Tuesday, April 30, 2013

Accurate Diagnosis of Mesothelioma: More Important Than Ever


Accurate Diagnosis of Mesothelioma: More Important Than Ever

Timothy Craig Allen MD, JD
From the Department of Pathology, University of Texas Health Science Center, Tyler.

There are few diagnoses more difficult to make with certainty, and carrying more prognostic and legal weight, than the diagnosis of diffuse malignant mesothelioma (DMM). Diffuse malignant mesothelioma's extremely limited therapeutic options, dismal prognosis, and serious legal implications make it a disease for which misdiagnosis carries grave and far-reaching medical, legal, and social consequences. At the same time, DMM's rarity, and the commonness of its mimics, makes it a diagnosis with which few pathologists attain familiarity. Indeed, a pathologist can spend a career having never diagnosed DMM. Moreover, the diagnosis of DMM is often difficult to make, and even pathologists expert in the diagnosis of DMM find some cases extremely challenging.

Raising the Quality of Care During Medical Missions: A Survey to Assess the Need for Clinical and Anatomic Pathology Services in International Medical Missions


Raising the Quality of Care During Medical Missions: A Survey to Assess the Need for Clinical and Anatomic Pathology Services in International Medical Missions

Agne Naujokas DO
Agne Naujokas, DO, Department of Pathology, Metro Health Hospital, Wyoming, Michigan and Department of Pathology, University of California—San Francisco, California.
Context.—Providing basic medical care to patients in underserved communities around the world is a valuable service and should not be compromised. Limited publicly available information on the use of pathology services during short-term medical missions (STMMs) shows a dire need for the improved quality of care being provided.
Objective.—To assess the need for clinical and anatomic pathology services in international medical missions by conducting an online survey.
Design.—A survey containing 35 questions aimed to understand the current use and availability of routine laboratory tests during STMMs, identify the need for particular tests that would improve quality of care, and determine the perceived obstacles preventing the delivery of the care to underserved communities worldwide. Answers from 21 health care providers who served on 50 medical missions were assessed.
Results.—Survey results revealed a significant discrepancy between the availability of pathology services in the United States and during STMMs. Statistical significance (P< .001) was found in areas of routine blood work, cytopathology, and histologic evaluation, among many others. More than half of the STMMs did not have access to basic metabolic panel, rapid hepatitis B test, and microbial cultures. Another 28% of health care providers indicated that having human immunodeficiency virus testing would have improved health care quality.
Conclusions.—Survey results show the need for improved pathology support during STMMs. The lack of precise diagnosis and disease monitoring has a negative effect on the quality of care provided during missions and the ability to enhance global health.

In Memoriam: Robert E. Scully, M.D. "His diagnostic skills were legendary..."


Robert E. Scully, MD

Eugene J. Mark MDEsther Oliva MDRobert H. Young MD
From the Department of Pathology, Massachusetts General Hospital, Boston

From Diane Davey: Recalled Items and the American Board of Pathology Certification Examinations: What Constitutes Cheating?


Recalled Items and the American Board of Pathology Certification Examinations: What Constitutes Cheating?

Diane Davis Davey MD
From the College of Medicine, University of Central Florida, Orlando, and the VA Medical Center, Orlando, Florida.
Accepted: January 10, 2013 ;Published Online: April 24, 2013

"The pathology profession needs to take a proactive  position and agree that cheating will not be tolerated.  Our image as a profession devoted to quality patient care depends on maintaining the trust of the public and other health care providers that we are competent and professional. Residency training programs and peer residents provide valuable didactics, training, and experiences that should prepare candidates to successfully pass the ABP examinations. Past practices of maintaining board remembrance files or distributing any  recalled test items either electronically or through copied documents are unacceptable and this type of behavior needs to cease."

