Sunday, May 31, 2009
There was a huge turnout this time. No worries. With over 100 fun board games and many players to choose from, everyone had a good time.
Be prepared to be thrashed by youngsters half your age though. haha.....
National Family Celebrations '09, an annual national campaign to celebrate the importance of the family, runs from 30th May to 28 June 2009. Singaporeans are encouraged to take time off their busy schedules to enjoy a day out with their familes.
My First Commenter - Mariuca
Friday, May 29, 2009
What can you find in a public library?
The books are not real. It's a Food Court, in a Singapore shopping mall, decorated to look like a library. :D
Wednesday, May 27, 2009
The dishes that were being brought in looked yummy, but I did not get a chance to taste them. These scrumptious dishes were prepared in a prison kitchen ..... by inmates.
They were the 12 finalists from both the mens' and womens' prisons taking part in the Yellow Ribbon Cooking Competition 2009 held in Changi Prison Cluster A on 26th May. The competition was a challenge to these participants because each team was given a set of predetermined ingredients and basic kitchen equipment to work with.
Under the watchful eyes of prison officers present in the kitchen, the participants went about their tasks. Knives and even vegetable peelers were chained to a kitchen bench. One team had to improvise a heart-shaped mould from aluminium foil. They had to produce the dishes within a time limit.
The dishes presented not only earned the praises of the judges but captured the hearts of the invited guests and prison officers. I was amazed when I was told some of the participants had little cooking experience and only went through 3 cooking lessons with SHATEC Institute's trainers. And the women particpants had no kitchen in their prison to practise for this competition.
The dishes were judged by 4 chefs - Tony Khoo (Executive Chef, Marina Mandarin), Paolo Zambrano (Executive Sous Chef, SATS Catering), Matthew Yim (Vice Principal, SHATEC Institute) and Catan Tan (SHATEC Institute).
The champion team is from Khalsa Crescent Prison. Besides cash, the winners will be given an opportunity to cook their winning dishes for their families. I hope to be invited for this special occasion. There would be touching moments.
Chef Tony Khoo was surprised at the particpants' high level of creativity despite the constraints of the prison kitchen. He was impressed with the enthusiasm and good working attitude of the participants. He would be more willing to hire ex-offenders if they display such qualities.
Vice Principal of SHATEC Institute, Chef Matthew Yim was certainly proud of these participants. They show a willingness to learn and take in criticisms. It was a satisfying and rewarding experience for his school to support such a meaningful project.
I was invited to this event by Singapore Prison Service.
For security reasons, my personal particulars was submitted prior to attending the event. I was allowed to carry only a notebook and a pen, all my belongings were left in a locker at the Prison Link Centre.
I went through barricade after barricade, security was so tight within the prison compound. It was not easy for EastCoastLife to go to jail. :P Surprisingly, I was getting more excited as each auto gate closed behind me. :D
I was warmly welcomed by Matthew Wee (Head, Public Affairs), the officers of SPS and SCORE (Singapore Corporation of Rehabilitative Enterprise).
Lunch was catered from SCORE's Catering & Central Kitchen. The dishes are cooked by inmates. I would recommend its really yummy Brownie and mini custard puff!
More than 11,000 ex-offenders complete their sentences and are released from our prisons and drug rehabilitation centres (DRCs) annually. The Yellow Ribbon Project helps the reformed inmates put their past behind them, especially when they try their level best at home, at work and in the community.
Photos - courtesy of Singapore Prison Service
One in four people suffer mental illness at some point in their lives.
Everyone knows that. But where does that number come from? The answer may surprise. Join me, if you will, as I explore the biography of a statistic.
"1 in 4" is ubiquitous, at least in the English-speaking world. I can't think of another such number which is better known, except perhaps the fact that 1 in 3 people will suffer from cancer.
Anyone who's used the London Underground or watched British TV recently will be familiar with the Time to Change anti-stigma advertising drive. This £18 million campaign, run by the charities Mind and Rethink, is awash with "1 in 4"s, left right and center. Mind have it on their About Us page. The BBC have it on their main mental health page. There's even a One in Four magazine. And so on.
