Tuesday, August 31, 2004
First of all, the chances that it'll find anything in an asymptomatic patient (i.e., the kind getting these scans, because if they had symptoms a doctor could treat them) besides false-positives is very low. Second, in addition to not being helpful in diagnosing or treating cancer (what it's mostly billed as doing), it looks like it actually increases your risk! Is anyone surprised? Not really. I really like Chris Rangel's advice to the people to want these scans (since they're paying out of pocket):
Change over to magnetic resonance whole-body scanning. It may be more harmful to your wallet but it has no proven cancer risk and is just as useless as a screening exam. Have fun!Now, since I just said people were paying out-of-pocket for this stuff, you're wondering why it makes health care more expensive for the rest of us? Here's how:
Mr. X goes to his doctor, and demands that he be given a full-body scan because *something* might be wrong with him. The doctor says no, but still bills for the visit. Since the doctor is Mr. X's GP, X pays his co-pay and insurance covers the rest. That's, say $100, out of the general pool of money.Even if the scan finds a real tumor (which is very very rare), it's not likely that detecting it this way will have any effect on his treatment outcome, and thus he's still wasted all that money.
Then, Mr. X goes to the body-scan guy on his own, and pays his own $2000 for it. And the scan guy finds ... something. Feeling vindicated, Mr. X goes back to his GP, who sends him on to a series of specialists to look at whatever the scan found. Most of the time, the scans find an artifact (a false positive), so Mr. X has just spent probably thousands of dollars of insurance money on specialist visits and more tests to prove that he does not have an illness no one thought he had in the first place.
The insurance pools have to be replenished from this, so the company raises premiums. Plus, he's increased his chances of actually getting cancer later on, which will cost even more!
A study just published finds that these differences seem to be mediated by a single gene: Bax, which is key to apoptosis. Bax knockout mice have equal numbers of cells in both areas, regardless of gender (or should we say sex? I'm not up on my current identity politics...). I am definitely looking forward to the behavioral examinations mentioned at the end!
HCV infection is on the rise, particularly among gay men in America, who seem to think that AIDS is over, and that AIDS is the only thing they can get from unsafe sex. And unlike Hepatitis A and B, there is no vaccine. Yet. But, the good news is that a new study shows hope of producing one. Yay.
Monday, August 30, 2004
Now, big surprise, these have also been found dangerous, and also ineffective. C. aurantium extracts appear to have similar metabolic effects to grapefruit, and also causes hypertension.
Take-home lesson? Try losing weight the old-fashioned way: eat a healthy diet and exercise! Also, once you're eating right and exercising, grow some self-esteem and stop worrying about it.
Saturday, August 28, 2004
Friday, August 27, 2004
In the course of my work, I occasionally run into some bizarre things. In attempting to find a good, policy-oriented (not too philosophical or too econometric) definition of medical technology, I came across this page. Either someone at Advamed has a brilliant sick sense of humor, they've been hacked, or, as is ever more likely, it's a portal to some alternate universe.
Anyone who's taken Latin more recently (not to mention seriously) than I might, just for fun, tell me what it says. But please, only one repetition.
I do note, however, that there seems to be an attractiveness bias in the photos used to make up the composites.
A German cancer patient who had his jaw removed in 1997 as a radical cancer treatment has now got a new one. Not a fake plastic or ceramic one either: a real, live, bone one! His doctors did a brilliant procedure, where they grew him a new jaw bone in his shoulder muscle, using a mesh model and bone growth factors, and then transplanted it into his face. He can now chew some solid food, and next year they'll get him some teeth!
So it seems we don't need to worry about no-carb or low-carb, but instead about GI. I can live with that.
Thursday, August 26, 2004
Don't you just love the internet?!?!
Today, in the Health section, right next to each other, are two very conflicting articles. One describes research (which, by the details given, is likely crap) showing that messy households are linked to lower intelligence in children. There does not appear to have been a control for income or education. The second highlights hyper-clean houses as a possible cause of asthma in children, and gently blames cleaning products for all sorts of other ills. I've seen some of the older research here, and it's pretty unconvincing.
So, we have two articles from a reputable source, simultaneously telling us that in order to raise smart, healthy, successful children, we must do so in a house that is either messy or clean. Useful, huh?
Other conventional wisdom has been that smoking pot induces psychosis and that excessive Anandamide (an endogenous cannabinoid: something your body makes which is what naturally acts on the system TCH does) was a possible cause of schizophrenia. Studies were done and researchers found that in schizophrenics, Anadamide was hugely increased, and that established a link.
