananas.

Nature addresses the growth of dichloroacetate sales (for veterinary uses *wink nudge*) on the internet for cancer patients, and how such activity, besides being illegal, throws a huge monkey wrench into the process of actually testing DCA in real clinical trials.

While the FDA hasn't found anything particularly wrong with Pfizer's inhaled insulin formulation Exubera, doctors and insurance companies just aren't impressed.

Kids with ADHD more likely to abuse alcohol

Strangely enough, from the same research group at WPIC that produced a big chunk of the research I used for term projects in Adolescent Health and Mental Health Policy classes last semester:

The 15- to 17-year-old children in the study with childhood ADHD reported being drunk 14 times, on average, in the previous year, versus only 1.8 times for age-matched teens who did not have childhood ADHD.

Fourteen percent of 15- to 17-year-olds with ADHD were diagnosed with alcohol abuse or dependence compared with none of the similarly aged subjects without ADHD.

My question would then be, how does effective ADHD treatment relate to allaying, if at all, the risk for substance abuse in ADHD teens? I might mail email the study author to see if her group has addressed/wondered about that as well.

And I thought my high school biology teacher was an idiot (not clairvoyant)

I REALLY wish I had made this story up, rather than being forced to document the sad truth about secondary science education in the Bluegrass State.

Imagine fifteen year old Garrett:

[Biology classroom, fifth period right after lunch. Garrett resumes his daily routine of walking into biology class and promptly falling asleep on his back pack. For some reason, Garrett can't sleep today, and feels a little guilty for being so flippant about a science class. He tries to feign some interest in Ms C's biology lecture]

Ms C: So, you get twins when two sperm fertilize the same egg...

Garrett: [mystified that the state of Kentucky would pay someone to say something like that in a biology class, sits up] Wait, did you just say that twins are caused by two sperm fertilizing the same egg?

Ms C: Yeah, that's how we get twins.

Garrett: [looks around room to other people he knows with IQs over 12, fails to find anyone else even remotely paying attention] But...

[Ms C continues with lecture on nothing, Garrett is able to return to his post-lunch nap with a clear conscience]

But now, Ms C's delusions are newly-minted medical science. Semi-identical twins, produced by the fertilization of one egg with two sperm, have now been documented.

[Cue Fade Music: "It's the End of the World as We Know It (And I Feel Fine)"]

Now if that whole Creationism thing would just pan out, Ms C might win the Nobel Prize.

Drugs Equal Benefits of Artery Stents

Was it for this my life I sought?
Maybe so and maybe not
-Phish, Stash

I don't really have anything to add to the New York Times article, which explores the study in remarkable detail impressive even for the NYT. Except that this, like any study, isn't the final say in the debate. It's just a really loud and integral portion of the debate.

But this has to be required reading for anyone in medicine or health policy and economics. Or anyone screwed with a load of Boston Scientific stock.

Sunday Link Roundup

1) Jay Farrar and Son Volt's new album The Search on All Things Considered.

2) Because of some loophole in a new Medicaid rebate law, pharm companies now have no incentive to offer OCPs cheap to universities. Because pregnant college girls are good health policy. Obviously.

3) But maybe that's okay in Texas. State Rep Dan Patrick (R-ealAsshole) wants to offer pregnant women considering abortion 500 bucks not to get abortions. Hey, Texas girls, have twins, and you might be able to pay for your books next semester!

4) Patients really don't give a flip if you wear scrubs, a white coat, or monkey boxer shorts. They do care if you are a douche nozzle. (For a history of the "douche nozzle," Ctl-F the term here.)

5) Docs around the world are calling for a boycott of Reed Elsevier (they publish the Lancet, among other obscure journals to which your EBM searches inevitably lead you), since apparently they have something to do with arms fairs to showcase cluster bombs, or something sketchy like that.

6) Disaster averted: Emma Watson will play Hermione through Film 7. Reports last week said she wanted to bail.

7) Creepy much?

In what is becoming a trend among conservative Christians in the United States, girls as young as nine are pledging to their fathers to remain virgins until they wed, in elaborate ceremonies dubbed "Purity Balls."

"Since I'm just the return on Daddy's investment into Mommy's sperm bank, he owns my hymen until he tells some boy its okay for him to have it." Eww.