Transformation of Pathologists: Responding in a Volatile, Uncertain, Complex, and Ambiguous Environment


James S. Hernandez and Timothy Craig Allen 
Transformation of Pathologists: Responding in a Volatile, Uncertain, Complex, and Ambiguous Environment.
Archives of Pathology & Laboratory Medicine: May 2013, Vol. 137, No. 5, pp. 603-605.

In “No Pay, No Play: The End of Professional Ethics in Pathology?”1 and “No Pay, No Play: Game Over,”2 we noted the general discontent among pathologists and reinforced that, even so, we must remain ever professional. We did not, however, delve into the causes of the discontent, frustration, and malaise that are too often seen among pathologists nor how they might be dealt with. Why are so many pathologists frustrated and disappointed, and sometimes, burned out? Why do so many pathologists believe their contracts with society have been broken? What exactly is today's reality? What has happened, and what can be done about it?

Today we pathologists live in a VUCA world: VUCA—volatility, uncertainty, complexity, and ambiguity—is an acronym used to describe an environment of volatility—“[t]he nature and dynamics of change, and the nature and speed of change forces and change catalysts”; uncertainty—“[t]he lack of predictability, the prospects for surprise, and the sense of awareness and understanding of issues and events”; complexity—“[t]he multiplex of force, the confounding of issues[,] and the chaos and confusion that surround an organization”; and ambiguity—“[t]he haziness of reality, the potential for misreads, and the mixed meanings of conditions; cause-and-effect confusion.”3

Monday, April 29, 2013

History of gene therapy


 2013 Apr 22. pii: S0378-1119(13)00434-4. doi: 10.1016/j.gene.2013.03.137. [Epub ahead of print]

History of gene therapy.


A.I. Virtanen Institute, Dept. of Biotechnology and Molecular Medicine, Univ. of Eastern Finland, Kuopio, Finland.


Two decades after the initial gene therapy trials and more than 1700 approved clinical trials worldwide we not only have gained much new information and knowledge regarding gene therapy in general, but also learned to understand the fear that has persisted in the society. Despite the drawbacks gene therapy has faced, also success stories have been reported. Examples for these are the positive recommendation for a gene therapy product (Glybera) by the EMA for approval in the European Union and the positive trials for the treatment of ADA deficiency, SCID-X1 and adrenoleukodystrophy. Nevertheless, there is still a lot to learn and during the course of time more safety data has become available that helps us to develop better gene therapy approaches. Also, with the increased understanding of molecular medicine, we have been able to develop more specific and efficient gene transfer vectors. In this review, we will take a historical view and highlight some of the milestones that had an important impact on the development of gene therapy. We will also discuss briefly the safety and ethical aspects of gene therapy and raise up some concerns that have been connected with gene therapy as a new therapeutic modality.

From CAP Today: New guidance on lung cancer testing


New guidance on lung cancer testing

April 2013
Feature Story
Karen Titus

"The guideline fills a gap in lung cancer care, says Philip Cagle, MD, another author on the study. Without evidence-based recommendations or at least consensus of expert opinion about how to handle specimens, there’s no consistency in care, and pathologists and oncologists may be making less-than-sound choices."

Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms


 2013 Feb;17 Suppl 1:55-64.

Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms.


Department of Emergency Medicine, "A. Gemelli" Hospital, Catholic University of the Sacred Heart, Rome, Italy. americotesta@gmail.com  


