Richard G. Petty, MD

Sir Richard Branson’s Integrated Health

Sir Richard Branson is a hugely popular British entrepreneur and adventurer who has been able to keep the common touch and does not seem to be as ruthless as some other self-made billionaires.

For more than three decades Richard has also shown that he has a remarkably good nose for identifying important and/or lucrative new trends. Like all people, he has made the occasional bad call, but his overall success rate is astonishing.

So I was extremely interested to see that Richard Branson’s Virgin Group has launched a foray into the British National Health Service (NHS) primary healthcare market and they are trying to persuade family doctors to join them in establishing a network of branded clinics.

It is particularly interesting that British government ministers are welcoming Virgin Healthcare’s decision to open the first of six “one-stop-shop” health centers later this year. The plan is to offer services from homeopathy to psychotherapy alongside typical primary care services.

This project has been two years in the planning and the group has just started its first advertising campaign to generate interest among family doctors who could join its health centers.

The business model allows family physicians to retain their existing contracts but Virgin would manage funds the doctors receive for staff costs and rental. Virgin would then offer a range of additional NHS and private services to visiting patients, including dentistry, screening, a pharmacy “and a range of conventional and complementary therapies.”

The British government has identified the importance of providing more and better primary care services and has £250m a year earmarked for the new services and Virgin wants to be a provider.

What is different is that Virgin Healthcare is proposing to work with primary care physicians to help develop more integrated, accessible and personalized services for patients and that they are quite prepared to consider providing less conventional therapies for which there is patient demand and/or empirical evidence.

That last piece – including less orthodox therapies – will inevitably put the cat amongst the pigeons, but Richard Branson and his advisers have correctly identified that there are some good reasons for including some of these therapies, even if the research base is not yet as good as we would like.

A New Lie Detector?

I am sure that this is a story that is going to be picked up and re-worked by those excellent writers over at Law and Order.

An academic at the University of Sheffield has used groundbreaking technology to investigate the potential innocence of a woman convicted of poisoning a child in her care.

Professor Sean Spence, who is a pioneer in the use of functional Magnetic Resonance Imaging (fMRI) to detect lies, carried out the experiments on the woman who, despite protesting her innocence, was sentenced to four years in prison. His results have now been published for the first time in the journal European Psychiatry.

Sean examined the woman’s brain activity as she alternately confirmed her account of events and that of her accusers. The tests demonstrated that when she agreed with her accusers´ account of events she activated extensive regions of her frontal lobes and also took significantly longer to respond: these findings have previously been found to be consistent with false or untrue statements.

Although the technology has previously been claimed to be 90% accurate, which is far superior to “lie detector" – polygraph – tests, its use has also been open to debate. Lie detection tests are already used regularly in parts of the United States justice system, as well as by businesses. But as far as I know, these are the first brain scanning tests of their kind, carried out on a real-life case, reported in the world literature.

Professor Spence said:

"This research provides a fresh opportunity for the British legal system as it has the potential to reduce the number of miscarriages of justice. However, it is important to note that, at the moment, this research doesn’t prove that this woman is innocent. Instead, what it clearly demonstrates is that her brain responds as if she were innocent."

"If proved to be accurate, and these findings replicated, this technology could be used alongside other factors to address questions of guilt versus innocence."

Blondes Makes Us Dumb??

No, this isn’t just a cheap excuse to display a picture of Pamela Anderson.

I just received this from a regular reader:

"Dear Dr Petty,

Have you seen this article Times Online?

“WHEN men meet fair-haired women they really do have a “blonde moment”. Scientists have found that their mental performance drops, apparently because they believe they are dealing with someone less intelligent.

Researchers discovered what might be called the “bimbo delusion” by studying men’s ability to complete general knowledge tests after exposure to different women. The academics found that men’s scores fell after they were shown pictures of blondes.

Further analysis convinced the team that, rather than simply being distracted by the flaxen hair, those who performed poorly had been unconsciously driven by social stereotypes to “think blonde”.

“This proves that people confronted with stereotypes generally behave in line with them,” said Thierry Meyer, joint author of the study and professor of social psychology at the University of Paris X-Nanterre. “In this case blondes have the potential to make people act in a dumber way, because they mimic the unconscious stereotype of the dumb blonde.”

Do you have any comment to make about the research??"

The answer is that I have seen this article all over the Internet, with all kinds of sage comments.

The trouble is that I have not yet been able to read and critique the research. As far as I know, neither the hard copy nor electronic versions are available yet, so I cannot evaluate the report.

This highlights one of the problems of the Internet: news travels across it like the wind, yet a lot of material is passed on without analysis. So the story is fun to read, but until we can see and analyze the data, we cannot comment.

As soon as I get a copy I shall see if I have anything to add to the firestorm of commentary!

Career Contentment Radio

Later today I have the privilege of speaking to Jeff Garton and Cathy Yin on Career Contentment Radio, which is broadcast by Business Voice America.

We are going to be talking about one of my favorite topics: Building Resilience.

This program goes out live at Noon Pacific, which is 3PM Eastern, and is rebroadcast at Midnight Pacific time.  It will then be available on demand and podcast ready.

I have already sent out e-card invitations with the links to people on my list. If you did not get one, please let me know.

Later today I shall also be posting a report on "Building Resilience" on my main website with more free resources for you to use.

The Mile High Club

Your humble reporter just saw this on the BBC website:

“Airline bans A380 mile-high club

Singapore Airlines has taken the unusual step of publicly asking passengers on its new Airbus A380 plane not to engage in any sexual activities.

The potential problem has arisen because the first class area of its giant super-jumbo contains 12 private suites complete with double beds.

Singapore, which is the first airline to start flying the A380, said the suites were not soundproofed.

It said it did not want anyone to offend other travelers or crew.

Singapore added that while the suites were private, they were also not completely sealed.

"All we ask of customers, wherever they are on our aircraft, is to observe standards that don't cause offense to other customers and crew," the airline said in a statement.”

Does this mean that Singapore Airlines is going to do something with Virgin?


Richard Branson: Care to comment????!

Sri Chinmoy Has Moved On

I just heard that Sri Chinmoy has died, or as many would say, entered Maha Samadhi.

I was never one of his followers, but I was impressed by some of the things that he achieved in his efforts to ground spirituality in the “external” world.

He was born Chinmoy Kumar Ghose in a small village named Shakpura in what is now Bangladesh. At the age of 12, after the death of his parents, entered the Sri Aurobindo Ashram, a spiritual community near Pondicherry in South India.

He spent the next 20 years there engaged in spiritual practices, including meditation, writing poetry, essays and spiritual songs.

He moved to New York City in 1964 to work as a clerk at the Indian Consulate, and to teach Western spiritual seekers.

He used some unorthodox methods: he spread his philosophy through his own way of life, exercising and creating art and music. He drew attention by breaking weight lifting records and stunts like power-lifting pickup trucks and public figures like Muhammad Ali and Sting.

He claimed to sleep for only 90 minutes a day and when he was not traveling to perform in concerts and spread his message, spent the rest of the time meditating, playing music, exercising and making art.

Sri Chinmoy drew upon Hindu principles to advocate a spiritual path to God through love and devotion, prayer and meditation. But he was one of the first to publicize the idea that meditation does not necessarily mean sitting quietly. Instead he recommended that his disciples develop their spirituality by transcending seemingly impossible physical challenges.

At one time or other he was the guru of many people including Carl Lewis, Carlos Santana, John McLaughlin, Roberta Flack and Clarence Clemons.

As with so many teachers, there were plenty of allegations of impropriety, but I have never seen any credible evidence to support them.

Many years ago he wrote his own epitaph:
“Before the final curtain goes down

On my life, 

I shall say to my Mother-Earth,
“My gratitude-heart is all for you, 
All for you.”

Here are some of my favorite poems and quotations that he wrote over the years. I do hope that you find some of them as helpful, enlightening and inspirational as I have.

“You hate someone whom you really wish to love, but whom you cannot love. Perhaps he himself prevents you. That is a disguised form of love.”

“Do not try to approach God with your thinking mind. It may only stimulate your intellectual ideas, activities, and beliefs. Try to approach God with your crying heart. It will awaken your soulful, spiritual consciousness.”

“If we know the divine art of concentration, if we know the divine art of meditation, if we know the divine art of contemplation, easily and consciously we can unite the inner world and the outer world.”

“By hating that person, you have lost something very sweet in yourself.”

“Be universal in your love. You will see the universe to be the picture of your own being.”

“If we call ourselves children of God, then others are also children of God.”

“Love is the only wealth that man absolutely needs.
Love is the only wealth that God precisely is.”

“You can only hate someone whom you have the capacity to love, because if you are really indifferent, you cannot even get up the enough energy to hate him.”

“Whether you accept or reject it, God's Love for you is permanent.”

“Let us not worry
About the future.
Let us only do the right thing
Today,
At this moment,
Here and now.
Let the future take care of itself.”

“There comes a time in the seeker's life when he discovers that he is at once the lover and the beloved.”

“Listen to the inner light;
It will guide you.
Listen to the inner Peace;
It will feed you.
Listen to the inner Love;
It will transform you,
It will divinize you,
It will immortalize you.”

“Love is not a thing to understand.
Love is not a thing to feel.
Love is not a thing to give and receive.
Love is a thing only to become
And eternally be.

“I shall love the whole world,
But I shall control
Only myself.

“The aspiring soul which he embodies is the lover in him. And the transcendental Self which he reveals from within is his Beloved.”

“Complete and total perfection will come about only when we feel that our perfection is no perfections as long as the rest of humanity remains imperfect.”

“He who loves, never grows old. God it a shining example.”

“The very nature of kindness
Is to spread.
If you are kind to others,
Today they will be kind to you,
And tomorrow to somebody else.”

“When we have
A childlike state of mind,
It becomes extremely easy to find God
Here, there and everywhere.”

“Of all the medicines
In the inner life,
A smile is by far
The best medicine.”

“Meditation is the only way to overcome fear. There is no other way. Why does meditation help us overcome fear? In meditation we identify ourselves with the vast, with the Absolute. When we are afraid of someone or something, it is because we do not feel that particular person or thing is a part of us. When we have established conscious oneness with the Absolute, with the Infinite Vast, then everything there is part of us. And how can we be afraid of ourselves?”

“For a genuine seeker,
The inner world
Is infinitely more real
Than the outer world.”

“My Lord does not want to know what I have done for Him. He just wants to know how I am. If he hears from me that I am happy, then he himself becomes exceedingly happy. In unmistakable terms He tells me that my happiness is His real and only Satisfaction.”

“Today I must dive deep within
And know what I come
To this earth-stage for.”

“Smile, smile, smile
At your mind
As often as possible.
Your smiling will considerably reduce
Your mind's tearing tension.”

“Your self-transcendence-goal
Is not something
That you have to achieve.
It was already given to you long ago
By your Beloved Supreme.
You have only to believe it.
You have only to receive it.”

“You follow
Your heart's love.
Your life's happiness
Will follow you.”

“God’s foremost treasure on earth
Is my ever-blossoming
Gratitude-heart.”

“Yes, I can!
I certainly can!
I can have
A gratitude-flower-heart
That shall remain open
At all hours.”

“If you give God your heart’s
Dearest treasure, surrender,
Then God will grant you
His Vision’s Dearest treasure, peace.

“Instead of telling the world
What it is supposed to do,
Why don’t you immediately do it yourself ?
In this way, I assure you,
Your happiness will be surprisingly multiplied.”

“Once you have established
Your inner contact
With your inner Pilot,
Your life's transformation-victory
Will not remain a far cry.”

“O kindle the fire of happiness!
Therein I shall see
The door of friendliness,
The room of greatness
And the palace of goodness.
I shall see, I shall see.”

“If your Lord Supreme requests you to do something, rest assured he has already given you the capacity – even more than necessary – long before you actually need it.”

“If you are already an awakened soul,
Then you must realize
That God has already given you
A supreme task to perform:
He wants you to work
For His Vision’s world-blossoms.”

“My service to humanity
Is my real opportunity
To prove my genuine love
For God and God alone.”

“Enthusiasm
Rules his inner world.
Determination
Rules his outer world.
Therefore
Happiness has become
His real name.”

“Of all the gifts
You have offered to God,
Your happiness-gift
He treasures most.”

“If you want to remain always happy,
Always perfect and always fulfilled,
Then always keep inside your heart
A pocketful of sweet dreams.”

“To my extreme happiness,
My Lord has come to tell me
That from now on
I must stand apart from my actions,
Divine and undivine.
He alone is the Doer;
I am a mere observer.”

“Be in love with your heart-life.
There, only there,
Is the flood of happiness.”

“God loves only one philosophy,
And that is the Do-it-here-now philosophy.”

“Every morning and evening I am
Determined to sing and dance
On the highest peak
Of my sun-flooded
Aspiration-mountain.”

“At last
He is healed of his self-doubt.
Now what is happening ?
He is awakening
To his souls ecstasy-sun.”

“Every second a seeker can start over,
For his life’s mistakes
Are initial drafts
And not the final version.

“We must see that God operates not only in us but in others as well. God also operates in our so-called enemies. But these are not our real enemies. Our real enemies are doubt, fear, anxiety and worry. When we do not cry to perfect others, but only try to perfect our own lives, then we will have joy.”

“A sincere seeker knows what his goal is: the highest Truth. He will not delay his journey.  In the spiritual life we aspire for the highest Truth, for God, and for nothing else.”

“Precious and spacious      
The aspiring heart has to remain    
Always.”

“I am not even six feet tall. Yet I am praying to the Absolute Supreme to reach His infinite Height, which is far beyond even my imagination's flight. For me to long to grow into that Height — is this not a miracle?"      

"I am mortal. My thoughts, my deeds, my experiences — everything that I have and everything that I am — represent mortality. Yet despite everything that I have and everything that I am, I am longing for Immortality. Is this not a miracle?”

“There is only one immediate question:      
Where is God?    
The immediate answer is:    
God is where    
My heart's love-breath is.”

“Ingratitude is as old      
As man himself.    
Gratitude is a child    
Of yesterday.”

“The supreme secrets of a peaceful life:      
Expect not; just give.    
Delegate not; just start and continue.    
Retire not; just aspire for    
self-transcendence.”

“In the spiritual life the easiest way to conquer ego is to offer gratitude to God for five minutes daily. If you cannot offer gratitude for five minutes, then utter it for one minute. Offer your gratitude to God. Then you will feel that inside you a sweet, fragrant and beautiful flower is growing. That is the flower of humility.”

“In our spiritual life very often we get fascinating experiences and then we don't want to aspire anymore. It is true that experiences can give us encouragement, but very often when we get too many experiences we enter into the vital world. Suppose you are walking along a street toward your goal. If you see beautiful trees, ponds and flowers alongside the street, what happens? The scenery is so beautiful that you take a rest. You say, "Let me stay here and enjoy this," and then you stop and enjoy it. But your destination remains a far cry.”

“The problem with fault-finding
Is that he who finds fault with others
Is in no way a happy person
Even after he has successfully
Accomplished his task.”

“True inner joy is self-created
It does not rely on any outer circumstances
A river is flowing in and through you carrying the message of joy.
This divine joy is the sole purpose of life.”

“Meditation is not an escape. Meditation is the acceptance of life in its totality, with a view to transforming it for the highest manifestation of the divine Truth here on earth.”

“When we meditate soulfully, devotedly, we have to accept humanity as our very own. We have to know that humanity as it stands is far, far, from perfection, but we are also members of humanity. We have to take it with us. If we are in a position to inspire others, if we are one step ahead, naturally we have the opportunity to serve the divinity in the ones who are following us. We have to transform the face of the world on the strength of our dedication to the divinity in humanity.”

“God-realization, or Siddhi means Self-discovery in the highest sense of the term. One consciously realizes his oneness with God. As long as the seeker remains in ignorance, he will feel that God is somebody else who has infinite Power, while he, the seeker, is the feeblest person on earth. But the moment he realizes God, he comes to know that he and God are absolutely one in both the inner and the outer life. God-realization means one’s identification with one’s absolute highest Self.”

“What we call our joy, God calls our perfection. Each human being has come into the world with the message of perfection. Each human being will one day realize the highest Truth. Each human being is destined to be fulfilled. It is the birthright of our soul.”

“Not one      
But twenty-four self-giving-hours    
Every day I have    
For my use.”

“At the end of all the roads      
There is only a sound-life    
That does everything,    
And a silence-life    
That becomes everything.”

“True spirituality is the acceptance of earth-life. A true seeker is he who accepts life, transforms life and perfects life so that the earth-life can become a conscious instrument of God.”

“When I was an animal I evolved through selfishness.
Now that I am a man my evolution can be achieved only through self-sacrifice.”

“How can one know who his spiritual teacher is?...His heart looks at the spiritual Masters and makes the choice. When the heart sees a spiritual Master, if it is overwhelmed with joy, then there is every probability that that spiritual Master is the right one for the seeker.”

“The joy of a self-giving life      
Can neither be measured    
Nor be expounded.”

“God is not a thing to be achieved, but a thing to be.”

“You may not know,
But it is absolutely true:
With each heartbeat
Your heart is calling: “God, God!” 
You may not hear it,
But God Himself definitely hears
Your heart’s cry.”

“The moment we use the term 'help', a kind of egocentric idea enters into us. If we help someone, that means we are in a superior position. When we help, we feel that we are one step ahead or one step higher than the ones that we are helping. But if we serve someone, then we offer our capacity with humility, on the strength of our loving concern and oneness. So let us use the proper term, 'service'.”

“A moment of
self-giving life
can conquer the sorrows
of many long years.”

“Forgive, you will have happiness.
Forget, you will have satisfaction.
Forgive and forget,
You will have everlasting peace
Within and without.”

“Imagination plays a most significant role in the spiritual life. Suppose you are not having good meditations, but six months ago you had a very good, powerful, high meditation. What you can do is try to imagine that powerful meditation. Then your imagination will become reality. After fifteen minutes or half an hour, you will get a good meditation. Vivekananda was such a great spiritual figure, yet sometimes for six months at a time he did not have a good meditation. What did he do? He used to imagine a time when he did have a good meditation, and inside his imagination was aspiration. So imagination is very good.”

