David Dobbs

Jet Lag

dblum — Fri, 09 Jul 2010 14:41:44 +0000

Jet Lag

I started Speakeasy Science in late January on my author website. I'd finished my book on the invention of modern forensic toxicology in 1920s New York City - The Poisoner's Handbook - but I'd developed an addiction to writing about chemistry and culture.

It was my first heady experience of working solely for myself. I've been a staff journalist at five newspapers, a freelance writer for a list of newspapers, magazines and websites, and a book author. I've worked with brilliant editors and indifferent ones, publishers who were generous, publishers who were penny counters.

My blog, right down to its artsy retro look, was just mine. My ideas, my unedited writing, my own vision of how to delve into the beautiful, fundamental and sinister science of chemistry. I was honored when, a few months later, I was asked to join the Science Blogs community, with so many writers I admired. And I learned to appreciate the astonishingly smart comments and diverse audience.

But I didn't shut down my old blogging platform, just renamed it (The Write Note) and let it go quiet. Occasionally someone still shuffles through the old posts there and leaves a smart comment there as well.

All of which leads me to this week, in which I wrapped up some journalism business in Italy (board meeting of the World Federation of Science Journalists), returned home Wednesday, discovered that United had lost my luggage, and started playing catch up with the crisis here at Science Blogs caused by the decision to allow a sponsored blog by PepsiCo on the subject of nutrition science.

Right. Hard to write that last sentence with a straight face since it was such a bad decision, publicly mismanaged, played out like a farce. Of course, since Wednesday, United has returned my suitcase and Science Blogs has dropped the PepsiCo plan. Probably reluctantly since it did so in response to a blogger uprising in which many writers I know and admire - Rebecca Skloot, David Dobbs, and Brian Switek among them - pulled their blogs from this community.

But it did respond, which is something. I've been at newspapers at which fiery self-immolation wouldn't have changed a planned direction. Business decisions are rarely pure, anyway, as we all know. In the most charitable light, mistakes get made and - as it appears to have happened here - mistakes get corrected. The part that's not so easy guess is whether the correction is a cultural shift or merely a move to end a controversy.

I believe that the best thing about such events is that we can use them to question our bearings. So - surprise - I'm asking myself whether to stay or return to my old home where there is no possibility of clumsy business decisions because there is no business plan. No publisher to worry about counting pennies because there are no pennies. Just a science writer and her Word Press platform (which I've missed dearly since moving here.)

Somewhere over the Atlantic, during those hours at 35,000 feet, I missed my opportunity to quit in protest, to make a difference as these other authors did. So my questions at this point are mostly selfish - is the remaining community still a comfortable home? Some of my favorite bloggers have chosen, after all, to stay. Is this the right place for a chemistry and culture blog still? Was I wrong to give up the pure pleasures of a personal blog where I'm responsible for no one's mistakes but my own?

If I knew the answers to those questions, I'd be able to tell you now my brilliant next move for Speakeasy Science. Still thinking it over, still jet-lagged.. Oh well. In just over a week, I'm flying to Jordan to teach a science journalism workshop in Amman. Perhaps somewhere in the clouds, back up there and out of touch again, the smart answer will come to me.

dblum Fri, 07/09/2010 - 10:41

Tags

The Poisoner's Handbook

Brian Switek

David Dobbs

PepsiCo

Rebecca Skloot

Science Blogs

Speakeasy Science

Personally, I'd wait. While I expect that there will be more cause to not trust SEED, they seem to be willing to back off this time. Maybe next time they'll be a little ... smarter? about it. As others have said, having those "other blogs" so close helps linkage and increases traffic.

One thing you might want to do to add a little protection is to look into whether you can use something like Feedburner for your RSS. That way, when you move, you can update the eventual destination, and we all come along without needing to convince everyone to update their feeds. I know Razib and Ed had a lot of issues getting everyone moved over.

Away from the main topic of your post, I would love to learn more about the World Federation of Science Journalists and your work teaching science journalism overseas.

After my Ph.D. (many years ago now) I travelled for year, making a point of trying to locate the local resources centres for deaf people in India & Pakistan, etc., with a romantic notion of putting this to use somehow. (I did write to the World Federation for the Deaf, but to cut a very long story short, I ended up back at my science.)

Your teaching overseas strikes a chord. I'd love to learn more about it, how you got into it, your experiences overseas.

I'm sorry, Deborah. I feel partially responsible.

I'd think carefully about staying. I'm not so sure that Pepsico isn't lurking in the background, ready to spring out with another offer when we've all been lulled into a false sense of security. I and a lot of other readers are following the exiting bloggers and we're not too keen about visiting ScienceBlogs any more. It's made me think carefully about who and what is behind some of these blog collections- I think I might do some research...

No, no, nothing to apologize for. You opened up a terrific opportunity for me and until this week, truly, I've had a great time, right down to writing about zombies! This wouldn't be so tricky for me if I wasn't such a journalist, I suspect.

Good advice - I really do appreciate it.

Yes, I appreciate the very sane perspective. And you are so right about the challenges of moving the blog. Still thinking!

Great take...the smart answer is to stay.

Hi all;
A fatal flaw was that they failed to have any representative posts ready to go up when the blog went live.

Had they done so, and had the content been surprisingly acceptable, the reception might have been better.

Instead we get this "Hi! Welcome to ShillBlog!" (crickets) and everyone, quite reasonably, expects the worst.

I realize the purpose of your blog is not to describe your travels.
The life of a journalist seems to be a world of travel based on your last few posts. Wow! What fun. You mention so many different organizations and forums of discussion- so, so fun.

