Yesterday’s post was primarily about the emergence of the Open Access movement. Fortunately for almost all of us, excepting of course, the grubmeisters that want to keep necessary science content to themselves for profit, Open Access has been picking up support while dispelling nasty rumors. This looks more and more like something that Victor Hugo once said:

Nothing is so powerful as an idea whose time has come.

As I advertised yesterday, I want to mention an article that was just published in PLOS Medicine. The research article discusses global mortality and the burden of disease. And since it is a PLOS Open Access article, it is available to anyone, in full, free of charge.

I don’t know if it is just me, but it seems like AIDS is slowly moving off the radar. Sure, there are still newspaper articles and media reports, but it just seems like they are buried a little - or perhaps done as one of those “specials” that nobody watches on a Sunday afternoon.

There continues to be a mountain of AIDS research being produced, but I wonder if the same money and forces are being directed to this cataclysmic occurrence as has been in past years. Well, the news is not good. There are actually many sources I could cite, but for now, I will just mention the PLOS article.

Right now, AIDS is listed by the WHO as the fourth leading cause of death worldwide. The authors of the study project three different scenarios in order to make comparisons. They calculate a baseline scenario, which essentially is a best-guess formulation based on currently identifiable trends. They also project an optimistic and a pessimistic scenario.

To give you a point of reference, the baseline scenario does not assume that things will stay the way they are now. For instance, baseline includes an assumption that antiretroviral drugs which can effectively treat HIV will reach 80% of the worldwide population who need them by 2012. Despite all the projected advances, AIDS is still projected to become at least the third leading cause of death by 2030. In 2002, 2.8 million deaths were attributable to AIDS. Using the baseline scenario, this would rise to 6.5 million. Under the optimistic scenario, which assumes much greater prevention, deaths would rise to 3.7 million. While under the pessimistic scenario, deaths could rise as high as 120 million per year.

Any way you look at it, AIDS has been and will continue to be a global pandemic. It is one of the worst, of not the actual worst, medical and human crises in recored history. It will continue to exert a shattering toll on humanity, both in terms of death and the burden it places on all levels of humanity, individual, family, community, country, and world.

The Open Access journal movement in science is growing and growing . . . thankfully. The basic idea is that all scientific journal should be barrier-free. In general, there are two kinds of relevant barriers: price and permissions. Open Access would retain important copyright protections and licensing. But all other barriers would be granted which would mean that the journals would be free to anyone and everyone on the public internet.

I think you might imagine who is trying to block this movement: corporate and business interests who want to remain in control of this extremely valuable content. To be fair, I should add that some scientists are also opposed to Open Access. However, more and more are joining the important cause of guaranteeing that the public has the access it needs. As you might also imagine, librarians are almost universally behind Open Access.

Ok - so now it’s time for a plug to all the librarians in the world: you are doing a heck of a job, against trying odds and vast forces arrayed against you, making sure that citizens’ First Amendment rights are upheld. I have no doubt you will continue to demand the free distribution of any content that is necessary for the public interest.

Maybe one could have argued in the past that scientific literature was not relevant to public interest. But with science having become increasingly politicized, it has become exceedingly clear that all scientific literature is not only relevant but vital to serve public interest. Everyone must have access to this information that is so often used to make governmental decisions, sometimes at the highest levels of office. A democracy can only sustain itself when all have such vital access. The citizenry of the US must be able to express support or rejection of laws, policies, and regulations informed directly by science. If people are deprived of such information, they can and have turned to other ways of expression.

I have not forgotten my promised plug for PLOS (Public Library of Science). They have vaulted to the forefront of the Open Access movement. Many said that Open Access would desanctify the peer-review process. I will talk about peer-review in a future post, so I will say for now that is that there are arguments for and against it. However, it has become quite evident that Open Access can peacefully cohabitate with peer-review.

I think almost all of the PLOS journals are peer-reviewed. It is very gratifying to see that one PLOS journal, PLOS Biology, has already achieved significant stature in the scientific world. It is now a journal where major scientists and researchers in the field of biology want to be published. I think that PLOS Medicine is not far behind. Here is a snippet from their masthead:

PLoS Medicine believes that medical research is an international public resource. The journal provides an open-access venue for important, peer-reviewed advances in all disciplines. With the ultimate aim of improving human health, we encourage research and comment that address the global burden of disease.

Tomorrow: I will post info from one just published article from PLOS Medicine.

Due to popular demand, I am forced to finally finish the post I started two days ago. As you probably don’t recall, I was talking about the relationship between personality and heart disease. It has been known for quite awhile that certain personality traits, usually seen by others as negative, are correlated with heart disease.

