Articles

Archive for Neuroscience/Mental Health

Lithium for ALS – Angioplasty for MS

Peter Lipson reported Monday about new research suggesting that Multiple Sclerosis may be caused by venous blockage. He correctly characterized some of the hype surrounding this story as “irrational exuberance.”

This is a phenomenon all too common in the media – taking the preliminary research of an individual or group (always presented as a maverick) and declaring it a “stunning breakthrough,” combined with the ubiquitous personal anecdote of someone “saved” by the new treatment.

The medical community, meanwhile, responds with appropriate caution and healthy skepticism. Looks interesting – let’s see some more research. There is a reason for such a response from experts – experience.

(more…)

Posted in: Neuroscience/Mental Health, Science and the Media

Leave a Comment (14) →

Communicating with the Locked-In

The primary reason that I and others favor science-based medicine, as opposed to the alternatives, is that science works. As Carl Sagan said, “Science delivers the good.” Science has other virtues – it is transparent and self-corrective also.

Recently two unrelated news items have provided an opportunity to compare a scientific vs a pseudoscientific approach to the same problem – that of communicating to patients who are locked-in.

Locked-in describes those who suffer from an injury or neurological disease that mostly paralyzes them, so that they cannot move or communicate. One scenario that leads to a locked-in state is a brainstem stroke, where patients are paralyzed below the eyes – they can only blink and move their eyes, but nothing else. Widespread trauma can lead to a similar situation. ALS, which leads to progressive loss of motor neurons, can also result in total or near total paralysis.

(more…)

Posted in: Neuroscience/Mental Health

Leave a Comment (10) →

Early Intervention for Autism

Many parents of children with autism have expressed to me their dismay that the anti-vaccine lobby is sucking all the oxygen out of the room for autism awareness. They feel that just being a parent of a child with autism makes others assume that they are anti-vaccine. They also worry that resources and attention are being diverted from promising legitimate research because of all the attention being paid to the failed vaccine hypothesis.

So it is good to occasionally focus on mainstream autism research to show that progress is being made, despite the unfortunate anti-vaccine sideshow.

A recent study published in the latest issue of Pediatrics shows that early intervention in toddlers with autism can have significant benefits. The study is a randomized controlled trial of  the Early Start Denver Model compared to conventional treatment in 18-30 month old children with a diagnosis of autism spectrum disorder (ASD). The study is a reasonable size for this kind of intervention – 48 children were randomized – and this is sufficiently powered to get statistical significance. But it should be noted this is still a smallish study and replication to confirm the results is welcome.

Another potential weakness is that the control group was “referral to community providers for intervention commonly available in the community.” Therefore the control group was not standardized and it’s possible this group was sub-optimally treated. Further, while the groups were randomized they were not blinded.

(more…)

Posted in: Neuroscience/Mental Health

Leave a Comment (37) →

Man in Coma 23 Years – Is He Really Conscious?

I don’t know. The mainstream media is doing a wonderful job sensationalizing this case, presenting it without skepticism. Some outlets are doing a good job of discussing the relevant issues – but they don’t have the information to have a meaningful discussion of this particular case. Details are tantalizing but thin.

The case is that of Rom Houben. The story was broke, as far as I can tell, by the Mail Online – yes, that is a huge red flag. It does not make the story wrong, it just doesn’t instill in me confidence in the reporting.

Mr. Houben was in a terrible motor vehicle accident 23 years ago and has been paralyzed ever since. His diagnosis has been PVS – persistent vegetative state. However, recently, we are told, his mother insisted on a neurological re-evaluation. This is actually quite reasonable, generally speaking (again, without knowing specific details of this case).

(more…)

Posted in: Neuroscience/Mental Health, Science and the Media

Leave a Comment (19) →

The Mythbusters of Psychology

Karl Popper said “Science must begin with myths and with the criticism of myths.” Popular psychology is a prolific source of myths. It has produced widely held beliefs that “everyone knows are true” but that are contradicted by psychological research. A new book does an excellent job of mythbusting: 50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behavior by Scott O. Lilienfeld, Steven Jay Lynn, John Ruscio, and the late, great skeptic Barry L. Beyerstein.

I read a lot of psychology and skeptical literature, and I thought I knew a lot about false beliefs in psychology, but I wasn’t as savvy as I thought. Some of these myths I knew were myths, and the book reinforced my convictions with new evidence that I hadn’t seen; some I had questioned and I was glad to see my skepticism vindicated; but some myths I had swallowed whole and the book’s carefully presented evidence made me change my mind. (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

Leave a Comment (80) →

It’s All in Your Head

I have never used those words to a patient or about a patient.  I have also never heard a colleague use any similar term to a patient. And yet on many occasions I have had patients ask me, “So you’re telling me it’s all in my head?”

The concept of what are now called psychogenic symptoms is a tricky one for various reasons. There is an unfortunate stigma attached to the notion that our brains can cause physical symptoms. Making the diagnosis is complex. Outcomes are variable and are hampered by the difficulty in communicating the diagnosis to patients. Psychogenic symptoms often mask underlying physiological disease. And the risks of both false positives and false negatives are high.

This complexity leads some to argue, in essence, that psychogenic symptoms do not exist at all – that the diagnosis is a cop out, a way to blame the patient for the failings of the physician. But this approach, ironically, is a cop out, because it seeks to white wash what is a real and complex disorder with an overly simplistic and moralistic approach.

(more…)

Posted in: Neuroscience/Mental Health

Leave a Comment (36) →

CFS: Viral vs somatization

On 10/08/09, the NIH and Science through press releases announced the following remarkable information:  Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome (CFS.) From Science on line:

Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.

“We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients,” said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association. Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.

