Tag Archives: medicine

tD, Technica

Personalized Care Courtesy of Big Data

The era of truly personalized medicine and treatment plans may still be a fair way off, but thanks to big data initiatives predictive and preventative health is making significant progress. This bodes well for over-stretched healthcare systems, medical professionals, and those who need care and/or pay for it.

That said, it is useful to keep in mind how similar data in other domains such as shopping travel and media, has been delivering personalized content and services for quite some time. So, healthcare information technology certainly lags, where it should be leading. One single answer may be impossible to agree upon. However, it is encouraging to see the healthcare and medical information industries catching up.

From Technology Review:

On the ground floor of the Mount Sinai Medical Center’s new behemoth of a research and hospital building in Manhattan, rows of empty black metal racks sit waiting for computer processors and hard disk drives. They’ll house the center’s new computing cluster, adding to an existing $3 million supercomputer that hums in the basement of a nearby building.

The person leading the design of the new computer is Jeff Hammerbacher, a 30-year-old known for being Facebook’s first data scientist. Now Hammerbacher is applying the same data-crunching techniques used to target online advertisements, but this time for a powerful engine that will suck in medical information and spit out predictions that could cut the cost of health care.

With $3 trillion spent annually on health care in the U.S., it could easily be the biggest job for “big data” yet. “We’re going out on a limb—we’re saying this can deliver value to the hospital,” says Hammerbacher.

Mount Sinai has 1,406 beds plus a medical school and treats half a million patients per year. Increasingly, it’s run like an information business: it’s assembled a biobank with 26,735 patient DNA and plasma samples, it finished installing a $120 million electronic medical records system this year, and it has been spending heavily to recruit computing experts like Hammerbacher.

It’s all part of a “monstrously large bet that [data] is going to matter,” says Eric Schadt, the computational biologist who runs Mount Sinai’s Icahn Institute for Genomics and Multiscale Biology, where Hammerbacher is based, and who was himself recruited from the gene sequencing company Pacific Biosciences two years ago.

Mount Sinai hopes data will let it succeed in a health-care system that’s shifting dramatically. Perversely, because hospitals bill by the procedure, they tend to earn more the sicker their patients become. But health-care reform in Washington is pushing hospitals toward a new model, called “accountable care,” in which they will instead be paid to keep people healthy.

Mount Sinai is already part of an experiment that the federal agency overseeing Medicare has organized to test these economic ideas. Last year it joined 250 U.S. doctor’s practices, clinics, and other hospitals in agreeing to track patients more closely. If the medical organizations can cut costs with better results, they’ll share in the savings. If costs go up, they can face penalties.

The new economic incentives, says Schadt, help explain the hospital’s sudden hunger for data, and its heavy spending to hire 150 people during the last year just in the institute he runs. “It’s become ‘Hey, use all your resources and data to better assess the population you are treating,’” he says.

One way Mount Sinai is doing that already is with a computer model where factors like disease, past hospital visits, even race, are used to predict which patients stand the highest chance of returning to the hospital. That model, built using hospital claims data, tells caregivers which chronically ill people need to be showered with follow-up calls and extra help. In a pilot study, the program cut readmissions by half; now the risk score is being used throughout the hospital.

Hammerbacher’s new computing facility is designed to supercharge the discovery of such insights. It will run a version of Hadoop, software that spreads data across many computers and is popular in industries, like e-commerce, that generate large amounts of quick-changing information.

Patient data are slim by comparison, and not very dynamic. Records get added to infrequently—not at all if a patient visits another hospital. That’s a limitation, Hammerbacher says. Yet he hopes big-data technology will be used to search for connections between, say, hospital infections and the DNA of microbes present in an ICU, or to track data streaming in from patients who use at-home monitors.

One person he’ll be working with is Joel Dudley, director of biomedical informatics at Mount Sinai’s medical school. Dudley has been running information gathered on diabetes patients (like blood sugar levels, height, weight, and age) through an algorithm that clusters them into a weblike network of nodes. In “hot spots” where diabetic patients appear similar, he’s then trying to find out if they share genetic attributes. That way DNA information might add to predictions about patients, too.