However, as anyone who takes research methods seriously will remind you: correlation does not equal causation!!! More research got done, and it now seems like Anandamide acts as a natural anti-psychotic, and THC causes psychotic symptoms because it reduces Anandamide receptors' (CB1) sensitivity.
Take-home lesson: always do your follow-up experiments!
A few brainy surprises appeared today, which doesn't really come as a surprise, since we know so bloody little about how all that grey goo does what it does. Anyone who tells you otherwise has never really studied neuroscience, or is delusional. This will be in multiple posts, because I don't want one huge one.
The conventional wisdom, up until this study is replicated, has always been that the adult brain is much, much less plastic (adaptable and changble) than the pre-adult brain. The press release is very short on details, but this is really fascinating. I want to understand the 'rewiring' process, especially...anyone know anything more?
Wednesday, August 25, 2004
The study was looking for a molecular basis for Chronic Fatigue Syndrome, a condition which may or may not exist (what I've seen seems to indicate that it does, and that it is debilitating), and hopefully sheds more light on that than the release does. And a better understanding of metabolic regulation is a Good Thing too, regardless of immediate commercial applications.
Jet lag sucks. I don't really get it anymore, having learned to trick my system into adjusting very quickly, but I used to be totally wrecked for a few days after a big trip. Possible treatments for jetlag and shift-worker fatigue are the more commercial (and far less interesting) results of research into circadian rhythms and biological clocks. Since sequencing the genome (and before that too), scientists have found a number of genes which seem to be associated with circadian cycles, but no 'masters' have yet been identified.
A series of experiments lead to identification of a transcription factor, called Rora, which seems to function as such a 'master,' controlling another key gene in the system. The release gives lots of good background on all the processes involved, so its great reading (and not too technical!). Enjoy!
And the bad news. It seems that the popular hormonal contraceptive, Depo Provera, triples the likelyhood of Chlamydia and Gonoccocal infections. A word for the ladies: D'Oh!
Tuesday, August 24, 2004
You are a XPIG--Expressive Practical Intellectual Giver. This makes you a Catch.
You are a magazine-cover, matinee idol dreamboat. Parents love you and want to set you up with their kids. However, first dates are tough because it takes time for your qualities to come out.
You are generous and kind. You think first and act later. You are cool in a conflict, but your practical side means if your partner throws out emotional appeals ("why can't we do what I want for a change?") they will grate on your nerves, even when the conflict is resolved.
You're a romantic. You enjoy the thrill of the hunt, and you don't just fall into bed with anyone. You pay close attention to your significant other's needs, and this makes you an excellent lover and partner. The problem is that your friends and lovers may find it so easy to express things to *you* that they lose sight of whether you feel as comfortable with *them*! This doesn't necessarily make you feel under-appreciated -- you're too well-adjusted and self-aware for that -- but you may feel restless. Thus you seek adventure in your life outside the relationship to prove and actualize yourself.
Of all the types, you would make the best parent.
You are coiffed.
Didja see "Big Fish"? 'Cause you're like Ewan MacGregor in "Big Fish."
I didn't see "Big Fish," but any comparison of me to Ewan MacGregor is probably OK in my book! Also, the first three sentences don't match: I'm a dream-boat (fine, ok, sure), parents set me up, but it takes a while for my qualities to come out. Huh? Yes, that third bit is definitely true, both about first dates and my qualities, but it's a non-sequitor there.
I am very attentive, and do tend to lose sight of my own needs while taking care of everyone else. Well-adjusted is another story.
Funny thing about the 'best parent' bit...I'm not at all sure I will ever want kids.
I think I'm pretty well coiffed.
Monday, August 23, 2004
The University of Washington reports that old people who wear sneakers (which, I note, both of my grandmothers refuse to do) are significantly less likely to fall. Other shoe types were associated with a 30% increased risk, while walking barefoot was even worse. I guess this means I will be going shoe shopping for my grandmothers soon. Oh joy.
British researchers have found that email communication between doctors and patients has serious potential (summary here) to improve the quality of that relationship and care overall, not to mention cutting costs. Even my grandparents use email, and it would be preferable for them to get info from doctors that way, since they often have trouble understanding and remembering what they hear (emails can be kept and/or forwarded to me for interpretation). Very interesting!
Friday, August 20, 2004
Eating disorders did well for Mary-Kate Olsen. I'd like to see Paris [Hilton] even thinner. Maybe she'd disappear entirely.I can think of a few other people I'd like to similarly encourage.