Morris heading to the Knicks

I'm slow on the draw, and every Cat fan knows that RaMo had 1.6 million reasons to leave. Plenty of griping going on, but I just wanted to put my two cents in to the world: good for you, Randolph.

Thanks for all the fish.

Abolishing the Middlemen Won’t Make Health Care a Free Lunch

Tyler Cowen takes a pot shot at the argument that Medicare's low overhead would still be a good thing in a Medicare-for-all scheme.

Not saying I buy it, or that I've had time to think about it, but Cowen's always at least smart and avoids partisan hackery.

Step 2 awaits Saturday, and I can't really think until after that. Not between Step 2, and Tubby going to Minnesota.

WTF???

Tubby Smith leaving Kentucky for Minnesota.

Didn't actually see that coming, because I didn't imagine Mitch Barnhardt was that inept as an AD. Does that leave us anywhere with Patterson or Lucas?

Gore's next greatest invention? Flame retardant babies!

“The planet has a fever. If your baby has a fever, you go to the doctor. If the doctor says you need to intervene here, you don’t say, well I read a science fiction novel that tells me it’s not a problem. If the crib’s on fire, you don’t speculate that the baby is flame-retardant. You take action. The planet has a fever.”

For some reason, I do expect that, in most pediatricians' careers, they'll have at least one parent argue with them over something they read in a science fiction novel. Maybe once every few months might be a better estimate, depending on the population.

Kennedy vs Kennedy in pursuit of the ghost of Paul Wellstone

The NYT describes the competing versions of a mental health parity bill, the Paul Wellstone-inspired House bill sponsored by Kennedy Jr., and the surprisingly pro-business bill sponsored by Papa Kennedy in the Senate.

The American Psychiatric Association supports both bills, describing them as different approaches to the same goal. Mental Health America, an advocacy group for patients, also supports both bills. But Ralph J. Ibson, the chief lobbyist for Mental Health America, said, “The House bill has greater protections and is therefore a stronger bill.”

The House bill is named for Paul Wellstone, the senator from Minnesota who championed similar legislation before he died in a plane crash in 2002. Jeff Blodgett, executive director of Wellstone Action, a nonprofit group that is continuing the Democratic senator’s work, said, “The Senate bill is a step forward, but the House version is true to Paul Wellstone’s vision.”

On behalf of the senator’s sons, David and Mark Wellstone, Mr. Blodgett said, he asked the Senate sponsors not to put the Wellstone name on the Senate bill at this time.

One of the biggest differences between the House and Senate bills is that the House version defines the “minimum scope of coverage.” Under the House bill, if a group health plan provides any mental health benefits, then it must cover the same wide range of mental illnesses and addiction disorders covered by the health plan with the largest enrollment of federal employees.

By contrast, the Senate bill does not specify what mental conditions or diagnoses must be covered.

Given that even Bush has endorsed the notion of mental health parity, at least in principle, I don't quite understand the necessity of the watered-down Senate Bill. Of course, industry doesn't like things that could possibly cost them money. Several policy memos I've read suggest that mental health parity probably wouldn't cost all that much anyway, and that concerns that the worried well (a term I despise, but will use in the context of this debate, in which it is so often cited) will flock to therapists for self-actualization probably don't make much sense.

Having seen at least one case in which a severely depressed patient ran out of psychiatry visits for the year during March, I'll be the first to admit that I'm going to be biased towards mental health parity. Since my salary will most likely depend on NIH instead of insurance companies, I can't say I have too much personal financial incentive in the matter.

But at some point, it seems like a lack of mental health parity comes down to simple discrimination against those with mental illness. We'll pay for your sprained ankle treatment, but not for your bipolar disorder. I'm pretty sure the situation isn't much more complicated than that, though I've seen plenty of people try to make it more complicated by distorting the realities of mental illness.

Boutique hospitals suck

A recent study published in JAMA indicates that specialty cardiac hospitals might be cathing everyone, whether they need it or not. They found that in areas where new hospitals opened, there were more revascularization procedures (CABG, PCI) than in areas where new cardiac programs opened at regular hospitals (thus it's not just the "if you build it, they will come" issue of adding resources to an area). Given the fact that these specialty hospitals are also exempt from the requirement that they provide emergency services (thus they don't have ER's and don't really benefit the community) and tend to skim well reimbursed patients from general hospitals (who are left with the expensive, uninsured, patients and less funding to provide care for them), this merely adds to my general hatred for these hospitals. That being said, my partial ownership of the local bariatric center has been very lucrative.