“Our goal is not to have      
A problem-free life.    
But to conquer all the problems
As they appear    
Along our life-road.”

“Let us serve the world soulfully. The pay we will receive for our service will be in the currency of gratitude, God's gratitude, God the only gratitude.”

“Each human being can at once be a fighter and forgiver. When self-doubt tortures him, he must play the role of a fighter. And when his own ignorance humiliates him, he must play the role of a forgiver.”

“A spiritual man should be a normal man, a sound man. God Himself is normal; He is not insane. In order to reach God, a spiritual person has to be divinely practical in his day-to-day activities. Spirituality does not negate the outer life. But we have to know that the outer life does not mean the animal life. The outer life should be the manifestation of the divine life within us.”

“Either by silencing the mind or by opening the heart, today's man can become tomorrow's God, tomorrow's Divinity. And embodied Divinity soon becomes revealed Immortality.”

“If we believe in our own      
Self-transcendence-task    
Then there can be    
No unreachable goal.”

“Love of the limited self, the very limited self, is another name for human love. Love of the entire world is another name for divine love.”

“Silence tells the seeker in us to love, to love himself. It tells us it is wrong to hate ourselves because of our imperfections. When the seeker loves himself, loves the Divine within himself, he eventually realizes the Ultimate Truth."

“Inner silence is not just the absence of thoughts. No! Silence is the blossoming of our indomitable inner will. Silence is our inner wisdom-light. "

“The way to become happy
Is to think
And to feel
That the very best is yet to come.”

“Failure 
Is not falling down.   
Failure   
Is desiring to live
Where I have fallen.”

“There is no greater miracle
Than our conscious efforts
To become good human beings.”

“Meditation is man's self-awakening and God's Self-Offering.
When man's self-awakening and God's Self-Offering meet together
man becomes immortal in the inner world
and God becomes fulfilled in the outer world.”

“You have no idea
How much you do for mankind
When you love God unconditionally
Even for a fleeting moment.”

“My soul reminds me
Again and again
That I am not the doer.
I am only a witness-
God-existence-life.”

“Allow everything else to vanish
Save and except your cherished dreams,
For your cherished dreams
Are treasured sleeplessly
By God Himself.”

“World-harmony
Should be taken
As a world-prayer
On a daily basis.”

“Just start your inner race without waiting to see
Who else is ready to run with you.
When others see you have reached your goal,
They will also be inspired to run.”

“Keep an open heart
To allow the world
Lovingly and faithfully
To come in.”

“Although it is extremely difficult
We must realize
That we came into the world
Not to destroy but to illumine
Our enemies.”

“Human love wants to possess and be possessed by the world. Divine love wants to establish its inseparable oneness with the world and then it wants to divinely enjoy this oneness. Supreme Love transforms human love into divine love and blesses divine love with boundless joy and divine pride."

“Each devoted moment
Prepares a beautiful sunrise
And a fruitful sunset.”

“A genius is he
Who ends rules and regulations.
A genius is he
Who is nothing but a powerful drop
In the ocean of cosmic life-energy.”

“When you consciously use time
To do something Divine,
You enter into timeless Time.

When you are consciously thinking
Of something divine, eternal Life come
And shakes hands with you.”

“The heart of every human being
Can leave behind a legacy
Of world-illumining compassion.”

“To inspire others
Is to be immediately rich
In the inner world.”

"What is joy? It is a bird That we all want to catch. It is the same bird That we all love to see flying.”

“When you talk and God listens, it is Prayer. When you listen and God talks, it is Meditation.”

“The moment you want to make progress is the moment you become an eternal beginner. The dawn is the beginning of a new day: it symbolizes hope, illumination and perfection. Every day the dawn begins its journey in the infinite sun. If you can feel that your whole being - your body, vitality, mind and soul - represents the ever-blossoming dawn, then you will always remain an eternal beginner.”

“Do not allow yourself
To be rued by dark doubts.
Make friends with bright hopes
At every moment
To change your own world
And the world around you.”

“Peace will come when we replace the love of power with the power of love.”

“God hears
The soulful prayers of a seeker
Not only with great readiness
But also with immediate
Oneness.”

“In tomorrow’s world
Many things will enlighten humanity.
But the thing that will enlighten
Humanity’s inner and outer life most
Is the transcendental temple
Of universal silence.”

Howard Hughes Medical Institute Joins the Open Access Revolution

The Howard Hughes Medical Institute (HHMI) has agreed to support Springer's Open Choice program. What that means is that if articles are accepted for publication after a process of rigorous peer-review, they will immediately be published with full open access and deposited in repositories such as PubMed Central, at a flat-rate fee per article of $3,000. Springer's Open Choice program applies to all its journals.

HHMI has a strong commitment to ensuring public access to original research articles. Beginning with papers submitted for publication after January 1, 2008, HHMI will require its scientists to publish their original research articles in journals that allow the articles and supplementary materials to be made freely accessible in a public repository within six months of publication.

HHMI is the largest private funder of biomedical research in the United States and commits more than $500 million a year for research and distributes $80 million in grant support for science education.

HHMI investigators already publish a significant number of research articles in open access journals or in journals with open access options. Under the new policy, HHMI will pay up to $2,000 in open access charges per article with the balance coming from laboratory budgets or other sources.

It is wonderful that one of the largest and most prestigious research institutes in the world, is actively supporting open-access publishing and backing up their words with significant funding

Taking Action on Food Additives and Hyperactivity

Regular readers will remember my recent article concerning food additives and hyperactivity in children.

I have just read that he British Food Standards Agency (FSA) has been accused by campaigners of "chickening out" of banning additives linked to hyperactivity in children even though they funded the research that was published in the Lancet.

After the research was published, the FSA issued updated advice that eliminating the artificial colorings from the diet might have some beneficial effects in hyperactive children.

But critics said it did not go far enough and several environmental and children's campaign groups, including the National Union of Teachers, called on the watchdog to extend that advice to all children since the additives posed a threat to psychological health.

The FSA responded by saying that the evidence was not strong enough to justify a ban and it would wait for the European Food Safety Authority (EFSA) to make a decision on use of additives in food.

EFSA says that it is considering the research as a matter of urgency and will be making an initial response within the next month.

We shall see what they have to say.


These were the main additives incriminated in the Lancet study:
Sunset yellow (E110) - Coloring found in some drinks
Carmoisine (E122) - Red coloring in jelly
Tartrazine (E102) - New coloring in some frozen and carbonated drinks
Ponceau 4R (E124) - Red coloring
Sodium benzoate (E211) - Preservative
Quinoline yellow (E104) - Food coloring
Allura red AC (E129) - Orange / red food dye

New Treatment Options: Knowing What to Use

One of the main reasons that I created this blog is that I want to empower you: I want to give to give you the information that you need to care for yourself and the people around you.

One of the problems with many new treatments is that they promise the earth, sometimes drag people away from things that may help them and then fail to deliver.

This is something that I struggled with in the field of holistic medicine for thirty years. I constantly hear and see fantastic claims that cannot be right and are often based on a complete misunderstanding of how the body functions. On the other hand there are some highly unorthodox methods and techniques that can be amazingly helpful. My job has been to find out which is which!

But it is not only in the field of unorthodox medicine. I have recently heard about something very questionable in the field of psychotherapy. Somebody has invented a new form of therapy that cuts across and ignores decades of research. He is now offering certifications in his method. So long as you have a very basic healthcare qualification, you pay him a few hundred dollars, do an online training and then you can set up shop as a therapist. Many members of the public do not know how little regulation there is for some of these therapies.

Here are some guidelines for checking out a new therapy or remedy:

1. Efficacy
Be suspicious of any treatment or therapist if they:

• Claim that a treatment works for everyone: I have yet to find ANY treatment that works for everyone
• Only use case histories or testimonials as proof. The plural of anecdote id not evidence. If we see or hear about something that looks promising, it is essential to confirm the reports with systematic, independent controlled research. Be aware that if that has not been done, the person selling you the treatment or the therapist claiming to help is essentially experimenting on you. And if they want to experiment they need your consent and the approval of an Institutional Review Board. And don’t buy into the “my work is so brilliant and cutting edge that nobody will publish it in a journal.” It is hard to publish really new work, but we cannot believe what people are saying until it has been subjected to peer review: other experts go through the work with a fine toothcomb to see if it is right.
• Cite only one study as proof. Hundreds of promising studies have turned out to be dead ends when someone else tried to repeat it. You can be a lot more confident if several studies have shown the same thing.
• Cites a study that did not have a control (comparison) group. That is always a first step in evaluating a new treatment.
• Cite a study that you cannot see yourself. We spend a lot of time checking some of the claims made on infomercials and websites. They often talk about some obscure study in a hard-to-find journal written in a foreign language. We go and find the papers and if necessary translate them. We constantly find that the studies quoted contain results that are 180 degrees away from what they claim.
• Only reference themselves. This recently came to light with a form of therapy that comes with a short book. There was not one scientific citation, but loads of self-references, so it looked as if there was something credible behind it.
• Testing a treatment without a control group is a necessary first step in investigating a new treatment, but subsequent studies with appropriate control groups are needed to clearly establish the effectiveness of the intervention.

2.  Safety?
Be wary if:

• A therapist or someone promoting a remedy cannot tell you the exact consequences of not following up with some other treatment. Safety is not only about the safety of a product or a therapy: it is also about the risks of declining a proven treatment
• A therapist tells you stop any other treatment that you are on without discussing the risks of stopping it, and without discussing the situation with any previous therapist. It does not matter whether you were on a medication or having acupuncture. Different treatments interact, and stopping and starting can be risky. If a therapist who does not prescribe medications tells you stop them, be very, very careful. There are precise ways to discontinue most treatments
• A remedy comes without precise directions about how to use it
• Something does not list its contents or ingredients
• A product has no information or warnings about side effects
• If a product or therapeutic approach is described as natural, with the implication that natural means safe. Hurricanes, arsenic and deadly nightshade are all natural!

3.  Promotion
Be very cautious if a therapy or treatment:

• Claims to be based on a secret formula or a secret that has been deliberately hidden from you
• Claims that the particular treatment or therapy is being suppressed or unfairly attacked by the medical or therapeutic communities
• Claims to work immediately and permanently for everyone
• Is described as an “Amazing breakthrough” or a “Miracle.”
• Claims to be a cure for something that other experts believe is incurable. They could be right, but then we have to go back to the first point about efficacy
• Is only promoted through infomercials, self-promoting books, online or by mail order

4. Evaluating Media Reports

• When evaluating reports of health care options, consider the following questions:
• What is the source of the information? Good sources of information include medical schools, government agencies (such as the National Institutes of Health and the National Institute of Mental Health), professional medical associations, and national disorder/disease-specific organizations. Information from studies in reputable, peer-reviewed medical journals is more credible than popular media reports.
• Who is the authority? The affiliations and relevant credentials of "experts" should be provided, though initials behind a name do not always mean that the person is an authority. Reputable medical journals now require researchers to reveal possible conflicts of interest, such as when a researcher conducting a study also owns a company marketing the treatment being studied or has any other potential conflict of interest.
• Who funded the research? It may be important to also know who funded a particular research project.
• Is the finding preliminary or confirmed? Unfortunately, a preliminary finding is often reported in the media as a "breakthrough" result. An "interesting preliminary finding" is a more realistic appraisal of what often appears in headlines as an "exciting new breakthrough." You should track results over time and seek out the original source, such as a professional scientific publication, to get a fuller understanding of the research findings

5. What Are the Financial Implications of This New Therapy or Remedy?

• Is the treatment covered by health insurance?
• What out-of-pocket financial obligation will you or your family have?
• How long will this out-of-pocket financial obligation be?
• Is there any kind of guarantee?
  

Tips for Finding Reliable Information Online
The good news is that the Internet is becoming an excellent source of medical information. The bad news is that with its low cost and global entry, the Web is also home to a great deal of unreliable health information.
In addition to the tips cited earlier, Web surfing really needs some special considerations:
Know the source. The domain name tells you the source of information on the Web site, and the last part of the domain name tells you about the source. For example:
.edu = university/educational
.biz/.com = company/commercial
.org = non-profit organization
.gov = government agency

The same rules do not always apply if you are looking at websites in other countries.
Obtain a "second opinion" regarding information on the Web. Pick a key phrase or name and run it through a search engine to find other discussions of the topic or talk to your health care professional.

Experts who spend time and trouble evaluating reports and then publish their findings online will often answer questions. RichardGPettyMD.blogs.com is one that does, and there are many others.

Albert Ellis, R.I.P.

I just heard that Albert Ellis has passed away at the age of 93.

I think that most people who have ever done a psychology course will have heard of him. He was always controversial and upset a lot of people, particularly in regard to some of his early comments about religion and human sexuality, but he also made some important contributions to psychologyadn , was not afraid of changing is position if he thought tht he was wrong.

In 1955 he developed Rational Emotive Behavior Therapy, and he was considered by many to be the grandfather of cognitive-behavioral therapies.

In 1982 a professional survey of U.S. and Canadian psychologists, declared that he was one of the most influential psychotherapists in history (Carl Rogers placed first in the survey; Sigmund Freud placed third). Ellis founded and was the president and president emeritus of the New York City-based Albert Ellis Institute. His 90th birthday party was attended by Bill Clinton and the Dalai Lama.

Here are a few of his quotations that I found in my library and database.

“Acceptance is not love. You love a person because he or she has lovable traits, but you accept everybody just because they're alive and human.”

“As a result of my philosophy, I wasn't even upset about Hitler. I was willing to go to war to knock him off, but I didn't hate him. I hated what he was doing.”

“By not caring too much about what people think, I'm able to think for myself and propagate ideas which are very often unpopular. And I succeed.”

“Cognitive behavior therapy and rational emotive behavior therapy are much more popular with the public than they ever were.”

“For that again, is what all manner of religion essentially is: childish dependency.”

“Freud had a gene for inefficiency, and I think I have a gene for efficiency.”

“From the start, I always included philosophic techniques as well as experiential, emotional and behavioral techniques.”

“I eventually gave up being an analyst. You had to be too passive and not speak up.”

“I get people to truly accept themselves unconditionally, whether or not their therapist or anyone loves them.”

“I had a great many sex and love cases where people were absolutely devastated when somebody with whom they were compulsively in love didn't love them back. They were killing themselves with anxiety and depression. “

“I had used eclectic therapy and behavior therapy on myself at the age of 19 to get over my fear of public speaking and of approaching young women in public.”

“I hope to die in the saddle seat.”

“I just had a client this week who came to me after 10 years of Freudian therapy. He's in love with his analyst, and she is sort of in love with him.”

“I regret that I've been so busy with clinical work that I haven't been able to spend much time on experiments and outcome studies.”

“I started to call myself a rational therapist in 1955; later I used the term rational emotive. Now I call myself a rational emotive behavior therapist.”

“I think it's unfair, but they have the right as fallible, screwed-up humans to be unfair; that's the human condition.”

“I think the future of psychotherapy and psychology is in the school system. We need to teach every child how to rarely seriously disturb himself or herself and how to overcome disturbance when it occurs.”

“I thought foolishly that Freudian psychoanalysis was deeper and more intensive than other, more directive forms of therapy, so I was trained in it and practiced it.”

“I would have liked having children to some degree, but frankly I haven't got the time to take the kids to the goddamn ballgame.”

“I wrote several articles criticizing psychoanalysis, but the analysts weren't listening to my objections. So I finally quit after practicing it for six years.”

“I'll be 87 tomorrow. When I'm in New York, I see as many 70 or more clients per week.”

“I'm very happy. I like my work and the various aspects of it-going around the world, teaching the gospel according to St. Albert.”

“I've lived in sin with the executive director of our institute for 35 years. I was married twice briefly before that.”

“If I had been a member of the academic establishment, I could have done other experiments.”

“If something is irrational, that means it won't work. It's usually unrealistic.”

“In the old days we used to get more referrals, because people had insurance that paid for therapy. Now they belong to HMOs, and we can only be affiliated with a few HMOs.”

“Let's suppose somebody abused you sexually. You still had a choice, though not a good one, about what to tell yourself about the abuse.”

“Many psychoanalysts refused to let me speak at their meetings. They were exceptionally vigorous because I had previously been an analyst and they were very angry at my flying the coop.”

“Most people would have given up when faced with all the criticism I've received over the years.”

“People could rationally decide that prolonged relationships take up too much time and effort and that they'd much rather do other kinds of things. But most people are afraid of rejection.”

“People don't just get upset. They contribute to their upsetness.”

“People got insights into what was bothering them, but they hardly did a damn thing to change.”

“People have motives and thoughts of which they are unaware.”

“Rational beliefs bring us closer to getting good results in the real world.”

“Self-esteem is the greatest sickness known to man or woman because it's conditional.”

“The art of love is largely the art of persistence.”

“The best years of your life are the ones in which you decide your problems are your own. You do not blame them on your mother, the ecology, or the president. You realize that you control your own destiny.”

“The psychotics, naturally, don't think straight. Severe personality disorders take much longer to treat than people who are neurotic.”

“There are three musts that hold us back: I must do well. You must treat me well. And the world must be easy.”

“There's no evidence whatsoever that men are more rational than women. Both sexes seem to be equally irrational.”

“We teach people that they upset themselves. We can't change the past, so we change how people are thinking, feeling and behaving today.”

“We teach people to be flexible, scientific and logical in their thinking and therefore to be less prone to brainwashing by the therapist.”

“We're a nonprofit organization, and it usually costs $100 an hour for individual therapy. Participating in a group costs $120 a month.”

“You largely constructed your depression. It wasn't given to you. Therefore, you can deconstruct it.”

“I just got fed up. I was ready to blow up. This country is about enforcing our laws and if we don't, we'll have chaos worse than we already do.”

“The more sinful and guilty a person tends to feel, the less chance there is that he will be a happy, healthy, or law-abiding citizen. He will become a compulsive wrong-doer.”

“Tolerance is anathema to devout divinity-centered religionists."

