Wednesday, January 30, 2008

Joy of free thinking

exit
Free thinking is good for your health because it is real stuff, based on science, and more than a placebo. This is my conclusion after ten months of blogging here at Med Journal Watch and after some posts about the placebo effect of religion and its common traits with quackery.

I have learnt a lot, plunged into tons of medical science news stuff and tried to sort out the most relevant of it. My skepticism has grown steadily, and I more and more considered the broad scope of my blog a weakness. I felt like I should put more focus, and this focus has been more and more on mind and brain, psychology, freethought, religion, philosophy and the like.

As a consequence, I've chosen to discontinue Med Journal Watch and take my exit to a new blog: Free Thinking Joy. Feel free to follow me and think with me, and to subscribe to my new feed.

Of course, Med Journal Watch will remain strictly under my control, serving as an old archive.

Photo credit: flickr.com/photos/hi-phi/299994030/

Tuesday, January 29, 2008

One single cigarette may be addictive

cigarette
Be warned against just trying it out because as little as one cigarette may be sufficient to get you hooked on nicotine. For all those who might have thought this danger to be low - me included, I must admit, before I have come across this study on diminished autonomy over tobacco - it is high time to learn that 25 to 30 percent of all young people, after having lit up once, feel some troubles not to light up a second and third time. With as little as one cigarette every one or two months, the addiction rate is as high as 46 percent!

Addiction, or loss of autonomy, has been defined in this study as a feeling of unpleasantness or difficulty towards quitting. And the data base is sufficient for a strong conclusion: More than ninety thousand young students aged fourteen and fifteen have been interviewed in New Zealand.

In retrospect, I consider myself a very, very lucky guy. I have been smoking a few but heavy cigarettes daily, about two decades ago, but not for longer than several weeks until I felt an unpleasant tightness and weakness in my lungs. Caused me to stop from one day to another. I am the exception to the rule. Don't follow me. Period.

Photo credit: flickr.com/photos/pensiero/283555417/

Monday, January 28, 2008

The subtle balance of human cooperation

free riders
Cooperation between strangers can only evolve if the cost of altruistic punishment is low and its impact on free riders is high. This is the result of a web based Dutch experiment with more than eight hundred participants where the cost of altruistic punishment and the impact on free riders have been varied, using real money in a public game.

It came out that the decision whether to punish free riders or not depends on a mix of emotion and cost to impact calculation. On the emotional side, a free rider provokes negative feelings in cooperative subjects. But before the subjects take action, they calculate the cost to impact ratio of the punishment. Cooperation only occurs if the level of free riding that goes unpunished is relatively low, and this in turn depends on a favourable cost to impact ratio.

Altruistic punishment costs the punisher some amount of effort, for instance time, emotional or physical energy, a risk of being attacked, maybe even money, without any direct personal benefit. The benefit is only indirect, serving the group as a whole. And this group typically is a group of strangers, only united by concordant interests.

Altruistic punishment can only lead to cooperation if reputation and reciprocity are important in the group of strangers, and if it is easily possible to opt out, that is, not to participate in any activity of the group.

The case of science, quacks, and skeptics

The success of science in modern world has prompted quacks to use pseudo science as a vehicle of free riding, and unfortunately they sometimes even manage to act against the only viable countermeasure, altruistic punishment. Skeptics play an important role in keeping up a high quality science by cooperation of all those who really use their brains, unmasking pseudo science, calling quacks quacks and exposing their fraudulent tricks in public. Even at the risk of lawsuits.

There has been a sad day recently when a self-appointed "professor" and leader of an "institute", Joseph Chikelue Obi, has managed to silence our skeptic colleague Le Canard Noir at Quackometer Blog. After having threatened the web service provider of Quackometer with a million pound lawsuit, Obi has won the first round of the game: Le Canard Noir has been forced to take down his critical remarks.

But there is a second round, fortunately. Many bloggers of the skeptical community have reposted the article that has been deleted from Quackometer, the first copy I have found is at Steven Novella's Neurologica Blog, and also Orac has reposted, and more than thirty others. It's worth following these links.

So, at last, I hope to gain back my confidence that altruistic punishment of quacks is still working.

http://www.flickr.com/photos/ayoumali/487771865/

Sunday, January 27, 2008

Would you like to become a digital zombie?

zombie
The survival instinct of the human mind is so strong that the idea of afterlife has survived religion and entered freethought in the twilight zone between science fiction and science facts. Why else would Steven Novella, a leading skeptic, post a long article on digital immortality plus follow-up? I have come across this old post (published a year ago) while gathering information about the fact that mind is linked to our brain and will die definitely with our brain.

Steven has put very interesting thoughts into the question whether and how a digital copy of the brain could be made and stored in a computer of the future. I like to go a step further and assume that it could be done: Would I want to have my mind digitally cloned for infinite survival?

I have a certain weakness for this type of reasoning. A couple of days ago, in a blitz chess tournament, I have wasted about half a minute contemplating whether I should want to give my Queen for two Rooks, only to become aware that this has been my only option. Fortunately, I kept enough time to checkmate my opponent with my two Rooks. Back to life: I am quite sure that my only option is the definite end of my mind after death. But Steven's science fiction stuff has fascinated me, so it may be appropriate to propose the desirability question for the hypothetical option.