In the next post, I'll be examining the truth behind this statistic, but first, a little history. Google archive reveals that 1 in 4 is a child of the 1990s. English-language news media from the late 1980s contain the statement that in 1 in 4 (American) families will have a member who suffers from mental illness, but this is not the same thing.
As far as I can tell, "1 in 4 people" entered the popular mind in the early to mid 1990s. By 1995, it was common and being referred to as an accepted fact. See for example this snap-shot of the newspapers in 1995 under the search term ("one in four" + mental), showing that the idea had taken root by this point. Whereas the equivalent from 1992 is quite different.
Interestingly, the early 1990s also feature repeated references to 1 in 4 (Americans) suffering from mental illness in any given year; this statistic, however, gradually fades from view as the decade goes on. By 2000, 1 in 4 appears more often than ever, but now it refers almost mostly to lifetime prevalence.
These graphs show the number of Google archive hits from 1950 to 2008. I had hoped that this would illustrate my argument nicely, but sadly, the picture isn't all that clear. Here it is anyway - the top graph shows the increase in ("1 in 4" + mental) hits. The second shows, by way of comparison, the number of hits for just ("mental health"), which is much more level. That's nice. But the bottom graphs shows that ("1 in 8" + mental) also becomes more popular over about the same time-frame, which is a bit confusing, as 1 in 8 is not a number especially linked to mental health.
But - where did 1 in 4 come from? When I set out to write this post, I thought it would be fairly easy to find out, but having done a lot of digging, I genuinely don't know.
My first guess was that it must have been the National Comorbidity Survey (NCS). The NCS was an ambitious attempt to measure the prevalence of mental disorders in a representative sample of the U.S. population, masterminded by Harvard Prof. Ronald C. Kessler. Data collection took place between 1990 - 1992 and the results started to be published in 1993 - just about the time when 1 in 4 started to appear in the media.
But in fact the headline finding from the NCS, as published in 1994, was that the lifetime prevalence of mental disorders was nearly 50%! That's 1 in 2 (sic). The proportion estimated to suffer from a disorder in any given year was almost 1 in 3. But no sign of 1 in 4.
Meanwhile, in Britain, 1993 also saw the first Psychiatric Morbidity Survey, a similar enterprise. (Attentive Neuroskeptic fans will recall that this was the survey that the Mental Health Foundation recently distorted to make it look like rates of anxiety disorders are rising). Could this be the source? No, the headline number here was 1 in 6, which referred to mental illness in the past week, not over the lifetime.
Going further back, the Epidemiological Catchment Area (ECA) project, the first large-scale psychiatric epidemiology study, happened in the early 80's. The ECA famously concluded that 1 in 3 Americans suffer at least one mental illness over the lifetime, and 1 in 5 do in any given six month period! 3, 5 - but still not 4.
The World Health Organization quoted 1 in 4 lifetime in 2001, to much media fanfare, and I have seen the WHO given as a source for the figure. But where did they get it from? Well, good question.
Their report, New Understanding New Hope: The World Health Report 2001, notes that according to the WHO's own data, 450 million people worldwide currently suffer from a "neuropsychiatric conditions". With 6 billion people on Earth that's less than 1 in 12 (and that includes Alzheimer's, Parkinson's, epilepsy, etc.) And that's at any one time, not over the whole lifetime.
The report then quotes at least 1 in 4 as a lifetime prevalence (on page 23). Finally! But this is not based on WHO data. Instead, they cite three references: Regier et al. 1988; Wells et al. 1989; and Almeida-Filho et al. 1997. Let's check these references.