Give it a bit and use the time to network :)
Leverage the opportunity at very leas to expand your ability to stay penny pinching publisher free longer.

Oh and I forgot to say, I'd still read what you write regardless of where it is posted.

Now that made the day. Thanks so much.

Selfishly, I want you to stay. I can read scienceblogs at work while other blog platforms are blocked. But I understand what a tough position this puts you in.

I am heartened by the management's pulling the pepsi blog. Everybody makes totally boneheaded mistakes from time to time. I'm not happy that they've given no public explanation or asked their readers for suggestions for revenue streams.

Perhaps you know a decent food technology journalist or can write about the chemistry of food (not the nutrition but the processing)? I wouldn't mind pepsi paying for an independent blog about food technology in the same way I don't mind when merck gives research money to a university. That way there are checks and balances.

I'll keep reading you too, wherever you are! Your blog is one of the best ways to make myself feel like I'm working when I'm actually procrastinating . . . and I mean that in the nicest possible way!

Marlene

You are so nice - can't wait for your new book, by the way. Keep me posted

I have to say that I personally liked your old blog. I came to it after reading The Poisoner's Handbook (which I adored!) and I liked the look you have going over there. But, wherever you go, I'll read your blog.

Bloggingheads with Sblings David Dobbs and Greg Laden

gregladen — Sun, 06 Sep 2009 19:20:09 +0000

Bloggingheads with Sblings David Dobbs and Greg Laden

The Bloggingheads with David Dobbs and Moi is now up at Blogginheads, and embedded here:

I had just posted a review of Dobb's book, Reef Madness, which I enjoyed a great deal, and here we discuss the book in more detail. I left out a lot of detail, especially the exciting multi-part ending, in my review. You'll hear more about what happened to the competing reef theories and to Alexander Agassiz in this hour long bla-bla-blawginghead's interview.

David Dobbs' main web site is here.

Added: Note something funny (as in funny strange) happening at about 23 or 24 minutes.

gregladen Sun, 09/06/2009 - 15:20

Tags

There's a hiccup at the beginning of the diavlog that jumps right to the end. You need to manually push the marker up to the 1 or 2 minute mark and start playing.

I also felt that the sped up dialog is annoying and distracting and made me leave after several minutes.

Those are two glitches that I think are not really there for everyone. This technology seems to act differently in different contexts. What do you mean by sped up dialog?

Added: Note something funny (as in funny strange) happening at about 23 or 24 minutes.

It can only be the hand of gÃd! You should apply for the Templeton prize. :-P

Very interesting, I've never heard of this historical debate before and it really does seem like a classic question of "how do we do science?"

Your article is very interesting, I have introduced a lot of friends look at this article, the content of the articles there will be a lot of attractive people to appreciate, I have to thank you such an article.

I was ready to give up on Bloggingheads after the creationism controversy and the waste of this week's Science Saturday on Wright's excuse-making, until I clicked on it one last time and saw that the REAL Science Saturday had been moved to "Percontations," and there was Laden.

This was a GREAT conversation. Fascinating topic. I was impressed by the way the two of you stretched the story out and made the conversation suspenseful. Now I have yet another book I have to read, dammit.

What with Plait leaving Bloggingheads too, you're going to be lonely if you keep on doing these.

Thanks.

All we did was to go in order of the book, pretty much. It's a great story with an excellent flow.

What I get is a greyed out screen and three buttons, two grey and one green. The grey ones say respectively, "Continue this video on Bloggingheads TV" and "Repeat this clip". The green button says, "link/embed".

At Bloggingheads you get the same clip, and a link below the screen that says, "click to play video". Click that and you get the clip again. Apparently in order to see the full video you have to click one of the three download links, and as I type the MP4 file is still downloading.

Update: So I've said screw it, and I'm going to download the audio (mp3) because I've gotten the feeling there's something screwy with the video download.

So now the audio is playing, and my first impression is, Greg is not a polished public speaker. :)

In any case, download the audio file and give it a listen. You'll get the gist of what Greg and Dave are talking about.

Alan #9: Have you ever seen Laden publicly speak? His audiences are usually left enthralled, except for the ones he kills:) I go to a lot of academic type public talks, and I've seen Laden twice. There are not many as good as him.

Most people will not have to download the audio. Just click on the little "go" arrow that is on most videos and it will play. If not, fix your computer.

I enjoyed it. It really is better than the average blogginghead.

Well, Alan, I don't like it much either, to be frank, but this is not public speaking. Or, if you think this is public speaking you need to get out more.

Thank you Liz. Next time, introduce yourself to me, I'll give you that twenty.

Sped up dialog for me watching was the appearance that both of you were either talking so fast that you never paused for a breath or to contemplate what you were going to say.

It seemed like every pause, no matter how small was edited out. The words were jammed together, the sentences were done as if there was no end of one and start to the next.

I have seen some BH dialogs like this and others at regular speed.

It was a strain to concentrate on what you two were saying.

Bob: Interesting. I'll have to look into that. I can tell you that the video I sent in was something like 59 minutes 38 seconds long, and we had a technical glitch that took out a minute or two during the process. So if this was speeded up, that should be numerically obvious. (Also, I can compare what i sent with what was posted)

Aha. I timed it.

For every 60 seconds on my watch the timer of the video ticked off 85 seconds!

New Enlgand Bob, are you using the "speed up the video button"? If yo dn't like the speedup, don't hit the "Sppedup the video button."

Swine flu and the Mexico mystery

ddobbs — Mon, 27 Apr 2009 13:22:52 +0000

Swine flu and the Mexico mystery

"Swine Flu and the Mexico Mystery," my story on the swine-flu outbreak, is up at Slate. It looks at a question hotly pursued right now: Why does this flu seem to take a much deadlier course in Mexico than elsewhere so far? The answers will suggest much about what's to come.

