The Corpus Callosum

Comparative Effectiveness Research: Priorities for Mental Health

Mon, 06 Jul 2009 08:46:04 -0500

Comparative Effectiveness Research (CER) has been controversial, as noted in the Washington Post. Admittedly, most of the controversy has been contrived. Fortunately, the process is moving forward; there is no meaningful opposition at this point.

A good summary of the objections of this was posted by Hilzoy at Political Animal. I'll deal with the objections simply by posting the link, as refuting them is not the point of this post. Let it suffice to say that there is no substance there.

The background of the push toward CER is provided by the Institute of Medicine's publication, Initial National Priorities for Comparative Effectiveness Research. You can read it online using the link above, or download the (uncorrected proof) PDF version using the link. (The book is 1.9MB, 207 pages, and it does not download directly from the link; you have to go to the page, fill out a form, then download it)

The U.S. Congress mandated this study in the American Recovery and Reinvestment Act of 2009, which the President signed into law 19 weeks ago. The legislation required the Institute of Medicine (IOM) to convene a committee to establish a list of research questions that would have the highest priority for study with comparative effectiveness research (CER) funds that the law placed at the discretion of the Secretary of Health and Human Services. Moreover, the law required the committee to seek advice from stakeholders who might benefit from the research: researchers, physicians, professional organizations, and the general public. Basing its approach on methods developed by the Agency for Healthcare Research and Quality, the committee held a public meeting to get advice from professional and consumer groups and from the general public and solicited nominations for research questions through a web-based questionnaire. The committee developed a process for deciding which conditions to place on its list of the highest priority research questions, and, over a 10-day period, winnowed several thousand nominations to a list of 100 high priority topics.

Pretty impressive: 19 weeks to design the study, collect the data, and write a coherent book about it. Congress should just go home and let these people take over.

The overall priorities are reviewed in a free-access article at NEJM: Prioritizing Comparative-Effectiveness Research -- IOM Recommendations, by John K. Iglehart. The priorities are summarized in a chart (click to make big) :

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Peak Psychology

Mon, 29 Jun 2009 09:06:53 -0500

Psychology is turning out to be a rather important field these days. Nate Hagens has a post on The Oil Drum, The Psychological and Evolutionary Roots of Resource Overconsumption Revisited. He reviews the evolutionary psychology of poor economic decision-making. Calculated Risk has a post, Scientific American: Bubbles and Busts. It's based on an article in Scientific American (The Science of Economic Bubbles), in which behavioral economics is discussed. Both posts have a similar theme: human psychology is such that people are not always rational when it comes to individual financial decisions, or to decisions pertaining to economic policy.

In a way, both posts are pessimistic. They both argue that we are susceptible to certain systematic errors that increase the likelihood of financial misfortune.

At least one psychologist has decided to do something about it.

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Baubike: Adventures in Design

Sat, 27 Jun 2009 13:04:48 -0500

OK, folks, explain this to me. It is a bicycle. Bicycles are cool. But from the looks of this thing, it seems as though it would be like riding an anvil around town. Sure, it'd be great if you got hit by a Hummer. The bike would be fine.

There are more photos at designbloom, and Yatzer. One person comments:

The BauBike is designed by Michael Ubbesen Jakobsen and available to order directly from him in Denmark. It is so beautiful to look at, even just leaning in a garage. I honestly haven't ridden it so I can only remark based on it's stunning and unusual design. Check out the link to read all about it and see many detailed photos along with the contact and ordering info.

The maker says:

The design follows a set of formal rules, limiting the geometry to straight lines in a pattern of 60 and 90 degree angles in proportions following the principle of the golden section.

OK, cool. Everyone like the golden section (AKA , AKA golden ratio, 1.61803399). But I would trade that for a comfortable seat, and handlebars that don't destroy my tendons. Regarding functionality, the maker says:

By limiting the form with a fixed set of design rules and stepping away from the traditional function-oriented approach to the design process, this project transcends the border between design and art, raising fundamental questions about the nature of the bike as design and as a lifestyle accessory and introducing a much needed playfulness on the bicycle scene.

Stepping away from the function-oriented approach? OK, if you have lots of money and your glutei maximi are made of carbon steel alloy #1090.

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Update on Nav1.7

Thu, 25 Jun 2009 11:27:41 -0500

PhysioProf commented about this back in 2006 after Alex Palazzo 's post, A silent mutation affects pain perception? That post discussed mutations that affect pain perception. Now, there is a bit more information available about potential commercial developments stemming from this line of genetic research.

Firewalker's Faulty Gene May Shake Up Market for Painkillers
By Dermot Doherty
June 25 (Bloomberg)

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Serious Mandate for National Health

Mon, 22 Jun 2009 08:24:37 -0500

It was the second-most-blogged article on the NYT when I got up this morning; now, it is the first-most-blogged. It is the article that reports on a survey that shows 72% support for a government-run health insurance program. The program would be similar to Medicare, but would be available to persons under 65 and not on Social Security Disability.

