Smooth Pebbles

First wine, now coffee's good for you!

Nothing like that first cup of the day

Personally I am glad to read this:

First came the fine news that red wine may help prevent Alzheimer's. Now a 20-year study (admittedly a bit flabby) of 125.000 health-care in Spain found that drinking 2 or more cups of java a day may help prevent heart disease. I find this a good thing to contemplate as I drink my first cup today.

Catch it in the abstract of the paper by Esther Lopez-Garcia and colleagues in the Annals of Internal Medicine, a news story by Ewen Callaway at NewScientist, or the skeptic's take at Dana Blankenhorn's ZDNet Healthcare blog.

Callaway's story at NewScientist notes that other studies have had other results and declares that study author "Lopez-Garcia and other experts caution that it's too early to act on the study's findings." Too early for a cup of coffee?

NYT Scientist at Work: A Young Surgeon-Pianist Who Performs with a Scalpel

For Claudius Conrad, a 30-year-old surgeon who has played the piano seriously since he was 5, music and medicine are entwined — from the academic realm down to the level of the fine-fingered dexterity required at the piano bench and the operating table.

C.J. Gunther for The New York Times

IN TUNE Dr. Conrad, a pianist and surgeon, says that he works better when he listens to music and that music is helpful to patients.

“If I don’t play for a couple of days,” said Dr. Conrad, a third-year surgical resident at Harvard Medical School who also holds doctorates in stem cell biology and music philosophy, “I cannot feel things as well in surgery. My hands are not as tender with the tissue. They are not as sensitive to the feedback that the tissue gives you.”

Like many surgeons, Dr. Conrad says he works better when he listens to music. And he cites studies, including some of his own, showing that music is helpful to patients as well — bringing relaxation and reducing blood pressure, heart rate, stress hormones, pain and the need for pain medication.

But to the extent that music heals, how does it heal? The physiological pathways responsible have remained obscure, and the search for an underlying mechanism has moved slowly.

Now Dr. Conrad is trying to change that.
Technorati Tags: music, surgery, Mozart, Dobbs, Claudius Conrad

Pebbles I stumbled on this week (notables from the web)

A Chopin Nocturne...

from Derek Bownds' MindBlog by noreply@blogger.com (Deric)

Bownds blogs on neuro matters -- and, each week, posts a video of him playing a bit of classical music on his piano. Gotta like it.

FDA To Mine Big Databases For Safety Problems

from Pharmalot

The effort, called Sentinel Initiative,
will be the first time the FDA will have an opportunity to monitor
almost immediately how drugs are affecting the public. To do so, the
agency will mine databases of more than 20 million patients who receive
their drugs through Medicare. The idea, of course, is to catch side
effects that might otherwise go undetected for months or years.

Also covered at the Wall Street Journal Health Blog

A Musical Aptitude Section Of The Genome?

from Scientific Blogging - Neuroscience

Molecular and statistical genetic studies in 15 Finnish families have shown that there is a substantial genetic component in musical aptitude.

Musical aptitude was determined using three tests: a test for auditory structuring ability (Karma Music test), and the Seashore pitch and time discrimination subtests. The study represents the first systematic molecular genetic study that aims in the identification of candidate genes associated with musical aptitude.

File this under "Interesting if true" -- or what scientists call "needs replication."

As General Surgery Ranks Dwindle, Patients May Suffer

from WSJ.com: Health Blog by Sarah Rubenstein

Sexual Dysfunction On Anti-Depressants Higher Than Thought, Longer Lasting

from Furious Seasons by Philip Dawdy

Thanks to CL Psych who flagged this issue the other day and posted one academic paper acknowledging that not only are there weird problems such as genital anesthesia--such a polite term--connected with anti-depressant use in some cases, but that the rate of sexual dysfunction on the happy pills isn't very happy at all. In fact, it's much higher than doctors have commonly assumed and than pharma companies have been willing to admit.

Dawdy -- a fearless chronicler of others' and his own experience with depression and antidepressants -- notes that he himself experienced no sexual side-effects.

The shifting sands of the 'autism epidemic'

from Mind Hacks by vaughan

The Economist has a short but telling article on whether the so-called 'autism epidemic', occasionally touted in the media, may simply be a change in how developmental problems are diagnosed.

It covers a new study that did something really simple - it tracked down 38 people who, years ago, had been diagnosed with a delay in language and re-assessed them using the latest diagnostic interviews.

An Omnidirectional Treadmill Means One Giant Leap for Virtual Reality

My (very short) story on a new omnidirectional treadmill for spatial cognition research is up at the Wired site:

An Omnidirectional Treadmill Means One Giant Leap for Virtual Reality.

