Political interference in science

Please purchase Unscientific America at your local, independent bookstore

terrasig — Fri, 17 Jul 2009 11:02:03 +0000

Please purchase Unscientific America at your local, independent bookstore

Chris Mooney and Sheril Kirshenbaum have released a new book entitled, Unscientific America: How Scientific Illiteracy Threatens Our Future. Mr Mooney and Ms Kirshenbaum also co-author the blog, The Intersection, a Discover Magazine online.

I was fortunate to receive a review copy from the publisher but must admit, sheepishly, that the book has sat unread beside my home office desk because of other responsibilities. The advance paperwork says it is to be released officially on 20 July. So, my plan is to get to it this weekend and get some magnitude of a review written.

During my relative absence from the blogosphere, a few tweets I've seen have led me to believe that there has been some manner of rigorous debate and rancor regarding the content of this book. This makes me even more excited to get to reading.

Given the level of controversy, there may be some wishing to purchase the book in order to contribute to this lively discourse in a well-informed manner. Particularly as the weekend approaches, I wish to make an appeal to those of who will purchase this work:

Please buy it at your local independent bookstore.

As my local bookstore notes on their blog: you contribute to the local economy, you contribute to local culture, and you reduce your impact on the environment.

My local folks make a pretty compelling series of arguments.

Why Shop at The Regulator?
When you shop at The Regulator:

You Contribute to our Local Economy
*For every $10.00 you spend at The Regulator, $4.50 stays in the Durham area.
-Spend that $10.00 at a big chain bookstore, and only $1.30 stays here.
-Spend $10.00 on amazon, and all of your money disappears from Durham, the Triangle, the whole state of North Carolina, for that matter.

Why? Because all of our employees live here. Our "back office" is in the back of the store, not in New York or New Delhi. We buy most of our supplies locally. We pay taxes to both Durham (city and county) and to North Carolina. We bank locally. We don't send dividend checks or inflated CEO salaries off to another state. So more of our money stays (and re-circulates) in our local area.

*Because of this local advantage, if everyone in Durham were to shift just 10% of their spending from chain and on-line stores to locally owned, independent businesses, we would add 800 new jobs to our local economy and $60 million a year to local economic activity.

You Contribute to our Local Culture
The Regulator is a place where you can relax, let your mind expand a bit, and enjoy the many pleasures of the written word. And, like Durham, we are unique--we're certainly not just another pre-packaged chain store. We give our honest opinions about books. Our shelf space is not for sale to the highest bidder.

We bring authors from around the state, around the country, and sometimes from around the world, providing stimulating readings, discussions, and book signings.

We support local non-profits, schools, teachers, and students with our expertise, discounts, and often with direct contributions.

You Help Protect the Environment
When you order a book from the big on-line guys, you use SIX TIMES MORE PACKAGING and, because all that packaging takes up more space, you put THREE TIMES AS MANY TRUCKS ON THE ROAD compared to buying the book from us and picking it up at the store.

So while the blogosphere argues about the content of Unscientific America, there is no argument about where you should purchase your copy of the book.

Addendum: Shortly after I posted this, I received a Tweet that The Regulator Book Seller had produced this 1940s-style video trailer and posted to YouTube on 9 July. Scenes are from inside and outside of the store for those who know the place.

terrasig Fri, 07/17/2009 - 07:02

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Blogging community

Books

Political interference in science

Science/medical journalism

I appreciate the sentiments regarding local bookstores, and I support mine whenever possible. As for Unscientific America, I think I'm more likely to buy a copy that's used or remaindered, if I buy it at all.

I appreciate the sentiments regarding local bookstores, and I support mine,

I'm somewhat sceptical about the environmental claims here.

The volume of the book plus packaging that I've received from Amazon can't be three times the volume of the book itself, more like one and a half times, I'd say. But then I'm in the UK, so maybe it's different in the US.

Parts of the distribution chain will be using existing capacity that otherwise would have gone unused, I expect.

A local store will be less efficient in terms of running (energy) costs, I would have thought, because it doesn't exploit economies of scale.

For those that have them, wouldn't using a book reader be the best in terms of environmental impact?

I'm not disagreeing that local bookstores should be supported, BTW, I'm just not sure about that claim.

What if I just check it out of my local library? It doesn't sound like something I really want to own.

@foolfodder: Yes, I'd like to see references on the energy and packaging data as represented. I neglected to consider your point about economies of scale. But as you note, I'm happy to support my local bookstore for the simple reasons of their contributions to local economy and culture.

And if you happen to be in Raleigh, you can't beat Quail Ridge Books. Sheril will be reading from her new book at QRB at 7:30 Thursday, July 24th. See you there!

"Complementary and alternative medicine (CAM)" is not a single "thing"

terrasig — Wed, 18 Mar 2009 20:02:16 +0000

"Complementary and alternative medicine (CAM)" is not a single "thing"

I just had a chance to check in on a triad of posts by Prof Janet Stemwedel at Adventures in Ethics and Science (1, 2, 3) on the ethical issues of the conduct of studies, particularly clinical trials, supported by the US NIH's National Center for Complementary and Alternative Medicine (NCCAM).

