Links

1. Ben Goldacre in Buzzfeed News: Scientists Are Hoarding Data And It’s Ruining Medical Research. "Major flaws in two massive trials of deworming pills show the importance of sharing data — which most scientists don’t do."

2. Hari Pulakkat in Economic Times Blogs: Why India is lagging in disruptive innovation.

3. John P.A. Ioannidis in Al Jazeera: Could Greece become prosperous again?

   Populism and a critical lack of know-how is the common denominator among the neo-Stalinist syndicalists, outspoken nationalists and eccentric university professors (most of whom are entirely disconnected from serious global scholarship) who now happen to run the country. Mass media, justifiably anxious to create anti-austerity heroes, manufactured an artificial reality about these people. For example, the original finance minister, Yanis Varoufakis, was heralded as a famous professor of economics, while he has never authored a single scientific article in any of the 30 top economics journals (as ranked based on citation impact factor by Thomson Reuters). In education and science, the two fields where Greeks particularly excel, emerging state policies are strikingly counterproductive. In his inaugural parliament speech, the minister of education (a professor emeritus) proudly declared himself a Marxist who considers excellence a stigma; fittingly, his deputy minister, a university professor of genetics, has not published any PubMed-indexed peer-reviewed scientific paper since 1996. This is Greek mediocrity at its finest.

Oliver Sacks on His Last Months

He has recently learned that he has "multiple metastases in the liver," the kind of cancer that "cannot be halted." He has a detached, yet touching, article on "how [he plans] to live out the months that remain to me." Here's a section on some of his choices, and the reasons behind them:

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming.

This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future. [...]

Measuring the effectiveness of medication

Sarah Fallon at Wired has an informative story on putting a number, called the number needed to treat (NNT), on the effectiveness of medication and procedures.

Developed by a trio of epidemiologists back in the ’80s, the NNT describes how many people would need to take a drug for one person to benefit. [...] If your kid is throwing up and you take her to the hospital, she might get a drug called Zofran. The NNT for that is 5, meaning that only five kids need to take Zofran for one of them to stop throwing up.

The story goes on to talk about a site called TheNNT.com with the tagline, "Quick summaries of evidence-based medicine."

It’s unfortunate ... that the NNT is not a statistic that’s routinely conveyed to either doctors or patients. But you can look it up on a site that you’ve probably never heard of: TheNNT.com. Started by David Newman, a director of clinical research at Icahn School of Medicine at Mount Sinai hospital, the site’s dozens of contributors analyze the available studies, crunch the numbers on benefits and harms, and then post the results.

Here's a bit more on NNT and how it is assigned to a medication or a treatment procedure:

As statistical tools go, the idea of the number needed to treat is relatively new. It was first described in 1988 by epidemiologists Andreas Laupacis, David Sackett, and Robin Roberts in a New England Journal of Medicine article titled “An Assessment of Clinically Useful Measures of the Consequences of Treatment.” They start by sketching out the problems with a number called the relative risk reduction. That’s the measure you often see hyped in media reports of scientific studies. Imagine, for example, a study of heart disease that finds that a new drug reduces the risk of death by an astonishing 50 percent. The reality behind that number is that the risk of death over a 10-year period for, say, a healthy 45-year-old man weighing 200 pounds went from 5 percent to 2.5 percent—50 percent! Such a finding is clinically significant, yes. Worthy of publication, maybe. But not quite as astonishing.

It would be better, the authors write, to look at a number called the absolute risk reduction—the 2.5 percent reduction that resulted from the new drug. But working with that measure can be hard to understand, because it is actually a percent of a percent. To make it more intuitive and apprehendable, the authors explain, you can use the inverse of absolute risk reduction: Divide 1 by 2.5 percent, or .025, to get 40. And that’s the number needed to treat. Forty people have to take the drug for one person to benefit. So is it worth taking? That depends. The NNT isn’t crazy high, so you might go for it, especially since a heart attack can kill you. But if the drug has terrible side effects, you might not.

Links

1. WiseGeek: What does 200 Calories look like? Pictures of 200 Calories of Various Foods.

2. Robert Cottrell (the editor of The Browser: Writing Worth Reading) in FT: Net Wisdom.

   My first contention: this is a great time to be a reader. The amount of good writing freely available online far exceeds what even the most dedicated consumer might have hoped to encounter a generation ago within the limits of printed media.

   I don’t pretend that everything online is great writing. Let me go further: only 1 per cent is of value to the intelligent general reader ... Another 4 per cent of the internet counts as entertaining rubbish. The remaining 95 per cent has no redeeming features. But even the 1 per cent of writing by and for the elite is an embarrassment of riches, a horn of plenty, a garden of delights.

   The essay covers a wide variety of topics -- including what is so great about blogs by academics writing about their fields of expertise.