A goal of this work, which is still unpublished, is to replace the general guidelines doctors often use in deciding how to treat diabetics. Instead, new risk models—powered by genomics, lab tests, billing records, and demographics—could make up-to-date predictions about the individual patient a doctor is seeing, not unlike how a Web ad is tailored according to who you are and sites you’ve visited recently.

That is where the big data comes in. In the future, every patient will be represented by what Dudley calls “large dossier of data.” And before they are treated, or even diagnosed, the goal will be to “compare that to every patient that’s ever walked in the door at Mount Sinai,” he says. “[Then] you can say quantitatively what’s the risk for this person based on all the other patients we’ve seen.”

Read the entire article here.

BigBang

The Half Life of Facts

There is no doubting the ever expanding reach of science and the acceleration of scientific discovery. Yet the accumulation, and for that matter the acceleration in the accumulation, of ever more knowledge does come with a price — many historical facts that we learned as kids are no longer true. This is especially important in areas such as medical research where new discoveries are constantly making obsolete our previous notions of disease and treatment.

Author Samuel Arbesman, tells us why facts should have an expiration date in his new book, A review of The Half-Life of Facts.

[div class=attrib]From Reason:[end-div]

Dinosaurs were cold-blooded. Vast increases in the money supply produce inflation. Increased K-12 spending and lower pupil/teacher ratios boosts public school student outcomes. Most of the DNA in the human genome is junk. Saccharin causes cancer and a high fiber diet prevents it. Stars cannot be bigger than 150 solar masses. And by the way, what are the ten most populous cities in the United States?

In the past half century, all of the foregoing facts have turned out to be wrong (except perhaps the one about inflation rates). We’ll revisit the ten biggest cities question below. In the modern world facts change all of the time, according to Samuel Arbesman, author of The Half-Life of Facts: Why Everything We Know Has an Expiration Date.

Arbesman, a senior scholar at the Kaufmann Foundation and an expert in scientometrics, looks at how facts are made and remade in the modern world. And since fact-making is speeding up, he worries that most of us don’t keep up to date and base our decisions on facts we dimly remember from school and university classes that turn out to be wrong.

The field of scientometrics – the science of measuring and analyzing science – took off in 1947 when mathematician Derek J. de Solla Price was asked to store a complete set of the Philosophical Transactions of the Royal Society temporarily in his house. He stacked them in order and he noticed that the height of the stacks fit an exponential curve. Price started to analyze all sorts of other kinds of scientific data and concluded in 1960 that scientific knowledge had been growing steadily at a rate of 4.7 percent annually since the 17th century. The upshot was that scientific data was doubling every 15 years.

In 1965, Price exuberantly observed, “All crude measures, however arrived at, show to a first approximation that science increases exponentially, at a compound interest of about 7 percent  per annum, thus doubling in size every 10–15 years, growing by a factor of 10 every half century, and by something like a factor of a million in the 300 years which separate us from the seventeenth-century invention of the scientific paper when the process began.” A 2010 study in the journal Scientometrics looked at data between 1907 and 2007 and concluded that so far the “overall growth rate for science still has been at least 4.7 percent per year.”

Since scientific knowledge is still growing by a factor of ten every 50 years, it should not be surprising that lots of facts people learned in school and universities have been overturned and are now out of date.  But at what rate do former facts disappear? Arbesman applies the concept of half-life, the time required for half the atoms of a given amount of a radioactive substance to disintegrate, to the dissolution of facts. For example, the half-life of the radioactive isotope strontium-90 is just over 29 years. Applying the concept of half-life to facts, Arbesman cites research that looked into the decay in the truth of clinical knowledge about cirrhosis and hepatitis. “The half-life of truth was 45 years,” reported the researchers.

In other words, half of what physicians thought they knew about liver diseases was wrong or obsolete 45 years later. As interesting and persuasive as this example is, Arbesman’s book would have been strengthened by more instances drawn from the scientific literature.

Facts are being manufactured all of the time, and, as Arbesman shows, many of them turn out to be wrong. Checking each by each is how the scientific process is supposed work, i.e., experimental results need to be replicated by other researchers. How many of the findings in 845,175 articles published in 2009 and recorded in PubMed, the free online medical database, were actually replicated? Not all that many. In 2011, a disheartening study in Nature reported that a team of researchers over ten years was able to reproduce the results of only six out of 53 landmark papers in preclinical cancer research.

