Who smokes?

October 19, 2010

A bit of a followup to a recent post on smoking bans-my route to the infographic was a tip from DirkH of Addiction Inbox blog.

smokers-us-graphs-101017.jpg


Source MyHealthNewsDaily.com, your online source for news and information about the latest medical research, health news and trends.

…and this is a story about political attitudes and behavior.
First, the bottom line from PalMD:

While many may cringe at the paternalistic nature of public health laws, few complain about the availability of clean water and the notable absence of open sewers.

I lived through the smoking ban enacted in bars and restaurants and I couldn’t be more delighted. Although I was never particularly bothered by the smoke, no more than most that is, I certainly noticed the lack after the bans went through. No more smelly hair and clothes. No more changing the pillowcases after a night out because the smoke smell went from hair to the pillow like clockwork.
Since I’m not a smoker there was no problem.
But oh, you should have heard the caterwauling. Personal liberty was being infringed! (Never mind the liberty of others to be free from annoyance of smoke, eh? Why do the libertarians always forget that?) Business will be AffEcTed! Bars will close. Nobody will buy alcohol anymore! Nobody will go out to dine.
Naturally this never came to pass in my region of the world. Nor did it in a myriad of other jurisdictions that passed smoking bans.
Including NYC.
And here is a tale from a bartender who was practically on the ramparts to oppose the smoking ban. Changing. His. Mind. Based on the results of the policy as he personally experienced it.

And it was at that moment, silently of course, that I grudgingly had to thank old Mayor Bloomberg. For regardless of what his motivation was and regardless of the fact that he did it with an iron fist, the son-of-a-gun when it’s all said and done was right. The good, as it all turns out, outweighs the bad. And not just because of the major things, of which we are all aware, but the minor things of which you’re about to read…

Test out a policy change, evaluate the outcome. If you are originally opposed to the policy….what do you do? Do you leave your ego at the door and really look at the data? Or do you stick to your guns no matter what the evidence?
Scribbler is a standup guy for admitting he was wrong. May we all be able to do the same when public policies have results that are demonstrably better than our initial preferences.

I am disappointed in the mainstream, and not so mainstream, media coverage of the Mithoefer et al, 2010 paper on MDMA-assisted therapy for Post-Traumatic Stress Disorder. I had been holding off reading any of it because I suspected it might distract me from actually discussing the paper.
After writing up my thoughts on the paper, I went strolling around the Google News hits for MDMA to see what had been written about this paper. There was a whole lot of of really bad journalism. Sure, for the most part they got the basic facts right, but I noticed a consistent issue having to do (I assume) with journalism’s penchant for selling a story they’d like to tell over the story that exists.
Let us start with the more venerable news organizations.
ABC News Ecstasy may help traumatised veterans
See the title? Pretty common to see something abut veterans or combat PTSD in the title as well as in the article body.

found that the drug seems to improve the effects of therapy in military veterans

No, there was one combat stress case. I noted that this stuck out as odd in my post on the paper. Well, now you can see why the authors might have been so keen to include this single warfighter subject. They enjoyed much wider press and nobody called them out for this scientific distraction
(This part of the ABC report caused me to laugh though:

The researchers, led by Dr Rick Doblin of the Multidisciplinary Association for Psychedelic Studies

Of course this is true, the driving force behind getting these studies rolling is the recreational legalization Trojan outfit MAPS. It looks better though, if you ask me, when they credit the therapist Mithoefer as being the leader of the project and MAPS as only providing support and assistance. )

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It seems like an opportune moment to revisit this post, for some reason or other.


The American Heart Associations recommendation to cut down on dietary sugar is all over the news. Discussion of this by Isis the Scientist triggered a comment from Callinectes :

Someone reading this may therefore assume diet drinks with Aspartame, Splenda, etc. may be okay because it’s 0 calories and added “sugar”. Can anyone comment authoritatively on this? The way I see it, it’s still just empty calories and not very good for you when consumed regularly on a weekly or (heaven forbid) daily basis.