3. Makarand Sahasrabuddhe's answer in Quora to: India: Is reservation the best method of affirmative action in India?

Links

1. Anirudh Krishna (Duke University) at Ideas for India: The root of poverty: Ruinous healthcare costs.

2. James Choi at : How Noisy is Economics/Finance Peer Review?, with excerpts from this paper. I was quite surprised to read this:

   For economics journals, when two referees are consulted, the top-10p [percentile] paper receives two rejects with probability 14%, one reject and one non-reject with probability 47%, and two non-rejects with probability 40%. With three referees, the top-10p papers receives a majority of reject recommendations with 30% probability, a majority of non-reject recommendations with 70% probability.

3. Annie Murphy Paul in NYTimes: It’s Not Me, It’s You, an essay on intelligence and stereotype threat.

4. Felix Salmon: What education reformers did with student surveys.

Scary Sentences of the Week

Every single hour of television watched after the age of 25 reduces the viewer’s life expectancy by 21.8 minutes.

By comparison, smoking a single cigarette reduces life expectancy by about 11 minutes, the authors said.

From this NYTimes story by Gretchen Reynolds.

Dr. Ken Murray on How Doctors Die

The subtitle -- It’s Not Like the Rest of Us, But It Should Be -- is a little cryptic, but these early paragraphs present a good summary of how doctors choose to live their last days, weeks and months:

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

See also: Paula Span's post at The New Old Age blog at NYTimes:

Dr. Murray contends in his post that doctors know too much about the futility of aggressive end-of-life treatment to subject themselves to it. His argument is anecdotal, based on people he has known but lacking statistical underpinnings. “It’s a fair criticism,” he said.

But recently an alert reader e-mailed him a study, published in 2008 in The Archives of Internal Medicine, of more than 800 physicians who graduated from Johns Hopkins University between 1948 and 1964. Most had reached their late 60s and 70s, so questions about end-of-life treatment were not purely hypothetical.

Asked what treatment they would accept if they’d suffered irreversible brain damage that left them unable to speak or recognize people but was not terminal, the doctors overwhelmingly said they’d decline CPR, feeding tubes and a host of other common interventions. “So there is actual evidence about this,” Dr. Murray said, pleased.

Peter Kramer: "In Defence of Antidepressants"

Critics raise various concerns, but in my view the serious dispute about antidepressant efficacy has a limited focus. Do they work for the core symptoms (such as despair, low energy and feelings of worthlessness) of isolated episodes of mild or moderate depression? The claim that antidepressants do nothing for this common condition — that they are merely placebos with side effects — is based on studies that have probably received more ink than they deserve.

More here. A rebuttal of sorts to the NYRB articles by ex-JAMA editor Marcia Angell [See this post for links. Thanks to commenter Vijay for the pointer ]

Placebo Effect with a Twist

...Kirsch [found] that the six antidepressants he studied were more effective than placebos, but the difference was very small [...]. Kirsch then speculated that even this small effect might not be real, because patients who received the antidepressant instead of an inert placebo would experience side effects that might enable them to guess that they were receiving an active drug, and therefore might make them more likely to report an improvement in their depression. In support of this hypothesis, Kirsch pointed to a few trials employing placebos that themselves had side effects, where no differences were found between drug and placebo. [...]

That's from Marcia Angell's response to critics of her reviews (Illusions of Psychiatry< The Epidemic of Mental Illness: Why?) of books on mental illness.

The entire set of articles offer a great primer on the power of Big Pharma in biomedical research and medical practice. Here's another excerpt from the end of her article:

Friedman and Nierenberg refer to the death of Rebecca Riley, who was diagnosed with bipolar disorder as well as ADHD when she was just two years old, as a “tragic anecdote.” While that is true, I believe it should also be seen in the context of the extraordinary epidemic of juvenile bipolar disease that was stimulated largely by the teachings of some of Dr. Nierenberg’s colleagues at the Massachusetts General Hospital. Three of them were recently disciplined by the hospital for not having disclosed some of their hefty payments from drug companies.

If readers check the NYR website, they will see that Dr. Nierenberg discloses his external sources of income, which include consulting arrangements with some of the major manufacturers of psychoactive drugs. While I am not in a position to, and will not, comment on Dr. Nierenberg’s consulting work, it seems to me that in general, one of the risks of close collaborations with industry is that even the best of physicians might develop an insufficiently critical attitude toward a company and its products, as well as to pharmacologic treatment generally.

Dr. Friedman seems to agree. In a review of a book by Alison Bass, published in The New England Journal of Medicine (June 26, 2008), he refers to the handsome payments by drug companies to physician researchers who test their drugs, and goes on to say, “Bass’s riveting and well-researched account of these disturbing ties should be widely read by members of the medical profession, many of whom continue to believe, despite all evidence to the contrary, that they are immune to the influence of drug companies.”

