Smooth Pebbles

Slate asks: Are MDs shilling for pharma ... on public radio?

In a nifty bit of reporting, veteran health reporters Shannon Brownlee and Jeanne Lenzer revealed in "Stealth Marketers," a story on Slate, that a "Prozac Nation: Revisited," a radio piece on antidepressants and suicide that ran on many public radio stations recently, "featured four prestigious medical experts discussing the controversial link between antidepressants and suicide" who all reportedly have financial ties to the makers of antidepressants -- as does the radio series, known as "The Infinite Mind," that produced the show.

As the story notes, the extent of the financial ties are unknown because those involved won't reveal them. Still, Brownlee and Lenzer argue, the show in question, "Prozac Nation: Revisited," "may stand in a class by itself for concealing bias." (Then follows a troubling paragraph outlining the conflicts of interest involved.)

is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public.

The story goes on to list several examples that point out out badly such influence compromises our ability to trust many news reports.

Conflicts of interest abound even in unexpected places. A recent survey of academic medical centers published in the Journal of the American Medical Association found that 60 percent of academic department chairs have personal ties to industry—serving as consultants, board members, or paid speakers, while two-thirds of the academic departments had institutional ties to industry. Such ties can be extremely lucrative. And according to these articles in the medical literature, researchers who receive funding from drug and medical-device manufacturers are up to 3.5 times as likely to conclude their study drug or medical device works than are researchers without such funding.

Brownlee and Lenzer put some focus on journalists as well. They cite one study of 544 science stories from top outlets (from 4/06 to 4/08) that checked whether the journalists quoted an independent expert and/or made some attempt to report researchers' potential conflicts of interest. "Half the stories failed to meet this requirement."

This doesn't surprise me. This story prompted a very lively exchange on a science writer listserve I participate in. That exchange confirmed that there's wide variation in how consistently researchers (and the institutions they work for) reveal their funding sources and in how often or consistently journalists ASK their sources about their funding resources. Science journalism is a field ever in tension between an excitement over the scientific discoveries in question and the more hard-nosed mission to vet the reported results and examine science as a social, political, and commercial activity. Most science journalists are ever balancing interest and enthusiasm with skepticism and critical thinking. They should do so conscientiously, of course; that's their job.

As Brownlee and Lenzer note, it's impossible to know at this point a) how much money some of the people involved actually got from drug companies and b) of course, how much it influenced them. But it's well-establshed that trust in scientific results -- especially in the much-tainted arena of psychiatric drugs -- depends on a transparency in funding that has been sorely lacking. This sort of thing -- undisclosed funding from pharm interest of a show that purports to EXAMINE the controversy over antidepressants and suicide -- can't help matters.

Technorati Tags:
depression, journalism, Lilly, medicine, pharma, Slate, Brownlee, Jeanne Lenzer

Psychiatry Handbook Linked to Drug Industry

From Well, Tara Parker-Hope's health blog at the NY Times:

More than half of the task force members who will oversee the next edition of the American Psychiatric Association’s most important diagnostic handbook have ties to the drug industry, reports a consumer watchdog group.

The Web site for Integrity in Science, a project of the Center for Science in the Public Interest, highlights the link between the drug industry and the all-important psychiatric manual, called the Diagnostic and Statistical Manual of Mental Disorders. The handbook is the most-used guide for diagnosing mental disorders in the United States. The guide has gone through several revisions since it was first published, and the next version will be the D.S.M.-V, to be published in 2012.

The American Psychiatric Association’s Web site has posted the financial disclosure of most of the the 28 task force members who will oversee the revision of the D.S.M.

It’s not the first time the D.S.M. has been linked to the drug industry. Tufts University researchers in 2006 reported that 95 — or 56 percent — of 170 experts who worked on the 1994 edition of the manual had at least one monetary relationship with a drug maker in the years from 1989 to 2004. The percentage was higher — 100 percent in some cases — for experts who worked on sections of the manual devoted to severe mental illnesses, like schizophrenia, the study found.

Salmon Fallout -- and Diver Deaths

I've been remiss in tracking here the farmed salmon issue I wrote about in the April/May Eating Well. Much has transpired; here a few tidbits and updates.

Soon after my feature ran, news broke that the Sacramento king (aka chinook) salmon run -- traditionally fairly robust, and the base of both the California salmon fishing industry and the main supply for many California restaurants -- went completely snuff this year. The California salmon fishery was closed for the first time in 160 years. A stunning blow to the fishing industry and all fans of salmon in general.