Of the two two qualities vital to a nasty pandemicm-- to spread readily, and to be deadly, -- this flu,a brand-new strain of swine flu, or H1N1, seems to possess the first: Evidence is high that it spreads readily among humans. In that sense, it's an inversion of the bird flu. Bird flu terrifies infectious disease experts because it kills about half the humans that get it--but it has so far failed to develop the ability to jump easily from person to person.

This swine flu, meanwhile, does seem to spread easily by airborne transmission. But how deadly is it? Despite the 100+ deaths in Mexico, we don't really know. And that's is why epidemiologists are working frantically to figure out the Mexico mystery: Why do the death rates there appear to be so much higher than those in the United States? In Mexico, it has reportedly killed about 100 of the 1,600 official suspected cases; elsewhere, it has appeared to take a far milder course, with zero deaths out of the approximately 300 instances. There are several possible explanations for this discrepancy--any one, two, all, or none of these ideas could shed light on how deadly this virus might prove.

ddobbs Mon, 04/27/2009 - 09:22

Tags

Two additional possibilities

1. More than half of the Mexican
population have no medical insurance.
Hence, unless they have one foot on
the grave, they do not seek medical
help. In this case, that makes the
illness worse.

2. Mexicans have far less frequent
general flu than the Americans (because
of less air conditioning) hence Americans
are more resistent to the virulent version.

Tapen Sinha
ING Chair Professor of Risk Management
ITAM, Mexico

Hence, unless they have one foot on
the grave, they do not seek medical
help. In this case, that makes the
illness worse.

In that case, it makes the illness seem worse; the 2000 reported cases could easily be 200,000 unreported cases, with folks at home in bed with fairly mild symptoms.

Ratios of random numbers are very sensitive to small wobbles; in this case, we may have huge wobbles, making the death ratio completely indeterminate. We will have to wait and see until we have some better way to narrow down the data, since we have a data set that can not be analyzed parametrically, compounded by unknown distributions for our sampling in the first place.

Due to the nature of the 1918 influenza that epidemic was deadlier to healthy young adults 25-45 than other population groups. If the new swine flu is similar to the 1918 then the age distribution differences between the US and Mexican population could account for some of the difference, i.e., we are on average older than Mexico.

There's a 4th (or 5th or 6th or 7th) alternative, which is that this is a slightly more severe strain of flu than what's typically seen, but it's * STILL * JUST * THE * FLU.

Remember how poor Gerald Ford allowed the experts to panic him into practically ordering the whole country vaccinated against swine flu back in 1976 and instead of saving us from the flu the vaccine created a mini-epidemic of Guillane-Barre syndrome? I'm starting to think that this is a gross overreaction as well.

Just look at the numbers: While the MSM are breathlessly reporting that: (a) about 100-110 people have died, all victims in the healthy age cohort of 25-50, (b) of 1,324 identified cases 929 have been treated and released from the hospital, and (c) nearly 2,000 people in Mexico have been hospitalized with serious cases of pneumonia since the first case of swine flu was reported two weeks ago, you almost NEVER see the answer to the question begging to be asked: how many of these things does Mexico have in a NORMAL year? For gosh sakes, they've got about 110 million people, with 20-25 million crunched into greater Mexico City alone.

Shall we run the math? Due to the fact that Mexican data is hardly available, my best angle of approach was to use US data and then divide by 3 since the US population is roughly 3x that of Mexico. So.
If the US has a population of 300+ million and 36,000 flu related deaths per year (according to the CDC), then with a population of 110 million Mexico probably has about 12,000 flu deaths per year or 1,0000 per month IN A NORMAL YEAR.

So trying to tease out rough numbers in a fast moving Swine Flu situation, Mexico is officially counting 103 deaths (let's use a timeframe of a month) with roughly 1,324 patients hospitalized and 929 of those treated and released already.

In a typical month historically, Mexico probably has about 1,000 deaths from the flu and while the majority of those patients are probably outside of the ages of 25-50, not all of them are . . . . if just 10% of the flu related deaths in a typical year in Mexico are in the 25-50 age bracket, that's 100 flu related deaths per month aged 25-50. Hmmmm.

So, I'm starting to have a hard time seeing this flu in its current incarnation (which I think I had and recovered from with no problems, though Relenza gets a H/T after the 2nd day) as anything more than a unique strain of Type A H1N1, suggesting that any prior flu vaccinations and natural exposures provided little or no protection and so this flu kicks like a country mule, as they say back home, but doesn't do any more lasting damage than THAT.

Noodling the data further, according to the NCHS and CDC, the U.S. had approx. 1.3 million hospitalizations due to pneumonia in the US 2002 (2001 National Hospital Discharge Survey, NCHS, CDC). The U.S. population is older than Mexico's and so our pneumonia patients probably have a hospitalization rate that's higher than theirs, so let's use 1.3 mil./300 mil. and multiply by the Mexico population of 110 million * 0.5 -- conservatively guessing that their hospitalization rate for pneumonia is half that of the U.S. due to younger age. That gives an annual estimate of pneumonia patients in Mexico hospitalized of about 240,000 people. So the monthly rate in a typical year could be around 20,000 per month or maybe 10,000 per half month. [Note: some observers suggest that flu and pneumonia complications in a normal flu year could be higher than that due to the smog in Mexico City, but in the interest of conservatism let's ignore that].

Why exactly are we supposed to be surprised that there are reportedly nearly 2,000 people in Mexico hospitalized with severe pneumonia over the past two weeks, when that number (if accurate) is measurably lower than typical experience. It's a country of 110 million people, after all.

