fMRI in court: Neuroscience may change the legal system. - Slate Magazine

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; "><em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">his article arises from Future Tense, a partnership of <strong style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-weight: bold; ">Slate</strong>, the New America Foundation, and Arizona State University that explores emerging technologies and their implications for public policy and for society. On Monday, Oct. 22, Future Tense will host "My Brain Made Me Do It," an event in Washington, D.C., on how the legal system will adapt to changes in neuroscience. For more information and to RSVP, or to watch the live stream, </em><a href="http://futuretense.newamerica.net/events/2012/my_brain_made_me_do_it" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; "><em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">visit the New America Foundation's website</em></a><em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">.</em></div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Although academic fields will often enjoy more than Andy Warhol's famous 15 minutes of fame, they too are subject to today's ever-hungry machinery of hype. Like people, bands, diets, and everything else, a field gets discovered, plucked from obscurity, thrown into the spotlight, and quickly replaced as it becomes yesterday's news.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Neuroscience is now the popular <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">plat de jour</em>, or, perhaps better, the <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">prefix</em> <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">de jour</em>, and neurolaw is one of the main beneficiaries—and victims. Neuroscience will have important and even dramatic effects on our society and, as a result, on our laws. But not yet, and not as dramatically as some envision.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">First, consider timing. Many of the most interesting neuroscience results come from functional magnetic resonance imaging (fMRI). This technique allows us to see what parts of the brain are working and when, and thus to begin to correlate subjective mental states with physical brain states. The use of fMRI on humans goes back about 15 years, and although about 5,000 peer-reviewed scientific articles involving fMRI will be published this year, we are still trying to figure out how it works—or doesn't. The fMRI results showing apparently purposeful brain activity in dead salmon are a wonderfully funny example of some of the limits of this technology, and fMRI is one of the oldest of the "new" neuroscience technologies. Half of what neuroscience is teaching us about human brain function will be shown, in the next 20 years, to be wrong—and we will need each of those 20 years to figure out which half.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">But, second, we need a sense of proportion. Neuroscience will provide tools that will change the law in some important ways, but those tools will be neither perfect nor used in isolation, and those changes are not likely to strike at the law's roots.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">For example, neuroimaging will be able to read minds—to some extent. A scanner may be able to tell whether I am hungry and even whether I want a burger. Without my cooperation, it will not know that I want a bacon cheeseburger, hold the mayo and mustard, extra ketchup. Similarly, it can never know what I was thinking three months ago or, with certainty, what I will be thinking three months from now.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Plus, neuroscience is likely to be used in conjunction with behavioral evidence. Typically, the best way to know what someone wants to do is to see what she does. Neuroscience will rarely make usable findings about, say, competence to stand trial or insanity, without evidence about the person's actual behavior. Normally, it will provide just one piece of the puzzle and not a magic key.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Finally, law is not going to disappear because of neuroscience. Getting a better handle on what brain machinery causes certain behaviors will change the criminal justice system, but it will not make it dry up and blow away. Neuroscience evidence of mental state may ultimately be admitted in trials, but it will not restrict the roles of judges and juries to reading brain scans. The most extreme outcomes are the most interesting—as science fiction and in the popular media —but they are not the most likely.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">After all this talk about what neuroscience will <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">not</em> do, what is left? Quite a lot, I think, in five different categories: prediction, mind-reading, responsibility, "treatment," and enhancement.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Neuroscience will help us predict future mental states or behaviors, usually not alone and not perfectly, but usefully. And these will lead to legal issues. When we can accurately predict which 60-year-olds are going to be diagnosed with Alzheimer's disease in the next 15 years, those predictions will affect, among other things, employment, insurance, guardianships, financial planning, and Medicaid. If we could tell which roughly one 15-year-old in 100 will be diagnosed with schizophrenia, to what ends would we want, or allow, those predictions to be used? Or what about good predictions of who is going to commit violent crimes, either after conviction or before? We already use psychology, demographics, and personal history to make such predictions—what will we do if neuroscience can greatly improve those predictions?</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Neuroscience will help us read minds better. We all read minds constantly, but we aren't very good at it. The subjective feeling of pain depends on the brain; hundreds of thousands of legal claims each year turn on whether a person is feeling pain and, if so, how much. When neuroscience can "see" that pain, the law will change, both in individual cases and in some broad policies. Similarly, if we can ever use neuroscience to help determine whether someone is lying—a use for which substantial controlled experimental evidence already exists—how would we use such a lie detector? At least three courts have already rejected <a href="http://www.aclu.org/blog/technology-and-liberty/high-tech-mind-readers-are-latest-effort-detect-lies" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">fMRI-based lie detection evidence</a> (properly, I think), but I make no bets about the situation in 2022.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">As to responsibility, neuroscience will not turn all criminal law into psychiatry, but there will be cases in which neuroscientific evidence plays a role in deciding whether someone is competent to be tried or to represent himself, really is experiencing aural or visual hallucinations, or, in a few cases, really does seem to <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">deserve</em> a particular verdict or punishment. The case of <a href="http://www.newscientist.com/article/dn2943-brain-tumour-causes-uncontrollable-paedophilia.html" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">the child molester whose pedophile impulses were triggered by a tumor</a> is a nice example. One may question whether he should be found guilty of child molestation or, at least, sentenced to prison rather than to surgery. On the other hand, almost no child molesters will be able (credibly) to show a similarly powerful tumor. Neuroscience's effects on responsibility will mainly be retail, not wholesale.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Surgery raises the issue of "treatment." No scare quotes are needed when willing patients seek treatment for schizophrenia, Alzheimer's disease, Parkinson's disease, or obsessive-compulsive disorders. But what about the unwilling? Should a judge be able to order a defendant to get brain surgery, even if it is proven safe and effective at preventing his future crimes? Or, perhaps, not "order" surgery but give the defendant a "free choice"—life in prison or the knife? Of course, prison also changes your brain—<em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; ">everything</em>, even this article, changes your brain. We know prison is neither safe nor effective. Is it morally different from surgery?</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Finally, what about enhancement? We are spending billions of dollars to find treatments to improve the memories of people who have dementia or, perhaps, just age-appropriate memory impairment (afflicting those of us whose memories aren't as good as we remember our memories having been). What if it works—and what if it works for young people, premeds studying for an organic chemistry exam or law grads cramming for the bar? Is that like using performance-enhancing drugs in sports? Or not? Inevitably, the law must at least draw the borders of the broad social uses of brain-enhancing technologies, as well as decide how it will use those technologies in its own workings.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">I have written far more questions than answers because we are just beginning to define the questions, let alone crafting the answers. I am confident that neuroscience, fueled by biomedical research funding and impelled by the moral desire to relieve human suffering, will learn things about the workings of our brains that will spill over from medicine to society, and to law. I am not confident, but I am hopeful, that thinking about some of those dual uses ahead of time will help us manage them wisely—or, at least, less catastrophically. The time to begin—with a proper sense of both timing and proportion—is now.</div></div></div><a href="http://www.slate.com/articles/technology/future_tense/2012/10/fmri_in_court_neuroscience_may_change_the_legal_system.single.html">http://www.slate.com/articles/technology/future_tense/2012/10/fmri_in_court_neuroscience_may_change_the_legal_system.single.html</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

