Wednesday, December 15, 2010

trigger: "you want the cops to come in and kill you"

Clay Duke, Clay A. Duke, THE Clay Duke, yes that one. Panama City. Rebecca Duke's man. The Gentle Giant. (Not that Gentle Giant, you hippie.) Schoolboard shooting.

Bill Husvelt was saved by God. Good move, God, since Bill was handling things well at 99%, but slipped up. We are all flawed, and need God, as clever as we might be.

Bill Husvelt is not an expert on narcissism. Or on crisis management intervention with a homi/suicidal narcissist. IMHO, Bill Husvelt performed awesomely as an impromptu psychologist. Kudos. He deserves an honorary degree.

Husvelt's one flaw, in his plain-talk I-thou intervention, was to directly call the sad reality of it all straight to the injured narcissist. Causing more injury. How did he do this? What did he say? He said, ""I've got a feeling you want the cops to come in and kill you because you said you are going to die today,"


William Husvelt blew the scheme. The heroic plan that was revealing Duke as Sir Duke. Everything was going so well. So well, that Sir Duke did not know what to say, in response to conversation. Well, that is to be expected because the only person Sir Duke was familiar with, by conversation, was himself. Circuitous conversations in his head painting the picture. Then, after enough laps around his head, he literally painted the picture: vengeance. V.

Bill pulled back the curtain. The careful, almost, no don't say it, I must, masterful -there, I said it- masterful Johnny Paycheck orchestration was exposed for what it was. A sadly pathetic program meant to be some spontaneous heroic stand.

But we cannot fault Bill Husvelt too much. Only the "V" for vengeance overgrown adolescent ended up dead. Bill literally ducked a bullet (that is where God stepped in).

Bill does not know what a narcissistic injury is, and it is quite unlikely, therefore, that he could, in the moment, calculate what man-to-man talk might de-fuse, and what mano-a-mano might blow up.

In crises, don't ever belittle your narcissistic client  - espeically when they are holding a loaded gun. Don't pull back the curtain to reveal the pathetic man furiously working machinations to maintain the Ozsome-ness. Don't reveal that you have calculated the end game.

Should Bill feel guilt that a death occurred? I don't think so. We may never know, but it sure seems that the story was scripted to end with Sir Duke's heroic death. Inevitable. I really kind of believe Bill was correct: Sir Duke fantasized an ending where he would go out in flames, suppressed by the Machine, or whomever was the oppressor. I have never watched V, and don't even know if it is a TV show or a movie, or both, or a comic book, or all three, so I don't know what kind of ending Sir Duke had in mind. But I believe Husvelt had it correct: Sir Duke would go out in glory by the tools of the oppressors.

I believe that because the sympathetic negotiations went nowhere. The pleas to ask about this guys' wife went nowhere. Nowhere. (store that detail - it may save your life.) Sir Duke was not trying to pay the mortgage or get his wife back into a job. He was out to be martyred.

PS: I saw the story, saw the video, and put my thoughts together, and have not, in these 24 hours, checked the blog of the Last Psychiatrist. I have just focused on this one aspect of the incident - Bill's mis-step - because I am pretty sure Alone will conduct a better psychological autopsy than I will. Alone will at least likely be familiar with "V."

Tuesday, December 14, 2010

the truth wears off; or was it never on?

This New Yorker article is getting a lot of blogsploitation...
"Rethinking the scientific method." Oh, great. A NY journalist is going to fill us in on what we scientists have not been able to figure out.
"On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news."
The Startling News? A bunch of cheating, unethical, greedy pharmaceutical people had a bunch of psychiatrists, who are not trained as scientists unless they deliberately go out of their way to do a science-based PhD in some spare 3 years, cooked up some data indicating that their new chemicals were superior to those whose patents had run out.

Now, just looking at this, you can begin to sniff the sweet smell of disaster. Clozaril was not really worth  a thousand dollars a month. Or worth the heavy monitoring for agranulocytosis. But hey, there's money to be made - I know  - I entertained the possibility of getting hired to go into doctors' offices and figure out who could be switched to Clozaril. Yes, the patent has run out - no one is doing this anymore - it was  a long time ago. But the opportunity was there for one brief, shining moment.

As time went by, and more studies were done under more circumstances, it became painfully obvious that Clozaril was not much better than the Haldol it had replaced. Same for the yellow one that was close on the heels - drawing a blank on the name. Give me a sec. Risperdal.

This has been the case with many new treatments: EMDR, etc. Initial optimism fades as the effect size shrinks like that perfect cotton t-shirt washed in hot water. A few times. The Thrill Is Gone. Same as the old one.

So, some person comes along, pretending to be the next philosopher of science, and declares that science is dead.

