Does chronic fatigue syndrome involve a neuropsychiatric failure of the placebo mechanism?

The New York Times > Health > For Chronic Fatigue, Placebos Fail the Test

Studies suggest that placebos relieve the symptoms for about 30 percent of patients suffering from a wide variety of illnesses. Migraine headaches, for example, respond at a rate of about 29 percent to placebo treatment, major depression at about 30 percent and reflux esophagitis at about 26 percent.

In some diseases, placebo treatments are even more effective - 36 to 44 percent of patients with duodenal ulcers improve on placebos, depending on how many of the treatments are offered each day.

But by pooling results from more than two dozen studies, the researchers, led by Dr. Hyong Jin Cho, a professor of psychiatry at King's College London, found that, among people with chronic fatigue syndrome, only 19.6 percent responded to placebos, not the 50 percent found by previous, less systematic studies.

Two NYT articles this month based on the same issue the Journal of Psychosomatic Medicine? Good for them!

This is tantalizing. The article quotes researchers arguing that this proves CFS is "organic". Phaw. To a reductionist everything is "organic" -- including joy, sadness, laziness and all varieties of fatigue. The question is really about mechanism and intervention. Most pain and suffering syndromes, including fairly severe angina (this was shown in a famous and impossible-to-replicate study of a sham surgical intervention for severe angina) respond very well to placebo. In general anything that is "perceived" by the brain responds to placebo. In contrast malignant melanoma does not respond to placebo (though pain due to MM will).

Many of the symptoms of CFS are things that live in the brain -- sensations of tiredness, fatigue, malaise. They ought to respond to placebo. If they don't then one wonders if the pathophysiology of CFS somehow degrades the normal placebo response.

One interesting study would be to take a group of people with CFS, inflict an ethical amount of discomfort, and give half a placebo and half a pain medication. Do the same thing for a control group. It would be interesting to compare the therapeutic gap in both cases.

Maybe when we understand the neurophysiologic basis for the placebo response, we'll understand CFS.

Hmm. That's a lot of speculation ...

Hyperlipidemia and IQ

The New York Times > Health > Vital Signs: Abilities: The Smart Side of Cholesterol

People with high levels of cholesterol do better on a variety of tests measuring mental ability, researchers from Boston University have found. The study, led by Dr. Penelope K. Elias, appeared in the January/February issue of Psychosomatic Medicine.

The findings grow out of information compiled by the long-term Framingham Heart Study, and are based on the medical histories of 789 men and 1,105 women over about 18 years.

Although high cholesterol increases the risk of serious illness, including heart disease, the researchers found that when it comes to the brain, it may be a slightly different matter.

When the volunteers were given tests to measure mental skills like memory, concentration, abstract reasoning and organization, those with cholesterol levels that were borderline-high or greater (200 and above) scored somewhat better.

I wanted to find this interesting for two reasons:

1. I've long been interested in the neuropsychiatric effets of lipid-lowering agents. For pete's sake, lipids determine a lot of the physical properties of the cell membrane. There's long been a concern that some lipid-lowering agents seemed to be associated with a higher risk of accidental death and many have wondered about a connection between lipid-lowering agents and neuronal function.

2. Hyperlipidemia is fairly common, yet it seems to only have downsides. That's a bit odd, even for an inbred species like the east african planes ape (humans).

Alas, there's probably a reason this wasn't published in a major medical journal. Doing this kind of analysis on a data set obtained for an unrelated measure has a high risk of finding a misleading association. Even if the association were true it could be that both mental skills (IQ) and hyperlipidemia were related to wealth -- and thus lots of Haagen-Daas ice cream.

So, despite my enthusiasm, I suspect this is probably meaningless.

Be the Best You can Be: Five siblings with varying flavors of autism spectrum disorder

Great USA today article. Utterly brilliant blog posting. (OK, so it's my blog.)

Last gasp of the Republican Rationalists

The New York Times > Opinion > John C. Danforth: In the Name of Politics

....When government becomes the means of carrying out a religious program, it raises obvious questions under the First Amendment. But even in the absence of constitutional issues, a political party should resist identification with a religious movement. While religions are free to advocate for their own sectarian causes, the work of government and those who engage in it is to hold together as one people a very diverse country. At its best, religion can be a uniting influence, but in practice, nothing is more divisive. For politicians to advance the cause of one religious group is often to oppose the cause of another.

Take stem cell research. Criminalizing the work of scientists doing such research would give strong support to one religious doctrine, and it would punish people who believe it is their religious duty to use science to heal the sick.

