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Introducing ADHD In Focus

Fri, 12 Mar 2010 00:00:00 +0100

Attention deficit disorder is a serious mental health issue that affects the lives not only of children and teens, but millions of adults as well. So we’re pleased to announce the launch of our latest blog, ADHD In Focus, that will focus on topics in attention deficit disorder (ADHD).

ADHD In Focus is hosted by Kathryn Goetzke. Kathryn is the driving force behind the non-profit organization for depression called iFred (the International Foundation for Research and Education on Depression). iFred is dedicated to encouraging research on depression and reducing the stigma associated with the disease.

In addition to her incredible work on iFred, Kathryn is someone who actually battles attention deficit disorder, hence the reason she agreed to write for this blog. I’m proud to welcome her to the Psych Central family, as I expect that the sharing of her experiences here will help us all better understand not only what ADHD is about, but also strategies one can use to help combat it in everyday life.

Check out the new blog today: ADHD In Focus

7 Depression Busters for Caregivers

Fri, 12 Mar 2010 00:00:00 +0100

Nearly one-third of people caring for terminally ill loved ones suffer from depression according to research from Yale University. About one in four family caregivers meet the clinical criteria of anxiety. And a recent study found that 41 percent of former caregivers of a spouse with Alzheimer’s disease or another form of dementia experienced mild to severe depression up to three years after their spouse had died.

Caregivers are so vulnerable to depression because they often sacrifice their own needs while tending to their loved one and because of the constant stress involved. Here, then, are 12 tips to help protect you from anxiety and depression and to guide you toward good mental health as you care for a relative.

1. Acknowledge it.

If you haven’t already, say this out loud: “This sucks.” Call a spade a spade. Granted, you don’t want to ruminate on negative thoughts for too long. But suppressing your emotions–forcing that positive cap on each and every thought–can actually do more harm than good. For example, a recent study in the journal Psychological Science reported that people with low self-esteem who told themselves positive statements (“I’m good enough, I’m smart enough, Gosh darn it, people like me!”) actually ended up grumpier and with less self-esteem than before they started. What does this mean? Sometimes the best thing that we can do for our mental health is to be honest. And if you’re a caretaker, that means acknowledging that your situation, well, simply sucks.

2. Educate yourself.

Relieve some of your stress by reading up on your loved one’s condition. I say that because if you’re like me, you’re probably scared. You don’t know what’s coming down the pike. You detest surprises, and ever since your loved one fell ill, your life has been full of these shockers.

There’s no way of eliminating all the surprises, of course, but if you understand the illness(es) of the person you’re nursing, then you can better predict his behavior, and can prepare yourself for what may happen in a month or in a year. You might also consider attending a caregiver training program. A recent study showed significant improvement in the quality of life of caregivers who received training. Finally, two books I recommend are The Caregiver Handbook: Powerful Tools for Caregiving and Caregiving: The Spiritual Journey of Love, Loss, and Renewal.

3. Grab your own oxygen mask.

It always goes back to the ten-second spiel you get right before your plane takes off (or crashes). “In the event of an emergency, an oxygen mask will drop from the compartment above you. Please fasten your own mask before assisting others.” Or, on Southwest airlines, they say, “Now would be a good time to choose your favorite kid.”

Taking caring of your own needs is really as important as grabbing your oxygen mask first because you’ll be running out of breath early in the inning if you hold off on breathing until everyone is well. A study published in the Journal of the American Medical Association found that stressed-out older caretakers tending to a sick spouse had a 63 percent risk of death compared to the non-stressed-out caregivers or to lucky folks who don’t have to fetch anyone a glass of water all day long.

4. Schedule a break.

Give yourself a break every day. That DOES NOT mean that you go about your day and grab whatever free 15 minutes you can get–before the meatloaf is done or the jello is solid–at which time you sit down to read some depressing headlines in the paper, hoping for no interruptions. That DOES mean scheduling one half-hour every day at the same time of day that you can, guilt-free, put out your “Off Duty” sign, and during that break no one is allowed to bother you with requests. By taking the same half-hour every day, you have a better shot at convincing your ill loved one that you really are serious about needing some time to yourself.

5. Label your guilt.

I’m not going to tell you to get rid of your guilt. Get real, I’m Catholic! But I am going to advise you to label your guilt as helpful or unhelpful, because I bet you think you’re supposed to own all of it. The negative intrusive thoughts that tell you that you are a loser for not doing more for your loved one? Bye-bye. The voice that says you could be managing all of this mayhem a tad more effectively? Try to tease out some specific suggestions. They might help you come up with ways to better delegate responsibilities or to clean up messes without using so many cuss words.

6. Get organized.

If caregiving is anything like parenting–and I think it is, except for the fact that kids eventually grow up (a truth that I cling to in moments of desperation)–a small bit of organization can go a long way.

My June Cleaver role became a tad easier when I implemented some simple household rules like: no TV before 5 pm, one treat a day, no snacks after dinner, and so on. I initially resisted this kind of structure–it’s so not my style–but I have found that it really does facilitate managing kids (and I’ll add in sick ones) … because they both want things all the time, and that can become very wearisome. If my kids know they can’t watch SpongeBob SquarePants before 5 pm–and I follow up consistently on that rule (the hard part)–then they will eventually stop asking. The same goes with a sick mother or wife: if she knows dinner is at 6 every evening, and that Wednesday is pizza day, then you’ve just given her one less thing to whine about. Theoretically, of course.

7. Get out of the house.

I know what it’s like to be captive inside your home, to be a prisoner locked in a dark and frightening cell. It will drive you straight to the community room of a psych ward. At least that’s where my isolation period ended up. When my kids were babies, I didn’t do anything but nurse, change diapers, watch Baby Einstein videos, and clean up squash stains on every piece of clothing I owned.

Today I make myself sign up for swim clubs and community programs even if I don’t want to, because I know that the time spent outside of the home with other human beings is as crucial to my mental health as eating the right foods and exercising and getting support.

Taking time to enjoy a pastime isn’t a selfish act. It will help you be a better caregiver because it will elevate your mood — not to mention assisting you with concentration and patience–which will in turn help your loved one.

Want to learn more?
Check out 5 more depression busters for caregivers or read the Psych Central article, Self-Care for Depression Caregivers.

Go Take a Nap

Fri, 12 Mar 2010 00:00:00 +0100

Well, the latest research confirms the positive effects of a mid-afternoon nap. Adults in the latest — albeit small — study suggest that people who took a 90-minute power nap after lunch did better on a battery of cognitive tests than those who didn’t. The improvement rate was about 10 percent better.

Some cultures have built in the concept of an afternoon break from the long and non-stop workday. There seems to be some empirical support for the benefits of such a break, in that a mid-afternoon break (including a nap) seems to help with our ability to focus, especially with tasks that need short-term memory (which is what a lot of desk jobs entail).

This should not be particularly surprising, since we already have a wealth of research demonstrating the benefits of a full, good night’s sleep. Is it that far a stretch to imagine similar benefits from a shorter, mid-day sleep or nap?

In another study examining napping of 32 adult men, Milner & Cote (2008) found similar positive effects of both 60-minute and 20-minute naps:

Napping led to improvements for all age groups in subjective sleepiness, fatigue and accuracy on a serial addition/subtraction task. Waking electroencephalogram (EEG) confirmed that the participants were more physiologically alert following naps.

Another study confirmed similar results for athletes (Waterhouse et al., 2007):

These results indicate that a post-lunch nap improves alertness and aspects of mental and physical performance following partial sleep loss, and have implications for athletes with restricted sleep during training or before competition

However, other research has not found as strong a link. Overall, it looks like there may indeed be benefits of a mid-afternoon nap, but for most, this becomes a moot point as such a nap is not possible to take during work.

Read the full news story: Napping Makes You Smarter

References:

Milner, C.E. & Cote, K.A. (2008). A dose-response investigation of the benefits of napping in healthy young, middle-aged and older adults. Sleep and Biological Rhythms, 6(1), 2-15.

Waterhouse, J., Atkinson, G., Edwards, B., & Reilly, T. (2007). The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation. Journal of Sports Sciences, 25(14), 1557-1566.

Pilfered Lunches Point to a Bigger Employee Problem

Fri, 12 Mar 2010 00:00:00 +0100

Stealing lunches from the office frig could be a symptom of a more serious problem — low employee engagement.

“Hunger does crazy things to you,” was the comment made by an employee interviewed on the Today Show segment, “Pains in the Office.” While physical hunger is one reason employees pilfer lunches, I suspect that employees who steal from each other have a different kind of hunger.

If your office is experiencing a rise in the number of stolen lunches, you are not alone. Recently several call center managers told me that they’re getting a lot more “stolen lunch” complaints. It’s no coincidence that these are the same managers who are plagued by low employee morale.

Low morale can have disastrous effects. When employees are dissatisfied and chronically unhappy they are less committed to delivering great customer service. Low employee engagement translates into sub-standard productivity, too many customer complaints, low customer satisfaction scores, negative turnover, and high operating costs.

If you have an employee morale problem, you have an employee engagement problem. Start by measuring engagement with a survey. I predict that one of the things you will learn from the survey results is that your employees yearn for a different, more personalized type of support from their immediate supervisor. When supervisors provide each employee with the right blend of coaching and mentoring, they feel more valued. When front-line employees feel valued, they make their customers feel valued.

I guarantee that once you satisfy your employees’ hunger for quality face time with their supervisor, they’ll have less reason to pilfer lunches from the office frig.

According to research by the Gallup Organization, only 28% of the 80,000 employees surveyed considered themselves fully engaged in their work. Even more troubling, many call centers report employee engagement levels of less than 20%. When 80% of the workforce is delivering sub-par performance, operating costs rise, efficiency drops and customer satisfaction suffers.

Supervisors play a pivotal role in driving employee engagement. In 2008, Vertex, a leader in business process outsourcing, conducted an innovative project that demonstrated that when supervisors get the correct training in coaching and mentoring skills, employee engagement improves dramatically. The ground-breaking project involved 250 reps from two call centers and included 21 supervisors. The results were impressive. Within three months after the supervisors completed training, the engagement survey scores jumped an average of 10%.

Five important lessons were uncovered by this project:

1. Supervisors required four things in order to improve the engagement and commitment of their employees:

Time. Internal surveys revealed that what the reps craved was more “face time” with their supervisor. Supervisors discovered that they could easily increase the amount of time they spent with their employees if they let go of “low-value” tasks and activities.
Accountability. Supervisors were accountable for employee engagement scores so had an incentive to acquire the necessary coaching and mentoring skills.
Training. The design of classroom training included ample opportunities for supervisors to NMM new cover onlypractice their coaching and mentoring skills.
Tools. The shared experience that came from reading a fable book that illustrated solutions fortypical work and life challenges, opened the door for meaningful conversations.

2. Employee morale improved across the board when supervisors focused less on enforcing performance standards and spent more time forging a positive, supportive relationship with individual employees.

3. Culture change takes time. To create a positive work environment in which employees are honored and valued required a sustained effort by the supervisors and upper management.

4. When employees have a positive relationship with their supervisor and feel appreciated for their contributions, they have fewer reasons to look for employment elsewhere.

5. The most valuable employee engagement surveys measure the quality of support employees receive from their immediate supervisor. That data helped supervisors measure their effectiveness and make adjustments as necessary.

Their secret to success was training supervisors to utilize a fable book, The Napkin, the Melon and the Monkey, as a tool for engaging customer service reps in “conversations that matter.” When trust increased, so did engagement. If employee engagement improvement is a goal for 2010 or 2011, let’s have a conversation.

Proof Positive Counting Your Blessings

Fri, 12 Mar 2010 00:00:00 +0100

The secret of happiness is to count your blessings while others are adding up their troubles.

– William Penn

Normally I’m known as a “nice guy:” easygoing, fair, pretty calm and generally happy. But several years ago I planned a weekend conference on psychodrama that unglued me. Planning the conference took six months and included the usual things; arranging for a block of rooms, guaranteeing registrants, coordinating lunches and dinners, and keeping the cost down wherever I could.

As a clinical professor, the presentations and training itself were easy. I could lecture and demonstrate the use of role-playing in dealing with post-traumatic stress disorder, show videos of how to apply group principles to people with intellectual and psychiatric disabilities, and demonstrate the various ways to deescalate a fight that had broken out between two members of a group. But guaranteeing payment for a block of rooms and coordinating the coffee sent shivers down my spine.

The pre-registration looked good enough to cover the costs. On the drive from New Jersey to Stockbridge, Mass. where the conference was to be held, I received a call on my cell phone. The shift manager explained that more people had shown up for the conference than anticipated and they could not be accommodated. They did not have reservations and he had no other options than to send them elsewhere.

I lost it.

In my car, alone, I began screaming at the top of my lungs. “You promised me they could accommodate up to 75 people! Now you’re telling me you only have room for 50! I’ve spent six months planning this damn thing with your hotel, we have a contract! You can’t tell me last minute that there is no place for these people — they’ll never trust me again! I’ll never be able to run another conference!” As Albert Ellis might have said, I was “awfulizing.”

Driving on the New York State Thruway I swerved, screamed, and generally worked myself up into what my mother would have called a “tizzy.”

I came to a tollbooth and dug into my pocket to pay. As the window went down I was still shrieking into the phone. I expected to pay and go, but instead the tollbooth operator said something that changed my life.

“There is no toll for you today, sir.”

“Don’t start with me,” I said in a huff. “Just take my money, please.”

“The car in front of you paid the toll. He said to tell you it was a random act of kindness — and to have a nice day.”

“What?”

“It has never happened before. He actually gave me more than what your toll is and told me to apply any leftovers to the car behind you.”

“Really?”

“Really.”

I thanked him, drove off, and told the guy at the hotel I would call him back in 10 minutes. The timing and impact of the random act of kindness caused a shift in me — a profound one. Instead of being so focused on the problem, it allowed me to shift into a more positive frame of mind. I calmed down, and called back the hotel.

The events coordinator got on the phone and told me it was a misunderstanding. It wasn’t that they didn’t have reservations for rooms, it was that these people didn’t have reservations for Saturday night dinner. This was an easy problem to fix as they staggered the seating times. The conference went off without a hitch.

I was happy, the participants were happy, the hotel was happy. But if I had kept shouting everyone would have suffered. I’d have been in a foul mood for the entire ride up, and, even if the mistake was taken care of, I would have wasted a lot of precious energy and time on being negative. This random act of kindness was my first experience in positive psychology.

This new discipline helps us not only count our blessings, but analyze and optimize their use as well. This field of inquiry opening up in psychology is more than a passing fad. Positive psychology is rapidly emerging as the direction for many researchers and practitioners. Long mired in the work of understanding negative conditions, emotions, and feelings, psychology is taking a completely different view on understanding best how to benefit the human condition. Rather than to simply ameliorate the conditions of depression and negative symptoms, positive psychology is a direct effort to both quash the frequency and intensity of depression and anxiety, and directly increase the happiness we experience in life. What positive psychology endeavors to do is to make us flourish in our life.

Researchers from around the globe have focused on determining the factors that we can identify as affecting our positive emotions. More specifically, the research is more often than not tailored into practical application of enhancing these factors.

Dr. Martin Seligman of the University of Pennsylvania is now introduced as “The Father of Positive Psychology.” He is, arguably, the world’s most influential living psychologist. The former president of the American Psychological Association changed the way psychologists understood and treated depression by introducing a theory of learned helplessness in the mid-1970s. He has now changed the way we understand happiness.

His work on depression years earlier took a research-based approach to interventions and outcomes. This isn’t simply a matter of saying ‘think happy thoughts and you’ll feel better,’ this is a highly scientific approach toward understanding the methods and techniques which have the greatest potential of increasing a sense of well-being and happiness and identifying which of them may work best for you.

Consider the exercise called Three Blessings. It is already one of the classics in the field. This amazingly simple technique has been shown to have a powerful, positive effect on reducing symptoms of depression and anxiety, while simultaneously increasing a sense of joy and well-being.

The task is simple enough. As your day comes to a close, allow yourself to think about three things that happened during the day that you are most happy about, and why you believe they happened.

The simple elegance of this exercise is part of the appeal, and in some ways the stumbling block people may find difficulty overcoming. Could it really be that something so easy could have such profound results? The unequivocal answer is yes!

The outcome from doing this exercise is astonishing. Participants doing this exercise for one week increased happiness and decreased depressive symptoms for six months. This is not a misprint. One week of doing this had a lasting effect for six months. While newer research suggests that this technique may actually be more effective if done less frequently rather than more frequently, the basics of the technique have value, a very positive one. The information is pouring in from all corners of the globe, and it is becoming clear that positive psychology is free, easy, effective, and worth the try. For a bit more on the history of this and other experiments launching positive psychology here is an interview with Dr. Seligman.

I encourage you to reflect this evening on the three blessings in your day. You may want to write these down and think about why they may have come into your life. Try this twice more during the week and note how you feel. If you need more encouragement to try this, consider these words from Charles Dickens: “Reflect on your present blessings, on which every man has many, not on your past misfortunes, of which all men have some.”

Become a Contributor to World of Psychology

Fri, 12 Mar 2010 00:00:00 +0100

Unbeknownst to some of you, World of Psychology welcomes guest contributors! Please send us your essays, commentary, opinion or rational (or sometimes irrational!) thoughts about anything in the world of psychology and mental health. This is a wonderful opportunity for the writers in our audience — professionals and laypeople alike — to share their point of view with our 1.1 million readers.

Entries should be about a psychology or mental health topic (obviously), and be something that hasn’t been published online already a hundred times before. We’re especially interested in folks who are interested in recent research or news on a specific topic, and can bring their own background, experiences and insight to bear on that topic.

World of Psychology is about opening up psychology to the people to share, to make psychology and mental health topics accessible in down-to-earth, plain English, and to open our minds up to all of the possibilities of the human mind.

Sound like fun? You bet it is! You haven’t had this much fun since Arthur Melin and Richard Knerr introduced the hula hoop to U.S. children in 1958. It’s that much fun.

You can join us by reading the submission guidelines here and submitting your articles to be published in future editions of World of Psychology. And if you’re interested in writing for us on a more regular basis, or even starting your own Psych Central blog, let us know.

7 Ways to Beat Depression After a Divorce

Fri, 12 Mar 2010 00:00:00 +0100

Divorce is the second most stressful life event, preceded only by the death of a spouse. And what is stress capable of? Expediting a severe bout of depression and anxiety to your limbic system (the brain’s emotional center) if you’re not careful. Acute and chronic stress, especially, undermine both emotional and physical health. In fact, a recent study published in the Journal of Health and Social Behavior suggests that divorced or widowed people have 20 percent more chronic health conditions such as heart disease, diabetes or cancer than married people.

Another study in Psychological Science claimed that a person’s happiness level drops as she approaches divorce, although there is rebounding over time if the person works at it. That’s what these 12 tips are: suggestions for preventing the devastating depression that often accompanies divorce, and techniques that you can use to keep your happiness level steady or maybe even higher!

1. Lose yourself in a book (or an afghan).

I think the one thing that kept my mom sane the years after she and my dad split were the 75 afghans she knitted for me, my sisters, and anyone who got married during between 1982 and 1985. The mundane, repetitive gesture, she told me later, kept her brain on the loop that she was making with her big plastic needles, away from all the sadness in her heart. Swimming is the same type of activity for me. I count each lap, so if I start to ruminate too much, I lose track. For an OCD gal who needs to burn calories, it’s a tragedy when that happens. A friend of mine who divorced last year said that losing herself in a juicy novel was a helpful diversion. Or I guess you could also watch reality TV, although I’d hate for you to sink that low.

2. Change your routine.

The year after my dad left, a counselor recommended to my mom that she go back to work. So she took a part-time job as a hostess at a nice restaurant downtown, working lunch hour. The job forced her to smile, meet new people, and be part of a fresh environment—all of which helped her to get out of her head for several hours of the day and gave her hope that there was new life out there, that her life wasn’t over just because her marriage had ended.

3. Plan, plan, and plan some more.

In her book Solace: Finding Your Way Through Grief and Learning to Live Again, psychotherapist Roberta Temes suggests a few activities that are therapeutic during bereavement (and divorce is a kind of bereavement). One of them is planning. That is, planning everything. I know this works because I did it during the really low months of my severe depression. I planned when I would eat my bagel, when I would shower, and when I would relieve my bladder. I planned when I’d write my distorted thoughts into a journal, and when I would try to count my blessings. All the planning cut down on my ruminations. You think I’m crazy? Temes writes:

Use a calendar to make your plans. Plan when you will go somewhere new. Plan when you will buy yourself a new outfit. Plan to learn to knit and decide when you’ll go to the yarn store. Plan to go fishing and call a buddy who likes to fish. Or, learn how to frame a favorite photo and plan when you will venture to a craft shop or to an art supply store. Plan to repair something in your house and plan to go to Home Depot or to Lowe’s or to your local hardware store. Planning activities for your future will help you reach that future.

4. Clean out and organize.

A productive way to grieve the end of a relationship is to clean out the drawers, closets, and other corners of your house that may still contain your spouse’s possessions, and replace them with new stuff. Your stuff. You don’t have to do it all at once, of course. As I said in the last point, you can plan each stage of the excavation. By manually picking up each item, recalling certain memories, and ever so tidily boxing them up for either him, Goodwill, or bulk pickup, you are acknowledging and bidding adieu to the marriage, while creating a space in your life for something new.

5. Preserve your energy.

In her book, Ready to Heal, Kelly McDaniel urges people who have just ended a relationship to preserve their energy, to avoid cluttering their days with too much activity. She writes, “The energy it takes to endure withdrawal [of a relationship] is equivalent to working a full-time job. Truthfully, this may be the hardest work you’ve ever done. In addition to support from people who understand your undertaking, you must keep the rest of your life simple. You need rest and solution.” You feel tired? You’re working two jobs … that’s why!

6. Defy the stereotype.

Mary Jo Eustace will make any reader, but especially those who have lived through divorce, laugh out loud with her memoir, Divorce Sucks. I loved the part where she challenges the divorcee to debunk the hurtful stereotypes of divorced people. Writes Eustace: “Our marriages didn’t work, so people assume we don’t quite work. And this is why it’s very important for those of us who have survived the hell of divorce to start redefining what the landscape of the divorced woman [or man] can look like. People can have us over for dinner, even a couple’s dinner party, and we promise we won’t seduce anyone’s husband or dance on the table, expressing ourselves through modern movement and our ability to do the splits.”

7. Take the high road.

My friend and mentor Mike constantly reminds me that it’s better to be happy or at peace than it is to be right. So, as I’m loaded and ready to fire off a nasty email to some jerk who could potentially make my life hell, I will stop and consider Mike’s pearl of advice. Then I drag the email over to the cute trashcan on my monitor.

I have no doubt your ex-spouse is responsible for a mother load of terrible things, legal pad after legal pad of inexcusable grievances you could report to your attorney. And you would be absolutely entitled to seek revenge (or even justice) for his all of his misjudgments. But is it worth it? That’s the question you might need to stick to your bathroom mirror on a sticky note. A friendly divorce isn’t necessarily a fair divorce. Which one do you want?

Want to learn more?
Check out these five additional ways to beat depression after a divorce.