fMRI in court: Neuroscience may change the legal system. - Slate Magazine

his article arises from Future Tense, a partnership of  Slate , the New America Foundation, and Arizona State University that explores emerg...

Read more »

NAAEE 2012--Friday

Friday of the 2012 NAAEE conference were spent mostly learning about outdoor classrooms.<br /><br />The most helpful sessions were put on by the U.S. Fish and Wildlife Service.  They have, or are involved in two excellent habitat education programs.<br /><br />The first is the Pacific Region's Schoolyard Habitat Project Guide.  You can download a copy of the guide <a href="http://www.fws.gov/cno/pdf/HabitatGuideColor.pdf" target="_blank">here</a>.  This fantastic guide lays out the following 9 steps to a successful habitat project:<br /><br />Step 1--Form a Team.  This is a critical first step that, if skipped, can really jeopardize the future of your site.  Many of these projects are championed by one enthusiastic teacher, typically the science teacher in the school.  But, if there is no formal committee or team to delegate projects and responsibilities to, to keep informed, to keep momentum, what happens when that teacher leaves the building or retires?  The project falls by the wayside.  I've seen this happen dozens of times and it's quite frustrating.  So, if you are interested in starting a habitat improvement project at your school, form a team or committee FIRST!<br /><br />Step 2--Develop a Master Plan.  This can also make or break your plans.  I always like to say "Think BIG, Start small."  Having a Master Plan doesn't mean that once a project or idea is in the plan, you can't take it out or alter it.  Master Plans just help you stay focused and thoughtful in your efforts so that you're not wasting your time or energy going after "the next big idea."  Try to draft everything in a thoughtful, timeline oriented plan at the beginning.  You can always modify the plan as needed, but this way you'll have set goals and it won't be so overwhelming to you and your team.<br /><br />Step 3--Assess Your Project Site.  You don't know where you can go until you know where you are.  This is also a great way to involve your students from the beginning.  You need to know what you have already, how you can use what you have already, then start planning on any modifications, additions, changes, etc.  Conduct soil testing, runoff calculations, plant and animal inventories, temperature variations from various parts of the site, sunlight exposure, water sources, accessibility issues, conflicts in use, and more.  You really need to get to know your site.  This can almost be done before your Master Plan, depending on what you're hoping to do.  At the very least, you can conduct your site assessment at the same time as your developing your Master Plan. <br /><br />Step 4--Design Your Project.  This is the meat of the plan.  Create a map of your site, based on your site assessments of course.  Once you're map is done, start laying out the first few parts of your Master Plan.  Where are you going to put a butterfly garden?  Where can you put the frog pond? Do you need a foot bridge over that seasonal wet area behind the soccer field in order to get to the woods? Add it to the map! <br /><br />Step 5--Decide Your Money Matters.  How much is it going to cost to do this?  This part can be overwhelming to your team.  But don't forget, Think BIG, Start small.  Break your plan into manageable, fundable parts.  Don't try to complete it all in one year.  You'll burn yourself out for sure.  Or worse, you'll burn out your team.  Settle on what parts of the plan you want to start with and find funding for those first.<br /><br />Step 6--Install Project.  Do what you said you wanted to do! Have the students help as much as possible with this part too.  The more you involve your students, the more they will take ownership of the projects and the less likely you'll have vandalism issues, etc.  And it allows them to see the fruits of their labor.<br /><br />Step 7--Create a Maintenance Plan.  One thing that is critical is to involve your maintenance staff as early in the process as possible.  If your maintenance staff doesn't know what's going on, or worse, doesn't approve or care about your project, it's going to be hard to keep your project maintained.  You and your students can only do so much.  Make sure you involve your maintenance crew in decisions about project placement as well as maintenance schedules.<br /><br />Step 8--Use the Project.  Get outside with those students and use these wonderful sites! And their not just for science.  Art, writing, history, phys ed can all be taught using outdoor habitats.  Get creative, don't think of it as an extra thing you have to do with your students.  Just think of it as a different way of teaching.  <br /><br />Step 9--Share Your Story.  For goodness sakes, show off your hard work!!  Tell people what you're doing, the benefits, the fun, the excitement of new and creative opportunities that you're creating for your students.  Have the students tell what their learning!  Create press releases, newspaper articles, conduct dedications of the site, make signs, invite the community to participate, toot your own horn!<br /><br />These are all critical steps to a successful schoolyard habitat project.  The Schoolyard Habitat Project Guide provides helpful tips and tricks for conducting surveys of the schoolyard, field notes from experienced planners, and suggestions for projects on both urban and more rural sites that can utilize woodland, wetlands and meadows.  This guide is an invaluable tool for anyone planning an outdoor learning area.<br /><br />The Ohio Division of Wildlife has a program called WILD School Sites that follows these same philosophies about outdoor areas, just a different name.  If you'd like to be involved in Ohio's program, contact us at 1-800-WILDLIFE or <a href="mailto:outdoor.education@dnr.state.oh.us">outdoor.education@dnr.state.oh.us</a>  You can find more on our website at <a href="http://www.ohioprojectwild.org/">www.ohioprojectwild.org</a>  <br /><br /><br /><br />The second program I sat in on was a program called Nature Explore, which was actually developed by the National Arbor Day Foundation and has been championed by the USFWS in the form of several certified Nature Explore preschools at their facilities.  We heard about one at fish hatchery in Montana and the newest site at the National Conservation Training Center in West Virginia.  <br /><br />These Nature Explore classrooms are fantastic for providing outdoor learning space for little ones.  They contain areas where kids can build things with natural materials, play in the dirt and mud, look at leaves, climb and explore logs and rocks, and generally enjoy themselves in unstructured play outside.  <br /><br />If you're interested in learning more on how to become a certified Nature Explore classroom, check out their website at <a href="http://www.natureexplore.org/">www.natureexplore.org</a> <br /><br />More on the local sites tomorrow.  Enjoy!