“Anyway, devout religionists are frequently attracted to and bound to their piety largely because it presumably offers them holier-than-thouness and one-up-man-ship over non-religionists."

Avandia and Heart Attacks: Hold Your Horses

The report in today’s New England Journal of Medicine about an apparent association between Avandia (rosiglitazone) and heart attacks made the front page of USA Today.

While it is an important study, it is important that we don’t go overboard until we have a little more information.

There is a key principle that we have looked at before: one study is rarely enough to prove that a thing is so. The scientific method is based on the principle of falsifiability: now that this data has been published it is up to scientists and investigators to try and disprove the finding.

The analysis in the New England Journal suggests that the risk of a heart attack increases by 43% for patients taking rosiglitazone compared to control groups, and the risk of death by heart attack by 64%. This data comes from the so-called “A Diabetes Outcome Prevention Trial” (ADOPT). This is one of three studies on the topic. The Diabetes Reduction Assessment with Ramipiril and Rosiglitazone Medication (DREAM) study that involved over 5,000 patients was published in the Lancet last September. This study showed small increases in cardiovascular events compared to controls, which were not statistically significant. The other key finding of the DREAM study was that it reduced the risk of progression of pre-diabetes to type 2 diabetes by 62%. That is important because it may mean that we need much longer studies: diabetes increases the risk of heart disease year after year. ADOPT involved more than 4000 patients, with the only significant relevant finding an excess of congestive heart failure episodes for rosiglitazone-treated patients compared with people who received the older diabetic medicine, glyburide (22 compared with nine events).

So there may be a signal there, but before stopping the medicine, we need to remember that the numbers of patients who developed problems is small. Obviously big enough if you are one of them, but the risk is still not that high given the high rates of heart diseases in people with diabetes.

There is another study on the horizon: The Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) trial, which is a phase III trial specifically designed to analyze cardiovascular events connected to use of rosiglitazone. The study that hit the front page is a meta-analysis, and even the authors admitted that there were some weaknesses in it. Though it is a personal choice that people have to make with their clinicians, many experts think that we can wait for the results of the third study so that we can make some sensible decisions.

And for the record, I have no connections with the manufacturer of Avandia, GlaxoSmithKline.

An Important Change in the Warning on Antidepressant Medicines

If we could, we would only use natural medicines to treat depression.

Sadly it is not always possible to do that, and it doesn't help when people with a demonstrable biochemical disturbance are told that their depression is all about internalized anger or an unwillingness to face some issue in their lives.

The trouble with those theories is that they often don't take into account a tragic fact: depression can be fatal.

Not only because of the risk of suicide and other kinds of self-injury, but because depression is associated with many physical problems including chronic inflammation and carbohydrate intolerance.

Today the United States Food and Drug Administration (FDA) asked makers of all antidepressant drugs to change the existing "black box" labels on their products to warn about increased risk of suicidality (suicidal thinking and behavior) among young adults aged 18 to 24 in the first few weeks of treatment.

The FDA has also asked the pharmaceutical companies to revise the existing warning to show that there is no evidence that this risk exists for adults over 24, and furthermore, for those aged 65 and older the scientific data suggests the suicidality risk is decreased.

The American Psychiatric Association (APA) said this:

"The FDA's new labeling acknowledges, for the first time, that untreated depression puts people at risk for suicide."

They said that studies showed that the old label issued in 2004 was associated with a steep drop in use of antidepressants and was followed by an increase in the rate of suicide "reversing a decade-long decline in suicide deaths in the United States".

The FDA said the emphasis on the new labels should be that depression and other serious psychiatric illnesses are themselves the most important causes of suicide.

Director of FDA's Center for Drug Evaluation and Research, Dr Steven Galson said that:

"Today's actions represent FDA's commitment to a high level of post-marketing evaluation of drug products."

"Depression and other psychiatric disorders can have significant consequences if not appropriately treated. Antidepressant medications benefit many patients, but it is important that doctors and patients are aware of the risks."

The FDA recommends that people who are currently taking antidepressants should not stop taking them as a result of hearing this news.

The warning revision applies to all antidepressants and comes in the wake of controlled trials that showed a reasonably consistent risk of suicidality across most of the antidepressant drug categories. The FDA said that the evidence does not support excluding any antidepressant medication from this update request.

This update request follows the labeling changes made in 2005 to warn of increased suicidality in children and adolescents taking antidepressants.

Since then, the FDA undertook a comprehensive review of 295 drug trials examining the risk of suicidality among adults taking antidepressants.

The trials included over 77,000 adult patients with major depressive disorder (MDD) and other psychiatric conditions.

The results was that in December last year, the FDA's Psychopharmacologic Drugs Advisory Committee said labels should be changed to tell doctors about the increased risk of suicidality among younger adults taking antidepressants.

The Committee also said the labels should remind doctors that the disorders themselves present the greater risk, and that among older adults the antidepressants do not carry the suicidality risk and have an apparent beneficial effect.

The FDA is preparing drafts of patient guides and wording for the labels. The manufacturers have 30 days to submit their own versions for FDA review.

The drugs affected include:

-- Anafranil (clomipramine)
-- Asendin (amoxapine)
-- Aventyl (nortriptyline)
-- Celexa (citalopram hydrobromide)
-- Cymbalta (duloxetine)
-- Desyrel (trazodone hydrochloride)
-- Elavil (amitriptyline)
-- Effexor (venlafaxine hydrochloride)
-- Emsam (selegiline)
-- Etrafon (perphenazine/amitriptyline)
-- Lexapro (escitalopram hydrobromide)
-- Limbitrol (chlordiazepoxide/amitriptyline)
-- Ludiomil (maprotiline)
-- Luvox (fluvoxamine maleate)
-- Marplan (isocarboxazid)
-- Nardil (phenelzine sulfate)
-- Norpramin (desipramine hydrochloride)
-- Pamelor (nortriptyline)
-- Parnate (tranylcypromine sulfate)
-- Paxil (paroxetine hydrochloride)
-- Pexeva (paroxetine mesylate)
-- Prozac (fluoxetine hydrochloride)
-- Remeron (mirtazapine)
-- Sarafem (fluoxetine hydrochloride)
-- Seroquel (quetiapine)
-- Sinequan (doxepin)
-- Surmontil (trimipramine)
-- Symbyax (olanzapine/fluoxetine)
-- Tofranil (imipramine)
-- Tofranil-PM (imipramine pamoate)
-- Triavil (perphenazine/amitriptyline)
-- Vivactil (protriptyline)
-- Wellbutrin (bupropion hydrochloride)
-- Zoloft (sertraline hydrochloride)
-- Zyban (bupropion hydrochloride)

The APA said:

"We believe the new label, which still contains important warning information, reminds physicians and patients that antidepressants save lives. Physicians and patients need all the facts in order to make appropriate, informed decisions about any proposed course of treatment."

This change is not in any way an indictment of the medicines, it just acknowledges the reality that depression is dangerous.

Why is the risk apparently greater in younger people? It is thought that it has to do with the fact that the frontal lobes of the brain, that are involved in the control of emotions, have not yet fully formed.
 

House Supporting NAMI

Regular readers will know two things about me:

1. I am a huge advocate for the mentally ill
2. Last year I had to publish two denials after some mendacious individual posted the preposterous suggestion that the character of Gregory House in the wonderful TV show, was in some way based on me. To this day I don't know where that idea came from, other than the fact that I have specialized in trying to crack diagnostic conundrums.

Take the two together, and I'd like to give credit where it's due.

I was delighted to see that the entire cast and crew got together to support the National Alliance of the Mentally Ill (NAMI).

House has a well known expression, "Everyone lies." The the show's producers and cast members, along with the slogan, will benefit the organization and its work in education, support, and advocacy for individuals and families affected by mental illness.

For a limited time, T-shirts from the show, emblazoned with the phrase "Everybody Lies," are being sold on-line.

The executive producer of house is Katie Jacobs, and she had this to say:

"Mental illness is stigmatized and misunderstood in our society, and we’re trying to do something about that. We’re very fortunate to be celebrating an extremely successful third season for HOUSE, and we’d like to give something back to a cause we feel is both worthy and overlooked."

The TV show, in the course of showing Dr. House attempting to diagnose illnesses with hallucinatory or psychotic symptoms, has helped educate the public about the medical nature of many psychiatric symptoms including mood and personality changes. These diagnoses have included herpes encephalitis, syphilis, hypercortisolism (Cushing's), Wilson's disease, hemochromatosis, and Korsakoff's syndrome (vitamin B1 deficiency).

"Everybody Lies" conveys a message about stigma, false perceptions and misinformation about mental illness. In the TV show, the phrase represents that people who are being diagnosed with ANY illness often withhold information. In a time when it seems that Hollywood has been indifferent to, or even has propagated, stigma about mental illness, it is refreshing that the producers and cast of a TV show are helping to combat that.

NAMI executive director Mike Fitzpatrick says,

"On behalf of every individual and family who live with major depression, bipolar disorder, schizophrenia and other mental illnesses, NAMI thanks the show and cast. They are making a difference in people's lives."

In addition to the sale of the T-shirts, an on-line auction is running for seven days (1 May 2007 through 7 May 2007) to sell five special autographed items. All proceeds go to NAMI.

Honey Bees, Blue Tits and Canaries

"If the bee disappeared off the surface of the globe, then man would only have four years of life left."
--Albert Einstein (German-born American Physicist and, in 1921, Winner of the Nobel Prize in Physics, 1879-1955)


Anyone interested in Integrated Medicine should also be interested in trends that may have a major impact on our health and our potential to grow.

Over the last year the sparrow population of England has been declining, and now there is something new. In recent weeks there have been reports from bird watchers in Southern England that some species of birds have suddenly started become obese. The birds most affected seem to be blue tits. There is no suggestion about why it is happening, or what they are eating. Or whether something else in the environment is changing and causing the problem.

Second, British Government inspectors are investigating reports of unusually high numbers of honeybee deaths. Beekeepers all over Southern England are reporting that their hives have been decimated. This is a serious matter. Not just to the bees, but because bees pollinate fruit trees and other crops, the consequences for British farmers of a collapse in honey bee numbers could be devastating. The total contribution of bees to the British economy has been estimated at somewhere around 2 billion dollars.

No one yet understands the cause of these widespread honey bee colony deaths, and it is not just in the England: unexplained, severe colony losses with bees failing to return from their searches for pollen and nectar in Poland, Greece, Italy, Spain and Portugal.

But here in the United States the situation is even worse: Beekeepers in 25 US states have lost 50 to 90 per cent of their colonies to a mystery condition being called Colony Collapse Disorder (CCD) - in which bees suddenly abandon their hives and disappear to die. It is having a major effect on the mobile apiaries (Bee farms) that are transported across the US to pollinate large-scale crops, such as oranges in Florida or almonds in California. Some have lost up to 90 per cent of their bees.

The cause of CCD is unknown, but some of the suspects include pesticides, malnutrition, antibiotics, mites and increased solar radiation due to ozone thinning. There has also been a theory that it might have something to do with all those towers that support the cell phone network, or the introduction of genetically modified crops.

In the 1990s, honeybee populations were badly affected by the varroa mite - a parasite that makes colonies more vulnerable to viruses. Some experts believe the recent deaths could be caused by the parasite becoming resistant to drugs used against it.

Like most things in nature, animal populations go through regular cycles: there is a sophisticated mathematics that can be used to describe fluctuations in populations. But when we see several odd things at once, that don't fit the mathematical models, it is time to ask the question whether the obese blue tits and the disappearance of sparrows and bees are a harbinger of further changes in our environment.

Are the bees and blue tits the “Canaries in the Coal Mine”?

Earth Day

Today is Earth Day. I am sure that everyone living on the planet is eager to keep it a decent place to live, and the recent flurry of gloomy reports has energized people in a way that I have not seen in decades.

Yes, there are plenty of nay sayers who point to the ice core date and say that there's not a problem, but that band is shrinking as quickly as the Arctic Ice. Information from the Lake Vostok ice core analysis has provided data going back 420,000 years, during which there have been four temperature peaks before the current one, all comparable to today's temperature levels. The causes for those peaks are poorly understood, but I am more and more persuaded that something profound is going on with the planet's weather, and we really have only three choices:

1. Prevent, which may be too late
2. Adapt
3. Mitigate

On April sixth, scientists and officials from more than 100 governments met in Brussels and agreed that Climate change is already under way and the Earth faces water shortages and famines in the poorest countries, plus huge floods and species extinctions if no action is taken to slow it down.

There was an unprecedented consensus on the mounting threat posed by global warming, and the final report was unanimously approved, even by the United States, China and Saudi Arabia. The officials from these countries had spent four days and two nights challenging the more dire predictions line by line.

The report by the Intergovernmental Panel on Climate Change (IPCC) warns that global warming will hit hardest in the Arctic, sub-Saharan Africa, on small islands and highly populated river deltas in Asia.

For example it predicts that 600 million more people could suffer from droughts in Africa and billions will face risks from coastal flooding by the end of this century.

And if that seems to far away to be of immediate concern, the report also makes a number of remarkably precise near-term predictions. The 21-page "policymakers summary" of a full report to be published later this year, charts the impact of temperature rise over the past 30 years and calculates the implications of the rise of about 3 degrees Celsius by the end of this century forecast by another IPCC panel in January.

Rajendra Pachauri, the chairman of the panel, said: "It's the poorest of the poor in the world, and this includes poor people even in prosperous societies, who are going to be the worst hit. This does become a global responsibility in my view."

Professor Martin Parry, who was co-chair of the panel's working group on climate change impacts, said evidence of changes already taking place that could be attributable to human influence had been found in 29,000 sets of data.

He said, "For the first time we are not just arm-waving with models."

Professor Parry said actions to adapt to climate change, such as sea defences and new forms of agriculture, should take priority over efforts to reduce greenhouse gases, which would take years to have any impact. He went on to say, "In the near term, adaptation is vital. The sooner we get on with that the better." Dr Pachauri revealed that the process had been a "complex exercise".

Many scientists objected to what they saw as an unprecedented level of interference from government officials in arriving at what is meant to be a scientific summary.

Professor Parry added that: "I don't think it is the right thing to say the message was watered down." Though he conceded that the scientific team made some compromises in their final report. As an example he revealed that a graph showing that billions would be at risk of coastal flooding by 2080 was changed to read "millions".

Joseph Alcamo, who is an American-born professor of environmental science and engineering at the University of Kassel in Germany, said: "I question why it needs to be such a difficult fight to get the science out there. Scientists have to play a role we are not really trained for. It is a dilemma for us." Professor Alcamo chaired the working group studying changes in Europe. He reproted that he had appeared on the podium to confront skeptical governmental delegations at 2am, after some objected to his use of the term "unprecedented" to describe the heatwave in Europe in 2003 which claimed up to 35,000 lives.

For the first time, the scientists broke down their predictions into regions, and forecast that climate change will affect billions of people.

Africa will be hardest hit. By 2020, up to 250 million people are likely to be exposed to water shortages.

According to the report, in some countries, food production could fall by half.

North America will experience more severe storms with human and economic loss, and cultural and social disruptions. It can expect more hurricanes, floods, droughts, heatwaves and wildfires, it said. Northern Europe will at first experience some benefits, such as a reduced demand for heating, but southern Europe will face more heatwaves and drought, with a reduction in crop productivity.

Parts of Asia are threatened with widespread flooding and avalanches from melting Himalayan glaciers. Europe also will see its Alpine glaciers disappear.

These were the Key Points from the report:

• There is clear evidence that from all continents that climate change is happening now
• The key "tipping points" are in the Arctic, small islands, sub-Saharan Africa and Asian "mega-deltas."
• Coastal flooding threatens "bilions" of people in low-lying delta regions with high population growth
• In Asia, climate change could put close to 50 million people at risk of hunger by 2020, with that number rising to 132 million by 2050 and to 266 million by 2080
• By 2080, between 1.1 billion and 3.2 billion people will face water shortages, and between 200 million and 600 million will face extreme hunger.
• Up to 30 per cent of animal species face displacement or extinction with average warming of 2 degrees C.
• If temperatures rise more than 3C, sea level rise threatens a third of coastal wetlands.
• Cereal productivity will drop globally with a rise of between 1 degree C and 2 degrees C - which could happen by 2050.
• Some impacts are already unavoidable due to past emissions

There remain some disagreements:

• The United States, China, Russia and Saudi Arabia objected to the statement that there is "very high confidence" that climate change is impacting on "many natural systems, on all continents and in some oceans".
• The United States objected to the statement that North America could suffer "severe economic damage" from warming.
• The United States led objections to the statement that European heatwave of 2003, which killed more than 20,000, was "unprecedented" but was routed by scientists.
• Billions affected by sea level rise changed in some places to millions.
• One illustration full of specific numbers - that up to 600 million more people in Africa were having difficulty finding water, and that 5,000 more heat-related deaths in Australia followed a 2 degree C temperature rise - was dropped after skeptical governments, including the United States, objected.

The publication of this report coincided with another published in the journal Current Biology
showing that more than half of the tropical coral reefs in the world are being degraded beyond repair. And 30 million people depend entirely on coral reefs for their income and for their food

This report also address the effects of climate change on disease and the threat that it will provoke wars over scarce resources. Those may be dealt with in more detail later in the year.

You may be interested to look at a projected timeline for some of these likely changes.

Despite these gloomy predictions, there is some cause for optimism: even if some were dragged in kicking and screaming, this is the first time that so many countries have agreed about ANYTHING. And secondly, the imminence of these changes hsould stimulate not just conservation and technological innovation, but a greater understanding that we cannot continue to live as we have done in the past: the planet is a great deal more fragile than our economies.

Sage Words about Violence and Mental Illness

One of the blogs that I highlight down of the left-hand side of this one is attached to schizophrenia.com.

