Smooth Pebbles

"TREE," the "photography-act"

via Daily Dish, with yet more at The World's Fair

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Jerome Kagan on The Meaning of Psychological Abnormality

Jerome Kagan, a highly prominent developmental psychologist, weighs in the Dana Foundation's Cerebrum on the roots of the skyrocketing rates of diagnosis of childhood bipolar disorder, autism, and ADHD. "[it] is important ... to ask," he writes

whether this troubling [increase] reflects a true rise in mental illness or is the result of changes in the definition of childhood psychiatric disorders. The latter explanation is likely because the concept of psychopathology is ambiguous, and physicians have considerable latitude when they classify a child as mentally ill. Because a diagnosis of ADHD, bipolar disorder, or autism allows parents to obtain special educational and therapeutic resources that would not be forthcoming if the child is called mentally retarded, incorrigible, or uninterested in academic progress, doctors are motivated to please the distraught parents who want to help their child.

As Kagan notes, a disorder is often declared mainly because the child is disorderly, rather than really sick. If the parents think the child needs help, the doctor usually goes along - and the solution is far more often pharmacological than family-based. This comes into play most seriously in the accelerating diagnosis of bipolar disorder in children in the U.S.

Equally serious, if not more so, is the dramatic rise (more than 40 percent in the past decade) in diagnoses of bipolar disorder in young children, based on parental complaints of chronic levels of extreme disobedience, impulsive bursts of aggression, and an inability to control emotion. These symptoms can in part be the product of permissive socialization practices by parents who are reluctant to induce anxiety or guilt in children placed in surrogate care because both parents are working. Most children classified as bipolar do not display the cycles of manic excitement and depression that define this disease in adults. Thus it is a diagnostic error to call children who cannot regulate their moods “bipolar” simply because they seem to have a single feature in common with the adult disorder: uncontrolled behavior. I do not believe that psychiatrists have detected a new childhood disorder; they have used a new term for a serious rise in poor regulation of emotion that is probably a result of experiential rather than genetic factors.

The setting aside of family issues in favor of focusing on genetic "causes" and pharmacological solutions gets overlooked in most of the writing -- both academic and mainstream media -- about pediatric bipolar disorder. Why don't doctors more often focus on the family and home environment? A slew of reasons -- little time, the desire for a quick fix, the awkwardness of bringing up the issue of family dysfunction and the difficulty of treating it or of getting the family to sign on to a solution that requires them to change behavior rather than just medicate the child.

At a panel about pediatric BPD at the first Neuroethics Society conference earlier this month, Hastings Center bioethicist Josephine Johnston suggested a major reason family issues aren't brought up is the "schizophrenogenic phantom" -- the memory that in the 1970s, schizophrenia, which usually shows itself in late adolescence, was blamed on harsh or cool upbringing by the patient's mother: the "blame the mom" etiology. Was quite a backlash against this when heavy genetic components were found underlying schizophrenia -- a backlash, Johnston suggested, that now keeps the touchy subject of family dysfunction off the table when parents bring deeply troubled or disruptive to doctors seeking help.

Kagan doesn't touch on this, but he covers much else. It's well worth reading the entire article -- and worth a peek at Vaughn's commentary on this piece at Mind Hacks, which gets the hat tip on this one.

The Dana Foundation - The Meaning of Psychological Abnormality:

Psych Problem #2: Cooking the Books

Lisa Bero

Critics of the FDA drug-trial process have often complained that the drug companies are free to publish only the trials that are flattering to their cause (that is, only those that show effects above placebo and relatively low side-effects). As explained in Wired Science, UC San Francisco health policy expert and Cochrane Collaboration co-director Lisa Bero has been picking this process apart:

The difference between what drug companies tell the government and doctors suggests that they're cooking the books, which could mislead doctors making prescriptions.

Of 33 new drugs approved by the Food and Drug Administration in 2001 and 2002, one-fifth of supporting clinical trials were not published in medical journals, according to a new study. And those results that were published were often more positive than what companies presented to the FDA in their applications. As a result, potentially unreliable data is being used to promote drugs on which billions of dollars and thousands of lives may ride.

"Some studies aren't published at all. Then, when they are, there are little changes that make the papers look more favorable towards the product," [said Bero].