To which Isis responded:

One might argue that diet drinks still activate the “Hedonistic food pathways” in the brain (centers in the ventral tegmental area and nucleus accumbens) that lead us to associate reward with food intake, causing us to take in more energy-dense food… That said, I don’t know of any multi-variate studies comparing risk between sugar drinks, diet drinks,… let’s be clear that Aspartame and Splenda are zero calorie sweeteners, meaning they would technically not contribute to the AHA’s recommended daily intake.

I am reminded of what I think of as a reasonably provocative series of observation from Susan Swithers and Terry Davidson at Purdue.

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“Sex matters. Sex, that is, being female or male, is an important basic human variable that should be considered when designing and analyzing studies in all areas and levels of biomedical and health-related research. “

Quite some time ago Dr. Isis reviewed the complications associated with doing sex comparisons in scientific research.

This is a particular issue that Dr. Isis, as a vascular physiologist and a woman, is painfully aware of and, yet, the difficulties associated with including women in clinical research can be more pragmatic than simple gender discrimination.

I chimed in (reposted) with an observation about the practical realities of scientists engaging in sex-comparison research. I concluded that:

Promoting special funding opportunities are the only way to tip the equation even slightly more favorable to the sex-differences side. The lure of the RFA is enough to persuade the experienced PI to write in the female groups. To convince the new PI that she might just risk it this one time.

Today I noticed (h/t: @KateClancy) a Program Announcement (with Set-aside funds) from the NIH. PAS-10-226 is titled “Advancing Novel Science in Women’s Health Research (ANSWHR)“.

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An Editorial in Nature this week highlights three studies of a sex bias in biomedical research.

And yet, despite the obvious relevance of these sex differences to experimental outcomes, three articles in this issue (see pages 688, 689 and 690) document that male research subjects continue to dominate biomedical studies. Some 5.5 male animal models are used for every female in neuroscience, for example. And apart from a few large, all-female projects, such as the Women’s Health Study on how aspirin and vitamin E affect cardiovascular disease and cancer, women subjects remain seriously under-represented in clinical cohorts. This is despite reforms undertaken in the 1990s, when sex discrimination in human trials was first widely recognized as a problem.

This reminded me of something I wrote a little while back to explore part of the reason for this bias in research models. The post originally appeared December 2, 2008.


The titular quote came from one of my early, and highly formative, experiences on study section. In the course of discussing a revised application it emerged that the prior version of the application had included a sex comparison. The PI had chosen to delete that part of the design in the revised application, prompting one of the experienced members of the panel to ask, quite rhetorically, “Why do they always drop the females?”
I was reminded of this when reading over Dr. Isis’ excellent post on the, shall we say less pernicious, ways that the course of science is slanted toward doing male-based research. Really, go read that post before you continue here, it is a fantastic description.

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As a bit of a followup to the poll we ran on whether or not cigarettes make you high, I offer context and my thoughts. As of this writing, btw, the votes are running 44% “Yes”, 47% “No”, the balance “other” with a fair bit of commentary to the effect that “high” is not exactly the right description for nicotine.
For the background, we might as well start with the comment from SurgPA:

This started with an email from PalMD asking why doctors react much more negatively to narcotics abusers than alcohol or nicotine abusers. I hypothesized that most people view acute use of the various drugs differently. Specifically I suspected that most doctors’ gut reactions when seeing someone light a cigarette are qualitatively (and vastly) different from seeing someone shoot heroin (or snort crushed oxycontin). In short that we don’t see the act of smoking as an acute intoxication by a neuroactive substance, even if we understand it intellectually.

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A recent post of Zuska’s discusses the pejorative use of “anecdote” to dismiss personal accounts of gender bias. The generic argument will be well familiar to many scientists who are used to sneering at sources of insight that are limited to individual data points. I concur in many cases however I also value anecdotal observations much in the way that commenter Sanguinity identified a number of useful applications of the anecdote in science including the following:

- suggest a new direction for query/research.