Psychiatric emergencies are conditions that mostly destabilize the already frenetic activity of the Emergency Department. Sometimes the emergency is clearly referable to primitive psychiatric illness. Other times, psychiatric and organic symptoms can independently coexist (comorbidity), or develop together in different conditions of substance abuse, including alcohol and prescription drugs. Differentiating between substance induced and pre-existing psychiatric disorder (dual diagnosis) may be difficult, other than controversial issue. Finally, an organic disease can hide behind a psychiatricdisorder (pseudopsychiatric emergency). In this review (part I), psychiatric disorders that occur with organic symptoms are discussed. They include: (1) anxiety, conversion and psychosomatic disorders, and (2) simulated diseases. The physiologic mechanisms of the stress reaction, divided into a dual neuro-hormonal response, are reviewed in this section: (1) activation of the sympathetic nervous system and adrenal medulla with catecholamine production (rapid response), and (2) activation of the hypothalamic-pituitary-adrenal axis with cortisol production (slow response). The concept of the fight-or-flight response, its adaptive significance and the potential evolution in paralyzing response, well showing by Yerkes-Dodson curve, is explained. Abnormal short- and long-term reactions to stress evolving toward well codified cluster of trauma and stressor-related disorders, including acute stress disorder, adjustment disorder and post-traumatic stress disorder, are examined. A brief review of major psychiatric disorder and related behaviour abnormalities, vegetative symptoms and cognitive impairment, according to DMS IV-TR classification, are described. Finally, the reactive psychic symptoms and behavioral responses to acute or chronic organic disease, so called "somatopsychic disorders", commonly occurring in elderly and pediatric patients, are presented. The specific conditions of post-operative and intensive care unit patients, and cancer and HIV positive population are emphasized.

From Brown U: Multiple Bilateral Circumscribed Masses at Screening Breast US: Consider Annual Follow-up


 2013 Apr 24. [Epub ahead of print]

Multiple Bilateral Circumscribed Masses at Screening Breast US: Consider Annual Follow-up.


American College of Radiology Imaging Network, Philadelphia, Pa; Center for Statistical Sciences, Brown University, Providence, RI.


Purpose:To determine prospectively the prevalence and rate of malignancy of multiple bilateral (MB) circumscribed breast masses detected atscreening ultrasonography (US) compared with those of other US-depicted masses.

Materials and Methods:This institutional review board-approved, HIPAA-compliant prospective trial included women at elevated risk for breast cancer, who gave written informed consent to participate in a study evaluating cancer detection rates for three rounds of annual supplemental screening US at 21 international sites. After exclusions, 2662 participants and 7473 screening studies were included. Physician-performed US studies were interpreted, with blinding to mammography results. Simple cysts were noted. Breast Imaging Reporting and Data System features of all other findings were recorded, with addition of the descriptor MB similar-appearing circumscribed masses (minimum of three total and at least one in each breast), with details of the largest such mass recorded. Rates of malignancy were determined after biopsy or mammographic and US follow-up at a minimum of 11 months. For this analysis, 490 women (1370 screenings) with prior mastectomy were excluded. Descriptive statistics and exact 95% confidence intervals (CIs) were generated.

Results:Of 2172 evaluable participants (6103 screening studies; median age at study entry, 54.0 years; range, 25-91 years), 1454 had unique findings at US. One hundred thirty-five (6.2%) participants had 153 unique MB circumscribed masses, with no malignancies (0% [95% CI: 0%, 2.4%]; 95% CI: 0%, 2.9% for the 127 masses with at least 2 years of follow-up). There were 1319 (60.7%) participants with 2464 non-MB lesions, including 1038 solitary circumscribed masses with a malignancy rate of 0.8% (eight of 1038). Of 836 solitary circumscribed masses with at least 2 years of follow-up, the malignancy rate was 0.4% (three of 836; 95% CI: 0.1%, 1.0%). Of the 135 women with MB circumscribed masses, 82 (60.7%) also had a solitary lesion. Two of these 82 women (2.4%) had cancer.

Conclusion:MB similar-appearing circumscribed masses seen at screening US are almost always benign, with no malignancies found among such lesions in this prospective, multicenter experience. These lesions are suitable for diagnostic follow-up in 1 year, with resumption of screening thereafter if they are stable.

From U Miami: Putting revenge and forgiveness in an evolutionary context


 2013 Feb;36(1):41-58.

Putting revenge and forgiveness in an evolutionary context.