[div class=attrib]Read the entire article after the jump.[end-div]

BigBang

Scandinavian Killer on Ice

The title could be mistaken for a dark and violent crime novel from the likes of (Stieg) Larrson, Nesbø, Sjöwall-Wahlöö, or Henning Mankell. But, this story is somewhat more mundane, though much more consequential. It’s a story about a Swedish cancer killer.

[div class=attrib]From the Telegraph:[end-div]

On the snow-clotted plains of central Sweden where Wotan and Thor, the clamorous gods of magic and death, once held sway, a young, self-deprecating gene therapist has invented a virus that eliminates the type of cancer that killed Steve Jobs.

‘Not “eliminates”! Not “invented”, no!’ interrupts Professor Magnus Essand, panicked, when I Skype him to ask about this explosive achievement.

‘Our results are only in the lab so far, not in humans, and many treatments that work in the lab can turn out to be not so effective in humans. However, adenovirus serotype 5 is a common virus in which we have achieved transcriptional targeting by replacing an endogenous viral promoter sequence by…’

It sounds too kindly of the gods to be true: a virus that eats cancer.

‘I sometimes use the phrase “an assassin who kills all the bad guys”,’ Prof Essand agrees contentedly.

Cheap to produce, the virus is exquisitely precise, with only mild, flu-like side-effects in humans. Photographs in research reports show tumours in test mice melting away.

‘It is amazing,’ Prof Essand gleams in wonder. ‘It’s better than anything else. Tumour cell lines that are resistant to every other drug, it kills them in these animals.’

Yet as things stand, Ad5[CgA-E1A-miR122]PTD – to give it the full gush of its most up-to-date scientific name – is never going to be tested to see if it might also save humans. Since 2010 it has been kept in a bedsit-sized mini freezer in a busy lobby outside Prof Essand’s office, gathering frost. (‘Would you like to see?’ He raises his laptop computer and turns, so its camera picks out a table-top Electrolux next to the lab’s main corridor.)

Two hundred metres away is the Uppsala University Hospital, a European Centre of Excellence in Neuroendocrine Tumours. Patients fly in from all over the world to be seen here, especially from America, where treatment for certain types of cancer lags five years behind Europe. Yet even when these sufferers have nothing else to hope for, have only months left to live, wave platinum credit cards and are prepared to sign papers agreeing to try anything, to hell with the side-effects, the oncologists are not permitted – would find themselves behind bars if they tried – to race down the corridors and snatch the solution out of Prof Essand’s freezer.

I found out about Prof Magnus Essand by stalking him. Two and a half years ago the friend who edits all my work – the biographer and genius transformer of rotten sentences and misdirected ideas, Dido Davies – was diagnosed with neuroendocrine tumours, the exact type of cancer that Steve Jobs had. Every three weeks she would emerge from the hospital after eight hours of chemotherapy infusion, as pale as ice but nevertheless chortling and optimistic, whereas I (having spent the day battling Dido’s brutal edits to my work, among drip tubes) would stumble back home, crack open whisky and cigarettes, and slump by the computer. Although chemotherapy shrank the tumour, it did not cure it. There had to be something better.

It was on one of those evenings that I came across a blog about a quack in Mexico who had an idea about using sub-molecular particles – nanotechnology. Quacks provide a very useful service to medical tyros such as myself, because they read all the best journals the day they appear and by the end of the week have turned the results into potions and tinctures. It’s like Tommy Lee Jones in Men in Black reading the National Enquirer to find out what aliens are up to, because that’s the only paper trashy enough to print the truth. Keep an eye on what the quacks are saying, and you have an idea of what might be promising at the Wild West frontier of medicine. This particular quack was in prison awaiting trial for the manslaughter (by quackery) of one of his patients, but his nanotechnology website led, via a chain of links, to a YouTube lecture about an astounding new therapy for neuroendocrine cancer based on pig microbes, which is currently being put through a variety of clinical trials in America.

I stopped the video and took a snapshot of the poster behind the lecturer’s podium listing useful research company addresses; on the website of one of these organisations was a reference to a scholarly article that, when I checked through the footnotes, led, via a doctoral thesis, to a Skype address – which I dialled.

‘Hey! Hey!’ Prof Magnus Essand answered.