These personality traits are depression, anxiety, and hostility and anger. Each of these three traits or symptoms has previously been shown to be correlated with an increased probability of developing some sort of cardiac problem. A very recent study that will appear in the journal Psychosomatic Medicine by Edward Suarez, Ph.D., at Duke University, is the first published study to investigate all three personality variables in relation to risk of heart disease. The study is currently available only online in an early edition of the journal. The entire study, not just the abstract, is available free in a download.

The study is extremely important for a number of reasons. The investigators tracked and analyzed data on 2,105 military veterans who took part in the U.S. Air Force Health Study. None of the men had any type of heart disease at the beginning of the study. They were followed for TWENTY years. It is truly unusual for a study to use so many subjects for such a long period of time.

Before I provide the results, I want to point out some of the limitations of the study. Only males were investigated and most of them were Caucasian. So it is clear that the findings can’t be generalized with any degree of certainty to nonwhites and females. Also, it turns out that all of the subjects had served in the Vietnam War. This could be a confounding factor that influenced the results. Finally, the study used a common personality test called the MMPI. As it happens I am thoroughly familiar with this test as I have studied it and used it in some research myself. I also taught advanced use of the test to other psychologists. I understand why this test had to be used in this particular study. Nevertheless, the MMPI can not in any way be considered to be highly reliable and valid for measuring the personality variables used in the study.

Having said all that, I do think the study provides a valuable contribution to our understanding of the connection between personality states and heart disease. The correlation between each of the three traits and development of coronary heart disease was validated and extended because of the large subject pool and the length of the study. The real strength of this investigation was the finding that the best predictor of an individual’s risk of developing heart disease was the cluster of all three traits together.

It is highly likely that that in order to properly evaluate any patient’s risk for cardiac problems that an assessment of personality traits, especially when inclusive of depression, anxiety, and hostility and anger, must be done. Dr. Suarez and his colleagues believe that the results in this study may prompt physicians to undertake such an assessment.

And here is where this study intersects with the quality of our healthcare system. In fact, physicians are not currently qualified to perform the kind of assessment that is needed. They simply are not trained that way and they are not able to spend the amount of time necessary with a patient to do it properly, even if they were trained. Does anybody think that physicians will refer their patients to a properly trained psychologist or other professional? Not a chance – except for those who are clearly distressed or otherwise at risk.

This study makes the argument better than any single person or even any other study of which I am aware that proper healthcare must include all the relevant dimensions of health. This might mean that initially more time would have to be spent with each patient. But there would be dramatic savings in both patient contact and utilization of healthcare resources over time, not to mention patient health. Of course this approach can only work if the mindset shifts towards prevention and use of so-called alternative and complementary treatments. Our present system will never do this. We must have a system in which physicians and other healthcare professionals are allotted the proper time and resources to evaluate and care for patients.

Guilty again. I threw in a teaser in yesterday’s post. And, uh, uh, hm, yesterday’s post turned out to be a post within a post - with a promise to get back on topic today. Would you believe me if I said that my intention was true? Well, you now know the punch line - I just have to explain yesterday’s teaser in today’s post.

The video shows a person in a full gorilla suit who walks onto a basketball court while players are throwing bounce passes. Of course all of you saw that gorilla, no doubt (if you didn’t, no problem, your local psychiatric locked ward is always open). But what if I told you before you watched that video to count the exact number of bounce passes among the basketball players?

It turns out that about 50% of an average audience will NOT see that darn gorilla. This experiment has been repeated over and over, and the results are always about the same. As you might expect, this study and the video have become a classic within the field of psychology. BTW, it does not matter if you show the video to a group of, let’s say, physicists. To date, no intervening factors have been found that alter the finding at a group level.

I have witnessed the video on several occasions. It never fails to get the audience buzzing for quite some time. So what’s the deal here? The concept at work has been named attentional blindness by the researchers who first wrote about it. The video was used in a defining study by Daniel Simons at the University of Illinois at Urbana-Champaign and Christopher Charbris of Harvard. The scientists have concluded that attention is more important in visual processing of information than previously believed. And it would appear that humans have a somewhat limited attentional capacity. The practical result is that we can only process a limited amount of information at any one time. Thus, even very prominent features of our immediate environment will be missed unless those features come under our direct attention.