Sometimes the total cluelessness of the MSM makes my teeth hurt . . . . . . or maybe this is the worst thing to hit Mexico since Cortes marched through, but you can't make that claim AND believe that the numbers in the media reports have a shred of credibility, either.

You'll want to fix your own "bad math":

"about 100 deathsâsuggesting a mortality rate of 6 percent. This is almost certainly bad math, as the total case count almost certainly ignores thousands or tens of thousands of other cases that have taken milder courses like those in the United States. It's perfectly conceivable Mexico has actually had 10,000 or 100,000 casesâor even 1 million cases. If so, then the kill rate would be not 6 percent but 0.1 percent (given 10,000 cases) or 0.01 percent (given 100,000 cases). If it's 1 million cases (quite possible if this thing really spreads easily) then the mortality rate is just 1 in 10,000."

You're off by a factor of ten. If there were 10,000 cases, then 100 deaths makes 1.0 percent, not 0.1 percent. Similarly, if there were 100,000 cases, then one in a thousand or 0.1 percent (not 0.01) would have resulted in deaths. You are right that if there were a million cases, the mortality rate would be one in 10,000 -- but that is 0.01 percent.

You're clearly right about the gross underestimate of infections in Mexico. Here in New Zealand a school party of 25 went there for three weeks, 11 of them came back with Swine Flu. However you look at it that makes the virus far more infectious than the official count of 1300 infections.

What I find interesting is that no cases have been reported in Asia yet. It's unbelievable that it hasn't reached there. If there is any significant danger in this pandemic it could well emerge from there. Large populations living in close proximity with livestock, unsanitary conditions and poor healthcare. I think we've got a few nasty surprises yet to come.

The US & Mexican Government (in conjunction with one another) are over-exposing this whole thing for the purpose of keeping people away from Mexico. Between the fact that Mexico has always been a huge hotbed of UFO and Government activity (and experiments) and the reason finding of a mysterious creature (DNA shows as nothing we know of thus far), it's no wonder that they are suddenly quarantining much of the Country by faking some huge outbreak. They need people to stay home and clear of what project thy need to complete.

Doug Bremner's "strike" at me and the PTSD establishment (not)

ddobbs — Tue, 24 Mar 2009 22:20:44 +0000

Doug Bremner's "strike" at me and the PTSD establishment (not)

Skip this post if you don't want to read a writer responding point by point to a self-indulgent, insubstantial attack by a major academic.

I should say right off that I've long admired the more measured critiques that J. Douglas Bremner, a PTSD researcher and professor of radiology and psychiatry at Emory University, has offered about the pharmaceutical industry's exploitation of the neurochemical model of depression. My regard for this work made his ~~critique of~~ attack on my article about PTSD, "The Post-Traumatic Stress Syndrome," all the more disappointing.

I'm not disappointed because Bremner disagreed with my article. I've received several critiques of "The Post-Traumatic Stress Syndrome," both privately and in blogs and public letters, that disagreed sharply with my argument. I'm disappointed because while these other critiques have ranged from thoughtful and considered to and savage and threatening, none has been so self-indulgently insubstantial. The others offered genuine arguments or genuine reactions. Bremner -- the third most-cited PTSD researcher on earth, as he's happy to tell you -- offered snark.

It would give me pleasure to merely insult Dr. Bremner back, but I think it more helpful for the discussion to actually address his points -- a good term for them, as he seemed more interested in scoring rhetorical points than in actually dealing with the conceptual, diagnostic, and epidemiological issues raised in the article. To wit, with Bremner's points -- all of them that came even close to substance -- quoted:

Bremner says

An example of one of [Dobbs's] (highlighted) retarded statements is "misdiagnosed soldiers receive the wrong treatments and risk becoming mired in a Veterans Administration system that encourages chronic disability." Since when does the VA want chronic disability?

I never said the VA wants chronic disability. Neither the institution nor its clinicians want chronic disability in their patients, and its extremely hard-working clinicians are trying hard to successfully treat PTSD. But they're handicapped by a disability system that works against them, but which the VA administration apparently accepts because it's politically expensive to speak of changing it.

Bremner then offers that

Not everyone develops PTSD, but for those who do, it is real, believe me, and it doesn't matter what some pointy headed professors (or journalists) who are seeking attention with provocative statements say.

I'm won't comment on Bremner lamenting about attention-seekers; that's too easy. The real problem here is the statement that "for those who do [develop PTSD], it is real." This is an argument? It's a circle. It's like saying those who get sunburn really have sunburn. I'm not saying that people who have PTSD don't have PTSD. I'm saying that some people who are suffering other problems are mistakenly diagnosed with PTSD -- with the result that some people we SAY have PTSD don't actually have it. It's absurd to hear a doctor argue this can't be so. Millions are diagnosed with PTSD, which is terribly easy to confuse with depression, and every diagnosis is correct? We're talking scale here. Bremner wants you to think we're talking exists versus not-exists.

Dobbs taps into an underbelly of academic psychiatry that looks for approval from others by trying to look like they buck the trend about trauma and PTSD, with the basic message that PTSD is an overblown diagnosis created by a bunch of cry babies.

More insults substituting for arguments. And where'd we get "cry babies"? If you read the critiques, you'll find that "PTSD is really cry babies" is not the argument being offered. The argument being offered is that we are mistaking other forms of genuine distress for PTSD. To speak of cry babies is to infantalize the entire debate.

Next up, Bremner chastises psychiatrist and researcher Simon Wessely for suggesting that

we should pay attention to the role of secondary gain (e.g. getting disability benefits) in the development of PTSD. Big deal, some people want disability payments, does that mean PTSD is a bullshit diagnosis? I don't think so.