This has had some interesting fallout right up the line. The Eater SF blog laments:

The cancellation of salmon season has made the question of farmed/wild salmon a hot topic, and now at least one more local won't be resorting to the Loch Duart alternative: "It will come as no surprise, then, that there is one fish I will not serve at Contigo: farmed salmon. Not even Scotland's eco-friendly Marine Conservation Society-endorsed Loch Duart salmon. My decision isn't based on holier-than-thou food snob bull shit. It comes from my heart. My decision is based on respect for and solidarity with people like Larry Miyamura, hardworking fishermen who depend on the salmon season for the majority of their income. It's a personal choice. It just wouldn't feel right to me to put farmed salmon on my restaurant's menu. Especially not this year."

That quote comes from chef Brett, who blogs at in praise of sardines and is soon to open a new restaurant, Contigo.

And yesterday's news brings report of another problem with the farmed salmon industry, at least in Chile: The death on April 25 of farmed-salmon industry diver Nelson Andrés Bustamente, from the bends, brought to 54 the number of Chilean salmon industry divers who have died since 2005. Crîstån Soto of the local divers union there in Chile told a Patagonia Times reporter that Bustamente died because he had been asked to go deeper than is safe. "Every day we go down further than we're supposed to, Why do we do it? Because if we don't, we'll be out of work." The Patagonia Times story ran no response from industry. The mere count, however -- 54 divers dead in a bit over 3 years -- seems rather damning itself.

Where All That Brain Energy Goes

That our brains account for 20 percent of our calorie use tends to amaze people, as it did me. Now it appears that about a third of that is devoted to brain maintenance rather than electrical signaling. The full dish here:

Link: Why Does the Brain Need So Much Power?: Scientific American.

It is well established that the brain uses more energy than any other human organ, accounting for up to 20 percent of the body's total haul. Until now, most scientists believed that it used the bulk of that energy to fuel electrical impulses that neurons employ to communicate with one another. Turns out, though, that is only part of the story.

A new study in Proceedings of the National Academy of Sciences USA indicates that two thirds of the brain's energy budget is used to help neurons or nerve cells "fire'' or send signals. The remaining third, however, is used for what study co-author Wei Chen, a radiologist at the University of Minnesota Medical School, refers to as "housekeeping," or cell-health maintenance.

Steroids for the Brain? Nature Survey Finds Many Neuro-Pill-Popping Scientists

We've seen our brain on drugs. Here's the dope on brainy people on drugs.

Survey results of 1400 scientists (or Nature readers, anyway) on use of neuroenhancers
Figure from Nature, "Poll results: look who's doping"

With baseball's steroid scandals seemingly behind us now -- or at least considered less newsworthy -- the press has recently turned some of its steroidal attention to neuroenhancement among major league academics. The journal Nature has taken the lead here, publishing a commentary in early March by two Cambridge University researchers who "reported," as a nicely turned New York Times story by Benedict Carey noted, "that about a dozen of their colleagues had admitted to regular use of prescription drugs like Adderall, a stimulant, and Provigil, which promotes wakefulness, to improve their academic performance. The former is approved to treat attention deficit disorder, the latter narcolepsy, and both are considered more effective, and more widely available, than the drugs circulating in dorms a generation ago."

Carey's article (and others, too; see below) is well worth reading.* But the news today is that Nature ran an open, online survey at its web site and found that 20 percent of those responding said they had used neuroenhancers such as Ritalin (an amphetamine used clinically for ADHD) and modafinil (a "wakefulness promoting" narcolepsy drug that has seen wide off-lable use not only for ADHD and depression but for increasing concentration, working memory, and other cognitive assets).

An online survey is hardly scientific, as it's likely to attract respondents with a, um, demonstrated interest in the subject. And this one was likely further warped by press attention that brought outside (i.e., possibly non-scientists) to take it.

That said, the 20 percent figure won't surprise anyone who hangs out at scientific conferences, where use of modafinil is talked of fairly casually. Many of those who use modafinil consider it a healthy substitute for coffee: better effects, fewer side effects, no demonstrated long-term harm. It sharpens attention, adds stamina, increases the power to resist distraction, and creates a smoother energy curve that lacks the jittery buzz that lots of coffee will predictably create. And some find it interferes less with sleep.

So is this bad? That question seems to flummox everyone. On its face, seemingly so: It's a drug, and we don't take drugs just to boost performance. This sits fine until you think about coffee. Is modafinil is simply a better coffee?These questions make it clear we're on a slippery slope. We'll be seeing a lot more handwringing and headscratching on this one.

Some of the more intriguing coverage so far:

The original Nature commentary, "Professor's little helper." (Nature subscription required)

An interesting pro-con discussion among academics at the Chronicle of Higher Education website.