To geneticists, the science makes perfect sense. It is a fact of human biology that healthy cells are programmed to die when they become infected by a virus, because this prevents the virus spreading to other parts of the body. But a cancerous cell is immortal; through its mutations it has somehow managed to turn off the bits of its genetic programme that enforce cell suicide. This means that, if a suitable virus infects a cancer cell, it could continue to replicate inside it uncontrollably, and causes the cell to ‘lyse’ – or, in non-technical language, tear apart. The progeny viruses then spread to cancer cells nearby and repeat the process. A virus becomes, in effect, a cancer of cancer. In Prof Essand’s laboratory studies his virus surges through the bloodstreams of test animals, rupturing cancerous cells with Viking rapacity.

[div class=attrib]Read the entire article following the jump.[end-div]

[div class=attrib]The Snowman by Jo Nesbø. Image courtesy of Barnes and Noble.[end-div]

Environs

Good Grades and Good Drugs?

A sad story chronicling the rise in amphetamine use in the quest for good school grades. More frightening now is the increase in addiction of ever younger kids, and not for dubious goal of excelling at school. Many kids are just taking the drug to get high.

[div class=attrib]From the Telegraph:[end-div]

The New York Times has finally woken up to America’s biggest unacknowledged drug problem: the massive overprescription of the amphetamine drug Adderall for Attention Deficit Hyperactivity Disorder. Kids have been selling each other this powerful – and extremely moreish – mood enhancer for years, as ADHD diagnoses and prescriptions for the drug have shot up.

Now, children are snorting the stuff, breaking open the capsules and ingesting it using the time-honoured tool of a rolled-up bank note.

The NYT seems to think these teenage drug users are interested in boosting their grades. It claims that, for children without ADHD, “just one pill can jolt them with the energy focus to push through all-night homework binges and stay awake during exams afterward”.

Really? There are two problems with this.

First, the idea that ADHD kids are “normal” on Adderall and its methylphenidate alternative Ritalin – gentler in its effect but still a psychostimulant – is open to question. Reading this scorching article by the child psychologist Prof L Alan Sroufe, who says there’s no evidence that attention-deficit children are born with an organic disease, or that ADHD and non-ADHD kids react differently to their doctor-prescribed amphetamines. Yes, there’s an initial boost to concentration, but the effect wears off – and addiction often takes its place.

Second, the school pupils illicitly borrowing or buying Adderall aren’t necessarily doing it to concentrate on their work. They’re doing it to get high.

Adderall, with its mixture of amphetamine salts, has the ability to make you as euphoric as a line of cocaine – and keep you that way, particularly if it’s the slow-release version and you’re taking it for the first time. At least, that was my experience. Here’s what happened.

I was staying with a hospital consultant and his attorney wife in the East Bay just outside San Francisco. I’d driven overnight from Los Angeles after a flight from London; I was jetlagged, sleep-deprived and facing a deadline to write an article for the Spectator about, of all things, Bach cantatas.

Sitting in the courtyard garden with my laptop, I tapped and deleted one clumsy sentence after another. The sun was going down; my hostess saw me shivering and popped out with a blanket, a cup of herbal tea and ‘something to help you concentrate’.

I took the pill, didn’t notice any effect, and was glad when I was called in for dinner.

The dining room was a Californian take on the Second Empire. The lady next to me was a Southern Belle turned realtor, her eyelids already drooping from the effects of her third giant glass of Napa Valley chardonnay. She began to tell me about her divorce. Every time she refilled her glass, her new husband raised his eyes to heaven.

It felt as if I was stuck in an episode of Dallas, or a very bad Tennessee Williams play. But it didn’t matter in the least because, at some stage between the mozzarella salad and the grilled chicken, I’d become as high as a kite.

Adderall helps you concentrate, no doubt about it. I was riveted by the details of this woman’s alimony settlement. Even she, utterly self- obsessed as she was, was surprised by my gushing empathy. After dinner, I sat down at the kitchen table to finish the article. The head rush was beginning to wear off, but then, just as I started typing, a second wave of amphetamine pushed its way into my bloodstream. This was timed-release Adderall. Gratefully I plunged into 18th-century Leipzig, meticulously noting the catalogue numbers of cantatas. It was as if the great Johann Sebastian himself was looking over my shoulder. By the time I glanced at the clock, it was five in the morning. My pleasure at finishing the article was boosted by the dopamine high. What a lovely drug.