While studies have replicated and expanded the original findings, the dimensions of inattentional blindness have not yet been explored. For right now, the suggestion is that just scanning our environment (whatever that happens to be at any given place and time), is not sufficient to notice, yet alone, internalize, all the significant details. So when it comes to our health, be careful what you assume, especially after being exposed to something only once. It could be the labels on our food, a report we just received from our doctor, lab results, or prescription side effect warnings.

Having appraised you of the dangers of underexposure, do not be too surprised if down the road, I examine the dangers of overexposure. You can bet this works both ways!

It has been known for quite awhile that certain personality traits are correlated with a greater risk of developing heart disease. The relationship between these personality traits and cardiac problems has not been demonstrated to be a causal relationship. That is, it has not been shown that having a particular personality trait actually causes that person to develop heart problems, let alone actual disease.

However, the evidence continues to mount. Frankly, it is highly unlikely that there will be any kind of proof of a causal connection anytime soon or perhaps ever. It is extremely difficult to establish such causal relationships within the framework of scientific investigation. Thus, it has become customary to keep piling up the evidence until enough scientific agreement is established. And when that point is reached, it becomes “general scientific knowledge” that such and such trait or thing or whatever causes such and such condition or disease or whatever. That is about as good as it can get with today’s knowledge and tools.

I think the downside is obvious. When is enough agreement sufficient to “establish” scientific “truth?” This is one very important consideration - critics might call it limitation - in evaluating scientific claims. Not enough people realize that very, very few scientific facts are definitively proven. Instead, it is data and interpretation of data, piling on top of yet more and more data and interpretations. Out of this often confusing morass, consensus will sometimes emerge. And presto – another scientific fact has been born. A not so inconsequential detail in this process is that politics – both scientific and otherwise – is commonly part of the development of scientific truths. In fact, it is usually so interwoven into the process that most of the scientists either do not see it or just pretend it isn’t there. You know the story – the 500-pound gorilla that just isn’t there.

You are probably asking yourself by now what about personality traits and heart disease? I had not planned on getting sidetracked on the nature of science and scientific facts. Well, what can I say? I just couldn’t help myself. No, not true – I could help myself – I just didn’t want to. It is way past due for shedding some light on science and the process of doing science. Science has become deified and that is not a good thing, either for consumers of science or for scientists. Science has wrought many wondrous things but is in very serious danger of becoming so insulated that the checks and balances are being tossed aside or torn asunder.

A huge part of the purpose of this blog is to reclaim science and restore it to its rightful and proper place. The first step – helping others to understand what science is and can do and just as importantly, helping understand what is not and can’t do.

I promise to deliver the punch line of my original post tomorrow.

I bet you think you are too smart to fall for any type of marketing scam, er, ad. I know I sure did. If you are honest, prepare to be humbled just a little bit.

Dr. Brian Wansink is an American professor of marketing and nutritional science. He has justifiably made a name for himself studying food psychology and eating behavior. In contrast to most academic and popular work on weight gain, he focuses on an individual’s immediate environment, that is, an individual food and its surroundings. An example would be soup and the size and type of bowl in which it is served. By contrast, most other work on weight gain focuses on the larger environment, usually things such as an entire dietary plan, motivation for weight loss, and so forth.

Dr. Wansink’s work zeroes right in on variables and decisions that an individual can actually control quite easily. I am just not sure that we yet now how to stop my periodic cravings for ice cream. I have heard all kinds of advice and read all kinds of research. Some of it even makes sense. But in the end, it all amounts to nothing – hmmm, actually something, I’m afraid to say.

Now it’s finally time to use that PubMed tip I gave you yesterday. Of course it would be easy enough to google Dr. Wansink and you would get relevant information. But when it comes to searching for this kind of information, nothing beats PubMed. Go ahead to the search page and enter: “wansink b”, without the parentheses. You will come up with a list of his greatest hits, which in this case consists of 20 results. Most of them make for a pretty fun read, if you can ignore the scientific gobblydegook.

Here is my personal favorite, which is #3 on the list: Ice cream illusions bowls, spoons, and self-served portion sizes. I am quite sure that the good doctor just loved pulling this stunt on all the so-called nutrition experts in attendance! If you read the rest of the studies, you will see that he can do this kind of thing over and over and on just about everyone.

Just in case you don’t want to go through all those fascinating, scintillating, and gripping PubMed results, here is a link to an article about Dr. Wansink’s work from the New York Times (registration required, free): Seduced by Snacks?

I am sure it is very clear that I greatly admire Dr. Wansink’s work. This is the kind of science is inspirational. His work manifests dedication, creativity, rigor, and abounds with practicality, and it evokes gentle (or perhaps not) humor with its sly subversion. The point is hammered home at the end of the Times article when Dr. Wansink is asked if being mindful about how we eat will make for weight loss of 100 pounds. He replies in the negative but affirms that such mindfulness might produce a loss of 10 pounds without even noticing.