Among the things Bero found:

Among the differences between results submitted to medical journals and to the FDA were trials that didn't favor a company's product, Bero found. Only half of 43 such outcomes were reported in the literature. More subtly, but just as importantly, key pieces of trial data vanished.

"The main thing that jumped out at me was the addition and deletion of primary outcomes. Those are the most important outcomes of a trial. To find that one disappeared from a paper, or just appeared in a paper, is pretty amazing to me," said Bero.

How to fix this? The FDA does things this way partly because the drugs companies are paying for the studies, and so get to control them. But there is a healthier model:

Bero calls for the FDA to be overhauled to run clinical studies itself, as is done by comparable agencies in Italy and Spain.

"The Italian FDA collects money from every drug company that sells drugs in Italy, pools that, and funds drug trials. They fund the sort of head-to-head drug comparisons that companies don't like to fund. And they have independent people peer-reviewing the trials. It's a great model," she said.

Bero's study is at PLOS Medicine.

It Gets Worse: Harvard Research Center Tied to Drug Company

More wheels coming off the bus.

Research Center Tied to Drug Company - NYTimes.com:

By GARDINER HARRIS
Published: November 24, 2008

When a Congressional investigation revealed in June that Dr. Joseph Biederman, a world-renowned child psychiatrist, had earned far more money from drug makers than he had reported to his university, he said that his interests were "solely in the advancement of medical treatment through rigorous and objective study."

But e-mail messages and internal documents from Johnson & Johnson made public in a court filing reveal that Dr. Biederman pushed the company to finance a research center at Massachusetts General Hospital, in Boston, with a goal to "move forward the commercial goals of J.& J." The documents also show that the company prepared a draft summary of a study that Dr. Biederman, of Harvard, was said to have written.

Who's Driving the Psych Bus? [was 'Psychiatry at a crossroads']

Sen. Charles Grassley, R-Iowa

As the Times reported Friday, Senator Charles Grassley's pharma-money sweep has taken down another huge player in psychiatry: Grassley revealed that Fred Goodwin, a former NIH director who has long hosted the award-winning NPR radio show "The Infinite Mind," which frequently examined controversies about psychopharmacology, had taken in over $1.3 million consulting and speaking fees from Big Pharma between 2000 and 2007 and failed to report that income to the show's listeners and, apparently, to its producers. (For rundowns on this, see Furious Seasons, Huffington Post, WSJ's Health Blog, PsychCentraol, and PharmaLot

The expansion of Grassley's investigation into journalism throws a new kind of light on the lines through which Big Pharma seeks to shape opinion about powerful psychopharmaceuticals. And the mounting body count from Grassley's campaign -- and the fear in psych departments across the country -- adds to the sense that psychiatry stands near some sort of crisis point.

A Bit o' Background

Goodwin's reported $1.3 million in pharma income is an iceberg the tip of which was exposed in May in a Slate article by Shannon Brownlee and Jeanne Lenzer; I wrote about that article -- and about the counterattack it produced from Pharma and Infinite Mind producer Bill Lichtenstein - in an article at Columbia Journalism Review's science blog. As I noted then, Lichtenstein's counterattack, which seemed to treat failure to disclose conflicts as a hassle that is optional, ignored that drug-industry-related conflicts of interest in psychiatry have have become so big a problem that they are central and relevant to any discussion of any psychiatric disorder.

If journalists like Lichtenstein want the information they present to the public to be taken as credible, they need to err on the side of transparency, presenting not only the voices, but also the relevant financial interests of the experts they feature. Failing to do so only damages message and messenger alike. In the wake of the repeated scandals about drug-company concealment of drug-trial data, it’s strange that I have to spell this out.

Not Getting It

This same tone deafness saturated Goodwin's reported response to Grassley's revelations. If the Times quoted Goodwin accurately, he argued that he suffered no conflict of interest because the various payments from different drug companies "cancelled each other out" -- as if the only concern was whether a particular company, rather than an entire industry, might win his favor.

Copernicus corpse confirmed

Computerized reconstruction, via BBC

from Nature's The Great Beyond:

Copernicus corpse confirmed - November 21, 2008

A skull from Frombork cathedral in Poland has been identified as that of revolutionary astronomer Copernicus.

