Cannabis hyperemesis: A brief update

Dirk Hanson‘s post on cannabis hyperemesis garnered another pertinent user comment:

Anonymous said…

My son suffers from this cannabinoid hyperemesis. At this moment he is here at my home on the couch suffering. I have been up with him for 3 days with the vomiting and hot baths. He says this time its over for good. This is our third bout. The first two time we went to ER, they put him on a drip to hydrate him, and gave him some pain medicine and nausea medicine. After a few hours he went home and recovered. This time we went to Urgent Care, put him on a drip, pain med, Benadryl, and Zofran. He felt better. That was yesterday, today we are right back with the nausea, but the Zofran limits the vomiting. I’m hoping tomorrow will be much better. He hasn’t eaten for 3 days. He let me take a video of him at Urgent Care before treatment, and in the video he was heaving and begging himself with tears never to smoke again. My son has smoked for 14 years.

I reviewed several case reports back in 2010. The comment thread was robust (this was originally posted at the Sb version of the blog) and there was considerable skepticism that the case report data was convincing. So I thought I’d do a PubMed search for cannabis hyperemesis and see if any additional case reports have been published. There seem to be at least 17 new items in Pubmed since the Soriano-Co et al 2010 that I referenced in the update.

One in particular struck my eye. Simonetto and colleagues (2012) performed a records review at the Mayo Clinic. They found 98 cases of unexplained, cyclic vomiting which appeared to match the cannabis hyperemesis profile out of 1571 patients with unexplained vomiting and at least some record of prior cannabis use. The profile/diagnosis was created from the prior Case Report literature that I reviewed but unfortunately I can’t get access to this paper to tell you more.

The other thing to think about is the relative increase in case reports in the past year or two. As I think I commented at the time, this is typical of relatively rare and inexplicable health phenomena. The Case Reports originally trickle out…this makes the medical establishment more aware and so they may reconsider their prior stance vis a vis so-called “psychogenic” causes. A few more doctors may obtain a much better cannabis use history then they otherwise would have done. More cases turn up. More Case Reports are published. etc. It’s a recursive process.

I think we’re seeing this at work.

And as more cases emerge, separated in time and space, the denialist position of blaming a contaminated cannabis product (or bad bongs) gets harder and harder to sustain.

Sample R21 grants with Summary Statements from NIAID

As I previously noted (somewhat critically) that the NIAID had posted sample R01 grants and the corresponding summary statements. Well, they’ve added some R21 applications to the page.

Again, I wonder how useful this really is for most applicants. First thing you notice is that it takes a perfect score to get funded. Three of the four received 10s and the fourth limped home with an 11. Remember, the study section score range starts at 1, which is then multiplied by 10 after the voting of the entire panel is averaged.

Then there’s this (emphasis added):
From the Dow summary statement’s resume of discussion: “Strengths of the application include the accomplished investigator and research team, strong preliminary data, the direct doable and logical set of experiments, and the likelihood of paradigm shifting insights into meliodosis”

From the resume on the Starnbach app: “Strengths of the application include the innovative use of the novel GPS strategy, compelling preliminary data, an investigator with a strong bacterial pathogenesis research track record, an excellent and appropriate set of collaborators, and a high degree of confidence that import results will emerge from these studies.”

Weis, individual critique #2: “Strong and compelling preliminary data is presented that indicate a high likelihood of success”

Well, at least NIAID is telling it like it is with these examples…..

If you can play, you can play

Also, if you get the GWG against the defending Stanley Cup champions in OT of Game 7 in the playoffs…well, you sure as hell can play.

Keep it classy, Bruins fans, keep it classy.

Kaaaaaaaahhhnnnnn!!!!

The eternal conundrum of institutional IT decision making: that designed to make it “easy” for utter morons in the system invariably fucks up workflow beyond all recognition for those who have even the slightest familiarity with the system.

Corollary: the morons never use the system anyway.

Idiot runners

Christ.

The notion that I have to be all #getoffylawn about the concept of fartlek pains me.