Bon Jovi Rocks for the Homeless

Fri, 12 Mar 2010 00:00:00 +0100

My wife is a big fan of Bon Jovi, so when I read this article about Bon Jovi’s fact-finding efforts to help better understand homelessness in order to help it through his foundation, I couldn’t help but blog about it.

If you didn’t know, a significant portion of homeless persons have a mental disorder, such as depression, anxiety, bipolar disorder, or schizophrenia. It’s hard to know for certain, but research suggests that approximately 2 out of 5 homeless people have a mental health issue.

Bon Jovi wants his foundation to do more to help the homeless:

That’s because this tour in support of Bon Jovi’s latest release, “The Circle,” is also a fact-finding mission. The singer plans on visiting as many homeless shelters and programs as time allows in hopes of getting ideas and inspiration to shape his own work with the Jon Bon Jovi Soul Foundation, a Philadelphia-based charity that fights homelessness by building affordable housing, establishing community kitchens and cleaning up vacant lots in blighted neighborhoods.

You can’t work on solutions to homelessness until you better understand it. SAMHSA has a great resource page about homelessness, and notes that most, or about 80 percent, exit from homelessness within 2 or 3 weeks. “They often have more personal, social, and economic resources to draw from than people who are homeless for longer periods of time. About 10 percent are homeless for up to 2 months, with housing availability and affordability adding to the time they are homeless.”

So contrary to the way many of us perceive homelessness, 90 percent of the homeless are not long-term. It is a short-term problem for the vast majority of the homeless.

The Jon Bon Jovi Soul Foundation has already built more than 150 units of affordable housing in seven cities since 2006. This directly addresses one of the primary problems of the vast majority of homeless people — affordable housing (that’s not crime-ridden). Bon Jovi is a realist and the article notes that the “homeless” are not some homogeneous group of people — different problems that cause or contribute to homelessness will require different solutions.

That’s good, because there are many different problems that need to be address; short-term housing and affordable housing are a good start. But greater access to treatment programs to help the folks with mental health concerns — including alcohol and drug problems — is also needed.

To me, this is a great example of a celebrity using their fame for good in a very pragmatic and helpful manner. I wish more celebrities followed in the footsteps of Bon Jovi.

Read the full article: Bon Jovi’s new tour doubles as a research mission

The Mother of Mindfulness Ellen Langer

Fri, 12 Mar 2010 00:00:00 +0100

Ellen Langer, a professor at Harvard, is also the mother of the psychological concept of mindfulness. There was a great profile last Sunday of her work in the Boston Globe Magazine.

The article describes how, as a doctoral student, she was intrigued by how people reacted when a poker hand was misdealt:

One round, the dealer accidentally skipped someone. “Everyone went crazy,” Langer recalls. It was out of the question, she learned, to simply give the skipped person the next card and proceed with the deal. She began to wonder why people were so attached to “their” cards even when they had no idea whether they were good or bad.[...]

[She also] ran a study in which she set up a lottery and varied the terms by which people got their tickets. She found that subjects valued their tickets much more when they were allowed to choose them, even though that did nothing to increase their chances of winning. She called this “the illusion of control.”

Langer followed this up by looking at the often meaningless factors that determine how people evaluate information. In one study, conducted with Benzion Chanowitz and Arthur Blank, she had experimenters approach people who were using a Xerox machine and ask to cut in to make copies. They found that people were more likely to let someone cut if offered a reason – but, intriguingly, it did not matter if the reason made sense. People were as receptive to a meaningless reason (“to make copies”) as a valid one (“I’m in a rush”).

“It is not that people don’t hear the request,” Langer wrote in “Mindfulness,” “they simply don’t think about it actively.”

And hence mindfulness was born. She wrote a 1989 book of the same name that lays out a lot of this thinking and description of these and related studies.

The psychological concept of mindfulness is so simple, you might believe you’re missing something — that we simply need to go through life paying better attention to life itself. We need to stop and actually think about what we’re doing, how we’re reacting, and perhaps even reflect on why we’re reacting in the way we are in the moment. We make so many choices in our lives on “autopilot,” we don’t always spend the time actually thinking about what choices we are making.

When we go to pick up our morning coffee, such an autopilot serves a purpose and thinking about getting your coffee isn’t likely to bring you much additional joy or insight.

However, when we hold on to an argument or a position in a discussion with a loved one for no good reason outside of a stubborn belief that “we’re right,” that might be an example of how our mindlessness can be a harmful influence in our lives.

I don’t see mindfulness as simply being optimistic or “thinking will make it so.” Instead, it’s trying to put your thoughts into some sort of context — in the moment you’re doing something. It’s a pragmatic world view, and while not a satisfactory explanation or technique for every situation, it is one that can bring you to become more connected not only with yourself, but with those and the world around you.

Read the full article: Mind Power

Friday Flashback for February 26 2010

Fri, 12 Mar 2010 00:00:00 +0100

I’m in Houston on my annual e-patients retreat. So what better way to help you get through your TGIF fever than to give you a look back on what we were talking about on Psych Central in years past (gee, I sound so old-timey!).

11 Years Ago on Psych Central

The Great Psychology Prescription Debate

I boiled psychologists’ push for prescription privileges down to a question of money in this post. Psychologists are being pushed down the income ladder by cheaper psychotherapy providers (like marriage and family therapists and clinical social workers), and so look upward to see what they could be doing that could be making them more money. Psychiatrists can make twice as much psychologists because they can prescribe psychiatric medications.

Re-reading this essay, I think things are a little bit more complicated than I originally suggested. Indeed, in some rural parts of our country, there is a lack of psychiatric prescribers. But I don’t think the answer is tacking on a few more years of study to psychologists’ training programs, who have no intrinsic or specialized medical training to begin with (psychological training, yes; medical training, no).

Over lunch a few weeks ago, Dr. Danny Carlat suggested the answer is an entirely new training paradigm for professionals, combining the best of both worlds of psychiatry and psychology. And why not, when it’s so clear the existing training paradigm for both professions leaves much to be desired. It sounded intriguing and full of potential, so I look forward to reading more about his ideas in this vein in the months to come.

5 Years Ago on Psych Central

Lovers no good in spotting others in love

I love this study, even five years later, because it goes against the conventional wisdom that lovers in love should be able to see such love in others, too. In fact, adding some traction to the saying that “love is blind,” people in love actually fared twice as badly in identifying love in others than those who were not currently in love. Love is not only blind to the partner we love, but also to anyone else in love too, apparently.

1 Year Ago on Psych Central

10 Ways to Make Friends

Regular World of Psychology contributor Therese J. Borchard listed 10 ways a person can go and make new friends. It seems like such a simple topic that you wouldn’t even need to write it. Yet as we get older and out of school, making friends can be a lot more challenging than you might realize. Especially if you’re shy, or are in a work environment where socialization is frowned upon.

Suicide: When It Hurts Too Much To Live

Suicide is a topic that still makes my heart skip a beat whenever I see it in print or write about it. I lost my dearest friend to suicide in 1990, so it’s close to my heart, even 20 years later. While we’ve come a long way in making progress to help decrease suicides in 20 years, it remains a significant problem and one of the leading causes of death in young adults. In this entry by World of Psychology contributor Erika Krull, MS, LMHP, she talks about the pain of suicide and invites readers to contribute to a discussion on this issue; readers respond with over 120 comments.

WebMD?s Depression Test Has Issues

Fri, 12 Mar 2010 00:00:00 +0100

Sometimes you have to wonder, “What were they thinking?”

Jim Edwards, writing for bnet, notes how when he took the WebMD depression test (here), it always told him he might be at risk for depression. Even if you answered all 10 questions negatively, it still noted that “You may be risk for major depression”:

To be fair to WebMD and Lilly, the test is clearly marked as “funded by Lilly.” And there’s a Cymbalta ad sitting on the same page. But that doesn’t excuse the fact that it is rigged. Even if you answer “no” to all of the 10 questions (which are all framed so that the “yes” answer indicates depressed behavior) you still get this response:

Lower Risk: You may be at risk for major depression.

I just took the test now to confirm this result and did not get that same descriptive narrative in my results. It had been removed and all I got was the rest of it, “Lower risk.” The fact is, if you answered all 10 questions “No,” you are — at that moment — at pretty much zero risk for depression (at that moment). Could you get it in the future? Sure. You could also get a cold or the flu in the future too, but that doesn’t mean you are, today, at “lower risk” for it. Ridiculous.

Edwards suggests this may be because the quiz itself is sponsored by an antidepressant pharmaceutical company. That may be (we can’t know for sure one way or another). But it shows a sloppy lack of testing and science in a premier resource that Eli Lilly spent a lot of money for WebMD to develop.

That’s one of the reasons I’m not a big fan of these quizzes developed on-the-fly for big health websites. We develop our quizzes in-house for a good reason — there’s a lot of work that goes into them to ensure they are both valid and reliable. That they don’t just tell you you need help when you clearly do not. That’s why you’ll find our quick 8-question depression quiz doesn’t just ask Yes/No questions, because you can’t get the fine granularity needed to help do an accurate and useful screen.

I suspect someone at Eli Lilly (and maybe even WebMD) knows this. Certainly Brunilda Nazario, MD — whose name appears as the medical reviewer on this content — should be ashamed of this. Why would a medical doctor of Dr. Nazario’s character not notice that in the world of WebMD, everyone is at risk?

Thanks to our new ADHD blogger and iFred founder, Kathryn Goetzke, for sending in this news tip.

Building Assertiveness in 4 Steps

Fri, 12 Mar 2010 00:00:00 +0100

All of us should insist on being treated fairly — to stand up for our rights without violating the rights of others. This means tactfully, justly and effectively expressing our preferences, needs, opinions and feelings.

Psychologists call that being assertive, as distinguished from being unassertive (weak, passive, compliant, self-sacrificing) or aggressive (self-centered, inconsiderate, hostile, arrogantly demanding).

Because some people want to be “nice” and “not cause trouble,” they “suffer in silence,” “turn the other cheek,” and assume nothing can be done to change their situation. The rest of us appreciate pleasant, accommodating people but whenever a nice person permits a greedy, dominant person to take advantage of him/her, the passive person is not only cheating him/herself but also reinforcing unfair, self-centered behavior in the aggressive person.

Assertiveness is the antidote to fear, shyness, passivity, and even anger, so there is an astonishingly wide range of situations in which this training is appropriate. Research into assertiveness has suggested several kinds of behavior are involved:

To speak up, make requests, ask for favors and generally insist that your rights be respected as a significant, equal human being. To overcome the fears and self-depreciation that keep you from doing these things.
To express negative emotions (complaints, resentment, criticism, disagreement, intimidation, the desire to be left alone) and to refuse requests.
To show positive emotions (joy, pride, liking someone, attraction) and to give compliments.
To ask why and question authority or tradition, not to rebel but to assume responsibility for asserting your share of control of the situation — and to make things better.
To initiate, carry on, change and terminate conversations comfortably. Share your feelings, opinions and experiences with others.
To deal with minor irritations before your anger builds into intense resentment and explosive aggression.

Four Steps to Building Assertiveness

There are four basic steps that can help you become more assertive in your every day interactions with others.

1. Realize where changes are needed and believe in your rights.

Many people recognize they are being taken advantage of and/or have difficulty saying “no.” Others do not see themselves as unassertive but do feel depressed or unfulfilled, have lots of physical ailments, have complaints about work but assume the boss or teacher has the right to demand whatever he/she wants, etc. Nothing will change until the victim recognizes his/her rights are being denied and he/she decides to correct the situation. Keeping a diary may help you assess how intimidated, compliant, passive or timid you are or how demanding, whiny, bitchy or aggressive others are.

Almost everyone can cite instances or circumstances in which he/she has been outspoken or aggressive. These instances may be used to deny we are unassertive in any way. However, many of us are weak in some ways — we can’t say “no” to a friend asking a favor, we can’t give or take a compliment, we let a spouse or children control our lives, we won’t speak up in class or disagree with others in a meeting and so on. Ask yourself if you want to continue being weak.

One may need to deal with the anxiety associated with changing, to reconcile the conflicts within your value system, to assess the repercussions of being assertive, and to prepare others for the changes they will see in your behavior or attitude. Talk to others about the appropriateness of being assertive in a specific situation that concerns you. If you are still scared even though it is appropriate, use desensitization or role-playing to reduce the anxiety.

2. Figure out appropriate ways of asserting yourself in each specific situation that concerns you.

There are many ways to devise effective, tactful, fair assertive responses. Watch a good model. Discuss the problem situation with a friend, a parent, a supervisor, a counselor or other person. Carefully note how others respond to situations similar to yours and consider if they are being unassertive, assertive or aggressive. Read some of the books listed at the end of this method. Most assertiveness trainers recommend that an effective assertive response contain several parts:

Describe (to the other person involved) the troublesome situation as you see it. Be very specific about time and actions, don’t make general accusations like “you’re always hostile… upset… busy.” Be objective; don’t suggest the other person is a total jerk. Focus on his/her behavior, not on his/her apparent motives.
Describe your feelings, using an “I” statement which shows you take responsibility for your feelings. Be firm and strong, look at them, be sure of yourself, don’t get emotional. Focus on positive feelings related to your goals if you can, not on your resentment of the other person. Sometimes it is helpful to explain why you feel as you do, so your statement becomes “I feel ______ because ______.” (see the next method).
Describe the changes you’d like made, be specific about what action should stop and what should start. Be sure the requested changes are reasonable, consider the other person’s needs too, and be willing to make changes yourself in return. In some cases, you may already have explicit consequences in mind if the other person makes the desired changes and if he/she doesn’t. If so, these should be clearly described too. Don’t make dire threats, if you can’t or won’t carry out them out.

See specific examples of situations, assertive responses and poor responses.

3. Practice giving assertive responses.

Using the responses you have just developed, role-play the problem situations with a friend or, if that isn’t possible, simply imagine interacting assertively. Start with real life but easy to handle situations and work up to more challenging ones expected in the future.

You will quickly discover, if your friend plays the role realistically, that you need to do more than simply rehearse the assertiveness responses. You will realize that no matter how calm and tactful you are, it will still sometimes come out smelling like a personal assault to the other person.

The other person may not be aggressive (since you have been tactful) but you should realize that strong reactions are possible, such as getting mad and calling you names, counter-attacking and criticizing you, seeking revenge, becoming threatening or ill, or suddenly being contrite and overly apologetic or submissive.

Your friend helping you by role-playing can act out the more likely reactions. In most cases, simply explaining your behavior and standing your ground will handle the situation. But there are additional techniques you might consider trying if standing your ground doesn’t work.

In most interactions, it is not just one person assertively asking for changes, but rather two people wanting to express their feelings, opinions or wishes (and maybe get their way). So, each of you must take turns being assertive and then listen with empathy. That’s good communication if it results in satisfactory compromises.

Another technique to try when confronting especially difficult situations or people is called the broken record. You calmly and firmly repeat a short, clear statement over and over until the other person gets the message. For example, “I want you to be home by midnight,” “I don’t like the product and I want my money back,” “No, I don’t want to go drinking, I want to study.”

Repeat the same statement in exactly the same way until the other person “gets off your back,” regardless of the excuses, diversions, or arguments given by the other person.

4. Try being assertive in real life situations.

Start with the easier, less stressful situations. Build some confidence. Make adjustments in your approach as needed.

Look for or devise ways of sharpening your assertiveness skills. Examples: Ask a friend to lend you a piece of clothing, a record album or a book. Ask a stranger for directions, change for a dollar, or a pen or pencil. Ask a store manager to reduce the price of a soiled or slightly damaged article, to demonstrate a product, or exchange a purchase. Ask an instructor to help you understand a point, find extra reading, or go over items you missed on an exam. Practice speaking and making small talk, give compliments to friends and strangers, call up a city official when you see something unreasonable or inefficient, praise others when they have done well, tell friends or co-workers experiences you have had, and on and on. Keep a diary of your interactions.

Read more about building assertiveness in Psychological Self-Help’s Chapter 13: Assertiveness Training.

This excerpt reproduced with permission from Psychological Self-Help and has been edited for length and clarity.

Harmful Side Effects of Psychotherapy

Fri, 12 Mar 2010 00:00:00 +0100

You cannot look up drug information on the Internet today without coming across at least one page about the negative side effects of taking the drug. In fact, such side effects are deemed so important, their publication alongside the benefits of a drug are strictly regulated by the U.S. Food and Drug Administration (FDA). But the FDA requires no such warnings connected to other mental health treatments, including the use of psychotherapy.

How could psychotherapy ever be harmful?

That’s a good question, and one explored in three articles in the January issue of American Psychologist. The one I’ll focus on is the one by David Barlow (2010). David Barlow is a well-respected psychologist and researcher, with a long career made on studies examining the positive impact of cognitive behavioral techniques for a variety of serious mental health concerns like anxiety and panic disorder.

In the article, Barlow notes how now that psychotherapy has become an accepted and effective treatment option within the health care community, researchers need to do a better job of describing and examining the negative side effects of psychotherapy. We can no longer make the claim that psychotherapy can have no negative side effects, even when wielded by an ethical and experienced therapist.

One of the best examples of this that Barlow noted is the research into something called “critical incident stress debriefing” (CISD). This is a therapeutic technique meant to help people immediately after experiencing a trauma in their lives (such as a natural disaster or car accident). The common wisdom is that counseling immediately after a trauma is likely to be beneficial to the victims.

But what the research has found is that in groups of people who have been treated with CISD actually experience greater and more severe symptoms when later measured. This made little sense to researchers — how could people who’ve actually been given a psychological intervention then later go on to experience even worse symptoms?

A more refined analysis found that it was actually only people who had high scores on a measure of the impact of the traumatic event who fared much worse later on after the psychological intervention. People with low scores on the same measure did just fine with the intervention. Barlow’s point is that we often can’t see the important variables that could have a negative impact in treatment until we take apart the data and examine it more closely.

Another example Barlow noted of negative side effects for a therapeutic technique is the use of breathing retraining and relaxation procedures during exposure-based procedures for individuals with panic disorder with agoraphobia. People who were taught these techniques actually fared worse off in coping with their panic than those who were not taught to use them. In other words, just because a therapeutic technique is useful in one situation — outside of exposure procedures, for instance, to help reduce anxiety or tension — doesn’t mean it might not be harmful in other situations.

These are often difficult cases to find, because just like psychiatric medications’ side effects, not everyone will experience them in every setting. There are specific traits or symptoms that may preclude the use of specific therapeutic techniques. To say nothing of normally-beneficial therapeutic techniques used inappropriately by inexperienced or poorly trained therapists.

Psychotherapy is a powerful treatment for mental health concerns. It’s time that more focus be given not only to its beneficial effects, but also to better understand when certain techniques are best not used and could, in fact, be harmful.

Reference:

Barlow, D.H. (2010). Negative effects from psychological treatments. American Psychologist, 65, 13-19.

Why Tiger Woods Need Not Apologize to Us

Fri, 12 Mar 2010 00:00:00 +0100

When Tiger Woods held a press conference last Friday to explain where he’s at in his life, I got this feeling that we were looking into someone’s personal and private life in a manner that felt a little silly. After all, what business is it of ours — the public — what this sports celebrity does in his personal life?

Then again, one could apply the same logic to virtually any celebrity and our seemingly-endless obsession with following the private lives and failings of celebrities. Entire print publications and weekly magazines are devoted to the following of celebrities’ lives, as well as popular websites like TMZ.com.

We love to follow other people’s lives — it takes our minds off of our own mundane (and often less-than-ideal) existence. It explains why these publications are so popular and well-read.

But why put yourself out there, voluntarily, while you’re still in the middle of your own recovery? Why hold a “press conference” where nobody is allowed to answer any questions? And where is the one person who should be there — your wife? What does it help or prove?

Now some ridiculous journalists — like Donald McNeil Jr. — are claiming that Tiger Woods is suffering from sex addiction, based upon nothing more than so-called “experts” who have never seen Tiger Woods in a clinical setting or had the chance to interview him personally. This “diagnosis from afar” is a ridiculous game some professionals (and even laypeople) play, in an effort to juice the headlines even further. Oh, and of course, the fact that “sex addiction” isn’t even a recognized or diagnosable disorder is, I guess, besides the point.

Perhaps Tiger Woods is going through his own version of a 12-step program. Perhaps he just feels badly about the publicity of it all. Or perhaps he was cajoled into appearing by trusted advisers, friends or lawyers.

But I would say he got some bad advice. This is none of our business and he does not need to be in the public spotlight at this time. He does not need to give public attrition for his personal acts, nor give us an apology. There is only one set of people Tiger Woods needs to apologize to, and there is only set of people who need to be there to hear it — his family. Here’s to hoping he continues his recovery in earnestness and humility, and for a new-found appreciation for the value of his family.

We all are human and we all make mistakes. None of us is perfect. We try our best, admit our mistakes (to our loved ones) and then pick ourselves up, and try and move on. We — you know, us normal people — don’t hold press conferences. We don’t twitter about it. We don’t post a Facebook status update that we screwed up royally and apologize for our actions. We don’t need to because nobody matters to us personally except those we care most about in our lives. Those people we personally harmed by our actions. No matter what else Tiger Woods may or may not have done (or what you think about it), his actions did not harm you or me.

We tell our loved ones or those we caused harm to, and then we quietly work on rebuilding trust and putting our lives back together. So while some may appreciate Tiger Woods’ apology, it was unnecessary and came across as merely self-serving. He need not apologize to us because he did nothing to you or I. The harm he caused was only to himself and his family, no one else.

The Myth of Depression?s Upside

Fri, 12 Mar 2010 00:00:00 +0100

Jonah Lehrer’s essay “Depression’s Upside” in the Feb. 28, 2010 New York Times Magazine raises many important questions about depression, and what, if anything, we can “learn” from suffering a bout of serious depression. Alas, the article obscures almost as much as it illuminates, and I fear that its net effect may be to perpetuate what I call “The Myth of Depression’s Upside.”

But first, let’s be clear: a “myth” is not the same thing as a lie. A myth is a transgenerational story we tell ourselves, which often has a grain of truth to it, and which usually serves some unifying function in our culture. It is a myth that George Washington threw a silver dollar across the Potomac River — there were no silver dollars at the time — but the story usefully reminds us, across many generations, that our first President was a powerful man capable of great accomplishments. No lie in that!

So, too, we have the myth of depression as a “clarifying force,” or as an “adaptive response to affliction” — notions being advanced by a number of psychologists, psychiatrists, and sociologists. Thus, Lehrer quotes psychiatrist Andy Thomson as saying, “…even if you are depressed for a few months, the depression might be worth it if it helps you better understand social relationships… Maybe you realize you need to be less rigid or more loving. Those are insights that can come out of depression, and they can be very valuable.”

Now, with all due respect to Dr. Thomson, I am inclined to ask, “Worth it to whom?” Perhaps the patients Dr. Thomson has treated emerge from their three-month bouts of depression saying, “Ya know what, Doc? It’s been a bad three months—lost my job, almost killed myself, and couldn’t get a damn thing done—but overall, it was worth it!” The depressed patients I evaluated over the past nearly 30 years almost never reported that their major depressive episodes had a “net mental benefit,” to quote Lehrer’s article. Most felt that their lives and souls had been stolen from them for the duration of their depressive episode. Many would have understood and endorsed Willam Styron’s description of his own depression, in his book Darkness Visible:

“Death was now a daily presence, blowing over me in cold gusts. Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain… [the] despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.”