Deep Thoughts (with Derby Spotterparks)

"Hmm... who would have thought that those silly Wildcats could do no worse than Duke, Louisville, or Arizona by Saturday afternoon of the first weekend of the tourney..."

The best of times, the worst of times

According to Pat Forde (who is apparently the only guy at ESPN I find worth reading, or at least quoting:

KENTUCKY (8)

Best case: Randolph Morris and Joe Crawford reach previously untapped reservoirs of passion, Ramel Bradley quits throwing the ball away and the Wildcats surprisingly pull out of a two-year tailspin by upsetting Kansas and reaching the regional final. Fans at least halfheartedly chant "Tub-by! Tub-by! Tub-by!" after every victory. Back home in Rupp Arena, Louisville loses in the first round.

Worst case: Fans chant "Tubby Must Go!" after phlegmatic Cats bow out against Villanova, their seventh loss in the final 10 games. To their dismay, athletic director Mitch Barnhart stands by his man for another season. Morris and Crawford go pro, hotly pursued recruits Patrick Patterson and Jai Lucas go to Duke and Oklahoma State, respectively, and Rick Pitino takes Louisville to the Final Four again.

Word on the street is that Patrick Patterson reads a lot of message boards and the such (maybe that's just the anxiety of those of us who worry about what retards say on those things). So, Patrick, if you happen to run across Sparkgrass, know that the rational wing of the Kentucky Wildcat Nation will be throwing huge parties on the day you join us, and wearing blue and black instead of blue and white for weeks if you don't.

Same goes for you, Jai. But the rumors don't tell us that you read blogs and message boards quite as fervently.

Note: I claim exemption from delusions of grandeur when I think that there is an infinitesimally small chance one of these guys would run across this page. That infinitesimal chance is more than enough

Happy Match Day!!

For all your M4 med students out there - Happy Match Day! Best of luck, I hope you end up where you want to! :)

Who's the candidate for LGBT voters?

There has been a lot of talk in the past few days about what the candidates think about homosexuality and morality. Most disconcerting is the way Obama and Clinton sidestepped the question and waited for their campaigns to issue statements later clarifying their positions. Does this mean that the most LGBT-friendly candidate in the pack is a Republican (Guliani)? If so, what's happening to the Democratic party?

Sparky Update: ThinkProgress has statements from both Clinton and Obama retracting their non-answers. It's sorta sad that left-leaning candidates have to be so careful to not piss off the fundies that they can't even allow themselves to be on film saying that homosexuality might not be the greatest plague ever.

New risk factors for DVT?

Every good medical student can tell you the primary risk factors for Deep Vein Thrombosis (DVT, or blood clots in your legs): smoking while on birth control, cancer patients, hypercoaguable abnormalities, and long plane flights. Well, add a new one to the list - office workers!

This study from New Zealand demonstrates that office workers are at increased risk of DVT formation, even compared to "long plane flight" patients. Who knew? I guess people need to get off their asses more at work instead of sitting in front of a computer screen all day. Not only is it good for cardiovascular health, but it just may prevent DVTs too.

what the market wants to do

Very rarely do I read an article on health care reform and think that an author actually gets it. Not like I have any answers, but almost every solution I see thrown out, by left and right alike, just seem like disasters waiting to happen, ya know, sorta like the current health care system. So Kudos to Tim Noah, who ends his article on a brilliant note:

The overall trend—the gift of an increasingly market-driven health-care system—is to undermine the very idea that the cost of illness should be spread out among the general population, healthy and unhealthy alike. In this sense, the market is too efficient. Assigning health care costs to sick people is what the market wants to do.

Markets can do many wonderful things, which is why I'm glad to live in a capitalist country. But they've made a complete hash of the health-care system. Doesn't that reality deserve more than passing respect?

In the rest of the article, Noah reviews Jonathan Cohn's to-be-soon-published history of health care disasters, Sick: The Untold Story of America's Health Care Crisis—And the People Who Paid the Price. Going straight to the top of the Wishlist.