An advice column at Wired about the competitive threat that neuroenhancement poses in the office environment. The answer, unfortunately, completely the cognitive enhancement of the drug in question (modafinil), advising the non-drug-doer to better his modafinilly enhanced coworker-competitor by working smarter rather than longer.

An fake April Fools Day press release from (not really) the NIH announcing "three new initiatives to fight the use of brain enhancing drugs by scientists." This fooled a lot of bloggers.

* The Carey article visits the inevitable comparisons with steroids in baseball. Some quoted in the article argue that academics taking drugs is different than athletes taking drugs because competition in academics in secondary -- an assertion that may strike many as questionable, given the intense competition not only for tenure but for glory and riches once tenure is secured. The most prominent scientists do well indeed. Those that don't make the cut, not so. As one anonymous scientist said of his thrice-daily does of Adderall in the the Times article, "“I’m not talking about being able to work longer hours without sleep (although that helps). I’m talking about being able to take on twice the responsibility, work twice as fast, write more effectively, manage better, be more attentive, devise better and more creative strategies.”

He makes a good point that is often missed: These drugs don't just pep you up; they sharpen and focus the brain, creating a double enhancement.

From Wall Street Journal: Rich, Not Poor, Are Crowding Emergency Rooms

It seems that the rise in ER use comes not from the poor uninsured but from a much more affluent income sector.

From the Wall St. Journal Health Blog:

Rich, Not Poor, Are Crowding Emergency Rooms:

This is the conventional wisdom: Priced out of health insurance, ever more Americans are crowding into emergency rooms because they can’t afford a trip to the doctor.

Yes, ERs are getting busier. But it’s not because of poor people or the uninsured, according to this analysis in the Annals of Emergency Medicine.

The study is based on national surveys conducted between 1996 and 2004. During that time, overall visits to the ER increased by 26% — but a disproportionate share of the growth came from those whose incomes put them at more than four times the poverty level, and who typically get their care at a doctor’s office. The percentage of uninsured ER patients remained flat, at roughly 15%.

The researchers did the study because the conventional wisdom didn’t seem to match the on-the-ground experience of ER docs. Instead, they saw a rise in ER traffic across the demographic spectrum, said Jonathan A. Showstack a study author based UCSF’s Institute for Health Policy Studies.

More at the Wall Street Journal Health Blog

Roundup of notables: The Certainty Epidemic, Dog Head Poetry, et alia

Some great stuff I've come across, lack time to blog on, but would hate for you to miss:

In On being certain, neurologist and novelist Robert Burton, who writes a column at Slate Salon, looks at the science of what makes us feel certain about things -- even when we're dead wrong about them. His book on the subject, which I read in advance copy a while back, is fascinating fun reading. The most startling (and disorienting) finding he describes is that, from a neurocognitive point of view, our feeling of certainty about things we're wrong about is pretty much indistinguishable from our certainty about things we're right about. Not something to think about when you're in the middle of an argument -- or maybe it is, because maybe it's the other guy who's certain but wrong. Hard to know!

Why are drug costs are going up?"Because they can," say the folks at Managed Care Matters

From Cognitive Daily, When we see a brain "light up," [most of] our brains shut off. How we are suckers for brain-scan pictures.

Mind Hacks drew attention to the wonderful poem below by Wislawa Szymborska, which is a reaction to a not-so-wonderful film, from 40s Soviet science, of a decapitated dog head that (supplied with blood) still reacts to many stimuli. Grim film, beautiful poem. Excellent commentary and links at Mind Hacks.

The Experiment
by Wisława Szymborska

As a short subject before the main feature -
in which the actors did their best
to make me cry and even laugh -
we were shown an interesting experiment
involving a head.

The head
a minute earlier was still attached to...
but now it was cut off.
Everyone could see that it didn't have a body.
The tubes dangling from the neck hooked it up to a machine
that kept its blood circulating.
The head
was doing just fine.

Without showing pain or even surprise,
it followed a moving flashlight with its eyes.
It pricked up its ears at the sound of a bell.
Its moist nose could tell
the smell of bacon from odorless oblivion,
and licking its chops with evident relish
it salivated its salute to physiology.

A dog's faithful head,
a dog's friendly head
squinted its eyes when stroked,
convinced that it was still part of a whole
that crooks its back if patted
and wags its tail.

I thought about happiness and was frightened.
For if that's all life is about,
the head
was happy.

We all seem convinced we're right about politics, religion or science these days. What makes us so sure of ourselves?