Are we our brain, really?

Every tiny bit of feeling, emotion, consciousness, reasoning, and memory is produced by our brain. So are we our brain? I strongly hesitate, and the longer I think about it, the more skeptical I get. Suppose a leg is amputated. I still can feel phantom pain. But it would be very hard to produce all the feelings and impressions provided by the skin, the muscles, and the joints of my leg. Amputate the whole body and keep the brain alive in a perfect nutrient solution, then it becomes virtually impossible to reproduce all the lost input and make the brain believe that it still has its own body. Let alone the simulation of the whole environment. Thus, should it ever be possible to clone a mind, its situation would be pretty like that of an isolated brain in a nutrient solution.

Digitally undead, can this be called life?

I strongly doubt that a thing digitally cloned from my mind to a supercomputer still would be "me". I guess I should not bother of this clone's fate and happiness because this is his (its) business and not mine.

But let me be altruistic. Would the life of this digital zombie be worth living? Either it would be sort of an endless dream where he would not miss his body and his environment because these sensations would be produced by the mind itself. Really? I think even in dreaming our body is active and gives input, so a complicated software environment may be necessary to maintain such a digital dream.

But what about waking the zombie up? Then it will be necessary to provide a complete second life environment. And I guess that just avatars won't do. Our mind has evolved hand in hand with a body interface, it will hardly be working well without it. Maybe not at all without it. A digital mind zombie will not be able to interact with another mind zombie because neither of them has a body.

The torture of solitary confinement

Solitary confinement violates a fundamental human right. It is torture. Yet the victim of such a torture is much better off than a digital mind zombie: He has his own body, he has a poor environment but still a much richer one than the mind zombie has, he can drink, eat food, urinate, defecate, touch the walls, touch his body.

Whatever the housing of a digital mind would look like, however perfect it would be designed, I suspect it would be much worse than the worst solitary confinement.

On the other hand, if a mind zombie would be adapted to feel well in such a confinement, he no longer would be something like me. Let alone that it might really be me.

Not without my perfect robot!

I also have my doubts whether a mind zombie could stay mentally fit without a body and its inputs. When I got it right, the recent research in artificial intelligence more and more is about robots because the physical interaction with the environment is part of human intelligence. Take this interaction away, and people quickly get demented.

Thus, a mind zombie may require a perfect robot, a physical copy of his own body. Such a thing is impossible to construct with technical means. But it may be possible to clone the own body cells and grow all human organs in a test tube, replacing the old ones as soon as they are worn out.

Now, we get a number of serious problems. The brain is also a part of the body, so it also should be replaced when worn but the original idea has been to replace it by a computer. I do not see how such a media break may be overcome. But even worse, such a humanoid zombie would need resources, taking them away from his children, grandchildren and great-grandchildren.

Conclusion

If I had the choice to have my mind digitally cloned, I probably would agree, partly out of survival instinct and partly because I would be curious how such an existence would look like. But I would insist on the option to have me deleted should I suffer from boredom or other unpleasant feelings. Without this being granted, I strongly hesitate. Probably I would prefer to be really, really dead, just as provided by mother nature.

Important note: This subject will be continued in my new blog Joy of Freethinking.

Photo credit: flickr.com/photos/eltonmelo/287298650/

Friday, January 25, 2008

Centenary of the camp toothbrush

camp toothbrush

Robert Baden-Powell has become famous as founder of the Boy Scout movement, but his role as pioneer of dental care is less known. A hundred years ago, in May 1908, in his bestseller "Scouting for boys", he has charged boys to be careful with their teeth, brushing them twice a day. In case toothbrushes should be missing, he showed how to make a camp toothbrush out of a dry twig, frayed out at the end. And he drastically described the consequences of tooth loss if teeth are neglected in young age.

Scouting for boys has been sold in more than sixty million copies in thirty languages all over the world. The ideal window of opportunity for adopting hygiene behaviour is thought to be the age of boy scouts, thus Baden-Powell probably is one of the most influential pioneers of dental care.

Obviously, he has been quite successful: In a 2003 survey, the toothbrush was selected as the number one invention Americans could not live without, beating out the automobile, computer, cell phone, and microwave oven.

A number of studies show the importance of teeth for health: Disease of the gums has been linked to heart disease, tooth loss to disease of aortic valves, rheumatic disease and a poor general health and quality of life, to name only a few.

Photo credit: Horace Cox, C. Arthur Pearson, and The Scout Association

Thursday, January 24, 2008

Our ears grow throughout lifetime

baby's ear
The outer ears are the only parts of the human body that continue to grow until death. Head, trunk, arms, legs, hands and feet, all the inner and outer organs stop when fully grown in adult age. Even the nose of Cyrano de Bergerac did not grow forever. Hair and nails do, but these are expendable items that constantly must be replaced.

In contrast, the human outer ear is something very special. In proportion to body size at birth, it is the biggest of all organs, even bigger than the head. And it continues to grow throughout lifetime, mostly in childhood and then slowly decreasing, but never stopping until death.