Links ...

1. Academic Destinations. A collection of articles, pics, personal narratives, infographics on quite a few (non-US) countries. While India merits just a brief sketch, Germany gets a much more extensive coverage.

2. Jane Brody in NYTimes: A good night's sleep isn't luxury -- It's a necessity.

3. Andrew Gelman on The "cushy life" of a University of Illinois (@Chicago) sociology professor

4. Johann Hari in The Independent: It's not just Dominique Strauss-Kahn. The IMF itself should be on trial: "Imagine a prominent figure was charged, not with raping a hotel maid, but with starving her, and her family, to death."

Links ...

With all that stuff about Kakodkar Committee Report, it has been a while since I did one of these. There's a lot to link to, but this will have to do for now:

1. Winners of the Worst PPT Slide Contest

2. A great infographic on Arab Spring [h/t: Chris Blattman]

3. If you use Google, here's some advice from the company on ensuring your information is safe online.

4. The Bilingual Advantage. Claudia Dreifus of NYTimes interviews Ellen Bialystok, a professor of psychology at York University, Toronto [On strong recommendation from Mark Liberman of Language Log].

5. Gary Taubes in NYTimes: Is Sugar Toxic? Scary story about the true badness of sugar (more specifically, fructose, which forms a big part of sugar, and sugary drinks). Caution: will change your behaviour -- just as it did mine -- in the presence of sweet stuff.

Links ...

1. Helen Pearson in Nature Study of a Lifetime [free access, thankfully]: "In 1946, scientists started tracking thousands of British children born during one cold March week. On their 65th birthday, the study members find themselves more scientifically valuable than ever before."

2. Paul Krugman: Falling Demand for Brains?

3. Zeynep Tufekci at TechnoSociology: Can “Leaderless Revolutions” Stay Leaderless: Preferential Attachment, Iron Laws and Networks .

4. And, finally, Arunn Narasimhan has a fine rant at nOnoScience: Response to N. Ram from a Thin Skinned Music Listener.

Abraham Verghese on Watson's role in hospitals

Watson would be a potent and clever companion as we made our rounds.

But the complaints I hear from patients, family and friends are never about the dearth of technology but about its excesses. My own experience as a patient in an emergency room in another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, her back to me while she clicked and scrolled away. Over her shoulder she said, “On a scale of one to five how is your ...?”

The electronic record of my three-hour stay would have looked perfect, showing close monitoring, even though to me as a patient it lacked a human dimension. I don’t fault the nurse, because in my hospital, despite my best intentions, I too am spending too much time in front of the computer: the story of my patient’s many past admissions, the details of surgeries undergone, every consultant’s opinion, every drug given over every encounter, thousands of blood tests and so many CT scans, M.R.I.’s and ultrasound images reside in there.

This computer record creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.

That's his NYTimes piece. Here's an excerpt from the end of the article:

I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds. Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.

An answer that might have been posed on “Jeopardy!” is, “An emergency treatment that is administered by ear.” I wonder if Watson would have known the question (though he will now, cybertroller that he is), which is, “What are words of comfort?”

Psychology of Anti-aging

Via Swarup: BBC News story on the power of thought to stop aging. It's almost entirely about research done in 1979 by Ellen Langer, who has written a recent book on it: Counterclockwise: Mindful Health and The Power of Possibility.

Some of the stuff is pretty amazing:

Pretty soon she could see a difference. Over the days, Prof Langer began to notice that [the 70- and 80-year olds in the experimental group] were walking faster and their confidence had improved. By the final morning one man had even decided he could do without his walking stick.

As they waited for the bus to return them to Boston, Prof Langer asked one of the men if he would like to play a game of catch, within a few minutes it had turned into an impromptu game of "touch" American football.

Langer's blog is here.

Love's in the air ...

"Dopamine is released when you're doing something [highly] pleasurable," like having sex, doing drugs or eating chocolate, says Larry J. Young, a psychiatry professor at ... Emory University.

That's from Jessica Pauline Ogilvie's LATimes column [Thanks to The Situationist blog for the pointer].

Love and dopamine are not all about young lovers; a bit later, there's stuff for middle-aged (and above) married couples:

... [A] great deal of research shows that doing novel, exciting things together boosts marital happiness. "Take a class together that you know nothing about," suggests Aron, who has co-written several studies in this area. "See a play, go to a new location, go to a horse race." The release of dopamine during these activities might remind couples of how it felt to fall in love or even be happily misattributed to the experience of being together.

Also, says Acevedo, be thoughtful with your partner.

"We know that things like celebrating the positive is important for a relationship's well-being, as well as being supportive when [our partners] need us," she says. Couples that took part in Acevedo's study also resolved conflict smoothly and quickly, were affectionate and communicated openly with their partners, and spent time bettering themselves as well as the relationship.