In Poll, Wide Support for Government-Run Health
By KEVIN SACK and MARJORIE CONNELLY
Published: June 20, 2009

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Progress in Clean Energy: Oil from Algae

Thu, 18 Jun 2009 08:25:44 -0500

This method, if it pans out, could not only be clean, it could make the environment even cleaner.

Jonathan Trent, the lead research scientist on the Spaceship Earth project at NASA Ames Research Center, has been working on a method to produce oil from algae. Their Algal Biofuels Team appears to be making progress.

NASA Envisions "Clean Energy" From Algae Grown in Waste Water

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AMA Slides Into Irrelevancy

Wed, 17 Jun 2009 09:01:59 -0500

When I first heard about the American Medical Association (AMA) opposing Obama's health care reform, I was troubled. I almost wrote a post about it, but by the time I got home, I found that others had beaten me to it. Revere, for example, appears to have written before work, posting at 6:46AM. That's dedication.

But it the interim, I've come up with a different angle. Part of it comes from an article on Medpage Today (free registration):

AMA: Obama Faces Tough Audience at the 'House of Medicine'
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: June 14, 2009

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Possible Genetic Link: Insomnia and Depression

Tue, 16 Jun 2009 08:12:12 -0500

This is one of those "interesting, wonder if it'll ever pan out" studies. So far it has been presented at a meeting, but not published. The study was summarized in an article on Medpage Today (free registration):

APSS: Depression and Insomnia May Be Genetically Linked

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Latest Hedge Fund Strategy

Tue, 09 Jun 2009 08:37:48 -0500

Market Folly writes of a new hedge fund strategy, and asks if there are any more ideas like this:

We came across this interesting piece in Dealbook the other day and thought it was very intriguing. Simply put: hedge funds are now investing in lawsuits. The premise is pretty simple: they invest in one side of the lawsuit and get a share of the winnings (if, of course, they win the case)...

...If you think about it, it makes sense. These investors essentially 'bankroll' a litigation team, thus giving them access to all kinds of different tools. The defendant/prosecutor obviously enjoys knowing that their team has deep pockets and the lawyers themselves will find comfort in the fact that they will have no problem getting paid...

...We're always on the lookout for interesting opportunities like these, so let us know if you find anymore...

Here's my idea. Invest in sick people. Have a single entity that amasses a large quantity of money. When people get sick, pay out for their health care. If they get better, take a slice of their productivity for the remainer of their lives.

The great thing about this idea is how simple it is. The strategy of investing in lawsuits makes sense only if you can select a very few cases that are likely to win. But when it comes to investing is sick people, you don't have to be selective at all. In fact, the best outcome would be attained by covering everybody. So it would not require a sophisticated analysis to pick and choose.

Drat. Someone else already came up with this idea.

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New Kind of Cloud

Mon, 08 Jun 2009 02:34:08 -0500

In 2008, we were informed that a kind of cloud formation had been named: the mammatus formation, so-called because it resembles a breast. Sort of. Whatever.

A new development is more serious. The Cloud Appreciation Society has suggested that the name asperatus be given to clouds that portray a particular kind of turbulence.

Flickr photo by Vince Perritano, Creative Commons license

Other, more dramatic examples can be seen at the BBC page, A New Kind of Cloud?, at National Geographic, New Cloud Type Discovered?, and, of course, at the Cloud Appreciation Society, 'Asperatus', a new variety of cloud?

Every schoolkid knows that there are four main types: nimbus, cirrus, stratus, and cumulus. (Actually, there are many cloud types, although many of the names are derived from the four listed above. Some are not: noctilucent clouds, contrails, funnel clouds, to name a few. See the Wikipedia page.) This classification had stood since 1953. Why mess with it now? If you do, there'll be committee meetings and newspaper articles. People will be chanting "Teach the Controversy!"

Then we will have to change all the textbooks (assuming the Texas Board of Education goes along with the scheme, which may not happen easily).

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Miscellaneous Financial Link

Wed, 03 Jun 2009 23:53:47 -0500

Business Matters has posted interviews about the financial crisis. these interviews provide a good overview of the origin of the crisis, plus some clues as to where we are headed. The first interview is with Paul Craig Roberts. Roberts was an Assistant Secretary of the Treasury in the Reagan Administration. The second interview is with Ilargi, one of the pseudonymous authors of the blog, The Automatic Earth. They have different perspectives, but similar conclusions.

Basically, we're screwed.

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More Ado About Area 25

Mon, 01 Jun 2009 08:17:02 -0500

Some may recall Brodmann Area 25 (a part of the brain also known as the subgenual area or area subgenualis). It was mentioned by Orli Van Mourik (Much Ado About Area 25) in 2006, and by me in 2008 (Update on Deep Brain Stimulation). David Dobbs profiled one of the key researchers, Helen Mayberg, (Neurologist Helen Mayberg in SciAm Mind) in 2007, and wrote about the topic again last month (Refining Depression's Wiring Diagram).

The key thing about Area 25 is that it is the spot that is affected when deep brain stimulation (DBS) is used to treat Major Depression. Dobbs' post last month detailed some of the more recent research on the tractography (the study of the white matter connections in the brain) of Area 25. See his post (as linked above, and here for convenience) for diagrams.