In that last case, the anecdote is a potential source for a vast new amount of information, but only if you don’t dismiss it out of hand as “just an anecdote.”

This reminded me of a post I wrote previously on the value of anecdotal case reports describing MDMA-related fatality and medical emergency.


The singular of data is “anecdote”.
We all know this hoary old scientific snark. Pure Pedantry ponders the utility of Case Reports following a discussion of same at The Scientist.
The Pure Pedantry Ponder identifies “rare neurological cases” as a primary validation for the Case Study, but the contribution goes way beyond this. Let’s take YHN’s favorite example, drug abuse science and MDMA in particular.

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Members of San Diego State University are expressing an interesting attitude in the aftermath of the drug sweep which arrested 75 students of SDSU. According to the initial reporting it is clear that members of an organized drug marketing organization were targets.

One alleged dealer, Theta Chi member Kenneth Ciaccio, sent text messages to his “faithful customers” announcing that cocaine sales would be suspended over an upcoming weekend because he and his “associates” planned to be in Las Vegas, authorities said.
The same message posted “sale” prices on cocaine if transactions were completed before the dealers left San Diego.

It is equally clear that some individuals arrested were merely customers. Drug users, not dealers. Presumably this is why elements of SDSU are now questioning the appropriateness of calling in undercover federal agents on this case.

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The Centers for Disease Control reported a higher number of measles cases in the US for first quarter 2008 in a recent report [h/t: occasional commenter ddt].

However, during January 1–April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported to CDC, the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.

The CDC also took the opportunity for directly addressing idiot anti-vaccination parents such as the ones causing the San Diego measles scare. Bravo.

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In his classic song the great philosopher and student of addictive disorders, Hank Williams, Jr., blames a traditional source for increasing the probability of developing substance abuse:

….Hank why do you drink?
(Hank) why do you roll smoke?
Why must you live out the songs you wrote?
Stop and think it over
Try and put yourself in my unique position
If I get stoned and sing all night long
It’s a family tradition!

A piece in the New York Times covers a county in New Mexico which experiences some of the highest drug-overdose rates in the nation

recorded deaths have been steady, around 20 a year in a county of 41,000. Meanwhile, the health department trades about 12,000 clean syringes for used ones in the county each week.

The article attributes much of the blame to a familiar “Grim Tradition”.

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The past few years in NIH-funded research land have been peppered liberally with cries for “translational” research. The notion is that while the prior decades of research have been excellent at generating basic science observations, progress in using this information to improve health care has been insufficient. The reaction, of course, has been to revamp the NIH funding to try and enhance the degree to which research directly related to improved health care is supported. This has had the dual results of irritating basic scientists and revealing a rather spotty infrastructure of available physicians who also do biomedical research.
Apparently one basic biomedical research institution has decided to enthusiastically back this translational trend by starting a medical school devoted entirely to physician researchers.

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Huffington Post blogger David Sloan Wilson wonders why the Huffington Post has no section for “Science”.

I am reminded of this cover every time I visit the Huffington Post and see the words “Politics,” “Media,” “Business,” “Entertainment,” and “Living” on the top banner. These comprise the Huffington Post’s view of the world. Where, I would like to know, is “Science?”

Where indeed?

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The Today Show took up the vaccination issue today and used the recent San Diego measles situation as the lure.
Matt Lauer served up a softball for his physician guest with this remark:

It seems to me the priority should be putting an end to this debate over whether these vaccines cause other conditions

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YHN and other parent bloggers (Abel Pharmboy, Dr. Free-Ride, DuWayne Brayton) have been musing on what DuWayne called “the conversation that never ends”. To wit, the conversation that parents anticipate having with their children over the use of recreational psychoactive substances and their attendant risks. The discussion touched on several topics related to parental involvement in teen alcohol consumption which led me to a simple proposal for your consideration DearReader.

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