Salt, Meet Wound

I always appreciate Pat Forde's ability to make Kentucky fans want to slit their wrists:

Tubby Smith. NCAA winning percentage: .700. He's lost only one first-round game, and that was at Georgia back in 1997. Took Tulsa and the Bulldogs to the Sweet Sixteen, and has gotten Kentucky there six times. Caveat: Hasn't gotten Kentucky to the Final Four since 1998, and the Wildcats are looking at the longest Final Four-less streak in school history if they don't make it this year.

Forde was a sportswriter at the Courier-Journal before his time at ESPN, so at least he has witnessed the moral depravity of Kentucky fandom at its lowpoints.

Eating-disorder education shows unintended effects

I keep accumulating all of these eating disorder research blurbs I want to blog, so here goes this one:

Yale University researchers found that when they presented female high school students with videos on eating disorders, it met the intended goal of boosting their knowledge about anorexia and bulimia.

However, the team saw that the students didn't necessarily find the results of eating disorders unappealing. Teens who watched a video featuring a woman recovering from an eating disorder became more likely to view girls with eating disorders as "very pretty," and some thought it would be "nice to look like" the woman in the video.

Health educators are clearly losing the battle in the prevention of eating disorders when students don't find vomit and electrolyte abnormalities particularly unappealing.

[T]he girls were more likely to say after [watching the educational videos] that "it's not that hard" to recover from an eating disorder. They were also more likely to believe girls with eating disorders have "strong" personalities.

At some point we have to wonder if such a study isn't just a strong cautionary tale against not pilot testing your educational materials. Our understanding of the teenage psyche somehow immediately disappears around the time that we can legally drink alcohol. Adults can pretend to understand why teenagers would think girls with eating disorders have strong personalities. We could draw flow charts and propose mechanisms, but I'm betting we'd never "get" it. That of course doesn't mean we shouldn't try to advance our understanding of disease context in eating disorders to its fullest. But we better be pretty humble in our pursuits.

The strongest message we might draw from this study might be that assumptions are futile in child psychiatry. And as soon as we know something, its probably changing due to social dynamics that defy our best mathematical models.

Kumar comes home from White Castle

Dana Stevens seems convinced that the film adaptation of Jhumpa Lahiri's really shitty novel The Namesake won't suck nearly as bad as the book did. Is there nothing that a little bit of Kal Penn idiocy can't save?

To be clear, there are very few books that I love, and very few books that I loathe. Any book within two standard deviations of my personal mean, I generally like a lot, even if I don't love it. The Namesake, I loathed. Maybe it's just from hanging around with too many Indian kids in high school. Maybe it's how Lahiri managed to create a stock character from second generation Indian-Americans, when no stock character really existed to my knowledge. Besides an interesting name, Gogol (whom Kal Penn must desperately save from lameness) is completely uninteresting. If you've ever met a single person whose parents immigrated from India, no matter how boring a person that person might be, that person is more interesting than Gogol.

The Unknown is Unattainable

So Josh sent this to me, and I stared at it with the sound off. He finally IM'ed me to tell me that the sound sorta added something. Strangely hypnotic.

Don't do this at work or anywhere where other folks are going to wonder what the hell you're listening to.

I Don't Want Health Care If Just Anyone Can Have It

How do you seek such truth, Onion?

Health care is all about exclusivity, pure and simple. It's for a group of like-minded people bonded by the dream of only having to contribute a portion of their weekly wages to ensure unfettered access to a number of licensed health care professionals. If we change all that, health care will be about as elite as a public restroom, open to any yokel who waltzes into an emergency room and can legally establish California residency.

Iowa relaxing blood donation ban?

The largest blood donor service in Iowa is recommending that a ban on gay-men donating blood be re-examined. As we all know, the ban on men who have sex with men from donating blood dates back to the 1970's when the height of the HIV scare was just beginning. However, since that time our ability to test for the HIV virus has improved dramatically.

Each year during this week, the fraternities and sororities of Iowa State University hold a contest to see who can collect the most blood donations. However, one fraternity (Delta Lambda Phi - an LGBT fraternity) complained that they would be unable to participate as a result of the ban. So the entire greek community has decided to not hold the competition. They estimate this will amount to a loss of 500 units of blood.

While as a physician-to-be I cannot support boycotting blood donation, I do applaud the campus community for supporting their LGBT brothers and sisters who are being unfairly discriminated against. Maybe someone with authority will finally listen and re-think this unnecessary and discriminatory policy.