They have a particularly good entry for April 20th, that discusses not just the tragedy in Virginia and its possible relationship to mental illness, but also some broader social questions. Having been born and raised in the UK, and then worked there and in the United States in both medicine and psychiatry I can really relate to many of the points made in the article. It really should be disseminated as widely as possible, so I am going to do something that I usually do not, and quote the article in full:

The Loss of Life in Virginia, and How it Could Have Been Prevented

Read more... Schizophrenia, Poverty & Crime

Whenever a tragedy happens such as the recent shootings in Virginia, the question inevitably turns to why did it happen, and how could it have been prevented.

While some reports (such as here, here and here) have suggested the shooter in this tragedy - Cho Seung Hui - might have suffered from psychotic depression, schizophrenia or bipolar disorder - its impossible to know with the limited amount of evidence available, and even after all the evidence is reviewed it will never be known for sure.

From what has been reported it does, however, seem obvious that he was seriously depressed and socially withdrawn, and had some significant delusions of persecution and paranoia. Whether these symptoms add up to a serious mental illness or some type of sociopathic disorder is unknown. Some factors don't seem to point towards schizophrenia - as Cho Seung Hui did not seem to suffer from the lack of motivation (called avolition) that is so common with schizophrenia. He was able to attend college and, from the sounds of things, was attending classes regularly and finishing his assignments. Typically when a person develops schizophrenia schoolwork and personal hygiene the first thing that suffers, and an inability to complete schoolwork is common.

With regard to the question of why did it happen - it is of course impossible to know for sure. But at the same time research into mental illness and brain disorders does point to some possible answers.

The path towards mental illness (any mental illness) is a complex one with many different factors - from genetic predisposition and pregnancy factors, to early life stresses and environmental factors, to social stresses. We have more information on this in our "Preventing Schizophrenia" - but fundamentally the factors that nudge people towards mental illness are many and varied. The factors that have been conveyed about the life of Cho Seung Hui suggest that early life experiences could have been factors. Here are some of the relevant points that have been discussed in the news:

1. A Difficult Early Life - news on the family has suggested that they had a difficult (low-income) family life in Korea which prompted the move to the US when the parents had a young family. A low income life that motivates a young family to leave a country - is likely to be a high stress environment - a factor that could contribute to mental illness.

2. Social stresses of immigration to the US (many studies out of the UK have indicated that immigrants frequently face extremely difficult social challenges in new countries due to a lack of understanding of social norms (as well as racism) - which causes a great deal of social stress and significantly higher rates of mental illness.

3. Cho Seung Hui's Father worked in a Dry Cleaning company - and the family may have been exposed to higher levels of dry cleaning chemicals - which are linked to neurological damage.

Additionally, on a related topic, Dr. Michael Merzenich, the Neuroscientist at UCSF - comments in his blog on the important issues related to the general social environment that is also a factor in the extremely high levels of gun violence and deaths in America - typically 300% to 600% higher than in other developed countries:

"Our jurisprudence is based on the principle of “blame” for behaviors that should by hypothetically controlled by our “free will”. Alas, human observers and psychologists (and with increasing clarity, we brain scientists) have understood from the beginning of time that your or my “will” is not entirely “free”. The boundaries of “good judgment” are defined by a combination of the inherited factors governing our brain function, by our physical brain status (2 million head injuries/annum in the US alone!), and the brain’s own plasticity-embedded experiences. For most of us, our genetics combined with fortuitously not busting our skull in the wrong place and with our particular plastic, experientially-driven brain ‘history’ adequately protects us from serious transgression. At the same time, in our (and other) contemporary society(ies), we tolerate conditions that result in millions of young men and women being reared with an experiential history that is NOT adequate to keep THEM safe from offending. THIS IS THE PART OF THE EQUATION THAT IS UNDER OUR (SOCIETY’S) CONTROL. We’re doing a bad job with it. In fact:

1) We live in a violent society chock full of models of behavior (a violence & fear-obsessed media, violent films, gangsta rap, et alia) that are well outside any rational societal norms. The mass murder of children on school campuses is one our MANY rather spectacular modern American-violence inventions with little historical precedent.

2) We tolerate the hardening of young brains to otherwise-not-tolerable bloody, shoot-em-/slash-em-up violence as an acceptable source of intensive training “fun” in the heavily-rewarded game-play of millions of our children. All that intensive training is somehow supposed to be just fine for the child and their brain?! Those tens or hundreds of thousands of violent repetitions in rewarded behaviors just don’t matter a whit? Stuff and utter nonsense.

3) We continue, collectively, to find innumerable ways to shame children in their young lives as “failures”, “weaklings”, “misfits” or “oddballs” in school and in life.

4) We send juveniles and young adults off to crime school (prison) at an extraordinarily high (and growing) rate.

Sometimes I think that we could hardly be doing a better job of training young people to misbehave. When they do, we hold them to a universal high standard of acceptable behavior that they may actually have had little experience with, in their own path through life, in our very own society."

Lastly - there is the issue of easy access to guns in the US - which when combined with all the above factors makes for an extremely toxic mixture. Easy access to guns results in high death rates in shootings; death rates that are typically 500% to 1,000% higher in the US than in other civilized countries, as can be seen in the diagram below.

National Comparisons for Selected Countries Homicide Rates Per 100,000 Population

Source: Corrections Service Canada

As New Scientist Magazine notes "Scientific studies have demonstrated over and over that owning a gun makes it significantly more likely that you will be shot. The US has the highest rate of firearms-related homicide in the industrialized world – Americans are literally sacrificing hundreds of innocent citizens each year upon the altar of the Second Amendment."

Are any of these factors preventable? Yes - of course they are - but the actions are costly and complex. To prevent these types of tragedies takes:

1. Better education of the public about how to achieve mental health for their children,
2. Early and easy treatment for mental disorders with early testing and screening in schools,
3. Good insurance coverage so that people can actually get their mental health problems addressed. The US is the only developed country in the world that severely limits coverage of mental health problems. Better and easier access to high quality mental health treatments is a great need in the US.
4. Laws that make it possible for mentally ill people to get treatment, even though they may not understand the need.
5. A reduction in the culture of violence in the US (a movement to reduce violence in movies, on TV, and in video games). Read: In denial about on-screen violence for more information.
6. Strict gun controls that take the millions of hand guns off US streets, and that will make it more difficult for the people who become mentally ill or who have psychiatric disorders - to obtain guns. Approximately 29,000 US citizens are killed by their fellow citizens each year, by hand guns. (see Statistics, Gun Control Issues, and Safety for more information)

The answers are relatively clear - but whether we actually do anything about it is up to you.

Related Reading:

Mental Health, the Law and Predicting Violence (NPR)

America's tragedy - Its politicians are still running away from a debate about guns (The Economist)

Mayors urge Bush to tighten gun control laws

Stricter gun control after shootings at U.S. university - not going anywhere fast

Relationship of US gun culture to violence ill-understood

Violence may be a 'socially infectious disease'

Fewer cheap guns = fewer criminals with guns

 

Posted by szadmin at April 20, 2007 08:45 AM

 

Schizophrenia, Psychosis and Psychopathy

Ever since the tragedy in Virginia earlier this week, everyone has been trying to second guess what happened. As I said, to the trained eye there is a lot to suggest that he had a psychotic condition, but whether it was schizophrenia, bipolar disorder or psychotic depression is guess work.

One of the things that has been worrying in all the media coverage has not only been the sensationalism that we have seen in some quarters, but the mistakes that reporters - and even some of the "experts" - have made in talking about mental illness. I have heard people constantly mixing up schizophrenia and psychopathy, which is more accurately called antisocial personality disorder. I have even heard an old mistake that I had thought died years ago: that schizophrenia is a "split personality." I think that mistake probably goes back to a misunderstanding of the roots of the term "schizophrenia," and it was perpetuated by Alfred Hitchcock's movie Psycho in 1960.

Let me just repeat: schizophrenia is NOT a split personality. Neither is it multiple personality disorder. There is even a lot of discussion whether multiple personality disorder, now known as "Dissociative identity disorder" really exists: a discussion for another day.

Because there has been so much confusion, I thought that it would be good to clarify what each of these disorders is.

You can get some of the information from Wikipedia. What has worried me a bit is that some websites have slightly questionable infrmation. Many people know that I do a great deal of advocacy work for the mentally ill, so these notes are from my own lectures.

For reliable back up information, I recommend using Healia.com to search, and you can check out at Wikipedia, Schizophrenia.com, the National Institute of Mental Health website, Medline Plus and the National Alliance for the  Mentally Ill.


Psychosis
Psychosis is simply a generic term for a mental illness in which people have a "loss of contact with reality." There are often other symptoms, such as hallucinations, delusional beliefs, disorganized thinking and a lack of insight into the unusual or bizarre nature of his or her behavior. Almost anything that stresses the nervous system enough may lead to psychosis. I have often told students that it is possible to induce psychosis in just about anyone. It is a symptom and not a disease. We sometimes call it the "fever of the nervous system."


Schizophrenia
This is a group of illnesses that describe a mental disorder characterized by impairments in people's perception or expression of reality and by significant social or occupational dysfunction. The point is that other people don't share their view of reality and it is causing suffering. There is always some smart Alec student who says, "But isn't religion a delusion?" The answer is no, of course it isn't. Millions of people share the same beliefs. The second piece is also important: is it causing suffering, distress or disability? Many people have ideas that are "different." That does not mean that they are mentally ill. Professionals should not get involved unless the beliefs are causing a problem.

A person experiencing schizophrenia typically has disorganized thinking, and may experience delusions or hallucinations. In Western cultures these are most commonly auditory hallucinations. Simply having hallucinations does NOT mean that someone is mentally ill. I seem to be one of the few psychiatrists that supports the aims of the Hearing Voices Network. The Network tries to help people who are experiencing hallucinations and to educate the public and professionals that there are many possible reasons for hearing voices and many have nothing to do with mental illness.

One of the most disabling things about the schizophrenic group of illnesses is that they primarily affect  cognition, and that is one of the things that can lead to chronic problems with behavior and emotion. For a long time there was a worry that the cognitive problems were a result of being on some of the older medications. But these cognitive problems were identified decades before the introduction of these medicines. Hence the old name of schizophreia: dementia praecox.

The diagnosis is based on self-report and observation. We do not have a laboratory test for these illnesses, but we are finding reproducible changes in the brain and in many genes. The main evidence for the illnesses is still based on their response to treatment.

There has been a lot of discussion about whether we should abandon the term "schizophrenias," since the current diagnostic approach is flawed: many people have psychotic experiences without becoming dsitressed or disabled. Neither can they - or should they - be diagnosed. This gets back to the categorical and dimensional argument that I have talked about before. The second point is that the label "schizophrenia" can be so stigmatizing.


Antisocial Personality Disorder
Antisocial personaity disorder is also referred to as psychopathy, sociopathy or dyssocial personality disorder. It is a condition characterized by lack of empathy or conscience, and poor impulse control or manipulative behaviors. The term originally came from the Greek psyche (meaning soul, breath or mind) and pathos (to suffer). At one time the term was used to describe all mental illness, and that is why there is confusion. It is quite different from psychosis. Psychosis is a chronic or intermittent symptom that comes on at some time in life. Antisocial personality disorder should have been present all the time, even though we cannot formally diagnose it until the age of eighteen. The term "psychopath" is not a good one: it has no precise equivalent in either the DSM-IV-TR or the ICD-10.

Only a minority of diagnosable psychopaths are violent offenders . There has been a lot of discussion about whether the manipulative skills of some of the non-violent psychopaths are valuable in corporate America, the military and academia, because they may bold and often charismatic leaders. The has even been a suggestion that becoming a "psychopath" may be an adaptation to working in a highly competitive environment: it gets results for both the individual and for their corporations or countries.

There is a recent book - Snakes in Suits - that does a good job of exploring these ideas.

In summary:
Psychosis = A symptom
Schizophrenia = A group of acute or chronic illnesses in which psychosis is a central feature
Antisocial Personality Disorder = a.k.a. "Psychopathy:" life long personality trait

   

The Tech Tragedy and the Mind

I have had a great many questions about the psychiatric aspects of the terrible tragedy at Virginia Tech.

Many friends and colleagues have swung into action to help with the oceans of grief and the inevitable post-traumatic stress disorder that will follow for many people.

The other questions have all been about the alleged gunman. Perhaps we can now stop saying "alleged."

I mentioned yesterday that the videos and "manifesto" might help us make some sense of the senseless.

What they show is incredible anger that had been building up and, until Monday, had no outlet. That kind of internalized anger can be very dangerous and is sometimes hard to pick up. Experts will often do some very careful "button pushing" to reveal what is going on inside. If a person is challenged, then the anger, disorganization and psychosis can all erupt. But it is a difficult technique unless you are a real expert.

A lot of what he says is disjointed and at times difficult to hear because he whispers and then becomes more and more angry. As expected there is some clear evidence of what we call "thought disorder" or "communication disorder."

You do not need to be a psychiatrist to see that the videos and the "manifesto" were the products of a very sick young person, and that the sickness lead to the tragedy.

Many commentators have asked questions along the lines of, "If he was so angry against the rich, why didn't he attack the rich?" That would be a good question except for one thing: psychotic delusions are usually "Un-understandable."

This clumsy term was introduced by the German psychiatrist and philosopher Karl Jaspers, since he believed that they were not produced by any kind of coherent thinking. Though not everyone agrees with this idea, it captures something important: it can sometimes be exceedingly difficult to understand the thought processes of the person in the depths of a delusion. We still try to understand their thinking, but it can be tough: some of the normal rules of logic do not apply. And one of the keys to delusions is that people hold them even when presented with evidence that their beliefs are wrong. It is totally different from people who hold odd or eccentric beliefs, but are happy to modify them as more evidence some along.

I am about to give a lecture to a large group of young doctors, and I have been told to expect a lot of questions about what they should do if they ever come across someone like this young man.

Answer: with hindsight the diagnosis seems clear; nobody can diagnose everyone every time. But trust you instincts, get another professional to have a look at the person and above all a it safe.

The Accelerating Open Access Revolution

It is only a couple of days since I last wrote something on the revolution in open access to information, but here are two new things that I need to share with you.

First, today saw the launch of the journal Open Medicine.

These are a couple of extracts from James Maskalyk's editorial in the inaugural issue:

...To attain their true worth, medical journals need to place the knowledge on their pages into as many capable hands as possible. In the past, this opportunity was limited mainly to those with a university library close by. Now, because of the Internet, one simply needs to be near a telephone line. The capacity of medical journals to disseminate knowledge has never been greater...

Unfortunately, physicians attempting to answer a clinical question are faced with two unappealing options: to navigate a sea of unedited pages of varying quality, or to pay for access to more carefully reviewed scholarly information. It seems an anathema to the spirit of medical research that, largely for economic reasons, the information it produces remains hidden from many potential users. Access is limited not only for health professionals in poorer countries, but also for health care providers in wealthy countries (most of whom do not have "free" access to information unless they work in universities), and for patients, who deserve the opportunity to become informed about research that affects their lives. The transformation of research findings and discussion of the results — the application of knowledge — is curtailed. Just as importantly, the debate over its merit is stifled before it can properly begin....

Medical knowledge should be public and free from undeclared influence. When possible, it should be free for those who apply it. Since people's lives depend on it, that knowledge must be filtered several times before it is ready to use. Studies need to be peer reviewed, to have their statistics analyzed, their content edited, then copy edited, then published quickly for as wide an audience as possible. The prospect of having a high-quality source of information that held true to these principles but was also free and globally accessible was impossible to imagine 20 years ago....


The second thing is something very helpful on Peter Suber's excellent blog:

OA podcasts from non-OA journals

Charles W. Bailey Jr. has collected some links for journals offering OA podcasts.

In a recent SSP-L message, Mark Johnson, Journal Manager of HighWire Press, identified three journals that offer podcasts or digital audio files:

• BJM
• JAMA
• New England Journal of Medicine

Here are a few others:

• ACS Chemical Biology
• Journal of Clinical Sleep Medicine
• The Journal of Law, Economics and Policy
• The Journal of Neurologic Physical Therapy
• The Lancet
• Nature
• Science

Reconstructing a Troubled Mind After Virginia Tech

There’s going to be a lot of discussion and speculation about the tragic events at Virginia Tech.

Ten years ago I became very involved with the media after a tragic shooting at the Capitol building by a man suffering from mental illness, and so I know the questions and the second guessing that will go on.

I have, of course, not examined the alleged perpetrator of the events on Monday, but I have received a great many questions about what I think may have been wrong with him. I did not want to answer until I had put together as much material as I could.

From the reports that I have received we can begin to construct a very plausible scenario.

The first thing to say is that it is very unusual for people with mental illness to commit major violent crimes.

Second is that many of the most horrendous serial killers have not had a psychiatric disorder at all. That may sound odd: how could someone do something awful and not be sick? Some people do bad thing because they are bad. Not because they are suffering from an illness.

Third, it is always easy to be wise after the event. Sometimes when people are mentally ill the illness itself stops them from communicating, especially to health care providers. Many people have admitted to me that they were hearing voices telling them to say nothing to me or to deny their existence. That is why we always watch to see if people may be attending to auditory hallucinations, or if they are preoccupied by internal stimuli.

Many years ago I knew a man who was obviously ill but would reveal nothing. Without tangible evidence of mental illness the courts told him to go on his way. The experience and gut instinct of one of the world’s top psychiatrists counted for little in the eyes of the court: they wanted evidence.

So the man left and immediately threw himself under a train. It was only later that his family found his writings and drawings about his fear that a demon was pursuing him. The poor man had been hallucinating and delusional all along. There are many ways of telling the difference between someone having evil experiences and someone with a mental illness: there are many people who specialize in such things.

I have been looking at the reports in the media that agree on certain points, and I am going to pick out the ones that really jump out at me as a professional.