...This April, a team based at the Max Planck Institute for Biological Cybernetics in Tübingen, Germany, unveiled the CyberWalk, an omnidirectional treadmill designed to serve as a VR-capable movement platform. Treadmills have been tried in VR before, of course, but early models were unconvincing — either too small to keep goggled wanderers on the platform or too slow, bouncy, or gap-ridden to feel the least bit real. The CyberWalk solves these problems with a stiff, gapless, 20 x 20-foot floor and movement and feedback systems that enable quick, fluid changes of direction.

We know what you're thinking: Halo! But gamers must wait. For now, access goes to spatial-cognition and perception researchers, who will use the CyberWalk to "explore all sorts of things we haven't been able to explore before," says William Thompson, a University of Utah computer scientist. In addition to studying our brains and understanding space and movement, they'll assess potential for military and disaster-response operations and see if the device can be used to treat medical issues such as Parkinson's.

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

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.

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.

NPR: Radio Lab: Into the Brain of a Liar

There's been a lot of attention the last couple years to the possibility of brain-based lie detector tests -- most of it premature. That coverage, I see now, has overlooked (as did I!) a 2005 study that showed compulsive liars are wired differently -- in an unexpected way -- than the rest of us. NPR's Radio Lab covered it this morning. You can get both the text and the audio at NPR: Radio Lab: Into the Brain of a Liar.

Here's the opening:

Morning Edition, March 6, 2008 ·

We all lie — once a day or so, according to most studies. But usually we tell little lies, like "your new haircut looks great!" And most of us can control when we lie or what we lie about. But some people lie repeatedly and compulsively, about things both big and small.In 2005, a study published in The British Journal of Psychiatry provided the first evidence of structural differences in the brains of people with a history of persistent lying. The study was led by Yaling Yang, a doctoral student in psychology at the University of Southern California, and Adrian Raine, an expert on antisocial disorders who is now at University of Pennsylvania.They expected to see some kind of deficit in the brains of these liars, Yang says. But surprisingly, the liars in their study actually had a surplus — specifically, they had more connections in the part of their brains responsible for complex thinking.

The compulsive liars had, in fact, 22-26% more white matter in their prefrontal cortex than did normal controls. The study's author is quoted as saying that allows them (or responds to a need) to "jump from one idea to another and ... come up with more random stories and ideas." I would wonder if the extra-robust prefrontal cortex (the 'thinking' part of our brain, and also a part crucial to negotiating the social world) is needed to run the complex calculations about others' receptions of his lies that a liar needs to do in order to fib successfully.

Hat tip to Jonah Lehrer at Frontal Cortex for spotting this first.

Tags: neuroscience, fmri, lying, Adriane_Raine

Slippery Ground: SSRI-Study Fallout Spreads

photo © iStockPhoto/AnikaSalsera

The ripples from the PLOS Medicine antidepressants-don't-work study by Kirsch et alia, which I covered below, just keep spreading. Those who want to follow it can do well by visiting or bookmarking this search I did (an ingenious Google News search for "Kirsch SSRI"). It seems to be tracking the press coverage pretty well. Note that the heavier and higher-profile coverage comes mainly from UK. As far as I can tell, none of the top 3 or 4 US papers have yet covered it.

This blog search should help as well.

Some of the more notable responses since yesterday:

Science weighs in. The Times Online (UK), with a hat top to SSRI as antidepressant, opines that "If it's all in the mind, fine."

The searches above will find more.

As many have noted, that antidepressants barely best placebo is not big big news; other studies have found that the drugs barely best placebo. But the starkness of Kirsch's "no effect" finding -- and the paper's assertion that there seems no reason to prescribe except for the deeply, dangerously depressed -- seems to have sparked a deeper examination of this issue than previous studies have. The anguish you see in many posts and comments, especially by doctors and depression sufferers, is that of an entire discipline and patient base having to confront the profound ambivalence of the data and the plain wierdness of the way in which psychiatric drugs work. Many drugs depend heavily on a placebo effect, of course. But the mind-body mystery raised by placebo effects in antidepressants presses itself more insistently, since "the body" doesn't seem so much in play.

This is slippery territory; not surprising that many are having trouble finding their footing.

Drug Bust Paper Blowback: Responses and implications to the Kirsch antidepressant study

The Kirsch study I wrote about a couple days ago, which found that antidepressants seem to have no more effect than placebo, has generated a wide variety of reactions in the blogosphere and press. Several things of note here:

1) In a pattern I've noticed repeatedly of late about other types of stories about things in the U.S., this story got much more attention in the British press than it did here in the U.S. (The authors were from the UK, but the paper was published in a U.S.-based journal, and antidepressant use is a huge issue in the U.S.)