It is not intervals, you do not pluralize the word and you most certainly should not be throwing up at the end of the workout.

The notion that mentoring is dead..

is wrong.

Seriously? People are complaining that mentoring in academic science sucks now compared with some (unspecified) halcyon past?

Please.

Polling the postdoctoral requirement

A question arose on the Twitts, to whit, how many years of postdoc training are required before getting a faculty level job. I’ll be flexible here, this is not just tenure track but let’s keep it to academic science and a professorial type equivalent appointment. Something that lets you apply for research grant funding and is not explicitly “training” or temporary or whatnot.

I am most curious about the trends over time. So I want to break this down by the year you were first appointed. Answer the appropriate poll for your case please.

First up, the youngsters:

Okay battle hardened, no-longer-noobians…your turn.

Okay oldsters, we know you all had it totally made in the shade when you were exiting graduate school….

Doctoral program performance

Thought of the day: if the core faculty of a doctoral program cannot reel off a good thumbnail sketch of their graduate’s professional destinations, there is a problem.

Also: A “top” program that cannot point to a healthy and steady number of faculty appointments over last decades….isn’t.

The graduate training pipeline

Quite a few folks around the Intertoobs have commented to the effect that we have too many mouths to be fed by NIH grants. They suggest that we need to take steps to cut down on the “overproduction” of PhD scientists who are, in large numbers, aiming to land independent research positions.

Mid April is the time when graduate programs are wrapping up their admit / acceptance lists for Fall 2012. I’ve heard on the order of a half dozen programs bragging about record numbers of doctoral students lined up for their next class of entry.

Are you kidding me?

Please Dear Reader…tell me you know of programs that are intentionally downsizing?

the bus

photocredit: Macon Phillips

Scientopia transitions

You will notice a new PayPal button on the sidebar of this blog and possibly other blogs around the Scientopia collective. Very likely you did not notice new amendments to our Code. The short version is, we finally have a way to handle money. This is good because it allows us to try to cover the operational costs of this blog collective which had heretofore been borne by a single member. It was thought that we should get our financial/tax/LLC/blahdeblah in order first and this apparently prevented even donations from ourselves to the cause.

We have apparently negotiated those rough waters. There are three issues on the table at the moment for your understanding and consideration.

First the button and my sidebar text: Your donation helps to support the operation of Scientopia – thanks for your consideration.

This is provided for anyone who would care to support Scientopia. Our expenses are the hosting and bandwidth charges, at the moment there is nobody getting paid to do anything service-related for the upkeep.

Second, the Scientopia schwag shop items now have a modest markup. Said markup will be routed into the Scientopia coffers.

Third, at some point in the future there will be ads on the blogs. Not sure who/what/how just yet, but it is in the works.

I won’t make the NPR style plea, you folks can do the maths for yourselves.

Detection is up, yes, but contingencies still matter

In a recent post Comraddde PhysioProffe supplies a necessary correction to the oft-repeated claim that scientific fraud is on the rise. Science blog legend Carl Zimmer’s bit in the NYT is only a reflection of a constant drumbeat which you can see in comments posted after many accounts of fraud, say over at retraction watch. As CPP puts it:

I keep hearing this asserted, but I see zero evidence that it is the case. What is clearly the case is that there is now an all-time vastly greater ability for interested sleuths to reveal failures of research integrity (e.g., by image analysis, sophisticated statistical analysis, etc).

Even so, his position tends to ignore some basic reality about the contingencies which influence human behavior in this instance. His first commenter notes this and in fact Zimmer had a followup NYT bit which talks mainly about the fact that scientists busted for fraud never admit their wrongdoing. Like one Michael W. Miller, a scientific fraudster discussed on this blog. One counter-example is listed by Zimmer:

One notable exception to this pattern…Eric Poehlman, was convicted of lying on federal grant applications and was sentenced to a year in jail. For the previous decade, he had fabricated data in papers he published on obesity, menopause and aging.

