Simple truth of the recentEbola hysteria and the ensuing media coverage of scientists working on hemorrhagic viruses. Approximately 85% of bioscience now wishing ill on a whole lot of people so as to draw attention to their scientific domain.
Archive for the 'Public Health' category
There's a strawman-tilting screed up over at substance.com from my current favorite anti-drug-war-warrior Maia Szalavitz. She's trying to assert that Trying to Scare Teens Away From Drugs Doesn’t Work.
In this she cites a few outcome studies of interventions that last over relatively short periods of time and address relatively small populations. I think the most truthful thing in her article is probably contained in this quote:
Another study, which used more reliable state data from the CDC’s Youth Risk Behavior Survey, concluded that “When accounting for a preexisting downward trend in meth use, effects [of the Montana Meth Project] on meth use are statistically indistinguishable from zero.”
This points out the difficulty in determining broad, population based outcomes from either personal introspection (where a lot of the suspicion about anti-drug messaging comes from, let's face it) or rather limited interventions. Our public policy goals are broad- we want to affect entire national populations...or at least state populations. In my view, we need to examine when broad national popular behavior shifted, if it did, if we want to understand how to affect it in the future.
The following originally appeared 21 July 2008.
If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of "The (US) War on Drugs is a complete and utter failure". Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.
Now I'm open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I'm most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.
It's a pretty interesting viewpoint on basic science, translation to humans and what we do when an emergency situation like an infectious disease outbreak happens. I have been struck in past days about the huge international discussion this ZMapp treatment has been sparking. As you might expect, we have dark thoughts being expressed along the lines of "Why does this apparently miraculous treatment emerge all of a sudden when Americans are infected but it hasn't been given to suffering Africans, hmmmm?". There are all kinds of ethical issues to think about.
The television version linked below is 5 minutes but be sure to click on the link to the "midday edition" which is a longer voice interview. It gives a much fuller discussion.
David Kroll on ZMapp
Maia Szalavitz has penned a new article on addiction that has been circulated, credulously and uncritically, on social media by people who should know better. So, once more, into the breech, Dear Reader.
The article in question is Most of Us Still Don't Get It: Addiction is a Learning Disorder is posted at substance.com.
We can start with the sub-header:
Addiction is not about our brains being "hijacked" by drugs or experiences—it's about learned patterns of behavior. Our inability to understand this leads to no end of absurdities.
From whence comes learning if not from experiences? And what is the ingestion of a psychoactive drug if not an experience? She is making no sense here. The second sentence is pure straw-man, particularly when you read the entire piece and see that her target is science, scientists and the informed public rather than the disengaged naive reader.
Academic scientists focused on drug abuse have talked about the learning aspect, of habits and of the lasting consequences of drug experiences since forever. This is not in the least little bit unknown or novel.
Continue Reading »
From the LA Times:
The University of Arizona has abruptly fired a prominent marijuana researcher who only months ago received rare approval from federal drug officials to study the effects of pot on patients suffering from post traumatic stress disorder.
The firing of Suzanne A. Sisley, a clinical assistant professor of psychiatry, puts her research in jeopardy and has sparked indignation from medical marijuana advocates.
I bet. Interestingly I see no evidence on PubMed that this Sisley person has any expertise in conducting research at all. I'm not saying I need exhaustive credentials but I'd like to see a published study or two.
Cue the usual raving about how this is all a vast right wing conspiracy to keep down miraculous medication...
Sisley charges she was fired after her research – and her personal political crusading – created unwanted attention for the university from legislative Republicans who control its purse strings.
“This is a clear political retaliation for the advocacy and education I have been providing the public and lawmakers,” Sisley said. “I pulled all my evaluations and this is not about my job performance.”
Well, this IS Arizona we're talking about. I'm going to want to see more* but I guess I am going to have to score myself as sympathetic to the notion that this was a political squelching.
Still, the University is denying the charge...
University officials declined to explain why Sisley’s contract was not renewed, but objected to her characterization.
“The university has received no political pressure to terminate any employee,” said Chris Sigurdson, a university spokesman. He said the university embraces research of medical marijuana, noting that it supported a legislative measure in 2013 permitting such studies to be done on state campuses.
Ok, "embraces", eh? We'll see if that turns out to be true.
*if this holds true to form the University will be compelled to make a case for how she wasn't competent at the "clinical assistant professor" category of association with U of A.
Well this is interesting. After being spanked by the FDA for selling their services without proper review and approval of their medical test (as the FDA interpreted it), the 23andme company is back.
I received an email spam suggesting I purchase one of their kits as a Mother's Day present.
Intrigued, I see this in an alert banner across the linked page.
23andMe provides ancestry-related genetic reports and uninterpreted raw genetic data. We no longer offer our health-related genetic reports. If you are a current customer please go to the health page for more information.
When you go to purchase a new kit you are obliged to check a box indicating you've read an additional warning.
I understand I am purchasing ancestry reports and uninterpreted raw genetic data from 23andMe for $99. I understand I will not receive any reports about my health in the immediate future, and there is no timeline as to which health reports might be available or when they might be available.