The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting. We were shown a movie of a house that had burned down in such ferocious heat that a package of frozen muffin dough had been completely baked. “So, the house wasn’t a total loss!” quipped one of the world-weary attendees. Yes, of course—people can learn from their severe depressive episodes, but often at the cost of emotional and spiritual conflagration.

Similarly, Lehrer trots out the old war-horse claim that there is a “…striking correlation between creative production and depressive disorders.” But such a correlation hardly proves that depression itself heightens creativity. Psychiatrist Richard Berlin, M.D., editor of Poets on Prozac: Mental Illness, Treatment, and the Creative Process, has summarized his experience as follows:

“The idea that depression might enhance creativity is a myth, often based on the life stories and statements of deceased artists and writers… Contemporary poets who are alive and can tell us about their experience with depression are consistent in reporting that it was only after effective psychiatric treatment that they were able to create at their highest levels.” (R.M. Berlin M.D., personal communication, 1/27/08).

One of the other notions put forward in Lehrer’s article is that depressive “rumination” may actually help us analyze our way out of difficult dilemmas — the so called “analytic-rumination” hypotheses. To support this claim, Lehrer cites several studies showing that depression leads to increased activity in the “problem-solving” part of the brain, the prefrontal cortex.

But there are also numerous studies showing the precise opposite, which Lehrer fails to note. For example, Hosokawa and colleagues in Japan found that, compared with healthy controls, subjects with major depression showed decreased metabolic activity in frontal brain regions. Furthermore, there are innumerable studies showing that major depression impairs higher-level thought processes. Dr. Charles DeBattista, in a recent review, concluded that, “The types of executive deficits seen in depression include problems with planning, initiating and completing goal-directed activities” and that such “executive dysfunction” tends to worsen in direct proportion to the severity of depression.

Lehrer is a thoughtful writer, but in this article, his conflation of terms like “depression,” “sadness,” “melancholy,” and “low mood” produces a kind of conceptual tossed salad. Some of the studies he cites, in which subjects are tested under transient, experimentally-induced states of low mood, have evidently befuddled Lehrer, who assumes that these brief, artificial states are somehow comparable to clinical depression. For example, Lehrer cites the work of social psychologist J.P. Forgas, who “…has repeatedly demonstrated in experiments that negative moods lead to better decisions in complex situations.” But Forgas’s research induces “negative mood” by giving his subjects bad feedback on a bogus test of their verbal abilities. It is simply ludicrous to extrapolate from a few minutes of bruised feelings to a few weeks of severe, major depression.

Lehrer also perpetuates the fiction that antidepressant treatment “interferes” with recovery from depression, by posing the issue as a classic false-choice. Citing psychiatrist Andy Thomson and psychologist Steven Hollon, Lehrer suggests that depressed patients prescribed medication will be “discouraged from dealing with their problems” — as if prescribing a medication slams the door shut on providing concomitant psychotherapy! Most studies find that, for severe depression, medication and “talk therapy” complement and enhance one another. There is no credible, controlled evidence that antidepressants “interfere” with the development of problem-solving skills.

That said, I fully agree that effective psychotherapy may have a greater “protective” effect than medication alone in preventing depressive relapse. Indeed, I advocate psychotherapy as the “first line” treatment for most mild-to-moderate depressive states.

Finally, it is time to challenge the dubious notion that if a condition, such as depression, is highly prevalent in the general population, this must mean that the condition confers some kind of evolutionary advantage, or represents a useful “adaptation.” (Following that line of logic, ignorance and superstition must also have some adaptive advantages, since they are both so widespread throughout the world!). It is more likely that the tendency to develop depression remains “conserved” in the human genome as a spandrel — a kind of genetic hitchhiker that does nothing to improve the ride.

In architecture, a spandrel is simply the space between two arches. Molecular evolutionist Richard Lewontin and paleontologist Steven Jay Gould argued that many traits in nature are nonadaptive, and—like spandrels—are simply byproducts of other, presumably adaptive traits. For example, Gould notes that bones are made of calcite and apatite for adaptive reasons, but they are white simply because that’s the color dictated by those minerals—not because “whiteness” confers an adaptive advantage.

In her upcoming book, The Pocket Therapist, Therese J. Borchard candidly observes that, “…the sensitivity that produces so much of my [emotional] pain is precisely what makes me the compassionate person I am.” [Disclosure: I wrote the forward to Borchard’s book]. I believe that Borchard may be gesturing toward one possible mechanism by which depression is genetically conserved: not by virtue of its adaptive value, but by virtue of depression’s ability to “hitchhike” along — as a spandrel — with a sensitive, altruistic, and compassionate nature: traits that are indeed adaptive, in many social contexts.

As Borchard wisely counsels, we should not renounce or disown the part of us that produces depression — it is a piece of our messy, complex, and wondrous humanity. And, to be sure: ordinary sadness or grief may indeed be a good teacher. We should not rush to suppress or “medicate” what Thomas à Kempis called “the proper sorrows of the soul.” At the same time, we should be under no illusion that severe clinical depression is a “clarifying force” that helps us navigate life’s complex problems. That, in my view, is a well-intentioned but destructive myth.

References

Lehrer, J: Depression’s Upside. New York Times Magazine, Feb. 28, 2010.

Forgas, JP: On being happy and mistaken. Journal of Personality and Social Psychology 1998;75:318-31.

Hosokawa T, Momose T, Kasai K. Brain glucose metabolism difference between bipolar and unipolar mood disorders in depressed and euthymic states. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):243-50

DeBattista, C. Executive dysfunction in major depressive disorder. Expert Rev Neurother. 2005 Jan;5(1):79-83.

Borchard, TJ. The Pocket Therapist. New York, Center Street, 2010 (April).

Gould, SJ: The Structure of Evolutionary Theory. Belknap Press of Harvard University Press, 2002.

Pies, R: The anatomy of sorrow: a spiritual, phenomenological, and neurological perspective. Philos Ethics Humanit Med. 2008 Jun 17;3:17. Accessed at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442112/?tool=pubmed

Medicare cuts will strengthen doctors’ negotiating position

Fri, 12 Mar 2010 00:00:00 +0100

by Richard Reece, MD Doctors will soon be wagging the reform dog. Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, [...]

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Your metformin may smell like dead fish

Fri, 12 Mar 2010 00:00:00 +0100

Originally published in MedPage Today An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned. Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a [...]

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New primary care doctors are going cash only

Fri, 12 Mar 2010 00:00:00 +0100

Primary care’s woes have been well documented, especially on this blog. Pressure on reimbursement, combined with rising bureaucratic impediments to the doctor-patient relationship, are both causing primary care physicians to retire early, or seek another career path. But what about on the other side of the spectrum, namely, newly graduated primary care doctors? Well, they’re no dummies, as [...]

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A nurse practitioner is valuable in hospice and palliative care

Fri, 12 Mar 2010 00:00:00 +0100

by Patrice Villars Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said. Yesterday, a longtime palliative [...]

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Health blog posts of the week February 2027 2010

Fri, 12 Mar 2010 00:00:00 +0100

Here are the top posts from this past week, based on the number of times they were viewed. 1) Does your cardiologist deserve his salary? 2) What doctors do when they don’t know the answer 3) Why Medicare and health care should be deregulated 4) How the ER is now used to triage every patient 5) How pediatricians should handle [...]

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A beautiful Valentine’s Day patient story

Fri, 12 Mar 2010 00:00:00 +0100

by Dr. Charles “I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily. “I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and [...]

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How patient comments will affect your physician practice

Fri, 12 Mar 2010 00:00:00 +0100

Originally published in HCPLive.com by Owen Dahl and Altamash Rahman “Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!” How would you [...]

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The Haiti earthquake and its broken health infrastructure

Fri, 12 Mar 2010 00:00:00 +0100

by Erin Marcus, MD Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the [...]

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Why cancer screening is not a black or white decision

Fri, 12 Mar 2010 00:00:00 +0100

by Shantanu Nundy, MD Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed. She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the [...]

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Medicare slashes pay to doctors and what that really means

Fri, 12 Mar 2010 00:00:00 +0100

by Wes Fisher, MD What we’re learning from the 21% Medicare pay cut to physicians that occurred today: * There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments. * There’s was widespread political support for blocking the scheduled pay cuts to doctors, [...]

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Tearing my hair out!

Fri, 12 Mar 2010 00:00:00 +0100

Why oh why do I sometimes feel that things are stacked against me, I try really hard to cope. The latest saga has been my glasses! I wear my glasses all the timeso rely on them but some how I managed to scratch the lenses my last test was 6 months ago and I was told there was no change so I asked for cheaper lenses to be put in as I didn't have �100 to pay for the ultra thin ones I had currently....ok fine so far!
5 days later I go to have the new lenses put in had to walk around in sunglasses and my daughter says how embarrased she is and walks a long way behind lol.
I go back to collect the glasses and basically couldn't see through them! I tell the staff this and basically they tell me they are the correct lenses and to go home with them and I will soon get used to them! pointed out that I couldn't as I COULD NOT SEE!!!!! basically was then told its because they are a different type of lense. Had a major battle to get the old lenses put back in. Wasn't until I told them that it was illegal for me to drive that they changed them back! Had then to wait another 5 days for another sight test which has shown my lenses need to be the same as my current ones......new lenses ordered and hey as a gesture of good will they are taking the money I paid for the wrong lenses off the right ones! what a joke a gesture of goodwill for their mistake! ended up in tears and felt deflated.

Also had major discussion with GP about lack of input for my diabetes! don't increase insulin anymore! but no input or advice on what to do! only "you will die young!"

complications

Fri, 12 Mar 2010 00:00:00 +0100

(kinda gross...just a warning)

I guess my fall was a bit worse then we originally thought. The day after I fell one of my wisdom teeth fell apart in mouth. I guess I must have really clenched my jaw on the way down. Yesterday I went to the dentist and what was left of my tooth had to be removed. I was kind of worried because my bgs haven't been great lately. The past week I hadn't been able to get them below 10. The dentist was a bit concerned, reminding me that lower bgs were crucial to healing fast and properly. But we went ahead with the removal because what was left of the tooth was very sharp and cutting the inside of my cheek.

Not long into the extraction I realized my normally confident dentist was nervous and frustrated. Things weren't going as planned. He said a root tip was lodged and he was having difficulty getting it out. He worked at it for almost an hour, lots of tools and tugging. It was very uncomfortable.

My husband and youngest son had come in with me. My son doesn't have a problem with that sort of thing, until yesterday. Part way through the extraction my husband had to take him out of the room and he vomitted...poor little guy. I felt so bad.

While they were out of the room my dentist stopped everything, stepped back and said, "Uhmm...I lost your root tip....in your sinus cavity. It was right there...I almost had it...and then it disappeared and I can see a perforation in your sinus."

I think my already elevated heart rate went through the roof at that point. They took another xray and said they'd decide what to do after that. I was really scared.

The xrays came back and he examined them and for the life of him could not find the root tip. He breathed a sigh of relief and said, "I can't find it...its not in the sinus cavity...thank GOD!" He scoured the xray and said he didn't understand it...maybe the suction had picked it up before it went through. He doesn't know where it is.

Then he said that in the 10 years since he got out of dentistry school he has never, ever had a perforated sinus. He said that he couldn't totally rule it out but he was almost certain that he wasn't the one to perforate it. He said it was as though my root had grown in to my sinus. Or its possible that with the fall my root was pushed through the sinus cavity.

So then came the damage control. This part really grossed me out. The dentist got me to plug my nose and blow hard. The air came out the hole in my mouth. YUCK!!! That's like the grossest thing ever to me. For some odd reason my mouth was refusing to bleed and wasn't forming a clot. He said that it needed to form a good clot so that it would block off the hole that is now in my sinus. He sat there for so long roughing up the spot where my tooth had been and making it bleed. Then he added a gel that would help block it all off.

He said that because of the complications there are a few more precautions to take now. I have to ensure that I do not blow my nose or sneeze for at least a week. How do you make yourself not sneeze for a week?? Sneezing is a daily occurance for me. So I'm kinda scared...okay...a lot scared. Then there is infection to worry about. Oi. What if he root tip is still somewhere in my sinus and he just couldn't locate it? Ick!! I don't want this to get worse or require more invasive treatment.

The pain has been really bad. I've been in bed for the last 24 hours. I couldn't eat yesterday...just felt sick. Slept really badly. I feel like crud. The dentist office called today to check on me and they're going to give me stronger pain medication so I hope that takes the edge off.

I'm testing my blood sugar like crazy and thankfully it came down in to the 6's and 7's. I'm going to work really hard to keep it as low as possible. I'm scared and I'm hurting and I just feel :stars: :sosadsmiley:

Frankie Boyle and I have something in common

Fri, 12 Mar 2010 00:00:00 +0100

GMTV annoyed me this morning. Remembering that sleep last night was that elusive creature which bounded gracefully through the night with me running exhaustedly after it, it�s not surprising that I was not in the best of moods when I woke (again), this time to the sound of my alarm. It�s an interesting psychological point that D is using my old mobile phone, and selected at one point my alarm ring tone for his phone ring. I couldn�t understand why I kept sitting up bolt upright and then heading for the bathroom everytime someone phoned him. So I was not in the mood to be told that it was raining, cold and that it was going to snow later, by a wide awake woman who then suggested that it was �A good day to stay in�. Really? In what reality do you find people watching your programme who don�t HAVE to get up? OK, we will allow for some insomniacs, and even for people who have just crawled in from a grave yard shift. But otherwise..... I don�t get up at 6.00 just for the fun of it. D always complains at the speed at which I get out of bed and head for the bathroom. He doesn�t understand that the first lunge for the alarm is my impetus, and were I to stop moving after that, I would be going to work at about 11.00. It�s only after I�ve had a shower, washed my hair, scrubbed dirt off my body�.sorry, that�s called �exfoliating�, or �I have a brillo pad in my bathroom, you wuss, what do you wash with?��that I can return to the sofa and slump down with my cup of tea and a good book. I�m reading Frankie Boyle�s �autobiography�, although I suspect it�s more a series of one liners he�s trying out for his next comedy gig. I don�t laugh all the way through, he�s a bit like Jim Lee�s artwork. Utterly glorious for several comics, and then you start to get uncomfortable reading them, and you realise it�s because everyone in every panel is posing. Even when sitting or lying on sun beds, they look as though they are getting ready for a photoshoot. So you get sort of �Frankie�d� out, and then as you read on, he�ll write something that�ll just hit your funny bone with the force of a sledge hammer. I was sitting at my desk this morning, only to read about the part where he wakes up thinking he�s blind, and then realising he�s not wearing his glasses. He has a vague memory of vomiting out the window and looks out. Sure enough, several floors down, there are his glasses sitting in a pile of sick. I can relate to this, because he said it was one of those defining moments which tells you that perhaps you and alcohol don�t mix very healthily. I remember standing at a bustop once, managing to time my upchucking so that I could at least catch the bus, and pretending that no one could hear me violently getting rid of the glass of lime juice I had consumed in order to stop my raging thirst - it also being the only thing I could bear to have in my stomach. It�s things like that I don�t miss. So having read several pages without so much as cracking a smile, I then began making noises like a deflating space hopper, which is my attempt not to annoy people by laughing out loud. Every so often, I get overcome with mirth, which leaves me silent, breathless and shaking. Eventually, my need to breathe overcomes my need to laugh, usually a little late, so I have to take in vast amounts of air. And I wonder why I tend to end up with the room to myself. It would be easier if I could explain that I�m reading a funny book, but anyone left in the room at that point tends to avoid my eye, and edge to the door a bit more.

I tried to get rid of D yesterday��no, I told him to go back to London. I didn�t drip anti freeze in his curry or something, although with my cooking, it probably would have improved the flavour. It was just that I�d looked at the telly paper and read that on Channel five, they would be showing, �The Fantastic Four : Rise of the Silver Surfer�, followed by �Predator�, topped off with �Dawn of the Dead : The remake�. So from 5.00 to 1.45, I�d have been quite happy, but I think D would have gotten a little bored. Still, I saw most of �FF� and some of �Predator� although I think that the announcer was taking the p*ss somewhat, by calling it the prequel to �Predator 2�. Like �Jaws� is the prequel to that cinematic classic, �Jaws 3�.

You know you�re tired when you�ve written very lazily, knowing that any spell checks will be picked up by those red wavy lines, and you click on the mis-spelled word, and the spell check shrugs its shoulders and says, �I have no idea. Where you trying for the name of some Russian town when you wrote �HDVZIKIZCV��

God�s Love for All

Fri, 12 Mar 2010 00:00:00 +0100

Click on the picture to go to this site of wonderment!

God�s Love for All
Jesus you love us all and never let us fall
We only have this time to listen
to the quietness
To know that we are blest.

Do try and send out love to everyone you see
Be forgiving also to your enemies
For God will be very pleased.

Inner strength, there is plenty of
Granted to you through our love
from a dove.

As God is the only one!
You�re living through Him is done

CHRISTIAN POETRY by Patricia Gooderham

Denial

Fri, 12 Mar 2010 00:00:00 +0100

I have been thinking about my two year anniversary coming up. My profile says I was diagnosed 5/08. But is that true? T2 diabetes is a real �creep up on you� disease. And then there are those doctors. And then there is denial.

Diagnosed 5-2008.
But during 2006 I was having severe neurological problems. I fell down for no reason, I lost a lot of my eye-sight on my left eye, developed neuropathy on my left foot and left hand, lost my ability to type � my little finger on my left hand stopped obeying me, and then there was the dizziness. I don�t chat because I have to chicken peck. Hannah types circles around me before I can type a single word. I had an MRI and it came back as MS according to the radiologist. I had a second MRI and again the radiologist said MS. But my neurologist said maybe/maybe not. He tested me in all kinds of medieval torturous ways and found neuropathy. I had an evoked potential test � came back slightly positive for MS. Finally, I realized that my symptoms were too mild to get a diagnosis. I accepted neurontin for the neuropathic pain and dropped it.

Then at the end of 2006/beginning of 2007 I was once again so miserable I had to get a second opinion. This time I went to a specialist in MS. He examined me and my MRI and asked me why I was seeking a diagnosis for MS when I diabetes is much more common. So March of 2007 I asked my doctor to test me for diabetes. I had an OGTT. Yesterday I decided to look back at it. My fasting BG was 133 mg/dL (7.39 mM). After 2 hours my BG was 329 mg/dL (18.3 mM) and I was spilling over 1000 mg/dL (55.5 mM) into my urine!!!!!!! So why isn�t my diagnoses date 3-07? My doctor said I was fine. I wasn�t over weight so it would go away. No metformin, no diet suggestions, no follow up.

A year later, on a business trip, I bled to death from a GI bleed. The bleed was most likely from acute pancreatitis due to diabetes. 6 units of blood, 14 hours on a respirator, and about 8 metal coils permanently stuck in one of my arteries saved my life. My x-rays now look like I have a metal tapeworm in my belly. During that week in the ICU I was asked about diabetes. Strangely they never said why and I never asked. When I received my labs weeks later I saw that I was over 200 mg/dL (11.1 mM) even after not eating for three days and having someone else�s blood in me. Two months later I went to a NEW doctor and my A1c was 6.9. That was still with part of someone else�s blood in me. That is why I have 5-2008 as my diagnosis date. I was sick, almost died, it was time to stop the denial.

So when was I diagnosed? I failed an OGTT in 3-2007. What about before that? My wife, a nurse, had brought home a glucometer in 2006 for us to play with. One day I tested myself and had readings above 250 mg/dL after breakfast and lunch. I showed that to my doctor (plotted in Excel :) ) and he said it was meaningless because I wasn�t qualified to check my glucose. So I diagnosed myself 4 years ago.

Denial

I knew I had high glucose levels as far back as 2006. I was diabetic back then. In fact, I was so diabetic that I now have atherosclerosis, neuropathy, a bad eye, trigger finger, and most recently Dupuytren�s Contracture. Dupuytren�s Contracture? My right hand has developed painful nodules and is curling up. At first I thought it was a stigmata and I was going to invite everyone on DD to my house and cure them. But, not my luck or yours, it is yet another D complication. I have to wear two pairs of socks because it feels like I have gravel in my shoes. That�s my description of neuropathy.

See thumbnail -- it really seemed like a stigmata.

I accept some guilt for denial. I knew I had this. I didn�t want it because of the changes I knew I would have to make. I denied myself almost to death.

Doctors

The doctors didn�t help. My family physician added to my denial by telling me I was too thin to have diabetes and it would go away. What the hell does go away mean? Most T2 diabetics suffer from prejudice because they are overweight. I was prejudiced because I was not overweight. I�ve had this disease for a long time and should have been treated a long time ago.

I thought I was through all the grief stages two years ago. There is no question of acceptance. But I still carry quite a bit of anger over my history of diabetes.

Attached Thumbnails

can you feel what i felt?can you relate?

Fri, 12 Mar 2010 00:00:00 +0100

12 yrs old.year after dx.still playing sports.had to take a break though.had a low during a hockey game.suffer a low on skates once and you dont want it to happen again.embarrassed mad and scared.buddies know but dont really get it.i can say now the coach didnt know anything.but mom was there. in the cold.i suspect now she went to all sports stuff just for this reason.other team does not have a clue.all i keep saying is im fine.of course i am.we always are. until the questions start after .than i just want to hide.its to much really.
do you know what that feels like?can you really relate?as a kid?
13-14 yrs old.a crush.this is the girl i have to marry!!we are at what would be a "social" event.a "mixer".games pool pinball foosball.and food.oh and lots of parents.
as we wait to be served in the "malt" line,i am met by a hard glare.crap.my aunt.ok what ever, im cool.2 large vanillas(please god)oh no.1 large 1 very small small cup.sigh.followed by"you know you cant have this"spoken in that tone.which leads to a discussion which the young lady who will never be my wife now learns from my buddies that not only can i not have ice cream candy etc but that i take shots everyday and have to be home to eat,blah blah and blah and the greatest thing of all.i pee on a stick!!!sigh.well they were trying to help.i think.do you know what thats like?
can you be in that spot?a a kid?
16 yrs old.pissed off at the world.hate my mom.hate my life.hate school.just plain hate
it all.normal ."would you please go do what i asked you to do". no!!i dont want to!"followed by all kinds of back and forth.
end result"your grounded till your 30!". no. "i am not"."i hate it here and im leaving" oh really?"well theres the door" i mean it im going!" "the door is not locked" ok so i ran away.great move.im free!!.yea.only 2 hrs later did i realize i have no insulin, needles or food.friends offered to go get my "stuff".
cool.they came back with a message."if you want it come home and get it and stop being such a dumbbell!"i cant run away like a kid should be able to because i cant care for myself.nice.(trust me i did not live that down for yrs)can you feel what i felt?can you be in those shoes?like a kid?
17 yrs old.first "real job".where mom works.
ok it sounded like a good idea at the time.she laid down the law to the "people" on what i could and could not do.and this included meals.i was to have nothing not approved and if she found out i did there would be hell to pay.for all of us.there were way to many folks paying attention to what i was doing.i was forced to break and eat at 430.i just got there!!oh sure the others said they understood but i really doubt it.even though it was said with a laugh"why dont you start at 500" i know what they felt.
did you feel that?
no point in bringing up halloween easter or christmas .its about candy.have you had to face those days?as a kid?did you experience it with a few token jelly beans?did you really stay home and not dress up for halloween?do you know what thats like?your 11.a apple or a bag full of candy?can you relate to that?
can you know whats its like to have to explain to teachers why you were in the hospital again.in a full class?and were you planning on finishing the year or dying first.
can you know whats its like or how it feels to have coaches be afraid to "use "you because of what might happen again?
did you try to explain to a girl that what you have is not dangerous and not catching no matter what her mom said!did you do that?
do you know what that feels like?
how do you explain what a low low is?how do you explain what your mind and body do?who can describe the will to survive
while laying on the kitchen floor stuffing anything you can in you mouth.?(which by the way is a bad idea because of the choking hazard!i include that in my speech to folks i tell that i work with.only give me liquids!!having the heimlich maneuver performed on you while suffering a low may look really funny but i doubt its something i want to have done to me)
have you felt that?can you go there?
did you feel the pain in your mothers eyes and your grandmother when they realized they not only could not "weave"their magic desserts for their only daughter grand daughter(my younger sister was type 1 before me)but now could not for their oldest son/grandson.did you see that pain?did you live through that?as a kid?
hunting fishing trips with dad or grandpa.every trip they were given a tongue thrashing to do what had to be done even if i said different.they were supposed to be the adult.i think it was to scary for them.i felt so bad when things "happened'.did you go through that?as a kid?
what in life can we relate it to?nothing that i can think of.because there is nothing else like it.they are snapshots of life.life as a child kid teen young adult with diabetes.
no matter the great advancements in treatment there are still and always will be problems in a area no one wants to acknowledge.and it starts and ends in each individuals mind.these are the ways most of us grow up.stuff happens.thats life.but the added little bit of being d can push you hard.
and to deny that you still carry this things is wrong.can you really relate to any of that?