News

Feb. 29, 2008 | Certainty is everywhere. Fundamentalism is in full bloom. Legions of authorities cloaked in total conviction tell us why we should invade country X, ban "The Adventures of Huckleberry Finn" in schools, eat stewed tomatoes, how much brain damage is necessary to justify a plea of diminished capacity, the precise moment when a sperm and an egg must be treated as a human being, and why the stock market will revert to historical returns. A public change of mind is national news.

My Eating Well Story on Wild Salmon -- and the Times' Story on Lost Wild Salmon

Suddenly it's salmon everywhere -- or in some cases, nowhere.

My story on "The Wild Salmon Debate: A Fresh Look at Whether Eating Farmed Salmon is ... Well ... OK," was published a couple weeks ago in Eating Well. You can see the Eating Well web version here or download a pdf here. The story describes why I came to swear off eating farmed Atlantic salmon because of their impact on wild salmon fisheries, which have enough troubles as it is.

I’m increasingly convinced that the larger issue of farmed versus wild salmon poses a similar choice. The withering array of injuries that salmon farms inflict on wild salmon forces a sort of long-range consumer decision. This is not like deciding whether you want free-range versus conventional chicken for tonight’s dinner; that’s a decision with limited echo. To decide that you may as well eat farmed Atlantic tonight, however, is to decide, in a very real sense, that you may as well eat farmed salmon, and farmed salmon only, forever. That just doesn’t sit well with me. For now, anyway, I’ve eaten my last farmed salmon.

Accompanying the story are some great recipes Eating Well gathered or put together -- delishy dishes like salmon panzanella, grilled salmon tacos, and something highly photogenic called New World Graviax.

This story was, among other things, an attempt to describe not just the salmon's status but a sort of metric -- the "Is it Okay" Algorithm -- by which to sort though the frequently confusing question of what fish are okay to eat. I can't say I came up with a universal metric, but with luck this offers a bit of guidance. The feedback so far has been quite good.

Quite a few readers have written me asking for guidance to the confusing world of salmon - as in, what kind to eat. As I note in the Eating Well article, the answer to that question depends on a formula whose variables will get weighed differently by different people. But for me it sugars to a decision to eat only wild Pacific salmon from Alaskan fisheries. If you want to keep it simple, that works. More, of course, in the article in the links above.

No sooner was that published than came the news that an important run of Chinook salmon -- the Sacramento River run -- seems to have vanished. The Times has an excellent story on that.

Did Antidepressants Depress Japan?

The Kirsch study published a few weeks ago has stirred much discussion of the placebo power of antidepressants (or is it the antidepressant power of placebos?); it's clear that the act of taking a pill that you expect to help you often does help you.

But can the availability of a pill meant for depression make you feel (or think of yourself as) depressed? That's the question behind another part of the drug debate, regarding whether the drug industry encourages us to medicalize ordinary experience.

In pondering these things I ran across this fascinating New York Times >article from 2004, "Did Antidepressants Depress Japan," about the introduction of the concept of depression in Japan beginning in the late 1990s. Before then, the article asserts, Japanese culture concerned itself little with depression outside of professional psychiatry and medicine. But when drug companies started pushing antidepressants beginning in 1999, a cultural awareness of depression grew -- and with it, the number of people who considered themselves depressed.

All arguments about the reality of severe depression aside, this says remarkable things about how cultures define -- and individuals experience (or not) -- a state of ill-being. The story is excerpted below the break, or read the whole thing here.

Drugs in Your Drinking Water

This one's getting a lot of play: There are traceable levels of prescription drugs in many public water supplies.

The Times includes the AP story, which is both long and good. I bumped into it first on the Wall Street Journal Health Blog:

Health Blog : Big Pharma is in the Water Big Pharma is in the Water Posted by Sarah Rubenstein

It's not so expensive to get pharmaceuticals after all: Just drink water.

An investigation by the Associated Press found trace amounts of scads of drugs in drinking-water supplies around the country. For a list of what was found in the watersheds of 28 metro areas, click here. Among the water's offerings were antibiotics, anti-convulsants, mood stabilizers and sex hormones. There were traces of sedatives in water serving the city that never sleeps.

The drugs get in the water via our own waste.

Clive Thompson looked at the ability to trace drugs in water supplies -- a "community urinalysis," as he called it -- in a brief item in the NY Times Magazine's "Ideas" issue.

Do these drugs have any effects? The drug content is pretty low, but as one scientist points out in the Times story, these drugs are meant to have effects at low doses. As the Times story notes in signing off:

''We know we are being exposed to other people's drugs through our drinking water, and that can't be good,'' says Dr. David Carpenter, who directs the Institute for Health and the Environment of the State University of New York at Albany.