29 January 2011

Why nearly everything Newsweek writes about medicine is wrong

Newsweek has an article about Dr John Ioannidis and his work discrediting many medical studies. Incidentally The Atlantic wrote about him and his work back in November as did The New Yorker in December. All of these articles highlight Ioannidis' findings that many studies are flawed, but take different approaches, and draw different conclusions from his work. Newsweek's take is by far the worst and most harmful.

25 January 2011

Amy Chua and the stereotype ladder

The amount of ink spilled over this Amy Chua WSJ excerpt is threatening to break BP's recent record for noxious black liquids we wish would go away. The problem with all of this blogging and emailing and tweeting and editorializing about her is that it misses the point.

Before I get to my big reveal and tell you what that point is I want to list some assorted facts about the Chua family.
  • Amy Chua is a professor at Yale
  • Jed Rubenfield (her husband) is also a professor at Yale
  • The family has two Samoyeds named Coco and Pushkin
  • Chua's Wikipedia page has 1,500 words about Battle Hymn of the Tiger Mother

24 January 2011

The future of the Army's suicide & PTSD problems

Part II: Where do we go from here?

A few days ago I told you what the Army's latest data says. Now I will tell you some things that people are looking at, what those things mean, and some options for getting the suicide and PTSD epidemics under control.

The first, most important piece of this puzzle, is a study out this month that assessed the effectiveness of mental health screening prior to their Iraq deployment. Screenings were conducted on three brigades, and three unscreened brigades served as the controls. There were 10,678 soldiers in the screened brigade, of those 347 were taking a psychiatric medication at the time of their screening.1 Of those on medications 74 (0.7%) were not cleared to deploy immediately and 96 (0.9%) received waivers to deploy on time. Among those not cleared for immediate deployment, 26 were delayed for 1-2 months to allow their medications to stabilize, 32 were not cleared for deployment because they were unlikely to stabilize quickly, and 16 were not cleared for deployment because of a psychotic or bipolar disorder diagnosis.

23 January 2011

Opium addiction in rural Afghanistan is not a big deal

CNN has a heart wrenching story about Afghan infants being fed pure opium. Or at least that's what the headline says. Aside from one anecdote early in the article there's nothing else in it about children, it's all about how widespread opium addiction is in rural Balkh. Moreover, it mentions "health risks" and that opium is addictive but does not elaborate.

First of all, opium is the raw paste harvested from slit seed poppies of Papaver somniferum, but also other poppies. It is composed of a variety of substances, but the pain killers are morphine, codeine, and thebaine. Most important is morphine which typically constitutes 10-15% of the raw latex paste. It also contains codeine (1-3%) and thebaine (<%5)1. The composition matters because morphine and thebaine get extensively metabolized when you ingest them orally and only a small amount of codeine will even end up as a bioactive compound (on its own it is inert).

20 January 2011

Breaking down the Army's suicide data

Part I: What does the data say?

There's a lot of grist to Wednesday's news briefing with Gen. Chiarelli on the 2010 Army suicide statistics. As usual, everything I write is my own opinion, unvarnished.

Looking past the headlines telling you some suicides were up and some where down I want to point out an underemphasized point that Gen. Chiarelli made during his briefing:
So the numbers [...] have really only focused on this group, both the Army Reserve and the Army National Guard, to collect this data for about five years.

17 January 2011

The geography of mental health

Over at The Atlantic there is an article mapping the geography of gun deaths. They go one step further and create the below list of correlates with deaths from gun violence that I added a big red box to for you.

What's going on here? Didn't I make a big fuss about there being a real correlation between mental illness and violent crime? Yes, and I am still correct. First of all, they're comparing gun deaths, not violent crime. More importantly though, the article is the bar room equivalent of blindfolding yourself, and spinning around while throwing darts wildly in the hope that a few hit the board.

Ike's other warning

In this day and age everyone knows Eisenhower's warning regarding the growing military-industrial complex. His lesser known, but equally important, fear bears mention on the 50th anniversary of his famous farewell address.
Today, the solitary inventor, tinkering in his shop, has been over shadowed by task forces of scientists in laboratories and testing fields. In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.
The prospect of domination of the nation's scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.