For background, NCCAM was originally established for political, not scientific reasons, as the NIH Office of Alternative Medicine in October 1991. It received a token budget of $2 million at the time. They still only get $120-ish million; modest by NIH standards as compared, say, with the 2007 NCI budget of about $4.8 billion. But that $120-125 million is pretty significant in that it could fund about 60 independent researchers and their laboratory groups for five full years.

How was alternative medicine defined then? Primarily as folk and cultural modalities not incorporated into conventional Western medicine but used and promoted for disease treatment or prevention without statistically-defined efficacy and safety. The net was cast very wide, from "energy therapies" that defy the basic tenets of physics to herbal medicines that have given rise to 25% of prescription medicines.

Hence, CAM is not one modality. It is a term used to describe a wide spectrum of health-promoting approaches that have not been evaluated previously under rigorous, controlled basic or clinical science standards.

CAM is a terrible term. It is NOT medicine. Modalities proven to work are medicine. Modalities that don't work are not medicine. There is no complement to medicine. Medicine is medicine. There is no integrative medicine, either. Medicine already takes advantage of all modalities: surgical, pharmacological, radiological, physical, psychological, nutritional - if a clear benefit can be offered to a patient that outweighs the risk.

So-called integrative medicine gurus have adopted proven, preventive medicine techniques - diet, exercise, meditation, yoga - and have used them 1) to justify that "CAM" works and 2) that the efficacy of these approaches justifies study and implementation of approaches that have absolutely no scientific basis.

Oh yeah, often with substantive personal financial benefit.

I must admit to having a dog in this fight. I have spent 23 years investigating the molecular action of chemicals derived from plants, fungi, and bacteria for their anticancer or cancer preventive activity. Some of these agents came from folk remedies, others came from pure compounds isolated from random plant sources because of the recognized chemical diversity of secondary metabolites produced by plants. Yet what I do is not of interest to NCCAM. I think it is, and well should be, but I have had no success convincing reviewers that what my lab and collaborators do will be informative to those studying the natural products side of untested herbal medicines.

Yet our nation's health agency separates the evaluation of biomedical research proposals across over more than 110 topical areas. NCCAM instead is charged with evaluating research proposal investigating dozens of potential therapies across dozens of therapeutic settings. And that's without even getting into the basic science foundations that might underlie the mechanism(s) of any potentially useful therapies. One could find an NCCAM grant application reviewed on reiki therapy for depression followed immediately by an application, say, studying a naturally-occurring plant product that inhibits the function of the hypoxia-induced transcription factor, HIF-1α, in cancer.

I must also make another disclosure: my laboratory has never received funding from NCCAM, although my collaborators and I have attempted repeatedly. Rather than write off NCCAM, though, I have offered instead to serve as a NCCAM grant reviewer and resolved to be part of the solution rather than whine about the problem (Review panel rosters are a matter of public record on the NIH website; while one can never be sure which reviewers were assigned one's grant, an investigator is provided with the roster of all those assembled at the meeting).

NCCAM is, sadly, still a political entity and if my colleagues and I don't agree to serve as scientific reviewers, we are likely to be substituted by individuals with lesser rigor and credentials. So, while it is in existence, I will continue to be part of it when called upon. Not telling tales out of school, I have provided strongly positive evaluations of a very small number grant applications for investigators and their projects that have been fantastic successes and published in top-tier peer-reviewed journals. Not many folks talk about this, but like some study section members I have followed the careers of basic and clinical investigators to whom I have given excellent scores to their research proposals. I am incredibly proud that I have served the scientific community by rigorously evaluating research proposals submitted to NCCAM.

However, these projects represent less than 5% of the projects I have reviewed for the agency. (No surprise since only 10-19% of NIH extramural projects are being funded these days.).

As a scientist, I share the proposal set forth others that NCCAM is really not necessary as an NIH entity. Untested therapies, and the basic science underlying their potential therapeutic efficacy, might be better evaluated by institutes or centers (ICs) of NIH dedicated to specific pathophysiological areas.

As far as I know, NCI is the only IC that has established an alternative medicine evaluation center that focuses on untested modalities for the broad area of cancer. The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) has a budget to support some intramural and extramural projects on therapies that may be of benefit to cancer patients.

In my very first blog post, I tried to note the diversity of rationale and application of so-called complementary therapies while invoking two of my science blogging mentors: Orac and the former-Dr Free-Ride, now Prof Janet Stemwedel. I have had the honor of knowing them both personally and respect both of their views in this area of the ethical and medical issues surrounding federal support of scientifically-valid, conceptually-possible, and absolutely implausible so-called alternative therapies. (A lively discussion currently ensues between them on studies supported by NCCAM.).

From 15 December 2005 at the old blog:

The polarizing quality of alternative medicine among academic health and life scientists is exemplified by the other extreme in the blogosphere: hucksters using blogs to sell supplements, services, books, etc. with dubious and often irrational claims of cures while feeding the conspiracy theorists with the idea that cures are out there that "they" don't want you to know.

