Jun
27
2017
Sleep is essential and yet many people get insufficient sleep or have poor sleep quality. A recent review gives the following stats:
Population studies show that sleep deprivation and disorders affect many more people worldwide than had been previously thought. A recent study found 20% of 25–45 year-olds slept “90 minutes less than they needed to be in good shape”. Insomnia is the most common specific sleep disorder, with ‘some insomnia problems over the past year’ reported by approximately 30% of adults and chronic insomnia by approximately 10%. Prevalence of obstructive sleep apnoea, characterized by respiratory difficulties during sleep, is also very high with estimates of 9–21% in women and 24–31% in men.
The CDC considers poor sleep a public health problem. As a practicing physician these statistics also match my experience. Poor sleep is comorbid with many neurological conditions I treat, such as migraine. What I find interesting is how many patients I see who are having frequent migraines, they have fatigue, have difficulty with weight control, and are having difficulty with concentration and short-term memory. Further, when asked they report having terrible sleep, and yet they did not volunteer this information or make any connection to their other symptoms.
What this tells me is that people under-appreciate the importance of sleep and the negative consequences of chronic poor sleep. In fact, many patients are initially dismissive of the idea that poor sleep could be a major explanation for their symptoms. They are used to having poor sleep and that is now their normal.
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Jun
26
2017
At the recent Starmus Festival, Stephen Hawking expressed some interesting ideas worth exploring. They are nothing new, especially for Hawking, but he seems to be speaking with more urgency on this issue. Essentially Hawking thinks that the human species needs to spread out off the Earth if we are going to survive long term. Here are his specific points:
- The Earth is not sustainable, and so we need to spread out.
- The Earth is at risk and therefore spreading out to other worlds will be a hedge against extinction events, like asteroids.
- Exploring the solar system and beyond will unite humanity.
He specifically recommends colonizing the Moon and visiting Mars (apparently with longer term plans for colonization). I partially agree with Hawking. I tend to disagree with him on the first point. To be fair, he does say we need to tackle global warming and take care of the Earth, but he also seems to be pessimistic about our chances. He also mentions that he is talking about surviving for the next million years, and so he is talking long term.
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Jun
23
2017
Recently I have been vacillating between two different views of humanity. On the one hand, we all share a core neuropsychology. We are all struggling to get through life with our humble meat machines, complete with cognitive biases, flawed perception and memory, and irrational tendencies.
On the other hand, it often seems like there are fundamentally different kinds of people in the world. I guess it depends on whether you focus on what we have in common, or what separates us. Articles like this make it difficult not to focus on the latter.
This has been circulating recently so you probably have already seen it – Paltrow’s wretched hive of scum and quackery she calls Goop is promoting a product called Body Vibes. This is the bottom of the barrel of pure pseudoscientific nonsense wrapped in holistic bling. The claims are also nothing new – your body has an energy frequency, and our little sticker (or bracelet, amulet, fez, whatever) will balance your energy vibrations and cure what ails you.
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Jun
22
2017
Perhaps the EU is trying to make the UK feel a little better about their Brexit vote. The highest court of the EU, the Court of Justice (is there another kind?) released a decision regarding a recent case in which a man blames his multiple sclerosis (MS) of the Hepatitis B vaccine.
The pronouncement was not a decision on this specific case, but general guidance for EU courts on how to evaluate evidence of a possible causal link between a product and alleged harm. I’ll discuss the general principles at stake first, and then the details of this specific case.
The current standard is that anyone claiming damage from a product has the burden or proof to demonstrate that there is a defect in the product and that defect caused harm. The current ruling deals with the threshold for meeting that burden of proof. They write:
“In the present case, the Court considers that the temporal proximity between the administering of a vaccine and the occurrence of a disease, the lack of personal and familial history of that disease, together with the existence of a significant number of reported cases of the disease occurring following such vaccines being administered, appears on the face of it to constitute evidence which, taken together, may lead a national court to consider that a victim has discharged his burden of proof. That could be the case inter alia where that evidence leads the court to consider, first, that the administering of the vaccine is the most plausible explanation for the occurrence of the disease and, second, that the vaccine therefore does not offer the safety that one is entitled to expect.”
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Jun
20
2017
Acupuncture still doesn’t work. We have thousands of studies collectively showing that it does not matter where you stick the needles or even if you stick the needles. Acupuncture is an elaborate placebo, and nothing else. It is not based on any sound scientific principles or knowledge about anatomy or neurophysiology. It is as much a scientific dead end as homeopathy, the ether, phrenology, and the four humors.
This, of course, creates a dilemma for acupuncture proponents. For a few decades they have been crying for scientific study of what they are sure (from their own anecdotal experience and philosophy) must work, but as the science came in it showed that their favorite treatment did not work. For a while you can get away with criticizing the studies – they are not doing it right. But then acupuncturists design and carry out more and more rigorous studies, accounting for all their criticisms, and acupuncture still doesn’t work.
We are definitely way past the point (thousands of studies over several decades) to conclude that acupuncture is a lost cause. Any intellectually honest scientist at this point would have to conclude they were wrong, and move on. Because this is medicine, and not just abstract science, there is also an ethical component. I could argue that it is now unethical to stick acupuncture needles into patients because we have sufficient evidence to conclude doing so is of zero benefit, and is also invasive and carries some risk.
That, of course, is not what happened. Instead acupuncturists ignored the research, or continued to nitpick and deny. Or they just cherry pick the studies that show what they want (even if they have to misinterpret them). But still they want to sell acupuncture as a modern science-based treatment, but pesky high quality studies keep getting in the way.