During the 18 years I served in the Senate, Republicans often disagreed with each other. But there was much that held us together. We believed in limited government, in keeping light the burden of taxation and regulation. We encouraged the private sector, so that a free economy might thrive. We believed that judges should interpret the law, not legislate. We were internationalists who supported an engaged foreign policy, a strong national defense and free trade. These were principles shared by virtually all Republicans.

... in recent times, we Republicans have allowed this shared agenda to become secondary to the agenda of Christian conservatives. As a senator, I worried every day about the size of the federal deficit. I did not spend a single minute worrying about the effect of gays on the institution of marriage. Today it seems to be the other way around.

It sounds like it might be possible to enroll Danforth as a "Guardian of the Enlightentment". He might even feel that natural selection belongs in science class, and intelligent design/creationism belongs in the philosophy or theology departments. (Gingrich is in the same category -- even though I disliked his conduct in the house).

So is this the last gasp of a powerless remnant of a now transformed party, or another sign that overreaching by religious conservatives is rousing a sleeping ... errr ...something? If the latter, we'll find out if the "something" is a "giant" or a dwarf.

Another reluctant guardian of the enlightenment -- and of a reality-based community

The New York Times > Science > Commentary: When Sentiment and Fear Trump Reason and Reality

Dr. Lawrence M. Krauss is chairman of the physics department at Case Western Reserve University. He writes in the NYT Science edition:

I have recently begun to wonder whether I am completely out of touch with the mainstream, and if so, what that implies.

When I was a young student it became clear to me that the remarkable success of the scientific method, which changed the world beyond belief in the four centuries since Galileo, made the power and efficacy of that method evident. Moreover, scientific ideas are not only powerful but so beautiful that they are on par with the most spectacular legacies of civilization in art, architecture, literature, music and philosophy.

This is what makes the current times so disconcerting...

... Those images came to mind again as I followed recent news of incidents in the United States in which fundamentalist dogma and its fear of the intellectual progress that comes from understanding nature has trumped the scientific method....

The "reality-based community," as one White House insider so poetically referred to it recently, is losing the fight for hearts and minds throughout the country to a well-orchestrated marketing program that plays on sentiment and fear...

...The pillar of our humanity that is most under attack is our remarkable ability to understand nature. We claim that in places like Afghanistan the enemies of truth are the enemies of freedom and democracy. If the scientific method is out of the mainstream in our country it is time to take a stronger stand against the effort to undermine empirical reality in favor of dogma.

The trouble with having sober rationalists as Guardians of the Enlightenment is that what they consider a passionate calls to arms is, in reality, snooze inducing. "Time to take a stronger stand"?. One imagines a sober council of elders about the round table even as the barbarian hordes gallop down from the mountains ...

Still, it's great to have such a noble recruit, even if he has been "out of touch with the mainstream". I do like the use of the phrase "reality-based community"; I'll adopt it too.

PS. Odd experience. I googled on "Guardians of the Enlightenment" and my blog post came up first. I doubt that will last.

Strong force black holes spit pions amidst a primordial quark-gluon liquid

The New York Times > Science > In Lab's High-Speed Collisions, Things Just Vanish

One would feel more confident that these little buggers can't swallow reality if the physicist's predictions were actually reliable. Alas, the scientific results appear to be somewhat surprising. While delightful, this does weaken the researcher's reputation as reliable prognosticators.

I like my title better than that of the New York Times.

The bits and pieces flying out from the high-speed collisions of gold nuclei at Brookhaven National Laboratory on Long Island have not been behaving quite as physicists had expected...

...In a normal black hole, the energy comes back out as photons, particles of light, what is called Hawking radiation. In a strong force mini-black hole, the radiation would come out as particles known as pions. Because of the differences between gravity and the strong force, a strong force black hole would inevitably fall apart, Dr. Nastase said...

... The collisions of gold nuclei produce matter as it existed shortly after the Big Bang. In the everyday universe, protons and neutrons in atomic nuclei are made of smaller particles known as quarks that are held together by the strong force, and because the strong force is so strong, it is ordinarily impossible to pull out a single quark...

... physicists expected that at ultrahot temperatures the bindings holding the quarks together would loosen and dissolve into a new state of matter, the quark-gluon plasma...

... Five years later, however, physicists are still holding off from claiming they have made a quark-gluon plasma. That is in part because the result of the collisions looks more like a liquid than a gaseous plasma...

... The scientists working on the experiment hope to figure out by summer a more definitive answer of what they actually produced at RHIC.

Update: Yes, a superfluid.

Lessons in technology: PDAs and the national health information infrastructure

Faughnan's Notes: Technology bites

Another example of why computers still don't work; and a comment on some deeper meanings.

Business need: be able to manage personal and corporate tasks and appointments separately. (Rule: don't intermingle.)

Ideal solution: A PDA/Desktop solution that allows one to identify tasks and appointments as being either work or home related and control their desktop synchronization appropriately.