There are few folks in the middle ground. Orac Knows at Respectful Insolence and Doctor Free-Ride at Adventures in Ethics and Science often take on alternative medical claims in a thoughtful, balanced, respectful manner that is based in fact. But what I see missing in many blog threads, however, is 1) a distinction between the relative validity of each of the alternative modalities and 2) an honest appreciation for what the natural world has lent to modern medicine, healthcare and wellness.

I have to admit: it's fun to look back at what one wrote more than three years ago.

Janet is correct to question how we evaluate therapies outside the realm of conventional belief; Orac is correct to criticize the existence of a political entity dedicated to prove things that are unlikely to be useful (based upon current basic science tenets).

The common thread here is that the discussion between Orac and Janet is being conducted by people trained in the scientific method: Orac is a MD, PhD, and Janet holds two PhDs, one of which is in physical chemistry. Neither is a finanically-driven woo-peddler or an anti-natural product person (as a breast oncologist, 55% of the drugs Orac's patients are given are naturally-derived).

Where I worry is when such discussions are held amongst patients and those trying to make a buck out of their misery and uncertainty.

terrasig Wed, 03/18/2009 - 16:02

Sex, Science, and Stem Cells: has anyone read it?

terrasig — Tue, 26 Aug 2008 05:46:18 +0000

Sex, Science, and Stem Cells: has anyone read it?

I was surfing around the DNC site last night and came upon this nice addendum to yesterday's post: a series of videos about the Denver area narrated by a proud native and six-term Congresswoman Diana Degette (D-CO, 1st).

I was reminded while going through 5280 magazine that Rep. Degette had written a book about the war on science by the Republicans called, "Sex, Science, and Stem Cells: Inside the Right-Wing Assault on Reason." (Actually the book was "co-written" with Daniel Paisner, the amazingly prolific and self-effacing "author, ghost-writer, reasonably nice buy.").

I'm a little short on reading time, much less blogging time, so I'd be interested to know if anyone has read Degette's book and how it might compare to Chris Mooney's, "The Republican War on Science."

terrasig Tue, 08/26/2008 - 01:46

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Colorado

Political interference in science

I haven't read it, hadn't even heard of it till reading your post about it.

However, I haven't been able to bring myself to read Mooney's book either because I've gotten so disgusted and frustrated with living through the Republican War on Science.

Someone with a lower indignation threshold than I needs to read it and report back to you.

Escalating lunacy

terrasig — Mon, 04 Aug 2008 19:47:31 +0000

Escalating lunacy

It's a lovely crescent moon this evening up here in the Northern Hemisphere so I can't blame the latest unbelievable and irrational happenings on a full moon (which would be unscientific, of course). Okay, maybe sunspots?

First, the Bush administration was proposing draft legislation to grant medical professionals the right to withhold care, prescriptions, etc., based upon religious beliefs or other objections by reclassifying birth control pills and IUDs as "abortion." PalMD covered this among others, but reminded me of several of my old posts on my objections to pharmacists refusing to fill legitimate prescriptions for emergency contraception and such:

Pharmacists, emergency contraception, and the responsibilities of a profession
Pharmacist "conscientious objection": a pharmacist's right or professional negligence?

Then I get an e-mail Sunday from the Foundation for Biomedical Research about the firebombing the homes of two UC-Santa Cruz researchers with a "Molotov cocktail on steroids.":

While a spokesman said he didn't know who committed the act, the Woodland Hills-based Animal Liberation Front called the attacks a "necessary" act, just like those who fought against civil rights injustices. Spokesman Dr. Jerry Vlasak showed no remorse for the family or children who were targeted.
"If their father is willing to continue risking his livelihood in order to continue chopping up animals in a laboratory than his children are old enough to recognize the consequences,'' said Vlasak, a former animal researcher who is now a trauma surgeon. "This guy knows what he is doing. He knows that every day that he goes into the laboratory and hurts animals that it is unreasonable not to expect consequences."

Clark, the Santa Cruz police captain, said it was "unconscionable'' for anyone to defend such acts: "To put this on par with any of the human rights issues is an absolute insult to the integrity of the people who fought and went through the human rights movement. This is what people do when they have an inability to articulate their point in any constructive way. They resort to primal acts of violence. Any reasonable person would need a logic transplant to begin to understand this level of degraded thinking."

Several colleagues have this covered as well, with Orac especially detailed on the genius that is Dr Jerry Vlasak.

Yes, Capt Clark, a logic transplant would indeed be necessary.

(If I missed anyone's link to either story, feel free to put it in the comments - I've got to go lie down and take some medicine.)

terrasig Mon, 08/04/2008 - 15:47

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Academia

Bioethics

pharmacy

Political interference in science

religion

I posted on the Bush regime's theocratic woman-hating scumbaggery:

http://physioprof.wordpress.com/2008/08/01/wackaloon-theocratic-sick-fu…

don't worry. soon enough, someone will decide for you that that medicine you're going to take isn't good for our moral fabric and take it away. the public is easier to subdue when they have no control over their own lives in the first place.