"And sex!" she adds. "Sex is always good."

While on the topic of married couples, John Medina at Brain Rules has a post on marriage reinvention.

Finally, check out the artwork in this website for a condom brand [NSFW]. For a sharp perspective on these drawings, read the first comment in this post!

Links ...

1. An inspiring lecture at TED India by Dr. Thulasiraj Ravilla on the truly revolutionary Aravind Eye Care System that has used the McDonald's model to provide eye care to millions. This post has a bunch of links about Dr. Venkataswamy, the founder of Aravind.

2. Year of first mention of Contact Lens in NYTimes: 1930.

3. NPR story -- Atul Gawande's 'Checklist' For Surgery Success -- on the author's latest book, The Checklist Manfesto (along with excerpts from Chapter 1):

   "Our great struggle in medicine these days is not just with ignorance and uncertainty," Gawande says. "It's also with complexity: how much you have to make sure you have in your head and think about. There are a thousand ways things can go wrong."

   At the heart of Gawande's idea is the notion that doctors are human, and that their profession is like any other.

   "We miss stuff. We are inconsistent and unreliable because of the complexity of care," he says. So Gawande imported his basic idea from other fields that deal in complex systems.

   "I got a chance to visit Boeing and see how they make things work, and over and over again they fall back on checklists," Gawande says. "The pilot's checklist is a crucial component, not just for how you handle takeoff and landing in normal circumstances, but even how you handle a crisis emergency when you only have a couple of minutes to make a critical decision."

Willpower as a muscle

The implications of this muscle metaphor are vast. For one thing, it suggests that making lots of New Year's resolutions is the wrong way to go about changing our habits. When we ask the brain to suddenly stop eating its favorite foods and focus more at work and pay off the Visa…we're probably asking for too much.

The willpower-as-muscle metaphor should also change the way we think about dieting. Roy Baumeister, a psychologist at Florida State University who has pioneered the muscle metaphor, has demonstrated in several clever studies that the ability to do the right thing requires a well-fed prefrontal cortex.

That's from The Science Behind Failed Resolutions by Jonah Lehrer (the man behind the blog The Frontal Cortex).

Links ...

1. Must-read link of the day: Night by Tony Judt in NYRB:

   I suffer from a motor neuron disorder, in my case a variant of amyotrophic lateral sclerosis (ALS): Lou Gehrig's disease. Motor neuron disorders are far from rare: Parkinson's disease, multiple sclerosis, and a variety of lesser diseases all come under that heading. What is distinctive about ALS—the least common of this family of neuro-muscular illnesses—is firstly that there is no loss of sensation (a mixed blessing) and secondly that there is no pain. In contrast to almost every other serious or deadly disease, one is thus left free to contemplate at leisure and in minimal discomfort the catastrophic progress of one's own deterioration.

2. Age-relevant link of the day: How to Train the Aging Brain by Barbara Strauch in NYTimes.

   “There’s a place for information,” Dr. Taylor says. “We need to know stuff. But we need to move beyond that and challenge our perception of the world. If you always hang around with those you agree with and read things that agree with what you already know, you’re not going to wrestle with your established brain connections.”

   Such stretching is exactly what scientists say best keeps a brain in tune: get out of the comfort zone to push and nourish your brain. Do anything from learning a foreign language to taking a different route to work.

3. Stephanie Zvan at Quiche Moraine: Readings in IQ and Intelligence. Lots of great stuff -- with links to many articles available online.

4. Greg Laden's Blog: The argument that different races have genetically determined differences in intelligence.

Age-relevant links?

I'm talking about my age. Here we go:

1. Jonah Lehrer in Wired: Accept Defeat: The Neuroscience of Screwing Up.

2. Roni Caryn Rabin in NYTimes: Risks: Fighting Diabetes With Lots of Espresso.

3. C. Claiborne Ray in NYTimes: Still, Then Stiff: Why do we stiffen up as we age after not moving for a long time?

4. And, finally, Greg Ross at Futility Closet: The Bodisattva Paradox.

My age makes me notice stuff like this ...

Making Eyeglasses That Let Wearers Change Focus on the Fly, a profile of the work of Stephen Kurtin by NYTimes's John Markoff:

Dr. Kurtin, 64, has spent almost 20 years of his career on a quest to create a better pair of spectacles for people who suffer from presbyopia — the condition that affects almost everyone over the age of 40 as they progressively lose the ability to focus on close objects.

After many false turns and dead ends, he has succeeded in creating glasses with a mechanically adjustable focus. He says they are better than other glasses and some forms of Lasik surgery. And they make an intriguing fashion statement: a bit of Harry Potter with a dash of “Revenge of the Nerds.”