Remember all those music lessons you hated as a kid? Well, it turn out they may have made you smarter. A new study of Canadian children showed that the ones who took music (voice or keyboard) lessons for a year had a small but significant, across-the-board IQ boost over control kids, who took no lessons and who took drama lessons. The drama kids, interestingly, got a unique boost in measures of adaptive social behavior (Fascinating, given the social standing of most 'drama kids' in high school!).
There's an old linguistic theory that says what language you speak affects your cognitive abilities. Annoyingly, there is now evidence to support this idea: researchers have found that people of the Pirahã tribe in Brazil, whose language has only the enumerations "one," "two," and "many," can't distinguish between larger groups of objects. It's really kindof creepy, and I almost hope the research turns out to be invalid. Because that's fucking scary.
Thursday, August 19, 2004
You are an enzyme. You are powerful, dark,
variable, and can change many things at your
whim...even when they're not supposed to be
changed. Bad you. You can be dangerous or
wonderful; it's your choice.
Which Biological Molecule Are You?
The second is unrelated to vision, but it's about wakefulness (opening your eyes...) so I'm putting it here anyway. UC-Irvine researchers have found critical roles for the relatively recently-discovered Neuropeptide S (NPS): it increases wakefulness/alertness and decreases sleepiness, and reduces anxiety responses. NPS receptors (G-protein) were found in Locus Coeruleus, which has long been associated with these functions. Cool beans, I want my new study drugs!!! NPS receptors (G-protein) were found in Locus Coeruleus, which has long been associated with these functions. Cool beans, I want my new study drugs!!!
Lastly, and most exciting, is a demonstration of a retinal implant system to restore vision. Instead of retinal transplantation, a traditional goal, these guys just put a chip onto the eye that stimulates the nerves that are already there (and usually undamaged). It's a wireless video link from a mini camera the patient has on his/her glasses. The put the implant outside the eye, because "the eye doesn’t like stuff inside; that’s why it doesn’t have a zipper.
So. Fucking. Cool.
Wednesday, August 18, 2004
But just when you thought Fox had taken the prize for demeaning, offensive programming, MTV strikes back!!! While it seems innocent, a show helping kids come out to their parents (which, thanks in part, I'm sure, to MTV's love for anti-gay stereotypes and artists, lots of kids need), the casting call belies the awful bit: "...we'll explain this hilarious new show..."
Yeah, because risking your relationships with your entire family and turning your life inside out is bloody funny! And no one could possibly get hurt. My parents didn't freak when I came out to them, but if I'd done it on international TV, I would probably not be alive today.
(hat tip to Chrisafer)
Plus, Dan Savage has managed to say most of what I would have said, albeit in a totally different way than I would have said it.
One of the major problems in health care today is making sure everyone gets the right treatments and tests, without going overboard and overtreating (which is at best expensive, and at worst dangerous). The VA began a number of years ago implementing its electronic patient tracking systems, with a particular focus on diabetes as a 'target' disease. The results are in, and VA system works better than HMOs. This is being touted as evidence that a nationally funded health program is effective. So maybe we can get some momentum towards a real national health plan!
In an intriguing new study, UK and US scientists have found that certain NK cell immunoglobulin-like receptor alleles seem to be more able to clear the Hepatitis C virus (HCV) than others, granting a sort of immunity to carriers. This effect is likely overwhelmed by high-dose infection, but I wonder if an initial, low-dose infection acts as a vaccine?
This finding likely has implications for other diseases as well, so expect some follow-up in this area.
Tuesday, August 17, 2004
The second study is really amazing. It seems that the ever-popular (and controversial) statins have a new benefit: they may block HIV!! Bloody amazing. You gotta wonder what it is about these drugs that makes them so widely beneficial...and what other effects they have that aren't yet apparent.
Monday, August 16, 2004
Previous research also shows THC's ability to affect apoptosis and other aspects of cell cycle regulation. But don't worry kids: all these things don't seem to happen just from smoking pot (unless you smoke A TON)!
Friday, August 13, 2004
Instead, JK does all the work!
Come on, people!
I'd really love to hear what everyone else thinks.
Wednesday, August 11, 2004
As we all know, the state of healthcare in the
Many doctors and Republicans seem very happy blaming the costs of health care on malpractice suits and judgments (which occur only in a
tiny miniscule fraction of suits filed), not to mention lawyers. This certainly has an effect, particularly on sole practitioners who get stuck with $150k per year premiums all alone, and doctors in
You'd think, along with wanting to reduce their malpractice insurance costs, doctors would want to try to reduce errors (and thus suits), right? Not so much. Doctors are protesting
And, on the stupid-government side, Vermont is suing the FDA to make it allow reimportation of Canadian drugs. Go
Tuesday, August 10, 2004
Monday, August 09, 2004
We all know health care in the US is ridiculously expensive. The costs seem to be out of control. There are lots of answers why, but none is complete. A convenient explanation is that, due to our third-party payment system, consumers are isolated from actual costs, and thus consume less wisely than they would in a direct payment scheme. This is almost certainly true: higher copays and coninsurance lead to less demand for care.