Sunspots? Can't be. There aren't any.

Scientists running for political office

terrasig — Sat, 10 May 2008 11:33:17 +0000

Scientists running for political office

Effective science communication and science advocacy in the public arena has been much discussed in the science blogosphere. But is ranting on science and medical blogs the most effective way to promote science, especially in the United States?

I've had some discussions with other scientists, including blog colleague PhysioProf, who submit that the best way for scientists to advocate for science policy is to become politicians themselves. To this end, I read with great interest this morning of an AP story written last night by Seth Borenstein, "A Crash Course in True Political Science":

Daniel Suson has a doctorate in astrophysics and has worked on the superconducting super collider and a forthcoming NASA probe. Now he's heading back to school to take on an even trickier task - getting elected to public office.
He is among a growing number of scientists who feel slighted and abused in the public debate in recent years and are mobilizing for a new effort to inject "evidence-based decision making" into public policy.

On Saturday, Suson, dean of engineering, mathematics and science at Purdue University Calumet, will join more than 70 other scientists, engineers and students at a hotel at Georgetown University for a crash course on elective politics.

The article even alludes to ScienceDebate2008.

For scientists with the social and communications skills to do so, politics might be another valuable career choice that may actually have greater societal impact than a typical academic laboratory-based career.

But I would venture to say that compensation would be a major barrier to this avenue. Most states only pay their state legislators in the range of $15,000 to $20,000 (North Carolina pays $20,659), requiring that most state reps keep some other job on the side. However, making it to most other state government positions will net you over $100,000, about the average US salary for a Ph.D. full professor in an academic medical center. If you get to Congress, your salary could be $165,200 - higher than the salary for most US governors.

However, I have no idea what it's like to be a politician. We all deal with "politics" in our respective research institutions but would it be any easier or harder to do it in public office?

But, as Borenstein's article noted, about 70 scientists were willing to devote a Saturday to exploring the possibility of running for public office. When considering "alternative" applications of one's PhD training, this might be a high-impact and satisfying option.

terrasig Sat, 05/10/2008 - 07:33

Tags

career development

Political interference in science

Politics

Research funding

Science Education

Die, you gravy-sucking pigs*

terrasig — Tue, 29 Jan 2008 07:02:46 +0000

Die, you gravy-sucking pigs*

. . .that's the message from Dr Bertha Madras, deputy director of the White House Office on National Drug Control Policy, to heroin and morphine users whose lives might be saved in the overdose situation by public distribution of "overdose rescue kits" comprised of a $9.50 nasal spray containing Narcan.

Narcan is the brand name for naloxone, an antagonist (blocker) of these drugs at μ opioid receptors. When an overdose of opioid drugs binds to these receptors in the respiratory control center of a primitive part of our brain, one stops breathing, a situation that pathologists say is "incompatible with life." Naloxone is ineffective when taken orally because it is metabolized too quickly and, even if it wasn't, wouldn't reach the brain in time to compete with heroin/morphine binding to these receptors. But when administered in a nasal spray, Narcan 1) bypasses metabolism by the liver and 2) gets to the brain much more rapidly.

Since being distributed in 16 communities the overdose-rescue kits have saved 2600 lives, nearly the number of people who perished in the combined terrorist attacks of 11 Sept 2001.

James Hrynyshyn at the Island of Doubt reminds us that this story, currently making the rounds of the blogosphere, first aired on NPR on 2 Jan. This story was originally brought to my attention by Dr Tom Levenson who writes the excellent blog, The Inverse Square (there's a reason he is a MIT full professor of science writing and author of several books). I believe that Mark Kleiman of The Reality-Based Community is responsible for starting this latest round of complete and utter disbelief of the hypocritical "compassionate conservatives" currently occupying positions of power over US public health policy.

The money quotes from Dr Madras are as follows:

"First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," she says. "I just don't think that's good public health policy."
Madras says drug users aren't likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn't as likely.

Madras says the rescue programs might take away the drug user's motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras says.

As the inimitable Dr PZ Myers then mused on how the administration might extend this compassion:

Hey, here's another suggestion: let's stop teaching people the Heimlich maneuver. Not only does it put a medical procedure in the hands of mere non-medical professionals, watching a few fat people in your local McDonalds choke and die, turning purple, thrashing on the floor, and clawing their throats, would be an excellent salutary lesson in the dangers of gluttony and poor dietary habits.

The very sad issue associated with this policy is noted by new ScienceBlogs colleague, DrugMonkey, in that Dr Madras is not some tool of the Bush administration; instead, she has had a distinguished career in the trenches as a drug abuse researcher:

The thing that bothers me the most about this is that Dr. Madras knows better. This is not some political hack or think-tank reject. This is a long time drug abuse researcher. If you read what she had to say closely you will note that she was trying to find the path that did the least insult to the available science. It was all about trying to justify on the basis of an opinion (read "political position") that had the least possible chance of getting attacked on scientific grounds. Very deft, Dr. Madras!