NAAEE 2012--Friday

Friday of the 2012 NAAEE conference were spent mostly learning about outdoor classrooms. The most helpful sessions were put on by the U.S. F...

Read more »

Monday, Monday

<span style="font-weight: bold;"><a href="http://www.archidose.org/wp/">A Weekly Dose of Architecture</a> Updates:</span><br /><br />This week's dose features <a href="http://archidose.org/wp/2012/10/15/francis-a-gregory-neighborhood-library/">Francis A. Gregory Neighborhood Library</a> in Washington, D.C., by Adjaye Associates:<br /><a href="http://archidose.org/wp/2012/10/15/francis-a-gregory-neighborhood-library/"><img alt="this week's dose" src="http://archidose.org/wp/wp-content/uploads/2012/10/Oct12-15.jpg" style="cursor: move;" title="This week's dose" width="640" /></a><br /><br />The featured past dose is the <a href="http://www.archidose.org/Jul07/23/dose.html">House of Sweden</a> in Washington, D.C., by Gert Wingårdh:<br /><a href="http://www.archidose.org/Jul07/23/dose.html"><img alt="this week's dose" src="http://www.archidose.org/Jul07/23/image01.jpg" style="cursor: move;" title="featured past dose" width="640" /></a><br /><br />This week's book review is <a href="http://archidose.org/wp/2012/10/15/ai-weiwei-art-architecture/"><i>Ai Weiwei: Art | Architecture</i></a> edited by Yilmaz Dziewior (L):<br /><a href="http://archidose.org/wp/2012/10/15/ai-weiwei-art-architecture/"><img alt="this week's book review" height="300" src="http://archidose.org/wp/wp-content/uploads/2012/10/ai-weiwei.jpg" style="cursor: move;" title="This week's book review" /></a>   <a href="http://www.archidose.org/books/turrell.html"><img alt="this week's book review" height="300" src="http://www.archidose.org/books/turrell.jpg" style="cursor: move;" title="This week's book review" /></a><br />(R): The featured past book review is <a href="http://www.archidose.org/books/turrell.html"><i>James Turrell: Into the Light</i></a> edited by Claudia Giannini.<br /><br />: : : : : : : : : : : : : : : : : : : : : : :<br /><br /><span style="font-weight: bold;">World-Architects.com U.S. <a href="http://www.american-architects.com/projects/reviews/41">Building of the Week</a>:</span><br /><br /><a href="http://www.world-architects.com/en/projects/project-current-review/38470_harvest_pavilion">Harvest Pavilion</a> in New Haven, Connecticut by David Thompson Architects:<br /><a href="http://www.world-architects.com/en/projects/project-current-review/38470_harvest_pavilion"><img alt="this week's Building of the Week" src="http://c214210.r10.cf3.rackcdn.com/files/projects/38470/images/900:w/HarvestPavilion1.jpg" title="Current Building of the Week on american-architects.com" width="640" /></a>

Monday, Monday

A Weekly Dose of Architecture Updates: This week's dose features Francis A. Gregory Neighborhood Library in Washington, D.C., by Adjay...

Read more »

Saturday Reference Librarian & Substitute Reference Librarians - Avon Free Public Library

<strong>Saturday Reference Librarian</strong> & <strong>Substitute Reference Librarians</strong> - <strong><span style="color: #48286d;">Avon Free Public Library</span></strong>. Saturday, Sunday and Substitute positions available at Avon Free Public Library. One Reference librarian position wanted for Saturdays 10:00 am to 5:00 pm, rotating every third Saturday at the Avon Free Public Library. Two Reference Librarian positions wanted for alternating Sundays from January through March 1:00 p.m. - 5:00 p.m. Also, substitute reference librarians wanted to work as needed, days, evenings, or weekends at busy reference desk. MLS required. Must have excellent people skills, a strong commitment to customer service, knowledge of print and electronic resources, Internet and computer software. Public library experience and working knowledge of SIRSI library system a plus. $25.46 per hour (no benefits associated with these positions). Deadline is 4:30 p.m. on <span style="color: red;">October 25, 2012</span>. Employment application at <a _fcksavedurl="http://www.town.avon.ct.us" href="http://www.town.avon.ct.us/" target="_blank">www.town.avon.ct.us</a> (under job opportunities). Send completed application and resume to William F. Vernile, Director of Human Resources, 60 West Main Street, Avon, CT. 06001. EOE/M-F, ADA.

Saturday Reference Librarian & Substitute Reference Librarians - Avon Free Public Library

Saturday Reference Librarian & Substitute Reference Librarians - Avon Free Public Library . Saturday, Sunday and Substitute positions...

Read more »