Department of Psychology, University of Miami, Coral Gables, FL 33124-0751, USA. mikem@miami.edu


In this response, we address eight issues concerning our proposal that human minds contain adaptations for revenge and forgiveness. Specifically, we discuss (a) the inferences that are and are not licensed by patterns of contemporary behavioral data in the context of the adaptationist approach; (b) the theoretical pitfalls of conflating proximate and ultimate causation; (c) the role of development in the production of adaptations; (d) the implications of proposing that the brain’s cognitive systems are fundamentally computational in nature; (e) our preferred method for considering the role of individual differences in computational systems; (f) applications of our proposal to understanding conflicts between groups; (g) the possible implications of our views for understanding the operation of contemporary criminal justice systems; and (h) the question of whether people ever “genuinely” forgive.

Tobacco on campus goes up in smoke


Tobacco on campus goes up in smoke


UH will become tobacco-free June 1, school officials announced Thursday.
The new policy, approved by UH President and Chancellor Renu Khator, bans the use of tobacco products in all university buildings and grounds, including parking areas, sidewalks and walkways. It will apply to all employees, students, contractors and visitors to the campus.
“We are very well aware that this will be an inconvenience to the UH community of smokers,” said Kathryn Peek, assistant vice president of University Health Initiatives and co-chair of UH’s Tobacco Task Force. “But nobody has to quit smoking. What we’re trying to do is eliminate second-hand smoke on the campus.”

Sunday, April 28, 2013

"there may be differences in how liberals and conservatives respond to dissonance-arousing situations"


 2013 Apr 19;8(4):e59837. doi: 10.1371/journal.pone.0059837. Print 2013.

"Not for all the tea in china!" political ideology and the avoidance of dissonance-arousing situations.


Department of Psychology, New York University, New York, New York, United States of America.


People often avoid information and situations that have the potential to contradict previously held beliefs and attitudes (i.e., situations that arouse cognitive dissonance). According to the motivated social cognition model of political ideology, conservatives tend to have stronger epistemic needs to attain certainty and closure than liberals. This implies that there may be differences in how liberals and conservatives respond to dissonance-arousing situations. In two experiments, we investigated the possibility that conservatives would be more strongly motivated to avoid dissonance-arousing tasks than liberals. Indeed, U.S. residents who preferred more conservative presidents (George W. Bush and Ronald Reagan) complied less than Americans who preferred more liberal presidents (Barack Obama and Bill Clinton) with the request to write a counter-attitudinal essay about who made a "better president." This difference was not observed under circumstances of low perceived choice or when the topic of the counter-attitudinal essay was non-political (i.e., when it pertained to computer or beverage preferences). The results of these experiments provide initial evidence of ideological differences in dissonance avoidance. Future work would do well to determine whether such differences are specific to political issues or topics that are personally important. Implications for political behavior are discussed.

From Karolinska Inst-Stockholm: Shame and guilt in social anxiety disorder


 2013 Apr 19;8(4):e61713. doi: 10.1371/journal.pone.0061713. Print 2013.

Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms.


Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden ; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.


Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt,depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD.

Zombie allusions: They just keep on coming-looking to bail


Bill Gates was bondholder in bailed-out Irish zombie banks

Billionaire held €27m in bonds here at end of 2006, including at Anglo and Irish Nationwide

The world's second-richest man, Microsoft founder Bill Gates, was a majorIrish bank bondholder ahead of the financial collapse that saw the taxpayer put on the hook for the €64bn bank bailout.
The identities of wealthy bondholders in the Irish banks, bailed out in most cases by Irish citizens, have never been revealed fully. Billionaire Chelsea owner Roman Abramovich emerged as a bondholder in Irish Nationwide after his investment vehicle Millhouse was involved in a UK lawsuit in which it tried to extract full payment for its bonds in the building society as part of a tender offer. Abramovich and his partners lost, but many other bondholders were repaid in full despite backing bust banks. German and French banks were the largest holders of Irish bank bonds.