11 January 2011

Jenny McCarthy is killing kids

Amazingly, on the same day that the Huffintgon Post runs a piece about cooling down political rhetoric they run a(nother) tragically misinformed, catastrophically misleading, and generally stupid piece from Jenny McCarthy. Message received, when the victims of your rhetoric blast to the front page of the paper because of a tragedy, we all must take note. When your rhetoric quietly sickens tens of thousands of people, most of them children, your platform will not be taken away, no matter the nonsense you shout from it.

09 January 2011

Mental illness, crime, and statistics

There was a tragedy yesterday. Because of the perpetrator's YouTube page and reports from people who knew him, the call is going out that he is "mentally disturbed," thus we have our explanation for the shooting. (Assuming you claim that national partisanship also had something to do with it.)

Not so fast warns Vaughan Bell at Slate, taking the misuse of statistics to new heights. He cites a meta-analysis of people with schizophrenia and/or bipolar disorder and concludes, "it's likely that some of the people in your local bar are at greater risk of committing murder than your average person with mental illness." Leaving aside the bizarre semantic construction of people being "at risk" to commit an act, what he says is half-true, but only because he's answering an unimportant question.

08 January 2011

Fraud and science, part II

There are reports all over (they're actually just disguised pressers since that's all the journalists read) about a new study in a journal no one reads (Pharmacoepidemiology and Drug Safety; it's the fourth google result when searching its title...). That antipsychotics are being prescribed off label in ever increasing amounts with scant data to support doing so. The actual study (gated, natch) is not linked to by a single one of those articles.

It does not reflect well on the PR acumen of Science (capital S) or scientists that the article was first "published" and the presser released on a Friday. It's as though they're undermining their own cause by ensuring that no one will read this article. (What possible incentive could they have for that? See III.)

07 January 2011

Statistics, antidepressants, and suicide

Statistics is hard. At this point the, shall we say, flexibility of statistics is well worn (even high schoolers have heard that there are, "Lies, damn lies, and statistics."). Why statistics is hard is an important, but rarely asked question. One of the reasons is because statistics sits at the intersection of quantification and inquiry. Anyone can count how many M&Ms are in the package, but first they have to ask how many there are. In any statistical venture it is very important to keep one foot firmly rooted in this initial inquiry, no matter where the mathematical convolutions take you. Which leads to the question: Is an increased suicide rate a side effect of antidepressants? The FDA think so. But they're wrong.

Fraud and science

Everyone else is writing about it, so I may as well too. Everyone is reporting that not only does the MMR vaccine not cause autism, but the data purporting to show that it did was fraudulent.

While everyone seems terribly outraged by this, they also seem to be treating the whole thing as some sort of crazy anomaly -- the scientific equivalent of that high school reunion your wife couldn't go to and where you had a bit too much to drink and the (still) hot girl you pined for long ago is now impressed at what you've become and somehow you end up with her panties in your luggage. I mean, why tell your wife? It'll turn both your lives upside down, hurt everyone involved, and it was just a once in a lifetime confluence of alcohol, chance, and reminiscence...

06 January 2011

PTSD and Canadian snipers

Up front: If you have not read Jim Gourley on what PTSD is stop reading this and go there now. This will be here when you get back.

What Gourley nails that is often missed is the import uncertainty plays in inducing PTSD (both as a chronic condition and acute attacks). Another way to think about this uncertainty is to couch it in terms of control. Soldiers have profoundly little control on their environment and this is a fact made nakedly apparent to them every single day they are down range (and many they are not). Here are two passages from Sebastian Junger's War that evince this:

05 January 2011

Identity Assault



And how in the world can the words that I said

Send somebody so over the edge

That they’d write me a letter sayin’ that I better

Shut up and sing or my life will be over

I.

Here's how: You tell someone something that challenges their conception of self. Music, sports, and religion are a few of the existential things we use as signs to mark out our own identity, as well as signal that identity to others. Largely because existential objects are hard to display we create concrete ones to denote particular aspects of ourselves and display them to the world.

When you challenge one of these identity symbols someone is displaying, or force them to rethink (read: reject) it they will reflexively attack. You’re seen as a threat to their core being and in today’s America no one has the right to question your identity, much less make you question your own.