Best available solution: Run two complete 'organizer' environments on my Palm PDA -- one is the native set, another Chapure is KeySuite. Each has its own synchronization. Integration is limited and occurs only on the PDA.

Problem: Even when the data models are consistent (that's another story, too awful to describe here), synchronization is problematic. Take for example today's story. Due to quirks in Outlook/Exchange I need to change the work desktop folder where I store my tasks.

1. Back up tasks in Outlook to a secondary store prior to surgery.
2. Copy all tasks to new folder. (Don't move, copy. I know from past experience moves are usually tougher for synchronization engines to handle than copies.)
3. Delete all tasks.
4. Synchronize and check.
5. Discover:

• there are two tasks on the PDA KeySuite app that the synchronization engine can't "see". So they can't be dealt with. One is missing completely from the desktop. Not good.
• when I copied in #2 there was an unrecognized filter applied; so the copy and sync didn't work the way I thought they did

Now #5 is a mixture of user error and bugs, but it's worse than that. I know from past experience:

1. In our setting Outlook/Exchange server are consistently messing up filters. Filter settings get lost or misapplied. It's a longstanding bug.

2. KeySuite has problems sometimes with filters -- it's a quirky bug and not replicable.

Fortunately, from years of experience, I know step 1 is reliable and it did indeed work today. So I'll wipe everything out, I'll get the missing task back somehow, and I'll sync and resync until everything is "clean" (for now).

How many people will handle all this? All those who combine servere geekishness with bull-headed obstinacy. I'd guess about five of us.

So once again -- why did the PDA market really collapse? It wasn't Graffiti that killed the Palm. I'd say it was a one-two punch:

1. Microsoft's FUD and well funded market entry incapacitated the few people at Palm who understood what was needed to provide true "profitable value" (vs. "user perceived value at time of buying decision").

2. Without a laser focus on the fundamentally very tough problem of synchronization and data models, the above was inevitable.

Are there broader lessons? Yes.

1. We are ver far from having a reliable personal technology infrastructure. We can only manage simplicity, but the user market demands complexity.
   
   
2. The US and UK are making billion dollar bets we can solve data model and synchronization problems in healthcare. But now I'm wandering into my real job, which I rarely mention on this blog ... This will, however, feature in a lecture I'm giving this Thursday.

Adaptive systems -- disabling the EPA hasn't been completely effective

Economist.com: Environment: New European rules will force electronics firms to eliminate toxic substances and take back and recycle their products

The Bush administration has neutered, knee-capped and decapitated the EPA. This has had consequences, but there are mitigating factors. Since auto makers can't afford two assembly lines, California's emission rules protect the entire nation. (This is a virtuous example of the same phenomenonn that is turning science texbooks into catechisms.) It turns out that the European Union is also helping out:

... The Restriction of Hazardous Substances (RoHS) legislation, which will apply throughout the EU from July 2006, bans products containing any more than trace amounts of lead, mercury, cadmium and three other hazardous substances. But it is just one of three pieces of EU legislation with which electronics manufacturers must comply. Another is the Waste Electrical and Electronic Equipment (WEEE) directive, which came into effect in August 2004 and requires manufacturers to take back and recycle electrical products. Finally, the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) directive requires firms to register the chemicals they use in their manufacturing processes.

Although these rules apply only in the EU, their effects are being felt around the world. “We cannot afford to run two production lines,” says David Lear, Hewlett-Packard's director of Environmental Strategies and Sustainability. “We will be producing just one product for the worldwide market.” And component suppliers, wherever they are, must ensure that they comply with the new rules if their parts end up in products sold in Europe.

Similar rules are also being adopted elsewhere. China's Ministry of Information Industry is basing its rules on RoHS. In America, the Environmental Protection Agency has remained quiet on the issue, preferring instead to let the industry regulate itself. As a result, many states are introducing their own regulations. “The EPA is not taking a leadership role, which leaves companies trying to deal with each state individually,” says Mike Kirschner of Design Chain Associates, an electronics-manufacturing consultancy. California's rules, for example, are based on the directives...

In the 7 years prior to 2005 the US dumped about 550,000 tonnes of lead from electronic components. This may yet reverse some of the gains of removing lead from paint and gasoline (it's shocking now to recall gas once had lead in it). It's good to benefit from the distant mercies of the EU.

Revenge upon Green Bay: Minnesota educational rankings

Landlocked, cold and now No. 1 in H.S. diplomas

Minnesota is doing well in the education races. Our local paper. the Strib, takes the opportunity to land one on Wisconsin (and the Dakotas):

...Despite having one of the nation's top public universities, Dambroski's home state of Wisconsin trails Minnesota in both brainpower categories by miles. Its record in attracting educated people ranks with the Dakotas. Minnesota's record more closely resembles Colorado and California.