Ok. Got it.
So what about existing customers who purchased their kit in the old, pre-ban era? Guess I'd better visit that "health page".
Current 23andMe customers who received health-related results prior to November 22, 2013 will continue to have access to that information. However, no new health-related updates will be provided to your account.
Customers who purchased kits before November 22, 2013 will still receive
Customers who purchase or have purchased 23andMe’s Personal Genome Service (PGS) on or after November 22, 2013, (date of compliance letter issued by the FDA) will receive their ancestry information and uninterpreted raw genetic data. At this time, we do not know the timeline as to which health reports might be available in the future or when they might be available.
Customers who purchased kits on or after November 22, 2013 through December 5, 2013 are eligible for a refund. 23andMe has notified all eligible customers by email with refund instructions. If you are eligible and have not received an email, please click here.
Ok, so they are not turning off the results already provided to the older customers. If you fell into the cease-and-desist gap, you don't get your info (boo FDA) but you can get a refund.
In the mean time, 23andme is an ancestry / genealogy company.
I suppose that is it until they pass regulatory approval for their health and trait information?
This is a guest appearance of the bluebird of Twitter happiness known as My T Chondria. I am almost positive the bird does some sort of science at some sort of US institution of scientific research. The bird is normally exhausted by typing messages 140 characters at a time so I was skeptical but....well, see for yourself.
MDs and PhDs are considered to be some of the brightest and the most insightful people in the country. Indeed, look no further than the nearest MD or PhD and ask them; they will attest at great length to their exceptional smarts and individual importance in maintaining the sun orbiting the Earth. Yet for all the combined education there remains a fundamental lack of appreciation of how intertwined the fate of these two professions are - ranking right up there on the irony scale with Pakistan threatening to nuke India (they are geographic neighbors, so that’s ironic, you see).
For anyone who has ever worked at a major academic medical center, we are told ad nausea how important we are in understanding human health. Yet we do so almost exclusively in parallel universes. Asked what its like to try to work with an MD, a PhD will often tell you MDs are ‘erratic, ill informed and totally lacking in any understanding of what goes into doing real research’. Conversely, asked what PhDs do, MDs will likely reply ‘they like to present very complex diagrams, write grants and develop models of disease and pathology that have little to do with any case I’ve ever seen.
I get to surf between these groups; my primary appointment in a clinical department affords me a perspective that is unique in that I am able to pass as either an MD or a PhD on any given day. I spend the majority of my time running a research lab but I can scream “House! Put down the scalpel you jackass! All you have to do is order a chest x-ray and look for pulmonary infiltrates to know it’s not sarcoidosis!” with the best of interns.
In drifting between these lands, I noticed the rifts earlier between ‘researchers and doctors’ which seemed vaguely amusing not so much now as first but as the business of academic medical is getting the shitte kicked out of it and PhDs think it has little to do with them.
In previous faculty meetings, I would watch tenure track PhDs glaze over as our beloved leader discussed the ‘blah, blah’ of clinical revenue streams.
Conversely, the MDs would eagerly reengage a new level of Candy Crush Saga as our chair commiserated with PhDs about pay lines and sequestration. (So clueless were the MDs about the recent plight of scientists that the esteemed journal JAMA even had to run an article in their online edition earlier in the year explaining sequestration to the primarily MD audience.)
At our most recent faculty meeting, there seemed to be a moment of real illumination between both groups that everyone in the medical center was screwed and better start making more widgets faster. Our Fearless Leader informed faculty that our hospital budget shortfall was progressing more quickly than we had anticipated even three months ago and vacations were canceled for faculty, more clinical hours were going to need to be booked and the bergermeister was coming to take all our toys (only two of these three have happened so far).Later that day, I took to on Twitter to vent and look for pictures of kittens doing cute things (see Fig 2 as evidence of my hard work). Many of my Twitter followers are porn bots, but at least 2 or 3 are PhD-types and aghast that my medical center was being so aggressive. There were many sad emoji’s sent my way and a flutter of ‘how could they’ and ‘oh, your poor little university’ that made me wonder what planet everyone is on and if donuts were as delicious there as they were here (see Storify by @mrhansaker here).
EVERY medical center in the US is getting carpet bombed into financial oblivion by the economy, Medicare reimbursements and Obamacare. And yes, I assured my Tweeps, the amount of our gross national product that goes to health care is stoopidly high. But, a startling number of my PhD buddies were taken aback by the idea that those pesky ‘high health are cost’ they glaze over in faculty meeting or when listening to NPR is also covering their academic PhD arses.