Again Bremner builds and whacks a straw man. Wessely is arguing not that "PTSD is a bullshit diagnosis" but that the VA's perverse disability incentives (as described in my article), might in some cases shape patient and clinician behavior. It's odd that Bremner, having written extensively on how money, gifts, and other incentives have influenced psychiatrist's prescription practices, should argue that financial incentives never sway patient nor clinician behavior.

Next up: DB tries to convince his readers that Richard McNally's best evidence for PTSD's diagnosis is drawn from a study of the psychology of alien abductions:

[McNally] gets a lot of mileage out of pointing to his study showing that people who think they were abducted by aliens have psychophysiological responses that look like PTSD as evidence that PTSD is a bs diagnosis (if those aliens did that to my rectum I think I would have PTSD too, wouldn't you)?

Readers who examine McNally's most comprehensive critique of PTSD [pdf download] will find that of its 17 pages, one sentence -- noting that people who believe they've been abducted have false memories -- alludes to that phenomenon. No matter; Bremner highlights this -- this weirdest thing he can find -- so he can make a rectum joke.

The rest is little better.

I do agree with Bremner on one point: He is right to complain that the DSM-V process is closed, secretive, and quite possibly dominated by a status quo perspective. But why is he claiming in his post title, and implying elsewhere within it, that he is "Striking Back at [the] Psychiatric Establishment on PTSD"? He's not attacking the psychiatric establishment here; he's striking at the very people (and one person who wrote about them) who are questioning the PTSD psychiatric establishment. Bremner compains he's locked out of the DSM-V's PTSD group. So are McNally and virtually all his fellow PTSD skeptics. Yet Bremner doesn't mention this, and it certainly doesn't seem to bother him. It just bothers him that he wasn't invited.

This is pretty deep irony. Well, no it's actually pretty shallow -- shallow, really, that Bremner, who has railed so effectively about the pharmaceutical industry's overextension of a paradigm based on increasingly tenuous evidence, should greet so cynically and glibly an evidence-based argument that something roughly similar -- and I am not equating the PTSD establishment with pharma here, but merely noting one paralle dynamic-- might be happening in his own field. The two fields differ in many ways. But in both, evidence is growing that a shaky model of mental disorder is being overapplied.

Bremner rails constantly about that dynamic in the treatment of depression. Yet when it comes to his own field, he acts as if such a thing is beyond imagining.

NB, 3/24/09: Soon after I posted a v of the above complaint as a comment at Bremner's blog, he replieed there with a more reasoned and civil response. This was helpful. And though I'm puzzled that I was able to morph in just a few minutes from a "pointy-headed journalist" to "a fine journalist" (unless Bremner's saying I'm both), I appreciate his gesture and more constructive tone.

ddobbs Tue, 03/24/2009 - 18:20

Tags

I used to like many of his posts, but these days Bremner gets on my nerves a lot, particularly with his "Before You Take That Pill" rants against everything big pharma. (Or so it would seem.) He's also posted at least a couple of real howlers about cancer that I've been sorely tempted to apply some not-so-Respectful Insolence to, so off base were they.

Maybe the next time.

Quite a few of his comments were out of line... and the more personal attacks seemed a bit, well, childish.

The link to McNally's critique is broken and I was looking forward to reading it-- do you have a fixed link for it by chance?

This guy's a mental health academic and he's calling arguments "retarded"? What a joke.

Also, it's bad enough when Rush Limbaugh talks about "pointy-headed professors", but when a Professor does it, you have to ask yourself if he really deserves that title.

Neuroskeptic - Before You Take That Pill is Dr. Bremner's personal blog, it's not JAMA or Biological Psychiatry or a rebuttal article in Scientific American. Didn't you read Bora's treatise (or diatribe, depending on your point of view) on The Shock Value of Science Blogs? This is the first I've read Bremner's blog, and I rather liked the fact that he used the words "morons" and "idiots" -- I guess you can say whatever you want when you have over 200 publications! That said, referring to a rival's opposing statements as "retarded" isn't the best way to make a reasoned argument.

Dave - Your article and subsequent commentaries have been very thought-provoking, as have some of the critiques (e.g., those of Mike Dunford). Ultimately, what everyone wants is appropriate treatment (and adequate funding) for the returning veterans who need help.

Thanks for the comment, Neuroskeptic; I'm always happy to read anything from your (digital) pen. I'm not with you on this one, however. I did read Bora's "Shock Value of Science Blogs," and had and have a mixed reaction. The informality of the blogosphere bring many benefits. So does the loosening of conventions and idioms that comes with it. But that doesn't change the essentially empty and even counter-productive nature of ad hominem attacks and insults masquerading as arguments. Snark and insult don't make an argument. And sometimes they're a way of avoiding one.

Yes, Bremner can say whatever he wants, and he can do so whether he's written 200 papers or not. But his post wasn't put up as entertainment. He posted it to counter a set of arguments about a deeply consequential issue â the well-being and mental health of hundreds of thousands of combat veterans. But while Bremner pretended to argue the issues in this debate, he didn't. He raised them, threw snark, pretended the issues were settled, and moved on dismissively.

And many of his readers bought it. Look at the comments there. Some clearly now think â or in some cases they did before, and now have their opinions strongly bolstered by the rhetoric of the world's third-most-cited PTSD researcher â that the scientists and historians raising questions about the PTSD Dx and its overextension are really just trying to increase Big Pharma's grasp on psychiatry and American culture. This is a ridiculous, deeply irresponsible accusation to either make or encourage -- and Bremner's support of it in the comments (where he declines to put a check on it and at one point actively encourages it) has effect precisely because he's a scientist. He harnessed unfounded accusations about motives, false representations of positions, insults, and his own authority to baldly misrepresent not just his opponents' arguments but the nature of the debate.

