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Posts Tagged ‘Book Review’

The Power Of Imagination

The placebo effect is well recognized in medical research and is taken into account in legitimate studies.

For the uninitiated, here is a brief rundown of placebos and the placebo effect:

A placebo is a sham medical intervention. In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief does indeed sometimes have a therapeutic effect, causing the patient’s condition to improve. This phenomenon is known as the placebo effect.

When an inert substance makes a patient better, that effect is called the placebo effect. The phenomenon is related to the perception and expectation which the patient has; if the substance is viewed as helpful, it can heal, but if it is viewed as harmful, it can cause negative effects, which is known as the nocebo effect. Placebo effects are a scientific mystery.

A distinguishing characteristic of legitimate scientific research is having  control group to gauge how much of any positive effect shown is real and how much can be ascribed to the placebo effect.

The study was conducted by researchers at the University of North Carolina at Chapel Hill and Duke University Medical Center.

For this study, 34 children ages 6 to 15 years old who had been diagnosed with functional abdominal pain by a physician were recruited to participate by pediatric gastroenterologists at UNC Hospitals and Duke University Medical Center. All received standard medical care and 19 were randomized to receive eight weeks of guided imagery treatment. A total of 29 children finished the study; 15 in the guided imagery plus medical treatment group and 14 in the medical treatment alone group.

Randomization also lends credibility to any study’s results since it removes a potential source bias and accusations of stacking the deck to achieve preselected results.

When we then heard that children were able to reduce abdominal pain by up to half through the power of their imagination we were skeptical but not entirely disbelieving. Other studies have shown similar results:

Prior studies have found that behavioral therapy and guided imagery (a treatment method similar to self-hypnosis) are effective, when combined with regular medical care, to reduce pain and improve quality of life. But for many children behavioral therapy is not available because it is costly, takes a lot of time and requires a highly trained therapist.

This study was different because the guided imagery material was prepared for the children to use on their own, independently of therapists.

The guided imagery sessions, developed jointly by van Tilburg, co-investigator Olafur Palsson, Psy.D. and Marsha Turner, the study coordinator, were recorded on CDs and given to children in the study to use at home.

The treatment consisted of a series of four biweekly, 20-minute sessions and shorter 10-minute daily sessions. In session one, for example, the CD directs children to imagine floating on a cloud and relaxing progressively. The session then gives them therapeutic suggestions and imagery for reducing discomfort, such as letting a special shiny object melt into their hand and then placing their hand on their belly, spreading warmth and light from the hand inside the tummy to make a protective barrier inside that prevents anything from irritating the belly.

The results are incredible:

In the group that used guided imagery, the children reported that the CDs were easy and enjoyable to use. In that group, 73.3 percent reported that their abdominal pain was reduced by half or more by the end of the treatment course. Only 26.7 percent in the standard medical care only group achieved the same level of improvement. This increased to 58.3 percent when guided imagery treatment was offered later to the standard medical care only group. In both groups combined, these benefits persisted for six months in 62.5 percent of the children.

The study concluded that guided imagery treatment plus medical care was superior to standard medical care alone for the treatment of functional abdominal pain, and that treatment effects were sustained over a long period.

Video games can have powerful and positive effect in developing and strengthening a child’s mind. Of course, there are plenty of other things to do which can develop a child’s imagination in that mystical land referred to as “not in front of the TV”.

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Happy Columbus Day!

From Admiral of the Ocean Sea: A Life of Christopher Columbus:

At the end of 1492 most men in Western Europe felt exceedingly gloomy about the future. Christian civilization appeared to be shrinking in area and dividing into hostile units as its sphere contracted. For over a century there had been no important advance in natural science and registration in the universities dwindled as the instruction they offered became increasingly jejune and lifeless. Institutions were decaying, well-meaning people were growing cynical or desperate, and many intelligent men, for want of something better to do, were endeavoring to escape the present through studying the pagan past. . . .

Yet, even as the chroniclers of Nuremberg were correcting their proofs from Koberger’s press, a Spanish caravel named Nina scudded before a winter gale into Lisbon with news of a discovery that was to give old Europe another chance. In a few years we find the mental picture completely changed. Strong monarchs are stamping out privy conspiracy and rebellion; the Church, purged and chastened by the Protestant Reformation, puts her house in order; new ideas flare up throughout Italy, France, Germany and the northern nations; faith in God revives and the human spirit is renewed. The change is complete and startling: “A new envisagement of the world has begun, and men are no longer sighing after the imaginary golden age that lay in the distant past, but speculating as to the golden age that might possibly lie in the oncoming future.”