Ibuprofen best for treating kids' pain

The first head-to-head study of three common painkillers found that ibuprofen works best, at least for kids with broken bones, bruises and sprains.

Available generically and under the brand names Advil and Motrin, ibuprofen beat generic acetaminophen and codeine in an emergency room study of 300 children treated at a Canadian hospital.

Not that I don't have enough soapboxes, but one of them is certainly the incredible underuse of ibuprofen and other NSAIDS for acute pain. Granted, I haven't read the real paper, and there's certainly a chance that narcotics may have been underdosed (which resembles real world situations--docs aren't nearly as afraid to prescribe higher doses of NSAIDs compared to narcotics). But I think we at least see further evidence that, barring any reasonable contraindication, there's little reason not to include ibuprofen as either a primary or adjunct pain reliever in the setting of acute pain.

God save the Veterans

Anyone who hasn't had their head in the sand over the last week has heard about how veterans discharged from a major VA hospital have been forced to live in substandard housing, fill out mountains of paperwork to get follow up medical care that may never arrive. The situation is so bad that politicians and military officials are tripping over themselves to apologize to everyone and fire anyone involved. And while I have a great deal of respect for our veterans, I'm getting pretty annoyed with the implicit implication. Much of the US lives in substandard housing and many more individuals with mental and other health issues are forced to wade through a public health nightmare of limited resources, bureaucratic hoops, and substandard care. But we don't seem to care about these people, because they're NOT veterans (nor children, nor pregnant mothers). It would seem that this country values health care as a basic right (why else would ED's be required to evaluate and stabilize EVERYONE who walks in the door), but when it comes down to the details (those details numbering in the millions of uninsured) we just don't seem to give a damn. Gee, if only all the uninsured were veterans, then we would actually care about their health care.

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.

Well, Barry-O IS articulate

And Joe Biden is a moron. At least when he opens his mouth. But of course, it's absolutely out of fashion to say that Barry-O is articulate because of the implication that he shouldn't be because he's black. Or that he's articulate considering he's a black dude (implying that if he were a white dude, his current level of articulateness wouldn't be remarkable). Or something like that.

Now, I say Barry-O is articulate not because he's a black dude, but because we've got a guy in the White House who couldn't form a complete sentence in front of a microphone without a teleprompter for the first three years of his presidency, and our last democratic presidential candidate couldn't tell you his favorite color without using a semicolon.

So let's claim the word back, and let's call Barry-O what he is. Articulate. He's a damn good orator. Cicero style. Ghandi style. Kennedy style. Lincoln style. AND MLK style. Hell, maybe even Jim Webb style. But absolutely NOT Joe Biden style.

So Barack isn't articulate because he's a black dude that talks good. He's articulate because he was the damn editor of Harvard Law Review, and he's articulate because he wrote a book ten years ago that actually had something to say. And he's articulate because you can listen to a speech of his and, even though he doesn't say any more or any less than anybody else does, you get that special feeling, that feeling you haven't had since fifth grade history class when the frigging War of 1812 made you proud of your country.

It's nice to feel good about your country, even if the guy is laying on the same bullshit that other politicians try to use less effectively. Barry Obama can make you feel good about your country, and I'm pretty sure he'd be able to do that even if he were a purple transsexual instead of a black dude.

I'm not saying his rhetorical excellence would make him a good president. But Dreams from my Father at least shows that this is a guy with a lot of smart things to say. He's openly thoughtful in his writing, and that's not something we can say all that often about politicians writing books.

But we're not talking about what he has to say right now. We're talking about how he's damn good at saying them. He could tell you how to make a peanut butter and jelly sandwich, and it might make you cry.

Now, if he just stopped smoking...

UPDATE: Political Wire compiles the media reactions:

Washington Post: "Biden Stumbles at the Starting Gate"
New York Times: "Biden Unwraps His Bid for '08 With an Oops!"
Chicago Tribune: "Hat in Ring, Foot in Mouth"
New York Post: "Biden Blows It"
New York Daily News: "Senator Stupid!"

UPDATE2: Biden explains himself on the Daily Show, doesn't refer to Jon Stewart as a 'clean Hebrew-American.'