Marie Allen, of Uppsala University, says DNA from the skull is a match for DNA from hairs found in books owned by Copernicus, whose book De revolutionibus orbium coelestium started the movement to viewing the sun -- rather than the Earth -- as the centre of the solar system.

"The two strands of hair found in the book have the same genome sequence as the tooth from the skull and a bone from Frombork," she says (AFP).

Polish police have used the skull to create a reconstruction of how its owner might have looked. This, says AFP, "bears a striking resemblance to portraits of the young Copernicus."

More via the BBC and the Guardian

Carlat: How Drug Companies Hid Millions in Physician Payments in Vermont

This one hits close to home, as I live in Vermont. As Daniel Carlat notes, Vermont is one of the few states to actually require drug companies to disclose drug-company payments to MDs, but the state allowed exception for payments related to 'trade secrets.' The companies apparently made the most of this.

The Carlat Psychiatry Blog: How Drug Companies Hid Millions in Physician Payments in Vermont:

Vermont is one of a handful of states that requires drug companies to disclose their payments to physicians. But the law contains a loophole as big as the Ritz%u2014companies are allowed to withhold information on payments that they consider %u201Ctrade secrets.%u201D

Ever since the Vermont law was passed, many have wondered what on earth these %u201Ctrade secrets%u201D might be. A research letter published in this week%u2019s edition of JAMA (Journal of the American Medical Association) finally provides the answer.

The non-profit group Public Citizen sued to obtain information on the trade secret payments, and here it is. During the two year period from the summer of 2002 to the summer of 2004, drug companies made 21,409 payments, primarily to doctors, totaling $4.90 million. 42.9% of these payments, totaling $2.72 million were labeled %u201Ctrade secrets.%u201D

The researchers, led by Dr. Joseph Ross at Mt. Sinai School of Medicine in New York, focused their analysis on those payments to physicians of more than $100 (the Vermont law requires disclosure of all payments of at least $25). There were 4743 payments that exceeded $100, totaling $3.2 million. 49% of these larger payments were trade secrets. The median trade secret payment was $500 per doctor, far greater than the median non%u2013trade-secret%u2013designated payment of $177.

What kinds of payments were considered trade secrets? One would assume these would be for consulting arrangements in which doctors give advice about secret new products in the pipeline. But %u201Cconsulting%u201D constituted only 8.2% of trade secret payments.

By far the majority of trade secret payments were for promotional speaking (43.2%) and for %u201Ceducational%u201D activities%u2014presumably CME (41.7%). Most such gigs are well-publicized by mailings to doctors' offices, and they are typically for products that are already FDA-approved.

Calling promotional speeches and CME events %u201Ctrade secrets%u201D is Orwellian double-speak at its finest. Luckily, the Physician Payment Sunshine Act, likely to be passed by Congress in the coming year, does away with this loophole.

Words & Music from a Pioneer of Fear, Joe LeDoux

For those in or near NYC, a notable event: Fear researcher Joseph LeDoux, whom I profiled a while back in Scientific American Mind, will lecture about fear -- and then, fearlessly, play with his R&R band, 'The Amygdaloids.' (The amygdala is the brain's fear center.)

I can't make it, much to my chagrin, but having met LeDoux -- who is highly enjoyable company and has done Nobel-Prize-level work defining fear's neuralogical pathways -- I know this will be a highly fascinating, fun, and funny evening.

at the NY Academy of Sciences
7 World Trade Center
(250 Greenwich St @ Barclay), 40th floor
Map & directions

More info (including registration, recommended) at the NYAS announcement.

Joe LeDoux speaks and plays live with his band, The Amygdaloids!

November 11, 2008
7:00 - 8:30 pm

In the world today it can often seem like there is much to fear, making it more important than ever that we understand how that fear makes us feel. Renowned NYU neuroscience researcher Joseph LeDoux presents his latest research about the mysteries of emotions and the workings of the brain, with a particular focus on how the brain reacts to fear.

To demonstrate some different points about the brain and emotion, LeDoux will then also play live with his band, The Amygdaloids. The groups is made up of scientists and musicians, including environmental biologist Tyler Volk, to perform songs about love and life inspired by the lab. You can hear samples of their music on our Facebook page in the music area.

LeDoux is a University Professor and Henry and Lucy Moses Professor of Science, and a member of the Center for Neural Science and Department of Psychology at NYU. His work is focused on the brain mechanisms of emotion and memory. Read the recent article on LeDoux's work from Scientific American.