Can You Do Too Much to Prevent a Stroke? - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><div id="well" style="color: rgb(0, 0, 0); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; " class=""><div align="left" class=""><div class="entry-content"><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><a href="http://health.nytimes.com/health/guides/disease/stroke/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Stroke</a> is the fourth leading cause of death among Americans, and a much larger contributor to chronic disability and health care costs than this ranking suggests. There's no question that preventing strokes is important. But a big question is how best to do so and in whom.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Currently, some experts say, far too many people who are free of symptoms that might herald a stroke are undergoing surgery to ream out carotid arteries that feed the brain, or are having stents inserted in these arteries, than is justified by available evidence.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Critics say these invasive procedures on asymptomatic patients are unnecessary and create a risk of serious complications like <a href="http://health.nytimes.com/health/guides/disease/heart-attack/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">heart attack</a> or, ironically, stroke itself, even death, and drive up health care costs by billions of dollars a year.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Based on the latest research, they maintain, most patients without symptoms like a mild stroke or <a href="http://health.nytimes.com/health/guides/disease/transient-ischemic-attack/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">transient ischemic attack</a> do as well - or nearly as well - with intensive medical therapy to control <a href="http://health.nytimes.com/health/guides/test/blood-pressure/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">blood pressure</a>, <a href="http://health.nytimes.com/health/guides/nutrition/cholesterol/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">cholesterol</a> and <a href="http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">diabetes</a>.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"Intensive medical therapy is a much safer way to prevent strokes caused by clots than either surgery or stenting," said Dr. David Spence, a stroke prevention specialist at the University of Western Ontario.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">But surgeons, even those who acknowledge the limitations of current research, say <a href="http://health.nytimes.com/health/guides/surgery/carotid-artery-surgery/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">carotid endarterectomy</a>, as the reaming operation is called, is the treatment of choice for many patients with serious blockages in one or both carotid arteries. That sentiment also is reflected in guidelines from the Society of Vascular Surgeons and the American Heart Association.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Michael Belkin, the chief of vascular and endovascular surgery at Brigham and Women's Hospital in Boston, who performs scores of endarterectomies each year, said, "In asymptomatic patients with high-grade carotid stenosis, meaning a blockage of 70 percent or greater, surgical therapy is better than medical therapy."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">But he emphasized that good surgical results depended on selecting patients who have at least a five-year life expectancy and are healthy enough to tolerate the operation. He also said the procedure should be done only by a surgeon with a good track record and lots of experience, someone who does at least 70 or 80 of the operations each year.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"This is an elective procedure," Dr. Belkin said. "Patients should be well-informed about the benefits and risks and not bullied into it."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><strong class="">To <a href="http://health.nytimes.com/health/guides/surgery/stent/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Stent</a> or Not</strong></div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Belkin and other experts are less sanguine about inserting stents in asymptomatic patients. They said pressure was being exerted by manufacturers of stents, who would like to see them as widely used as possible. Stents, which are threaded through a catheter from the groin to the carotid arteries in the neck, are used to keep an artery open after a balloon presses the plaque against the artery's walls.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"Stents are pretty good, but not as good as surgery for asymptomatic disease," Dr. Belkin said.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Still, many cardiologists who insert stents into coronary arteries to prevent heart attacks are now stenting partly blocked carotids in hopes of preventing strokes in patients otherwise free of symptoms.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Frank J. Veith, a vascular surgeon affiliated with New York University and the Cleveland Clinic, called carotid stenting in asymptomatic patients by interventional cardiologists "a moneymaking free-for-all" that doesn't take into account vital differences between arteries to the heart and those to the brain, which has more vessels feeding it.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Spence said, "Cardiologists have no business messing with carotid arteries."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">There is "a natural bypass called the Circle of Willis at the base of the brain to which all four arteries that feed the brain are connected," he said. "If one artery is blocked, blood gets to the brain through the other three."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Despite pleas from interventional cardiologists, <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Medicare</a> has thus far declined to cover the costs of carotid stents in low-risk patients without better evidence of their benefit.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Complicating the issue is that only about one-quarter of strokes result from carotid disease. The rest are caused by problems like clots coming from the heart and ruptured blood vessels in the brain. So treating carotid arteries surgically or with stents is no guarantee against a stroke.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Another problem is identifying patients without symptoms of carotid disease who do face a high risk of stroke, Dr. Veith said. About 50 of his patients with severe carotid disease have remained free of strokes for years, he said.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><a href="http://health.nytimes.com/health/guides/test/ultrasound/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Ultrasound</a> is most often used to screen for carotid disease, which may also be suggested by a whooshing sound in the neck, called a bruit, heard through a stethoscope.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><strong class="">Reducing the Risks</strong></div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">No one questions that surgery or stenting is advisable for patients with symptoms if they are healthy enough to undergo the procedure. But for patients who lack symptoms, all sides agree that a trial comparing the benefits and risks of surgery, stenting and modern medical therapy is sorely needed.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Until that study is done, the controversy will continue over how to best treat carotid disease in patients without symptoms.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">For example, Harvard Medical School experts recently stated that before carotid surgery or stenting is recommended, doctors should consider that "medical treatment is preferred for symptomatic patients with mild narrowing and also for many asymptomatic patients with moderate or even severe narrowing. And even patients who undergo artery-opening procedures need long-term medical therapy."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Spence, noting that <a href="http://stroke.ahajournals.org/content/41/10_suppl_1/S31.full.pdf+html" style="color: rgb(0, 0, 102); text-decoration: none; " class="">the main study used to justify invasive treatment, called Crest</a>, enrolled patients in 1995, said, "Interventionists are using old data to justify procedures now not warranted because the risk of stroke in asymptomatic patients has changed dramatically since then."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">These reductions in stroke risk, Dr. Spence said, are the result of better drugs to treat <a href="http://health.nytimes.com/health/guides/disease/hypertension/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">high blood pressure</a>, lower cholesterol and prevent clots; stopping smoking; and improved control of blood sugar in people with diabetes.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Veith said statin therapy is primarily responsible for reducing the risk of stroke in asymptomatic patients to a level equivalent to the benefits of surgery or stenting. <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/statins_cholesterollowering_drugs/index.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Statins</a> are mainly used to lower artery-damaging cholesterol, but the drugs also stabilize arterial plaque, preventing pieces from breaking off and blocking small blood vessels in the brain where they would cause a stroke.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dr. Spence is a strong advocate of a traditional Mediterranean <a href="http://health.nytimes.com/health/guides/specialtopic/food-guide-pyramid/overview.html?inline=nyt-classifier" style="color: rgb(0, 0, 102); text-decoration: none; " class="">diet</a>, high in whole grains, fruits and vegetables, lentils and beans, olive oil and canola oil and low in cholesterol and animal fats.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"Americans tend to name their meals by the meat. 'Tonight we're having steak, or chicken or fish,' " he said. "I recommend that my patients go vegetarian every other day, and when they eat meat, chicken or fish on the days in between, the portion should be the size of the palm of their hand."</div></div></div></div></div><a href="http://well.blogs.nytimes.com/2012/10/15/can-you-do-too-much-to-prevent-a-stroke/?pagewanted=print" class="">http://well.blogs.nytimes.com/2012/10/15/can-you-do-too-much-to-prevent-a-stroke/?pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><br class="webkit-block-placeholder"></div>

Can You Do Too Much to Prevent a Stroke? - NYTimes.com

Stroke  is the fourth leading cause of death among Americans, and a much larger contributor to chronic disability and health care costs than...