The blues didn’t hit me until the next day – and took the best part of a week to banish.

And this is what they give to nine-year-olds.

[div class=attrib]Read the entire article after the jump.[end-div]

[div class=attrib]From the New York Times:[end-div]

He steered into the high school parking lot, clicked off the ignition and scanned the scraps of his recent weeks. Crinkled chip bags on the dashboard. Soda cups at his feet. And on the passenger seat, a rumpled SAT practice book whose owner had been told since fourth grade he was headed to the Ivy League. Pencils up in 20 minutes.

The boy exhaled. Before opening the car door, he recalled recently, he twisted open a capsule of orange powder and arranged it in a neat line on the armrest. He leaned over, closed one nostril and snorted it.

Throughout the parking lot, he said, eight of his friends did the same thing.

The drug was not cocaine or heroin, but Adderall, an amphetamine prescribed for attention deficit hyperactivity disorder that the boy said he and his friends routinely shared to study late into the night, focus during tests and ultimately get the grades worthy of their prestigious high school in an affluent suburb of New York City. The drug did more than just jolt them awake for the 8 a.m. SAT; it gave them a tunnel focus tailor-made for the marathon of tests long known to make or break college applications.

“Everyone in school either has a prescription or has a friend who does,” the boy said.

At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse prescription stimulants, according to interviews with students, parents and doctors. Pills that have been a staple in some college and graduate school circles are going from rare to routine in many academically competitive high schools, where teenagers say they get them from friends, buy them from student dealers or fake symptoms to their parents and doctors to get prescriptions.

Of the more than 200 students, school officials, parents and others contacted for this article, about 40 agreed to share their experiences. Most students spoke on the condition that they be identified by only a first or middle name, or not at all, out of concern for their college prospects or their school systems’ reputations — and their own.

“It’s throughout all the private schools here,” said DeAnsin Parker, a New York psychologist who treats many adolescents from affluent neighborhoods like the Upper East Side. “It’s not as if there is one school where this is the culture. This is the culture.”

Observed Gary Boggs, a special agent for the Drug Enforcement Administration, “We’re seeing it all across the United States.”

The D.E.A. lists prescription stimulants like Adderall and Vyvanse (amphetamines) and Ritalin and Focalin (methylphenidates) as Class 2 controlled substances — the same as cocaine and morphine — because they rank among the most addictive substances that have a medical use. (By comparison, the long-abused anti-anxiety drug Valium is in the lower Class 4.) So they carry high legal risks, too, as few teenagers appreciate that merely giving a friend an Adderall or Vyvanse pill is the same as selling it and can be prosecuted as a felony.

While these medicines tend to calm people with A.D.H.D., those without the disorder find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward. “It’s like it does your work for you,” said William, a recent graduate of the Birch Wathen Lenox School on the Upper East Side of Manhattan.

But abuse of prescription stimulants can lead to depression and mood swings (from sleep deprivation), heart irregularities and acute exhaustion or psychosis during withdrawal, doctors say. Little is known about the long-term effects of abuse of stimulants among the young. Drug counselors say that for some teenagers, the pills eventually become an entry to the abuse of painkillers and sleep aids.

“Once you break the seal on using pills, or any of that stuff, it’s not scary anymore — especially when you’re getting A’s,” said the boy who snorted Adderall in the parking lot. He spoke from the couch of his drug counselor, detailing how he later became addicted to the painkiller Percocet and eventually heroin.

Paul L. Hokemeyer, a family therapist at Caron Treatment Centers in Manhattan, said: “Children have prefrontal cortexes that are not fully developed, and we’re changing the chemistry of the brain. That’s what these drugs do. It’s one thing if you have a real deficiency — the medicine is really important to those people — but not if your deficiency is not getting into Brown.”

The number of prescriptions for A.D.H.D. medications dispensed for young people ages 10 to 19 has risen 26 percent since 2007, to almost 21 million yearly, according to IMS Health, a health care information company — a number that experts estimate corresponds to more than two million individuals. But there is no reliable research on how many high school students take stimulants as a study aid. Doctors and teenagers from more than 15 schools across the nation with high academic standards estimated that the portion of students who do so ranges from 15 percent to 40 percent.