Science does not answer questions. It is a method for helping us discern what might be true. Withering efficacy does not change that. No need to change science.

If you can get behind the firewall, you will find this:
"Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe."

Does this disprove science? Is Lehrer the next Nietzsche? Is God alive again? If science is dead, can there still be a gay science?

Witheing results do not disprove the value of science.

This totally fits with the scietific paradigm, and, as a scientist, I have no problem with this.

Scientists, those people who have actually studied and practiced epistemology, scientific method, research design, likelihood/probability analysis, and such, have no problem with the quote above.

How? For starters: accept as a rule a few concepts:

"experiments" don't give us truth; they give us evidence that plays a role when attempting to discern truth.

no single studies proves anything. (ten lousy studies with consistent results don't prove it, either.)

all of our studies are based on models, and the map is not the landscape/ ceci n'est pas une pipe. with our measures and tests, the best we can do is confirm a model.

all measurement have some degree of error.

science never arrives at the truth; when working well, it approaches truth asymptotically.

science doesn't tell us what to study. we decide, then use scientific principles and methods to evaluate our pet theory. thus, we are always beginning with some agenda before the first trial is run.

physical reality is wildly more complicated than we can grasp. (not all scientists beleive this, but when you begin considering all of the machinations you would need to have a valid and generalizable medical outcomes study, it becomes incredibly daunting.)

finally: accept the reality that what we hold as our faith, science, is really only a method for approaching knowledge, and should not be regarded as a faith, or dogma; science only helps us be very systematic, in a certain way, in evaluating claims of knowledge. let's not be so dogmatic. you cannot swear allegiance to the idea that whatever findings might emerge from "science" will be your truth. it just doesn't work that way.

these concepts are in my mind whenever i read a journal article.

Especially if it is from Big Pharma.

Tuesday, December 7, 2010

Earth To Dr. Manny: No Evidence Curcumin Cures Cancer. Or Prevents.

Dr. Manny is the FoxNews Doc on the Block. Sure to share some conventional wisdom and house-call hominess regardless of the evidence.

I don't know who the "Medicine Hunter" is, but apparently Dr. Manny trusts this guy.

Fox health video:

"Curing With Curcumin

The Medicine Hunter tells Dr. Manny how incorporating one popular Indian spice into your diet can lower your risk for cancer and improve your mood. Find out how much you should be taking a day."

Mood? Bonus.

I help teach people how to evaluate clinical evidence. My strength is in mental health/psychology/psychaitry, but I can dabble. My students include Indian students, along with students from many places. So, when we review people's pet theories of what heals and does not, curcumin / turmeric comes up. So, I keep challenging students to provide the evidence. When we apply our standards for evaluating studies, we never arrive at the conclusion that curcumin looks promising. I hate to tell someone Grandma is not correct. So, I give an alternate explanation: it is the social support and love that comes with the lovingly home-cooked meal.

Thursday, December 2, 2010

In The Moment, There Is No Music. Mindfulness thoughts

Hi, there.
Studies keep coming out trialing mindfulness meditation as a psychological intervention component for a range of disorders and problems. About time: counselors had already been using mindfulness before any actual emprical evidence was ever out there. But hey, does that ever stop anyone?

I have participated in some of this, in practice and in research. So, I have carried out a pretty good reading plan on this. And thought about it a pretty good amt. when I was practicing regularly, in the course of guiding patients through the practice, I noticed that I slept better, and had a lower desire for coffee in the morning. And, we had a holding-the-breath-while under-water contest, and I was able to really simply observe the panicky suffocation thoughts and remain underwater, and allowing my need for oxygen, rathe than the prompting of panic, to send me back above the water line, winning the contest. So, I am certainly willing to believe there is something there.

Mindfulness essentially is a matter of getting to become increasingly aware of what your mind does by paying steady attention to what it is doing. Sounds easy. Well, you try it. It is like walking an energetic pup with no leash.

Also, you want to get attention focused on some specific thing, and that only. Usually, it is the activity of breathing. This works. You become more aware of how thoughts flow into your mind, and have their effects on your viscera.

A goal is to have your attention simply in the present moment. with practice, you will discover that your mind is almost never in the present moment - our minds are so awesome, they have to devote minimal attention to keep us in line with social interactions, navigation, and routines. So, it is a new thing to put deliberate attention in the moment.

Not reflecting on some argument from yesterday, or some pleasant memory from eight years ago, or worrying about the weekend to come, or looking forward to 5 o'clock quittin' time. In the present.

Well, it occurred to me: if you do this well enough, music would lose its music-ness, wouldn't it?

Music depends on acoustic events occurring in some purposeful arrangement in time. Right?

So, if you ceased having your mind on the past, the music-ness of music would disappear. Right?