The greatest ear length is 52 millimeters (2.04 inches) at birth on average; at seventy years of age it is 78 millimeters (3.07 inches) in men and 72 millimeters (2.83 inches) in women. About half of the growth between birth and old age is reached at age twenty. But the inner part of the auricle, the so-called concha, has reached its final size already at birth. Detailed statistics about ear sizes may be used for forensic age estimations.

Photo credit: flickr.com/photos/breckenpool/37345467/

Wednesday, January 23, 2008

Four years of dementia lifespan

4 candles
Four to five years after the onset of dementia, half of the affected persons have died but this is only an average, largely depending on the age at onset. Such is the result of a fourteen years follow-up statistics in more than four hundred aged persons with dementia in England and Wales.

The median lifespan of aged people with dementia, that is the time from onset of the disease until half of all surveyed persons have died, is 4.1 years in men and 4.6 years in women. Age is by far the most important factor; the median survival time varies from 10.7 years in those aged 65 to 69 down to 3.8 years in those aged ninety and more. Women and those with a better mental or physical status survive longer.

Quartiles give a more detailed picture of how the different lifespans are distributed in the population: A quarter of men will be dead 2.5 years after onset, three quarters 7.6 years after onset of dementia. In women, these lifespans are 2.9 and 7.0 years, respectively. Again, these figures vary with age.

How to deal with these figures

Be aware that this is statistics and cannot be applied to individual cases. These figures are from England and Wales and may be different in other parts of the world.

But all the same this information may help better enjoying the company of a loved one suffering from dementia because he or she may not be around much longer. On the negative side, the burden of caregiving, it may help seeing that this will not go on forever. For professional providers of care as well as for family members, it may help for mid to long-term prognosis, planning, and better coping with the rapidly approaching fact of the inevitable.

Photo credit: flickr.com/photos/anataman/68751167/

Tuesday, January 22, 2008

Understanding the French Obesity Paradox

ratatouille
The French eat more fat, are less diet obsessed but also less obese than Americans; a new study has found a reason, possibly the most important one. It is about the cues that lead a person to stop eating. For this decision, the French rely mostly on cues from the gut, the Americans from the environment. This is the outcome of a study on internal and external cues for meal cessation. Looking at this dish of ratatouille, a French probably will put it aside because he feels full and a dessert is yet to come while an American may feel that it's normal to finish such a yummy meal.

Different food worlds in Paris and Chicago

Two groups of college students, more than a hundred in each group, have been surveyed, one in Paris and one in Chicago. They had to rate how strongly they agree or disagree with the following statements:

  1. I usually stop eating when I start feeling full.
  2. I usually stop eating when I want to leave room for dessert.
  3. If it doesn’t taste good, I’ll still eat it if I am hungry.
  4. I usually stop eating when I’ve eaten what most think is normal.
  5. I usually stop eating when I run out of a beverage.
  6. I usually stop eating when the TV show I’m watching is over.
The first three refer to internal cues, coming from feelings of the gut. The last three refer to external cues, coming from the environment.

The most significant correlation (p-value less than 0.001) was that Parisians relied mostly on internal cues and Chicagoans mostly on external cues. Another correlation was also strongly significant (p-value 0.005): Students with a higher body mass index (BMI), regardless of residence, were more influenced by external cues. Despite some limitations of the study, for instance BMI only self-reported and not measured, not controlled for smoking, not a representative sample of the whole population, the findings are quite telling.

Don't let them super size you!

Given these findings, it is very easy to understand why fast food companies sell ever bigger portions: This strategy works very well with Americans because it exploits their reliance on external cues. Much has been said about public health efforts, for instance advertising bans, to alter the "obesiogenic environment". I am not a fan of this approach, and I feel assured by this study. If U. S. Americans manage to listen more to their guts, they may learn to push half-eaten super size burgers aside to leave room for dessert.

http://www.flickr.com/photos/princess_of_llyr/261096976/

Health Blog Carnival Watch 1:15

Grand Rounds
4:18 at ButYouDontLookSick
4:17 at Sharp Brains
4:16 at Pathtalk
4:15 at Other Things Amanzi

Skepticism, Freethinking, Humanism
SC #78 at The Skeptical Surfer
CotG #82 at Axis of Jared
HS #13 at Faith in Honest Doubt

Monday, January 21, 2008

Frequent flyers think twice about jogging!

airport
All those with an elevated thrombosis risk, frequent flyers as well as elderly, may fare better with walking than with jogging. This is the conclusion of a study about exercise and thrombosis in the Netherlands.

Venous thrombosis, the formation of blood clots in the deep leg veins, has also been called economy class syndrome because it often has been observed after long-haul flights. Advanced age is another major risk factor for this disease. If the blood clots get loose, they may travel to the lungs and block arteries there, causing a life-threatening lung embolism.

In the Netherlands, more than five thousand women and men have been examined, asked about their exercise activities, and followed up to eleven years on average. During this time, 171 new cases of venous thrombosis have been observed. Linking these cases to the exercise activities, it came out that a moderate intensity, for instance walking, comes along with a lower thrombosis risk than high intensity, such as jogging. Jogging is also linked to a higher thrombosis risk than no exercise at all. The researchers admit that they did not expect such a result and that further studies are needed to explain this finding.