Christopher Columbus belonged to an age that was past, yet he became the sign and symbol of this new age of hope, glory and accomplishment. His medieval faith impelled him to a modern solution: Expansion.

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There are a number of doctors who prescribe a high volume of commonly abused pain medications, sometimes to clients who turn around and sell the pills on the street. It is the responsibility of the Drug Enforcement Agency to stop flagrantly illegal behavior. Clinics run by such doctors are called “pill mills”.

People seek pain relief for all sorts of conditions and as individuals may have different levels of pain tolerance. Someone who is on a particular medication for awhile may need to have the dosage increased because their body gets used to it. Certain medications may also cause chemical dependency.

Judging how much pain medication a patient needs is a fundamental part of a physician’s job, and that decision should be free from interference by the government. Unfortunately, should someone at the DEA decide that you, as a doctor, are prescribing too much medication to a patient, you will face arrest, fines, loss of license, and imprisonment. The overzealous attitude of those in government are creating the conditions today in which patients suffering from chronic pain are routinely under medicated.

The problem is not limited to the DEA. Local prosecutors working for the Department of Justice are the ones actively pursuing these cases, even though it doesn’t make any sense. Harry A. Silverglate writes in Forbes about a particularly egregious case:

The current contretemps in Wichita has its roots in 2002 when Sean Greenwood, who for more than a decade suffered from a rare but debilitating connective tissue disorder, finally found a remedy. William Hurwitz, a Virginia doctor, prescribed the high doses of pain relief medicine necessary for Greenwood to be able to function day-to-day.

Shortly thereafter, Dr. Hurwitz was arrested and shut down by federal agents. Greenwood couldn’t find any other doctor willing to risk the wrath of the DEA, so he suffered for 3 years before dying. High blood pressure, caused by years of untreated pain, was likely a strong factor in his untimely death.

Improprieties galore marked the prosecution of Dr. Hurwitz. Before his trial in federal court in Virginia in 2004, the DEA published a “Frequently Asked Questions” (FAQ) pamphlet for prescription pain medications. In a remarkable admission, the DEA wrote that confusion over dependence and addiction “can lead to inappropriate targeting of practitioners and patients for investigation and prosecution.” Yet on the eve trial, the DEA, realizing that Hurwitz could rely on this government-published pamphlet to defend his treatment methods, withdrew the FAQ from its Web site. Winning the case proved more important than facilitating sound medical practice. Hurwitz was convicted.

Sadly, Dr. Hurwitz is not alone, and his case is not nearly the most egregious.

The litany of abusive prosecutorial tactics could fill a volume. A “win-at-all-costs” mentality dominates federal prosecutors and drug agents involved in these cases. After a Miami Beach doctor was acquitted of 141 counts of illegally prescribing pain medication in March 2009, federal district court Judge Alan Gold rebuked the prosecution for introducing government informants–former patients of the doctor who were cooperating to avoid their own prosecution–as impartial witnesses at trial.

Greenwood’s wife, Siobhan Reynolds, decided to do something about a situation she saw as outrageous.

In 2003 she founded the Pain Relief Network (PRN), a group of activists, doctors and patients who oppose the federal government’s tyranny over pain relief specialists.

Somehow, the arrogant fools in power decided that having a concerned citizen shed light on their abusive practices is a bad thing to be stopped.

Now, the PRN’s campaign to raise public awareness of pain-doctor prosecutions has made Reynolds herself the target of drug warriors. Prosecutors in Wichita have asked a federal grand jury to decide whether Reynolds engaged in “obstruction of justice” for her role in seeking to create public awareness, and to otherwise assist the defense, in an ongoing prosecution of Kansas pain relief providers. The feds’ message is clear: In the pursuit of pain doctors, private citizen-activists–not just physicians–will be targeted.

An attorney for the government should know better than to try and squash op-ed pieces. Even if it were Reynolds opinion that everyone in the United States should get cases of whatever pain pills they desire for no particular reason, it is still her 1st Amendment protected right to express her opinion.

In Kansas, it appears that zealous prosecutors are targeting not only the doctors, but also their public advocates. When Reynolds wrote op-eds in local newspapers and granted interviews to other media outlets, Assistant U.S. Attorney Tanya Treadway attempted to impose a gag order on her public advocacy. The district judge correctly denied this extraordinary request.

Having learned nothing up until this point, Treadway is still going in for the kill with a new subpoena.