Is this somehow enlightening? Is it constructive? I can't see it.

I disagree. Yes I would argue that I engage in a form of psychiatric populism, but I see nothing in the posts on PTSD about the argument that PTSD is a problematic diagnosis being related to a plot on the part of big pharma. The opinion that the DSM process has been manipulated for the profit of the pharmaceutical industry is not an opinion that I hold in isolation. Go look at their web site and the convoluted attempts to explain away the entrenched ties with the pharmaceutical industry. Then look at the committee and then go to pubmed and count the number of PTSD publications actually WRITTEN by people on their committee. As for the style used, I make no apology for writing in a way that is interesting, and if it is snark, so be it. If I offended anyone unjustly, I apologize, and certainly didn't mean to take on the WRITER of the piece in question.

That said I wrote a reply on my own site.

On guard!

David: I think you've got me mixed up with the Neurocritic. I was the one defending you :)

Yes, it's true, I am the more sarcastic one...

Dave - I certainly agree with you that dismissive snark, instead of making reasoned arguments in reply to the important issues under debate, is not the way to further the dialog on PTSD diagnosis. Plus, Bremner's overall position can be viewed as inconsistent... he's critical of big pharma and his peanut gallery is the usual anti-psychiatry crowd, yet he does research in biological psychiatry. I do like some of his Photoshopped images, though.

The PTSD Trap - Extras (sources, links, a bit of multimedia)

ddobbs — Mon, 16 Mar 2009 10:02:48 +0000

The PTSD Trap - Extras (sources, links, a bit of multimedia)

Below are materials supplementing my story "The Post-Traumatic Stress Trap," Scientific American, April 2009. (You can find the story here and my blog post introducing it here.) I'm starting with annotated sources, source materials, and a bit of multimedia. I hope to add a couple sidebars that didn't fit in the main piece -- though those may end up at the main blog, so you may want to keep an eye there or subscribe via RSS or Atom.

Main sources and documents in "The Post-Traumatic Stress Trap."

These are organized by story section, roughly in the order the relevant material appears. Quoted passages are from the article, with source material following.

- Introduction-

â¢ Harvard psychology professor Richard J. McNally's, "Progress and Controversy in the Study of Posttraumatic Stress Disorder [pdf download]," Annual Rev Psychology 2003:229-52, As the story notes, the PTSD debate has been going on a while now -- since the PTSD diagnosis' creation in the late 1970s -- but was fanned into heat in 2003 by this long review essay by McNally.

"This critique, which was originally raised by military historians and a few psychologists, is now being pushed by a broad array of experts..." These have appeared in many venues, but are presented together most comprehensively in Gerald Rosen's (ed) 2004 Posttraumatic Stress Disorder: Issues and Controversies (also in a Kindle edition and in a special 2007 issue of the Journal of Anxiety Disorders.

â¢ The 1990 National Vietnam Veterans Readjustment Survey, which surveyed over 1,000 Vietnam veterans in 1988 and found that 15.2 percent of them had PTSD then and 30.9 percent had suffered it at some point since the war, is a key document in the PTSD debate. It established the canonical rate estimates -- but came under fire almost immediately for not confirming cases and for rate estimates some historians and diagnosticians thought unrealistically high. Its findings are summarized nicely here by Jennifer Price at the VA's National Center for PTSD.

â¢ In "The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods in Science in August 2006, Columbia University epidemiologist Bruce Dohrenwend and others, hoping to resolve the debate about the NVVRS, presented a reanalysis of the original NVVRS data. They found that the 1988 rate was 9.1 percent and the lifetime rate 18.7 percent -- 40 percent drops from the original. Both sides claimed these findings proved their case. The PTSD establishment said the study supported the construct's basic integrity by confirming most cases and showing a dose-response relationship. Critics said it proved that this seminal 1990 study had overstated Vietnam veterans' PTSD rates.

â¢ McNally's "Psychiatric Casualties of War," presented alongside Dohrenwend's study in Science, stressed how sharply Dohrenwend's revision cut the canonical rates established by the NVVRS -- and argued that applying standard clinical defintions of impairment would cut the rates even further. The letters section that follows these pieces online gives a good picture of the academic dispute that flared up afterwards.

It was that exchange that drew my attention to the controversy; as editor of Scientific American's Mind Matters blog, I solicited "The Costs of War,", a pair of commentaries on the controversy -- one by McNally, one by William Schlenger and Charles Marmar -- that ran in Mind Matters in the fall of 2007. (Apologies for the post's present formatting; it did not fare well in sciam.com's later website overhaul.)

The flap in Science also led to a special, hastily called symposium at the November 2006 annual meeting of the International Society for Traumatic Stress Studies (ISTSS), which featured presentations by Dohrenwend; Terry Keane, a leading PTSD researcher and clinician at the Boston VA; then-ISTSS president Dean Kilpatrick, who is is a PTSD researcher and clinician at the Medical University of South Carolina; and -- via an 8-minute presentation delivered via DVD, as he was in Europe on a previous commitment -- Richard McNally.

I am hoping to secure ISTSS's permission to place here an audio recording of the entire symposium. McNally's video presentation, however, is viewable below.