The Dr OZ Show! Airs This Thursday March 4th

Fri, 12 Mar 2010 00:00:00 +0100

The Dr. OZ show I will be on airs This coming Thursday March 4th on NBC!! Please tune in!

Me, Dr. OZ and My Husband

Thank you for the support!!
Get Up and Get Moving

Playing Solitaire By Flashlight

Fri, 12 Mar 2010 00:00:00 +0100

Our electricity was gone at 2:30 AM wednesday morning. We assumed it would be restored in a few hours. Twelve hours later we heard there were 90,000 people without electricity in our county and a neighboring county. We had about one foot of very wet snow and it caused limbs and trees to break and power lines were down in many places. Help was called from distant sources and they worked on areas where a larger number of people were affected first. Our little area involved only 44 houses so we felt it would be a long time before our power was restored.

I had computer withdrawal!!! :sosadsmiley: We wrapped up in heavy quilts and blankets as the house temperature dropped. It was 55 degrees after 24 hours. A neighbor said his house was 35 degrees. His home is not well insulated.

I became desperate for something to do. I actually resorted to reading the first proof copy of my book. I had been tired of reading it beforehand. Then I got really desperate when it was dark so early. I played solitaire with a flashlight. There was no other light source. There were two days like that. Then we heard that the projected date for restoration was sunday at 8PM, at the latest.

We made reservations at a motel for friday, saturday and sunday. We packed the car thursday evening and made appointments for our three cats at the vets. We wrapped up under a pile of covers at 9 PM that night. About 30 minutes later the clock on top of the TV came on. The electricty was restored three days earlier than we expected. :thumbsupsmiley:

We were up at 10 PM and we unpacked our car and cancelled our reservations at the motel. It did not bother us that we had to do that. We were so happy that the house was getting warm again! I was on the computer until after midnight. I don't know if I have ever appreciated my computer more! :wink3:

I learned that evening that my second PDF and new book cover had been approved and I ordered two copies. They are to arrive in our mail on March 2. If everything looks good I will have amazon start selling my book. My amazon page and site may be available in a couple of weeks, I hope. :)

Field of Innocence

Fri, 12 Mar 2010 00:00:00 +0100

"You hold the answers deep within your own mind.
Consciously, you've forgotten it.
That's the way the human mind works.
Whenever something is too unpleasant, to shameful for us
to entertain, we reject it.
We erase it from our memories.
But the imprint is always there."

(Can't wash it all away)
(Can't wish it all away)
(Can't hope it all away)
(Can't cry it all away)

"Understanding" lyrics, Evanescence

I remember how excitedly my mother told me about the woman she met who had type 1 for 30 years. I was recently diagnosed and I think she was trying to show me that I would survive this thing for a very long time. However, I was shortly past the age of 13 and to hear of someone in their 40's with this thing, well, didn't make me want to jump up and down with glee. I first thought the poor thing had to live with this for 30 years and no cure or anything even close to it? Was that fair? And I could barely cope with this thing right now. How could I hack it for decades?

I never met the woman who carried the battle with her for as long as I have today, but I understand the good intent. I can talk ad nauseum about exchange diets, counting, excluding, resisting and all of that stuff that really separated me from the rest of the crowd. However, it really seemed to be a lot of making us feel like we could endure and actually go on to be fabulous in our own way. Of course, we had to mitigate the risks as we stumbled along. I was a modest nation with no natural borders staving off the constant aggression of my chronic illness. My approach could never be called subtle.

Are we all good now that we've reached the point of longevity with the type 1? I'll have to get back to you on that. I do have enough going on to not really focus on a brutal summer day back in 1981 that had me incoherent at a friend's house without my candy. These humiliations do multiply and divide, though. We don't want to look weak. We don't want the rest of the population to see inside our little world that most people don't live in.

Taking care of me

Fri, 12 Mar 2010 00:00:00 +0100

It feels like that's all my family has been doing for days. I'm so thankful for them. They're all stressed because Mom is laid up but they are being so sweet and helpful. Not only are they looking after me better then any one could, they are keeping the house clean and in order. Wonderful people they are!!

I experienced a very slight reduction in pain for a very small portion of the day. Even with the prescrip. pain meds I don't know what to do most times but gently hold my cheek and try not to cry so I don't risk losing the clot. I can't even describe this pain. It's on a whole different level then any thing I've ever felt and its just not leaving fast enough for me. I'm in agony.

I still can't consume solid foods and don't much feel like eating anyways. I only take in the soft foods when I must so that I have something on my stomach for the meds.

I'm really whipped from the pain and haven't been able to find my way out of bed much. I don't ever wish to experience a punctured sinus ever again.

Thankfully my bgs are staying in the 5 to 7 range and I can't really complain about the 7 pounds I've lost in the last 3 days.

Help! the Carbs got me!!!!

Fri, 12 Mar 2010 00:00:00 +0100

I was doing so well.

I switched a mostly Raw/Alkalising diet last July '09, within 5 weeks i no longer needed insulin or diabetic meds.
my blood sugars have been near perfect all of that time and would only wobble when i challenged my Pancreas with Carby meals, the result was usually a sluggish PP which would be back to normal at 3 to 4 hours instead of the expected 2 hours.

I don't test too much these days, usually twice daily, fasting and bedtime. fastings typically are between 5.4 and 5.9mmols, bedtimes can be anything between 5.2 and 9.2.

Hubby and I enjoyed a Chinese take-out meal with family over the weekend, i ate more rice than usual (about 75 grams) followed by about 6 prawn crackers (resistance was futile!!!) bedtime reading was 9.2 and fasting the followng morning was 5.8mmols.

to be honest i've been eating more carby meals like that lately, i dont know why but i just had a magnet for carby input, i knew it was no good for me yet i still ate it!

Too many carbs!!! not allowing the pancreas to rest and recuperate and eating way too much has taken its toll. i have also put on 6 pounds in a couple of weeks which i dont like.

Anyway palpitations several times this past week have reminded me why i started the diet in the first place and now i have started back on track.

and now i can tell the carbs...get thee behind me!!!!

HC Blog ‘n Stuff

Fri, 12 Mar 2010 00:00:00 +0100

I wrote a post today that was published by the Health Care Blog. Head on over there to check it out. John Irvine, one of the publishers of THCB asked if I would mind if they re-published some of my posts, and so has done so. He initially put a pic of John Smoltz (from my Facebook page), who I have been told I resemble, but then got a take-down notice from the Major League Baseball Players Association. I think John is just tired of being asked if he’s me.

The comments have been plentiful over there, but the commenters are not nearly as nice as my readers here. That’s not just flattery, it’s truth. Still, it’s nice that my posts get the attention they have, as my goal is to reach as many people as possible and possibly have a small influence on the process.

————-

Oh yes, thanks to all who voted for me on the Medgadget Medblog awards. I was a distant second to Gary Schweitzer, but I was very happy with the support. Gary has a bunch of Swiss relatives who got the entire country voting for him, which means I am one of the few people defeated by the Swiss. They threatened to use that fish scaler on me if I didn’t buzz off. I think I’m more afraid of the cork screw, though.

Gary writes a terrific blog, so there is no shame in losing to him; check it out if you haven’t already (but come back, of course).

Maybe it’s all for the best. They might give away an iPad next year… I think I’ll have to start kissing babies and promising to compromise my integrity for votes as soon as possible.

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Chaos Theory

Fri, 12 Mar 2010 00:00:00 +0100

Chaos theory – Noun - The branch of mathematics that deals with complex systems whose behavior is highly sensitive to slight changes in conditions, so that small alterations can give rise to strikingly great consequences.

Alternative definition:

Chaos theory – Noun – The branch of healthcare that deals with making the payment system increasingly complex and ever changing. This complexity and confusion impact physicians and patients in such a way that appropriate services in care of the patient are subject to rules and regulations that are deliberately complex, making alterations from the momentary rules inevitable. This exists so that even small alterations will free the insurance company from the responsibility to pay for said service.

I am no physicist, but I honestly think that a grasp and understanding of the first type of Chaos theory is more likely than that of the second. Let me give a demonstration of the second chaos theory in action:

Step 1: Patient comes in to be seen.

Step 2: What insurance do they have?

Step 3: Patient produces insurance card

Step 4: Office has to verify that this plan is actually valid for this patient, with several alternatives:

The insurance is valid.
The patient has changed insurance but still holds an old card.
The patient has been dropped from the insurance due to nonpayment or losing employment.

Step 5: Once verified, the patient does one of several things:

Pays copay where that is required.
Pays past due balance.
However, if past due balance is due to the insurance company not paying on a claim yet, the patient won’t be required to pay (as long as it is a reasonably short period of time).
Does not pay (either because of insurance like Medicaid that pays in full or because of indemnity insurance).

Step 6: Insurance card is scanned in, documenting what patient presented at the time of the visit and giving access to the card by clinical staff for the rest of the visit.

Step 7: Once settled, the patient comes back to the office to be seen by the medical staff.

Step 8: Patient is seen by clinician.

Step 9: If procedures are performed, they may or may not be billed by clinician, depending on insurance coverage. Several possibilities exist:

The procedure is covered.
The patient has Medicare or Medicaid, which does not pay for certain services. In this instance, the procedure code pays less than simply coding the visit at a higher level (E/M) due to complexity of the visit.
The patient has HMO which is paid by cap and the procedure is not an “over and above” and so won’t be covered. Here it doesn’t matter if the procedure is billed or not.

Step 10: If immunizations are given, the insurance must be checked to see if the vaccine is covered. Since there are numerous plans under a single insurer, simply knowing the name of the insurer (eg. Aetna, United Health Care) does not guarantee coverage. Of ten this results in step 10a, which is for the clinical staff to call the insurance company and ask directly if the immunization is covered (the results of which are only somewhat reliable).

Step 11: Once insurance coverage of the immunization is determined, several possibilities exist:

The immunization is covered and so is taken from regular stock and administered to patient
The immunization is not covered, but others are by the insurance company. In this case, the patient is informed by the billing staff that they will have to pay out of pocket for this before the immunization is given. The patient is generally aghast at the cost and often foregoes the immunization, making step 10 superfluous.
Immunizations are not covered by this insurer or the patient has no insurance and the patient is a child. In this case, the immunization is taken out of a different stock of vaccines (“Vaccines for Children”) and given. The procedure is billed under an entirely different code.
The patient has Medicare, and the immunization is not covered (like Zostavax, the shot for shingles). In this case, the patient is given a prescription for the immunization and picks it up at the pharmacy, brings it back, and gets it administered by the nurse.

Step 12: If the patient requires labs, the patient’s insurance needs to be checked so they can go to the proper lab. A single payer such as Aetna cab have different policies that require different lab facilities to be used, so there is significant risk that the sample will be sent to the wrong lab. Here, too, several possibilities exist:

The patient can get the labs drawn in the office, and it does not matter which lab is used. In this case, the nurse sends the sample to the lab which is easiest for us to use.
The insurance company allows “pass through billing,” which allows our office to bill for the labs and pay the lab a negotiated amount.
The insurance company specifies a lab that picks up samples from our office, in which case we draw and put the samples in the collection bin for that lab.
The insurance company specifies a lab that does not pick up samples, in which case we send the patient with a printed requisition to get labs drawn at that facility.
The lab sample cannot be drawn here (needs to be frozen, for example) or the patient does not want the test drawn at the time of the visit. In this case, the proper lab facility needs to be determined and the appropriate requisition filled out and given to the patient.

Step 13: If the patient requires an x-ray to be done, it needs to be determined if the insurance requires authorization for that x-ray. Several possibilities exist:

The insurance does not require authorization and does not specify where the x-ray must be done, in which case the patient is given a requisition and told to go to the preferred facility.
The insurance does not require authorization, but specifies a specific facility. In this case, the patient is told to go to the appropriate facility.
The insurance requires authorization, in which case a note is sent to our referral coordinator (full time position), who gets authorization and then informs the patient where the procedure needs to be done.
The insurance does not require authorization, but the procedure must be scheduled. In this case, the referral coordinator is notified of the request and schedules the procedure with the preferred facility.

Step 14: If the patient requires a referral, it needs to be determined which physicians or facilities are on the list of providers for that insurance. This too can vary under different plans, as HMO will be very specific, PPO’s will be somewhat specific, and indemnity insurance will not be specific as to which providers must be used. Furthermore, some types of referrals do not require referrals (dermatology, ob/gyn, ophthalmology, psychiatry) and so the patient is told to make their own appointment. Once it is determined which physician to use, there are several possibilities that exist:

The visit is urgent, and the insurance does not require authorization. In this case, the patient stays until the appointment is made by the referral coordinator.
The visit is urgent, and the insurance company does require authorization. In this case, the referral coordinator gets authorization from the insurance company, then calls the referral facility to make an appointment, giving them the authorization number. The referral coordinator must know just how urgent the visit is (immediate, today, this week?) and depending on that, either makes the patient stay until the appointment is made.
The visit is non-urgent and the insurance does not require authorization. The appointment is made by the coordinator and the patient is contacted by phone/email with details.
The visit is non-urgent and the insurance requires authorization. Same as above, plus authorization.

Step 15: If the patient requires a prescription, it several non-clinical factors come into play:

Is the drug on the formulary for the patient’s insurance? This can vary with plans, and so may be different under a single carrier.
If on formulary, what tier is it? If it is a higher tier, the patient may not be able to afford it or be willing to pay.
If not on formulary, which drugs in the class are? Have others been tried?
If not on formulary and still necessary, what is the process to get this authorized? In this case the prescription is given, the patient gets it filled, the pharmacy notifies us of the need for PA, and we try to obtain it. This process can take up to 3 weeks.
If denied by the insurance company and still necessary, what is the process for appeal?
If patient has to pay out of pocket, then which drugs are cheap and which do we have coupons for?
If patient is Medicare, then we cannot give coupons (because for some reason it is wrong to make the government pay less).

Step 16: The patient is dismissed with a plan and is scheduled for a follow-up appointment.

Step 17: The patient is asked to pay the remainder of the balance at check-out, depending on what the doctor ordered and what was done in the office.

Pitfalls

There are a number of possible pitfalls.

If the patient supplies the wrong insurance information, then all of the above is invalid and may not be covered
If the patient (or their blood) is sent to the wrong lab, x-ray facility, or referral facility, the insurance company will not cover the procedure (even if appropriate)
If the patient is sent for an appropriate referral to an approved facility, but the proper authorization is not gotten, the visit will not be covered.
If the lab/referral/consult is sent with the wrong diagnosis code, or one that is no longer valid, the insurance will not cover.
If the lab is done at all early (under 3 months for a Hemoglobin A1c, for example), the insurance will not cover.
If the immunization is given even 1 day early, it will not be covered, and won’t be counted as being given.

Who pays for these pitfalls? Either the patient (who then gets mad at the doctor for doing it wrong), or the doctor’s office.

Confusing? Yes, that’s my point. Multiply all of this times the number of different insurances the office accepts (including all managed Medicare and Medicaid), and watch what chaos ensues. Who benefits?

Not the doctor.

Not the patient.

Not nurses.

Hm…. Who’s left?

Getting There Those who read me much know I have a very...
I’m Sorry I am very worried about many of the things proposed...
I Work for a Living “Patient was very angry about this. Are you going...

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HIMSS From the Front Line

Fri, 12 Mar 2010 00:00:00 +0100

It’s happening right now!

The Healthcare Information and Management Systems Society (HIMSS) conference is going full blast in Atlanta and Better Health is on the scene, bringing us interviews and information from the latest in telemedicine/emedicine!

The Ustream is live right now:

Live Video streaming by Ustream

Dr. Anonymous and Dr. Val are interviewing the leading healthcare technology entrepreneurs!

Unbelievable stuff for nursing here!

HIMSS From the Front Line

Five Years On?

Fri, 12 Mar 2010 00:00:00 +0100

Well, this is creepy!

It’s a photo from the Library of Congress‘ digital nursing collection.

It looks like a still from a Hitchcock film.

She’s going to the light….

Actually, she is probably going down to central supply for gauze.

Wouldn’t be surprised if Rod Serling stepped into view…

“Nurse Nell is about to take a step…into the Twilight Zone…”

Oh geeze, now I’m freaking myself out.

********************

I came across a blog post today. I was floored.

I have reprinted it here with permission:

I�ve come to terms with something recently; I have absolutely NO urge to get my BSN.

I used to think that I should, if I could and that I would. Eventually. Now the kids are virtually grown, I have the time, I could swing the funds and I don�t want it. I�m a bedside nurse. Always have been, with the exception of a foray into psych nursing and telephone triage. It�s what I love, when you get down to the core of why I�m a nurse. It�s what I am good at. It�s what my Associate degree prepared me for.

The thought of writing papers and researching and comparing differing nursing models while dealing with the obnoxious topic of nursing diagnoses makes me comatose. (Good ol� Sister Callista Roy�s Adaptation Model was good enough for me in school and it is good enough for me now…)

Ironically, I love learning! I read the journals, I love attending classes, and working… requires me to keep up-to-date on all the specialties. I want to increase my fluency in Spanish, take a class on Shakespeare, pick up a violin � maybe even learn to play it, speak Japanese and, well, you get the idea.

But�.I�ve no interest in managing a department, I respect those who can. Teaching is not one of my gifts. I enjoy the hospital environment; I�ve never been interested in public health nursing. I�ve never needed a BSN to accomplish what I�ve wanted in my career.

*****

Wow.

Sounds like the writer is pretty adamant.� I should be so sure of myself.

And I was.

Back when I wrote this in September of 2005.

*****

So what changed?

I started blogging. Writing about nursing made me think about nursing. Really think about it.� I started reading the blogs of nursing students.� They were so excited to be entering the profession. Excited. I hadn’t felt that way in years. What did they see in nursing that I no longer saw? Why were they sacrificing so much to embark on a career I had come to take for granted?

I wanted what they had.

I would get that BSN.� I only looked at two programs. I chose the University of Green Bay’s BSN-LINC program. To this day I can’t tell you why. It just felt right.

Of course, I’d take it nice and easy and enjoy the process, like your typical Type A personality.

Yeah, right.

Oh, I’ve enjoyed the process. But like Ike and Tina, I “nevah, evah do nothin’ nice. And easy.”

Well, it turns out I love research, am fascinated by nursing theories, get a thrill out of producing a perfect APA paper and think public health nursing rocks.

I’m such a nerd!

Bedside nursing is wonderful,� but there are public health programs to produce, nursing research to conduct and new generations of colleagues to educate.

And maybe, just maybe, I’ll have something to contribute to those areas, as well.

�

Five Years On…

42000 Year Old Baby Mammoth Gets CT MRI Scanned

Fri, 12 Mar 2010 00:00:00 +0100

GE Health donated time on their latest CT and MR systems for researchers from the Field Museum in Chicago to image the insides of an ancient baby mammoth. Lyuba, apparently one of the finest preserved mammoth specimens, was found by a Siberian reindeer herder three years ago. Now, thanks to modern technology, the researchers believe they know the cause of death of the mammoth. Lyuba is currently on view at the "Mammoths and Mastodons: Titans of the Ice Age" exhibit at the Field Museum. Of course, there's also something to be said for today's tomography scanners with bore sizes that can accommodate a mammoth.

First, she was scanned on the Discovery CT750 HD, a 64-slice, high definition CT scanner. The images obtained from this scan allow scientists to learn more about her internal mineral deposits as well as her bone structure. Second, in an effort to see her entire skeletal structure from head to tail, she was imaged on the Innova® 4100IQ, a three-dimensional digital X-ray system. Finally, Lyuba was scanned on a high performance open MRI system, the Signa OpenSpeed EXCITE 0.7T, to view her soft tissue including the brain, liver and heart.
The scientists studying Lyuba also have been trying to determine what caused her death. As best as they can tell, she became trapped in a mud hole and inadvertently ingested mud. With the CT scan, the scientists now have evidence of silt in her trunk and in her lungs that confirm her cause of death as accidental suffocation. The cause of death is important because the scientists can reconfirm that Lyuba was not ill or poorly developed, factors that might negate her value as a normal mammoth specimen.

GE press release: Ice-age mammoth in space-age scan at GE Healthcare ...

Exhibit: Mammoths and Mastodons: Titans of the Ice Age

New Technology Stabilizes Viral Vaccines for Room Temp

Fri, 12 Mar 2010 00:00:00 +0100

Researchers from Oxford University and Nova Bio-Pharma Technologies out of Leicester, UK have been able to keep viral vaccines stored at relatively high temperature without losing their effectiveness. The technology is showing promise in being able to ship unrefrigerated vaccines to remote areas where they're most needed.

Oxford University carried out the proof-of-concept study, showing that vaccines they are developing could be stabilised for months using Nova’s patented technology, called the Hypodermic Rehydration Injection System (HydRIS).
The team demonstrated it was possible to store two different virus-based vaccines on sugar-stabilised membranes for 4–6 months at 45°C without any degradation. The vaccines could be kept for a year and more at 37°C with only tiny losses in the amount of viral vaccine re-obtained from the membrane.

The method involves mixing the vaccine with the sugars trehalose and sucrose. The mixture is then left to slowly dry out on a simple filter or membrane. As it dries and the water evaporates the vaccine mixture turns into a syrup and then fully solidifies on the membrane.

The thin sugary film that forms on the membrane preserves the active part of the vaccine in a kind of suspended animation, protected from degradation even at high temperature. Flushing the membrane with water rehydrates the vaccine from the membrane in an instant.

Abstract in Science Translational Medicine: Long-Term Thermostabilization of Live Poxviral and Adenoviral Vaccine Vectors at Supraphysiological Temperatures in Carbohydrate Glass

Oxford press statement: New method makes vaccines stable at tropical temperatures ...