From Monash U: Eyewitness identification law reform: the need for persistence


 2013 Mar;20(3):503-11.

Eyewitness identification law reform: the need for persistence.


Law Faculty, Department of Psychology, Monash University. I.Freckelton@vicbar.com.au


The overturning of many convictions, including by DNA evidence, and an extensive body of experimental psychology evidence have demonstrated unequivocally the dangers of eyewitness identification evidence. In many countries this risk has been marked by procedures mandating identification parades, judges' warnings, discretionary exclusion of such evidence and heightened awareness of the dangers on the part of trial lawyers. In the United States there has also been an additional check and balance--the due process check. In the Supreme Court decision of Perry v New Hampshire 132 S Ct 716; 181 L Ed 2d 694 (2012) the majority declined to extend the ambit of the check, determining that it should only be enlivened when police misconduct is established. Such an approach failed to acknowledge in a significant way the core risk of unreliability of such evidence when identifications are contaminated by factors such as suggestion. However, rather than bemoaning another failure of the law to draw adequately upon the fruits of social science, the quest should continue internationally to find ways to build upon the knowledge generated by experimental psychology in order to reduce the risks of miscarriages generated by misidentifications.

From St Louis U: Maturing the Minor, Marginalizing the Family: On the Social Construction of the Mature Minor


 2013 Apr 24. [Epub ahead of print]

Maturing the Minor, Marginalizing the Family: On the Social Construction of the Mature Minor.


Saint Louis University, St. Louis, MO, USA.


The doctrine of the mature minor began as an emergency exception to the rule of parental consent. Over time, the doctrine crept into cases that were non-emergent. In this essay, we show how the doctrine also developed in the context of the latter part of the 20th century, at the same time that the sexual revolution, the pill, and sexual liberation came to be seen as important symbols of female liberation-liberation that required that female minors be granted the status of a mature minor. To do so moves sexual morality out of the domain of the family, where it had always been situated, and into the domain of the state. We also show how a phenomenological account of the care of the body in the family conforms to the latest in neuroscientific understandings of adolescent brain development. The family attenuates the dependency of adolescents and provides an important social contextualization for the care of the body, including the inculcation of sexual mores in adolescence. We conclude that the drive to push sexual decision making as a matter of state concern further undermines the foundations of the moral meanings of sex and sexuality.

"For vegans and ethical meat abstainers, it is suggested that questions concerning what to feed their pet approaches a tragic tradeoff contrasting two sacred values: protecting the well-being of their pets and protecting the well-being of other animals and the environment"


 2013 Apr 22. pii: S0195-6663(13)00149-9. doi: 10.1016/j.appet.2013.04.012. [Epub ahead of print]

A Meaty Matter: Pet Diet and the Vegetarian's Dilemma.


Bellarmine University, 2001 Newberg Rd., Louisville, KY 40205 USA. Electronic address: hrothgerber@bellarmine.edu.


The present research examined pet ownership, current pet diet, and guilt associated with pet diet among a fairly large sample of non-meat-eaters (n=515). It specifically focused on the conflict that pits feeding one's pet an animal-based diet that may be perceived as best promoting their well-being with concerns over animal welfare and environmental degradation threatened by such diets, here labeled the vegetarian's dilemma. Questionnaire responses indicated that ethically motivated meat abstainers were more likely to own pets and owned more of them than those motivated by health concerns or a combination of ethical and health concerns. Vegans and those resisting meat on ethical grounds were more likely to feed their pet a vegetarian diet and expressed the greatest concerns over feeding their pet an animal-based diet. For vegans and ethical meat abstainers, it is suggested that questions concerning what to feed their pet approaches a tragic tradeoff contrasting two sacred values: protecting the well-being of their pets and protecting the well-being of other animals and the environment. For meat abstainers motivated by health concerns, this constitutes a relatively easy moral problem because the primary concern for such individuals is the health of their pet with less or no regard for other ramifications of the decision, i.e., harming other animals or the environment.