PubMed is a service created by the U.S. National Library of Medicine. NIH (National Institute of Health) is also a partner in administering this indispensable service. It is the most widely used service of its kind. Essentially, it is the search engine and interface for the vast biomedical and life sciences journals, periodicals, and articles published across the world. I know of no scientist or researcher who does not make use of it.

PubMed used to charge for non-affiliated individuals to perform searches. A few years back, a very good thing happened - it was completely opened up. Now, anyone can use all of it services, including opening an account to save searches, for free. PubMed can a bit daunting to use until you get the hang of it. But with the help of the tutorials and so forth, anyone can be a pro within a very short period of time.

Tomorrow, I will demonstrate a very basic search. Ok - the point of tomorrow’s post is not going to be about how to do a basic search - heck, you could learn how to do this one in about two minutes, or less. But I will promise that the search results obtained from tomorrow’s post will be more interesting than you might think would be obtained from scientific literature.

Two years ago, the National Cholesterol Education Program set goal levels for LDL cholesterol levels in patients with heart disease. Cholesterol is made of two primary components, HDL (high-density lipoprotein) and LDL (low-density lipoprotein). LDL is the part of cholesterol that is presumed to be correlated with increased risk to the heart.

BTW, Just to clear up any confusion - there are not two kinds of cholesterol, only one. The so-called “bad” cholesterol is, in fact, LDL, while “good” cholesterol is HDL. LDL and HDL are both a part of cholesterol. The difference between them is the proportion of lipids to proteins. LDL has a much higher ratio of lipids to proteins than HDL. Thus, it is “fattier.”

I have had a lot of doubts about the science behind many recent proclamations about cholesterol. Too often reductionist thinking has been trumpeted as being the light of truth about not only heart disease, but also health in general. This has all the makings of another idea whose time should never have come. When you take one piece of information about the human body and take it out of context, it is likely that the resulting information will be distorted and incomplete. One of the overriding purposes of this blog is show how reductionist thinking has permeated Western medicine, and as a result, many valuable healthcare insights and information has either been axed or just doesn’t fit into the paradigm.

This recent study sheds some much needed light on this area of interest. While these researchers are not exactly interested in knocking the concept of use statin drugs to lower cholesterol, let alone kicking the pants out of reductionist thinking. But as a result of their rather excellent science, it can at least be said that there is no evidence at all to support the idea that heart disease patients should be given adequate statin medication to reduce their LDL to any particular level. In actual clinical practice, such patients have often been given two or even three different statins in order to artificially ramp down their LDL. The study also points out the serious flaws in other studies that have tried to find that an LDL target can be set.

Most health-conscious folks understand that their emotions play a crucial role in your health overall. Taking an antidepressant drug may or may not beneficial and has plenty of risks, some of which are very well known and some are not (more about the lesser-known side effects in a future post).

One of central tenets in healthcare is trying to find effective aids that are also very safe. There are usually more of those available than commonly realized.

An interesting report reviews one of the best and safest options for treating depression without a drug: foods rich in omega-3 fatty acids.

An interesting statistic that explains why an increasing number of patients are plagued with depression, particularly in America: The average daily intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is about 130 mg., no more than 20 percent of the minimum requirement recommended by international experts.

The article argues, correctly, mental health specialists don’t have to be experts in clinical nutrition to appreciate the real connection between improved nutritional habits and better emotional health. They merely have to accept that the link exists.

And, I have come to the conclusion that krill oil is the best source of omega-3 fats. Here is a link to just one supporting piece of evidence. This was a three-month investigation that is medicine’s favorite research design: the holier than thou double blind, randomized clinical trial. The study found that krill, containing more EPA as well as naturally occurring phospholipids than fish oil, treats PMS better than fish oil.

BTW, I do think the referenced PMS study is a pretty good one. And double-blind, RCT (randomized clinical trial) studies can be very powerful. However, there are quite a few pitfalls. And in many cases, such a study is either inappropriate or totally unpractical or even unethical. I plan on posting more on this down the road. It is critical that we all have as keen perception as possible when it comes to evaluating what kinds of things are healthy and unhealthy for our mind-body.

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The NIMH researchers detail most of the usual suspects when it comes to the side effects encountered by the children in the study. That is, the children that were left. You see it turns out that many parents, wisely, removed themselves and their children before the drug phase.

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