“They’re the A students, sometimes the B students, who are trying to get good grades,” said one senior at Lower Merion High School in Ardmore, a Philadelphia suburb, who said he makes hundreds of dollars a week selling prescription drugs, usually priced at $5 to $20 per pill, to classmates as young as freshmen. “They’re the quote-unquote good kids, basically.”

The trend was driven home last month to Nan Radulovic, a psychotherapist in Santa Monica, Calif. Within a few days, she said, an 11th grader, a ninth grader and an eighth grader asked for prescriptions for Adderall solely for better grades. From one girl, she recalled, it was not quite a request.

“If you don’t give me the prescription,” Dr. Radulovic said the girl told her, “I’ll just get it from kids at school.”

[div class=attrib]Read the entire article here.[end-div]

[div class=attrib]Image: Illegal use of Adderall is prevalent enough that many students seem to take it for granted. Courtesy of Minnesota Post / Flickr/ CC/ Hipsxxhearts.[end-div]

Idea Soup

Doctors Die Too, But Differently

[div class=attrib]From the Wall Street Journal:[end-div]

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.

It’s not something that we like to talk about, but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made “arrangements,” as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

[div class=attrib]Read the entire article here.[end-div]

[div class=attrib]Image: The Triumph of Death, Pieter Bruegel the Elder, 1562. Museo del Prado in Madrid.[end-div]

BigBang

Women and Pain

New research suggests that women feel pain more intensely than men.

[div class=attrib]From Scientific American:[end-div]

When a woman falls ill, her pain may be more intense than a man’s, a new study suggests.

Across a number of different diseases, including diabetes, arthritis and certain respiratory infections, women in the study reported feeling more pain than men, the researchers said.

The study is one of the largest to examine sex differences in human pain perception. The results are in line with earlier findings, and reveal that sex differences in pain sensitivity may be present in many more diseases than previously thought.

Because pain is subjective, the researchers can’t know for sure whether women, in fact, experience more pain than men. A number of factors, including a person’s mood and whether they take pain medication, likely influence how much pain they say they’re in.

…

In all, the researchers assessed sex differences in reported pain for more than 250 diseases and conditions.

For almost every diagnosis, women reported higher average pain scores than men. Women’s scores were, on average, 20 percent higher than men’s scores, according to the study.

Women with lower back pain, and knee and leg strain consistently reported higher scores than men. Women also reported feeling more pain in the neck (for conditions such as torticollis, in which the neck muscles twist or spasm) and sinuses (during sinus infections) than did men, a result not found by previous research.

…

It could be that women assign different numbers to the level of pain they perceive compared with men, said Roger B. Fillingim, a pain researcher at the University of Florida College of Dentistry, who was not involved with the new study.

But the study was large, and the findings are backed up by previous work, Fillingim said.

“I think the most [simple] explanation is that women are indeed experiencing higher levels of pain than men,” Fillingim said.

The reason for this is not known, Fillingim said. Past research suggests a number of factors contribute to perceptions of pain level, including hormones, genetics and psychological factors, which may vary between men and women, Fillingim said. It’s also possible the pain systems work differently in men and women, or women experience more severe forms of disease than men, he said.

[div class=attrib]Read the entire article here.[end-div]

[div class]Image courtesy of CNN.[end-div]

Idea Soup

Hitchens on the Desire to Have Died

Christopher Hitchens, incisive, erudite and eloquent as ever.

Author, polemicist par-excellence, journalist, atheist, Orwellian (as in, following in George Orwell’s steps), and literary critic, Christopher Hitchens shows us how the pen truly is mightier than the sword (though me might well argue to the contrary).

Now fighting oesophageal cancer, Hitchen’s written word continues to provide clarity and insight. We excerpt below part of his recent, very personal essay for Vanity Fair, on the miracle (scientific, that is) and madness of modern medicine.

[div class=attrib]From Vanity Fair:[end-div]

Death has this much to be said for it:
You don’t have to get out of bed for it.
Wherever you happen to be
They bring it to you—free.
—Kingsley Amis

Pointed threats, they bluff with scorn
Suicide remarks are torn
From the fool’s gold mouthpiece the hollow horn
Plays wasted words, proves to warn
That he not busy being born is busy dying.
—Bob Dylan, “It’s Alright, Ma (I’m Only Bleeding)”

When it came to it, and old Kingsley suffered from a demoralizing and disorienting fall, he did take to his bed and eventually turned his face to the wall. It wasn’t all reclining and waiting for hospital room service after that—“Kill me, you fucking fool!” he once alarmingly exclaimed to his son Philip—but essentially he waited passively for the end. It duly came, without much fuss and with no charge.