“Obstruction of justice” is the subpoena’s listed offense being investigated, but some of the requested records could, in no possible way, prove such a crime. The prosecutor has demanded copies of an ominous-sounding “movie,” which, in reality, is a PRN-produced documentary showing the plight of pain physicians. Also requested were records relating to a billboard Reynolds paid to have erected over a busy Wichita highway. It read: “Dr. Schneider never killed anyone.” Suddenly, a rather ordinary exercise in free speech and political activism became evidence of an obstruction of justice.

On Sept. 3, a federal judge will decide whether to enforce this subpoena, which Reynolds’ lawyers have sought to invalidate on free speech and other grounds. The citizen’s liberty to loudly and publicly oppose the drug warriors’ long-running reign of terror on the medical profession and its patients should not be in question. Rather, the question should be how the federal government has managed to accumulate the power to punish doctors who, in good faith, are attempting to alleviate excruciating pain in their patients.

Harvey A. Silverglate is the author of Three Felonies A Day: How The Feds Target The Innocent. Glenn Reynolds writes about it here:

Some years ago I started on a project entitled Due Process When Everything Is A Crime. The gist was that since criminal law has expanded to the point where everyone is some sort of a felon, the real action is in the area of prosecutorial discretion — in choosing whom to prosecute from among this population-wide mass of the guilty — where, in fact, due process basically doesn’t apply. That suggests that maybe there should be some due-process limits on decisions to prosecute. I never got to it (my scholarly rangetop has so many back burners it must be a half-mile deep) but the issue continues to deserve attention.

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Before we light this gasoline soaked issue on fire, please understand that we are exempting people who have abstained voluntarily as part of religious obligations. They are nutty for entirely different reasons.

From a study published in Addiction:

It has long been recognised that excessive alcohol consumption can lead to poor physical and mental health.  However, there has been mounting evidence that low levels of alcohol consumption may also be associated with poor mental health possibly due to abstainers having other health problems or being reformed heavy drinkers.

Drinking alcohol is like many other enjoyable facets of life – don’t overdo it. Whatever the underlying reason, whether genetic susceptibility or purely psychological, it is clear that being unable to moderate consumption is an indicator of some kind of problem.

The authors conclude that in societies where some use of alcohol is the norm, abstinence may be associated with being socially marginalised or particular personality traits that may also be associated with mental illness.

One of the things we do which truly makes the sun shine brighter, the air taste sweeter, and life more enjoyable is exposing quacks and hustlers. For that reason, it is our duty to inform you that Alcoholics Anonymous, a group dedicated to helping alcoholics through a 12 step program of abstinence, may not be as helpful and benevolent as they first appear.

  • The Alcoholics Anonymous 12 step treatment plan may cause more harm than good, and is not based on science.
  • Alcoholics Anonymous is a religious organization, which may not be suitable for many people. They offer religion as a cure for a disease.
  • Alcoholics Anonymous represses information about alternative programs, which offer treatment in a secular environment.
  • Alcoholics Anonymous represses information about the fact that abstinence, as opposed to moderation, may be a poor choice for many.
  • A good portion of the Alcoholics Anonymous clientele are coerced by the courts to join, thus making their “attraction rather than promotion” marketing spiel complete baloney.

We recommend reading Alcoholics Anonymous: Cult or Cure by Charles Bufe to get a detailed look at all the sordid details. Obviously, a Mormon who chooses not to drink is different from an underhanded, cult-like organization promoting its religious message as the only possible solution to a medical problem.

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Carl Zimmer has a new brief article up discussing an interesting point which was raised during his research for On The Origin Of Eukaryotes.

No living eukaryote, whether animal, plant, fungus, or protozoan, has completely lost its mitochondria since that symbiotic milestone some 2 billion years ago. It wasn’t the only time that two species merged, however. Plants, for example, descend from algae that engulfed a species of photosynthesizing bacteria. Many protozoans have swallowed up photosynthetic partners as well.

Absorbing an external organism through a cellular membrane and safely enclosing it in a bubble takes complex molecular machinery. One theory is that such a system evolved in eukaryotes, not prokaryotes, which gave them an advantage in integrating mitochondria.

But today, there’s a provocative new alternative to consider. Maybe a lot of today’s prokaryotes are also the result of an ancient merger. The idea comes from James Lake of the University of California, Los Angeles, a veteran researcher on the early history of life. In my essay, I describe how Lake first proposed in the early 1980s that the host cell that gave rise to eukaryotes belonged to a lineage of prokaryotes he dubbed eocytes. Now, a quarter of a century later, new studies on genomes are strongly supporting his eocyte hypothesis.