Sorins C5 CPB Machine Gets Green Light in US

Fri, 12 Mar 2010 00:00:00 +0100

Milan, Italy based Sorin Group has received FDA approval for the firm's S5 Heart-Lung Machine. In its press release, the company touts C5 as a highly advanced "lighter in weight and more compact" system that has "excellent manoeuvrability and a well thought-out, logical structure, functional ergonomic design and reliable safety systems. Its solid, brushed stainless steel housing reflects the product's high quality." The cardio-pulmonary bypass (CPB) system has already earned European CE Mark of approval last year.

Add'l features:

Console for 3 to 5 roller pumps

2 additional roller pumps can be mounted on the mast

Panel with 3, 4 or 6 display modules

Flexible mast system

Pump heads can be rotated into position to optimize tubing layout

Two vertically and one horizontally moveable masts for mounting external devices and disposables

Up to four TFT displays can be stacked vertically in the mast panel and each can be configured according to your required perfusion parameters

The brushless, direct-drive motor of the roller pumps reduces noise and vibration, making S5 one of the quietest systems of its kind

The footprint of the S5 has been reduced by 20% and overall weight has been reduced by 10%

System panel can be easily mounted and adjusted both horizontally and vertically

High resolution TFT displays enable the perfusionist to easily view displayed values from greater distances and at an angle of up to 140 degrees

Full text messages for alarms and warnings

One key each for muting, clearing and overriding alarms

Differentiated alarm tones

Quick and easy replacement of all DCMs

UPS can bridge a power failure up to 130 minutes (20 minutes at full load)

Speed adjustments are performed via an Incremental Encoder, a maintenance-free technology that increases longevity and reliability

Clearly structured, intuitive and descriptive menu system eliminates guesswork, and one-touch accessibility improves user convenience

Miniaturized sensor modules utilize 100% SMD technology

Operated by PC-independent software using state-of-the-art microcontrollers in conjunction with a high-integrity serial CAN bus

No boot time required after power-up—the system is ready for operation within 3 seconds

Product page: S5 HLM...

Press release: SORIN GROUP ANNOUNCES U.S. FDA CLEARANCE OF NEWEST GENERATION HEART LUNG-MACHINE (.pdf)...

H pylori Gene Regulation Decoded

Fri, 12 Mar 2010 00:00:00 +0100

A team of European researchers discovered a set of 60 sRNA's (small ribonucleic acids) that are responsible for gene regulation within the pesky ulcer causing Helicobacter pylori bacteria. Until now it was not clear where gene regulation came from in this bacteria.

The decoding of the H. pylori genome in 1997 revealed this pathogen to possess surprisingly few genes for transcriptional regulators, sparking a number of crucial questions: Where do the genes of Helicobacter start, and how are these switched on and off? Have all genes been discovered already?
Researchers have been searching for new types of gene regulators in this pathogen, especially for sRNAs. It has recently been realized that these tiny RNA particles are far more abundant in all organisms than previously thought. They can regulate genes by binding to sequences of the genetic information, thereby inhibiting the production of a protein. Yet strangely enough, sRNAs seemed to be lacking in Helicobacter. Jörg Vogel, leader of the RNA Biology Group at the Max Planck Institute for Infection Biology, and his team have finally tracked down a number of sRNAs in the pathogen. To enable their discovery, they modified a technique called "deep sequencing", to decipher millions of RNA-sequences newly produced in a cell. The surprised scientists found 60 sRNAs: "To date, it was believed that this organism completely lacks sRNAs", says Vogel.

"We found as many sRNAs in Helicobacter as in widespread intestinal bacteria like Escherichia coli or Salmonella", explains Vogel. But a very important protein required for the regulation of gene expression by sRNAs is missing in Helicobacter pylori. The stomach pathogen possibly uses different signalling pathways, which makes it a possible candidate as a model in RNA-research. "We hope to get completely new insights into gene regulation", says Vogel.

Thanks to the novel technique, the researchers could also define the starting point of every gene in Helicobacter.

Abstract in Nature: The primary transcriptome of the major human pathogen Helicobacter pylori

More from Max Planck Society for the Advancement of Science: Gene regulation: Can we stomach it? ...

Ins and Outs

Fri, 12 Mar 2010 00:00:00 +0100

Obama Readies a Fallback Health-Care Proposal... [WSJ]

What happens next in health care... [Politico]

What Obama Wants in the Health-Care Overhaul... [WSJ]

FDA Approves Pneumococcal Disease Vaccine with Broader Protection... [FDA]

'Seek, test and treat' slows HIV... [Nature]

Study: Half of Infection Deaths Linked Directly to Hospital Care... [WSJ]

Covidien Announces New Source of Vital Medical Isotopes... [Covidien]

Physio-Control Resumes Unrestricted Global Shipments of Its LifePak® Defibrillators... [Medtronic]

ITGI wins $1m stent order for clinical trial... [Globes]

ETview in reverse merger with First SBS ... [Globes]

Philips and VU Medical Center Amsterdam sign long term research agreement aimed at new multi-modality imaging solutions... [Philips]

Ethicon Endo-Surgery Announces Agreement with Hologic Inc. To Resolve Patent Disputes... [J&J]

FDA Announces New Safety Controls for Long-Acting Beta Agonists, Medications Used to Treat Asthma... [FDA]

FDA Announces Possible Safety Concern for HIV Drug Combination... [FDA]

Published Study Demonstrates Patients with Low Hemoglobin Levels Can be Managed Without Blood Transfusions ... [Masimo]

Statins: Still worth taking... [Nature Blogs]

Researcher decodes a molecular process that controls the growth of nerve cells... [Max Planck Society for the Advancement of Science]

Induced Pluripotent Stem Cells From Patients With a Premature Aging Disorder Bring Surprises... [Johns Hopkins]

The mystery of symmetry is revealed... [CNRS]

What Model Organisms Can Teach Us about Emotion... [HHMI]

New Tool Illuminates Connections between Stem Cells and Cancer... [HHMI]

The microRNA network and tumor metastasis... [Oncogene]

Web 2.0 in Action in Hospitals... [ScienceRoll]

Sight savers: New weapons trained on blindness... [New Scientist]

Cell phones show human movement predictable 93% of the time... [Arstechnica]

Skype helping dementia patients, families stay in touch... [Computer World]

Caltech Scientists Investigate Physiological Evidence of Brain's Response to Inequality... [Caltech]

Pregnant curler competing in Olympics... [SCOPE]

Photoacoustic Method Screens Lymph Nodes for Cancer

Fri, 12 Mar 2010 00:00:00 +0100

University of Missouri researchers developed a laser induced ultrasound method to image the general consistency of lymph notes. If the technology becomes clinically useful, this can help oncologists, pathologists, and general surgeons to screen the progress of melanoma faster and less invasively than by doing sentinel node biopsies or by other current methods.

From the study abstract in Journal of Biomedical Engineering:

Melanoma is the deadliest form of skin cancer and has the fastest growth rate of all cancer types. Proper staging of melanoma is required for clinical management. One method of staging melanoma is performed by taking a sentinel node biopsy, in which the first node in the lymphatic drainage path of the primary lesion is removed and tested for the presence of melanoma cells. Current standard of care typically involves taking fewer than ten histologic sections of the node out of the hundreds of possible sections available in the tissue. We have developed a photoacoustic method that probes the entire intact node. We acquired a lymph node from a healthy canine subject. We cultured a malignant human melanoma cell line HS 936. Approximately 1×10⁶ cells were separated and injected into the lymph node. We also had a healthy lymph node in which no melanoma cells were implanted. We used a tunable laser system set at 532 nm to irradiate the lymph nodes. Three piezoelectric acoustic detectors were positioned near the lymph node to detect photoacoustic pulses generated within the lymph nodes. We also acquired lymph nodes from pigs and repeated the experiments with increased amplification and improved sensors. We detected photoacoustic responses from a lymph node with as few as 500 melanoma cells injected into the tissue, while normal lymph nodes showed no response. Photoacoustic generation can be used to detect melanoma micrometastasis in sentinel lymph nodes. This detection can be used to guide further histologic study of the node, increasing the accuracy of the sentinel lymph node biopsy.

Full story: The Sound of Melanoma Can Help Doctors Find Cancer ...

Abstract in the Journal of Biomedical Engineering: Photoacoustic Detection of Melanoma Micrometastasis in Sentinel Lymph Nodes

A New Tool to Analyze Cardiac Cell Health Distribution of Adrenergic Receptors

Fri, 12 Mar 2010 00:00:00 +0100

Researchers at Imperial College London have developed a new cellular physiology imaging technique called Scanning Ion Conductance Microscopy (SICM) to analyze the surface of cardiac muscle cells. The new method, based on a combination between nanoscale live-cell scanning ion conductance and fluorescence resonance energy transfer microscopy, is already answering some questions about the relationship of heart failure and ischemia to myocardial health.

There are two types of receptors for adrenaline. The first, beta1AR, strongly stimulates the heart to contract and it can also induce cell damage in the long term. The second, beta2AR, can slightly stimulate contraction but it also has special protective properties. For today's study, the researchers combined SICM with new chemical probes which give fluorescent signals when beta1AR or beta2AR is activated.
They found that the beta2AR receptors are normally anchored in the t-tubules, but in those cells damaged by heart failure they change location and move into the same space as beta1AR receptors. The researchers believe that this altered distribution of receptors might affect the beta2AR receptors' ability to protect cells, and lead to more rapid degeneration of the failing heart.

One of the most important categories of drugs for slowing the development of heart failure are the beta-blockers, which prevent adrenaline from affecting the heart cells by targeting the beta receptors. The new finding increases understanding of what happens to the two receptors in heart failure and could lead to the design of improved beta-blockers. It may eventually help resolve an existing debate about whether it is better to block the beta2AR receptors as well as the beta1AR.

For the study, the researchers looked at single living cardiac muscle cells in a culture dish, taken from healthy or failing rat hearts. They stimulated the beta1AR and beta2AR receptors using drugs applied via nanopipette inside the t-tubules on the heart muscle cell.

Abstract in Science: β2-Adrenergic Receptor Redistribution in Heart Failure Changes cAMP Compartmentation

Press release: Researchers gain detailed insight into failing heart cells using new nano-technique ...

SCUT Slices Through Clothes Belts Zippers for Quick Access to Patient

Fri, 12 Mar 2010 00:00:00 +0100

Ivor Kovic, our former editor and an ER doc in Croatia, has been very fond of a new clothes removal tool his ambulance service has been using in the last few months. Ivor says that the S-CUT is faster than any scissors and it can slice just about any normal clothing people wear on a daily basis.

From the product page:

S-CUT replaces scissors, knifes and similar tools. Ordinary fabrics as well as leather belts, zippers and heavy outerwear can be easily cut. All you need is a free edge of the clothes where you can start the cut.

S-CUT is designed for optimal ergonomics and provides an excellent grip. Using scissors in heavy materials will most often require a lot of effort. The S-CUT is used with a pulling action requiring minimal effort.

The circular cutting blade is recessed in order to protect the patient and user from injury. The cutting blade can be easily replaced without the need for any additional tools.

Model S-CUT 06-601 also has a slitting function. This extra feature eliminates the need for a free edge
to start the cut. Simply cut a slit into the material wherever you need it.

Product page: S-CUT ...

Better Health Coverage of HIMSS Starts Today

Fri, 12 Mar 2010 00:00:00 +0100

HIMSS10, one of the world's premier conferences on medical information and technology management, begins today in Atlanta, Georgia. Better Health, a community of medbloggers we are proud to be a part of, will be providing extensive coverage of the event. Dr. Nick Genes of Medgadget, Dr. Val Jones, CEO of Better Health, and Dr. Mike Sevilla who writes at Dr. Anonymous will be taking interviews, checking out the latest gear, and giving access to the vendors and presenters at the conference.

Here are the ways to keep an eye on HIMSS10:

1. Watch live interviews of exhibitors, conducted by physicians on UStream. Tune in to Dr. Val's UStream coverage (beginning at 9:30am each morning at HIMSS, March 1, 2, and 3rd). Click here: http://www.ustream.tv/channel/live-from-himss-what-s-hot-in-health-it

2. Participate in real time via Twitter. Follow @drval and tweet your questions to her during the interviews. She may ask the interviewees YOUR questions LIVE. To follow Dr. Val, go to: http://www.twitter.com/drval or follow the Twitter hashtag #HIMSS10 during the event to see tweets from UStream attendees and others.

3. Meet the bloggers at HIMSS. There will be a special panel discussion with Dr. Val and other popular health IT bloggers scheduled in the HIMSS Social Media Center. Check here for times: http://www.himssconference.org/education/socialmedia.aspx

4. Watch Dr. Val Reporting from HIMSS on ABC News (DC only): Tune in to News Channel 8 at 10:50am, Wednesday March 3rd to get Dr. Val's take on the hottest technology presented at HIMSS. Dr. Val will join ABC News' Dave Lucas via Skype.

5. Follow the Better Health blog team. Better Health contributors - nurses, doctors, and health writers - will offer feedback via their blogs on HIMSS events, speakers, and exhibitors. You'll see their blog posts on their individual blogs and also at Better Health. Flip cam clips of HIMSS events (captured by one of the Better Health MDs at HIMSS) will be featured as well.

6. Blog Talk Radio: HIMSS Wrap Up With Dr. Val and Dr. Anonymous. Tune in to the Dr. Anonymous show at 8pm ET, Wednesday, March 3rd to hear final impressions about the show. Call in to discuss the event with hosts, or join the chat room. Find the show here: www.blogtalkradio .com/doctoranonymous

Pantecs PLEASETransdermal Therapeutic System Shows Early Clinical Success

Fri, 12 Mar 2010 00:00:00 +0100

Pantec Biosolutions of Liechtenstein just announced positive results from a Phase I clinical trial of the FSH (follicle stimulating hormone) patch when used in conjunction with the firm's proprietary P.L.E.A.S.E. microporation drug delivery device. The system, profiled by us before, uses painless lasers to create cutaneous micropores prior to transdermal injection of large molecular weight drugs. The P.L.E.A.S.E. system is designed to be flexible in the number of the micropores and the depth of delivery, allowing to fine-tune the amount of a therapeutic injectate.

From the latest announcement:

Although smaller peptides and some proteins have previously been delivered transdermally, this is the first time a molecule as large as this protein (32 KDa) has been successfully delivered in this way.

The purpose of the study was to investigate the primary pharmacokinetic characteristics as well as the safety and tolerability of the newly developed FSH protein patch in healthy male volunteers. Due to its size and physicochemical properties FSH, a 32 KDa protein hormone, cannot permeate passively across intact skin. Therefore, prior to patch application, the skin was microporated using Pantec Biosolutions’ P.L.E.A.S.E.® laser device. This pre-treatment creates microchannels in the skin’s outermost layer, the stratum corneum, that facilitate FSH transport through the skin and accelerate its entry into the systemic circulation.

The serum profiles further demonstrated that the P.L.E.A.S.E.® – FSH patch combination was able to achieve reproducible pharmacokinetics with negligible inter-individual variability. All of the volunteers considered the method to be convenient and easy to use, and there were no reports of any adverse events.

Product page: The P.L.E.A.S.E. - platform ...

Animation showing the functionality of the P.L.E.A.S.E. system...

Press release: Pantec Biosolutions reports successful Phase I for delivery of FSH using P.L.E.A.S.E. ...

Flashbacks: P.L.E.A.S.E. = Painless Laser Epidermal System ; P.L.E.A.S.E. To Improve Effectiveness of Drug Patches

RoSS Simulator Preps Surgeons to Use da Vinci Robot

Fri, 12 Mar 2010 00:00:00 +0100

Researchers from Roswell Park Cancer Institute and State University of New York at Buffalo, developed a surgical simulator to help train physicians to operate the da Vinci robot. The RoSS Robotic Surgical Simulator has been turned into a product and commercialized by a spinoff called Simulated Surgical Systems of Williamsville, NY. Practicing physicians and students can train on common tasks like suturing and knot tying, and even perform complete procedures like radical prostatectomies and hysterectomies.

Features of the device:

Stand-alone surgical simulator that is independent of a surgical robot, vision cart

Cost of operating the RoSS is minimal as no consumables or disposables are required

The RoSS data management system allows performance analysis and measurement tools to objectively measure and record performance

User does not require monitoring thus enabling maximum flexibility and opportunity for training

Surgical procedures can be rehearsed

New surgical procedure modules can be added to the RoSS

RoSS does not require an operating room environment and can be set up in a location most advantageous to access and training needs

RoSS has a monitor which allows a user or tutor to observe the procedure

Comprehensive curriculum to train for motor, and cognitive skills required to operate surgical robot

Suite of simulated surgical procedures for fellow or resident to follow, and recreate the surgical steps of an expert surgeon

Press release: Introducing RoSS, a "Flight Simulator" for Robotic Surgery ...

Product page: RoSS Robotic Surgical Simulator ...

Molecular Venus Flytrap Grabs and Holds Onto Cesium Ions

Fri, 12 Mar 2010 00:00:00 +0100

Researchers from Northwestern University and Argonne National Lab have developed a material that can grab and encapsulate radioactive cesium isotopes, much like a Venus Flytrap does with flies. Cesium is an abundant byproduct of nuclear waste and has been difficult to concentrate/separate when cleaning up superfund sites polluted with the substance.

The new material, a rigid frame composed of metal sulfides, has a negative charge. Its pores, therefore, attract positively charged ions. This makes it a good candidate for ion exchange—when immersed in a solution with other positive ions, the ions tucked inside the pores switch places with the ions outside.
Sodium ions do this dance freely, switching as many times as they're immersed. However, when the team filled the material with cesium ions, they refused to move out of the material.

To find out why the material trapped cesium but not sodium, Kanatzidis [Mercouri Kanatzidis, Argonne] and Ding [Nan Ding, Northwestern] had to come up with an image of the material's crystalline structure itself. They found that sodium bonded strongly to the water in the solution, which prevented it from becoming trapped by the framework; but a cesium ion doesn't form strong bonds with water molecules, so it has less protection. The ion binds to several sulfur atoms in the rings of the framework, causing the rings to change shape, and the hole is sealed shut.

Press release: New material traps radioactive ions using "Venus flytrap" method ...

Abstract in Nature Chemistry: Selective incarceration of caesium ions by Venus flytrap action of a flexible framework sulfide

Pawan Sinha How Brains Learn to See

Fri, 12 Mar 2010 00:00:00 +0100

Pawan Sinha, a vision scientist at MIT, spoke at TED India last November about his research into the way the brain learns to interpret sight. His studies are part of a project to bring vision to children in India born with childhood cataracts.

Link @ TED: Pawan Sinha on how brains learn to see..

The 2010 DiabetesMine Design Challenge Announced

Fri, 12 Mar 2010 00:00:00 +0100

We are really excited to be a part of this year's DiabetesMine Design Challenge. This is a truly unique competition to spur the development of new products and services for patients with diabetes. This year's contest features three grand prizes worth $7,000 each. There is also a kids prize in its own creative category.

Last year's competition brought together fantastic ideas and devices, and we're looking forward to new concepts this year to make diabetics' lives better, more manageable and enjoyable.

More details from the official announcement:

This competition is open to any individuals or organizations passionate about diabetes and product design – whether you're an enterprising patient or parent, a startup company, a design student, an independent developer or engineer, or a pharma R&D pro. Entries from participants age 17 and under are also welcome, and will be judged in a separate category.
To help refine and realize their design concepts, three winners will each receive the following prizes:

$7,000 in cash, plus:

a complementary consulting session with Health and Wellness experts at the global design and innovation firm IDEO

a free access ticket to the “innovation incubator” Health 2.0 Conference planned for October 2010 in San Francisco, CA

introduction to Silicon Valley investors and other relevant experts

additional hands-on assistance towards commercialization of your design idea, as appropriate

Two additional prize categories will also be awarded -- $1,000 cash each for the “Most Creative Idea” and the “Best Kids’ Concept” (age 17 and under). Total cash prizes are $23,000.

Also new this year is open community voting on the website, which will determine the top 10 finalists for this competition. Final winner selections will be made by a group of judges, including individuals with expertise in diabetes care, medical technologies, design, and venture capital funding. Submissions are accepted in the form of a 2-3 minute video to be uploaded to the DiabetesMine YouTube channel, or a 2-3 page written "elevator pitch" plus supporting graphics, also to be uploaded online. The deadline for entries is Friday, April 30th, 2010, at 11:59 pm Pacific time. Winners will be announced on Friday, June 11th, 2010.

Link: The 2010 DiabetesMine™ Design Challenge

Press release: DiabetesMine™ Launches 2010 Design Challenge; Fostering Innovation to Improve Life with Diabetes ...

Flashback: The 2009 DiabetesMine Design Challenge Winners Announced

New fMRI Approach Pinpoints Early Brain Disease

Fri, 12 Mar 2010 00:00:00 +0100

University of Oxford researchers have been using a technique called Resting-state fMRI to detect similarities among people with a common brain condition. In a paper published in the Proceedings of the National Academy of Sciences, the scientists had people undergo fMRI scanning while doing nothing at all. This provided a baseline reading which can be correlated with readings of others:

The group at FMRIB [Centre for Functional Magnetic Resonance Imaging of the Brain], led by Dr Clare Mackay and Steve Smith, has already shown the value of the technique. Last year they found differences in young people’s brain activity using resting-state fMRI according to whether or not they had a gene variant that is linked to increased risk of Alzheimer’s. This difference in brain activity is decades before any symptoms of the disease would be apparent.
Clare said at the time: ‘We have shown that brain activity is different in people with this version of the gene decades before any memory problems might develop. We’ve also shown that this form of fMRI, where people just lie in the scanner doing nothing, is sensitive enough to pick up these changes. These are exciting first steps towards a tantalising prospect: a simple test that will be able to distinguish who will go on to develop Alzheimer’s.’

As well as the potential clinical relevance of this form of brain scanning, the hope is that resting-state fMRI could connect differences in people’s brain activity with factors like age, sex, genes, behaviour, or disease progression.

Another great advantage of resting-state fMRI is that everyone will be conducting their experiments in the same way. This means that data can be combined from groups all over the world to map out the functioning networks in the brain - essentially giving the complete wiring diagram of the brain.

This is what the new paper by the international collaboration set out in PNAS this week. They show how it is possible to combine data from over 1000 volunteers collected at 35 different centres across the world (including Oxford). With all the data, they show they find the same patterns of networks functioning in the brain and are able to begin to see differences between different groups of people by age and by sex.

The PNAS paper compares this approach to genomics. Indeed, the maps produced of connections in the brain are being called the ‘connectome’ in the same way that the genome is the map of all our genes.

Steve Smith does see the analogy with genomics, suggesting that mapping out the connections which determine how our brains work is similar in concept to decoding our genes to discover how our body works. And there is also the similarity in approach - big international consortiums gathering data to pinpoint variation between people to gain more understanding about disease.

Abstract in PNAS: Toward discovery science of human brain function

Oxford press statement: Resting brain reveals connections ...

Psychotropics and Youth Part 2 ? The Solutions

Fri, 12 Mar 2010 00:00:00 +0100

“Prescribed psychotropic medications are now high on the research agenda,” assert Lakhan and Hagger-Johnson. Their study advocates new approaches to research to address the rising concern over dramatic increases in psychotropic prescriptions for both children and young.