Read more »

rug-less dining rooms

I'm currently working on a little experiment in the <a href="http://news-these-days.blogspot.com/p/dining-room.html" target="_blank">dining room</a>. As much as I love that big chunky sisal rug, it is a pain in my arse. It is not very easy to clean when little ones drop their food and it sheds like a...something that sheds a lot. It's like having another dog in the house.<br /><br />So after cursing at it and complaining about it, I had the hubs help me to roll it up and take it out. Just to see how it felt.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwzbwK0VDR3mxPDHRVhdh8r2FsDUpX3fhdsXVGrCc3ET1ZDJlv_VoBRF8U4G9FqZE754Eb6zG4S4mX5W1iLlBPFhVCFG0cGfC9wSjSkMtgmNINqrCrou47RdBJDZEeviQbjx0TyxsSlsL_/s1600/DiningRoomLBD2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="587" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwzbwK0VDR3mxPDHRVhdh8r2FsDUpX3fhdsXVGrCc3ET1ZDJlv_VoBRF8U4G9FqZE754Eb6zG4S4mX5W1iLlBPFhVCFG0cGfC9wSjSkMtgmNINqrCrou47RdBJDZEeviQbjx0TyxsSlsL_/s640/DiningRoomLBD2.jpg" width="640" /></a></div><br />And so far I'm loving it. It's like cutting off all your hair, or a long hot shower after a camping trip. I feel lighter, and my vacuum is happy for a rest.<br /><br />I was a bit perplexed about a room without a rug but the more I see it around, the more I like it.<br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAkoXnPcsPiMVIGqfWiwlbOVo_sn7iytNqXZpKwiRJW44VKyZ9nrV-zKmDRD9FFTjzNXjiTG5tTkcl8PfIMkt6qGI7XjdxXzIh4fAS7Hqx9kB-x2n46kpsfW0__BQydvpdZgvtcisfuErp/s1600/Home+of+Tanja+Vibe+of+ATWTP.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAkoXnPcsPiMVIGqfWiwlbOVo_sn7iytNqXZpKwiRJW44VKyZ9nrV-zKmDRD9FFTjzNXjiTG5tTkcl8PfIMkt6qGI7XjdxXzIh4fAS7Hqx9kB-x2n46kpsfW0__BQydvpdZgvtcisfuErp/s640/Home+of+Tanja+Vibe+of+ATWTP.jpeg" width="571" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Home of Tanja Vibe via <a href="http://pinterest.com/pin/6896205650685115/" target="_blank">Pinterest</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi06Ka8oUK0OvJ_21EMbasnLDDkOPMzuyxvlGDhqpReoWXPqwIrEeyW7w0QnHX6ya8vGKmwMpNU9Bmcwmx2raXTXrLjlpJ5AZIQFd3gCW83kfV_r9Lab4pE3-HPIA-3IyBfyXcGe0BXN4Nu/s1600/welcome-to-our-house.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi06Ka8oUK0OvJ_21EMbasnLDDkOPMzuyxvlGDhqpReoWXPqwIrEeyW7w0QnHX6ya8vGKmwMpNU9Bmcwmx2raXTXrLjlpJ5AZIQFd3gCW83kfV_r9Lab4pE3-HPIA-3IyBfyXcGe0BXN4Nu/s640/welcome-to-our-house.jpeg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://absolutelybeautifulthings.blogspot.com/2008/12/welcome-to-our-house.html" target="_blank">Anna Spiro</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoF-nfyfve42HgM3-QvJI3Jy01alB_LTjflKsjqkekb1zKfw1UK-_gdplu8MbevxRFIZuiPB9AeQixuCdO40rOwpXaYeyFlnjeJyIiChg2_C1yKxq0ut_u6q1b-NBlckLZcTixdgS8eow_/s1600/mr-banks-beforeafter-entryway-living-dining-rooms.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoF-nfyfve42HgM3-QvJI3Jy01alB_LTjflKsjqkekb1zKfw1UK-_gdplu8MbevxRFIZuiPB9AeQixuCdO40rOwpXaYeyFlnjeJyIiChg2_C1yKxq0ut_u6q1b-NBlckLZcTixdgS8eow_/s640/mr-banks-beforeafter-entryway-living-dining-rooms.jpeg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.peppermintbliss.com/2012/06/mr-banks-beforeafter-entryway-living-dining-rooms/" target="_blank">Bailey McCarthy</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw1sygpovwCVjA81AsmXou7Gvjr-vO_dJYe4h-ACX6y1hbPNP2goRLxVVggdjbmiMR6I9wmNyRRoQnGRUPIrOkpsg8j3lkHSTVP3LLn2fpkFH8mvVbhx7a2PenIcL3RDCAxC-yZ_gx0mfr/s1600/perfect-gray.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="448" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw1sygpovwCVjA81AsmXou7Gvjr-vO_dJYe4h-ACX6y1hbPNP2goRLxVVggdjbmiMR6I9wmNyRRoQnGRUPIrOkpsg8j3lkHSTVP3LLn2fpkFH8mvVbhx7a2PenIcL3RDCAxC-yZ_gx0mfr/s640/perfect-gray.jpeg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Nate Berkus via <a href="http://pinterest.com/pin/6896205649654902/" target="_blank">Pinterest</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmitGxHdUcUs0BIqhLmjFNnYDDkfYC_0UK2v4GL9cw3dZ8L5cO1uzCMTJNN9hqxbWtY2IOMXOh6PnAOuwW9pX0e27Cna3aRTw3WU9eAT5mXWSmD-ptxBu8tbx0fB-HABDSI7vXt_9fZAn2/s1600/search.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmitGxHdUcUs0BIqhLmjFNnYDDkfYC_0UK2v4GL9cw3dZ8L5cO1uzCMTJNN9hqxbWtY2IOMXOh6PnAOuwW9pX0e27Cna3aRTw3WU9eAT5mXWSmD-ptxBu8tbx0fB-HABDSI7vXt_9fZAn2/s640/search.jpeg" width="510" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.elledecor.com/" target="_blank">Elle Decor</a> via <a href="http://pinterest.com/pin/6896205649144107/" target="_blank">Pinterest</a></td></tr></tbody></table><div>So, a dining room without a rug (gasp). What do you think?</div>

rug-less dining rooms

I'm currently working on a little experiment in the dining room . As much as I love that big chunky sisal rug, it is a pain in my arse. ...