(It was this presentation that led Kilpatrick to "essentially call McNally a liar," as I said in the piece. Specifically, after McNally's presentation aired, Kilpatrick took the floor (it was his turn) and said, "What I would like to do is swear Rich McNally in under oath to tell the truth, the whole truth, and nothing but the truth. If that were done, I think you'd have seen an entirely different presentation." Kilpatrick later said he meant not that McNally lied, but that he failed to present the entire story -- an odd thing to ask, as one observer noted, of an 8-minute presentation)

- A Problematic Diagnosis -

The fourth Diagnostic Statistical Manual (DSM-IV) provides the present diagnostic definition and guidelines for PTSD. This is updated somewhat from the original construct presented in the 1978 DSM-III.

On the reliability of memory: Elizabeth Loftus's "Creating False Memories," from Scientific American, Sept 1997, describes how malleable memory can be, as does Daniel Schacter's Seven Sins of Memory. McNally's book Remembering Trauma gives a fuller, more trauma-specific account of memory's foibles. The "1990 study at the West Haven VA Hospital" that explored malleability of memories in veterans of the 1990 Gulf War is by "Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm, " by Southwick and others.

On PTSD's endocrinology:Rachel Yehuda's "Biology of posttraumatic stress disorder," from 2001, is one of several studies that found evidence of neuroendocrinological pecularities in PTSD; a 2004 study by Lindsey et alia's is one of several that did not. On the search for correlates of PTSD detectable through brain imaging, see Francati, Vermetten, and Bremner, "Functional neuroimaging studies in posttraumatic stress disorder: review of current methods and findings," 2006.

On the ties between trauma and PTSD symptoms,: see the Bodkin, Pope, and Hudson study described in the article, "Is PTSD caused by traumatic stress," which found zero correlation between PTSD diagnoses made by symptom clusters and those made by trauma histories.

"The most effective PTSD treatment is exposure-based cognitive behavioral therapy" - This is asserted by many experts and authorities, including a comprehensive review by a National Academy of Science committee, Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence (2007).

The symptom overlap between PTSD and traumatic brain injury is explored, among other places, in Hoge et alia's "Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq," New England J of Medicine, 31 Jan 2008.

- Disabling Conditions -

"In civilian populations, two-thirds of PTSD patients respond to treatment." from, e.g, "A Multidimensional Meta-Analysis of Psychotherapy for PTSD," Am J Psychiatry 162 (Feb 2005) (Search for "Across all treatments")

"...most veterans getting PTSD treatment from the VA report worsening symptoms until they reach 100 percent disability -- at which point their use of VA mental health services drops 82 percent." From VA Office of Inspector General, "Review of State Variances in VA Disability Compensation Payments" [large download] (Report VAOIG-05-00765-137), May 2005, p ix.

"... although the risk of PTSD from a traumatic event drops as time passes, the number of Vietnam veterans applying for PTSD disability almost doubled between 1999 and 2004, driving total PTSD disability payments to over $4 billion annually." from Veterans Compensation for Posttraumatic Stress Disorder, Institute of Medicine and National Research Council PTSD Compensation and Military Service, National Academics Press, 2005.

The innovative disability program used in Australia is described here.

- Two Ways to Carry a Rifle -

Finally, the conflicting studies of PTSD in US veterans of the Iraq and Afghanistan wars cited in the piece are Milliken et alia, "Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War," JAMA 14 Nov 2007, which found rates of around 20%, and Smith et al, "New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study," BMJ 16 Feb 2008, which found rates of under 5%.

(NB: To simplify housekeeping, I've closed the comments on this post only. If you want to comment on the story, please do so at my post or at the story.)

ddobbs Mon, 03/16/2009 - 06:02

The PTSD Trap - War, culture, and the overdiagnosis of PTSD

ddobbs — Sat, 14 Mar 2009 20:55:37 +0000

The PTSD Trap - War, culture, and the overdiagnosis of PTSD

My story in the April 2009 Scientific American story, "The Post-Traumatic Stress Trap", just went online. Here's the opening:

In 2006, soon after returning from military service in Ramadi, Iraq, during the bloodiest
period of the war, Captain Matt Stevens of the Vermont National Guard began to have a problem with PTSD, or post-traumatic stress disorder. Stevens's problem was not that he had PTSD. It was that he began to have doubts about PTSD: the condition was real enough, but as a diagnosis he saw it being wildly, even dangerously, overextended.

[snip]

"Clinicians aren't separating the few who really have PTSD from those who are experiencing things like depression or anxiety or social and reintegration problems, or who are just taking some time getting over it," says Stevens. He worries that many of these men and women are being pulled into a treatment and disability regime that will mire them in a self-fulfilling vision of a brain rewired, a psyche permanently haunted.

The story presents the case -- one being made by a growing number of experts in trauma psychology, psychiatry, epidemiology, and diagnostic science -- that post-traumatic stress disorder, or PTSD, is a conceptually flawed diagnosis that is being markedly or even wildly overapplied, especially in veterans, with disastrous results.

The diagnostic criteria for PTSD, [these experts and critics] assert, represent a faulty, outdated construct that has been badly overextended so that it routinely mistakes depression, anxiety, or even normal adjustment for a unique and particularly stubborn ailment.

We are likely overdiagnosing PTSD in veterans by some 300 to 400%. This might be an academic matter if those veterans soon got better. But as the story describes, this flawed construct and overdiagnosis combines with an outmoded, counter-therapeutic Veterans Administration disability system to mire many of them in dysfunction and disability. The number of veterans receiving PTSD diagnoses and disability from the VA has skyrockted over the last decade1999, with a huge surge of new diagnoses in Vietnam Veterans (one that began before the conflicts in Iraq and Afghanistan) now being joined by growing numbers of veterans of the Iraq and Afghanistan wars. Yet the arcane disability system at the VA so discourages recovery that those receiving VA treatment -- which is roughly similar to treatments that cure 2/3 of civilian patients -- show no treatment effect at all. They're no more likely to get better than are vets with PTSD not getting treatment.

