Smooth Pebbles

Measles Cases Grow in Number, and Officials Blame Parents’ Fear of Autism - NYTimes.com

When I called out a Scientific American post yesterday about a rise in measles cases because of unvaccinated children, I forgot to include a link to a longer story on the same issue that ran in the NY Times. It's short, but worth a look as well:

Measles Cases Grow in Number, and Officials Blame Parents’ Fear of Autism - NYTimes.com

More people had measles infections in the first seven months of this year than during any comparable period since 1996, and public health officials blamed growing numbers of parents who refuse to vaccinate their children.

Many of these parents say they believe vaccines cause autism, even though multiple studies have found no reputable evidence to support such a claim. In Britain, Switzerland, Israel and Italy, measles outbreaks have soared, sickening thousands and causing at least two deaths.

Tags: measles, autism, epidemiology, vaccination, public health

Removing the Stone of Madness: Biophemera considers a Renaissance psychosurgical mystery

Surgeon, attributed to Jan Sanders van Hemessen, c. 1550. Museo del Prado, Madrid

Over at Biophemera, a ScienceBlog I've somehow overlooked to date, biologist and artist Jessica Palmer ponders a question raised by a number of Renaissance paintings depicting surgeons removing "stones of madness" from patients's skulls: Did surgeons (or quacks) sham these operations?

It's a juicy and provocative consideration, well worth a look both for the article and the several paintings shown there.

Hemessen, Huys, and Bruegel all depict the same procedure: the removal of stones from the heads of restrained patients, in the presence of nurses or assistants and other onlookers. In many ways, they appear similar to other pieces of the realistic medical genre. Yet these operations, if they were actually performed, clearly had to be shams - playacting in which the surgeon pretended to remove a pebble from the skull, in deference to the "stone of madness" superstition.Could charlatan "surgeons" have fleeced desperate families by purporting to remove a palmed stone from an impressively bloody scalp wound? Could well-intentioned practitioners have done this as a placebo, to convince despairing patients that they had been "cured"? The scenarios seem plausible. Medical quackery was common in the sixteenth and seventeeth centuries, as doucmented in paintings, books, and edicts of the time. However, there is no historical evidence to suggest that stone extractions were actually conducted in late-medieval or Renaissance Europe, much less a widespread medical scam.  Schupbach (1978) suggests that extractions were theatrical performances, farces or tableaux associated with processions and celebrations, and that these paintings were never meant as documentation of real procedures. In any case, medical historians and art historians have disputed whether the sham operations depicted in the "stone of madness" paintings reflect real events, or are allegorical.

Link to Bioephemera post 'The Stone of Madness'.
Link to TINS article 'Psychosurgery in Renaissance art'.

Hat tip (yet another!) to Vaughn at Mind Hacks.

Tags: psychiatry, psychosurgery, Renaissance, art, madness, psychosis

Measles is back, and it's because your kids aren't vaccinated: Scientific American Blog

This one's causing a dust-up over at the Scientific American's "60-Second Science" blog

Measles is back, and it's because your kids aren't vaccinated
David Biello

If you didn't vaccinate your kids, you too could find yourself partly responsible for the resurgence of a disease thought eliminated in 2000.

Measles—a highly contagious disease-causing virus—is making a comeback in the U.S., thanks to parents fears over vaccines. Fifteen children under 20, including four babies, have been hospitalized and 131 sickened by the red splotches since the beginning of this year in 15 states and the District of Columbia, according to the U.S. Centers for Disease Control.

The CDC had announced in 2000 that the disease was eliminated in the U.S. thanks to a vaccine that can completely control it. But fears of autism have led some parents to forego this treatment and at least 63 of the sickened children were unvaccinated.

Peditrician Pauline Filipek of the University of California, Irvine told ScientificAmerican.com this spring that parents who don't vaccinate their kids are putting the tykes at risk of long-forgotten diseases, like measles. What they're not doing: preventing autism.

"Many, if not most, of the younger siblings [of autistic children] never have any vaccinations," says Filipek, who believes that autism is not caused by vaccines. "And they are as autistic as the day is long."

Catch more at:

Measles is back, and it's because your kids aren't vaccinated: Scientific American Blog

Tags: measles, vaccines, autism, health, epidemiology, Scientific American

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 [email protected] (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.

A Fine Flap Over Pharma Influence on Medical Reporting

A couple weeks ago Slate ran a piece asking "Are doctors shilling for drug companies on public radio?", which I took brief note of in a previous post.

Now I've written up a longer reaction (actually a reaction to the reaction to the Slate story) for Columbia Journalism Review's "Observatory" blog, which covers science journalism. The gist:

If journalists ... 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. But 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.

As expected, this generated some blowback from people less worried than I about the trust problems created by failure to disclose potential conflicts of interest in experts quoted in medical stories. I expected, for instance, to be accused of trying to end all links between doctors and drug and device developers or to shush doctors with such ties from public discussion, and I was, at least indirectly. Yet as I noted in the comments column:

I am not proposing that doctors or researchers with financial ties to industry be excluded from press stories or public discussion of medicine. That would be destructive. I am arguing that the relevant financial ties of quoted experts should be disclosed so that the public can consider those in considering their positions. Butterworth appears averse to this idea. But it's one that the leading medical journals have embraced, and it seems to have raised rather than eroded faith in the studies published in those journals.

The issue of industry influence on medical opinion is a rich one; may this little squabble shine a bit of light on it. Check it out at "To Disclose or Not to Disclose."

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

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.

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.