An editorial in today's Wall Street Journal discusses this, and the author concludes that expanding tax benefits to cover all health care costs would help. If you make out-of-pocket expenses deductible, she says, high copay/coinsurance plans will become more attractive, and consumers become more exposed to costs, and become wiser consumers, and costs go down. Fine. That's probably right, but I strongly doubt it's the whole story.
First off, the insurance and provider industries would find a way around it. Second, people seeking less care is not necessarily a good thing.
The theory put forth by the authors, of an overactive insuln/IGF-1 pathway, fits nicely into the Atkins Diet, which is designed to lower this pathway's activity.
It appears pretty robust, although much more information is needed before we need to go recommending diet changes. The study is current incident/retrospective, and a prospective study is a critical follow-up.
HIV passed from monkeys to humans some time ago, and while no one is precisely sure how that happened, HIV now epidemic in humans and a global disaster. One very good idea of how HIV made the simian-human jump is through people eating bushmeat, which essentially means monkeys. Despite this, and many other diseases associated with bushmeats, people keep eating them. And now, other, unknown AIDS-like symptoms are showing up unattached to known HIV strains. Under most natural circumstances, the disease would die out quickly, as mostly only those eating the bushmeat would get it, but in the modern world, plagues spread like, ... well ... plagues.
Friday, August 06, 2004
I am a politics junkie, even in boring times. But these days, there are so many things about which to froth at the mouth. Terrorism. The economy. Generalissimo el Fuckwit in the White House. Etc, etc.
However, the one issue that makes me the angriest, even when I dissociate my own personal interest in it, is the gay marriage bullshit. For starters, as my grandmother pointed out some time ago, this is not an issue that should even be legislated at all. Marriage is a religious institution, and that the government calls its civil unions marriage is a side note, and probably at least philosophically inappropriate. The government has no right to tell people how to live their lives, when they are not committing a crime.
The whole idea of our Constitution is that being different type of person than the majority cannot be, per se, a crime. But of course certain people like to ride around on perceived moral high horses and dictate Morality (which is very different and usually opposite from morality). And those people have a disproportionate amount of power in America The reasons are numerous and complex, but they come down to a combination of history - who ended up here - and geography - who ended up where and how they created segregated ideological groups, which, aided by the two-party, federalist electoral system, allows them to wield huge influence.
Yesterday, the state of Missouri passed, by an overwhelming majority, an amendment to the state constitution banning gay marriage and effectively relegating gays to second class citizenship. Other states are in the process of doing the same, all fueled by hate and ignorance, the flames fanned by politics which are (at best) cynical or (at worst) pure demagoguery.
Gay rights groups, who tend to be maddeningly short-sighted, have started focusing on the Kerry/Edwards teams' sort-of approval of this event, instead of working to correct all the societal factors which not only passed it, but make it impossible for K/E to say anything against it.
Anyone who pays even decent attention to things knows that Sen. Kerry, at the very least, would like to see gays granted all the rights they deserve as American citizens, which is no fewer and no more than any other American has or deserves. But, in an election year, when the Republican party has so masterfully crafted a debate around something that shouldn't be a debate at all, the Dems have no choice but to keep pretty quiet. Yeah, condemning this bullshit would be The Right Thing To Do, and would shore up the GLBT vote (except for the fucking evil that is the Log Cabin Republicans), but it would guarantee bigger losses in Missouri, Ohio, Nevada, Iowa, and other critical "swing" states. If the Johns said what they really thought about this issue, they might as well go home now.
But what makes me so mad about this issue/business is: it's so totally, blatantly, undeniably contrived. The opponents of gay marriage really don't have a leg to stand on. There is NO REASONABLE ARGUEMENT against it. The other 'culture war' issues, like abortion, at least are based in real philosophical/religious differences. The so-called "Religious Right" has essentially made up a great deal of theology to create an issue here...there is no consensus among religions that gays are bad or that they shouldn't get married. Not even among Christian denominations. Never has been. All the bits of the Bible that get tossed around as proving that homosexuality is a sin are more or less the same kinds of bits that got tossed around 50 years ago to prove that blacks were inferior, or sub-human. Things taken out of context, mis-translated, etc (the Sodom and Gomorrah story is big here, the subtleties of the original text are generally left out of discussion, for instance the multiple meanings of "to know" in Hebrew and Aramaic, and Midrash regarding both the importance of hospitality and Lot's wife).