Read more »

AN IWS Vlog....Matt-Man's Fridge

<div dir="ltr" style="text-align: left;" trbidi="on">As you freaks know, Jayman did a vlog last week showing the <a href="http://news-these-days.blogspot.com/2012/10/whats-in-jays-wallet.html" target="_blank"><i><span style="color: blue;">contents of his wallet.</span></i></a><br /><br />Well, in keeping with the video magic that he began, I offer this video of me, half asleep, taking you on a journey of the Bagwine fridge, freezer, and cabinets.<br /><div style="text-align: center;"><br /></div><div style="text-align: center;"><iframe allowfullscreen="allowfullscreen" frameborder="0" height="315" src="http://www.youtube.com/embed/WmZELZzccPM" width="560"></iframe><br /></div><br />And don't forget...Yesterday, Jayman and I talked about all the guys we'd like to get hot with as we presented another sure to be Number One IWS Radio Show.<br /><br />If you missed it, you can catch it it right here:<br /><br /><div style="text-align: center;"><object classid="clsid:D27CDB6E-AE6D-http://www.blogtalkradio.com/im-with-stupid/2012/10/14/man-crush-show11cf-96B8-444553540000" codebase="http://download.adobe.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,0,0" height="105" id="143577" name="143577" width="210"><param name="movie" value="http://www.blogtalkradio.com/btrplayer.swf?file=http://www.blogtalkradio.com%2Fplaylist.aspx%3Fshow_id%3D3882849&autostart=false&bufferlength=5&volume=80&corner=rounded&callback=http://www.blogtalkradio.com/flashplayercallback.aspx" /><param name="quality" value="high" /><param name="wmode" value="transparent" /><param name="menu" value="false" /><param name="allowScriptAccess" value="always" /><embed src="http://www.blogtalkradio.com/btrplayer.swf" flashvars="file=http://www.blogtalkradio.com%2Fplaylist.aspx%3Fshow_id%3D3882849&autostart=false&shuffle=false&callback=http://www.blogtalkradio.com/FlashPlayerCallback.aspx&width=210&height=105&volume=80&corner=rounded" width="210" height="105" type="application/x-shockwave-flash" pluginspage="http://www.macromedia.com/go/getflashplayer" quality="high" wmode="transparent" menu="false" name="143577" id="143577" allowScriptAccess="always"></embed></object></div><div style="font-size: 10px; text-align: center; width: 220px;"></div></div>

AN IWS Vlog....Matt-Man's Fridge

As you freaks know, Jayman did a vlog last week showing the contents of his wallet. Well, in keeping with the video magic that he began, I o...

Read more »

A Hospital Says ‘No’ to an $11,000-a-Month Cancer Drug - NYTimes.com

<base href="data:"></base>At Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancer drug to our patients.<br /><br />The reasons are simple: The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price — at $11,063 on average for a month of treatment — is more than twice as high.<br /><br />In most industries something that offers no advantage over its competitors and yet sells for twice the price would never even get on the market. But that is not how things work for drugs. The Food and Drug Administration approves drugs if they are shown to be "safe and effective." It does not consider what the relative costs might be once the new medicine is marketed.<br /><br />By law, Medicare must cover every cancer drug the F.D.A. approves. (A 2003 law, moreover, mandates payment at the price the manufacturers charge, plus a 6 percent cushion.) In most states private insurers are held to this same standard. Physician guideline-setting organizations likewise focus on whether or not a treatment is effective, and rarely factor in cost in their determinations.<br /><br />Ignoring the cost of care, though, is no longer tenable. Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver.<br /><br />This is particularly the case with cancer, where the cost of drugs, and of care over all, has risen precipitously. The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000. Two of the new cancer drugs cost more than $35,000 each per month of treatment.<br /><br />The burden of this cost is borne, increasingly, by patients themselves — and the effects can be devastating. In 2006, one-quarter of cancer patients reported that they had used up all or most of their savings paying for care; a study last year reported that 2 percent of cancer patients were driven into bankruptcy by their illness and its treatment. One in 10 cancer patients now reports spending more than $18,000 out of pocket on care.<br /><br />Which brings us back to our decision on Zaltrap. In patients with advancing, metastatic colorectal cancer, the new drug, approved by the F.D.A. in August and jointly marketed by Sanofi and Regeneron, offers the same survival benefit as Genentech's Avastin, which works through a similar molecular mechanism. When compared with the standardchemotherapy regimen alone, adding either medicine has been shown to prolong patient lives by a median of 1.4 months. Major clinical practice guidelines, like those from theNational Comprehensive Cancer Network, agree that Zaltrap is no better than Avastin in this setting. (Full disclosure: Two of us, Dr. Bach and Dr. Saltz, have been paid consulting fees by Genentech.)<br /><br />But Avastin costs roughly $5,000 a month: very expensive in its own right, yet less than half of Zaltrap's price tag. And while the side effects in both drugs are roughly equal, doses of Avastin generally take less time to administer than those of Zaltrap, which makes Avastin more convenient for patients.<br /><br />Consider that colorectal cancer is typically diagnosed in older individuals and the cost issue becomes starker still. Many patients are on Medicare and living on fixed incomes. And because Medicare requires patients to co-pay for cancer drugs, 20 percent of the cost of drugs like Zaltrap and Avastin is passed on — absorbed either by supplemental insurance or by the patients themselves.<br /><br />To put these percentages in perspective, an older colorectal cancer patient without extra insurance would have to pay more than $2,200 out of pocket for a month's treatment with Zaltrap. That's greater than the monthly income for half of Medicare participants.<br /><br />Once you take all this into account it may seem surprising that the decision to exclude Zaltrap from our hospital's formulary was a hard one to make. But because our medical culture equates "new" with "better" so unequivocally, a decision like this one can seem out of place at a leading cancer hospital<br /><br />Political rhetoric today is similarly slanted. Our refusal to adopt this remarkably expensive therapy risks being labeled "rationing," not rational.<br /><br />This political climate also helps explain why the Affordable Care Act precludes Medicare from changing its coverage or payment amounts based on cost comparisons like the one we have outlined, even when two drugs appear to work equally well. And it is probably why neither presidential candidate has addressed runaway cancer drug prices.<br /><br />But if no one else will act, leading cancer centers and other research hospitals should. The future of our health care system, and of cancer care, depends on our using our limited resources wisely.<br /><br />The current level of spending on health care, estimated to be $2.8 trillion this year, is already too high. The growth rate in health spending is unsustainable.<br /><br />Of course, we know our decision about Zaltrap will not meaningfully address these larger problems. Projected United States sales of Zaltrap in 2013 are less than $150 million, or 0.005 percent of all dollars spent on health care. Our use would account for a very small percentage of even that number.<br /><br />But it is a step in the right direction — one of many we need to take.<br /><br /><i>The writers are doctors at Memorial Sloan-Kettering Cancer Center. Peter B. Bach is the director of the Center for Health Policy and Outcomes, Leonard B. Saltz is chief of the gastrointestinal oncology service and chairman of the pharmacy and therapeutics committee, and Robert E. Wittes is the physician in chief.</i><br /><div><br /><a href="http://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html?_r=1">http://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html?_r=1</a><br /><br /></div>

A Hospital Says ‘No’ to an $11,000-a-Month Cancer Drug - NYTimes.com

At Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenom...