Is surgical smoke harmful to theater staff?


 2013 Apr 19. [Epub ahead of print]

Is surgical smoke harmful to theater staff? a systematic review.


Aneurin Bevan Health Board, Newport, UK.



Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff.


Cochrane Database, MEDLINE, PubMed, Embase classic and Embase, and the metaRegister of Controlled Trials were searched for studies reporting the constituents found in the smoke plume created during surgical procedures, the methods used to analyze the smoke, the implications of exposure, and the type of surgical instrument that generated the smoke. Studies were excluded if they were animal based, preclinical experimental work, or opinion-based reports. The common end points were particle size and characteristics, infection risk, malignant spread, and mutagenesis.


The inclusion criteria were fulfilled by 20 studies. In terms of particle size, 5 (25 %) of the 20 studies showed that diathermy and laser can produce ultrafine particles (UFP) that are respirable in size. With regard to particle characterization, 7 (35 %) of the 20 studies demonstrated that a variety of volatile hydrocarbons are present in diathermy-, ultrasonic-, and laser-derived surgical smoke. These are potentially carcinogenic, but no evidence exists to support a cause-effect relationship for those exposed. In terms of infection risk, 6 (30 %) of the 20 studies assessed surgical smoke for the presence of viruses, with only 1 study (5 %) positively identifying viral DNA in laser-derived smoke. One study (5 %) demonstrated bacterial cell culture (Staphylococcus aureus) from a laser plume after surgery. Regarding mutagenesis and malignant spread, one study (5 %) reported the mutagenic effect of smoke, and one study (5 %) showed the presence of malignant cells in the smoke of a patient undergoing procedures for carcinomatosis.


The potentially carcinogenic components of surgical smoke are sufficiently small to be respirable. Infective and malignant cells are found in the smoke plume, but the full risk of this to the theater staff is unproven. Future work could focus on the long-term consequences of smoke exposure.

The happy meal® effect: the impact of toy premiums on healthy eating among children in ontario, Canada


 2012 May 24;103(4):e244-8.

The happy meal® effect: the impact of toy premiums on healthy eating among children in ontario, Canada.


University of Waterloo. dhammond@uwaterloo.ca.



"Toy premiums", offered with McDonald's Happy Meals®, are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age.


A between-groups experimental study was conducted with 337 children aged 6-12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald's Happy Meals® as part of the camp lunch program: two "healthier" meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two "healthier" meals.


Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17).


Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.

From Curtin U-Perth: Publications from Clinical Trials: Process, Conflict of Interest and the Evidence Base


 2013 Apr 22. pii: S0091-7435(13)00114-X. doi: 10.1016/j.ypmed.2013.04.005. [Epub ahead of print]

Publications from Clinical Trials: Process, Conflict of Interest and the Evidence Base.


School of Public Health and Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia. Electronic address: C.Binns@curtin.edu.au.



To review the issues of publication of clinical trials with consideration of ethics and the incomplete evidence base.


A review of clinical trials and issues of communications and ethics. Several case studies of notable public health researchers will be discussed.


Many of the major breakthroughs of public health practice, including the works of John Snow would not have been published under modern guidelines for scientific communication. The research - publication system of modern health care poses many challenges for editors. Journal editors need to include a balance of different types of studies where insufficient randomised controlled trials are available.


Clinical trials are a reliable source of evidence for health care practitioners. Journals need to uphold the integrity of the information provided by RCTs and synthesise and communicate health information. At the same time, editors must assess non-RCT evidence and be vigilant for many of the other potential problems in health and medical communication.