Small risk but you may want to keep it as low as possible

Given the small absolute risk of only three percent in this study, the findings are far from being alarming. Jogging has many benefits, so these may be more important than the small increase in thrombosis risk. On the other hand, for elderly people, time spent in physical activity is most important, and a higher intensity may not bring much more benefit.

For frequent flyers, the absolute risk of a deep vein thrombosis is about 0.3 percent a year, summing up to again three percent when compared to the eleven years of the Dutch study in the elderly. Thus, frequent flying seems to be about an equal risk factor for thrombosis as being elderly.

Frequent flyers who love jogging more than walking need not give up their hobby. Instead, on long flights, they can prevent thrombosis risk with leg and foot gymnastics, avoiding to freeze too long in a cramped position. But if your joints ache and your wife or partner would prefer your company going out for a walk together, then turning to walking may be the better decision anyway.

Additional risk factors

Other risk factors are female sex, the pill, smoking, but not varicose veins. If your physician has warned you against or has diagnosed a vein thrombosis, you may prefer walking to jogging.

Photo credit: flickr.com/photos/appaloosa/205091570/

Friday, January 18, 2008

Vitamin C as a training killer

vitamin pill
Muscles gain less endurance with the same amount of training when supplemented with vitamin C, so athletes may be better off with both less efforts and less vitamins. This tip, based upon new research done in Spain, seems to be badly needed given all the marketing claims I have found, googling for vitamin supplements and training.

Two things are for sure. Training increases the so-called oxidative stress by formation of free radicals. Vitamin C, on the other hand, acts against oxidative stress. Therefore, it has been recommended for all those who perform heavy workouts.

But there is a serious drawback in this strategy because vitamin C supplements hamper the endurance training effect of exercise. In a double-blind randomized study, fourteen young men have been trained for eight weeks in Valencia, Spain. Five of the men have received a vitamin C supplement, the others only a placebo. With the same amount of training, the supplemented men gained less endurance than those taking placebo. In addition, a similar experiment has been undertaken with rats where the muscles could be analyzed after the training. It came out that vitamin C hampers the generation of mitochondria in the muscle cells. Mitochondria are the "power plants" of the cells, and the number of mitochondria in a muscle cell is a measure for its endurance capacity.

Conclusion 1: Vitamin C may help to reduce oxidative stress caused by training, but for gaining the same training effect as before, a more intensive training may be needed, causing more stress. In the light of this study, it seems to be better to leave the vitamins pills aside and take training a bit easier if done for better health.

Conclusion 2: If want to win a competition and use vitamin C against catching a flu in these days, you must face the fact that you'll need more training and a longer recovery than without the vitamin supplement.

Photo credit: flickr.com/photos/98277799@N00/20884986/

Thursday, January 17, 2008

Sense of value adds pleasure

expensive wine
Expensive wines taste better also because the sense of value turns on a pleasure mechanism in the frontal brain - this is real stuff and not just an illusion. That is, the wine taster really perceives a better taste as can be shown by brain magnetic resonance imaging. This is more than a simple expectation of the type "it's a Chateau, must be good" as a neural marketing experiment at Caltech has shown.

Twenty volunteers have been given the task of tasting five sorts of wines, identified by their retail prices of 5, 10, 35, 45, and 90 dollars. However, in reality, there were only three sorts of wines, two of them have been used twice. For instance, wine number two has been presented as 90 dollar (its real price) and also as 10 dollar wine. Subjects reported the higher priced wines to taste better than the cheaper ones. Plus the area of the brain that is involved with pleasantness was more active when the subjects reported a better taste.

The researchers hesitate to conclude that these brain scans show a real or just an imagined increase in pleasure. But it is hard to believe that a mere illusion would produce such a result. Beauty is in the eye of the beholder. The object may not meet all general beauty standards but, if the beholder is highly tuned to it, he may perceive it as the most beautiful in the world. Without this principle, men only would fall in love with supermodels, women only with supermachos.

How to make use of it

These findings may be important to sales managers but even more so for all those who like to add more pleasure to life. Adding more value may be a good first step. This does not mean just to buy expensive things but also to be aware of the most valuable good we have, time.

The Caltech wine experiment somehow reminds me of the finding reported yesterday, awareness of death as a source of positive feelings. It would be interesting to know if the same brain mechanism is involved in both cases.

Photo credit: flickr.com/photos/waynemah/69992582/

Wednesday, January 16, 2008

Face death and enjoy life more

memento mori
Dare it, do it, because an unconscious tuning mechanism of the human brain will help you. This is really exciting. You do not have to take painful efforts for reaching this goal. In people facing the inevitable fact that they must die, tuning thoughts from terror to joy works automatically, according to experiments that have been performed at the Department of Psychology, University of Kentucky, in Lexington.

I have missed this study when it was published back in November, but thanks to the improved search strategy that is part of my 2008 blogging intentions, I have found it at last. It is never too late.

Fear of death completely different from fear of pain

In the Kentucky study, subjects have undergone three experiments. In two experiments, the accessibility of positive information has been measured. The third experiment was a word similarity test where subjects had to group words according to their meanings. This test can be used to assess whether a person is tuned to more positive or more negative emotions.

Prior to the tests, the subjects have been instructed, based on detailed information, to think about death or about dental pain.