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Jun
19
2017
It seems that for every major practice in the world there is someone who will add an unnecessary layer of woo or pseudoscience. This is generally done for marketing, appealing to the emotions, which I guess is the underlying problem – that there is a market for feel-good pseudoscience. Sometimes the practice is philosophy-based, but that is just a way of saying that the pseudoscience is embedded in the culture.
Yoga is a good example. Start with stretching and exercise and mix in gratuitous woo. Massage is similar – there’s nothing wrong with getting a good massage, and it can relax tight muscles. Too often, however, they feel the need to talk about releasing toxins or activating your chi.
In other cases the process is the reverse, the pseudoscience came first and real science is just a patina on top to help make it more palatable. Naturopathy is a good example of this – it is based almost entirely on various pseudoscientific practices, like homeopathy, water cures, and nutritional pseudoscience. They throw in, however, some common-sense advice about diet and exercise and market themselves as lifestyle practitioners. They are defined, however, by the pseudoscience. You also can’t trust what they say, right or wrong, because they do not have a science-based quality control filter in place. So any given bit of advice can be complete nonsense. Continue Reading »
Jun
16
2017
For about five years Jeffrey Beall, an academic librarian, maintained a list of predatory journals. Earlier this year he removed the list and all associated websites from the internet. Recently he explained exactly why he did this, and it’s a chilling tail.
Predatory Journals
A predatory journal is generally one in which authors pay a fee in order to publish a paper. This in itself does not make a journal predatory, but it sets the stage. This is part of the open-access movement, which is also not synonymous with predatory but is vulnerable to predatory practices.
Traditional journals earn their money from subscriptions and advertising. In order to maximize revenue, they want to maximize their reputation and impact factor. This gives them an incentive to publish high quality articles, although also surprising and new studies, which may not be replicable, but that is a separate issue.
Open access journals make the papers they publish freely available to the public. Because they don’t, therefore, have subscriptions, they make their money by charging researchers a publication fee. Again, there is nothing inherently wrong with this model and the idea of open access is a good one. But, with this model publishers have an incentive to publish a lot of papers and no financial incentive to reject poor quality submissions or to engage in rigorous peer review.
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Jun
15
2017
Ken White, a first amendment attorney and proponent, has an excellent op-ed in the LA-Times about the law and free speech. It’s a necessary read for anyone interested in the ongoing debate about the role and limits of free speech in America.
The article is framed around pointing out common free-speech tropes, which is a good way to communicate about such topics. However, the scope of the article doesn’t really address the debate itself, it only provides a solid logical and legal framework for the debate. This is necessary to get the discussion to the point where it needs to be in order to address the actual issues, without getting distracted by legal myths.
The First Amendment
The First Amendment protection of free speech is based on the principle that a free and open society requires individual citizens to have the space and comfort to express their opinions without fear of oppression. White points out that the courts have generously interpreted this right over the years. Essentially all speech is protected except for very specific exceptions, which he lists as: “obscenity, defamation, fraud, incitement, true threats and speech integral to already criminal conduct. ”
You will notice that “hate speech” is not on the list. The courts have recognized that any speech which might be part of political expression must be protected, and that the speech which most needs protection is that which some or even most people will find objectionable.
Interestingly, the go-to example of not-protected speech that most often comes up, crying “fire” is a crowded theater, is actually protected. The current precedent is that the “incitement” criterion must be direct and immediate – “You, go kill that guy right there,” Indirect or vague incitements, or speech that might inspire someone to do something illegal or harmful, are still protected.
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Jun
13
2017
I suspect that CRISPR is rapidly following the path of DNA in that many people know the abbreviation and what it refers to but not what the letters stand for. Clustered regularly interspaced short palindromic repeats (CRISPR) is a recently developed technology for making precise gene edits. Such technology carries a great deal of promise for treating or even curing disease, for accelerating research, and for genetic modification technology.
However a recent study has thrown some water on the enthusiasm for CRISPR and sparked a mini-controversy. The authors looked at two mice that were treated for blindness with CRISPR-cas9, sequencing their entire genome. They found over 1,500 unintended mutations. That would be bad news for the technology, which is revolutionary partly because it is supposed to be so precise.
For a little background, CRISPR was discovered in bacteria and archea. It is essentially part of their immune system – locating inserted bits of DNA from viruses and clipping them out. Researchers realized they could use this system to target specific sections of a genome to insert or remove a genetic information. The technique is fast, cheap, and convenient.
What this has meant is that genetic modification can now be cheaply available to even small labs. Further, since the technique can be used in living organisms, it could theoretically be used to cure genetic diseases.
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Jun
12
2017
Last month I wrote about Graecopithecus, a possible human ancestor from just after the split with chimpanzees about 7 million years ago. Also last month it was reported that an analysis of new Homo naledi specimens dates the fossils from as recently as 236 thousand years ago. H. naledi share some primitive features that paleontologists thought would date to about 2 million years old, but they also have some more modern features.
In April I also wrote about the latest study of H. floresiensis (the Hobbit) showing that it is very likely this was indeed its own species.
All of these news items share a theme – that the picture of the evolution of modern humans from our last common ancestor with chimpanzees is likely much more complicated than we currently know and previously suspected. I think the analogy of a jigsaw puzzle is apt. We are trying to piece together this puzzle, but we don’t know what the final picture looks like. We are connecting lines to the pieces we have, but when we find more evidence we are not just filling in the picture, we are expanding it.
Our map of how human evolution proceeded was just a best fit to the existence evidence. We are still in a stage of our discovery where every new major find alters that best fit. This process was inevitable as we started with a maximally simple (and naive) map – a linear progression from apes to humans. Now we know, as with pretty much every other evolutionary tree, the real map is much more bushy. Adaptive radiation lead in multiple directions simultaneously, only one branch of which survived to be modern humans.
Homo Sapiens from Jebel Irhoud Continue Reading »