• “He sat right beside the door, and as soon as class was over, he left."
• “On the first day, when the instructor asked students to write their names on a sheet of paper and hand it up, Cho wrote a question mark.”
• “Always wore a hat and sunglasses.”
• "He never looked up.”
• “He never looked anyone in the eye. If you even say hi, he'd keep walking straight past you."
• “He often spoke in a whisper, if at all.”
• "He would keep his headphones on a lot."
• "It was like he was carrying on a conversation with himself."
• “Nobody knows him really, he’s always quiet. When I talk to him, there's no response."
• “The teacher had addressed a question to him and he really just stared off into space. He didn't even recall acknowledging that she was talking to him.”
• “He disappeared from class.”
• “Taking secret pictures of his classmates.”
• “A loner.”
• “Angry, menacing, disturbed and so depressed that he seemed near tears.”
• “Rambling multi-page "manifesto" directed against the rich, the spoiled and the world in general.”
• On the day of the tragedy, “Cho's face was blank and expressionless. There was always just one look on his face.”
• And in 2005 he was declared mentally ill and said to “present an imminent danger to himself as a result of mental illness."

We do not yet know what diagnosis and treatment were offered, but he does not seem to have followed up. As with the man who jumped in front of a train, people with persecutory delusions can be very good at concealing them.

If we look back over these items, it is likely that he sat by the door so that he could escape from some perceived threat; he probably had real questions about who he was; the hat and sunglasses are commonly worn for “protection” and the avoidance of eye contact is usually because people are preoccupied by things going on inside their heads, or because they fear that you can see through their eyes. Many people who are experiencing auditory hallucinations use portable music systems to drown out the voices:  I have known more than one person who has had hearing damage from cranking up the volume. He probably was carrying on a conversation with the voices in his head. The avoidance and staring into space are usually signs of being preoccupied with internal experiences. The pictures would have been used to fuel his paranoia. The blank, expressionless face is a classic feature of one of the schizophrenic illnesses as is the social isolation. We would have to see the “rambling manifesto” to be sure, but the “rambling” could be a sign of what is known as “thought disorder” or “communication disorder.”

Several previous killers have been found to have different forms of brain disease. Taken together these clinical features are most likely the signs of a major psychiatric illness rather than something like a brain tumor.

The other thing of importance is that at least one person said that he seemed to be “mean,” so there may have been more than just a psychiatric or neurological illness going on.

Time will tell, and this is so far all informed guesswork. But at this point it makes some sense of this tragedy.

There will inevitably be a lot of speculation about what could or should have been done. But there is an extra factor that needs to be considered: the law is designed to allow people’s freedom. I have been in mental health courts on countless occasions and it is rare for a person to be committed for involuntary treatment unless there is really compelling evidence of a person being a danger to themselves or someone else.

Many people will feel that they should have noticed the signs of mental illness. Well hindsight is always 20/20 and I can tell you that the greatest experts have sometimes been fooled. If I, or one of my colleagues had, by some strange chance, run into this young man, would we have been able to diagnose him? As with my patient all those years ago, I would have been pretty sure, but I couldn’t prove it. And without that proof it is very hard to take any action.

Let me finish by saying again that the vast majority of people struggling with mental illness are not dangerous. The job of professionals is to find the ones who are, and to this day we have no reliable way of doing it.

Amazon.com

I am a bibliophile. Always have been. I started collecting books when I was twelve years old and now have somewhere between twelve and thirteen thousand. I try to read at least one book a day and sometimes a lot more. That being said, there are some books that can take weeks to finish.

So I am a good customer for Amazon.com.

Over the last year or two I’ve started submitting a few book reviews and book lists on things that I think might help people.

I recently got a letter from a delightful person who asked me why I go to the trouble of writing book reviews.

This was my response,

“I was rather reluctant to do reviews at all, but then discovered that some people found my comments helpful. I am often told that my forte is being able to extract the essence from a book or program and then summarize it. I hope that is true. For more expensive books I also like to provide detailed contents. I will have bought and read them, but before someone spends fifty or a hundred dollars, I would like to give them a good idea of what they will get for their money. Or even if it might be better for them to go to a lending library.
 
I see my reviews as complementary to my occasional Amazon lists: to help provide a reading list or bibliography. I also write articles, a blog and books, and these Amazon reviews support all three. I often have people contact me and say, "That's interesting, where can I find out more?" These reviews are part of my response. I read many books that I don't care for, but unless they are saying something dangerous or untrue, I prefer not to review them at all. I certainly belong to the "If you can't say something nice, don't say anything" school. So it is no accident that the reviews are virtually all four or five stars.
 
I have been sent only two books to review and I know the occasional author: I always try to ensure that I reveal that. After a lifetime in medicine and research, I am very hot on "full disclosure." There have been some cases in which people have offered reviews to boost sales of books, while negative reviews have been removed. There was a book last year for which there were a number of reviews purporting to be from people working in a non-existent medical school. I stay on the lookout for the people who have only written one laudatory review.

It is said that there are thirty million spiritual seekers in the United States, and many more who would like impartial advice on wellness and personal performance. The reviews are designed to offer these good people whatever assistance I can.

 
My only reward has been personal satisfaction, and the occasional kind letter like yours!”

As I started doing reviews I noticed several things. Apart from the occasional vanishing review and the rave reviews from vanishing reviewers! There are obviously some people who have their own fish to fry. Someone canned a review that I wrote about a book on metabolism and nutrition and asked about my qualifications. That’s just fine with me: I’ve spent my professional life in academia! But then I saw that he has attacked every positive review about the book and keeps citing an article that doesn’t seem to be relevant. So he obviously just has something against the author: you can’t please everyone.

The other thing that amazed me was the sheer number of reviews written by some people. The number one reviewer at Amazon.com says that she is a speed-reader. But once, in an idle moment, I found that she had reviewed over fifty books in one day. Assuming that each of her short reviews takes ten to fifteen minutes to write, well, you can do the math. Being a naïve soul, I just assumed that she had a bit of a backlog.

But now I’m not so sure. An investigative reporter named Vick Mickunas has had a look to see what is going on

He has written three blog items that make very interesting reading:

1. The Mysterious Harriet Klausner
2. Bogus book reviews on Amazon.com?
3. Amazon.com book reviewer shakeout

Some people will think that this is just a storm in a teacup, and perhaps it is. But if there is something fishy going on with some of the reviews at Amazon.com it is worrying. So many people base their buying decisions on these reviews and it is essential that people can have confidence in what they read.

Obviously publishers like positive reviews, but only if they are credible. I know a number of people in the publishing world and they most certainly do not want reviews from people of questionable integrity.

As a company Amazon has always impressed me, and I am sure that if there is something going wrong with the review process, they will deal with it.

Or am I being naïve again?

Biomedical Journals and Open Access

I have written before about my enormous admiration for the global attempt to make research freely available to everyone. This is such an important step toward patient empowerment and greater transparency in science and medicine.

There is currently an online petition to support free and open access to European research, and if you also believe in the principles of integrity, transparency and personal empowerment, you may want to consider signing.

I was gratified to see how many major journals are now making articles immediately and permanently available online without charge. A number of journals require an institutional or a personal subscription to view other content, such as reviews or paper reports. Free trial subsciptions to these journals are available.

This seems to be the most up-to-date listing, and everyone involved really deserves our gratitude. I shall continue to update this list as more journals become involved.

	A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
	Acta Veterinaria Scandinavica     all content Open Access

	AIDS Research and Therapy     all content Open Access
	Algorithms for Molecular Biology     all content Open Access
	Annals of Clinical Microbiology and Antimicrobials     all content Open Access
	Annals of General Psychiatry     all content Open Access
	Annals of Surgical Innovation and Research     all content Open Access
	Arthritis Research & Therapy     all research articles Open Access; subscription required for other content; free trial available
	Australia and New Zealand Health Policy     all content Open Access
	Behavioral and Brain Functions     all content Open Access
	Beilstein Journal of Organic Chemistry     all content Open Access
	Biology Direct     all content Open Access
	BioMagnetic Research and Technology     all content Open Access
	Biomedical Digital Libraries     all content Open Access
	BioMedical Engineering OnLine     all content Open Access
	BioPsychoSocial Medicine     all content Open Access
	BMC series
	BMC Anesthesiology     all content Open Access
	BMC Biochemistry     all content Open Access
	BMC Bioinformatics     all content Open Access
	BMC Biology     all content Open Access
	BMC Biotechnology     all content Open Access
	BMC Blood Disorders     all content Open Access
	BMC Cancer     all content Open Access
	BMC Cardiovascular Disorders     all content Open Access
	BMC Cell Biology     all content Open Access
	BMC Chemical Biology     all content Open Access
	BMC Clinical Pathology     all content Open Access
	BMC Clinical Pharmacology     all content Open Access
	BMC Complementary and Alternative Medicine     all content Open Access
	BMC Dermatology     all content Open Access
	BMC Developmental Biology     all content Open Access
	BMC Ear, Nose and Throat Disorders     all content Open Access
	BMC Ecology     all content Open Access
	BMC Emergency Medicine     all content Open Access
	BMC Endocrine Disorders     all content Open Access
	BMC Evolutionary Biology     all content Open Access
	BMC Family Practice     all content Open Access
	BMC Gastroenterology     all content Open Access
	BMC Genetics     all content Open Access
	BMC Genomics     all content Open Access
	BMC Geriatrics     all content Open Access
	BMC Health Services Research     all content Open Access
	BMC Immunology     all content Open Access
	BMC Infectious Diseases     all content Open Access
	BMC International Health and Human Rights     all content Open Access
	BMC Medical Education     all content Open Access
	BMC Medical Ethics     all content Open Access
	BMC Medical Genetics     all content Open Access
	BMC Medical Imaging     all content Open Access
	BMC Medical Informatics and Decision Making     all content Open Access
	BMC Medical Research Methodology     all content Open Access
	BMC Medicine     all content Open Access
	BMC Microbiology     all content Open Access
	BMC Molecular Biology     all content Open Access
	BMC Musculoskeletal Disorders     all content Open Access
	BMC Nephrology     all content Open Access
	BMC Neurology     all content Open Access
	BMC Neuroscience     all content Open Access
	BMC News and Views     all content Open Access
	BMC Nuclear Medicine     all content Open Access
	BMC Nursing     all content Open Access
	BMC Ophthalmology     all content Open Access
	BMC Oral Health     all content Open Access
	BMC Palliative Care     all content Open Access
	BMC Pediatrics     all content Open Access
	BMC Pharmacology     all content Open Access
	BMC Physiology     all content Open Access
	BMC Plant Biology     all content Open Access
	BMC Pregnancy and Childbirth     all content Open Access
	BMC Psychiatry     all content Open Access
	BMC Public Health     all content Open Access
	BMC Pulmonary Medicine     all content Open Access
	BMC Structural Biology     all content Open Access
	BMC Surgery     all content Open Access
	BMC Systems Biology     all content Open Access
	BMC Urology     all content Open Access
	BMC Veterinary Research     all content Open Access
	BMC Women's Health     all content Open Access
	Breast Cancer Research     all research articles Open Access; subscription required for other content; free trial available
	Cancer Cell International     all content Open Access
	Carbon Balance and Management     all content Open Access
	Cardiovascular Diabetology     all content Open Access
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Oral Health and Pointless Tests

I really like the Fox News Channel, but I sometimes worry about some of the medical advice that they dish out. The other morning I heard a dentist recommend that people should ask for a blood test to measure inflammation. She was saying that everyone should have the test, called C-Reactive Protein (CRP). This is really bad advice that is based on a fundamental misunderstanding of research data.

Yes, there is a link between dental disease and arteriosclerosis. And yes, there is a link between CRP and arteriosclerosis. But there is no good evidence that we should be measuring it on a routing basis.

The CRP Molecule

So what’s the problem about measuring CRP? If it is elevated, then what? There is no point in measuring anything at all unless you can take some action, or it guides prognosis. No good doctor would ever recommend treating a lab value. So if the CRP is elevated that would not just mean that it’s time to have a look at his or her pearly whites, it would mean a total body workup. There are dozens of causes for an elevated CRP. I know a lot about the topic: sixteen years ago I wrote one of the early scientific papers on CRP. It may go up if you have a fat tummy, have arthritis, allergies or if you are depressed, have fibromyalgia or irritable bowel syndrome. It also goes up as you get older, if you are physically inactive, or if you happen to have one of the genetic variants that can push it up.

In fact the questions of whether or not measuring CRP would improve coronary risk prediction is the subject of three papers and two editorials in the July 10, 2006 issue of the Archives of Internal Medicine and the July 4, 2006 issue of the Annals of Internal Medicine. In the July 10, 2006 issue of the Archives of Internal Medicine, a team led by Dr Aaron R. Folsom from the University of Minnesota in Minneapolis reported the results of the Atherosclerosis Risk in Communities (ARIC) study, which assessed the association of 19 novel risk markers with incident CHD in 15 792 adults followed up since 1987-1989.

The participants underwent a physical examination, including assessment of major risk factors, at the beginning of the study and every three years afterward. At four times during the follow-up period, researchers collected blood and DNA samples for analysis. Patients continue to be tracked for the development of CHD.

Novel markers included measures of inflammation, endothelial function, fibrin formation, fibrinolysis, B vitamins, and antibodies to infectious agents.

Folsom concluded that:

"C-reactive protein level does not emerge as a clinically useful addition to basic risk-factor assessment for identifying patients at risk of a first CHD event. Routine screening is not warranted for any of the other 18 novel risk factors tested, either."

Another study from Brigham and Women's Hospital in Boston did suggest that CRP might be helpful in predicting coronary disease in some women. But in an editorial, George Davey Smith from the University of Bristol in England had this to say:

"There are many reasons for skepticism about the role of CRP as a predictor of CHD: CRP may not be causally related to CHD; it remains more expensive than asking patients about their health, lifestyle, and socioeconomic background; and it adds only modest additional predictive ability over conventional risk factors, even in Cook and colleagues' (i.e. the Brigham and Women’s) study."

The moral of the story? Random measurements of CRP have not been shown to be of much value.

And be a bit cautious about medical advice on Fox News.

Information Overload

The British Economic and Social Research Council (ESRC) has funded some very important research that confirms something that many of us have feared for quite a while: there is now so much information online that important science websites are in danger of becoming buried in a sheer avalanche of facts. Key science sites are failing to register in the top 30 Google search results.

Dr Ralph Schroeder, Dr Alexandre Caldas, Professor William Dutton, and Dr. Jenny Fry of the Oxford Internet Institute have investigated how the Internet is changing the way in which people seek out sources of scientific expertise.

Traditionally publishers have held a central position because of the importance of academic articles, but this is changing with increasing uses of the Internet and Web.

The study focused on how academic researchers in particular interact with the Web on topics including HIV/AIDS, climate change, terrorism, the Internet and society. These subjects are, of course, all highly topical, but the findings of this study will apply much more widely to the uses of the Internet and Web for searching for information on a variety of topics.

The research also confirmed something that clinicians have known for some time: the Web is far from being a neutral source of information. It has a particular structure that steers the search in directions that may not be intended by the user and so makes some sites more accessible than others. Search engines such as Google play an increasingly important gate-keeping role that will influence the information that is found. They can shape "winners and losers" by means that are not always apparent and moreover do so in a manner which can vary according to subject matter.

There is also a problem  that some vested interests are able to "buy" high visibility. Many people with psychological difficulties have stumbled on Scientology websites without realizing it. And there are some people who have the time and the energy to attract a lot of "hits."

The researchers came to several conclusions:

* The "visibility" of information on the Web is of increasing importance. Do people looking for research results on climate change or terrorism find themselves directed to a few top sites rather than a wide array of diverse sources? Do they encounter the most highly regarded researchers rather than marginal ones?

* Interviews revealed that researchers' ideas of key networks, structures and organisations may not be mirrored by search engines. For example the HIV/AIDS researchers reported using national journals, charity organisations, statistics and public sector organisations but none of these appear in the top 30 search results for generic domain keywords. In addition, a number of institutions, people and other key organisations and resources failed to appear in the top 30 search results.

* The role search engines play can vary according to topic. In the HIV/AIDS and the Internet and society domains, for instance, search engines such as Google was mainly used as an aide memoire for locating known sources. For researchers on terrorism, the search engine played a more central role in exploring the object of research and identifying relevant sites of information.

"This will be an issue not just for policymakers," Dr. Schroeder says, "but for educators, organisations involved in science and research communication, regulators responsible for access to the Web, and citizens who are concerned with the diversity and richness of the information world around them."

Deep Vein Thrombosis

I am sorry to hear that the United States Vice-President Dick Cheney has just developed a blood clot in his leg and is being treated with anticoagulants (blood-thinning medications) that he will need to be on for several months.

He experienced some discomfort in his lower left leg this morning, and the diagnosis of deep vein thrombosis was made.

Mr Cheney is now 66 years old and has a history of cardiac problems. He has suffered at least four  myocardial infarctions (heart attacks) and has a pacemaker.

He had quadruple bypass surgery in 1988 after his third heart attack.He also had an operation to remove blood clots around his knees in 2005.

Mr Cheney recently returned to Washington after long flights to Japan, Australia, Pakistan and Afghanistan.

As I discussed a few months ago deep vein thrombosis - often shortened to "DVT" - can be associated with long-distance flying because it leads to inactivity and dehydration. Not, as was formerly thought, low oxygen pressure.

Blood clots in the legs are not in themselves life-threatening but they can be dangerous if they become wedged in the lungs (pulmonary embolism) or other organs, which can in severe cases be fatal.

Although the venous and arterial sides of the circulation are often thought of as quite different, it is not that unusual for someone to have problems in both, either because of immobility, metabolic disturbances or low grade inflammation.

With Spring Break and early summer vacations coming up, please don't forget to keep moving when you are on planes, limit the alcohol and coffee cnsumption, and have plenty of water to drink.

Bon voyage!

More Saturday Satire

I think that I can tease Apple because I like their products so much: I've bought enough of them! And I'll be getting a lot more come June.

Here's another piece of fun.

Enjoy!

Becoming Cosmopolitan

I grew up in a country where football – that’s the soccer variety – is almost a religion and it’s virtually impossible to go through life without attaching yourself to one team or another. It all becomes rather tribal. But it reflects a need to belong to groups or clans. Many of us eventually grow out of that need to belong to a group and detaching like that is an essential part of personal and spiritual growth and development.

One of the most pernicious ideas is born of a myth that we are separated and segregated into groups that are defined by criteria like gender, language, race, religion or some other kind of boundary. And it is easy to see that these boundaries are a major cause of conflict.