In all three tests, the subjects exposed to death thoughts have been tuned more to positive emotions than those exposed to dental pain thoughts. This reaction has been detected immediately after the exposure to thoughts, but it also worked after a delay. Concluding from interviews with the participants, this reaction works on an unconscious level and is not a result of an effort.

Death denial is the wrong way of coping

In the light of this study, both religious denial of death by believing in an afterlife and suppression of death thoughts in a Freudian sense are bad ways of coping with the inevitable and ultimate fact of death.

A weak afterlife belief is not really a source of comfort, and a strong one is a source of suicide bombing. And suppressed thoughts, according to Freud, are a source of mental disorder.

In contrast, there is much reward in freethinking. Our life is so precious, so valuable and so beautiful because we have this one and only and limited life. The more limited, the higher the value. This is a fundamental law of economics. So let's enjoy every moment of it.

Suggested reading: Truly Alive, a site about "facing death in the prime of life" with many useful ideas and suggestions that are compatible with freethinking.

Photo credit: flickr.com/photos/15942690@N00/859899563/

Tuesday, January 15, 2008

First sex step by step is safest

young love
Young people who proceed with sex step by step, from the first kiss to fondling of growing intensity up to intercourse, take less risk than those who leave out one or more steps. This is the result of a Dutch study about a link between sexual trajectories and sexual risk.

More than two thousand young Dutch of both genders who had engaged in sexual intercourse, aged 12 to 25, have been interviewed. About three quarters have followed a continuous path in their early encounters, from less intimate to the most intimate. These were also most likely to consistently use contraceptives with the most recent partner. On the other hand, those not using contraceptives or engaging in unprotected anal intercourse were most likely to have an abrupt sexual career. Such a career is most likely in immigrants with a traditional cultural background and in less educated young people.

The use or non-use of condoms remained fairly stable even after a long sex career. Thus, it seems that the path of beginning a sexual career, rather than its duration, is important for safer sex.

Conclusion: Safer sex, using condoms, is only possible with a sufficient amount of control. This control has to be learnt, and this requires time. Therefore, a stepwise progression offers the best security. In addition, it also helps both partners to learn more about their own needs and wishes which is important for a satisfying sex life.

Photo credit: flickr.com/photos/sullyt64/2120328195/

Monday, January 14, 2008

No moral without a free will

contemplating
Ethical feelings are weakened by the belief that human behaviour is determined by environmental and genetic factors. This has been shown in a psychological experiment at the Carlson School of Marketing, University of Minnesota, finding that encouraging the belief in determinism increases cheating.

Oh yes, this not only proves the old French saying to be true: "Tout comprendre, c'est tout pardonner." It also gives a good reason to my personal reaction whenever I hear someone trying to "understand" why a rapist, pedophiliac or amok killer committed his crime.

Cheaters in two experiments

In a first experiment, students had to solve math problems that were presented by a computer program with a built-in flaw, "erroneously" allowing students to view the solutions. Prior to the test, students have been given either a text describing human behaviour as a consequence of environmental and genetic factors or a neutral text not supporting a deterministic view. Those who have read the deterministic text cheated more than the others.

In a second experiment, students had to assess their own reward for performing a cognitive task. Again, they have read a text before, either supporting determinism or a free will. Those indoctrinated by determinism tended to cheat by overpaying themselves, those who have been convinced of a free will did not cheat.

No contradiction

In philosophy, there have been many disputes about the subject. Some have rejected free will because they have been aware that a wide range of human behaviour is determined by internal and external causes. Others have rejected determinism because they feared a loss of ethics, a fear that is supported by the above experiments.

The most reasonable view has been formulated more than three hundred years ago by Thomas Hobbes, stating that free will is compatible with external or internal forces that coerce a person to do something, possibly against his own free will. The forces may be too strong to be overridden, but they do not exclude a free will. Free will is what makes us subjects, otherwise we'd be no more than bio-robots. I even won't exclude the possibility that some animals may have a free will, at least from their subjective point of view, even if we may be able to explain their choice by environment and instincts. But this is speculation because no animal will ever be able to tell us its feelings.

Photo credit: flickr.com/photos/brixton/404168521/

Friday, January 11, 2008

Tango beats exercise for Parkinsonians

tango class
Any type of physical activity may prevent frailty but tango seems to be best when it comes to balance and fall prevention. These issues are particularly important in frail elderly, and they are most pronounced in people suffering from Parkinson's disease. For this reason, a group of Parkinsonians have been chosen for a preliminary experiment comparing tango dancing with conventional exercise.

Nineteen patients have been assessed as to symptoms of Parkinson's disease and performance in various tests. Then, assigned by random, they visited either twenty tango lessons or twenty exercise lessons. After the program, the same tests have been performed. It came out that Parkinson's symptoms improved significantly after both interventions. But only the tango dancers improved in the Berg Balance Scale, a test where tasks such as standing on one leg, doing balance tasks with eyes closed, and the like have to be performed. The Berg Balance Scale is very important in the elderly because falls are a main source of disability in old age.

Due to the small number of participants, this test does not allow definite conclusions, and the usefulness of tango dancing versus exercise should be confirmed with greater samples. But one thing can be taken for granted: Tango is more fun!