Read more »

Is psychiatry committing 'professional suicide'? - CNN.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">British psychiatrist and Big Pharma gadfly David Healy is so controversial amongst his colleagues that some have tried to have his medical license revoked — but there he was, speaking at the American Psychiatric Association's (APA) second largest annual meeting at a well-attended session on conflicts of interest.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"It's a miracle that I was asked along to give a talk [here], and I'm extremely grateful," Healy said.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">His disquisition was perhaps less humble.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Arguing that his profession is "committing professional suicide" by failing to address its dangerously close relationship with the pharmaceutical industry, he likened psychiatry's attitude toward its faltering legitimacy to the Vatican's widely derided response to its child-sex-abuse scandal by priests — essentially that psychiatry is brushing off justifiable concerns as hype instead of dealing with the source of the problem.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Few experts believe that psychiatry's relationship with the drug industry is healthy. While several speakers at the session pointed out that other specialties are similarly entangled with industry, "everyone does it" is generally not a valid defense where conflicts of interest are concerned.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">The conflicts throughout medicine — not just in psychiatry — are clear. In 2004 alone, pharmaceutical companies spent about $58 billion on marketing, 87% of which was aimed squarely at the roughly 800,000 Americans with the power to prescribe drugs.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The money was spent mainly on free drug samples and sales visits to doctors' offices; studies find that both free samples and sales calls increase prescribing of brand-name drugs and raise medical costs without improving care.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Moreover, nearly half of all continuing medical-education classes are sponsored by industry. By their third year of medical school, 94% of psychiatrists in training have already accepted a "small noneducational gift or lunch" from a drug company, according to Dr. Paul Appelbaum, a past president of the APA and director of Columbia University's Division of Law, Ethics and Psychiatry, who spoke on the panel with Healy.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">And while only 34% psychiatrists believe that receiving food or gifts affects their own prescribing patterns, 53% believe that it influences that of their colleagues, according to a study cited by Appelbaum. Research shows that this type of thinking —</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Everyone else is prone to biases and social factors, but not me!" — is common and confounds attempts to address conflicts. "At least some of our colleagues are wrong," Appelbaum said drily of the study.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Healy's jeremiad was more severe and sharply worded, but it seemed to be well received by the psychiatrists assembled in the audience. Many even asked questions that suggested they too were troubled by the status quo.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I'm going to argue that we need you to be biased. We want you to be biased by treatments that work," Healy told his colleagues. "I don't mind if you're my doctor and you've given talks for industry. My concern is not that you've been paid by industry, but that you've been fooled by industry. The key conflict is whether people are hiding data from you."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">Healy went on to discuss how drug companies have repeatedly concealed important information about the risks of their medications, whether by hiring ghostwriters to spin the results of scientific studies and then getting renowned experts to put their names on the published papers; by employing tricks in clinical trials like using inadequate doses of comparison medications to make the company's own drug look better; or by simply keeping unfavorable data out of the public domain.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Healy himself has also been targeted directly by drug companies that haven't been happy with his critiques. In fact, he's widely believed to have lost an academic job offer at the University of Toronto as a result of one such critical lecture.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">At the session on Thursday, one slide in his presentation contained information he sought via a Freedom of Information Act request detailing drugmaker Eli Lilly's strategy for shutting Healy down. To counter his public insistence that drug companies reveal hidden drug data, Eli Lilly proposed doing things like planting confederates in the audience of his presentations to ask questions that support industry's view.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Healy also described how in his own attempts to publish formerly hidden data — which all now reside in the public domain — he encountered legal issues with journals, which ultimately resulted in rejection of publication. The clinical-trial data in question in this case showed a greater risk of suicidal acts associated with antidepressants than had previously been revealed.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Healy also referenced hidden data from trials of the antipsychotic drug Zyprexa.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"None of them mentioned [that the drug could cause] <a href="http://topics.time.com/diabetes/" target="_blank" style="padding: 0px; margin: 0px; border: 0px; font-weight: inherit; font-style: inherit; font-size: 14px; font-family: inherit; vertical-align: baseline; text-decoration: none; color: rgb(0, 66, 118); outline: 0px; ">diabetes</a> or [had] the highest suicide rate in clinical-trial history," he said.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Although drug companies are now required by medical journals to register all of their clinical trials with the National Institutes of Health if they wish to publish them — including those that never end up being published — this is not a legal requirement. They can still hide relevant data from the Food and Drug Administration by not disclosing trials that they never attempt to submit to a journal.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Healy noted further that when data surfaced showing a link between antidepressant use and risk of suicide in children, the APA issued a statement proclaiming that "we believe that antidepressants save lives."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">"What I believe they should have said is that the APA believes that psychiatrists can save lives because it takes expertise to manage the risks of risky pills," he said; if psychiatrists' only role were to dole out drugs, then less trained physician's assistants could easily replace them, he noted.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">But when a questioner, claiming himself "speechless" in the face of Healy's arguments, asked whether he should just stop prescribing antidepressants, Healy said no. Healy prescribes them himself, but believes that the role of the doctor is to manage risks, not view drugs as harmless. "Medical treatment is poison, and the art of medicine is trying to find the right dose," he said.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">As for what could be done to disentangle medicine from industry, Healy wasn't entirely pessimistic.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"The key issue in the short term is access to data. We have to insist on that," he said. "We let industry come to our meetings and let them talk in our programs. I don't think it's huge problem that they get paid. The big problem is that if you ask for data, they can't give it to you. That's not science, that's marketing masquerading as science."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But what of the issue of doctors being visited by paid-industry types — or being paid by industry themselves? The panel's organizer, Dr. Daniel Carlat, director of the Pew Prescription Project, noted a new disclosure law, passed as part of President Obama's health-reform bill in 2010.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Under the legislation, drug companies must reveal which doctors have taken any payment or gift from them worth more than $10, and describe the exact amounts taken and the purpose for them on a publicly available website. (Unfortunately that website will not be up and running until 2014 at the earliest.) All of the panelists agreed, however, that while public disclosure is good, it is not enough.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Dr. Roy Perlis, who heads the Center for Experimental Drugs and Diagnostics at Massachusetts General Hospital, cited research showing that disclosure can actually backfire in unexpected ways. In one study, for example, people were asked to estimate the number of coins in a jar and provided an "adviser" to help them guess. Unbeknownst to them, the adviser had been paid to try to push people to make higher estimates than they otherwise might.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">In one condition of the trial, participants were told in advance that the adviser had this bias, but that made matters worse. Under this circumstance, the adviser encouraged participants to make even higher estimates than in the situation without disclosure.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">"There are two different mechanisms" to explain the phenomenon, says Perlis. "One is strategic exaggeration: 'I know you're going to discount what I say, so I deliberately will be more effusive and tell you a higher number.' The other is so-called moral licensing: 'I've disclosed my conflict, therefore I'm allowed to be biased.' This very thing may well also play out when disclosing conflicts of interest in medicine."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Maran Woolston, a woman with multiple sclerosis, also spoke on the panel about how betrayed she felt when she learned her doctor had referred much of her care to a drug-company subsidiary, but had not revealed it to her — and had also taken $300,000 in funding from various drugmakers.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">"In my opinion, transparency isn't a silver bullet," she said. "My ideal solution — and this may be naive — is that [doctors should] accept no payments whatsoever because then there can be no conflict of interest."</div></div><a href="http://www.cnn.com/2012/10/09/health/psychiatry-professional-suicide/?iref=obinsite">http://www.cnn.com/2012/10/09/health/psychiatry-professional-suicide/?iref=obinsite</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Is psychiatry committing 'professional suicide'? - CNN.com