I just finished an enthralling book - Cosmopolitanism: Ethics in a World of Strangers - by Kwame Anthony Appiah, in which he challenges this kind of separative thinking by resurrecting the ancient philosophy of “cosmopolitanism.” Cosmopolitanism is the idea that all of humanity belongs to a single moral community. This is contrasted with ideologies of patriotism and nationalism. This school of thought dates back almost 2500 years to the Cynics of Ancient Greece. They first articulated the cosmopolitan ideal that all human beings were citizens of the world. Later on, these ideas were elaborated by another group of philosophers: the Stoics.

According to Appiah, a Professor of Philosophy at Princeton, the influence of cosmopolitanism has stretched down the ages and through to the Enlightenment. He takes Immanuel Kant’s notion of a League of Nations and the Declaration of the Rights of Man to be two manifestations of this ancient idea.

Appiah sees cosmopolitanism as a dynamic concept based on two fundamental ideas. The first is the idea that we have responsibilities to others that are beyond those based on kinship or citizenship. Second is something often forgotten: just because other people have different customs and beliefs from ours, they will likely still have meaning and value. We may not agree with someone else, but mutual understanding should be a first goal. I think that most of us can agree with that.

In parts of Europe, there have recently been misgivings about the growing diversity and multiculturalism of countries like the United Kingdom, with people asking whether it is doing no more than fracturing society. Appiah has this to say, “If we want to preserve a wide range of human conditions because it allows free people the best chance to make their own lives, there is no place for the enforcement of diversity by trapping people within a kind of difference that they long to escape. There simply is no decent way to sustain those communities of difference that will not survive without the free allegiance of their members.”

Cosmopolitanism, balances our “obligations to others” with the “value not just of human life but of particular human lives,” what Appiah calls “universality plus difference.” He remains skeptical about simple maxims for ethical behavior such as the Golden Rule. He demonstrates its failings as a moral precept. He argues that cosmopolitanism is the name not “of the solution but of the challenge.”

Cosmopolitanism is an important concept that bears close examination, particularly in the light of some of the new discoveries about ethics and the brain and also about the fundamental inter-connectedness of all life. I shall have a little more to say about that in another post.

The Latest Report on Climate Change

As expected the Intergovernmental Panel on Climate Change (IPCC) concludes that there is more than a 90% chance that global warming has a human cause. The panel said that temperatures were probably going to increase by 1.8-4 degrees Celsius (3.2-7.2 degrees Fahrenheit) by the end of the century. It also projected that sea levels were most likely to rise by 28-43cm, and global warming was likely to influence the intensity of tropical storms.

The findings are the first of four IPCC reports to be published this year.

Also as expected, the attacks on the report began even before it was published. Some radio critics have committed a fundamental mistake of saying that people have been warning of this for years and nothing has happened. First, something has happened, and second, the report is careful to say that precise estimates are difficult. It is the direction of change which should be of greatest importance.

The Mail and Guardian Online is reporting that some scientists and economists have been offered $10 000 each by a lobby group funded by one of the world's largest oil companies - ExxonMobil - to undermine the report.

There is also a very well reasoned article about the semantics of climate change. The precise language of science and the quite different way in which politicians and many marketing people use language. It is well worth reading.

My main concern remains the impact of climate change on health and well-being. And many parts of the world, from Florida to the Horn of Africa are already experiencing that.

Saturday Satire

Most people seem to know that I am a cheer leader for virtually all things Apple. I'm on about my fifteenth Macintosh and I have no idea how many iPods we have. And the thought of the up-coming iPhone has me palpitating with desire. I've been lovingly poring over it's specs and I know that I'm going to be at the front of the line when it comes out in June.

But I just had a mega snigger when I saw this from the Borowitz Report:

Apple Recalls iPhone; Forgot to Include ‘Phone’ Feature

Jobs: Oops

In what could prove to be the most embarrassing misstep in consumer electronics history, Apple Inc. announced today that it would recall its entire production run of the Apple iPhone after discovering that it had failed to include a “phone” feature in the much-hyped handheld device.

Speaking from Apple corporate headquarters, company founder Steve Jobs offered consumers his apology for the monumental goof and seemed to be searching for an explanation for how it could have occurred.

“First and foremost, we’re sorry,” a red-faced Mr. Jobs said in a conference call with Wall Street analysts. “When you make a product called the iPhone, people expect it to include a phone, and we messed that part up.”

Mr. Jobs suggested that Apple had been so focused on making the iPhone the “coolest handheld device ever” that it had forgotten to include one of the most important features of any cellular phone: “One thing people like about cell phones is that you can dial numbers into them and call people.”

Instead, he explained, Apple’s engineers had crammed the iPhone with a plethora of what he called “non-phonal features,” such as a camera, an MP3 player, a taser, and a tactical nuclear weapon.

While Mr. Jobs said that almost all of the nine million iPhones that had been shipped to stores were on their way back to Apple’s manufacturing plant, he offered advice to consumers who somehow had already obtained the phoneless iPhone: “Just hold it up to your head and pretend to be talking into it.”

Elsewhere, the Fish and Wildlife Service said that it would remove wolves from the endangered species list and add Republicans.

RP On The Radio

Next Monday, February 5th, I am going to have the privilege of having a one hour conversation about Healing, Meaning and Purpose with Kimberley Colvard at Radio Sandy Springs. We are going to be on from 12 noon to 1PM EST. The show gets repeated twelve hours later for you folk in Europe and Australasia.

Here is the neat thing: you can either listen on the radio (AM 1620 in Atlanta) or listen in on line. I am hoping to put the audio file on this website. So you can listen at your leisure as I explain how we discovered that the Laws of Healing are changing, what it means for your health, well-being, personal development and business, and how you can use these new insights starting today.

I do a lot of radio and TV work, but I am particularly happy to be doing this particular show. Kim is the author of an extremely interesting book - Life is a Perception, What's Yours?: How your thoughts and beliefs determine your life - that is full of novel ideas clearly showing that she is completey in tune with the aims and objectives of Integrated Health and Medicine. When I first started explaining the principles to her, she was one of the few people who "got it" straight away. So I am expecting this to be a very dynamic and creative program.

Stayed tuned (!), and you will be able to assess that for yourself!

Over-Medicating America

There is an important study in this month's issue of the Annals of Family Medicine It concerns something that most health care professional in the United States have been worried about for some time: it is direct-to-consumer advertising of prescription medicines. I rarely watch much television, but out of interest I had one channel on for an hour this morning and saw six advertisements for medicines. It is not widely known that this practice is illegal in most of the rest of the world, with the exception of New Zealand.

The research suggests that this direct-to-consumer television advertising of prescription drugs may be influencing Americans to believe that they are sicker than they really are. This may in turn lead to taking more medication than they actually need.

The study was funded by the National Cancer Institute's Centers of Excellence in Cancer Communication Research and the Robert Wood Johnson Foundation, and was led by Dominick Frosch from the David Geffen School of Medicine at the University of California, Los Angeles.

The researchers evaluated the educational value of 38 direct-to-consumer television advertisements for prescription drugs and analyzed how they tried to influence viewers. The drugs in question were for treating illnesses ranging insomnia and depression to high cholesterol and high blood pressure.

Their findings suggest that the advertisements had virtually no educational value. Furthermore they failed to describe who is most at risk for which illnesses, what their symptoms might be, and whether non-medicinal alternatives such as lifestyle changes might also be viable options.

According to the figures cited, Americans watch up to 16 hours of television advertising about prescription drugs per week. The scientists watched the advertisements shown during the evening news and prime time periods. They used a coding system that takes into account a number of attributes of each ad. The attributes included the factual claims made about the illness the drug is aimed at, the method used to attract the consumer, and also what is revealed about the behavior and lifestyle of the people in the advertisement.

Although they found that over 80% of the advertisements did make some factual claims and put forward rational arguments for use of the drugs, only 25-26 per cent of them described symptoms and causes of illnesses, the associated risk factors and how common or rare they are.

The scientists also found some common strategies: many of the advertisements portrayed the drugs in terms of people losing control over their lives (58%) and then regaining it (85%) once they took the medication. 78% of the ads also portrayed the medication as engendering social approval, while 58% of them implied that the drug was a medical breakthrough.

The findings also show that nearly all advertisements (95%) used emotional appeal to influence viewers and none of them showed lifestyle and behavior change as viable alternatives, except for 19% of them that showed this as an adjunct to taking the drug. 18% of the advertisements suggested that changes to lifestyle would not be enough to deal with the illness.

The conclusion of the study is that despite the claims that television advertisements play an educational role, they contain limited information about causes and symptoms of their target illnesses, their prevalence and risk factors. They also show people that have "lost control over their social, emotional or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health."

Dr Frosch said that "We're seeing a dramatization of health problems that many people used to manage without prescription drugs," and that the "ads send the message that you need drugs to manage these problems and that without medication your life will be less enjoyable, more painful and maybe even out of control." He said that the US should consider banning direct to consumer television advertising of prescription drugs too. Something that was echoed in the accompanying editorials.

I have spent a great deal of time weighing the pros and cons of direct-to-patient advertising with health care professionals and people in the pharmaceutical industry in Europe, the United States and Australia and New Zealand. Despite all of our work to empower people, I remain unconvinced that they are ultimately in peoples' best interests.

Open Access

I have had a number of kind comments about my brief piece concerning the revolution in open access to information.

Few people have yet realized the impact that it will have on our lives.

I am most honored to have just received this note from Peter Suber:

Hi Richard: PLoS is part of a larger movement for open access to peer-reviewed research literature, and a lot has happened since PLoS was launched in 2001. For details, see my Timeline [ http://www.earlham.edu/~peters/fos/timeline.htm ], and for daily updates see my blog, Open Access News [ http://www.earlham.edu/~peters/fos/fosblog.html ].

I have had a good look at Peter's material, and I have also subscribed to his blog, so it will now appear on the left-hand side of this blog under "What I'm reading," so you can access his writings without having to dart all over the place.

The entire open access movement encompasses a great deal more than just scientific and medical research, and is all precisely aligned with my aim of achieving greater personal empowerment, so that you can take control of your life, your health, your future and the legacy that you leave behind.

Several correspondents have agreed with my point, that the next imperative is to teach people how to use this information.

Checking Data

Following my brief piece on the sun and some of its potentially adverse effects, someone was kind enough to leave this comment:

"Don't forget that skin cancer is cured by melatonin and vitamin A.
Reference 1
Reference 2

I am extremely grateful that he wrote, because it gives me the opportunity to illustrate the point about checking the data. The person who wrote was obviously motivated by a desire to help, but he had been given some information that was not correct.

I pulled out both of these papers and discovered that they said something rather different.

The first paper in the Indian Journal of Medical Sciences is quite a good review article about melatonin. There are several reasons for us to be interested in melatonin, and I actually plan to write a brief review about it as soon as I have finished analyzing the literature. There is indeed some experimental work to suggest that melatonin may modulate and in some cases arrest the growth of some malignant cell lines (1. 2. 3.) But we are still a long way from being able to say that melatonin is a viable treatment option for melanoma.

The second paper does not talk about melanoma treatment at all: it is a paper about the possible use of Vitamin A as protection against cancer in sun-damaged skin.

As I mentioned in my piece about the new open access journals, our next task is to help people learn how to interpret the data in all of these papers. I am on the review and editorial boards for several scholarly research journals and it is amazing how often the article summary does not tally with the data in the paper.

And also how often people cite articles that they cannot have read. Within the last 24 hours, the editor of a well-known journal asked me to review a research paper that had been submitted for publication. There was very interesting data in the paper, but the author had made at least one error in his citations. He accidentally claimed that a piece of research had discovered one thing, when the research had actually said something quite different. I happened to know that because I wrote the original paper!

This problem of misinterpreting data keeps coming up, and I’m sure that we may all have missed something at some time. It’s sometimes hard to analyze all the ins-and-outs of a piece of research.

You may have heard about a bit of a scandal over a book on gender differences that was just published. I liked reading the book, but I was worried about some of the references about hormonal effects on behavior. I know this literature very well, and some of the statements and inferences were a bit questionable. Now several experts have been checking some of the citations about gender differences in language that were used by the author. They discovered that some were just plain wrong.

Have you ever heard that one about, “Women talk more than men?” It always sounded pretty silly. And of course, if something sounds silly it probably is. Does it matter? If someone is going to write a popular book, good luck to them: I actually think that scientists have a duty to make their work accessible to the public.

But if they quote a lot of papers to give themselves an air of authority, they really have to make sure that they are not misleading anyone. If some references are wrong, then it’s difficult to be sure which ones we can trust.

We cannot have one set of rules for a book written for professionals and another for the general public. Each must be created with the utmost care, clarity and attention to detail.

My last book and CD series – Healing, Meaning and Purpose – cites over 800 books and websites, all carefully checked by yours truly. I did this just so that people can follow up on what I say. That way my books, articles, papers – even this blog – become portals to a world of ideas and information that you can use to improve your life.




Science and Medicine at Your Fingertips

There is a very important initiative which will likely have far reaching consequences.

A number of organizations are creating a Public Library of Science (PLOS), which is a non profit organization of scientists and physicians who are committed to making the world's scientific and medical literature a freely available public resource. The impressive Board of Directors includes the Nobel Prize winner Harold E. Varmus, Chairman of the Board, and President & Chief Executive, Memorial Sloan-Kettering Cancer Center in New York; Patrick O. Brown , Stanford University School of Medicine and the Howard Hughes Medical Institute and Michael Eisen, Lawrence Berkeley National Laboratory University of California at Berkeley.

Some of the journals that are relevant to Health, Integrated Medicine, Meaning and Purpose are in the "journals" section in the side bar on the left.

Let me explain why this is so important. Since the early days of science, most of what has been written has been hard to get at and therefore often open to misunderstanding and misquotation. Books - including textbooks - are full of errors that have been repeated from one to another, in most cases simply because the authors did not bother to check their sources. There's a good example in popular literature. Book after book has repeated the story of the Hundredth Monkey. According to the story, Japanese scientists in the 1950s discovered that when a hundred monkeys learned a new task, monkeys elsewhere - without any physical means of contact - suddenly and spontaneously learned the same thing. The idea was that once the global monkey mind learned something, then the information was available to monkeys everywhere.

A number of years ago I looked at all the original research papers, copies of which are lodged in the Senate House Library in the University of London. The papers showed that the whole thing was untrue! There is a short piece about the hoax here.

If the papers had all been openly available, this urban legend would never have been able to take root.

Our next task will be to show people without a strong scientific background how to go about reading a paper: it is not as simple as it may seem, but is a learned skill. So almost anybody can be shown how to do it.

This is a terrific step toward greater freedom of information and everyone involved deserves our thanks.

Robert Anton Wilson R.I.P.

The American writer, humorist, philosopher, psychologist and futurologist Robert Anton Wilson finally passed last Thursday. I say "finally" because he has suffered for some time with post-polio syndrome that caused a bad fall last year. Since then he had required continuous medical care.

I never met him, but felt that I got to know him in the thirty some years since I first picked up a copy of The Illuminatus! Trilogy which he co-authored with Robert Shea. Advertised as "a fairy tale for paranoids," it was very funny in parts, using humor to examine American paranoia about conspiracies. Since then I read more than twenty of his books and there is no doubt that some of his ideas influenced not just me, but a generation of people who were interested in thinking outside that famous box.

Even thirty years later, one of his best and most influential books was Cosmic Trigger I: Final Secret of the Illuminati in which he examined everything from The 23 Enigma (the number 23 appears more often in "random" number series than any other and is said to have hundreds of odd correlations, from the number of human chromosome pairs to the Bible), leprechauns, Mr. Spock's ears, Discordianism, Sufism, Futurology, Zen Buddhism, Dennis and Terence McKenna, the occult practices of Aleister Crowley and G.I. Gurdjieff, the Illuminati and Freemasons, Yoga, and other esoteric or counterculture philosophies. He also advocated Timothy Leary's eight circuit model of consciousness and neurosomatic/linguistic programming.

"RAW" as he was affectionally known, also introduced millions of people to the idea that consciousness can affect the material world.

Some people found some of his writing difficult, simply because he was always trying to force people to make new associations and to see things differently. And few people would agree with absolutely everything that he said. Because he did not want them to: he wanted to make people think and to develop their intuition.

I shall always be grateful for RAW's influence, and I hope that he enjoys the next stage of his journey.

Common Misconceptions About "Weight Loss" Supplements

My recent comments about chromium, the penalties handed down over false weight loss claims and my inability to find  any support for an apparent claim concerning probiotics and  weight gain, have lead to a flurry of questions and helpful responses.

By far the most common has been surprise. Most people assumed that:

1. These dietary supplements are regulated and that:
2. They are therefore safe and
3. They have had to demonstrate that they are effective

In fact all of those three assumptions are wrong.

I have just found a most helpful article that you can download for free.

Last October at the 2006 Annual Scientific Meeting of NAASO - the Obesity Society - the results of a collaborative research program by the University of Connecticut's Center for Survey Research & Analysis (CSRA) in Stamford, Connecticut and the University of Pennsylvania's Center for Weight Loss and Eating Disorders in Philadelphia were presented. GlaxoSmithKline (GSK) Consumer Healthcare funded the study.

Findings from this first national survey on the safety and regulation of dietary supplements for weight loss include:

• 65% believing that weight-loss products are tested for safety
• 63% believing that weight-loss products are tested for effectiveness
• 54% believing that weight-loss products are approved by the FDA
• 64% believing that manufacturers are required to include warnings about side effects
• 50% of African Americans and 49% of Hispanics were more likely than Whites of European origin (36%) to believe supplements are safer than OTC or prescription weight-loss drugs

Congressman John Dingell from Michigan has indicated that the new Congress will be re-visiting the issue of the FDA's regulation of some of these supplements.

That would probably be wise.

Though as a very firm advocate for health freedom, I always worry when new regulations are proposed, simply because they sometimes lead to the baby being ejected with the bath water.

I shall continue to watch this developing story and to let you know how things develop.