We're all better off with headlines like this

Aqua Teen Hunger Force Brings Boston to a Halt

As it should, my friends. As it should. The fact that ATHF has not brought most major cities to a halt in general is a testament only to the lame choices of American television watchers.

If the mooninites are terrorists, then maybe I'm batting for the wrong team.

HPV vaccine for gay men?

Merck, the makers of Gardasil (the HPV vaccine now being given to women) is conducting a trial of 4000 men, including 500 self-identified gay men, to test the effectiveness of HPV vaccination in men to prevent anal cancer. Although I think this vaccine should be given to all gay men, especially "bottoms," I'm glad to see the company pursuing this study. Obviously there are far more women who are eligible for the vaccine than gay men, but that they're still going after this market is a good sign, in my opinion.

Finally, a real reason to move to Europe

Europe-wide smoking ban proposed!

Places usually only ban smoking in public places AFTER I live there. My podunk, asscrack-of-earth hometown has banned smoking at bars and restaurants, and people are ready to throw a fit because of a new proposal to ban smoking at the park (which is where people go to smoke because they can't smoke at the private hospital across the street). And Lexington, the cultural capital of the #2 tobacco state in the union, banned smoking in bars and restaurants right after I left my undergraduate career there.

I move to the most left-leaning, health conscious, crazy-ass hippy white-bred hybrid-SUV driving college town in the entire Midwest (sorry, Madison), and people can still smoke at restaurants and bars? Who did I piss off to deserve this crap? They can ban smoking smack dab in the middle of a zillion acres of tobacco fields, but folks haven't even put it on the ballot in Ann Arbor?

They're probably more likely to legalize smoking pot in bars than they are to get rid of smoking tobacco in bars. Damn hippies!

Harriet Washington's 'Medical Apartheid' book

Haven't read it yet, but the NPR interview suggests that Washington's take on the historical mistreatments of blacks by white doctors goes well beyond Tuskegee (but of course, includes it) to illuminate the legacy of the sort of racist cruelty that makes blacks suspicious of white doctors even now.

Washington also expresses the importance of African Americans participating in research today, and ends on a bit of an upturn that I didn't really expect. Good for her.

The Pain of Buying Stuff

John Tierney visited Stanford so an MRI could watch his brain make decisions about buying stuff. The result is an exceptionally well written article about the neuroscience of irrational consumer behavior.

I will not try to justify my need for the mood clock, the “Dodgeball” DVD, the desk-clip lamp and the smoothie maker. I would rather pin these choices on two culprits.

The first was my nucleus accumbens, a region of the brain with dopamine receptors that are activated when you experience or anticipate something pleasant, like making money or drinking something tasty. In the experimental subjects at Stanford, this region was activated when they first saw pictures of things they wanted to buy. My nucleus accumbens just happened to respond more strongly than the typical subject’s, so what else could I do? If it feels good, buy it.

The other culprit — the main villain, really — was my insula. This region of the brain is activated when you smell something bad, see a disgusting picture or anticipate a painful shock. It was typically activated in the brains of the other shoppers when they saw a price that seemed too high. I’d like to think of my insula as particularly stoic, the strong, silent type, but he’s probably just an oblivious slob.

The lazy insula is a rarer affliction than you’d guess by looking at Americans’ indebtedness. Tightwads slightly outnumber spendthrifts, according to surveys by George Loewenstein and his colleagues at Carnegie Mellon, Scott Rick and Cynthia Cryder. These behavioral economists think tightwads aren’t any more rational than spendthrifts, because neither group is carefully weighing the long-term benefits of a Foreman grill versus college tuition. Dr. Loewenstein says the brain scans demonstrate that both kinds of shoppers are guided by instant emotions.

“We developed this propensity to experience direct pain when we spend money,” Dr. Loewenstein said. “This explains why tightwads won’t spend money even when they should. It also helps to explain why we overspend on credit cards, and why people prefer all-you-can-eat buffets instead of paying for each item they order. We like schemes that remove the immediate pain of paying.”

I'm trying new template stuff from the new blogger. We'll see what this thing actually winds up looking like, or if I should just go back to the old look.

UPDATE: I think I'm comfortable with this color scheme, and cleaning up the ads. I wasn't exactly paying my bills with them, and everything just looks cleaner now. I'm trying to update some of the old posts with labels, but geez that gets boring after about 50 posts. If you think the new look sucks, or is a major improvement, let me know.