British psychiatrist and Big Pharma gadfly David Healy is so controversial amongst his colleagues that some have tried to have his medical l...

Read more »

Tracking a killer: Cell phones aid pioneering malaria study in Kenya - CNN.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">If you're going to pursue an elusive killer, you sometimes have to get creative.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">A pioneering study into malaria transmission in Kenya, using data gleaned from the cell phones of nearly 15 million people, has given scientists new clues into how the deadly disease spreads.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">By tracking the population's movement over a year using cell phone data and comparing it with detailed information on malaria infection rates across the country, the study reveals how human travel contributes to the disease's spread.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The study, led by researchers at Harvard School of Public Health and seven other institutions, could inform how governments -- particularly in sub-Saharan Africa -- act in future to control the disease's spread. Malaria deaths are concentrated in that part of the continent.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Published in the journal Science on Thursday, the study, "Quantifying the impact of human mobility on malaria," gives key insights into a disease that kills a child a minute in Africa, according to the World Health Organization.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">"This is the first time that such a massive amount of cell phone data -- from millions of individuals over the course of a year -- has been used, together with detailed infectious disease data, to measure human mobility and understand how a disease is spreading," said senior author Caroline Buckee, an assistant professor of epidemiology at Harvard.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Since the disease is passed on to humans by mosquitoes that carry the malaria parasite, the movement of infected people into areas of lower incidence is an important factor.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Between June 2008 and June 2009, lead author Amy Wesolowski, a Carnegie-Mellon doctoral student, and her team mapped every call or text made by 14,816,521 Kenyan mobile phone subscribers to one of 11,920 cell towers in 692 different settlements.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">This allowed them to follow the destination and duration of each trip made from the cell phone user's primary place of residence.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Using detailed data from a malaria prevalence map for 2009, drawn up by the Kenya Medical Research Institute and the Malaria Atlas Project, the researchers determined that malaria largely emanates from western Kenya's Lake Victoria region and spreads east, chiefly toward the capital, Nairobi.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The team "found that a surprisingly large fraction of 'imported' infections — that is, infections that are carried by people moving from one place to another — wind up in Nairobi, with infected residents returning there after journeys to spots such as Lake Victoria or the coast," the news release says.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">This may lead to an increased risk of local transmission within Nairobi and its surrounding areas, despite the lower number of mosquitoes, or "malaria vectors," in urban areas.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The research suggests that efforts to control malaria could benefit from a focus on "source" areas where incidence is high, rather than on areas where fewer people are infected. Human travel patterns mean the parasite is likely repeatedly to be carried back to areas where it has been almost eliminated.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The study advises that on a very local scale, "hot spots of transmission can be targeted by indoor residual spraying, vector habitat removal, insecticides, drug administration, and bed-net use."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">But attempts to control transmission by targeting human travel between regions "will be completely different from those that concentrate on local transmission hot spots, focusing on communicating risks to travelers to alter their behaviors, restricting travel patterns, and/or conducting routine surveillance in high-risk areas."</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">This could mean encouraging people from areas of high prevalence to use insecticide-treated bed nets when traveling to areas of lower malaria incidence to avoid bringing the parasite with them.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">It also advises visitors to areas such as Lake Victoria to take greater care not to become infected before their return home.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Wesolowski acknowledges certain limitations such as following only cell phone users in areas where there are cell towers and inability to track people's cross-border movements.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">However, the importance of such research into one of the world's largest preventable causes of death should not be underestimated.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">There were about 216 million cases of malaria worldwide in 2010 and about 655,000 deaths from the disease that year, according to the World Health Organization.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Understanding and preventing the disease's spread from areas of high incidence is a key weapon in the fight against malaria.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The innovative research could also point the way for other studies into infectious diseases, helped by ever growing rates of cell phone usage worldwide, and particularly in the developing world.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">"As mobile phone data sets become increasingly available and representative of entire populations, we anticipate that studies like the one we present here will become common for understanding a range of different infectious diseases, as well as for gaining greater insight into human behavior on a population level," the study's authors say.</div><div style="padding-top: 0px; padding-right: 24px; padding-bottom: 19px; padding-left: 186px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; font-family: arial; vertical-align: baseline; font-variant: normal; line-height: 19px; color: rgb(0, 0, 0); letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">The WHO's 2011 world malaria report shows that concerted efforts to tackle the disease can make a difference, with death rates down by more than 25% globally since 2000.</div></div><a href="http://www.cnn.com/2012/10/13/health/kenya-malaria/index.html" class="">http://www.cnn.com/2012/10/13/health/kenya-malaria/index.html</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><br class="webkit-block-placeholder"></div>

Tracking a killer: Cell phones aid pioneering malaria study in Kenya - CNN.com

If you're going to pursue an elusive killer, you sometimes have to get creative. A pioneering study into malaria transmission in Kenya, ...

Read more »