…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.

Of course there is no particular reason to think that bike racing celebrity types should be any smarter than your average Hollywood actor or even one of those ruthless self-promoting celebrities who you can’t quite figure out why they are famous.

Levi Leipheimer is a US professional cyclist who has become, over the course of a long career, a top talent with a long list of accomplishments. Recently his accomplishments have been in association with Lance Armstrong who is an absolute pitbull when it comes to battling cancer. I’ve mentioned before that following his Twitter gives you a whole new appreciation for how much this guy works at the whole LiveStrong charity.

And it isn’t like Levi is just a passive participant. He puts the name of some kid with “pineoblastomas, a rare and aggressive brain cancer that afflicts less than 2% of all juvenile brain cancer patients” on his bike. Or remembers the name of a junior high school counselor who fell to colon cancer in another race.

He sponsors and promotes “Levi’s Gran Fondo“, a charity ride to raise money for various causes including “The Lance Armstrong Foundation received a $10,000 donation from the GranFondo for their ongoing funding of cancer research”.

Research.
So what in the hell is he doing
tweeting this?

Odesssa and I hanging w/ @richroll and @jaiseed at the 30th anniversary [famous ARA wackanut organization-DM] Gala. Great night http://yfrog.com/3upsxnj

I’ve said it before…we really need to get Lance Armstrong focused on including animal research as part of his message.

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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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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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.

Read the rest of this entry »

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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When I first read Abel Pharmboy’s post introducing the notion of recreational use of a synthetic cannabinoid adulterated burnable product, my first thought was the US Controlled Substance Analogue Enforcement of 1986, aka the Federal Analog Act (Wikipedia). From the justice department page about analogues:

They are structurally or pharmacologically similar to Schedule I or II controlled substances and have no legitimate medical use. A substance which meets the definition of a controlled substance analogue and is intended for human consumption is treated under the CSA as if it were a controlled substance in Schedule I.

K2-Spice300.jpg
source
As Abel pointed out, these so called synthetic marijuana products are some variety of dried vegetable matter adulterated with one or more compounds that convey similar pharmacological properties as does Δ9-Tetrahydrocannabinol (THC), the primary psychoactive constituent of marijuana. Compounds which appear to be highly popular are the ones known as CP-47,497 and JWH-018.

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A recent alert from the Center for Substance Abuse Research (CESAR) presents an interesting juxtaposition of data from the Monitoring the Future study. It pits the rates of past-30-day marijuana smoking against the perception of harm with regular use in the US high-school senior population.

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Deputy Director of the ONDCP A. Thomas McLellan, Ph.D. [ PubMed ] being interviewed on Here & Now from WBUR.
[ Notes on McLellan’s appointment at Terra Sigillata and The Discovering Alcoholic. ]
He was talking about stigma, the addition of prevention, intervention, treatment and recovery to the traditional ONDCP focus on interdiction.
“addiction is an illness”
“drugs that have the greatest harm are those that have the greatest availability”
” [use of] prescription opiates has gone up more than 1,000 percent over past 10 yrs…led to record numbers of overdose deaths… 2nd only to automobile deaths”
same genetics, relapse rate as other chronic illnesses but we treat it differently. “imagine if we treated hypertension that way….”
(on proper treatment, early intervention at primary medical care level) “It’s not more money, it’s less money”
(on anti-drug abuse vaccines) “I think they will be miracles” [DM- Hmmmm….]
[h/t: Occasional commenter SurgPA]

ResearchBlogging.orgThis is awesome. I’ve been waiting for the paper to show up ever since I saw the poster presentation at a meeting last year. Or maybe I just saw a related type of poster because I seem to recall the analysis being particularly critical of general medical doctors? At any rate, this is a pretty important finding because it speaks to the stigma that surrounds certain types of medical problems. This stigma might have serious implications for judicial decision making when crimes are involved, personal health care recommendations / efforts from physicians, etc. The paper is in the queue at the International Journal of Drug Policy.
Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms
John F. Kelly and Cassandra M. Westerhof, International Journal of Drug Policy, In Press, Corrected Proof, Available online 14 December 2009, [DOI]
I was alerted to the publication by the description here at Science Daily.

The investigators randomly distributed surveys to more than 700 mental health professionals attending two 2008 conferences focused on mental health and addiction. The surveys began with a paragraph describing the current situation of “Mr. Williams,” who is having trouble adhering to a court-ordered treatment program requiring abstinence from alcohol and other drugs. On half of the surveys, he is referred to as a “substance abuser;” on the others, he is described as having “a substance use disorder,” with the rest of the narrative being exactly the same. The survey consisted of 32 statements about Mr. Williams’ situation, and participants were asked to indicate how much they agreed or disagreed with those statements.

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ResearchBlogging.orgThere is an interesting paper that I just ran across which will possibly please a certain segment of my audience. You see, it provides a bit of a test of the hypothesis frequently bandied by my commenters that anti-drug messages backfire. That if you tell adolescents all sorts of bad things are going to happen to them if they try an illicit drug once, and it doesn’t happen, somehow you are actually encouraging them to try the drug again. This general area is an occasional interest of mine and you can read a few thoughts here, here, here, here and here. The paper itself is this one.
Skenderian JJ, Siegel JT, Crano WD, Alvaro EE, Lac A. Expectancy change and adolescents’ intentions to use marijuana. Psychol Addict Behav. 2008;22(4):563-569. [Free PubMed Central version]
This paper describes a secondary analysis of data collected under the National Survey of Parents and Youth which focuses on the efficacy of an anti-drug media campaign. This means that it is, necessarily, correlational in nature, not a prospective experiment*. The purpose of this secondary study was laid out as:

There are many possible reasons for [poor effect of anti-drug messages] including the possibility that the typical campaign often is designed to develop expectancies regarding marijuana use outcomes that may not be experienced by the initiate. Changes in expectancies regarding marijuana, and the effects of such changes on initiates’ intentions to continue use, are the focus of this investigation.

In short, if we deliver lies-to-children to adolescents, do we end up encouraging cannabis use?

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A recent bit in the Vancouver Courier touts another clinical trial for MDMA as adjunctive therapy for Post-Traumatic Stress Disorder. If you haven’t been following along some of my prior observations are here, here, here. If you want everything I’ve opined on this drug, click the MDMA link under the archive.
I was just talking about main stream media accounts and how they generate an inaccurate impression by making comments that are, in isolation, more or less true but add up to an incorrect impression. In this case it was two quotes from the psychiatrist in charge of the Vancouver clinical trial.

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