Dogs, Diet Pills and Healthy Eating

Pfizer Animal Health announced today that the Food and Drug Administration (FDA) has approved Slentrol(TM) (dirlotapide) for the safe and effective management of canine obesity, making it the first and only veterinary-approved obesity drug for dogs in the United States.

Because of our intense interest in metabolism, we have been tracking the rise in canine obesity since 2001. Wild dogs do not get fat, but under-exercised canines given the wrong food rapidly do. Many owners think that they are too busy to exercise them and many neighborhoods either have no side walks or are simply not safe for a walk. Having just received multiple bags and boxes of food, I can also attest to something else: we often equate food with love - without being aware of the potential adverse health consequences.

According to 2002 data from the American Veterinary Medical Association 40 percent of dogs - around 17 million - are considered overweight (5 percent to 20 percent over ideal weight) or obese (20 percent or more over ideal weight).

Depending on the species, our canine friends get many of the same problems that we associate with overweight in humans: arthritis, heart disease, respiratory conditions and some cancers. Obesity can also worsen the signs associated with pre-existing diseases such as osteoarthritis. In addition, obesity can affect a dog's quality of life by making exercise and play more difficult or even impossible.

The medicine is, quite rightly, designed to be used with a diet and exercise plan.

This new medicine does appear to be a real advance, and its mode of action very interesting. Indeed I am at this moment looking at a dog who might benefit!

But I also notice that a number of news outlets have reproduced the Pfizer press release verbatim, and presented it as a news item.

What Pfizer said is 100% accurate, but when the media reporduce something without comment I worry that this is an example of "fake news."

It is interesting to me that this story was released two days after the release of a report from researchers at the University of Alberta Hospital that has just been published in the Lancet.

Their conclusion? That we need better data on the long-term effects of anti-obesity drugs before more widespread use of the therapies. We need to know not just if a medicine leads to weight loss, but whether it leads to clinical benefit. We saw this with the recent tragedy with the medicine torcetrapib. This was a medicine designed to increase levels of HDL-( "good") cholesterol. Indeed it does, but more people taking it died in a clinical trial, which was then stopped.

I am often asked, "Wouldn't it be great if we could do anything that we wanted and then to take a pill to cancel out the effects?"

The answer to that one is surely a big, "No!"

Fortunately such a solution - which would destroy personal responsibility - seems to be years in the future.

If ever.

We MUST take responsibility for the things that we do.

To do anything less is to accept the fantasy that we are no more than machines at the mercy of our brain cells.

We are all far more than that.

And deep down we all know it.

Probiotics: Caveat Emptor Part 2

After I posted about the new data on the apparent importance of intestinal microorganisms and weight management, I received some very helpful comments and emails.

If you look at the "comments" section of the post, you will see this:

"www.Probiotic-Lab.com is manufacturing and distributing Bacteroidetes as a natural bacteria supplement for weight loss."
Posted by an "R.Russell"

Now I have previously reported on a conference in London at which a number of experts expressed concern about some probiotics available in the United Kingdom. So on your behalf, I not only posted the following response, but also emailed the company. First, because there is nothing on their website about marketing probiotics for weight loss and second because it is important to have these questions answered whether they are marketing probiotics for weight loss or for skin care.

This is what I wrote on the blog and also in my email to the company:

On behalf of my many readers may I ask www.Probiotic-Lab.com two questions?
1. In my posting I referred to a short piece that I wrote about a conference in London, at which some of the speakers warned that some products on the market did not contain the active ingredients claimed on the label. How do you guarantee the activity of your preparations?

2. Though I am very familiar with the use of probiotics - I first used them in, I think, 1982 - I am intrigued that you are already distributing Bacteroidetes as a natural bacteria supplement for weight loss. What evidence do you have that they are effective? I could not find anything on your website or from a search of the literature. If you have some data to share I would love to analyze it, and if it's of good quality I will go ahead and write about it, both here and in my articles.

Kind regards,

RP

I wanted to give them time to respond because of the holidays.

But as of today - seventeen days later - there has still been no response to my communications.

I also checked the scientific references on the front page of Probiotic Lab's website. The first does not have anything to do with weight or skin infections, but actually refers to a study of ear infections. The second reference is problematic: it refers to the "American Medical Journal." But sadly I am not familiar with a journal of that name. I have looked at a range of American Medical Journals in case the journal name or date is wrong. But again I can find nothing.

I shall be delighted if someone can help.

I also looked to see if there is any published peer-reviewed literature on the use of probiotics and either weight management or skin disease, and again I have not been able to find anything.

So you can draw your own conclusions.

Should any data come to light I shall report it. Or if the company responds, I shall post what they say.

Wacky Warnings

The BBC just alerted me to the winner of the "wackiest warning" award for 2006.

First prize went to a washing machine that came complete with a warning not to put anyone inside....

An engine manufacturer who warned "Never use a lit match or open flame to check fuel level" won second prize.

Warnings not to dry wet mobile phones in microwave ovens and not to iron lottery tickets tied for third place.

Honorable mentions went to a telephone directory that advised: "Please do not use this directory while operating a moving vehicle".

The awards were made by the Michigan Lawsuit Abuse Watch who say that the tendency of Americans to sue companies has gone too far, encouraging absurd warning labels on products. Their website also has a list of just a few "loony lawsuits," some of which are mind boggling. One of my "favorites" was a prison inmate who sued because he thought that prison food was causing flatulence and a couple who claimed that dust from a neighbor's house was "trespassing" on their home. These cases have been settled.

Given the level of frivolous lawsuits, the manufacturers of the products are unrepentant. One spokesperson said that the height of the washing machine would be just about right for a small child to climb inside. Who would not be able to read the warning label anyway. Mind you, we always check to make sure that none of our clowder of cats is lurking in the laundry before we switch on the washing machine.

All this reminded me of the annual Darwin Awards for people whose extreme lack of judgment may lead them to be removed form the gene pool.

Well this does not have much to do with our main themes of Health, Integrated Medicine, Meaning and Purpose. Or does it?

Actually it does. And not just because humor is an essential part of healthy living. It is because many people feel that there is a disconnect in our legal system: a disconnect between justice and legality. Whether dealing with the health of the body or the health of the legal system, if those two are not in harmony, we can expect for there to be problems.

We all want people to have legal protection and the right of redress, but I sometimes worry. Two cases in point. In the first a lawyer told me that he would take any case against a doctor because, as he told me, "Who cares? Nobody gets hurt and if I can get some money out the insurance company nobody loses." I know that his was an extreme minority opinion, but it worried me on several levels. I have seen what legal action can do to the most innocent of people. This individual told me that he was not interested in the consequences of his actions!

The second happened on a long flight. I was sitting next to a defense attorney who was defending someone who had admitted to a string of horrible crimes. He recognized my name, told me about a neurological defense that he was working on and asked me what I thought? I said that it was impossible to comment without seeing the records, doing interviews and so on. "But doesn't it sound like a good defense?" he persisted.

"Well on the face of it he does not have any features of that illness," I replied.

He told me that another neurologist has already said that and that he was going to ignore his report.

I found this intriguing. I asked him whether he was interested in the truth of whether or not his client had the illness. He said, "Of course not, it's my job to clear him."

And although that is, of course, his duty, all of this leads me to ask myself about common sense. And this is what the wacky warnings, the frivolous lawsuits and the letter of the law as opposed to its spirit have in common. And what all three have in common with Integrated Medicine.

Don't they all need a really good dose of common sense to thrive?


“Common sense, to most people, is nothing more than their own opinions.”
--William Hazlitt (English Writer and Essayist, 1778-1830)

“Common sense is not so common.”
--Voltaire (a.k.a. François-Marie Arouet, French Writer and Philosopher, 1694-1778)

“As a rule, only very learned and clever men deny what is obviously true. Common men have less brains, but more sense.”
--W.T. Stace (English Philosopher, Former Mayor of Colombo and, from 1932-1955, Professor at Princeton University, 1886-1967)

The Price of False Weight Loss Claims

It has just been reported that this afternoon the United States Federal Trade Commission has recovered more than $25 million ro settle allegations of deceptive marketing for four products:

1. Xenadrine EFX
2. CortiSlim
3. TrimSpa
4. One-A-Day WeightSmart

This is not a surprise. For anyone with any knowledge of human metabolism some of the claims made in television and print advertisements were really far-fetched.

The fines may sound large, but are probably just a drop in the bucket for the companies.

This legal action is all about false claims, but there is another worry, and that is that some of the alleged weight-loss products may also have side effects. Two months ago I mentioned that there are currently investigations underway of at least two people who appeared to have developed manic symptoms while on Cortislim. It remains to be seen if there is a causal relationship.

Pretty much ANYTHING will help you lose weight in the short term. But if these products really worked and were safe, then why on earth wouldn't doctors and nurses be using them themselves and prescribing them to their patients?

Sad to say weight loss does not come in a bottle: I only wish that it did!

Stick with the principles of gradually modifying your diet, exercise and be aware of the psychological traps that can sabotage healthy living. And please don't waste your money on quick fixes that cannot possibly work.

If it seems too good to be true, then it probably is.

New Medicines for Schizophrenia

Many health care providers read this blog, although most focus on non-invasive healing methods.

But it is still important to know a little about conventional medications, and one of the basic tenets of Integrated Medicine is that we use orthodox medicine together with precisely individualized treatments aimed at harmonizing the whole person.

Last night the Food and Drug Administration in the United States granted final approval for a new medicine for the treatment of schizophrenia. It is called paliperidone, and will be marketed under the name Invega.

We have also heard that three other new medicines are in the late stages of development: bifeprunox, asenapine and iloperidone.

It is a sad fact that many people with severe mental illnesses are not well served by any currently available treatments, be they medicines, psychotherapy, nutrition or anything else. So it is good news that new treatment options are emerging. The next step is to see how these new medicines work in practice and if there are any side effect issues that did not show up in the clinical trials.

Paliperidone will become available in the United States in early January. You can read something about it here.

We expect that bifeprunox will be the next one to come to market, and you can read something about it here.

We shall continue to provide up to date and independent information about all the new approaches to treating major mental illness here.

Advertising Medicines

Web Mistress (that still sounds a bit rude) Carol Kirshner has just alerted me to something very important.

It looks as if there is going to be more oversight of direct-to-consumer advertising of medicines.

She posted this on Thursday:

"According to an article published today by Reuters the General Accountability Office (GAO) has published a report that the Food and Drug Administration (FDA) needs to improve their monitoring of direct-to-consumer drug advertising. Specifically, the FDA should issue warning letters more quickly when misleading advertisements appear.

The GAO findings are based on an examination of 19 letters issued in 2004 and 2005 which took, on average, 8 months to send out. The GAO asserts that by the time the companies received the letters, most had already discontinued the ads. Additionally, the GAO found that even after the letters were received, some companies continued to break the rules on the same medications.

The GAO report found that the pharmaceutical industry spent 4.2 Billion dollars on DTC ads in 2005. This is almost double the amount spent in 1997. Breakdown of other spending includes 7.2 Billion dollars promoting directly to doctors and 31.4 Billion dollars spent on R&D.

Logic would seem to suggest that if spending on DTC advertising continues to grow exponentially, monitoring will become even more difficult. There will simply be too much volume to keep up with given the current resources of the FDA. In fact, the FDA has tried to proffer this as an explanation for the lapses. According to the article, the GAO is standing firm that the FDA could do more."

The first thing to say is that the vast majority of pharma companies do a great job of providing clear and accurate information, and I know of several for whom patient welfare always trumps the bottom line. But clearly there have been some problems.

Second, is that consumers need to be aware that the inofmration in the advertisements may no longer be 100% accurate, so check before you take anything. One of the reasons for creating this blog was so that I could be responsive to questions and quick to provide new information as it appears.

I also have a number three point, and it is something that surprises many of my friends and colleagues in the United States. Direct-to-patient advertising is prohibited almost everywhere else in the world. The rationale for that prohibition is most definitely not to disempower people! It is that careful prescribing of medicines is becoming an ever more complex art and science.

Regular readers may remember a report about the lamentable level of training of British doctors in how to prescribe and combine medicines. And British doctors do not have the added burden of patients asking for medications by name.

Some years ago I was at a meeting at which I was told a statistic that 92% of American doctors will prescribe a medicine if tha patient asks them to, while the figure throughout Europe was less than 20%. I've never been able to find any documentation for those figures, though they were given to me by a senior executive in a pharma company.

If those figure are anywhere near the truth they would worry me: there are just so many inter-individual differences in response to treatment and so many potential interactions between medicines, herbs and supplements. Explaining them all to someone who hasn't been trained in phamacology can be tough.

Trust me! I've been teaching medical students, residents, junior attendings, pharmacists and nurses since the 1970s. All have biomedical backgrounds, but teaching them all the ins and outs of modern pharmacology can be a Labor of Hercules!

So this is absolutely not a criticism of members of the public asking about things that they have seen on TV or the internet. Neither is it a criticism of 99% of the pharmaceutical industry.

I think that it's great for people to ask for what they want, the problem is this: How many doctors and nurses are able to say no?

And also to explain their reasons clearly?

Isn't it just an extra stressor for patients and prescribers alike?

The Sixth Extinction

“Once we spread out into space and establish colonies, our future should be safe.”
-- English Theoretical Physicist and Lucasian Professor of Mathematics at the University of Cambridge, 1942-

Five times before the world has almost died. Many experts believe that we are now in the Sixth Extinction. More accurately known as the Holocene extinction event, it refers to the widespread, ongoing mass extinction of species during the modern Holocene epoch that began 10,000 years ago, at the end of the last Ice Age.

The previous ones were all a very long time ago, and were probably caused by cosmic events:

1. 444 million years ago: the End Ordovician
2. 360 million years ago: the Late Devonian
3. 251 million years ago: the Permian-Triassic transition
4. 200 million years ago: the End Triassic
5. 65 million years ago: the End Cretaceous (this is the one that you probably learned about in school: it was the one that is thought to have ended the reign of the dinosaurs)

The reason that so many people are becoming more conservationist in their outlook is that the observed rate of extinction has accelerated dramatically in the last 50 years to a pace that is greater than the rate seen during the Big Five extinctions.

Unlike the previous extinctions that were likely caused by astronomical events, most experts attribute the sixth extinction directly to human activities. So they can be a good barometer of where we are going wrong with the world. Since 1500 AD, 698 extinctions have been documented by the International Union for Conservation of Nature and Natural Resources.

In the United Kingdom, the publication of the Stern Report that outlined the frightful impact not of extinctions but of global climate change, was endorsed by the current Prime Minister, Tony Blair. He endorsed it not out of the goodness of his heart, but because the report demonstrated the impact not just on people but on the economy. It seems a shame that it takes money to persuade some people in high places to do the right thing. Naturally the Stern report has had more than its fair share of criticisms. But the fact that more people in politics and industry are talking about global climate change and the impact of our activities on people and on many other species is obviously a good thing.

However I think that the real change in how we live with the earth lies not simply in understanding the impact on our bottom line, but in our own level of development. Rather tha following Stephen Hawking's advice and heading off into space, we need to get ourselves in order, unless we want to take all the behaviors that have caused this catastophe with us.

In recent years I have been persuaded by the spiral dynamics model. As more people embrace the Green, Yellow and Turquoise Memes they understand not just intellectually, but viscerally, the importance of preserving the planet and terminating the headlong rush toward the sixth extinction. Ken Wilber has written eloquently about the downside of what he calls the “Mean Green Meme.” But once enough of us make the jump to second-tier thinking there are no longer these mean downsides. Just a constant desire, need even, to nurture and preserve the planet.

One of the reasons for my efforts to assist your personal growth and development is that neither health nor illnesses exist in isolation. They are born from and affect everyone in the individual’s social group, and their resolution requires the cooperation of everyone in the group. And that social group includes the planet and all the creatures around us.

I have been asked to start sharing yet more of the practical techniques that have helped thousands of students over the last 30+ years, so I am going to start creating a new set of podcasts to help anyone who would like them.

“By 2050, at bio-extinction's current rate, between 25 per cent and 50 per cent of all species will have disappeared or be too few in numbers to survive. There'll be a few over-visited parks, the coral reefs will be beaten up, grasslands overgrazed. Vast areas of the tropics that have lost their forests will have the same damn weeds, bushes and scrawny eucalyptus trees so that you don't know if you're in Africa or the Americas.”
--Stuart L. Pimm (English-born American Conservation Biologist, Doris Duke Professor of Conservation Ecology Environmental Sciences and Policy Division at Duke University and Originator of the “Food chain” concept in research into extinction of plants and animals, 1949-)

“Every creature is better alive than dead, men and moose and pine trees, and he who understands it aright will rather preserve its life than destroy it.”
-- Henry David Thoreau (American Essayist and Philosopher, 1817-1862)

Beer Goggles

With Christmas coming, your humble reporter felt it important to share some critically important research from the cutting edge of science.

Beer goggles is a Britishism to describe the infamous phenomenon by which “ugly” people are magically transformed into “beauties” as more alcohol is consumed. An effect that normally only lasts until the following morning. A couple of years ago the BBC ran an article on this common observation with the catchy title, 'Beauty is in the eye of the beer holder!'

Your humble reporter has - of course - never experienced the phenomenon for himself, but he was nonetheless impressed to hear that even beer goggles has now succumbed before the onslaught of the scientific method.

Researchers at Manchester University report that while beauty is indeed in the eye of the beholder (beer-holder?), the amount of alcohol consumed is not the only factor. They have identified some additional factors including the level of light in the bar, pub or club, the drinker's own eyesight and the room's smokiness. The physical distance between two people is also a factor.

Just to prove that this is real science, the researchers have generated a smart looking equation:

This is the key to the magic formula:
An = number of units of alcohol consumed
S = smokiness of the room (graded from 0-10, where 0 clear air; 10 extremely smoky)
L = luminance of 'person of interest' (candelas per square meter; typically 1 pitch black; 150 as seen in normal room lighting)
Vo = Snellen visual acuity (6/6 normal; 6/12 just meets driving standard)
d = distance from 'person of interest' (meters; 0.5 to 3 meters)

You can use the formula to calculate a final score, ranging from less than one - where there is no beer goggle effect - to more than 100. The higher the score, the higher the chance that the esthetically challenged will appear more attractive.