One way to practice focused meditation is to pay attention to ambient noises. This is striking: you discover a whole panoply of noises all around. You can hardly identify and catalog them all, can hardly be aware of all of the current, momentary noises occurring in a moment.

I sure have not been able to get the music to stop. I have never heard of any yogi describing this as an experience or a goal. Please post a note if you have.

Also, it is curious that a lot of the faux-riental meditation-based experiences (yoga, or shopping at a crystal boutique) have the typical Steve Halpern or Deuter music. If your mind is supposed to be "focused" in the moment, then why are these people providing sensory input that commands attention to follow along in time? Would it not be the same to ask someone to meditate, and expect that a car rushing toward them would be helpful to not think about the next 10 seconds, but to stay in the moment?

I just don't know.

[warning: you can either focus your mind on something, or focus your mind on nothing; i really believe, based on case reports and such, that focusing your mind on nothing can be mentally bad, such as inducing psychosis, and leaving you disorganized for months afterward; I see no reason to try this at all, and I would avoid any meditation effort that has a mind full of nothingness as a goal. Others will disagree. Go enter meditation and psychosis into Pubmed and start reading.]

Wednesday, December 1, 2010

NEJM sez 'overweight die early;' I say, Wrong.

Body-Mass Index and Mortality among 1.46 Million White Adults

Amy Berrington de Gonzalez, D.Phil., Patricia Hartge, Sc.D., James R. Cerhan, Ph.D., Alan J. Flint, Dr.P.H., Lindsay Hannan, M.S.P.H., Robert J. MacInnis, Ph.D., Steven C. Moore, Ph.D., Geoffrey S. Tobias, B.S., Hoda Anton-Culver, Ph.D., Laura Beane Freeman, Ph.D., W. Lawrence Beeson, Dr.P.H., Sandra L. Clipp, M.P.H., Dallas R. English, Ph.D., Aaron R. Folsom, M.D., D. Michal Freedman, Ph.D., Graham Giles, Ph.D., Niclas Hakansson, Ph.D., Katherine D. Henderson, Ph.D., Judith Hoffman-Bolton, Jane A. Hoppin, Sc.D., Karen L. Koenig, Ph.D., I-Min Lee, Sc.D., Martha S. Linet, M.D., Yikyung Park, Sc.D., Gaia Pocobelli, M.S., Arthur Schatzkin, M.D., Howard D. Sesso, Sc.D., Elisabete Weiderpass, Ph.D., Bradley J. Willcox, M.D., Alicja Wolk, Dr.Med.Sci., Anne Zeleniuch-Jacquotte, M.D., Walter C. Willett, M.D., Dr.P.H., and Michael J. Thun, M.D.

N Engl J Med 2010; 363:2211-2219December 2, 2010


A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.


We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).


The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.

the media love this.

BMI 25 to 29.9 'overweight'
30+ obese
So, a man at average height, say 5 foot 10 inches, is 'overweight' at 174 pounds, and is 'obese' at 209.
A woman who is 'average height at 5 foot 4 inches is 'overweight' at 145 pounds, and 'obese' at 174 pounds.
You can google and find the BMI tables, but here is a website that is paying to have theirs high up on the search results:
Who is paying for this study? Remember: follow the money.
They want to continue making physicians believe that being "overweight" means that you will die early, and so you should PANIC and ACT. Specifically, by taking some patented medication.
Generally, this is not true. And, no one has evidence indicating that if you take tehir patented medication, you will be an overweight person who lives longer, or will move from being oevrweight to being obese, and consequently live longer.
Please prove me wrong: post the study.
So, their lips are moving. Now, to figure out the lie.
First: we will ignore the obese people. Why? Because either you have been on steroids, or are immobilized, or you are flat out using your minutes unwisely. In any of these cases, you are an exception, or should be considered an exception. There are such great needs on this planet. If you have devoted time and money to consuming food instead of figuring out something socially redeeming to do with your time and money, that is up to you. Like we say in career counseling when attempting to help people who have the amazing fortune of being able to be undecided about work: "what if you only had one life to live?"
I do care about the plight of the obese. Just, when discussing epidemiology and pharmacology, it is a distraction. Pay me $100/hour and I will feel self-fulfilled to help you address the obesity lifestyle you have chosen.
And, anyway: who cares? The 'overweight' care. Not all. Some. But this 'some' is the bulk targeted by the profiteers. The overweight pester the docs, and crowd the gyms, and take the supplements. They hear things about body fat, or dietary fat, and flock. They perked up when the young woman in the Meridia ad said, "I'm Ready." [BTW: she is still 'overweight,' in case you were wondering.]