During his sentencing hearing, Dr. Poehlman apologized for his actions and offered an explanation.

“I had placed myself, in all honesty, in a situation, in an academic position which the amount of grants that you held basically determined one’s self-worth,” Dr. Poehlman said. “Everything flowed from that.”

Unless he could get grants, he couldn’t pay his lab workers, and to get those grants, he cut corners on his research and then began to fabricate data.

It’s just reality. Grant getting is harder and yet laboratory heads are still expected to land plenty of funds. More mouths to feed and fewer grant dollars to throw into them means the pressure is on. And the choices are sometimes stark, or seemingly so. Failing to get a grant can mean losing your job. Take the case of Peter Francis, previously of OHSU. He had a foundation award which notes that his faculty appointment was in 2006. A RePORTER search pulls up just the one award funded in 2011…this R01 was the one that included falsified data and was the (sole) subject of the ORI finding of research misconduct.

As always, I assert my possibly naive belief: Nobody sets out in a science career because they want to fake data and publish made-up results.

It proceeds from this that the data fakers must stray from the path at some point. And the reasons for straying are not due to random cerebral infarct. The reasons for straying are heavily influenced by contingencies. Facing a failure to secure grant funding is a pretty big contingency. Thinking that faking up a preliminary result (hey, it’s just pilot data, we shouldn’t take it as true until a full study follows it, right?) will make the difference in a fundable score is a pretty big contingency.

People like CPP can insist that contingencies were always at play. But they simply were not. The success rates for NIH grant getting show a clear difference in the difficulty of getting funded across scientific generations.

Those who are our older and more established scientists have been shaped by three cycles of NIH budget woes forcing down grant success rates- the early 80s, late 80s into the early 90s (which caused the political pressure leading to the doubling) and the present one starting about 2004 (after the decade-of-the-double). Some of them may have only been trainees for the first one but the campfire lore and attitudes were transmitted. The graph gives us a point of reference. For established investigators in the mid-80s, a success rate of about 37% represented the dismal landing from a down cycle! Then just one cycle later the success rates were down at 25%- OMMFG we have to DO SOMETHING!! The doubling was great and indeed success rates started to go back up towards the 35% value.

Yeah well the success rate was 17.7% in FY2011.

The contingencies are most assuredly different. And to think this plays no role in the rates of data faking and scientific fraud is dangerously naive.

Double blind paper and grant review can't work

People who suspect non-scientific shenanigans (of the political or craven variety) have blocked the acceptance of their paper or findable score for their grant often cry for double-blind review.

At present the reviewers are not blinded as the the identity of the authors or grant proposer(s).

The thought is that not providing reviewers with author/Investigator identity will prevent reputation or other seemingly irrelevant social cachet/hand/power from contaminating a sober, objective evaluation of the science.

It can’t work. There are simply too many clues in the topic, cited literature, approaches and interpretive framework. In the fields that I inhabit, anyway.

Even if in some cases the reviewers would be unable to nail down which lab was involved, it would be uneven. And let me tell you, the chances of detection would be highest for well-known groups.

All this would do would be to reinforce the reputation bias!

Please, I beg you my idealistic friends, tell me how this is supposed to work? Think hard about all the manuscripts you’ve reviewed and tell me how they could be restructured so as to provide a near guarantee (p<0.05) of blinding.

Oh, you can yammer on about how you were done dirty, too. Sure you can get all red about how I am an apologist for status quo and defeatist and all that. And by all means rant about the horrible effects on science.

But try, this once, not to sidestep my main point…..how is blinding supposed to work?

Happy Tax Day to all my US readers!!!

All right-thinking and patriotic Americans should be beaming with pride as they pay their part of the community bargain today.

I know I am proud to contribute my part towards all the great things our State and Federal governments accomplish. Admittedly, I’m not so keen on the blowing-other-people-up stuff but this is what a social compact of millions means. We take the good with the bad.

So join me in wishing out fellow citizens a Happy Tax Day!!!! Put a smile on your face and puff up with nationalistic pride.