Our first post delineated the five erroneous myths often adhered to when prescribing youth’s psychotropic medication. Here are the three areas of recommended research to address this “alarming” problem. … [visit site to read more]

Brain Blogging FortyNinth Edition

Fri, 12 Mar 2010 00:00:00 +0100

Welcome to the forty-ninth edition of Brain Blogging. In this round, we try to undercover the neuroanatomy of depression, breakdown emotion into a binary process, take a history lesson on learning theories, and discuss other topics.

Remember, we review the latest blogs related to the brain and mind that go beyond the basic sciences into a more human and multidimensional perspective. You can check out our archive for past editions. … [visit site to read more]

How Your Brain Groups Words

Fri, 12 Mar 2010 00:00:00 +0100

When you say or hear a concrete noun, such as “apple”, what happens in your mind? Even without seeing a physical apple in front of you, your brain is drawing up an image of an apple, maybe the last one you ate or saw in the stores or on TV. A team of researchers at Carnegie Mellon used an fMRI (functional magnetic resonance image) machine to find out. Rather than using complex transparent concepts, like “honesty”, the team used simple words that convey physical, everyday objects to see which parts of the brain was activated. The goal was to see how the brain functions when we think of an object, rather than just trying to see an object in our mind. The brain was activated in many different parts for the simplest words, showing a complex, networked effect for even the easiest thoughts. … [visit site to read more]

The Child Brain and the Playing Teacher

Fri, 12 Mar 2010 00:00:00 +0100

Scientific research has established that the major part of the development of human brain happens in a child’s first three years of life. These first three years of pre-school life is the most impressionable period of human brain during which new neural networks are being formed in certain parts of the brain. A child who is one year old has the maximum number of brain cells the human brain can have in its entire life span. Neurobiologists believe that about 10 billion nerve cells in the infant brain are constantly making the synapses that promote thought, emotion, and physical movement. The capacity to form such neural connections depends on whether the infant brain receives proper stimulation. … [visit site to read more]

KISS From PNI

Fri, 12 Mar 2010 00:00:00 +0100

(Slept too late - so no time to blog for both Paper Not Included and here - so here is what I've written over there)

Publishers are missing the two important things that they should have for every ebook release.

Ease of access and wide access.

][][][][

Ease of Access
Why do I use iTunes to download my music instead of torrent sites? Why do I pay for albums instead of typing "band name + torrent" into Google?

First - because it is wrong and illegal, but secondly and perhaps, for many people, more importantly it's because iTunes is easy. I can buy an album with one click - I don't have to worry about it being in an odd format that my iPod won't play, I don't have to worry about it being a fake file or it being a low resolution thing that sounds bad.

*Click* = *bought*.

I don't have to type in my credit card details whenever I buy something, I don't have to log in with a password - I boot up the software, press a button or two and suddenly the file is downloaded and synced to all my devices.

It's this ease of use that makes Amazon so attractive to use - Find the book, press the 'buy it now' button and it uses your stored credit card to purchase the file and then send it down to all your 'Kindle' devices (be that Kindle, PC or iPhone - still waiting on that Mac option folks...).

In contrast look at Waterstones site - I have to type in my account details to log on to the site, then find the book using the frankly awful search engine (want to look for ebooks? well you need to do an 'advanced' search, and then we'll still return paperback and hardback results), then add it to your basket, then view your basket, then checkout, then type in your credit card details (plus expiry date, and security code). Then, and only then, are you able to download the books you want.

It's actually simpler to google for a torrent.

(I won't go into the problems of DRM, as that's a whole other discussion).

So, if you are a non-Kindle user, you are stuck using an awful website.

][][][][

Wide Access
What is the other reason for going to the torrent sites? Regionalisation.

All my friends are blogging about a great book that's been released in America, they all love it and the subject matter is right up my alley.

I go to buy it and, lo and behold, 'this book is only available in the US'.

Now, I could wait, in the hope that they will eventually release it in the UK, and hopefully I won't have forgotten all about it in the year that this takes to happen. When I do forget about it maybe the publisher will pay all over again for the marketing that will raise it's profile on my radar.

Or I could physically import the dead tree edition from America, pay excessive shipping, import taxes and hope that when it is delivered it's not been dropped into the moat at Kellett mansion.

What is more realistic, and simpler option, is to search for a torrent of the file download it and hope that it is either a decent scan, or the ebook with the DRM stripped out. Then should the book ever be released over here - buy the actual legal copy in order to reward the author and publisher.

And that's if I (a) remember, and (b) am honest.

Are you starting to see why regionalisation of books is a really bad idea. It is pretty much always possible for me to get your book via torrent, and no draconian Digital Economy Bill will stop the committed pirate, especially when 'committed' means 'able to click a button or two'.

][][][][

A Proposed Solution
As I have mentioned in the past, the real game-changer about Apples iPad is the iBookstore (or however it is capitalised) - a simple and easy way to download books, with a decent economic model for the publishers and simple syncing with a device.

Sadly it seems obvious that Apple will restrict their books to iPad DRM format - thus leaving the Sony Reader, and countless other devices, out in the cold. You won't be able to read your iPad books on anything other than an iPad.

This is my suggestion - and it's for all the publishers in the UK, if not the world.

Beat iTunes.

Get together, and get together quickly before the iPad gains too much traction - form a jointly owned company, association, or whatever. Create a piece of software that is cross platform, both on the user's end (PC/Mac/Linux/iPhone/Blackberry/maybe even Xbox and the like), and on the formats that it supports (iPad, Kindle, PDF, EPUB, Mobi, Plaintext).

Make it amazingly simple and easy to buy a book - 'reduce the friction' as I believe they call it in the business lingo world. Make it so easy to buy a book that an impulse buyer, like me, can easily slap down my money and have the book sent to me within seconds without having to type in my credit card details for the umpteenth time.

Do away with regionalisation with ebooks. If you are spending some of your marketing budget on internet awareness (and if not, why not? Internet users read almost by definition), then why are you saying that you don't want the money from people in America, in Europe, in the Southern hemisphere?

Sure - you won't make the money on selling the regional rights to a publisher in country X, but won't you make up that money by expanding the market and from word of mouth marketing (and remember, those world royalties are going straight to you, not via someone else who takes a cut - disintermediation). Plus ebooks can be 'in print' forever - check out that long, long tail.

I'd also say do away with DRM, but that's a discussion for another day.

If you create an iTunes for ebooks - then you control how your books are sold, not Apple, not Amazon, but the publisher. Split the cut however you like, fiddle around with minimum and maximum prices to reach the ideal selling point, suck money directly from my credit card as I always have the purchasing client to hand and clicking on one button gets me my book.

Is it really that difficult to build a bit of software that is,

Simple enough for my mum to use.Good, effective search.Frictionless purchasing and downloading.Multiformat.Multiclient.A large and persistent library.Without pointless barriers due to geography.

If publishers do this I can guarantee that the percentage of ebook readers that resort to torrents will drop. They won't go away (because for some people free is all they can afford), but it would stop people like me from wondering if breaking the law on this one occasion is maybe worth it.

Hell, make it simple enough and more people will download ebooks - and with a per-unit-purchase price of pretty much zero, that's all profit.

And if publishers don't want to work together then at the very least Waterstones need to start from the ground up and completely revamp their web experience - perhaps starting with a cross platform piece of software that will act like iTunes...

10 Mitos sobre el Cerebro y la Gimnasia Mental

Fri, 12 Mar 2010 00:00:00 +0100

(Editor’s Note: by popular demand, following goes the Spanish translation of an excerpt from The SharpBrains Guide to Brain Fitness, available in English by clicking on Debunking 10 Brain and Brain Fitness Myths)

10 MITOS SOBRE EL CEREBRO Y EL ENTRENAMIENTO MENTAL: VERDADERO O FALSO?

Extraído del libro electrónico “La guía de SharpBrains para un cerebro en forma” (The SharpBrains Guide to Brain Fitness). Con permiso de sus autores Alvaro Fernández y Dr.Elkhonon Goldberg.

Mito 1. Mis genes determinan el destino de mi cerebro

Realidad. La neuroplasticidad hace que nuestro estilo de vida, acciones y experiencias tengan un rol importante en la evolución física de nuestro cerebro a lo largo de toda la vida, especialmente dado el incremento de la esperanza de vida.

Mito 2. El envejecimiento acarrea automáticamente el declive cognitivo

Realidad. No hay nada inherentemente fijado sobre la trayectoria precisa de cómo nuestros cerebros evolucionarán con la edad

Mito 3. La medicación es la principal esperanza para la mejoría cognitiva

Realidad. Las intervenciones no invasivas pueden tener efectos comparables y más duraderos, libres de efectos secundarios

Mito 4. Pronto tendremos una “píldora mágica” o solución general para resolver los desafíos cognitivos

Realidad. La investigacion cientifica existente recomienda un enfoque multifacético, centrado en nutrición, regulacion emocional y ejercitación tanto física como mental.

Mito 5. Hay un solo “lo” en “úselo o piérdalo”

Realidad. El cerebro está compuesto de múltiples estructuras y funciones especializadas.Nuestra calidad de vida y productividad dependen de una multiplicidad de funciones, no de una sola

Mito 6. Todas las actividades o ejercicios mentales son iguales

Realidad. Diferentes actividades activan diferentes partes del cerebro, con lo cual es importante mantener un regimen de ejercicios variados y enfocados para asi estimular un amplio rango de funciones cognitivas

Mito 7. Hay una sola manera de entrenar el cerebro

Realidad. Las funciones cognitivas pueden impactarse de diversas maneras: a través de meditación, terapia cognitiva, biofeedback, y entrenamiento cognitivo

Mito 8. Todos tenemos algo llamado “edad cerebral”

Realidad. La “edad cerebral” es una ficción. No hay 2 personas con el mismo cerebro o manifestación de funciones cerebrales a una msma edad

Mito 9. Esa supuesta “edad cerebral” puede reducirse en 10, 20, o 30 años

Realidad. El entrenamiento cerebral puede mejorar determinadas funciones cognitivas, pero con las investigaciones disponibles actualmente no se puede decir que se puede reducir la “edad cerebral” en un cierto número de años.

Mito 10. Todos los cerebros humanos necesitan el mismo entrenamiento

Realidad. Al igual que con la gimnasia física los usuarios deben preguntarse: “Qué funciones necesito mejorar?” “En qué tiempo?”, “Cuál es mi presupuesto?”

A Decade after The Decade of the Brain ? Educational and Clinical Implications of Neuroplasticity

Fri, 12 Mar 2010 00:00:00 +0100

(Editor’s Note: In 1990, Congress designated the 1990s the “Decade of the Brain.” President George H. W. Bush proclaimed, “A new era of discovery is dawning in brain research.” During the ensuing decade, scientists greatly advanced our understanding of the brain. The editors of Cerebrum asked the directors of seven brain-related institutes at the National Institutes of Health (NIH) to identify the biggest advances, greatest disappointments, and missed opportunities of brain research in the past decade—the decade after the “Decade of the Brain.” They also asked them what looks most promising for the coming decade, the 2010s. Experts focused on research that might change how doctors diagnose and treat human brain disorders.)

Neuroscience is at a historic turning point. Today, a full decade after the “Decade of the Brain,” a continuous stream of advances is shattering long-held notions about how the human brain works and what happens when it doesn’t. These advances are also reshaping the landscapes of other fields, from psychology to economics, education and the law.

Until the Decade of the Brain, scientists believed that, once development was over, the adult brain underwent very few changes. This perception contributed to polarizing perspectives on whether genetics or environment determines a person’s temperament and personality, aptitudes, and vulnerability to mental disorders. But during the past two decades, neuroscientists have steadily built the case that the human brain, even when fully mature, is far more plastic—changing and malleable—than we originally thought.1 It turns out that the brain (at all ages) is highly responsive to environmental stimuli and that connections between neurons are dynamic and can rapidly change within minutes of stimulation.

Neuroplasticity is modulated in part by genetic factors and in part by dynamic, epigenetic changes that influence the expression of genes without changing the DNA sequence. Epigenetic processes are of particular clinical interest because their external triggers (such as early parental care, diet, drug abuse and stress) can affect a person’s vulnerability to many diseases, including psychiatric disorders. In addition, in contrast to genetic sequence differences, epigenetic alterations are potentially reversible, and thus amenable to public health policy interventions.

It also has become increasingly clear that the human brain is particularly sensitive to social stimuli, which likely has accelerated the rate of human brain evolution. Humans have evolved a complex neuronal circuitry in large areas in the brain to process complex social information (such as predicting others’ reactions and emotions) and to respond appropriately. New research has revealed that social stimuli (such as parenting style and early-life stress) can epigenetically modify the expression of genes that influence brain morphology and function including the sensitivity of an individual to stressful stimuli.2 In the future, this knowledge will enable us to tailor personalized prevention interventions that are based on information on how genetics and epigenetics affect brain function and behavior. For example, a recent study showed that a prevention intervention based on improving parenting style reduced the risk for substance use disorders only in adolescents with a particular variant of a gene that recycles the chemical serotonin back into the neurons, which is a variant that results in greater sensitivity to social adversity.3

In the coming decade, insights about what underlies neuroplasticity, combined with technological advances that allow us to “see” with greater precision the human brain in action, are bound to revolutionize the way we view learning and the methods we use to educate young people. New research will also show us how to help people overcome or compensate for many of the deficits associated with drug abuse, addiction and other mental disorders.4

For example, scientists are using imaging technologies in neurofeedback programs that train people to voluntarily recalibrate their neural activity in specific areas of the brain, allowing them to gain unprecedented control over, for example, pain perception5 or emotional processing.6 During drug addiction treatment, this approach could greatly reduce the risk of relapse by enabling a patient to control the powerful cravings triggered by a host of cues (e.g., people, things, places) that have become tightly linked, in the brain of the user, to the drug experience.

Other promising advances stem from ongoing research and development of direct communication pathways between a brain and external computer devices, the so called brain-computer interfaces (BCI). In a recent study, one version of BCI appeared to help paralyzed stroke victims regain some movement control.7 In the next decade, forms of BCI might help people with a variety of neuropsychiatric conditions that have proved resistant to traditional treatments. For example, early evidence suggests that BCI training could benefit patients with epilepsy or attention-deficit/hyperactivity disorder (ADHD) that is unresponsive to drugs.8

As we build on these rapid advances in neuroscience research, we must keep a watchful eye on their vast social and political implications. For example, neurologists have started to uncover the molecular components and neural circuitry that underlie the learning process.9 We also are learning how to use transcranial magnetic stimulation (TMS), a noninvasive method to modulate the activity within a neural circuit, more effectively.10 Should we use this knowledge to better educate young people and teach new skills to seniors, or should we use these tools only to treat people with neuropsychiatric disorders? As we begin to understand how parenting styles affect the development and function of the brain, how far should we go to protect children from the long-term and deleterious effects of bad parenting?

Recent progress in brain research and associated fields has been impressive, and we are sure to witness further acceleration in the pace of neuroscientific discovery in the next couple of decades. Indeed, we are entering a new era in which our technologies are beginning to affect our lives in profound ways. We are bound to recast our relationship with our brains and, in the process, to redraw the boundaries of human evolution.

(Note: references are available below)

Nora D. Volkow, M.D., became director of the National Institute on Drug Abuse (NIDA) in May 2003. Her work has been instrumental in demonstrating that drug addiction is a disease of the human brain. As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects of drugs and their addictive properties. She also has made important contributions to the neurobiology of obesity, ADHD, and the behavioral changes that occur with aging. Article is republished with permission from the Dana Foundation.

‘A Decade after The Decade of the Brain’ series, at Cerebrum

Thursday, Feb. 18: Nora D. Volkow, M.D., National Institute on Drug Abuse

Friday, Feb. 19: Thomas R. Insel, M.D., National Institute of Mental Health

Monday, Feb. 22: Story Landis, Ph.D., National Institute of Neurological Disorders and Stroke

Tuesday, Feb. 23: Kenneth R. Warren, Ph.D., National Institute on Alcohol Abuse and Alcoholism

Wednesday, Feb. 24: Paul A. Sieving, M.D., Ph.D., National Eye Institute

Thursday, Feb. 25: James F. Battey Jr., M.D., Ph.D., National Institute on Deafness and Other Communication Disorders

Friday, Feb. 26: Richard J. Hodes, M.D., National Institute on Aging

References

1. A. Holtmaat and K. Svoboda, “Experience-Dependent Structural Synaptic Plasticity in the Mammalian Brain,” Nature Reviews Neuroscience 10, no. 9 (2009): 647–658; M. Butz, F. Worgotter, and A. van Ooyen, “Activity-Dependent Structural Plasticity,” Brain Research Reviews 60, no. 2 (2009): 287–305.

2. I. C. Weaver, N. Cervoni, F. A. Champagne, A. C. D’Alessio, S. Sharma, J. R. Seckl, S. Dymov, M. Szyf, and M. J. Meaney, “Epigenetic Programming by Maternal Behavior,” Nature Neuroscience 7, no. 8 (2004): 847–854.

3. G. H. Brody, S. R. Beach, R. A. Philibert, Y. F. Chen, M. K. Lei, V. M. Murry, and A. C. Brown, “Parenting Moderates a Genetic Vulnerability Factor in Longitudinal Increases in Youths’ Substance Use,” Journal of Consulting and Clinical Psychology 77, no. 1 (2009): 1–11.

4. N. D. Volkow, L. Chang, G. J. Wang, J. S. Fowler, D. Franceschi, M. Sedler, S. J. Gatley, E. Miller, R. Hitzemann, Y. S. Ding, and J. Logan, “Loss of Dopamine Transporters in Methamphetamine Abusers Recovers with Protracted Abstinence,” Journal of Neuroscience 21, no. 23 (2001): 9414–9418.

5. R. C. deCharms, F. Maeda, G. H. Glover, D. Ludlow, J. M. Pauly, D. Soneji, J. D. Gabrieli, and S. C. Mackey, “Control over Brain Activation and Pain Learned by Using Real-time Functional MRI,” Proceedings of the National Academy of Sciences USA 102, no. 51 (2005): 18626–18631; S. J. Johnston, S. G. Boehm, D. Healy, R. Goebel, and D. E. Linden, “Neurofeedback: A Promising Tool for the Self-regulation of Emotion Networks,” Neuroimage 49, no. 1 (2009): 1066–1072.

6. S. Johnston, S. Boehm, D. Healy, R. Goebel, and D. Linden, “Neurofeedback: A promising tool for the self-regulation of emotion networks,” Neuroimage 49 (2009):1066-1072.

7. E. Buch, C. Weber, L. G. Cohen, C. Braun, M. A. Dimyan, T. Ard, J. Mellinger, A. Caria, S. Soekadar, A. Fourkas, and N. Birbaumer, “Think to Move: a Neuromagnetic Brain-Computer Interface (BCI) System for Chronic Stroke,” Stroke 39, no. 3 (2008): 910–917.

8. N. Birbaumer, A. Ramos Murguialday, C. Weber, and P. Montoya, “Neurofeedback and Brain-Computer Interface Clinical Applications,” International Review of Neurobiology 86 (2009): 107–117.

9. C. A. Miller, S. L. Campbell, and J. D. Sweatt, “DNA Methylation and Histone Acetylation Work in Concert to Regulate Memory Formation and Synaptic Plasticity,” Neurobiology of Learning and Memory 89, no. 4 (2008): 599–603.

10. C. A. Dockery, R. Hueckel-Weng, N. Birbaumer, and C. Plewnia, “Enhancement of Planning Ability by Transcranial Direct Current Stimulation,” Journal of Neuroscience 29, no. 22 (2009): 7271–7277.

Brain Fitness Update Man is a ToolMaking Animal

Fri, 12 Mar 2010 00:00:00 +0100

Here you have the February edition of our monthlyeNewsletter covering cognitive health and brain fitness topics. Please remember that you can subscribe to receive this Newsletter by email, using the box in the right column.

The recent SharpBrains Summit witnessed the convergence of Benjamin Franklin’s words (”Man is a Tool-Making Animal”) with neuroscientist Santiago Ramon y Cajal’s (”Every man can, if he so desires, become the sculptor of his own brain.”) The neuroplasticity revolution that may well transform education, training, healthcare, aging, is under way.

New Tools

Will the Apple iPad Be Good for your Brain: Prof. Luc Beaudoin lays out key criteria to assess Apple iPad’s potential value for our cognitive fitness, and judges the iPad against a comprehensive checklist. His verdict? Thumbs-up.

Is Working Memory a better predictor of academic success than IQ?: Dr. Tracy Alloway summarizes a recent landmark study, published in the Journal of Experimental Child Psychology, which tracked children over a six-year period. Key finding: Working memory can be a more powerful predictor of academic success than IQ scores.

Old Tools

Building Fit Minds Under Stress: According to Science Daily’s take on a just published study, “a high-stress U.S. military group preparing for deployment to Iraq has demonstrated a positive link between mindfulness training, or MT, and improvements in mood and working memory”.

The Evolution of Empathy: Empathy is not a uniquely human trait, explains primatologist Frans de Waal in this Greater Good Magazine article. Apes and other animals feel it as well, suggesting that empathy is truly an essential part of who we are.

Reflections

Reflections on Creativity – Interview with Daniel Tammet: Scott Barry Kaufman recently interviewed Daniel Tammet, known for vividly describing autistic savantism from the inside. Their in-depth conversation made Scott reflect that “Daniel Tammet’s feeling of a great loneliness and isolation growing up spoke to me, for sure. But I’m sure it also spoke to a great many people reading the interview.”

Summit Reactions

The SharpBrains Summit took place January 18-20th, helping engage over 250 participants in 15 countries. Here are a couple of reactions from participants:

5 Key Reflections on “Neurocentric Health”: Institute For The Future researcher Jake Dunagan summarizes his main take-aways, including this overall assessment – “Although the conference was virtual, aside from the rigors of travel and a basket of bagels on the hallway table, my level of intellectual stimulation (and fatigue) mirrored most of my face-to-face conference experiences. It was a technical success and the content was first-rate.” (Thanks, Jake!)

The Future of Cognitive Enhancement: Neuroethics researcher Peter Reiner ponders, “Will brain fitness software dominate the world of cognitive enhancement?”. His take: “Prior to this conference I was quite skeptical, but the overall impression that I was left with was that brain fitness software may turn out to have some distinct advantages over pharmacological approaches.” Read his article to discover why.

Community

Network for Brain Fitness Innovation (private LinkedIn group): Members are engaging in many good discussions, including most surprising things learned during the SharpBrains Summit, how to deal with conflicts of interest in industry and academia, resources and conferences relevant to education and children, and ways to elicit a wider interest in brain health.

Looking for Speakers: We are always looking for best practices and research-based innovation. If you are interested in speaking at future SharpBrains events (including Games for Health brain tracks), please Contact Us and tell us about 1) your innovation or research, 2) its measured and/ or potential impact, 3) recent coverage in general, trade, or scientific media, 4) the typical audience you talk to, and a couple of descriptions of recent talks, 5) what you propose talking about.

Offer

Brain Fitness Information Package for Libraries: libraries of all kinds can now order a copy of our main report, The State of the Brain Fitness Software Market 2009, at 50% off price. Using discount code sharplibrary leaves this premium report at $645 (offer valid until March 31st, 2010). Offer is valid for individuals and organizations who commit to donating their copy to a library, in good shape, after consulting it.