Photo credit: flickr.com/photos/lizdance14/825877861/

Thursday, January 10, 2008

Schizophrenia: A hundred years of a dubious concept

Eugen Bleuler
The idea of a split mind has been introduced 1908 by the Swiss psychiatrist Eugen Bleuler, replacing Kraepelin's idea of premature dementia, but modern science has found that Kraepelin got closer to the point.

The zeitgeist of the Freudian era in the early 20th century was in favour of the view that psychic diseases can be cured by cognitive interventions. Bleuler's new term schizophrenia (Greek for split mind) has opened such therapeutic perspectives whereas the older term dementia praecox, coined by Emil Kraepelin, implied a damage that cannot be cured in therapeutic sessions.

During most of the 20th century, both terms have been used at the same time and partially as synonyms. Schizophrenia tended to be more broadly defined, also including psychogenic causes. Dementia praecox, on the other hand, was defined in a more narrow sense, stating that the causes are organic and that the prognosis is bad.

With the new brain imaging techniques (fMRI), a number of deficits in the brain have been localized in schizophrenics. These findings support the concept of Kraepelin.

The split mind concept, on the other hand, has not been verified, and its diagnostic power is poor. In Japan, it has been replaced 2004 by the concept of integration disorder. In the Western world, despite some controversies, it is still being used. A new review of the current research findings on schizophrenia comes to the conclusion that this term should better be abandoned.

Photo credit: University of Zurich

Wednesday, January 9, 2008

The final checkmate

When it comes do death, some know that the game definitely is over and some believe that the pieces are set up anew somewhere they don't know - this post is in memoriam of my old chess team pal Kurt.

He has been a pillar for us in many team matches. He has been the best supporter of young players at our club (see photo). He has got so frail that, in his last days, he wished to die as one of our teammates told us yesterday. Most likely he died from an organ failure, sleeping, at age eighty-seven. He died of old age, one would have said in earlier days. I am about to leave for the funeral, being fully aware of the fact that, sooner or later but inevitably, I'll be in his place, that is, a small heap of ashes.

I have always asked myself what makes chess playing so attractive even for those who lose all the time. And I have come to the conclusion that one of the best feelings in chess is setting up pieces anew after a game is over. In chess, there is always a new game. And this feeling may be most rewarding after a lost game because losing raises the likeliness that the next game will be better.

Wishful thinking

The belief in a life after death, in my opinion, can be explained by the survival instinct of every living being. Death must be avoided at any cost. Even at the cost of free thinking for many of those who, in general, base their thinking on science and facts. Afterlife belief is survival instinct extended to a point where the subject that is supposed to be saved no longer exists. Thus, the whole idea of an afterlife is getting absurd.

Another question is whether the conceivable forms of such an afterlife would be worth living or not. I have spent some thoughts on this question and I suspect that any "eternal" afterlive might be the worst torture that could be conceived. I have not worked this out yet and will come back to it in a later post. Just some hints for the moment. Orgasm is the most pleasurable feeling we can have. But what about an orgasm that goes on for hours, days, months and years? I'll bet my fortune that the victim of such a state would beg for being shot on the spot.

A non-conceivable difference

I have tried to figure out the difference between two variants of what has happened tonight while I have been in my deepest and dreamless sleeping stage, between two given moments, starting with moment A. Moment B is one minute later when I have been still alive, still deeply sleeping. Moment X is a hypothetical moment when I could have died from any cause that would not wake me up. Now, trying to figure out the difference between the moments B and X, I cannot find any such difference. Both moments are so fare away from me as any moment in history, even before my birth. Both moments are just "nothing", and the difference between nothing B and nothing X is again nothing.

I even cannot find any difference between Kurt's moment X and mine. But I am happy that, next Tuesday at our club, the pieces will be set up again, and, as ever, I hope to win my club championship game. And, oops, I should not neglect my chess blog!

P.S. I just have discovered this excellent article by Greta Christina: Comforting thoughts about death that have nothing to do with God.

Tuesday, January 8, 2008

Good sex every day keeps the doctor away

kiss
Enjoy the feeling every day and the doing from time to time, without stress for body and mind, and a look at how well you achieve may be the easiest way to check your health status. Sorry girls but this post is based upon a study in men. Yet I suspect that its findings may also apply to women, at least in part.

Okay boys, here we are. The relations between sexual symptoms, life satisfaction, and health have been assessed in more than fifteen thousand Finnish men aged 40 to 69 years. In a mailed questionnaire, they have answered questions about sex life, social life, and health. In the youngest age group, only twenty percent reported a low frequency of erections and problems with libido and potency. In the oldest age group, two out of three reported such problems.

Between the youngest and the oldest, there was a steady linear increase of sex problems but not of other health problems. While not linked to age, the latter showed a close relationship to sex problems: Men with moderate to severe sexual symptoms have visited their physicians up to three times more often than men without or with only minor sexual symptoms. Thus, sexual wellbeing seems to be an easy and quite reliable indicator of general health, irrespective of age. In the light of ever-growing medical expenditures, this may be worth considering.

Which cause, which effect?

As always in such studies, the question of cause arises. Is bad sex caused by disease or does good sex prevent disease? The former has been proven in many studies and there can be no doubt about it. But the latter is also very plausible because good sex is a source of wellbeing and this will in turn promote health.