The takehome is that getting scientists into even quite senior positions is insufficient. Because they obviously get themselves into positions in which they are forced to prioritize the political over the scientific.

Epidemiologist Dr Tara Smith gives her take from a public health policy perspective:

I don't doubt that this "scared straight" effect works for some drug addicts, but it's absurd to base a public health policy on something so unlikely. This is much like the uproar over needle exchange programs--they'd been shown to work, shown to reduce the spread of disease and to save lives, but many conservatives opposed them because they "encouraged" or somehow gave validation to injection drug use as a lifestyle; or like arguing to withhold the HPV vaccine for fear of increasing promiscuity.

We return to James Hrynyshyn who follows up on Tara's point in discussing how the ends do justify the means:

Please. As any honest ethicist will tell you, sometime the means are justified. Sometime they don't, but often they can. The case of abortion is a perfect example. If you want to reduce the number of unwanted children, and therefore the demand for abortion, then the best way is to make sure everyone has ready access to contraception. And because the demand for abortion is unaffected by the laws governing the procedure, the best way to reduce the maternal mortality associated with the process is to make it legal and easy to procure.

The bottom line is that public health policy should be defined by experts in public health, independently of any political influence or alliance with a party line. Drug abuse is an extensive problem in the US and evidence has accumulated that much of the propensity toward substance abuse is genetically determined; of all the experimenting with drugs that occurs on college campus, only a small fraction of those go on to abuse drugs in their later adult years. Treatment and rehabilitation are two of the answers. Look around you: you are certain to have family members, co-workers, and/or other people you love who are substance abusers and deserving of help.

In prohibiting the distribution of the Narcan kits, Mike the Mad Biologist noted succinctly,

And desperate people won't get the help they need to stay alive.

*the title of this post pays homage to Steve Martin on his 1978 "A Wild and Crazy Guy" album (Warner Bros, HS3238) in a monologue about his failed attempts writing cheers for his high school - yes, I still have my own original copy of this record.

terrasig Tue, 01/29/2008 - 02:02

Tags

Bioethics

neuroscience

Pharmacology

Political interference in science

public health

toxicology

Try and make a touchdown, you scumbags!

I replaced my vinyl copy with a CD, and the contents now reside on my iPod.

Thanks for this post. One very minor correction: no doctor, me.
Other than that -- here's the issue assembled into a single coherent structure. Good stuff.

Tom (aka Inverse Square)

I'm more on the side of all of you advocating protecting drug users and such, for reasons of compassion and decent human empathy, but I also do think that such programs do encourage drug use (though the effect may be small). It's simple supply and demand; if you lower the cost (i.e. lower some of the risk associated with drugs), you increase the demand. Undoubtedly, more people went skydiving once having a backup parachute became standard, because there was less risk involved. In the same way, I think more people would use drugs because of programs like needle exchange, distributing drug overdose kits, and such, though I think the effect is probably pretty small, considering the other, dominant cost of taking drugs (expense, addiction, brain and health damage, etc.).

Those negative side effects of the programs, though, are pretty slim compared to their value in saving lives, making room in a crowded medical system for other people to use emergency services and whatnot. So, I guess I agree with both sides, to a certain extent; it's just that I think the balance is tipped in your favor, simply due to the worth of a human life.

One could also ask how far one should go in helping drug users stay clear of risks; if one is going to supply clean needles and tools for using drugs, what about the risk of using contaminated drugs, which is surely non-negligible? Wouldn't there be some public health benefit to supplying addicts with clean, government inspected drugs? There would obviously be bad consequences to such a program, ones which may outweigh the good benefits, and (alas) the decision for my support would ultimately come down to the hard calculus of human lives.

Narcan ain't exactly a walk in the park, either. Never met anyone who enjoyed the experience of acute withdrawal, complete with nausea, diarrhea, tremors, etc.

In the spirit of post-9/11 amendments of the 4th amendmend I would sell the Narkan sprays cheaply in vending machines. Each spray would be equipped by a remotely-activable radiofrequency homing beacon that would also sound whenever the spray would be used.

Such Ire wrote

but I also do think that such programs do encourage drug use ... I think more people would use drugs because of programs like needle exchange, distributing drug overdose kits, and such, though I think the effect is probably pretty small,

In fact all the evidence shows that needle exchange and similar programs do not encourage drug use and send more people into treatment programs (in Australia drug treatment rose from 68% to 75% after needle exchanges became prevalent, and injecting drug use fell from 0.6% to 0.4%). Along with reduction of HIV infection, Hepatitis C infection, reduction in drug use litter and increases in public order, as well as significant reductions in public health costs, needle exchange is a major positive step in dealing with injectable drug abuse.

Given that needle exchange programs do not encourage drug use, it is hard to see how Narcan rescue kits would encourage drug use (overdose will still be horrible, just less likely to be lethal). The rejection of a kit that can save lives without any evidence that there are significant harms associated with its use is reprehensible.