Finally, a reminder that Brain Awareness Week (March 15-21, 2010) is approaching soon!

Layoff News

Fri, 12 Mar 2010 00:00:00 +0100

More job loss news to report, unfortunately. Pharmalot comes in with an item that fits with what I'm hearing, that Sanofi-Aventis appears to be making small cuts, over and over, at its various sites. There hasn't been a single big announcement that I've heard, but the company seems to be shrinking headcount nonetheless.

And I've also heard recently that Astra-Zeneca is ready to announce more layoffs, although I don't have a handle on the size. This appears to be some of the follow-through from their earlier nonspecific announcements - it looks as if they're finally going to start getting down to some details. Anyone with more information on either of these situations is welcome to add it in the comments. . .

Cranking Away

Fri, 12 Mar 2010 00:00:00 +0100

Not as much time to blog this morning (and it's been hard getting into the site, since there are a lot of people who apparently want to know how to order some dioxygen difluoride). For one thing, I'm clearing a bunch of reactions out, and I've been devoting thought to how to do that in the laziest possible manner.

Maybe I should clarify that. What I mean is, how do I work up all these reactions quickly, in such a way as to make clean compounds that are worth testing, but spend the least amount of effort doing so? There are, of course, all sorts of brute-force ways to bang these things through, some of which would involve me not leaving my lab for the next three days or so, but I have other demands on my time. It's worth thinking about the most efficient way to do it.

Since these things I'm making all have acidic groups hanging off them, the most appealing idea I have right now is to use a basic resin to clean them up - as most med-chem types know, you can generally stick acidic compounds onto such resin, wash a lot of the crud off and throw that away, then bump your desired compounds off with some sort of acidic wash. This sort of solid-phase cleanup became popular in the combichem era, and has persisted for situations like this.

That's probably how I'll go, as opposed to, say, individually loading every single one of the compounds onto the HPLC machine. That would make me rather unpopular with the other people who might want to use that instrument before March is upon us, for one thing, and it would be complete overkill as well. These compounds are all pretty clean looking - a wash-and-rinse protocol should turn them out in good shape, and there's no need to use Super Ultimate Purification on them. (And besides, I'm making them all in reasonable quantity, which would bog down the HPLC even more).

An even more brainless way to do this workup would be to run every single compound through an automated column (like a Biotage). At least the HPLC has a liquid handler on it - I could set the thing up with a few rows of samples to inject, and walk away with some degree of confidence that it would run them. But the Biotage-type machines are usually one-at-a-time things, for larger samples. One batch of five grams of stuff would be perfect - two or three dozen at 100 mgs each, not so.

And all this makes me think of someone who used to work down the hall from me (no more clues than that!) I noticed that he was always cranking away in the lab, every time I went past. I mean, this guy looked like one of those multi-armed Hindu god statues, with each hand holding a round-bottom flask or a TLC plate. Impressive! Until I realized, after dealing with him a while, that the reason he was zipping around in there like a hamster was because he was doing everything in the most brutal and time-wasting way possible. He seemed to pick his reactions and protocols according to how much hand labor they involved: the more, the better.

I took a vow never to be him, and today I plan to live up to that. Measure twice, cut once and all that.

Knocking on Doors

Fri, 12 Mar 2010 00:00:00 +0100

A correspondent writes in with an interesting and useful question: he's with a small company that believes that it's discovered a useful lead compound in an area where they're hard to find. But no one there has any experience with knocking on the doors of Big Pharma to talk about a deal, and they're wondering about the best way to go about it.

I (and people like me) can provide some general advice. But I know that there are consultants out there who've brokered things like this before and have both contacts and expertise that can help out. But that just kicks the problem along: how does a fledgling company find one of those? Some startups naturally begin with connections of this sort, but others don't. Anyone have some leads for them?

Steve Nissens Meeting with GSK

Fri, 12 Mar 2010 00:00:00 +0100

Well, this is interesting. Back when Steve Nissen was about to publish his meta-analysis on the safety of Avandia (rosigiltazone), he met with several GlaxoSmithKline executives before the paper came out. At the time, GSK was waiting on data from the RECORD study, which was trying to address the same problem (unconvincingly, for most observers, in the end). Nissen had not, of course, shown his manuscript to anyone at GSK, and for their part, the execs had not seen the RECORD data, since it hadn't been worked up yet.

Well, not quite, perhaps on both counts. As it happens, a reviewer had (most inappropriately) faxed a copy of Nissen's paper-in-progress to the company. And GSK's chief medical officer managed to refer to the RECORD study in such a way that it sounds as if he knew how it was coming out. How do we know this? Because Nissen secretly taped the meeting - legal in Ohio, as long as one party knows the taping is going on. At no point does anyone from GSK give any hint that they knew exactly what was in Nissen's paper. Here's some of it:

Dr. Krall asked Dr. Nissen if his opinion of Avandia would change if the Record trial — a large study then under way to assess Avandia’s risks to the heart — showed little risk. Dr. Krall said he did not know the results of Record.

“Let’s suppose Record was done tomorrow and the hazard ratio was 1.12. What does...?” Dr. Krall said.

“I’d pull the drug,” Dr. Nissen answered quickly.

The interim results of Record were hastily published in The New England Journal of Medicine two months later and showed that patients given Avandia experienced 11 percent more heart problems than those given other treatments, for a hazard ratio of 1.11. But the trial was so poorly designed and conducted that investigators could not rule out the possibility that the differences between the groups were a result of chance.

Somehow, I don't think that many pharma executives are going to agree to meetings with Nissen in his office in Cleveland after this. But I certainly don't blame him for making the tape, either.

Write A Book Why Dont You

Fri, 12 Mar 2010 00:00:00 +0100

Yesterday's "Things I Won't Work With" post has brought on calls to turn these (and some other parts of the blog) into a book. And you know, I'm game, actually - but I have no real contacts in the publishing world. If anyone out there in the readership knows a good agent, or knows someone who does, I'd be glad to have some contact information. Thanks!

Things I Wont Work With Dioxygen Difluoride

Fri, 12 Mar 2010 00:00:00 +0100

The latest addition to the long list of chemicals that I never hope to encounter takes us back to the wonderful world of fluorine chemistry. I'm always struck by how much work has taken place in that field, how long ago some of it was first done, and how many violently hideous compounds have been carefully studied. Here's how the experimental prep of today's fragrant breath of spring starts:

The heater was warmed to approximately 700C. The heater block glowed a dull red color, observable with room lights turned off. The ballast tank was filled to 300 torr with oxygen, and fluorine was added until the total pressure was 901 torr. . .

And yes, what happens next is just what you think happens: you run a mixture of oxygen and fluorine through a 700-degree-heating block. "Oh, no you don't," is the common reaction of most chemists to that proposal, ". . .not unless I'm at least a mile away, two miles if I'm downwind." This, folks, is the bracingly direct route to preparing dioxygen difluoride, often referred to in the literature by its evocative formula of FOOF.

Well, "often" is sort of a relative term. Most of the references to this stuff are clearly from groups who've just been thinking about it, not making it. Rarely does an abstract that mentions density function theory ever lead to a paper featuring machine-shop diagrams, and so it is here. Once you strip away all the "calculated geometry of. . ." underbrush from the reference list, you're left with a much smaller core of experimental papers.

And a hard core it is! This stuff was first prepared in Germany in 1932 by Ruff and Menzel, who must have been likely lads indeed, because it's not like people didn't respect fluorine back then. No, elemental fluorine has commanded respect since well before anyone managed to isolate it, a process that took a good fifty years to work out in the 1800s. (The list of people who were blown up or poisoned while trying to do so is impressive). And that's at room temperature. At seven hundred freaking degrees, fluorine starts to dissociate into monoatomic radicals, thereby losing its gentle and forgiving nature. But that's how you get it to react with oxygen to make a product that's worse in pretty much every way.

FOOF is only stable at low temperatures; you'll never get close to RT with the stuff without it tearing itself to pieces. I've seen one reference to storing it as a solid at 90 Kelvin for later use, but that paper, a 1962 effort from A. G. Streng of Temple University, is deeply alarming in several ways. Not only did Streng prepare multiple batches of dioxygen difluoride and keep it around, he was apparently charged with finding out what it did to things. All sorts of things. One damn thing after another, actually:

"Being a high energy oxidizer, dioxygen difluoride reacted vigorously with organic compounds, even at temperatures close to its melting point. It reacted instantaneously with solid ethyl alcohol, producing a blue flame and an explosion. When a drop of liquid 02F2 was added to liquid methane, cooled at 90°K., a white flame was produced instantaneously, which turned green upon further burning. When 0.2 (mL) of liquid 02F2 was added to 0.5 (mL) of liquid CH4 at 90°K., a violent explosion occurred."

And he's just getting warmed up, if that's the right phrase to use for something that detonates things at -180C (that's -300 Fahrenheit, if you only have a kitchen thermometer). The great majority of Streng's reactions have surely never been run again. The paper goes on to react FOOF with everything else you wouldn't react it with: ammonia ("vigorous", this at 100K), water ice (explosion, natch), chlorine ("violent explosion", so he added it more slowly the second time), red phosphorus (not good), bromine fluoride, chlorine trifluoride (say what?), perchloryl fluoride (!), tetrafluorohydrazine (how on Earth. . .), and on, and on. If the paper weren't laid out in complete grammatical sentences and published in JACS, you'd swear it was the work of a violent lunatic. I ran out of vulgar expletives after the second page. A. G. Streng, folks, absolutely takes the corrosive exploding cake, and I have to tip my asbestos-lined titanium hat to him.

Even Streng had to give up on some of the planned experiments, though (bonus dormitat Strengus?). Sulfur compounds defeated him, because the thermodynamics were just too titanic. Hydrogen sulfide, for example, reacts with four molecules of FOOF to give sulfur hexafluoride, 2 molecules of HF and four oxygens. . .and 433 kcal, which is the kind of every-man-for-himself exotherm that you want to avoid at all cost. The sulfur chemistry of FOOF remains unexplored, so if you feel like whipping up a batch of Satan's kimchi, go right ahead.

So does anyone use dioxygen difluoride for anything? Not as far as I can see. Most of the recent work with the stuff has come from groups at Los Alamos, where it's been used to prepare national-security substances such as plutonium and neptunium hexafluoride. But I do note that if you run the structure through SciFinder, it comes out with a most unexpected icon that indicates a commercial supplier. That would be the Hangzhou Sage Chemical Company. They offer it in 100g, 500g, and 1 kilo amounts, which is interesting, because I don't think a kilo of dioxygen difluoride has ever existed. Someone should call them on this - ask for the free shipping, and if they object, tell them Amazon offers it on this item. Serves 'em right. Morons.

Avandia Off the Market or Not?

Fri, 12 Mar 2010 00:00:00 +0100

The Senate report that leaked on Avandia (rosiglitazone) over the weekend has made plenty of headlines. It quotes an internal FDA report that recommends flatly that the drug be removed from the market, since its beneficial effects can be achieved by use of the competing PPAR drug Actos (pioglitazone), which doesn't seem to have the same cardiovascular risks. The two drugs have been compared (retrospectively) head to head, and Avandia definitely seems to have come out as inferior due to safety concerns.

There had been worries for several years about side effects, but the red flag went up for good in 2007, and the arguing has not ceased since then. According to another FDA document in the Senate report, there are "multiple conflicting opinions" inside the agency about what to do. The agency ordered GSK to set up a prospective head-to-head trial of Avandia and Actos, but other staffers insist that the whole idea is unethical. If the cardiovascular risks are real, they argue, then you can't expose people to Avandia just to find out how much worse it is. The trial is enrolling patients, but will take years to generate data, and Avandia will be generic by the time it reports, anyway. (Presumably, the only reason GSK is running it is because the drug would be taken off the market for sure if they didn't).

The FDA's internal debate is one issue here (as is the follow-up question about whether the agency should be restructured to handle these questions differently). But another one is GlaxoSmithKline's response to all the safety problems. Says that New York Times article:

In 1999, for instance, Dr. John Buse, a professor of medicine at the University of North Carolina, gave presentations at scientific meetings suggesting that Avandia had heart risks. GlaxoSmithKline executives complained to his supervisor and hinted of legal action against him, according to the Senate inquiry. Dr. Buse eventually signed a document provided by GlaxoSmithKline agreeing not to discuss his worries about Avandia publicly. The report cites a separate episode of intimidation of investigators at the University of Pennsylvania.

GlaxoSmithKline said that it “does not condone any effort to silence” scientific debate, and that it disagrees with allegations that it tried to silence Dr. Buse. Still, it said the situation “could have been handled differently.”

Well, yeah, I should think so. I don't know what the state of the evidence was as early as 1999, but subsequent events appear to have vindicated Buse and his concerns. And while you can't just sit back and let everyone take shots at your new drug, you also have to be alert to the possibility that some of the nay-sayers might be right. We honestly don't know enough about human toxicology to predict what's going to happen in a large patient population very well, and companies need to be honest with the public (and themselves) about that.

The Front Lines of Cancer Treatment

Fri, 12 Mar 2010 00:00:00 +0100

The New York Times is starting a series of articles on the clinical trials of a recent B-Raf inhibitor (from Plexxikon and Roche, PLX4032). The first installment is an excellent look at what early-stage clinical research is like in this field. For example:

Typically, Phase 1 trials are limited to a few dozen patients and end when the dose reaches the point where side effects like rashes and diarrhea make patients too uncomfortable.

Dr. Flaherty and Dr. Chapman started the first three patients on 200 milligrams per day. After two months with no side effects — and no response — they doubled it.

Two more months passed, still nothing. They gave three more patients 800 milligrams, the equivalent of the dose that made tumors stop growing in mice. Even shrinking tumors, the doctors knew, would not mean the cancer had been cured but might at least offer a reprieve.

Dr. Flaherty pounced on the scans when they arrived. In some patients, tumors had remained the same size. “Maybe we’re starting to see something,” he could not help thinking. But at the next set of scans, the disease had progressed. On conference calls, Dr. Nolop sometimes referred to those patients as “responders.”

“They’re not responders,” Dr. Flaherty gently corrected him: under the accepted definition, tumors had to shrink to qualify patients as responders.

By the time they had doubled the dose four times, Dr. Flaherty could not help wondering if the targeted therapy skeptics were right. Dr. Chapman, crisp and businesslike on the weekly calls, supplied no comfort. He pointed out new research that B-RAF was mutated even in benign moles, and therefore could not be the key driver in melanoma. . .

What everyone involved in this work has to deal with is living between two very different mental states: you have to see people who are dying, and who you will probably not be able to help, even with your best efforts. But it's also possible that the next new thing you try might be the thing that keeps some of them alive. It's a hard place to work.

Back here in early research we don't see the patients, of course (which is good, since I'm pretty sure I couldn't take it). But we also have the same narrow path to walk: most of the compounds we make aren't drug candidates. Most of the drug candidates we send on for development fail. But the answer to that is not to stop making drug candidates, because every so often, something works.

Blog Traffic Thanks!

Fri, 12 Mar 2010 00:00:00 +0100

Just a quick note to say that traffic here broke all the house records last month - over 440,000 page views (partly thanks to a late surge in interest in the wonderful properties of dioxygen difluoride). The number of people interested in this sort of thing continues to exceed my estimates. . .!

Calorimetry What Say You?

Fri, 12 Mar 2010 00:00:00 +0100

I've been involved in a mailing list discussion that I wanted to open up to a wider audience in drug discovery, so here goes. We spend our time (well, a lot of it, when we're not filling out forms) trying to get compound to bind well to our targets. And that binding is, of course, all about energy: the lower the overall energy of the system when your compound binds, relative to the starting state, the tighter the binding.

That energy change can be broken down (all can all chemical free energy changes) into an enthalpic part and an entropic part (that latter one depends on temperature, but we'll assume that everything's being done at a constant T and ignore that part). Roughly speaking, the enthalpic component is where you see effects of hydrogen bonds, pi-pi stacking, and other such "productive" interactions, and the entropic part is where you're pushing water molecules and side chains around - hydrophobic interactions and such.

That's a gross oversimplification, but it's a place to start. It's important to remember that these things are all tangled together in most cases. If you come in with a drug molecule and displace a water molecule that was well-attached to your binding pocket, you've broken some hydrogen bonds - for which you'll pay in enthalpy. But you may well have formed some, too, to your molecule - so you'll get some enthalpy term back. And by taking a bound water and setting it free, you'll pick up some good entropy change, too. But not all waters are so tightly bound - there are a few cases where they're actually at a lower entropy state in a protein pocket then they are out in solution, so displacing one of those actually hurts you in entropy. Hmm.

And as I mentioned here, you have the motion of your drug molecule to consider. If it goes from freely rotating to stuck when it binds (as it may well), then you're paying entropy costs. (That's one reason why tying down your structure into a ring can help so dramatically, when it helps at all). And don't forget the motion of the protein overall - if it's been flopping around until it folds over and clenches down on your molecule, there's another entropy penalty for you, which you'd better be able to make up in enthalpy. And so on.

There's been a proposal, spread most vigorously by Ernesto Freire of Johns Hopkins, that drug researchers should use calorimetry to pick compounds that have the biggest fraction of their binding from enthalpic interactions. (That used to be a terrible pain to do, but recent instruments have made it much more feasible). His contention is that the "best in class" drugs in long-lived therapeutic categories tend to move in that direction, and that we can use this earlier in our decision-making process. People doing fragment-based drug discovery are also urged to start with enthalpically-biased fragments, so that the drug candidate that grows out from them will have a better chance of ending up in the same category.

One possible reason for all this is that drugs that get most of their binding from sheer greasiness, fleeing the water to dive into a protein's sheltering cave, might not be so picky about which cave they pick. There's a persistent belief, which I think is correct, that very hydrophobic compounds tend to have tox problems, because they're often just not selective enough about where they bind. And then they tend to get metabolized and chewed up more, too, which adds to the problem.

And all that's fine. . .except for one thing: is anyone actually doing this? That's the question that came up recently, and (so far), for what it's worth, no one's willing to speak up and say that they are. Perhaps all this is a new enough consideration that all the work is still under wraps. But it will be interesting to see if it holds up or not. We need all the help we can get in drug discovery, so if this is real, then it's welcome. But we also don't need to run more assays that only confuse things, either, so it would be worth knowing if drug-candidate calorimetry falls into that roomy category, too. Opinions?

Layoffs Coming at Eli Lilly?

Fri, 12 Mar 2010 00:00:00 +0100

I hate to start the week out like this, but I have a report that Lilly is looking to cut quite a few chemistry positions (and maybe others), with word to come on Friday, March 12. Anyone else have anything on this?

Update: to clarify, these appear to be the layoffs that were announced last fall, not a new series. It's just that we finally seem to be finding out who stays and who doesn't. . .

A Friday Book Recommendation

Fri, 12 Mar 2010 00:00:00 +0100

This isn't exactly med-chem, but its focus probably overlaps with the interests of a number of readers around here. I recently came across a copy of A Field Guide to Bacteria and enjoyed it very much. I don't think there's another book quite like it available: it describes where you're likely to find different varieties of bacteria (from hot springs to your fridge), how they behave in a natural environment (as opposed to a culture dish) and how to identify them by field marks, if possible. It's not written for microbiologists, but it can provide a different perspective even if you work in the field (since many people that do focus on pathogens - really a very small subset of bacteria, when you get down to it).

I'm already inspired to set up some Winogradsky columns with my kids, perhaps with some unusual chemical additives to see what happens. If we discover anything, I'll report back. . .

HER2 Confusion

Fri, 12 Mar 2010 00:00:00 +0100

For years now, drug companies and journalists have been touted the new era of personalized medicine. This is one of those things that always seems to be arriving, but is taking its time getting here. The industry has sunk a huge pile of money into biomarker research, and it's safe to say that it hasn't paid off yet - although, at the same time, one still has to think that it should, eventually.

Nature Biotechnology has a good article that shows how tricky the whole business can be. HER2 is one of the more validated cancer biomarkers, and there's a drug (Herceptin) that's targeted specifically for breast cancer patients that express it. So how's that going? Not so well:

A recent study from the University of California, San Francisco, reveals that one in five HER2 tests gives the wrong answer1. Furthermore, the article, which reviews the medical literature, reports that as many as two-thirds of breast cancer patients who should be tested for HER2 are not, and consequently a significant fraction of women treated with Genentech's Herceptin (trastuzumab) have never been tested for HER2 overexpression.

The health benefit provider Wellpoint, of Indianapolis, might dispute that finding. According to Genentech staff scientist Mark Sliwkowski, the insurer has data showing that 98% of its breast cancer patients are tested. However, doctors differ in their views on testing before prescribing Herceptin. “Some doctors don't know how to interpret test results, they prefer just to prescribe it and assess the patient's progress,” says Michael Liebman of the patient stratification company Strategic Medicine of Kennett Square, Pennsylvania.

More than a decade after the drug received US Food and Drug Administration (FDA) approval, the personalized medicine paradigm clearly has holes. . .

That it does. As the article goes on to explain, there are doubts about how good many of the existing HER2 tests are, worries about how they don't always agree, questions about whether some HER2-negative patients might be benefiting from Herceptin anyway, and more questions about those results due to uncertainties about the tests. That's the state of the art right there, folks, and it's clear that we have a long way to go. I don't see any reason why biomarkers (of various kinds, not just genetic) won't help us figure out which patients should be getting which drugs, but don't let anyone tell you that we're there yet.

Dear Mark Embodied Cognition

Fri, 12 Mar 2010 00:00:00 +0100

The following reader email brought to mind a NY Times article I read a few weeks ago. The article discusses a fairly new field of research that is uncovering the surprisingly fundamental and intricate ways our bodies influence our thinking and vice-versa. We’ve discussed the mind-body connection in the past, but embodied cognition puts the relationship in a new cast. Think motion-emotion, action-thought. It’s all integrated in ways you wouldn’t expect….

Hey Mark,

I’ve been a PBer for a couple years now and feel better than I ever have. I’m at this point interested in digging deeper into new areas of the PB. I’m intrigued by the mental-physical connection some of your posts and book refer to. Other than the relaxation and stress influence, what kind of sway does the mind-body thing really hold? How do you suggest harnessing it? Thanks and Grok on!

Thanks to Ben for the question this week. As he mentions, most of us are aware that our thoughts have the power to set off a chain of positive (or negative) physiological responses. But the picture is much more nuanced than meditation=good, chronic stress=bad. The field of embodied cognition is probing the connection right down to the evolutionary roots, measuring not just how one can influence the other but how the mental and physical realms largely operate as a unified, integrated recipient/responder to the outer world. Our bodies not only physically sense and move in response to external stimuli; they steer our emotional and intellectual reactions, and they subtly mirror – embody – even abstract social, cultural and intellectual concepts. Hmmm…I see some health and wellness implications coming, but first a quick rundown of the research.