What about women? Arousal and orgasmic reactions are very similar in both sexes when it comes to the whole body and not just the sex organs. When problems are concerned, these are more prominent in the male sex, of course. But for the good side, this is not necessarily so.

Photo credit: flickr.com/photos/photophreak/223529620/

Monday, January 7, 2008

Old body mass, fat mass, and fitness

walkers
The problem of obesity in old age may be due to a lack of fitness, but it remains unclear which is the cause and which is effect. Body mass index in elderly people has a serious drawback because, as people get older, muscles and bones (the fat-free mass) are being reduced and body fat mass is increasing. Thus, in spite of being weight stable, seniors may become "fat". They may be better off adding weight and not losing muscle mass.

A new study has addressed this problem, analyzing fat mass and fat-free mass in seniors and their effects on fitness. More than nine hundred Canadian men and women between 67 and 84 years of age have been studied. Fat mass and fat-free mass have been measured by a special dual x-ray method. Fitness has been assessed by measuring walking speed and performance in the one leg stand test. It came out that fat mass is negatively linked to fitness.

Fat-free mass, on the other hand, is not linked to fitness - which is quite a surprise to me. Obviously, the fitness levels of all the study subjects have been high enough so that deficits did not (yet) emerge.

The old obesity paradox

Old obese often have been reported to live longer than old thin people. One aspect is easy to understand: a slow death is often preceded by weight loss. A second aspect is the diminishing accuracy of body mass index in old age given the shifts in fat and fat-free masses that may vary a lot between different people.

These two effects may offset possible bad effects of obesity in old age. It is not even possible to speak of an "effect" because we just have seen a link between more body fat and less fitness. Which one is the cause? A fat, heavy body with weak muscles is most likely a handicap to physical activity. But, on the other hand, a sedentary lifestyle may be the real cause that body fat is being accumulated and muscle mass is diminishing.

Key message: The role of obesity in old age remains unclear in many aspects, but this study shows a clear link between high body fat and low fitness. Given that fit old people live better and longer, fitness should be the main concern.

Photo credit: flickr.com/photos/dhammza/330268832/

Friday, January 4, 2008

Skeptical remarks on the definition of overweight

Currently, a body mass index of more than 25 is considered overweight, but this should be checked against the newest mortality data from the Centers for Disease Control and Prevention.

In compliance with my good blogging intentions for 2008, I forget all my earlier posts about body weight, reset all my opinions to zero and have a new, fresh and unbiased look at the data. Not just some data, but data from the most recent "big" publication based on more than 2.3 million deaths, by Flegal and co-workers in JAMA 2007;298:2028.

There has been some debate in the skeptic community as to whether we always should take the side of mainstream consensus, about the difference between skepticism and crankery, and about the analysis of rhetoric tactics as a diagnostic tool. My point of view is that facts is what counts, so let's have a look at them.

The body mass indices in this study have been calculated from measured height and weight values which makes them more reliable than the self-declared values used in other studies.

graph

We see that obesity (BMI 30+) is strongly linked to excess deaths from coronary heart disease and from other cardiovascular diseases and is substantially linked to some, but not to all cancers. All other weight classes are not linked to mortality from these diseases. In particular, overweight (BMI 25-29) is not significantly different from normal weight.

graph

Looking at non-heart and non-cancer deaths, we see excess deaths from diabetes and kidney disease linked to overweight and obesity and a reduction of excess deaths from chronic respiratory disease, from injury and from other causes.

To sum up the excess deaths linked to overweight, we see a decrease of 25'000 deaths even when considering the data in favour of the mainstream definition: a maximum of +25'000 from diabetes related diseases, a minimum of -20'000 from chronic respiratory disease, a minimum of -10'000 from injury, and a minimum of -20'000 from other causes. In other words, a body mass index of 25 to 30 is linked to a lower mortality, mainly from causes other than heart disease and cancer. When those "big killers" are considered, overweight shows no link.

May smoking have distorted the data, causing more excess deaths in the normal weight category? Excluding smokers from the analysis did not significantly change the results, according to the authors. Moreover, it never could have explained links of such an extent. And without a pro mainstream bias, the decrease in mortality would even be as many as 95'000 excess deaths.

History of consensus

The old definition of overweight has been lowered from BMI 30+ to 25+, based on mortality data, a couple of years ago. This adjustment shows that the scientific community is ready to take new findings into account. Thus, with updated mortality data, a backward shift should also be possible.

graph

When the data of different study periods are compared, we see a decreasing link of extreme body fat (obesity) to excess deaths from 1975 (NHANES I) to 2000 (NHANES III). An explanation may be difficult, but facts are facts and should be considered.

A skeptic view

As far as I know, there is no broad scientific debate about the definition of overweight taking place in the public health community. On the contrary, we see public campaigns aimed at keeping people below BMI 25. Why? I see two main reasons.

The first one is mass inertia caused by the sheer number of experts dealing with body weight today.

The second one is primary prevention, the idea that "overweight" is the first stage of obesity (BMI 30+) which has been linked to an "unhealthy", sedentary lifestyle and various diseases, see the discussion here. I strongly agree with the idea that prevention is better than cure, and that a lifestyle that favours diseases and obesity (not necessarily diseases caused by obesity) should be changed to the better. But, in my opinion, the restrictive definition of "overweight" and the general weight obsession in modern western societies may be counterproductive. Physical activity, regardless of weight, may be a much better concept. The worst thing in extreme obesity, in my view, is being a handicap to physical activity (see also my post about obesity and fitness in the elderly). Instead, for many people, physical activity is only a means to the real end, weight loss.