"In the several years I spent in VA PTSD clinics," one long-time VA PTSD clinician and researcher told me, "I can't think of a single PTSD patient who left treatment because he got better. But the problem is not the veterans. The problem is that the VA's disability system, which is 60 years old now, ignores all the intervening research we have on resilience, on the power of expectancy and the effects of incentives and disincentives."

This is a real mess. We have a diagnosis whose fundamental mechanism -- memory -- has been shown to be spectacularly unreliable; a culture and a clinical discipline that reflexively sees any sign of distress as PTSD; and a disability system that actively discourages healing.

For many this will be an unattractive assertion. In the many months I worked on this story, running back to 2006, talking to scores of people, I saw a deep resistance to this proposal that war -- which, make no mistake, is greatly stressfult and roubling, hell indeed -- might not be as scarring as we like to think it is. I soon began to see that this was not just a medical and a bureaucratic problem but the expression of deep cultural conflicts and anxieties. American culture seems to have a deep investment in the the picture of war as irredeemably toxic, and in its experience as incurably damaging. "I don't understand why they don't all get it," one acquaintance said to me.

I cannot stress this point enough: The point of the story, and the questioning of the PTSD construct and its application, is NOT to question the suffering of soldiers or others exposed to trauma. It's to suggest that we often misunderstand that suffering and anguish, and that this leads us -- especially with veterans -- to respond in ways that often fail to help them and sometimes even do them harm. And the history of this diagnosis, and the deep resistance to confronting its problems, speak of not just a troublesome construct and a troubled bureaucracy, but of a culture struggling to come to terms with its participation in war.

The debate over the PTSD diagnosis and its application stands to affect the expenditure of billions of dollars, the diagnostic framework of psychiatry, the effectiveness of a huge treatment and disability infrastructure, and, most important, the mental health and future lives of hundreds of thousands of U.S. combat veterans and other PTSD patients. Standing in the way of a healthy reconsideration is conventional wisdom, foundational concepts of trauma psychology, and deep cultural resistance. As I put it in the story,

PTSD exists. Where it exists we must treat it. But our cultural obsession with PTSD has magnified, replicated, and finally perhaps become the thing itself -- a prolonged failure to contextualize and accept our own collective aggression. It may be our own postwar neurosis.

"The PTSD Trap" at sciam.com. You may also be interested in a page of supplementary material and links I built.

ddobbs Sat, 03/14/2009 - 16:55

A talk on Darwin's coral reef theory -- his first and final test

ddobbs — Thu, 05 Feb 2009 07:47:12 +0000

A talk on Darwin's coral reef theory -- his first and final test

A coral atoll, from Darwin's The Structure and Distribution of Coral Reefs, 1842.

For those teeming millions near Hanover, N.H., here's notice that I'll be giving a talk at Dartmouth at 4pm today -- Thu, Feb 5 -- about Darwin's first, favorite, and (to me) most interesting theory, which was his theory about how coral reefs formed.

This is the subject of my book Reef Madness: Charles Darwin, Alexander Agassiz, and the Meaning of Coral, and I'll be posting more about it next week, during the Blog for Darwin festival. But the short version -- and the topic of my talk -- is this:

Darwin's coral reef theory, published immediately after his return from the Beagle voyage, was a sort of test-run for his theory of natural selection. It anticipated the species theory in both method and concept:, for it was bold, imaginative, and it explained a variety and distribution of forms as the products of incremental change in response to dynamic forces. It was also deductive as hell, and so flew in the face of the inductive principles that supposed ruled science then. Yet it won him a place in British science on his return to England. Charles Lyell, the leading figure in geology at the time, was so delighted with the theory that when Darwin told him about it, Lyell danced around the room shouting and laughing.

It's a beautiful theory, and none, he said in late life, ever gave him more pleasure. Yet it spurred a controversy that inverted weirdly the controversy over his evolution theory. While he didn't publish his evolution theory until he had collected massive evidence, he published his coral reef theory after seeing only a handful of reefs. This made it vulnerable, and while it won quick acceptance as the textbook explanation, it came under increasing fire during the century as new evidence seemed to undermine it. By the 1870s, when Alexander Agassiz -- the son of Darwin's old creationist foe Louis Agassiz, but a Darwinist himself -- challenged the reef theory in earnest, it was quite vulnerable. Darwin found himself again facing an Agassiz -- only this time it was an Agassiz who held the stronger evidentiary hand. The challenge would test, in ways both illuminating and torturous, both Darwin's coral reef theory and for the brand of creative empiricism that Darwin had helped establish with his theory of natural selection.

Why haven't you heard of this before? Beats me. The book, though warmly received by the scientific and lay readers it found, was not strongly promoted when it was published in 2005. In this year of Darwin I'm hoping to reach more people with this overlooked but crucial episode, and will be giving this talk at several venues. If you're interested in hosting a talk at your university, library, scientific society, or Darwin festival, drop me a line at dave[at]daviddobbs.net.

Or come to snowy Hanover today! The talk is at the Rockfeller Center on the Dartmouth green at 4 pm. Free and open to the public.

PS You can read the introduction to Reef Madness here.

ddobbs Thu, 02/05/2009 - 02:47

Tags

Books

culture of science

History/philosophy of science

I'm really sorry to say that I have not read your book, but clearly I should. I've been fascinated by the role of this question (the reefs) in Darwin's development as a scholar, but I have not really explored the post monograph history of the idea in any detail.

I've been playing with my new Kindle. Should I kindle it?