Subjects in a Yale University study (PDF) were more likely to rate the target person as interpersonally warm if they held a hot drink in their hand and, conversely, more likely to rate the person as cold if they held an iced drink.
A University of Wisconsin study showed that subjects took longer to process negative statements when frowning muscles were deactivated by Botox injections.
A University of California, Santa Barbara study showed participants an instructional video about exercising and followed up on their efforts in the week following the video. Although all subjects were told to imagine performing the exercises during viewing, those that were instructed to walk in place while watching exercised nearly 27% longer than those who were sedentary during the video. In a follow-up scenario, women participants who were allowed to hold dental floss during flossing instruction reported flossing more times in a week than those women participants who didn’t hold dental floss during the instruction.
Subjects in a University of Illinois study were more successful at solving a given physics related problem when researchers instructed them to swing their arms for a short time.
Other research showed that students judged a book as heavier when told it was key to their studies. In subsequent scenarios, participants further confirmed the weight-importance association, in one situation by assessing foreign currency as more valuable if they held heavier clipboards while recording their responses.
A study recently published in Psychological Science demonstrated that participants shifted their bodies to reflect spatial metaphorical concepts by consistently leaning forward when talking about the future and reclining when recalling the past.

This is just a sampling of the research of course. Nonetheless, it’s enough I think to illustrate the breadth and depth of the power physical cues have on our thinking. (And, again, vice versa – the power of even unconscious thought over physiology.) Kinesthetic engagement has sway over everything from emotion to learning, memory to intention. In terms of intention, the research shows that passive instruction for fitness (or much else) isn’t as effective as incorporating physical experience. In other words, to bolster people’s intention to get their bodies moving, you have to – well – get them moving to begin with. It’s important to use the connection of physical action with motivation and intention to our benefit. Next time you log onto MDA, pick up some kettlebells or do some lunges as you read.

In this regard, maybe embodied cognition speaks to a larger lifestyle issue as well. There’s an inclination in our culture toward passive observation. Our entertainment pastimes, our communication modes as well as work setups for those of us with desk jobs leave us stuck in the “virtual” or one-dimensional experience. Like the researchers warnings about Botoxed-bounded expression, perhaps relating to the world so often through constrained means shuts off whole realms of experience and feeling. Real wellness, I believe, obliges the actualization of our physical selves. When we compartmentalize the corporeal or diminish the role of our bodies in our perception and experience, we neglect whole dimensions of fulfillment. As embodied cognition teaches us, we deny something fundamental in our nature when we diminish the inextricable connection between our physical and intellectual/emotional lives.

Grok lived an earthy and sensual existence. He was seamlessly of the world in ways that elude us now. As the research shows us, however, the hardwiring is still there. Give the moment – whether it be a workout, a walk, a dinner with the family – not just your full attention but your full physical engagement. Apply all the senses. Be wholly physically present. Imagine what that would mean in the day to day. What would that look like? Feel like? What would you gather or gain exercising – and living – that way?

Send me your thoughts. As always, thanks for the great questions and comments, and keep ‘em coming!

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Pork Tenderloin with Cilantro Pesto

Fri, 12 Mar 2010 00:00:00 +0100

What drew us in to the pork recipe submitted by Susan Rosenberg (for the Primal Blueprint Cookbook Contest) was not the pork itself, although any meal involving pork tenderloin is bound to be good. The pork preparation is simple and straightforward, involving nothing more than searing medallions in a pan. It is what Susan serves with the tenderloin, a creamy variation of pesto with flavors ranging from slightly spicy and sweet to cool and pungent, that makes us swoon.

As much as we like this pesto with pork, we immediately started thinking about all the other foods we might pair it with. This led to mixing some pesto in with a little shredded cabbage that happened to be in the fridge, and the result was a killer coleslaw. It’s just as easy to imagine serving the pesto over steak or seafood. What, exactly, makes it so versatile? First of all, you’ve got to love cilantro, an aromatic herb that people tend to have very strong feelings about.

From a distance, cilantro can easily be mistaken for parsley, but when you look at cilantro closely, the leaves are flatter and more feathery. Cilantro has a perfumed (some might say soapy) aroma and fresh, clean flavor. Those who love it will put it on just about anything, although the cool flavor makes cilantro especially delicious with Asian, Indian and Mexican dishes. Those who hate cilantro won’t even let it come near their kitchen. If you fall into this category, try the pesto with a different herb, like mint or parsley. You might also consider joining the Facebook group “I Hate Cilantro,” where you can get moral support from more than 700 members.

But if you love cilantro, you’re not going to be able to get enough of this pesto. Although Susan’s right, a little bit goes a long way, so you can make one batch and save half for another meal. The rich texture and bold flavor add an addictive flavor to the pork tenderloin or whatever you choose to serve it with. While the flavor mostly comes from the cilantro and ginger, the almond butter and coconut milk add just the right amount of creaminess.

Marinade Ingredients:

2 pounds of pork tenderloin
4 tablespoons olive oil
2 teaspoons sesame oil
2 tablespoons rice wine vinegar
2 cloves of garlic, chopped
1 inch fresh ginger, peeled and chopped

Instructions:

Slice the tenderloin into rounds of 1-inch thickness. Mix oils and vinegar, add garlic and ginger.

Marinate the pork slices in a non-reactive glass container for at least 2 hours or overnight, turning at intervals to marinate both sides of the slices. When the pork is ready to cook, prepare the pesto below:

Pesto Ingredients:

1 bunch of cilantro, leaves only
2 large garlic cloves
1-inch piece of ginger, peeled and sliced thin
1 tablespoon fish sauce
1/4 cup olive oil (or less, to taste)
1 teaspoon sesame oil (or more, to taste)
1/4 cup almond butter
1 teaspoon honey (optional)
1/2 -1 cup coconut milk
sea salt to taste

Blend sauce ingredients in blender or food processor until smooth, adding coconut milk until preferred consistency is reached.

To cook the pork, heat some coconut oil, lard, or olive oil in a large skillet over medium-high heat. Quickly sear the slices, turning once, until just cooked through. Do not crowd the pan, cook in batches as needed so they sear and don’t steam.

Keep each batch warm in a warm oven or covered in foil wrap.

To serve: Put a few slices of pork on a plate with a little bit of pesto on each slice, or serve pesto on the side. (A little pesto goes a long way, flavor-wise.)

Serve with cooked greens with sesame seeds and sliced red peppers for a nice color combo.

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How to Choose a Safe Water Bottle

Fri, 12 Mar 2010 00:00:00 +0100

I’ve made my stance on bottled water quite clear before, but I’ll go ahead and reiterate: bottled water is a joke. It’s completely unnecessary, unless you’re in a nation with unsafe water quality, and the plastic bottles make for excellent landfill fodder. You could reuse the bottles, but then you’ve gotta worry about the plastic leaching into your water, especially the more you refill and reuse them (and don’t ever stick ‘em in the dishwasher). Poor taste is one thing – I can’t expect a person to happily drink tap water that tastes terrible – but tap is perfectly safe to drink, especially if used with a simple filter. And if it weren’t, most bottled water wouldn’t be any better, since it’s often just repackaged tap (check the label or cap – if it says “from a municipal source” or “from a community water system” or anything along similar lines, it’s tap water). Sparkling water in glass bottles is justifiable (tap isn’t bubbly, after all, although you could make it so at home, and the glass bottles are definitely reusable (I like filling them with homemade salad dressings).

But if you’re just after fresh drinking water, the tap will be fine. You can buy a filter if you like – I do, myself – or you could locate a nearby freshwater spring, if tap isn’t cutting it. The best water I’ve ever tasted came from a campsite faucet in Lake Tahoe. You could taste the minerals; it was like drinking from a fresh water stream before it got dangerous. I swear, if it didn’t mean a eight-hour drive each way, I’d get all my water from that tap. Oh well. I’m getting off topic. Just don’t buy crate after crate of water in plastic bottles is the essential gist of my spiel.

Still, bottled water is undeniably convenient, which is why it’s probably so popular (along with unfounded fears regarding tap water safety). I can’t ignore the convenience factor. I like it myself. Most people just reuse their old plastic bottles, those simple, unassuming polyethylene terephthalate (PET) bottles. It’s an environmentally friendly gesture, but it’s one that may promote health issues, including the leaching of DEHP – a potent carcinogen – with repeated use. And, of course, there’s always our old friend, Bisphenol A, to contend with when plastics are involved. He turns up in the darndest of places, but that doesn’t mean you should simply throw in the towel. Avoid those old plastic bottles. Then there are the glass bottles. Safe? Yeah, but they’re also heavy and fragile – not the ideal water vessel for active individuals like our readers.

A better option is to go with a permanent water bottle expressly designed for the purpose. There are dozens on the market, but it usually comes down to a standoff between bottles made of polycarbonate plastics, aluminum, and stainless steel. Let’s see if we can find a clear winner.

Polycarbonate bottles

These are the “safe” plastic bottles; the permanent ones. They’re incredibly durable, and they exude an air of impermeability. They don’t wither under heat, like the PET bottles, and they maintain their shape. Plus, they often come in neat colors and attractive mesh shoulder slings. All the cool kids are using them, but should you?

I’d stay away. Polycarbonates have been proven to leach BPA into drinking water. There are no good reasons to take any chances considering the reams of animal data showing definitive deleterious effects outlined in the last BPA post.

But what about “BPA-free” plastic water bottles? Despite BPA-free claims I remain skeptical of plastic water bottles. With misinformation and the unregulated state of bioaccumulating pollutants, for my money there are much safer options.

Aluminum bottles

Aluminum is a solid choice. They’re pretty durable and very light, but they’re also expensive. Aluminum water bottles have become pretty damn trendy, if that weighs on your decision at all. Sure, trendiness can be annoying and all, but at least it shows people are becoming more aware of the folly of buying several plastic bottles of water a day – and that’s always a good thing. Is aluminum the way to go?

I hesitate to give my unequivocal affirmation. While the newest (post 2009) aluminum water bottle models from Sigg are claiming to be free of BPA, all their earlier stuff has it in the interior lining. So, the most recent Sigg bottles are probably safe, but as for the bottles from other, less reputable companies? I wouldn’t take a chance. Sigg is the biggest name in the aluminum water bottle game, and if they’re only just now ditching the BPA (a move momentous enough for the president to turn into a public statement ) in their bottles, I’d be careful about buying aluminum bottles from other companies. And definitely avoid filling an aluminum bottle with acidic liquid (not that PB folks are big lemonade drinkers or anything), which can cause the aluminum itself to leach.

Stainless Steel bottles

Stainless steel wins, in my book. Sure, it’s a bit heavier, but it’s a proven material, and it won’t leach (and if it could, you’d have pure steel running through your veins – a net win, if you ask me). If you’re attacked by a mountain lion, your stainless steel water bottle becomes a dangerous weapon. You can fell the vicious beast, wipe the blood off, then immediately take a sip of refreshing water. You think polycarbonate and aluminum bottles could do that? Please. Wild animals in this country have (sadly) seen more than enough used condoms and faded cans of Budweiser to last them a lifetime. They’d laugh at your plastics and pseudo-metals (who ever heard of a metal that a ten year-old boy could crush underfoot?). If you tried to face down a big wild cat with a polycarbonate bottle, you’d better hope that feral felines are highly sensitive to trace amounts of BPA.

Seriously, though, stainless steel is the best choice, followed closely by reputable aluminum bottles. With steel, you don’t have to worry about weird chemicals, nor do you have to spend a ton of cash to keep up with a trend, making it the clear choice for anyone interested in a durable, reliable permanent water bottle. Kleen Kanteen appears to be a trusted manufacturer.

What do you use to transport your H20? Is there anything I’ve overlooked? Any additional safety concerns? Share your infinite wisdom in the comment board!

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HunterGatherer Body Composition

Fri, 12 Mar 2010 00:00:00 +0100

A couple weeks ago in my post about health and vanity a good discussion got started in the comment board about the body composition of our hunter-gatherer ancestors. Was Grok lean and ripped or not? Let’s take a look at what we know.

It’s pretty well established that hunter-gatherers eating their traditional, whole-foods hunter-gatherer diet (whether Inuit, or Masai, or Pacific Islander, or whatever else) display little to no signs of the diseases of civilization. Infection, warfare, pestilence, starvation, and colonial incursion were occasional or even frequent sources of poor health outcomes, but for the most part they were well-nourished and free of degenerative diseases, even the long lived members. These guys weren’t dying for lack of statins or chemotherapy – let’s put it this way.

They were also physically active. They had to be, since dinner wasn’t to be found on a menu or on a store shelf (or even a farmers’ market). And if food was to be hunted, gathered, or wrestled wriggling from a rushing river, physical prowess increased the chances of success. Some anthropologists even suggest that the athletic prowess of Paleolithic man rivaled that of modern day Olympians. A few months back, I linked to paleoanthropologist Peter McAllister’s claims that his analysis of 20,000 year old Australian aboriginal footprints revealed a top speed of 37 km per hour – pretty damn close to Usain Bolt’s 42 km per hour. Give these guys a hard surface, some modern training, and McAllister bets they’d match or top Bolt. He cites similar feats in other peoples, including 110 meter hardwood spear throws and Tutsi initiation rites requiring high jumps of 2.52 meters. Even if he’s exaggerating or mistaken, the average hunter-gatherer – modern or Paleolithic alike – is going to be fitter than the average modern sedentary human, just as gym rats are fitter than people who never exercise. It’s a pretty simple concept.

But were they jacked? Could they grace the cover of Men’s Fitness? Or did Grok possess the universally lauded “Brad Pitt in Fight Club” physique?

Before we get into this too far let me make one important point. While Grok certainly had the capacity to become very strong and very lean very quickly (just as we do), survival dictates that he (or she) conserve energy. Grok’s not worried about definition in his lats, or getting lean enough to show off his 6 pack or in topping his personal records in the squat rack. It was much more practical for Grok. All that mattered to Grok was whether he was fit enough to bag that next boar. In other words, the capacity to be ripped doesn’t mean you have the obligation to be ripped. When you don’t know where the next meal is coming from conservation of energy is a huge consideration. Additionally, for a society that has virtually no material objectives other than catching the next pig and gathering the next palm frond it’s wealth is leisure time. The ability to relax, play, rest and just live was Grok’s luxury. So Grok’s mentality would have been, “how can I get the most amount of enjoyment with the least amount of input”. (Hmmm. Sounds a lot like The Primal Blueprint.) There is evidence that they were stronger and leaner and genetically they were certainly capable, but bear in mind that there is also a premium put on energy conservation.

Now back to the question of whether Grok looked like Mr. Pitt.

We don’t know for sure. I mean, it’d be silly to suggest no one had the rippling abs, but we can’t say they were normal features for early man. Going by fossilized remains, it certainly seems plausible that Grok was carrying a fair amount of lean mass on his body; Paleolithic human fossils typically evince far higher levels of mineral bone density than do modern humans, and strong, dense bones are hallmarks of physically active people engaged in weight bearing exercises (in a gym or on the savannah). The science is quite definitive on this note, but it still doesn’t mean Grok was overly muscular. It just means Grok was active and strong enough to make it through the day, and he was bearing plenty of weight, enough to stimulate bone density growth. Bones are living organs that respond to stimuli, much like muscle does. Exerting oneself and lifting weights (barbells or fallen game) tells your body to build stronger bones.

But do dense bones necessarily mean big muscles? Couldn’t they simply mean big exertion?

A small British study from several years back might give us a clue as to how bone mineral densities correspond to muscularity in active individuals. After comparing the bone mineral densities of several groups of athletes to that of a (non-exercising age-matched, gender-matched) control group, researchers found that rugby players displayed the greatest adjusted increase in bone mineral density. Strength athletes were close behind, followed by triathletes and tennis players. These groups all showed major increases in bone density when compared to the control group, while the “low-strain, low-impact” cyclists and rowers showed no beneficial growth in bone density. To get an idea of the type of physiques that accompany the various bone mineral densities, take a look at a group of rugby players, a powerlifter, and a triathlete. Now, check out some rowers and a cyclist. These are just pictures of individuals, and they don’t tell the entire story, nor do they rule out the existence of heavily muscled cyclists and emaciated rugby players, but I’d say they’re at least somewhat representative of the average. I think it’s safe to suggest that high mineral bone densities derived from athletic activity correspond to relatively robust muscularity. I also think it’s safe to suggest that since our ancestors were undoubtedly active on a regular basis, their robust bone densities indicate a pretty decent physique – unless they somehow found a steady source of fructose-rich honey, continuously gorged on root strips fried in a hollowed-out buffalo skull filled with boiling tallow, and developed an insulin-resistant belly to cover up those muscles.

Based on fossil evidence and modern understandings of how bone densities correspond to muscular hypertrophy in athletes, we can surmise that hunter-gatherers did have the potential for impressive physiques. The actual composition of HG musculature undoubtedly varied based on how they exerted themselves – if you were more gatherer than hunter, for example, you wouldn’t be bearing as much weight or exerting yourself as much, whereas a big game hunter with a steady diet of explosive thrusts, sprints, and carcass-heaving might be a hulking mass of corded muscle (like a Neanderthal).

What about modern hunter-gatherers? They don’t look all that impressive. Are they accurate corollaries for Grok?

Any photographs we have are of fringe hunter-gatherers, of displaced peoples subsisting on less than ideal lands with less available game and fewer resources. They aren’t necessarily indicative of what actual untouched hunter-gatherers looked like. Photos of Native Americans twiddling their thumbs on reservations are just sad reminders of their plight and their destruction; if anything, it’s an indication of the poor Western diet and the effects of sedentarism and perpetual despair. The camera records for posterity, but its very presence affects its subjects. Photos aren’t taken in a vacuum; they are taken amidst the dissembling of the very conditions that enabled our ancestors’ robust health and physicality. It’s impossible to separate the two.

Modern hunter-gatherers no longer have the lay of the land, and what land remains open is forever (short)changed. Roads and towns disrupt the delicate balance of wildlife, the natural ebb and flow that traditional people – as willing, integrated members of the natural cycle – came to rely upon for sustenance and survival. Beyond that, though, the arrival of civilization means the widespread destruction of wildlife and habitat. It’s a basic formula: human population increases (either through agricultural explosion or colonization), wild game population decreases (either by destruction of habitat or overhunting). History is replete with tales of bountiful hunting grounds rendered fallow in a single generation. It’s progress, yeah, and it’s made for some incredible advances, but it also undoubtedly spells certain doom for the hunter-gatherer folk who still happen to be living and eating there. So when someone points out the subtle man-boobs of a hunter-gatherer barely eking out a somewhat traditional existence on a sliver of land in some war torn nation, I don’t think that’s fair to Grok.

There are the stories, though – the anthropologic accounts of individual explorers and scientists living among traditional, mostly untouched peoples still following the old ways before the wagons arrived. There’s the Lewis and Clark journal (available free online), in which our intrepid explorers write of “plains Covd. with game” and witness “immence quantities of game in every direction around us…consisting of herds of Buffaloe, Elk, and Antelopes with some deer and wolves” – game so plentiful “that two good hunters could conveniently supply a regiment with provisions” and so “gentle that the men frequently throw sticks and stones at them in order to drive them out of the way.” These weren’t the skittish, sparse herds that populate civilized America today and have to dodge cars and hunters; no, the America known by historic hunter-gatherers was populated by reams of walking, running, nibbling, grazing, and brazen sacks of living meat willing and liable to walk right up to you. Their native guides would go for a light stroll and come back bearing several elks, a buck or two, and an antelope, almost by accident.

Travel accounts and skeletal records from the precolonial era (or, at least, pre-reservation era) reveal that the native peoples of the North American plains tribes were taller than their colonizer counterparts, as well as stronger, fitter, and healthier (except when faced with guns and foreign diseases, of course). Richard Steckel, from the Ohio State University Anthropology department, published a paper called “Tallest in the World: Native Americans of the Great Plains in the Nineteenth Century” that asserts the Plains nomads were actually “tallest in the world during the mid-nineteenth century” as confirmed by “travelers’ accounts and by the skeletal record.” He compared 9,000 individual fossil records from 51 different Native American groups ranging from North to South America, and the horse-riding, buffalo-eating Plains tribes were the tallest and most robust. They were also among the most physically active – and physically impressive – groups, and they obtained a significant portion of their caloric intake from animal fat and protein. Their neighbors to the south, like the Southern Cheyenne, were more sedentary and ate a more agrarian diet. They were also “less considerable in stature.”

I don’t think that’s a coincidence. I think it’s obvious that activity level and macronutrient ratio plays a huge role in hunter-gatherer body composition. The more activity they get, the more hunting they do, the more calories they derive from animal foods, the more physically impressive they are – the more typically “ripped” they appear. Kinda like what you’d expect from modern humans following a meat-and-animal-fat-heavy diet and strength-training regimen versus a vegetarian diet and yoga regimen (nothing against yoga!). The animal eater and heavy-thing lifter is going to have more muscle and less fat, on average (I know, I know, bring on the “entirely representative” pictures of crazy vegan bodybuilders).

This seems to play out in other hunter-gatherer cultures, too. While most of the pictures I was able to find were of flabby or nondescript modern hunter-gatherer physiques (subsisting on less than ideal lands, remember), there were a few with impressive, lean looks – and they were often members of meat-centric groups who still managed to maintain a fairly traditional diet. Take the Ache, from Paraguay, who get over 80% of their calories from animals or insects. Pretty impressive all around:

Check out this bow hunter and note the dense shoulder striations.
Or how about this guy mean mugging the camera?
Here’s another bow hunter with a good build.
Here’s both men and women.
And I’d be willing to bet this guy would have a very respectable back squat.

There’s also the Hadza, out of central Tanzania, who still manage to scrape together a decent proportion of meat in their diet. They do the root-and-tuber thing, too, of course, but meat remains the most prized – if not always plentiful – food.
The guys aren’t completely ripped, but they’re solid enough and plenty lean. Check out the leg musculature, especially the calves. And check out this dude in Papua New Guinea.

Australian Aboriginals, around the turn of the century, weren’t exactly slouches, even the old guys! Here’s a younger one, and here’s a group of lean, dangerous looking hunters. Of course, there’s always variation in any population.

The pictures don’t mean much either way; it’s just my way of showing that, despite pretty much everything stacked against their way of life, some modern hunter-gatherers are still able to forge impressive physiques. They weren’t all flabby. Assuming wild game was as plentiful in the Paleolithic as the travel writers claim it was before widespread colonialism, I’d imagine that earlier hunter-gatherers had more opportunities than their modern counterparts to be decently ripped. That’s all.

The physique of early man was dependent on many factors: activity level, activity type, diet, availability of animal protein/fat, and the seasonal patterns, to name just a few variables. The more hunting they did and meat they ate, the “better” their physique was – at least, that’s how it played out among modern hunter-gatherers, as well as those of us who follow a Primal eating (high meat) and exercising (high exertion) plan. And let’s remember that Grok had an interest in not exerting himself. More often than not conditions were such that Grok had to labor and his physique showcased this fact. But if conditions changed so would his body composition.

I think it’s safe to say that, judging from the robust bone structure and intense physicality of our ancestors, plus what we know about bone density and modern musculature today, there were more than a few well proportioned individuals running around the tundra, the savannah, the forests, and the bush of the ancient world. They may not have had mirrors with which to chart the developing definition of their abdominals, and they probably didn’t care about vascularity or the “pump,” but they were strong enough, fast enough, smart enough, and tough enough to make it this far… do you really think there weren’t even one or two six packs among the lot of ‘em? I mean, if we pampered moderns can somehow manage to put up respectable weight and assemble decent bodies while driving cars, working office jobs, and sleeping in soft fluffy beds, I bet Grok could too.

What do you think? Was Grok a slouch, ripped or somewhere in between? Does it matter? Share your thoughts in the comment board and Grok on!