Mr. Robert Zimmerman of Hibbing, Minnesota, has had at least one very close encounter with death, more than one update and revision of his relationship with the Almighty and the Four Last Things, and looks set to go on demonstrating that there are many different ways of proving that one is alive. After all, considering the alternatives …

Before I was diagnosed with esophageal cancer a year and a half ago, I rather jauntily told the readers of my memoirs that when faced with extinction I wanted to be fully conscious and awake, in order to “do” death in the active and not the passive sense. And I do, still, try to nurture that little flame of curiosity and defiance: willing to play out the string to the end and wishing to be spared nothing that properly belongs to a life span. However, one thing that grave illness does is to make you examine familiar principles and seemingly reliable sayings. And there’s one that I find I am not saying with quite the same conviction as I once used to: In particular, I have slightly stopped issuing the announcement that “Whatever doesn’t kill me makes me stronger.”

In fact, I now sometimes wonder why I ever thought it profound. It is usually attributed to Friedrich Nietzsche: Was mich nicht umbringt macht mich stärker. In German it reads and sounds more like poetry, which is why it seems probable to me that Nietzsche borrowed it from Goethe, who was writing a century earlier. But does the rhyme suggest a reason? Perhaps it does, or can, in matters of the emotions. I can remember thinking, of testing moments involving love and hate, that I had, so to speak, come out of them ahead, with some strength accrued from the experience that I couldn’t have acquired any other way. And then once or twice, walking away from a car wreck or a close encounter with mayhem while doing foreign reporting, I experienced a rather fatuous feeling of having been toughened by the encounter. But really, that’s to say no more than “There but for the grace of god go I,” which in turn is to say no more than “The grace of god has happily embraced me and skipped that unfortunate other man.”

Or take an example from an altogether different and more temperate philosopher, nearer to our own time. The late Professor Sidney Hook was a famous materialist and pragmatist, who wrote sophisticated treatises that synthesized the work of John Dewey and Karl Marx. He too was an unrelenting atheist. Toward the end of his long life he became seriously ill and began to reflect on the paradox that—based as he was in the medical mecca of Stanford, California—he was able to avail himself of a historically unprecedented level of care, while at the same time being exposed to a degree of suffering that previous generations might not have been able to afford. Reasoning on this after one especially horrible experience from which he had eventually recovered, he decided that he would after all rather have died:

I lay at the point of death. A congestive heart failure was treated for diagnostic purposes by an angiogram that triggered a stroke. Violent and painful hiccups, uninterrupted for several days and nights, prevented the ingestion of food. My left side and one of my vocal cords became paralyzed. Some form of pleurisy set in, and I felt I was drowning in a sea of slime In one of my lucid intervals during those days of agony, I asked my physician to discontinue all life-supporting services or show me how to do it.

The physician denied this plea, rather loftily assuring Hook that “someday I would appreciate the unwisdom of my request.” But the stoic philosopher, from the vantage point of continued life, still insisted that he wished he had been permitted to expire. He gave three reasons. Another agonizing stroke could hit him, forcing him to suffer it all over again. His family was being put through a hellish experience. Medical resources were being pointlessly expended. In the course of his essay, he used a potent phrase to describe the position of others who suffer like this, referring to them as lying on “mattress graves.”

If being restored to life doesn’t count as something that doesn’t kill you, then what does? And yet there seems no meaningful sense in which it made Sidney Hook “stronger.” Indeed, if anything, it seems to have concentrated his attention on the way in which each debilitation builds on its predecessor and becomes one cumulative misery with only one possible outcome. After all, if it were otherwise, then each attack, each stroke, each vile hiccup, each slime assault, would collectively build one up and strengthen resistance. And this is plainly absurd. So we are left with something quite unusual in the annals of unsentimental approaches to extinction: not the wish to die with dignity but the desire to have died.

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[div class=attrib]Image: Christopher Hitchens, 2010. Courtesy of Wikipedia.[end-div]