See:
Dolan, K, et al. (2005) Needle and Syringe Programs: A Review of the Evidence, Australian Government Department of Health and Aging, Canberra
Needle Exchange Programs (NEPs) FAQs
Harm Reduction: Questions and Answers

It's simple supply and demand; if you lower the cost (i.e. lower some of the risk associated with drugs), you increase the demand.

I think any assumption that the normal laws of economics -- i.e., that people act in their rational interest -- apply to drug users is highly suspect, if not absurd on its face. And I speak from experience. The pull of addiction highly distorts, if not obliterates completely, rational calculus. Only actual evidence, not blithe assumptions, would be acceptable to support the notion that distributing Narcan increases heroin use. And, as Ian points out, the evidence as respects needle-exchange suggests precisely the opposite.

Supply and demand is as close to a law as you can get in economics; they apply almost universally. Economics also uses a special definition of the word "rational", in the same way that science uses a special definition of the word "theory." To economists, "rational" means "preferences are consistent" and "people respond to incentives" (e.g. addicts consistently prefer drugs to, say, good health, and they'll respond if you offer them more drugs or money). We modeled drug addiction in my microeconomics class quite simply when I took it; there's no conflict between the behavior of addiction and a the economist's rational agent.

Just look at the cigarette tax to see supply-and-demand laws at work; higher taxes on cigarettes led to falling sales in cigarettes, if only because fewer people could afford to buy the cigarettes. In the same way, if more people can afford the risk of drugs, more people will use them. Demand curves slope down.

Of course, this negative side effect could be so small that it gets lost in the noise of other, positive side effects of needle exchange programs, such as incentivizing addicts to have more contact with those who can help them out of their addictions, or simply the humanitarian and ethical benefits of keeping people from disease. I'm not saying that we shouldn't do the needle exchange program; I'm saying that it's disingenuous to say that the normal laws of economics don't apply to this situation.

such ire -

I'm saying that it's disingenuous to say that the normal laws of economics don't apply to this situation.

But they don't, at least not in simplistic terms. People just don't look at highly addictive drugs from a perspective that would make it apply. They don't come at heroin or cocaine with the notion that they would ever have a use for needle exchanges or something that would save them in the event of an overdose. In short, they don't believe that they will become addicted. If they aren't addicted, things like needle exchanges and Narcan aren't going to enter the equation when they decide whether or not to use a highly addictive substance. Once they are addicted, it becomes irrelevant.

Of course, if you aren't going to let Ian's actual evidence in the form of study convince you, I doubt this will. But take it from someone who has had a lot of experience with illicit drugs, no one begins using any addictive drug, thinking that they might at some point need a needle exchange or Narcan. They don't think gosh, since I can use the needle exchange and the Narcan is out there to help me, I think I'll become a junkie. It just doesn't happen.

Presidential debate focused on science & technology

terrasig — Mon, 10 Dec 2007 13:00:00 +0000

Presidential debate focused on science & technology

Yes! "A Call for a Presidential Debate on Science & Technology."

Imagine a presidential debate focused solely on issues of science and technology as they relate to medicine, international competitiveness, terrorism, public health, embryonic stem cell research, bioethics of genotyping and other molecular diagnostics, research policy/funding and job creation, or minimization of health disparities, among others.

Science Debate 2008 is a grassroots initiative spearheaded by a growing number of scientists and other concerned citizens. The signatories to our "Call for a Presidential Debate on Science & Technology" include Nobel laureates and other leading scientists, presidents of universities, congresspersons of both major political parties, business leaders, religious leaders, former presidential science advisors, the editors of America's major science journals, writers, and the current and several past presidents of the American Association for the Advancement of Science, among many others.

And now count me among the many others - in fact, take a gander at this tremendous list of science bloggers, known as the Blogger Coalition.

The impact of science and technology is not just for scientists and researchers. This point seems so obvious but science too often takes a backseat to the marital issues and religious affiliations of presidential candidates. The press is so taken by endorsements from celebrities like Oprah Winfrey but probably wouldn't wink an eye if Harold Varmus supported a candidate.

We have seen what happens when science and technology is brushed aside by a presidential administration, or worse, how scientific facts have been distorted to push agendas and industry-favoring policies. The US cannot afford another eight years of scientific ignorance. Regardless of whether the next president is a Republican or Democrat, the country needs a leader who understands science and technology and seeks the expertise of those knowledgeable enough to advise the administration on scientific issues that have broad impact on Americans and the rest of the world.

One of the best ways to learn about the stance of candidates and compare and contrast the importance they place on science is to hear it from the horses' mouths.

That's why we are registering our support for A Call for a Presidential Debate on Science & Technology. Stay tuned here and elsewhere on ScienceBlogs, especially Sheril Kirschenbaum and Chris Mooney at The Intersection.

terrasig Mon, 12/10/2007 - 08:00

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Blogging community

health care

Pharmaceuticals

Political interference in science

Politics

Research funding

Science Education

Release of Tripoli 6 / Benghazi 6!

terrasig — Tue, 24 Jul 2007 07:38:25 +0000

Release of Tripoli 6 / Benghazi 6!

