Smooth Pebbles

Pebble Collection

A few that rolled away with the tide ...

PsychCentral not impressed with Outliers

Look Who's in the Operating Room

From the Deutches Museum, tractors as core culture

And from Boing Boing, a Studley tool chest. And I was all excited to get my little canvas toolbag yesterday.

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Malcolm Gladwell, Medtronics, Deutsches Museum, Wildlife

The Media Equation - Stoking Fear Everywhere You Look - NYTimes.com

I get a couple media-industry newsletters, which lately have made gruesome reading: The blood is running deep in most media companies, and today came the news that the New York Times, from which I get some of my better freelance assignments, is borrowing against its own brand-new building to meet cash shortages.

The same paper today runs an essay on how constantly rains such bad news these days. My favorite line:

Every modern recession includes a media séance about how horrible things are and how much worse they will be, but there have never been so many ways for the fear to leak in.

Read the whole thing at Stoking Fear Everywhere You Look:

The Moffatt Christmas Tree Farm -- Some Old Friends of Mine

Eva Sollberger of Seven Day has posted a charming video feature about the Christmas tree farm run by Jim and Steve Moffatt, of Craftsbury, Vermont -- a family that occupies a major part of my first book "The Northern Forest," which I wrote with my friend Richard Ober. I spent a lot of time with the Moffatts, some of the finest people I've ever known. This video captures their wonderful combination of humor, intelligence, and virtue.

Short, sweet, and just the thing for the season.

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Jim Moffatt

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Steve Moffatt, Eva Sollberger, Christmas tree farms, Vermont, The Northern Forest, Richard Ober

Pebble collection

A few that keep slipping out of my hands:

It's All in Your Head -- Sally Satel, in the Wall St Journal, on a recent study showing about half of American doctors use placebos in practice. Satel, who wrote an interesting piece NY Times Magazine piece a while back on her search for a kidney donor, also has an interesting piece on a Senate bill designed to allow states to reward organ donors.

PhamaLot on Pharma's Influence on the Media.

On a related note, a Columbia Journalism Review piece on Science Reporting by Press Release

Andrew Sullivan on The AP's Cowardice.

Hospitals Fail to Take Basic Steps to Stop MRSA’s Spread, from the Wall St Journal's Health Blog. MRSA -- the antiobiotic resistant germ -- killed my uncle on October 1. Man had survived being shot down and crashing in Vietnam, but was no match for MRSA.

Boing boing on awareness after decapitation

Mouse bites snake to death. I also watched a video where a wild pig turned tables on a lioness and butted her till she ran away ... but I can't find it now.

I better stop there.

Technorati Tags:
Sally Satel, Big Pharma, Columbia Journalism Review

Musical Audition 2.0: Live, from Carnegie Hall, the YouTube Symphony Orchestra

Beautiful -- YouTube and Carnegie Hall are holding online auditions for the "world's' first collaborative online orchestra":

In short, YouTube is offering a new twist on the familiar formula of how to get to Carnegie Hall: Practice, practice, upload.

From the Washington Post, YouTube Announces Auditions for Its Own Symphony Orchestra

You can even download the score for the audition piece, "Internet Symphony No 1: Eroica."

"TREE," the "photography-act"

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

Technorati Tags:
photography, art, Daily Dish, The World's' Fair

Obama to bring cheaper meds, universal coverage, pharma nightmares?

So says the Wall St. Journal's Health Blog:

Obama Presidency Could Bring Cheaper Medicines, Universal Coverage

Disclosure of interest: I spent about $10,000 this year on health insurance, $6000 out of pocket; owe $1200 to doctors and hospitals; and still haven't gone through my deductible.

The Lightning Rod Makes Time

Last month I drew notice to an Atlantic story about (and an interview with) Michelle Rhee, the Washington, D.C., school chancellor who is aggressively pressing reforms in that district, most notably an effort to replace tenured teacher tracks with a system emphasizing higher salaries but more accountability and merit pay. She's been controversial, to say the least. She'll get only more so now that she's on the cover of this week's Time.

The U.S. spends more per pupil on elementary and high school education than most developed nations. Yet it is behind most of them in the math and science abilities of its children. Young Americans today are less likely than their parents were to finish high school. This is an issue that is warping the nation's economy and security, and the causes are not as mysterious as they seem. The biggest problem with U.S. public schools is ineffective teaching, according to decades of research. And Washington, which spends more money per pupil than the vast majority of large districts, is the problem writ extreme, a laboratory that failure made.

Others have pointed to other factors for our lagging performance, noting, for instance, that kids in other countries spend longer and more days in school; that their curricula are often both more diverse (invariably including foreign languages from early on, something that's absent from many U.S. districts); and that most other countries have more consistent national standards that let them more easily evaluate and use what works best. And in "First, Kill All the School Boards," an article in the January/February 2008 Atlantic ,Matt Miller argued that the dominance in U.S. education of "local control" by local school boards effectively leaves education policy in the hands of much more powerful statewide teachers' unions that resist reform and teacher accountability and dominate everything from curricula to school calendars.

The reformers may emphasize different problems, but they generally circle around to a similar stance: The need to shift power from teachers' unions to school leaders and to empower administrators to enact best practices. Michelle Rhee represents, in a personality hard to ignore, exactly that approach, and she does so in a personality and presence that clearly means business:

ONE DAY IN AUGUST, I SPENT THE MORNING with Rhee as she made surprise visits to Washington public schools. She emerged from her chauffeured black SUV with two BlackBerrys and a cell phone and began walking--fast--toward the front door of the first school. She wore a black pencil skirt, a delicate cream blouse and strappy high heels. When we got inside, she walked into the first classroom she could find and stood to the side, frowning like a specter. When a teacher stopped lecturing to greet her, she motioned for the teacher to continue. Rhee smiled only when students smiled at her first. Within two minutes, she had seen enough, and she stalked out to the next classroom.

ONE DAY IN AUGUST, I SPENT THE MORNING with Rhee as she made surprise visits to Washington public schools. She emerged from her chauffeured black SUV with two BlackBerrys and a cell phone and began walking--fast--toward the front door of the first school. She wore a black pencil skirt, a delicate cream blouse and strappy high heels. When we got inside, she walked into the first classroom she could find and stood to the side, frowning like a specter. When a teacher stopped lecturing to greet her, she motioned for the teacher to continue. Rhee smiled only when students smiled at her first. Within two minutes, she had seen enough, and she stalked out to the next classroom.

You can why she badly scares a lot of teachers (and some parents) and inspires many reformers (and some parents). She has become what the reform debate has long lacked: a national focal point.

Rhee has promised to make Washington the highest-performing urban school district in the nation, a prospect that, if realized, could transform the way schools across the country are run. She is attempting to do this through a relentless focus on finding--and rewarding--strong teachers, purging incompetent ones and weakening the tenure system that keeps bad teachers in the classroom. This fall, Rhee was asked to meet with both presidential campaigns to discuss school reform. In the last debate, each candidate tried to claim her as his own, with Barack Obama calling her a "wonderful new superintendent."

Her appearance on the cover of Time -- and paragraphs like that one -- will only elevate her profile. She may fade away. Or she may take the debate over school reform -- and the so-far inconsequential 25-year-old debate over how to save America's schools -- into a new, more serious phase.

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.