Clearly we Minnesotans are still mad about losing (again) to Green Bay.

PS. Blogger performance is truly abysmal today!

The NYT Magazine profiles Republican Exurbia -- through a megachurch

The New York Times > Magazine > The Soul of the New Exurb

One of the more striking facts to emerge from the 2004 presidential election was that 97 of America's 100 fastest-growing counties voted Republican. Most of these counties are made up of heretofore unknown towns too far from major metropolitan areas to be considered suburbs, but too bustling to be considered rural, places like Lebanon, Ohio; Fridley, Minn.; Crabapple, Ga.; and Surprise, Ariz. America has a new frontier: the exurbs. In a matter of years, sleepy counties stretching across 30 states have been transformed into dense communities of subdivisions filled with middle-class families likely to move again and again, settling in yet another exurb but putting down no real roots. These exurban cities tend not to have immediately recognizable town squares, but many have some kind of big, new structure where newcomers go to discuss their lives and problems and hopes: the megachurch.

I'm going to have to visit Fridley! I never thought of it as an Exurb. I'd love to know why these are such Republican bastions.

Remember Homeland Security? The EAPA can't handle prevention.

Schneier on Security: TSA Lied About Protecting Passenger Data

The Transportation Safety Authority lied about how they used travel data obtained from airlines. Shocked I am not. I would have been shocked if they'd actually been both competent and honest.

Schneier's story and the comments are both well worth reading. Arguably the ongoing thread of incompetence is even worse than the deceptions (is it a lying if no-one believes you?). My own experience with TSA staff has been unremarkable -- I've found them to be polite and far more attentive than I could be in their place. As an organization, however, they seem to be overwhelmed.

Alas, the Department of Homeland Security (remember them?) is no better. In a recent detailed analysis of US intelligence, The Economist dismissed the DHS with a single curt sentence. It's been a costly failure.

The 'East African Plains Ape' (that's us) was not designed to deal with prevention in a modern industrial society. It probably has something to do with the way we evolved, and the kind of probability heuristics natural selection programmed into us. Even so, Bush isn't helping.

The age of the net -- do we understand what we're riding?

IDEAS

Welcome to the largest bibliographic database dedicated to Economics and available on the Internet. Over 300'000 items of research can be browsed or searched, and over 200'000 can be downloaded in full text! This site is part of a large volunteer effort to enhance the free dissemination of research in Economics

Disregard the slightly mangled english -- this is an astounding work. There are so many of these projects on the net. Any one of us sees only a fraction of the whole.

Fifteen years ago there were only hints of what was coming. How well do we understand the changes swirling about us?

Redefining science: the Justice Department's 'religious rights' unit

The New York Times > Arts > Frank Rich: The God Racket, From DeMille to DeLay

The Los Angeles Times has uncovered a three-year-old 'religious rights' unit in the Justice Department that investigated a biology professor at Texas Tech because he refused to write letters of recommendation for students who do not accept evolution as 'the central, unifying principle of biology.'

I assume this unit will also protect Scientology in its attacks on psychiatry, and guarantee that Christian Science pre-med students suffer no discrimination in admissions based upon their religious beliefs. If not, I strongly urge the Christian Scientists, Scientologists, and other faiths, cults and variants thereof to bring a class-action discrimination suit against the Justice Department. Science must not discriminate based on its bizarre concepts of testable models and non-consensus reality.

[correction: in the first version a typo meant I wrote "consensus" instead of "non-consensus". Sorry!]

Madness of the Great WAr

t r u t h o u t - Niall Ferguson | Sinking Globalization

This Foreign Affairs article by Niall Ferguson compares today's world to that of 1905. This is not new; it's been a common comparison since 9/11. Even so, Niall does a good job of bringing these comparisons to life.

I've been particularly interested for the past few years in American history from 1885 to 1910. This is a fascinating article.

Creepy logo award: Social Explorer

Social Explorer - About Us

Social Explorer is an organization based in New York City. Our objective is to help Visually Analyze and Understand the Demography of the U.S. through the use of Interactive Maps. Our primary functions include Demographic Data Analysis, Interactive Map Design and Software Development.

One of our main goals is to show demographic change that's occured in the U.S. since 1870 till present. We maintain a collection of interactive maps that visually show some of the available Census Data running back to 1870s.

We have over 60 years of combined experince in data analysis. With Dr. Beveridge at helm, we have produced statistical information and themathic maps to Prudential Financial Services, New York Times, Time Warner, and many other entities.

Then New York Times and National Science Foundation are sponsors, but they need to do something about their logo. The eye in the nation is creepy.