I woke this morning to BBC reporting that the six Bulgarian nurses and doctor charged erroneously with transmitting HIV to over 400 Libyan children have been released and are safely home in Bulgaria.

Orac and Revere here at ScienceBlogs covered the upholding of death sentences against the six that opened the procedural door to their release.

It appears that the wife of new French prime minister Nicolas Sarkozy, Cecilia, played an important role over the last 48 hrs in negotiating the terms of release together with other EU officials. The terms are only just beginning to emerge, but it appears that the Libyan High Judicial Council made its decision after the equivalent of $1 million was pledged to families of each of the 438 children affected with HIV at the Benghazi hospital. ("An EU official told the BBC that the payout was made from the Gaddafi Foundation, a charity overseen by Libyan leader Muammar Gaddafi's son, Seif al-Islam.")

However, commentators on BBC Radio this morning questioned the wisdom of the EU reopening diplomatic ties with a nation that is responsible for the deaths of thousands of its critics in Libya and elsewhere. This discussion will no doubt expand in the coming days.

Many thanks are due to Revere at Effect Measure for raising awareness of this case with a great many science bloggers. The high-profile support of Nature's Declan Butler is also deserving of great praise. It will be interesting to learn what others think of the impact of the scientific press and blogosphere in contributing to international attention to this case.

Thankfully, justice has played out and the scientific facts have won. However, nothing will diminish the pain and suffering experienced by our international medical colleagues over the last eight years whose original admission of guilt was secured by methods of torture.

terrasig Tue, 07/24/2007 - 03:38

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infectious diseases

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Political interference in science

Thankfully, justice has played out and the scientific facts have won.

I'd be interested to know on what you base this conclusion. I don't think I've seen anything that indicated that the scientific facts had anything to do with the outcome.

Scott, I see your point but my guess is that the Nature phylogeny paper might have give negotiators a scientific leg to stand on in arguing the innocence of the medics. I do, agree, however, that none of the press accounts to date cite the importance of the scientific facts.

Indirectly the scientific facts have won out, since it was those that convinced the EU to get involved on behalf of Bulgaria. The PM of Bulgaria has made clear that without the commitment of the EU, the release of the six would never have happened.

One minor note about your post Abel - the doctor is actually Palestinian. He was granted Bulgarian citizenship last month, to enable him to get transfered to Bulgaria with the other five. Technically, they got transfered to Bulgaria to serve the rest of their sentence, and then got pardonned by the Bulgarian President.

Kristjan, as always you are quite thorough. Yes, I meant to imply that the Palestinian doctor is now Bulgarian (i.e., six Bulgarian nurses and doctor) by virtue of his being granted citizenship. I neglected to note that they were then turned over to Bulgaria to complete their sentence but were then officially pardoned by the president of Bulgaria. Thanks for making things more clear.

Sorry if I came off as a nitpicker. I didn't want to make it sound like your post was wrong Abel - the essence was right, but there were some interesting diplomatic moves involved that I thought was worth mentioning.

When looking at this story, I can't help but wonder if the current US president will learn anything about the proper use of presidental pardons, as demonstrated by the Bulgarian president.

No offense taken, Kris. I was joking a bit as I admire how thorough you are on your blog.

Indeed, there are many things the current US president can learn from the conduct of other international leaders.

Plan B OTC approval - no guts, no glory

terrasig — Thu, 24 Aug 2006 14:29:04 +0000

Plan B OTC approval - no guts, no glory

The wimpy approval of OTC status today for Plan B emergency contraception only for women 18 and older has me nonplussed.

I've been disgusted by the intrusion of politics into science and medicine on this issue for quite some time.

As some Terra Sig readers know, a major network news outlet keeps the real Dr Pharmboy on their experts list for commentary on pharmacotherapy issues but my exact comments rarely make it on-air. Perhaps these will be inflammatory enough to get a call to be on this time, and then you'll all know who I am. (No, I am not Dr Raymond Woosley, but I wish I were.)

So here are my comments, verbatim, so that someone at least benefits from my bile-spewing:

Firstly, I am relieved that Plan B has been approved for women 18 or older - this decision should have been made almost two years ago and I regret how many unnecessary abortions were required as a result of political interference in the scientific process at FDA, not to mention the unnecessary need for the resignation of Dr Susan Wood.

Moreover, it is a travesty and miscarriage of the scientific and medical deliberative process that Plan B is not being made available OTC to women of 14 or 16. There is adequate evidence that it is safe and does NOT encourage sexually promiscuous behavior in teenage women. I would argue that younger, sexually-active women in their teenage years are most in need of free, unfettered access to Plan B, even if they simply have to ask pharmacists for the medicine, just as we do with pseudoephedrine.