Convicted fraudster of alcohol research, Michael W. Miller, tries re-web-ilitation

We convered Alcohol research fraudster Michael W. Miller in a prior post. This was following a finding of the ORI of the NIH and a note on retractionwatch. My post focused on the fact that when cheaters like Michael W. Miller are finally caught, there is no way to recover for their sins. No way to reclaim that money. No way for the person who really deserved the job or the award to be compensated.

That pisses me off.

It also pisses me off when people who do dodgy things in science, like Charles Nemeroff, get to keep on keeping on as if nothing happened. Some patsy University will happen along to hire the dude if they think it is in their interest to do so.

Well, I see from a comment at retraction watch that Michael W. Miller plans a full court press to rehabilitate his image. Online anyway.

Welcome to michaelwmiller.net. According to Network Solutions, it was registered by Reputation Changer on Mar 15, 2012.

Registrant:
Reputation Changer LLC
39 West Gay Street
West Chester, Pennsylvania 31410
United States

Registered through: GoDaddy.com, LLC (http://www.godaddy.com)
Domain Name: MICHAELWMILLER.NET
Created on: 15-Mar-12
Expires on: 15-Mar-13
Last Updated on: 20-Mar-12

The ORI finding of misconduct was published in the Federal Register on Feb 27, 2012. So this fraudster immediately used Reputation Changer to do what they do :

ReputationChanger.com specializes in helping people make their mistakes vanish from the eyes of potential clients and employers. Embarrassing arrests and unseemly articles can be pushed off of the front page of Google searches, where they are unlikely to be viewed by the majority of Google users. Because people tend to only look at the first page of results, Google searches can once again reveal the great things you or your company achieved, rather than the negative reviews overzealous and under impressed individuals have posted. People have an array of motivations for posting negative press, but the important question is not why do they post it– you should be asking yourself how to get rid of it.

How do they do it? By building a fawning self-web-presence that says crapola like:
Michael W. Miller Presents Astounding Findings or perhaps Michael W. Miller Publishes Scientific Gold. This latter conveniently omits to mention the two retracted papers that were, of course, not “Gold” but more like “made up crap”.

As far as I can tell, every link in the site points to somewhere else on the site. I’m sure this is hot stuff in repairing your Google ranks.

Wait, wait…what’s this? I tried to see if his Google presence had been improved and I found another site. michaelwmillerupstate.com was registered….by Reputation Changer …. on Mar 15, 2012. Here’s what I learned about the good Professor Miller’s attitude toward’s research:

But research is not the only component in a successful endeavor. Michael W. Miller understands that documentation—accurate documentation—is pivotal. Without this documentation, research findings could not undergo duplication. All the work that went into a study would prove wasted. This is why Michael W. Miller publishes so many different writings.

It overlooks all the “work” that other people put into trying to replicate Michael W. Miller’s faked (and now retracted) research papers. It seems that “accurate” documentation perhaps is in the eye of the beholder? or just a flagrant lie on the part of the Reputation Changer system for rehabilitating the web image?

As his career moves forward, researcher Michael W. Miller will continue to conduct research. Through his writing, Professor Michael W. Miller will share this research with the world. The result, Michael W. Miller hopes, will manifest as improved medical knowledge and techniques.

Really? He’s going to continue is he? Can’t wait to see what University is willing to hire him.

Okay, what else do you have to offer, Google? OMMFG, ANOTHER ONE!!!! michaelwmillerblog.com was registered….shall we just guess? Yep, by Reputation Changer on Mar 15, 2012.

Wonder how many more of these frigging things are out there?

Ahh, well. Just remember to keep linking to the ORI finding showing that Michael W. Miller faked data. And maybe to the retraction watch blog entry on Michael W. Miller.

__
Added: I’m particularly intrigued by the michaelwmillerupstate one. His place of employment when the fraudulent papers were detected was the State University of New York Upstate Medical University. I wonder how they feel about this use of “upstate”?