From Bryan Liang and Tim Mackey: Direct-to-Consumer Advertising With Interactive Internet Media


Direct-to-Consumer Advertising With Interactive Internet MediaGlobal Regulation and Public Health Issues

Bryan A. Liang, MD, PhD, JD; Timothy Mackey, MAS

Direct-to-consumer advertising (DTCA) is legal only in the United States and New Zealand and has been linked with drug overutilization, public health concerns, and higher costs.1 Despite global proscriptions, DTCA is the most rapidly increasing form of pharmaceutical marketing, with approximately $4 billion in US expenditures, outpacing physician marketing and research and development.2
JAMA. 2011;305(8):824-825. doi:10.1001/jama.2011.203.

Saturday, April 27, 2013

From Boston U: Preventing cancer: a community-based program for youths in public housing


 2013 May;52(5 Suppl):S83-8. doi: 10.1016/j.jadohealth.2013.01.010.

Preventing cancer: a community-based program for youths in public housing.


Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. Electronic address: lstrunin@bu.edu.



This article describes a feasibility study of a program that mentors boys aged 14-18 living in inner city public housing, engages them in a basketball league, and provides educational sessions on life skills and ways to resolve conflicts without violence. Such programs have the potential to engage adolescent males living in public housing in activities that reduce cancer-related behaviors and increase protective behaviors.


We conducted a feasibility evaluation of the program, which included a survey of participants, interviews with coaches, and observations of games and practices.


Lifetime and previous-30-day substance use was common among participants, and many were exposed to and had experienced various forms of violence. Keeping youths active helps prevent their joining gangs and using drugs.


Youths from disadvantaged backgrounds are at a high risk for cancer because they are at greater risk for obesity and other adverse health-related conditions than are more affluent youths. Implementing and sustaining community programs for youths in public housing can reduce the effects of exposure to factors that put them at risk for cancer during adulthood: chronic poverty, lack of safe areas for recreation, easy access to alcohol and drugs, and exposure to violence. In addition, workshops to prevent substance use and violence and to teach leadership, sportsmanship, conflict resolution, and healthy youth development are needed for youths, coaches, and parents or guardians.

From U Colorado: Political Extremism Is Supported by an Illusion of Understanding


 2013 Apr 25. [Epub ahead of print]

Political Extremism Is Supported by an Illusion of Understanding.


1Leeds School of Business, University of Colorado, Boulder.


People often hold extreme political attitudes about complex policies. We hypothesized that people typically know less about such policies than they think they do (the illusion of explanatory depth) and that polarized attitudes are enabled by simplistic causal models. Asking people to explain policies in detail both undermined the illusion of explanatory depth and led to attitudes that were more moderate (Experiments 1 and 2). Although these effects occurred when people were asked to generate a mechanistic explanation, they did not occur when people were instead asked to enumerate reasons for their policy preferences (Experiment 2). Finally, generating mechanistic explanations reduced donations to relevant political advocacy groups (Experiment 3). The evidence suggests that people's mistaken sense that they understand the causal processes underlying policies contributes to political polarization.

Sleep patterns and insomnia among adolescents: a population-based study


 2013 Apr 24. doi: 10.1111/jsr.12055. [Epub ahead of print]

Sleep patterns and insomnia among adolescents: a population-based study.


The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health, Uni Research, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.


The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10 220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekenddiscrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.

Does Chocolate Consumption Really Boost Nobel Award Chances? The Peril of Over-Interpreting Correlations in Health Studies


 2013 Apr 24. [Epub ahead of print]

Does Chocolate Consumption Really Boost Nobel Award Chances? The Peril of Over-Interpreting Correlations in Health Studies.


Psychological Science Research Institute, and.


A correlation observed between chocolate consumption and the number of Nobel laureates has recently led to the suggestion that consuming more chocolate would increase the number of laureates due to the beneficial effects of cocoa-flavanols on cognitive functioning. We demonstrate that this interpretation is disproved when other flavanol-rich nutriment consumption is considered. We also show the peril of over-interpreting correlations in nutrition and health research by reporting high correlations between the number of Nobel laureates and various other measures, whether cogently related or not. We end by discussing statistical alternatives that may overcome correlation shortcomings.