The request that Duramed/Barr modify their application to FDA was a clear tactic to manipulate the Senate hearings for the nomination of Dr. von Eschenbach as FDA director to create a situation that appeases as many senators as possible. A more brave, scientifically-sound decision, that is respectful of womens' reproductive rights would have been to make Plan B available without prescription to women 14 and older.

terrasig Thu, 08/24/2006 - 10:29

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health care

Pharmacology

Political interference in science

women's health

"If we let young girls have PlanB without a prescription, then child molesters will be able to hide the evidence of their crimes." Yes, this is one of my favorite defenses this latest political control of women's health. They are pretending it's good for us. It's really all about ferreting out the child molesters. Like they haven't been good at covering their tracks before this? Like pregnancy is the only, or first, clue we have that young girls are being molested? And what about the young boys who are molested? How's keeping PlanB out of the hands of young girls going to do them any good? I really, really, really want to hork up some serious barf on a lot of people's shoes when I hear this one. AbelPharmboy, I would gladly spew bile at your side any day. Thanks for this particular rant.

An acceptable quid pro quo on Plan B?

terrasig — Mon, 31 Jul 2006 10:38:03 +0000

An acceptable quid pro quo on Plan B?

Interesting timing: former US National Cancer Institute director and current acting FDA commish Dr Andrew von Eschenbach is about to go before the Senate tomorrow regarding his nomination for the permanent position. You know that he was going to get reamed over FDA's delay of over-the-counter approval for the Plan B emergency contraceptive, despite all scientific reasons to move forward.

Well, the Associated Press is now reporting that:

The Food and Drug Administration notified manufacturer Barr Laboratories Inc. Monday that it wanted to meet within seven days to define new steps the company must take in its three-year battle to sell the pill, called Plan B, without a prescription to at least some women.

The morning-after pill is a high dose of regular birth control that, taken within 72 hours of unprotected sex, can lower the risk of pregnancy by up to 89%.

Contraceptive advocates and doctors groups say easier access to a pill now available by prescription only could halve the nation's three million annual unintended pregnancies, and FDA's own scientists say the pills are safe. In December 2003, the agency's independent scientific advisers overwhelmingly backed nonprescription sales for all ages.

You may recall that this episode has been one of the most egregious examples of political interference in the scientific process in the United States. The resignation last fall of FDA assistant commisioner for women's health, Dr Susan Wood, and her subsequent whirlwind lecture tour of US academic medical centers has left egg on the face of the FDA and the Bush administration.

Dr von Eschenbach is a well-known supporter of the Bush family dating back to his time at M.D. Anderson Cancer Center in Houston. His leadership of NCI has been highly politicized and some cancer researchers feel that he sold a bill of goods to Congress and left frontline scientists holding the bag of his unrealistic claims to reduce the pain and suffering due to cancer by 2015. Beyond the Plan B issue, there is significant opposition to von Eschenbach leading FDA.

So, is today's reopening of discussions with the manufacturer of Plan B a strategic maneuver to pacify the opposition to von Eschenbach's nomination and confirmation? Or does he, a physician-scientist, finally see the writing on the wall that women's health is not an issue to be toyed with?

Regardless, I strongly support the move forward to potentially open up over-the-counter access to Plan B for any woman who has reached menarche. And regardless of the outcome of the current Plan B deliberations, I hope that the Senate will be vigilant and look closely and critically at von Eschenbach's qualifications and motivations for leading the embattled FDA.

terrasig Mon, 07/31/2006 - 06:38

Tags

Political interference in science

women's health

Thanks for keeping Plan B "in view." I'd like to see a coalition of women's rights organizations put together a national campaign to demand that the FDA fall into line with its own scientific advisors. Plan B can be safely and effectively self-administered. What more needs to be said?

I feel I would have to oppose the availablity of emergency hormonal contraception over the counter. Yes, EHC is safe and effective, however, there is a need to check that EHC is needed (i.e. in the case of missed pills), and there is a great opportunity to educate patients about the dangers of unprotected intercourse.

The straightforward solution would to be to introduce a pharmacy only category for medicines, as exists in the UK and other countries. There was an outcry in the UK when EHC was made available direct from pharmacies. Had it been available from supermarket shelves, the outcry would have been deafening, however it is now widely accepted as being available from pharmacies, and the research I've read points to pharmacies being the prefered point of access, especially for teenagers.

Thanks, Bob - I truly fear for the future of the FDA as the nation's drug approval and safety monitoring agency. Yes, more scrutiny and pressure to adhere to the advice of their scientific advisors is crucial. There are a tremendous number of dedicated and thoughtful scientists and docs in the FDA ranks, but it is the leadership that must be viewed with a very critical eye.

Steve: Yes, I would also share enthusiasm for a pharmacy-only distribution system for EHC in the US. My only concern is that the objections to filling Plan B scripts has already been a problem with faith-based pharmacists and I fear that keeping EHC behind the counter will still unfairly restrict access to young women, especially those in rural areas who may have very few pharmacies from which to choose. States must better articulate the professional duties of licensed pharmacists and establish far better provisions for med access in what should be very rare incidences of conscientious objection.