The leader of the research team, Nathan Efron, Professor of Clinical Optometry at the University of Manchester, had this to say: "The beer goggles effect isn't solely dependent on how much alcohol a person consumes, there are other influencing factors at play too… For example, someone with normal vision, who has consumed five pints of beer and views a person 1.5 meters away in a fairly smoky and poorly lit room, will score 55, which means they would suffer from a moderate beer goggle effect."

But why, one wonders, would alcohol have the effect of making other people more attractive? After all the disinhibitory effects of alcohol can also make people aggressive, and the drinker will likely be less attractive to the people around him. Unless, of course, they are in a similar state. And why should less visual acuity make others more attractive? We could probably construct a model based on evolutionary psychology, but inquiring minds need to know.

Your reporter was left with a question: at a time when everyone in academia is fighting over a dwindling research budget, who on earth funded this research? Then he found the answer: the eye care company Bausch & Lomb PureVision.

But come to think of it, isn’t this the opposite of the result that the company would have wanted?

Fake News

There was a report in the British Medical Journal in April that got very little publicity, and even came in under my pretty sensitive radar.

The Center for Media and Democracy, a public interest group based in Madison, Wisconsin, that exposes "public relations spin and propaganda," issued a report that tracked the use of 36 video news releases (VNRs) aired by news outlets over the past 10 months. VNRs are designed to look like independently produced news but they are actually prepackaged promotions containing film footage created by corporate publicists or their public relations firms.

The media is always hungry for new material, but I was surprised to see that during the tracking period stations aired the pre-packaged VNR in its entirety more than one-third of the time. The other point of importance was that VNRs were not only widely used but their source was usually not disclosed. Another worrisome thing was that when it came to pharmaceuticals the safety data was usually shortened or even removed.

I have no problem at all with advertising and marketing. But it is surely misleading to dress up a company release as a news story.

To be fair, most television networks have rules and disclosure policies, but they are obviously sometimes (often?) being ignored.

I have been looking to see if there has been any change since this report came out in April, and I don't see anything.

This strikes me as an important issues, so I shall continue to track it on your behalf.

Arsenic and Water Safety

Here is a new study that may turn out to be one of the most important of the year.

Tens of millions on people around the world, most particularly in Bangladesh, are forced to drink water containing dangerously high amounts of arsenic. The very same stuff that has been used by countless poisoners.

The classic symptoms of arsenic poisoning are:

• Headache
• Abdominal pains
• Vomiting
• Difficulty breathing
• Light headedness
• Delirium
• Neuropathy
• Stroke
• Skin lesions: usually thickening of the skin of the palms and soles with wart-like excresences
• Reduced production of red and white blood cells
• Increased risk of cancers of the lung, skin, bladder, liver, kidney and prostate
• Death

The exact pattern of symptoms depends on the acuity of the exposure, the amount of arsenic to which a person is exposed and the individual's own makeup.

The new research - published this week in the journal Science - is from Rice University's Centre for Biological and Environmental Nanotechnology in Texas, and it may give us a quick and cheap way of getting most of the arsenic out of drinking water. The investigators used minute particles of iron oxide - very similar to common rust - to bind large amounts of arsenic. The iron oxide particles are really tiny: just 12 nanometres (billionths of a metre) across, about 5,000 times smaller than the width of a human hair. When mixed into contaminated water, the tiny crystals became coated with the poison and began behaving like iron filings. The iron oxide/arsenic combination can then be removed from water using a simple hand-held magnet.

One of the investigators, Professor Doug Natelson had this to say, "The idea of using magnetic particles to filter and clean water is not particularly new. The trick here is that these particles are very, very small, which means they're essentially all surface. So the arsenic sticks to the surface of the particles, and what we've found is that when the nanoparticles are in the right range of sizes, you can pull them out of solution with a relatively small magnetic field gradient that you could get from, say, a permanent magnet."

As an additional refinement, the scientists needed to develop a technology that would be usable in one of the poorest parts of the world. In one experiment flakes of rust were made into nanoparticles by heating them in coconut or olive oil at 350C. They could then be used in water purification.

This is excellent news, and if confirmed, it could save hundreds of thousands if not millions of livees, and unspeakably awful chronic ill health.

Conflicts of Interest

Last week I made some comments about the claims made in the new book by Suzanne Somers.

As expected, I had a good many people who said, “About time somebody said something,” and a few others who just felt that her publisher should have arranged for more fact checking.

To the people who agreed with me, thank you.

To those who did not, I respect your various positions, and I think that we have to look at this problem in a bit more detail.

By “this problem,” it is not simply about whether Suzanne needs to have some facts checked. I think that there is a very real problem with someone who has no medical training giving medical advice.

The more so if that person or persons is unable to undertake a critical review of published research.

This is much the same as the monstrous comments made by Tom Cruise earlier this year. He abused his position to make comments that made no sense. I saw several people who were weeping and distressed by what he had said. Many were saying things along the lines of  “These medicines have saved my life, how can he say something so terrible?”

This is similar to the recent problem with Kevin Trudeau, who has made a great deal of money out of peddling highly questionable advice. He can do so in the United States because of the First Amendment. Nobody would want to change a constitutional right, but I get very worried about people saying anything that they want about health, and if anyone gets harmed, they say that it’s not their fault.

Some don’t even seem to have the wit to understand that their recommendations may cause harm. Harm that can come not just from commission – taking something harmful or being given a harmful treatment – but also of omission: not getting a treatment with proven efficacy. Trudeau claims that he is fighting on behalf of the American public. In which case, why has he not contributed the entire proceeds from the sales of his books to an independent central fund to educate the public about health?

I certainly do not think that people with an MD, DO or ND have all the answers: none of us does. But when we are talking about people’s health, I think that we all have to be extremely careful about dishing out advice.

I am also very aware that there are millions of people – mainly, but not exclusively women – who have severe problems with hormonal imbalances, and that they have not always been well-served by the medical professions. Giving unsubstantiated advice to people who are suffering is so unfair.

A number of people who are known for their work in hormone replacement have published an open letter that they have written to Suzanne Somers’ publisher, Crown House, expressing their dismay over some of the claims in her book. The signatories include Christiane Northrup and Diana Schwarzbein. Neither of whom would be called pillars of the establishment.

The Endocrine Society has just published a position paper about bioidentical hormones that I would urge you to read if you want further clarification about the whole issue of hormone replacement.

The front cover of the magazine Life Extension gleefully proclaims “Suzanne Somers Versus the Medical Establishment.” Life Extension is a fine looking glossy publication that looks like a peer reviewed Journal. It seems, though, to be a medium for disseminating information about supplements. Some of the articles are really quite good, but there is always the subtext that they are written in order to promote products.

The Journal uses a familiar tactic in some of these magazines that are selling products. This tactic is that they are letting you in on A Secret. A secret that is being kept from you by those terrible doctors or, shock horror, pharmaceutical companies that are trying to keep you sick. I’ve worked with countless pharmaceutical companies, and I’m well known for speaking my mind. But I have to tell you that in every company that I’ve worked with on five continents, the vast majority of the people involved have had a genuine concern for human welfare. Yes, they have a business to run, but pretty much all the people that I’ve known in the industry have been in that particular industry because it meshes with their own life goals of helping humanity. And as I pointed out a moment ago, the open letter to the publishers was not penned by pharmaceutical company lackeys.

Is Suzanne Somers making money out of her claims? Well, of course she is. She is using her celebrity and her extravagant claims to sell books. I’m quite sure that far fewer people would be interested in reading her material ff she just stuck to the facts.

That in itself presents some important ethical issues. Clearly, if she stuck to the data and gave a clear account of the pros and cons of what she is suggesting, she’s not likely to sell so many books.

As a spin off, she is also getting large numbers of people to visit her website, where they may buy products that may not contain bioidentical hormones, but ARE touted as being “anti-aging.” In other words the products on sale make some of the same claims that are associated with the hormones. This is a well-known marketing tactic. She claims to have one million people in her database, though we have not been able to confirm those numbers.

People all over the Internet are trying to find out if she is receiving any payments for endorsing products. I know that because several have contacted me. Of course she can do any kind of business deals that she wants, but there are ever-evolving rules about conflict of interest. Some new rules have just been proposed in the medical literature, and it would be excellent if the same standards were applied in all publications, whether print, online, in infomercials, interviews or any other kinds of medium of communication.

An important article on conflict of interest and full disclosure has just been published in the American Journal of Psychiatry.

Most major scientific journals now require that authors fully disclose ALL sources of funding. There are also strong, and I believe welcome moves to ensure that when patients receive medications, that they are fully informed if the prescriber has any relationships with drug companies. I have seen some people suggest that there should be a complete separation of pharmaceutical industry and the medical professions. A moment’s thought shows that would not be an answer to anything. If we can do this in conventional medicine, why not in every area of healthcare?

(As I’ve said before, my own list of disclosures is available to anyone who wants them, and they get updated every time that I do any work for which I get compensated. And not just me, any members of our staff. We are determined to remain squeaky clean.)

So what to do about the people who make wild claims about health, without disclosing their conflicts of interest?

Since we’ve just been through an election we’ve all seen how the squeaky wheel gets the grease!

People who say things loudly and repeatedly and appear to be saying something novel, do get attention. There’s no question about it, and there’s a good reason: Our brains are hard wired to notice and respond to loud noises and novelty. But when we are dealing with outrageous medical claims, the soft whispers of good data will ultimately drown the foghorns of dogma and opinion, however loudly they are blasted from the rooftops.

Some of the claim makers retire behind the fig leaf of saying, “Well there isn’t any data but if there were any, it would prove what I’m saying.”

Believe it or not, I’ve had that said to me on several occasions by several different people.

All of whom managed to keep a straight face…

The CSI Effect

Over the last three or four years, American lawyers and law enforcement have been struggling with something that has become known as the CSI Effect.

Following the phenomenal success of the TV show CSI and its spin-offs, a major problem has been developing in courtrooms across America. Jurors are drawn form the ranks of television viewers, and they may have unrealistic expectations about the nature and quality of the evidence that they will be asked to examine. It is being claimed that cases are being lost because the evidence offered might fall far short of what the television-trained jurors have learned to expect.

I have not been able to find any god evidence for the CSI effect, and it may just be a case of attorneys who are upset about losing a case, but I don’t think so. I’ve spoken to quite a number of lawyers as well as physicians who do legal work, and there does seem to have been quite a shift in the courtroom. Most jurors now appear to rate scientific evidence much more highly than eye-witness accounts and confessions by defendants.

Even allowing for artistic license, I’m constantly astonished by the largesse of whoever is funding the CSI laboratories! I spent years working in basic research, and know only too well how hard it can be to make ends meet. Many of the reagents that they slosh around on the set would cost thousands of dollars in the real world.

One very good consequence of CSI is that it seems to be enhancing the status of scientists. At least it is in the United States. The idea of the super-smart well equipped team being able to out-fox the villain is very popular. I’ve recently had to spend a bit of time in England, and the difference in the cops and robbers shows is remarkable. The current crop of English detectives seem to be conflicted and charismatic, and it is they with a combination of street smarts and intuition who solve the crimes, with only an occasional nod toward the backroom boffins. (And yes, I know, “boffin” is a Britishism. Guilty as charged M’lud.)

I recently read that all over the United States, young people are flocking to enroll in science courses. So long as they have something to do with forensic science. A University in West Virginia now boasts 500 students studying forensic science, compared with only four in the 2000-2001 academic year. Another positive for CSI and for science is the key role of female and minority investigators, who all play equal roles in bringing the guilty to book.

The jurors’ demand for scientific evidence reflects a broader trend in society. In these uncertain times, people like to have certainty: The kind that you can get from a printout or a picture. It’s the same in medicine, where people demand certain diagnoses where none might be available. The combination of defensive medicine and the patient demand for certainty have between them fueled an unprecedented rise in the number of tests being ordered, to the exclusion of common sense and clinical skills. I’m a huge fan of what the new technologies are helping us do for people. But it is essential for us to remember that tests are meant to complement and not replace clinical skills.

There is still no good way of understanding a person and his or her distress by doing a scan, inserting a scope or taking a blood test. They all need to be used together. But even when we do that, medical decision making, just like weighing the evidence in court, remains a balance not just of objective data, but also of experience and intuition.

And we need to continue to explain that not all in this world is certain and predictable.

“Uncertainty and expectation are the joys of life. Security is an insipid thing, though the overtaking and possessing of a wish discovers the folly of the chase.”
--William Congreve (English Playwright, 1670-1729)

The Death of Fish

“Thank God men cannot fly, and lay waste the sky as well as the earth.”
--Henry David Thoreau (American Essayist and Philosopher, 1817-1862)

The BBC has just run a gloomy report based on an article  published this week in the journal Science.

For years now, fisherman have been reporting that many of the larger game fish have been getting smaller and younger, and the same has been reported of smaller fish in the major fishing grounds.

Now this research, which seems quite impeccable, predicts that there will be virtually nothing left to fish from the seas by 2048 if current trends continue. Stocks of fish have collapsed in nearly one-third of sea fisheries, and the rate of decline is accelerating.

When the first reports came out, they quickly became fodder for the late night comedians: “You think they use a lot of batter now? Just imagine how much they’re going to have to put around a minnow, come 2050.”

But that quickly gave rise to an understanding of he gravity of the situation: the decline in numbers of fish is closely tied to a broader loss of marine biodiversity. And that is the point. I’ve heard people say, “I’m a vegetarian, so I don’t care,” or “I don’t like fish anyway.” The ocean, like every other known ecosystem, is like a vast interlocked organism.

Everything that lives in the ocean is important. The diversity of ocean life is the key to its survival. The areas of the ocean with the most different kinds of life are the healthiest. If we knock out entire species the whole will cease to function, and then we have dead oceans. Ocean fish filter toxins from the water. They protect shorelines, and they reduce the risks of algae blooms such as the red tide.

In addition, a large and increasing proportion of our population lives close to the coast; the loss of services such as flood control and waste detoxification can have disastrous consequences.

These findings are not a computer model, or some prediction of future trends. They are based on actual observations of what is happening right now.

Why are we talking about this issue in a blog dedicated to personal growth, integration and wellness? Because seeing the larger You - the You that is interconnected with the rest of the Universe, the You that transcends your physical body, your brain and your emotions – is crucial to all of those three goals.

Yes, you can certainly feel a lot more healthy by eating better. Breathing exercises are valuable too. Do the two together and you get the advantage of synergy: they leverage each other. But you will really make progress when you begin to feel, really feel in a deep down visceral way, that You are something much larger and more grand. And that You also have responsibilities for the welfare of the planet. Because You are part of it, and it is a part of You.

Once You – the whole Big You – really “gets that,” you will feel the need to leave an enduring legacy, and You become an unstoppable force for good. Then you progress rapidly. Not because you are working on yourself, but because you are now acting from your Higher Self.

“I have had the experience of being gripped by something that is stronger than myself.”
--Carl G. Jung (Swiss Psychologist and Psychiatrist, 1875-1961)

“In the end we all must turn to the inner Source of all our best human sources, to the Guru of all the gurus, to the Overself. Then why not now?”
--Paul Brunton (English Spiritual Teacher and Author, 1898-1981)

DNA Databases

Regular readers will have noticed that I’ve written a lot less over the last couple of weeks, as I’ve had to scuttle to and from the UK.

England has really changed in the last few years. I probably noticed more than most, because although being born and bred in England, with the exception of changing planes at Heathrow, I’ve been away for a few years.

It is just stunning how many closed circuit TV cameras there are now. I hear that the average Londoner now expects to be photographed around 20 times a day.

The cameras are said to have helped solve a lot of crimes. Apart from hordes of hapless drivers caught by the traffic cameras.

Something even more interesting to an American Citizen, is the rapid growth of the massive British DNA database, that now has samples running into the millions, and has lead to the apprehension of a number of villains and ne’re-do-wells. Though I am a huge proponent of individual liberties, I thought that this was a good use of technology that would probably never fly in the USA. I remember all the furor over those two youngsters who denial in the driving deaths of two innocent people was nailed by a sensor in their car. Many people cried “Foul,” but I rather thought that the idea of criminal penalties was to catch and re-educate people who broke the social contract. Instead some have suggested that the citizen should seek to outwit the law. A slippery slope, IMHO.

So though I knew that the FBI has established a DNA database in the USA, I wondered whether data from it will be admissible in court, and how circumscribed would be the use of the information in criminology. I had imagined that its use would be severely limited by the courts but now I’m learning otherwise.

USA Today reports that the national database of criminals' DNA, originally designed by the FBI to help solve rapes and murders, is now increasingly being used to identify suspects in unsolved burglaries and other property crimes.

I learned that in 10 states — Alabama, Florida, Indiana, Michigan, Missouri, New Mexico, Ohio, Oregon, Virginia and Wisconsin — the total number of DNA matches in property-crime cases has exceeded the number of matches in violent crimes.

In my home state of Georgia, of the first 171 matches, only 13 involved DNA from the scenes of unsolved burglaries. Of the 300 matches that followed, 79 were in burglary cases.

Civil libertarians have worried for years abut mass fingerprinting, and collecting DNA seems yet more intrusive. It is important that we have a good discussion about the ways that DNA is collected, stored and the data used.

Many of us are already worried about the ways in which some medical insurance companies may want DNA analyses to determine whether you are a good risk to insure. If you have, say, a gene for breast cancer, then they may decide not to give you medical insurance. This is one of the many reasons for our intense focus on the “New Genetics,” that are teaching us that biology is not destiny. In most cases, just because someone has a high-risk gene does not mean that they will inevitably develop an illness.

Because of the kind of work that I have done, my fingerprints are on file, and my DNA is preserved in a number of freezers around the world. Personally I have no problem with that.

With all that DNA sloshing around, perhaps I should scan the news more often. To see if someone’s announced that they’ve cloned me. If they did Dolly the sheep, maybe Petty the Doc will be next??

;-)