In conclusion, I see an intriguing discrepancy between the most recent mortality data and the current definition of overweight, and I see no signs that this may change in the near future. I am not a scientist but only a skeptic watchdog, and all I can do is to bark, hoping to find more fellow skeptics who are ready to bark with me. There is a border between sound public health and unsound healthism, weight obsession and food nazism, a border that must be recognized and not be crossed.

Thursday, January 3, 2008

It ain't necessarily helpful

Porgy and Bess
Religious beliefs, if not being true, should at least help in coping with disease and disasters, but a new study sheds doubt on this pragmatic approach.

Christian religious functioning and trauma outcomes have been assessed in more than three hundred church-going trauma survivors in Minnesota. Looking at the outcomes, I hear the sound of Ira Gershwin's great skeptic sermon song of Sportin' Life: "It ain't necessarily so ..."

Only a part of the observant Christians have profited from their faith. Others have found it a source of distress, and still others have abandoned it. When it comes to coping, religion seems to be a double-edged sword. On the one hand, it may be a source of spiritual support which is positively related to successive coping or "posttraumatic growth". On the other hand, it may be a source of religious strain which is related to worse posttraumatic symptoms. When seen in terms of a therapy, religion has many unwanted side effects and should not be recommended to everybody.

"Why must this happen to me?"

I think that questions of this kind may be the main source of religious distress. Looking for reasons coming from God is not a very good idea. There are two religious concepts to deal with this question: Disease may be a "punishment" for being bad or an "exam" that must be passed to reach a superior state of spiritual maturation. With "punishment", the patient has already lost, and in the "exam" he may fail. Both concepts are a source of distress. If a religious person is successful in coping, then possibly in spite of religion and not because of it.

Non-religious coping

One positive aspect in religious coping is the idea of accepting the fate and not trying to change things that cannot be changed. But religion is not a prerequisite of this view, nor do I think that it is relevant. What really counts is the ability of looking at the half full and not at the half empty glass.

Photo credit: flickr.com/photos/boelaars/339862871/

Wednesday, January 2, 2008

Welcome new science based medical blog

Science Based Medicine
This blogging year has seen a good start with a brand new blog aimed at promoting a science based view on health and countering false claims. The first real post of today is about the false dichotomy of "good" plants versus "bad" chemical pharmaceuticals. This distinction not only lacks scientific basis but is also a source of vulnerability to quackery. A very needful and relevant post.

Here is the mission statement published yesterday:

"Science-Based Medicine is a new daily science blog dedicated to promoting the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public. This includes reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.

The philosophy of this blog, at its core, is simple: Safe and effective health care is critical to to everyone’s quality of life; so much so that it is generally considered a basic human right. The best method for determining which interventions and health products are safe and effective is, without question, good science. Therefore it is in everyone’s best interest for health care to be systematically evaluated by the best science available.

Too often the nature of science itself is misunderstood or misrepresented to the public. Science is not an arcane and privileged discipline. By its very nature it is meant to be transparent and public. Science is nothing more than a systematic and careful use of evidence and logic to evaluate factual claims. And good science possesses certain virtues that are not unique to science but generic to all intellectual endeavors: fairly accounting for all available evidence, using valid and internally consistent logic, using unambiguous concepts and language, proper use of statistics, being quantitatively precise and accurate, and above all being honest."
Science Based Medicine is run by three authors well known to the skeptic community: Steven Novella, clinical neurologist and president of the New England Skeptical Society, Wallace Sampson, retired hematologist and oncologist, and Harriet Hall aka the SkepDoc. I am looking forward to the upcoming posts of this great team. Update: The team is growing ...

Tuesday, January 1, 2008

Intentions 2008

happy 2008
Looking at facts with an open mind and with as little bias as possible, looking for more hot issues such as obesity and health and avoiding getting obsessed with any single theme or opinion, these are my most important blogging intentions for 2008. I hope we'll have a good time together, and I wish that things can be debated in a fair way. Some fellow bloggers have missed the possibility to leave comments on my blog. Yes, I understand them, but I have found that quality blogging is quite time consuming, and that I just have no capacity left for maintaining and moderating an open forum. But I think that referring posts and cross-linking between blogs may be even better means of a high quality debate. And I have seen that it works.

In the obesity issue, I may proceed with a phase of mainstream cherry picking, that is, looking for study results that link obesity to bad health outcomes. Obesity may not be a problem as big as most people think, but it may still be some problem. I think I should try to find out more about this question. Never fix your own opinion, be always ready to challenge it.

Besides obesity, there are many more interesting fields where I should put more focus on. One big complex is the brain, its fitness, dementia prevention, and the wide field of human psychology. I already have stepped into religion and philosophic reasoning about the big last questions such as death and how we may deal with it. Religion is a traditional way, but I think that atheists should not wimp out of these questions. Stay tuned.

Photo credit: flickr.com/photos/mischiru/2154094322/