I must stop now, and go back to work.
Semi-related, Oregon researchers have developed a new antimicrobial, edible food wrapping from chitosan and lysozyme, which could possibly revolutionize shipment and storage. If this means I can reclaim that cabinet currently filled with tupperware, I'm thrilled!
But what happens to all your symbiotic bacteria?
Thursday, August 05, 2004
NIMH researchers have found that a circuit, involving the orbitofrontal cortex, thalamus, anterior cingulate, and ventral striatum, is active in patients with depression even when they are not depressed. Very interesting, since it shows a substrate of susceptibility, which could not only lead to better (and perhaps even preventative?) diagnosis and therapy, but also further he search for pathenogenesis. Pretty cool, neh?
Other research has found that antibody targeting of amyloid-beta peptides, which make the plaques characteristic of Alzheimer’s, reduces the tangles of the disease, and may slow progression. Clinical trials of a related vaccine were halted due too encephalitis, so who knows where this might lead. But killing this disease would be great.
Wednesday, August 04, 2004
Following up on this week's development theme. The conditions under which an individual female lives, in the animal kingdom, affects what sex her babies are likely to be. Those in poorer health and lower social caste tend to have girls, higher-ups tend to have boys. This has never, however, been very well established in humans (although there are some effects seen in poor women in developing countries, mostly confounded by nutrition).
An letter published in the current Biology Letters and reviewed here seems to show a trend in richer Western women. Sortof. The women reported on the sex of their first child, and how long they thought they would live. Women who gave themselves longer tended to have had boys. There may be a real effect here, but by the write-up, I don't see any reason to take it seriously. Why did they think they'd live longer? Maybe because they're healthier, wealthier, and have family history (all linked to boy babies in poor women and monkeys)? and it's a bloody major stretch to go from there to psychological effects, as the piece wants us to do.
Tuesday, August 03, 2004
In order to make most enzymes, you need vitamins. Besides that, vitamin supplements are all the rage these days, supposedly to prevent and guard against any number of diseases. Antioxidants are especially popular, due to their links to better cardiovascular health. However, new research indicates that you have to actually eat the fruits and veggies that naturally contain the vitamins, as opposed to popping supplements, to get any benefit. Sorry Dr. Atkins!!
One of the biggest questions in schizophrenia research is etiology. Why does it happen? What is the cause? There are endless theories and ideas, many supported by some good evidence, but no clear answers. There are genes known to be associated, but none necessary or sufficient for the disease to manifest. Trauma seems to trigger the disease, but not in everyone. A new study has found that exposure to influenza during the first half of pregnancy seems to increase the risk of developing the disease later in life. It looks like a pretty good study, so I look forward to seeing where it leads.
In less exciting news, NIH/NIAAA has released the results of a survey which claims that about 15% of Americans meet the criteria for a Personality Disorder. This may or may not be true, but it reads to me like another case of the pathologization of everything. Psycholog/iatrists are notoriously good at that.
Monday, August 02, 2004
There are lots of ways of defining 'adulthood.' The most obvious definition is physical: you are physically mature sometime in your mid to late teens, give or take some years for each person (nevermind that development continues in some significant ways after that...for real biological and most all practical purposes you're an adult). Another way is when you turn 18 (in most of the West), and get to vote/not be legally bound to your parents (except for in a number of financial terms, like financial aid at colleges, f'rinstance). Or when you turn 21 and can legally drink (in the US). In Jewish tradition, you traditionally (although that's its only significance these days) become an adult at 13, with your Bar/Bat Mitzvah. Other definitions include various senses of being 'grown up.' And the meaning of that has changed a good bit recently, as well.
The American Sociological Association has released news of a study on the transition from adolescence to adulthood. It's bloody interesting. For me, the key issue is the artificial extension of childhood-like dependence well past when it seems to be biologically (and I include psychologically here too) useful or appropriate. At 15 or 16, most people could go hunt and gather (not to mention have children) effectively on their own, and certainly have the urges and instincts to do so. This is why "abstinence education" is so ineffective.
The piece mentions educational systems as part of extending early adulthood...I wonder what a similar study in Europe, for instance would see: people there live with their parents much longer than we do here, and there is not (at least in where I was in France) nearly the stigma there is here either. And what about in cultures where many generations live together at all times? Being able to provide for your family still would be a factor there, but in so many different ways.
Hmph. Too bad I didn't have time for a sociology major as well!