In that post, Dobbs mentioned that Mayberg was conducting more research on Area 25, hoping to find a way to identify which patients would be most likely to benefit from deep brain stimulation. While that remains a work in progress, there are some interim findings:

Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder
Jakub Z. Konarski, MSc; Sidney H. Kennedy, MD; Zindel V. Segal, PhD; Mark A. Lau, PhD; Peter J. Bieling, PhD; Roger S. McIntyre, MD; Helen S. Mayberg, MD
J Psychiatry Neurosci 2009;34(3):175-80.

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Kalamazoo Beers

Thu, 28 May 2009 23:41:11 -0500

It has come to my attention that Kalamazoo is on the map, again.

The last time was is 1942, when the Glen Miller Orchestra played I've Got A Gal In Kalamazoo (lyrics).

Now, Ratebeer.com has included TWO Kalamazoo beers on their "top rated" list:

Westvleteren Abt 12
Närke Kaggen Stormaktsporter
Three Floyds Oak Aged Dark Lord Russian Imperial Stout
Three Floyds Dark Lord Russian Imperial Stout
AleSmith Speedway Stout
AleSmith Barrel Aged Speedway Stout
Rochefort Trappistes
Bells Expedition Stout
Bells Bourbon Barrel Double Cream/Expedition Stout
Surly Darkness

Bell's Brewery originally was known as the Kalamazoo Brewing Company. While their new facility is in Comstock, Michigan, they still have operations in Kalamazoo.

Speaking of oddly named Michigan towns, Ratebeer.com also calls our attention to the Michigan Brewer's Guild 12th annual Summer Beer Festival (Friday, July 24, 2009 - Saturday, July 25, 2009)...in Ypsilanti, Michigan. If you go, be sure to check out the Corner Brewery at 720 Norris St. If you go a week early, you also can participate in the Shadow Art Fair.

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On Empathic Judges

Thu, 28 May 2009 12:17:40 -0500

Last night I heard a snippet of an interview with some Senator, who expressed fear that the Supreme Court candidate, Sonia Sotomayor, would let her feelings interfere with her judgment. Evidently, this was based upon Obama's characterization of Ms. Sotomayor as "emphatic." Although I can't recall who the Senator was, these sentiments are captured in the following:

Mr. Hatch, a longtime Judiciary Committee member, said he would focus on whether the judge is committed to deciding cases based on the law, not "personal feelings or politics." Senator Mitch McConnell of Kentucky, the Republican leader, said he and his colleagues want to be certain Judge Sotomayor will apply the law even-handedly, despite her own "feelings or personal or political preferences." Senator Charles Grassley of Iowa, another member of the Judiciary Committee, said the panel would take time to ensure that Judge Sotomayor would "apply the law, not personal politics, feelings or preferences."

Very few people have no empathy. Those who totally lack empathy are usually sociopaths. I think it is fair to say that it would be dumb to nominate a sociopath to the Supreme Court.

But what about the notion that a person should not allow his or her feelings to influence her or his decisions? Is that even possible?

No.

The internal experiences that we call thoughts, and those we call feelings, are both manifestations of brain activity. Although the brain activity for the respective experiences is different, being centered in different parts of the brain, it simply is not possible to separate the two. These parts of the brain are linked. They continuously influence each other.

If a person is sufficiently introspective -- as I hope all judges are -- it is possible for that person to minimize the influence of emotion upon cognition. But in order to do that, one has to be aware of their own emotional states. Moreover, one has to be cognizant of the effect that other persons have upon one's own emotional state. That is part of what empathy is; it is a necessary step in the process of inferring what emotions the other person is experiencing. The more mindful a person is, regarding the interplay between thought and emotion, the more one is able to act impartially. For a judge, this is a desirable trait.

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"Green Shoots" in Graphs

Mon, 25 May 2009 08:25:26 -0500

Courtesy of Chart of the Day...

Click on the graphs to see the Chart of the Day explanations for the data.

The top chart shows the aggregate earnings, over time, of the companies in the S&P 500 Index. The second chart shows the ratio between the aggreagte price of the stock, and the earnings of the companies.

Oversimplified view: A low price-to-earnings ratio means that you are not paying much, to get a share of a company that is earning a lot. A high P:E ratio means that you are paying a lot for companies that aren't earning so much. Although there are many factors involved in determining whether a certain stock is a good investment, a lower P:E ratio is one indicator that suggests that the stock is a good investment.

What remains to be seen is whether the turn things around, to get their P:E ratios down. But until you see that happen, you really don't know what you are getting into, if you buy stock in these companies.

Historically, the P:E ratios have been cyclical. So some people will be tempted to assume that the P:E ratios will cycle down, turning their iffy investments into good ones. However, the current situation is unprecedented. That indicates that the old patterns and assumptions may not apply at this point in time.

This is an illustration of how assumptions can lead to false conclusions. It is impossible to conduct one's life without making assumptions. Given that, it is helpful to be mindful of the assumtions one makes when making important decisions. It then is important to look for indications that those assumptions might not be valid.

When you see things happening that are literally unprecedented, it is an indication that it might not be valid to assume that historical patterns will repeat themselves.

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