So, for my PhD pals, whom I shall refer to as ‘People who are doctors only when they book hotel rooms’ (I’m kidding, I’m a kidder!), I wanted to run this down a bit further. If you have a medical center as part of your university, you have been riding clinician’s financial coat tails for a long friggin time. The indirect rate charged to granting organizations in no way covers operating costs for research. That takes an endowment or an additional revenue stream. Endowments usually come from long dead old rich doods. These endowments don't just sit in Scrooge McDucks cave. They get invested in things like the stock market. And the stock market got the shitte kicked out of not too long ago. Billions in endowment money were lost in the economic collapse - most Universities took 25-50% hits on their Scrooge McDuck funds. So, if you’re a PhD, you can take endowments out of the equation as what’s been filling in those pesky financial gaps between costs and expenses. No worries, you’re at a medical center so you have a revenue stream- your clinical enterprise. Sick people. America is ALWAYS good for some damn unhealthy and foolish folks who will make the worst choices possible and rack up a small fortune in insured and uninsured care.
Thank God for stoopid and unhealthy people, amirite?? This is even better because our Commander-in-Chief got an electoral mandate to insure everyone’s (ish) stoopid arse. More money for medical centers has got to be a win, yes? Not so much. Show me a medical center meeting its financial goals, hell even one that isn’t heading for a hundreds of millions of dollars of deficit for 2014, and I will show you a for profit medical center (read here: “not academic, so no jobs for you PhDs”).
The proverbial sky has been falling for research scientists for some time now as well documented by my kind host Drug Monkey and others with inferior blogs and better shoes. And indeed, MDs have been hounded into appreciating the genius that is the bench scientist. So valued are the basic researchers that they are sought after to heap more prestige on the medical center and an even better training environment which increases numbers of trainees, blah, blah.
Unlike clinicians, scientists have known the economic sky was falling for some time and have been zealously advocating the importance of science research bracing for impact. To the outside world, that looks a lot like holding your collective sphincters together as tightly as humanly possible and waiting for things to improve. Well-done people. Actually, you sort of sucked at advocating for yourselves as evidenced by the two of you who actually sent @nparmalee letters to hand deliver to your Congress Critters a few weeks ago, but I will need another bottle of wine for that.
The first warning to those PhD types in the 35+-age bracket would have been when Scamp-in-Chief Bill Clinton never quite delivered on his ‘peace dividend’. The one where all those pesky defense dollars would go to building a bigger, better, smarter American work force with futures in STEM (Dumber Bombs! Smarter People!). We would turn in our tanks and churn out better-educated versions of ourselves with outstanding oral hygiene to lead us forth into the new millennium free of disease and with cats with laser vision. Not only did we forget to provide sustainable growth mechanisms for STEM, we also neglected to maintain world peace and not screw the interns. Bill, you lovable rascal, at least you didn’t shoot anyone in the face. Just in the foot. Or both feet.
In the parallel world of MDs, who kindly request you simply refer to them as ‘real doctors’ for the rest of this diatribe, the pesky business of health care in academia has always been a house of cards. About 7% of MDs practice in the rare air that is academic medicine. This affords prestige, time for clinical research, collegiality, security and none of the business hassles of private practice, but about half the salary. Which, to be honest, is still a metric shitte ton of money especially if you do a bit of consulting. But now, there’s no research time, Medicaid is squeezing out every reimbursable dime and you are keeping the same hours as your hapless residents.
My take home from today friends is that the party seems to be winding down. Rather than recognizing that our fates are intertwined, MDs and PhDs frantically see more patients and write more grants and wonder when the sun will shine on us once again and society will appreciate our true worth. I have yet to see any evidence that for all the brain power and letters after peoples names, PhDs are even aware of that medicine money is research money. So you go put your blinders on and find that spear, and I’ll put mine on and grab this rope and no one will call it an elephant.
The Food and Drug Administration has ordered DNA testing company 23andMe to stop marketing its over-the-counter genetic test, saying it’s being sold illegally to diagnose diseases, and with no proof it actually works.
I did not see this coming at all. Guess I was too focused on thinking about informed consent issues.
I originally posted this Jan 09, 2008 on the old blog and reposted it 12/12/2008 with small improvements over the prior version. It has been one of my more popular posts when it comes to Google hits. You might want to check out a personal recipe for opiate based cough remedy as well.
The US Food and Drug Administration (FDA) began sending warning letters to sellers of so called "bio-identical hormone replacement therapy" today according to an AP report. Apparently the claims for alleviating menopausal symptoms are
not supported by medical evidence and are considered false and misleading.
Needless to say, these "compounded" products are being sold without FDA approval. It's all a conspiracy man! Dang FDA is a tool of BigPharma trying to keep cheap and effective remedies from the public. Noted tool of TheMan(BigPharmaDivision) Abel Pharmboy has a recent post in which he touches on "cosmeceutical" marketing of drugs and the FDA's authority to regulate cosmetics under
their regulatory authority is in part ordered by the Federal Food, Drug, and Cosmetic Act of 1938 (and subsequent legislation).
This reminds me of the glory days of the quack remedy / patent medicine era and today, from the mouldering archives, we take up a Case Report published by A. B. Hirsch, M.D. ["Mrs. Winslow's Soothing Syrup. American Medical Journal, 1884, 12(11):504-506] which is available from Google Books here. A footnote indicates that this Abstract was read before the Philadelphia County Medical Society on Sept 17, 1884. Ahh, Mrs. Winslow's . Used for over 60 years by mothers for their teething children.