You who are overweight are a vast portion of the populace, and are the target - they want you to perceive yourself as 'obese,' so that you sign up for interventions that ought to be delivered to the obese. Look at the ads. A woman who looks perfect to us men is posted as a 'before,' and a well-defined body-builder with a six-pack is featured as 'after.' Will she live longer? Short answer: no. If we convince her that being 'overweight' is 'unhealthy,' or not 'fit,' then we can make money off of her. Lots of money. Because she is not 'overweight.' She is 'normal,' as God intended.

So, we will consider the 'overweight' and ignore the obese.

This study, as far as I can tell (electronic is not accessible to me yet - I will have to do something as primitive as walk over to the physical library to get details - but logic, and the space-time continuum have a stranglehold on rhetoric that is challenging to break), does not say that overweight people die earlier, but that EARLY DEATH is associated with being overweight.

Here is the key: THEY GIVE IT TO YOU IN THE ABSTRACT: TEN-YEAR FOLLOW-UP. AND MEDIAN AGE 58. People! Wake up and do the math!!!
Two questions are needed to sort this out:
1. When do people die, on average?
2. Who did they study?

That is it. Common sense defeats Goliath.

Here in the U.S., those who are sensitive to the marketing of Meridia and health club memberships have a life expectancy of 75 years, give or take.
So, the optimal way to figure out who dies early and who dies late, given a ten-year 'parameter' (self-imposed limit), would be to follow people from the age of 65 to 75, and see who dies.

for those who have made it that far, which should be a pretty representative group of the pop in general (despite inherent limits, such as the inordinate portion of Blacks who die in the womb or in early adulthood by their brothers).
That is not early death. That would be examining the differentialiation of normal death.
The odds ratios just don't fit this pattern.
If they are examining people, with a median age of 58, with a ten year follow-up ----
let me see...this will require a calculator...

OK: now we know: they examined death in a group of people from ages 58 to 68.
Life expectancy is 75.
An average.
So, the study is looking at people who...calculator needed again....
...are a whopping 7 years before expected death.
So, we are not looking at death, but at "early death."
THat is to say: MOST people die around the age of 75; but if you HAPPEN to be an exception, and die several years before that, we have figured out the characteristics associated with EARLY DEATH, not normal death.
Not: among those living a full life, who dies earlier.

For that, you need a group who reach some age beyond 58. Maybe 65, then follow through the age of 80. Let's get the inter-quartile range of life expectancy.

The minority (doubel-entendre intended -we epidemiologists need to be painfully aware of these disparities ) who die early are different from most of us. They have behavioral problems, or cancers, or are victims of violence or occupational hazard, or were hit by the tornado, or died from a hospital-acquired infection.

The heaving bulk of us die from heart disease, and between 70 and 80 years of age.

This study is not about the bulk of us.

That is good news: we can relax and enjoy our 'overweightness.'

All this to say: 'overweight' is a marketing tool. BMI has a loose relation with body fat. It is the body fat that will kill you; the rest of us simply believe it will kill us, but have big estimation errors in our thinking.

Look at this:

It is the correlation between BMI and actual body fat. Points on or near that horizontal line are well-predicted from one to the other. The MAJORITY of dots are not wll-predicted.

Variability. What accounts for that? What accounts for data that say: my BMI may not be too bad, but my body fat is gravely indicative of my impending early death AND My BMI is bad, but I will live to be 90.

Open your Bible. Work hard, and enjoy the love of your family and community. Stay in financial control, rather than living in debt. Have kids. Have sex only in marriage. AND: eat and drink your wine, because none of us knows when we will shrug off the mortal coil.

Nothing about being 'overweight,' or supplements, or treadmills.

That is ALL from the Bible. I know, I know: "eat, drink and be merry, for tomorrow we may die" is what they made us memorize to typify the Epicurean philosophy. If your course was decent, they told, you, Epicurus NEVER actually said that, and neither did Lucretius. They did not tell you that Solomon said it.

And "mortal coil?" As with much he wrote, Shakespeare lifted that, as he lifted a gret deal, from a book he was helping translate.

The rest: heavily in Proverbs, a lot in Leviticus, and elsewhere.

You will not die early from being overweight. That contradicts established epidemiology that follows cohorts from middle-age for well beyond ten years, through the normative death expectancy range. THAT is the only way to answer the question regarding what factors will generally lead to earlier death.

Being overweight will mathematically predict your death if you are overweight because you are sedentary, or a drunkard, or have some other health condition such as something requiring steroids, or are paraplegic and inactive.

Otherwise, you are not notably at risk of early death if overweight, compared to BMI 20-25.

Relax. Don't buy their drugs or supplements. Grow old gracefully. Like Solomon says, enjoy the company of your wife, the pride your children bring, and a couple glasses of Shiraz. And stay prayed-up.
And what is up with all of those authors?