2) The responses -- some by bloggers, writers, and other critics, some by doctors -- are a fascinating mix of hard-line rhetoric (from both sides) and more nuanced points about the difficulties of drawing definite conclusions from meta-analyses that are by their nature heavily statistical. Pointers to a few are below. Most intriguing is the exchange on the the PLOS Medicine site itself (where the paper was published), which involves mainly doctors. My thoughts on that are at bottom, below a far-from-complete annotated list of responses here and there

My thoughts on that are at bottom, below this shorter list of worthwhile responses:

Ben Goldacre, who writes the column "Bad Science" for the UK's Guardian, points out some of the more troubling implications of this study.

The Washington Post's Kevin Drum drew brief notice to it. His post is notable mainly for the lively and long string of reader comments it produced -- an exchange that suggests reader interest in the U.S. is perhaps more intense than editorial interest.

The journalist/blogger James Hrynshyn, of North Carolina, wrote a thoughtful post on his blog at Seed, as did Jonah Lehrer at his Seed blog The Frontal Cortex.

The Socratic Gadfly takes a shot at some of the study's limitations.

PsyBlog takes a measured, educational approach.

Among posts noting the study's limitations, the most damning I came across is perhaps that of Henry Gee, an editor at Nature. Gee is one of several writers who point out that a major caveat of this study is that it is limited to patients taking the drugs over only about 8 weeks or less, thus missing anyone who would have benefited from taking the drug for a longer period. He finds this completely damning:

This will affect the conclusions of the study, as every doctor (and patient) knows, antidepressants are drugs for the long haul. It takes weeks for them to have much effect, and this study seems to have had a cutoff before any such effect could be manifested. The results of this study are therefore compromised, and people who have been distressed by it have, I think, been misled....

So, shame on PLoS Medicine for touting what looks like a sensationalist story that grabs headlines on the distress of others; and shame (as usual) on the hog-whimperingly low standards of science news editing and reporting that have failed to pick up on this important flaw.

I think Gee goes too far. SSRIs do sometimes take weeks to kick in; but in most cases, they kick in inside of 8 weeks -- and some users get an initial lift then that then fades. So this time limit (created primarily by the drug companies who nevertheless repeatedly claimed to find high benefit during that period) strikes me as one of several limitations on the study rather than a fatal flaw. And the criticism ignores the fact that the drug companies repeatedly claimed to find a significant therapeutic effect inside that 6- to 8-week window. I'm not sure why we're supposed to accept on one hand that the drugs have proven themselves effective within an 8-week window ... but reject a study that finds they were not effective in that window because the drugs supposedly aren't effective till later. If they're not effective till later, how did the drug companies ever find an effect inside of 6 or 8 weeks? Strange logical territory.

As Gee notes, however, quite a few people, many of them doctors, lodged similar critiques at the PLOS Medicine "responses" site, as well as other objections more substantive. This is the juiciest reading on the paper I've found -- well worth perusing to get a sense of the debate and an education in the problems with meta-analyses, especially as applied to placebo effects. It's a serious debate even among doctors.

One doctor, for instance, says the study is a needed wake-up call to doctors who have been essentially falling for a placebo effect themselves; another doctor argues that "dozens of clinicals trials plus decades of clinical practice plus millions of content patients can't be that wrong. Whatever the bias in whatever the study, common sense clearly says: the sum of the parts attesting antidepressants efficacy blatantly outnumbers the evidence showing the opposite. The use of these antidepressants is now deeply rooted and well-established in medical society worldwide, it's safe, it works, and there's no shadow of doubt about it. Instead, this study insists in a different truth."

Overall, the discussion among doctors on the PLOS Medicine Responses page is The meta-analysis is a strange animal, in some ways more reliable than individual studies, since it looks at many; but problemmatic for the same reason, because it has to use some sometimes sophisticated (even obscure) statistical methods to extract (hopefully) reliable, consistent information from studies that may differ in structure and method.

How this all sugars out (no pun intended), I'm not quite sure myself. Two paradoxes jump to my mind, however. One is that the drug companies, with nods from the FDA, dug much of this hole themselves by structuring studies and often filtering results in ways designed to highlight advantages and minimize disadvantages. The short timespan of these studies is an example: When psych drugs work, they generally work their best early on, and the 6- or 8-week drug trial took advantage of that. That's just one way in which the drug companies created a clinical trial system that pretty much begs for harsh criticism; it worked for a while, but now it has cast the industry's credibility into question, making it extremely difficult to ferret out what really works and what does not.

The other paradox, even more painful, is that many, many people, both clinicians and patients, have found these drugs genuinely helpful. In a highly limited but important sense, whether these drugs help through biological mechanisms or through placebo effect is almost a moot point for those they help: They've given quite a few people the buoyancy to float atop life again instead of getting tugged under. The question I tried to raise in my earlier post remains: If these drugs lack a genuine biological effect (or if they have that effect only for a very few) but work well as placebos, how the heck do we replace them?

*update later 2/28/08: Another interesting thread of comments from doctors is this one at the Herald (the one from the UK).