It is still not clear how prokaryotes handled fusion, but there is evidence that it happened. The double membrane of gram negative bacteria seem to be one indication of a bacteria swallowing another at some point in the ancient past.

It will be interesting to see if Lake’s new hypothesis fares as well as his eocyte hypothesis is doing. If he’s right, this symbiosis had an impact on the history of life on par with the origin of eukaryotes. Gram-negative bacteria were the first photosynthesizers, for example, and were then swallowed up by the ancestors of plants. And the same lineage also gave rise to the bacteria that became our own mitochondria. Our cells, in other words, are not just microbes within microbes; they are microbes within microbes within microbes: a true Russian doll of evolution.

Carl Zimmer is the author of Evolution: The Triumph of an Idea and Parasite Rex : Inside the Bizarre World of Nature’s Most Dangerous Creatures among others. We highly recommend these books.

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So… Why Sleep?

Jerome Siegel, UCLA professor of psychiatry and director of the Center for Sleep Research at the Semel Institute for Neuroscience and Human Behavior at UCLA and the Sepulveda Veterans Affairs Medical Center is one scientist who is delving into the reasons behind our need for sleep.

It was thought that sleep has to provide a neurological benefit which cannot be attained during an awake state because sleep puts an animal in a vulnerable state, and prevents other functions from being carried out, such as a searching for food. Different species have varying requirements as far as sleep duration and patterns. Migrating birds can be awake for days at a time, whereas bears go into hibernation in the winter.

Siegel’s lab conducted a new survey of the sleep times of a broad range of animals, examining everything from the platypus and the walrus to the echidna, a small, burrowing, egg-laying mammal covered in spines. The researchers concluded that sleep itself is highly adaptive, much like the inactive states seen in a wide range of species, starting with plants and simple microorganisms; these species have dormant states — as opposed to sleep — even though in many cases they do not have nervous systems. That challenges the idea that sleep is for the brain, said Siegel.

Animals, including humans, have a selective system which can shift from a sleeping state to an awake state in milliseconds if the right stimulus occurs. The answer then has to do with metabolism and energy conservation.

In humans, the brain constitutes, on average, just 2 percent of total body weight but consumes 20 percent of the energy used during quiet waking, so these savings have considerable adaptive significance. Besides conserving energy, sleep invokes survival benefits for humans too — “for example,” said Siegel, “a reduced risk of injury, reduced resource consumption and, from an evolutionary standpoint, reduced risk of detection by predators.”

“This Darwinian perspective can explain age-related changes in human sleep patterns as well,” he said. “We sleep more deeply when we are young, because we have a high metabolic rate that is greatly reduced during sleep, but also because there are people to protect us. Our sleep patterns change when we are older, though, because that metabolic rate reduces and we are now the ones doing the alerting and protecting from dangers.”

It is an interesting hypothesis, but it still remains to be seen if it is in fact correct. If you are interested in this subject and would like a more in depth analysis, we recommend reading The Neural Control of Sleep and Waking.

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You can’t be a runner past the age of 40, as I am, without hearing that running will ruin your knees, by which doomsayers usually mean that we’ll develop “degeneration of the cartilage in the kneecap, which ­reduces its shock-absorbing capacity,” says Ross Tucker, a physiologist in South Africa and co-author of the new book “The Runner’s Body: How the Latest Exercise Science Can Help You Run Stronger, Longer and Faster.” In other words, we’ll be afflicted with arthritis.

It seems to be common knowledge that certain sports and exercises such as distance running are bad because of the eventual suffering in the knees by participants. A long term study of runners has found that there is no particular reason for that to be the case simply because the knees are being used more often and in a tougher fashion than walking or other milder exercises.

In fact the opposite is true:

Instead, recent evidence suggests that running may actually shield somewhat against arthritis, in part because the knee develops a kind of motion groove. A group of engineers and doctors at Stanford published a study in the February issue of The Journal of Bone and Joint Surgery that showed that by moving and loading your knee joint, as you do when walking or running, you “condition” your cartilage to the load. It grows accustomed to those particular movements. You can run for miles, decades, a lifetime, without harming it. But if this exquisite balance is disturbed, usually by an injury, the loading mechanisms shift, the moving parts of the knee are no longer in their accustomed alignment and a “degenerative pathway” seems to open. The cartilage, like an unbalanced tire, wears away. Pain, tissue disintegration and, eventually, arthritis can follow.

The key factor is injury. Preventing an injury by strengthening the muscles involved in running is a good start. Once an injury has been sustained, it is likely to lead to another and possibly cause even more damage, so always consult with a doctor before resuming a normal running regimen.

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