Reception and book signing to follow.

Blackboard scribblings from Einstein & others

From "Bye-bye blackboard ... from Einstein and others," an exhibit at the Museum of the HIstory of Science in Oxford.

‘I wrote the music on this blackboard while I was giving a lecture about Bach’s Goldberg Variations at the Holywell Music Room on 22nd March this year, before performing them. I was trying to make a connection between Bach’s super-sensitivity to the contemporary styles around him – very very acute in this piece – and today’s musicians. There’s a lot of information in the Goldbergs – structure, harmony, a ladder of canons – and coded information we can only guess at – myths, cosmological allegories, and a soulful journey. It all starts with the bass line.’

Joanna MacGregor
Pianist

Unfortunately, MacGregor, who is a sort of Brian Eno of the British classical scene (indeed; she has collaborated with him), has not recorded the Goldberg Variations -- though she does have a nice recording of Bach's French Suites.

The blackboard exhibit is definitely worth a visit, as is the larger Museum of the History of Science website, which I hope to revisit here (and visit in person as well).

Chimpanzee hunting tactics - an aerial view

The good folks at Neuroanthropology drew my attention to a pair of videos showing how chimpanzees work together to corral, kill, and then eat colubus monkeys. Amazing stuff.

The embedded video below shows a hunt from the rather chaotic point of view of cameramen chasing the chase at jungle-floor level. Impressive enough in itself:

Even more riveting, however, is the second video, which can't be embedded but which can be seen on YouTube. It mixes from-the-ground footage with aerial shots taken with infrared cameras to show how a team of five chimps -- a driver, three blockers, and an ambusher -- work to funnel the colobus monkeys into the arms of the ambusher. The driver climbs into the treetops and sets the colubus into motion. The blockers on the ground, outracing the tree-swinging colubus, move in front of them and then climb to create a sort of gate through which they'll corral the prey. The ambusher climbs to a spot beyond this gate. The trap works: One of the colobus flees right into the ambusher's tree, and soon becomes a meal.

This is more than a little unsettling to watch: It looks remarkably like a scene from Patriot Games, the Harrison Ford movie, in which CIA agents in Washington, D.C., watch a live satellite infrared feed of U.S. commandos executing a lethal nighttime raid on a purported terrorist came -- a scene in which we watch the D.C.CIA team becoming uncomfortable at the silent savagery they're witnessing -- and ordered -- from a world away.

And so, watching this, we feel a bit complicit as well -- at once impressed and horrified. Well we might. As the narrator in the embedded video notes, these hunts, though disturbing, may be the evolutionary forerunner of the kind of coordinated teamwork that has allowed humankind to accomplish so much -- not just higher scales of coordinated lethality, but agriculture, government, cave art, orchestra music, you name it.

There's a history-of-science aspect to this too: I find it interesting to see the emphasis on the social/evolutionary aspect of this hunting. This reflects not just changes in the scientific view of such behavior but changes in the larger zeitgeist since Jane Goodall began reporting more heart-warming chimp behavior in the early 1960s. When chimpanzee hunting was first discovered in the 1970s -- a far less idealistic time than the early 1960s, a time when the U.S. in particular was in turmoil over its involvement in Vietnam -- the most prevalent public reaction was horror, and the most prominent debate even in the scientific community was whether chimp hunting meant that humans, being close cousins to chimps, were not inherently gentle beasts but savages inclined to organized violence.

Since then, though, ethology and primatology has increasingly focused on how primates show sophisticated social behavior -- the social brain theory and so on -- which in turn has steered the interpretation of hunting away from issues of savagery and toward this stress on social cooperation. Meanwhile the larger American culture, seems to me, has moved from a highly moralistic view of military action -- one in which the soldiers were blamed for the war in Vietnam, for instance -- to one that is at least implicitly more cognizant of our misadventure in Iraq as a expression of social dynamics we're all part of. We aren't as eager to see people as either savage or pacific; we're more ready to see them as part of a social organism.

Does the culture drive the science or the science the culture? I've gotta think the answer is Both.

Hat tip to the excellent Neuroanthropology, which features some good references to both scientific and pop literature on chimp hunting and its implications.