(more…)

Posted in: History, Medical Academia, Neuroscience/Mental Health, Science and Medicine

Leave a Comment (38) →

Minimally Conscious vs Persistent Vegetative State

ResearchBlogging.orgA new study suggests that it may not be uncommon for patients who are in a minimally conscious state to be misdiagnosed as being in a persistent vegetative state. The study underscores the necessity of using standardized and objective diagnostic criteria in diagnosing coma. However, it also leaves some important questions unanswered.

As background it is essential to understand a bit about consciousness and coma, for not all comas are created equally. In order to be conscious a person requires at least one hemisphere of the brain be mostly functioning and they require a functioning brainstem. The cortical hemispheres contain the gray matter – that part of the brain that thinks. So it makes sense that a certain minimal amount of gray matter is necessary to generate consciousness. As gray matter is damaged or inhibited from functioning one’s level of consciousness decreases until it descends beyond that fuzzy boundary into unconsciousness. When such unconsciousness is persistent we call that coma.

But interestingly the cortex by itself cannot generate consciousness. It requires constant prodding by a diffuse region in the brainstem (that primitive part at the base of the brain that connects the brain and the spinal cord) called the brainstem activating system. This region sends a constant barrage of electrical signals through the thalamus (the relay center of the brain) and then onto the cortex. Without this constant stimulation the cortex will lapse into sleep and coma.

(more…)

Posted in: Neuroscience/Mental Health

Leave a Comment (6) →

Woosceptibility: A Brief Interview With James Randi

James Randi, perhaps better known as “The Amazing Randi” has spent most of his life performing magic shows. In 1996 he created the James Randi Educational Foundation (JREF) designed to expose the fraudulent claims made by psychics, faith healers, and snake oil salesmen. The ultimate goal of the JREF is to create a new generation of critical thinkers – people who will not be hoodwinked by the aforementioned hucksters.I had the good fortune of interviewing Mr. Randi briefly at the recent conference known as “The Amazing Meeting.” I was eager to pick his brain about human behavior and magical thinking. This is what I learned…

Randi identified certain groups of people who seem to be more susceptible to magical thinking and/or belief in the paranormal. According to him, the top two are:

1. News reporters. Although at first I wasn’t sure if Randi meant that reporters like a good story versus they believe a good story – he told me that in his experience, they were some of the most gullible people on earth. In fact, they were more interested in implausible stories than true ones – and Randi said that the more fantastical his explanation for phenomena, the more likely they were to believe it and write about it.

2. Academics. This surprised me since I assumed that this group would actually be less susceptible. Randi suggested that they are more likely to be taken in because they are single-minded about phenomena. They are over confident in their ability to understand how things work, and when something cannot be explained in their framework, they’re willing to attribute it to the paranormal.

Who are the least susceptible? Children. Why? Because they are simple thinkers, and harder to distract. The art of magic is in distraction of the sophisticated mind. Children tend to be very concrete, so they don’t expect things to happen with hand-waving and flourishes. They keep their eye on the coin (or other item being transferred from hand to hand), and are more likely to know where it is at all times.

To wrap up our short interview, I asked Randi if he could explain why people believe in magic, fantasy, and the paranormal? He responded plainly:

Ultimately it’s not about intelligence or lack thereof. It’s about people not wanting to accept that life is random, suffering is inevitable, and there is no good reason for bad things happening.

What do you make of Randi’s observations?

Posted in: Faith Healing & Spirituality, Health Fraud, Neuroscience/Mental Health

Leave a Comment (53) →

Chemical castration for autism: After three years, the mainstream media finally notices

We’ve written a lot about anti-vaccine zealotry on this blog, as Steve and I take a particular interest in this particular form of dangerous pseudoscience for a number of reasons. One reason, of course, is that the activities of antivaccine groups like Generation Rescue and its spokesmodel since 2007 (Jenny McCarthy, a frequent topic on this blog) have started to frighten parents about vaccines enough that vaccination rates are falling well below that required for herd immunity in some parts of the country. Indeed, McCarthy, at the behest of her handlers in Generation Rescue, serves up a regular “toxic” brew of misinformation and nonsense about vaccines, most recently in a video that was the subject of a post by Val Jones about her unbelievably pseudoscience-laden blather. Truly, it has to be seen to be believed. Meanwhile, Generation Rescue has sent McCarthy on a media propaganda tour for her latest antivaccine pro-quackery book and set up a misinformation-laden propaganda site called Fourteen Studies (blogged about by Steve Novella, Mark Crislip, and, of course, yours truly) in which they attack well-designed studies that have failed to confirm their pet idea that somehow, some way, vaccines must be the cause of autism. And, when their pseudoscience is criticized, the antivaccine movement has a tendency to launch vicious ad hominem attacks, as they recently did against Steve Novella and have done multiple times in the past against me.

However, there is one other consequence of the antivaccine movement, however, and it is at least as important as the public health implications of the potential dimunition of herd immunity caused by the fear mongering of groups like Generation Rescue. That consequence is the cottage industry of “biomedical” treatments to which desperate parents subject their children. Gluten-free diets, chelation therapy (which has caused deaths), hyperbaric oxygen chambers (a recent story described a child getting severely burned when one of these caught fire), autistic children have been subjected to it all. But of all the biomedical woo to which autistic children have been subjected, one form of woo stands out as being particularly heinous. Indeed, I agree with our fearless leader Steve in characterizing it as an “atrocity.”

I’m referring to Mark and David Geier’s favored “treatment” for autistic children, namely a drug called Lupron.
(more…)

Posted in: Clinical Trials, Health Fraud, Medical Ethics, Neuroscience/Mental Health, Politics and Regulation, Public Health, Science and the Media, Vaccines

Leave a Comment (24) →
Page 12 of 16 «...1011121314...»