The first refers to an Epidemiological Catchment Area study of 12 month prevalence. Not lifetime. The ECA, as we've previously seen, gave a lifetime estimate of 1 in 3. The 12 month estimate is 15.4%, or 1 in 6. No 1 in 4 to be found here. The second refers to a 1989 paper from Christchurch, New Zealand. It reported a lifetime prevalence of 65.8% (sic) for any mental disorder. 2 in 3. For the "main" diagnoses, i.e. excluding most anxiety disorders, it was 36.6%. 1 in 3. The closest I could find to 1 in 4 in this study was 22.9% for main disorders, also excluding substance abuse disorders. 1 in 4, 1 in 3, or 2 in 3 - take your pick. The last reference is to a Brazilian study finding lifetime prevalence rates from 31.0% to 50.5% in three cities.
So, in 2001, the WHO quoted 1 in 4, but their only references, if taken seriously, put the lifetime prevalence is more like 1 in 2. So we still don't know where 1 in 4 comes from.
Recently, the National Comorbidity Survey Replication (NCS-R), another Kessler project, claimed a lifetime prevalence of any disorder in Americans of 50.8%. But the proportion suffering from a disorder in any one year was estimated at about one in four. So that's 1 in 4 at last, but that number appeared only appeared in 2005 - far too late to explain the origin of the meme. (And it was yearly, not lifetime, but you can see how people might have misinterpreted it.)
So, I give up. I don't believe there is a single source for 1 in 4. If anyone thinks they know where I've gone wrong, please let me know. But as far as I can see, 1 in 4 lifetime represents a kind of informal average of all of the studies I've discussed. It's a number that sticks in people's minds because it's high enough to capture the sense that "they're very common" while not being so high as to make people think "that's ridiculous" (as most of the actual estimates do). It's less a statistic, more a collective guess.
In the next post, I'll try to make sense of all these numbers.
Grant, B. (2006). About 26% of people in the US have an anxiety, mood, impulse control, or substance disorder Evidence-Based Mental Health, 9 (1), 27-27 DOI: 10.1136/ebmh.9.1.27
Sunday, May 24, 2009
Christopher and I got to catch up with fellow Mensans at our 1st Quarterly Mensa Singapore Lunch at NYDC cafe and restaurant, Bugic Junction branch.
At this event, we welcome new members to the society and hope they will mingle with existing members. Members are encouraged to bring their family or friends.
The owner of NYDC is a Mensa member, so we got a good deal. :D
Diners can choose from 3 main dishes. One of the main dishes was its Mushroom Madness Pizza. Named “Best Pizza in Singapore” by a local paper, it came with lots of fresh mushrooms, garlic sauce and mozzarella.
Dessert was another famous item on its menu, Ally's New York Cheesecake. yum yum...
We will be having our Monthly Boardgame Meet next Sunday. :)
Our 20th Anniversary Gala Dinner will be held on 5th June. We hope to raise funds for the meal coupons, transport allowance and school uniform of NorthLight School's needy students.
The students have put up some of their art pieces for sale.
Mensa Singapore conducts the Mensa Singapore Admissions Test for persons aged 14 and above. The MSAT is interesting and challenging as it involves only symbols and pictorial representations, and does not require knowledge of any particular language or mathematics. It costs S$55 per person.
Register for the Mensa Singapore Admissions Test to be held on Saturday, 20 June 2009 at Suntec City NUSS Guild House.
Saturday, May 23, 2009
Drugs 'can help mild depression'
It was about this time last year that Irving Kirsch and colleagues released Initial Severity and Antidepressant Benefits. This bombshell of a meta-analysis concluded, notoriously, that the benefits of antidepressants over and above placebo are in general pretty small. Moreover, it claimed that the benefits are even smaller - indeed pretty much zero - in people whose depression is not very severe to begin with.
However, Neuroskeptic readers will know that antidepressant trials are not all they're cracked up to be (1,2). On top of which Kirsch et al. were a little "creative" with their statistics, as bloggers P J Leonard and Robert Waldmann aptly demonstrated. So, the claim that antidepressants don't work in mild depression rests on shaky foundations.
But that doesn't mean that they do work. In fact, there have been very few studies looking at the effectiveness of drugs in mild to moderate depression. That's a shame, because mild depression is the most common reason why people are given antidepressants in real life.
Now a new clinical trial, run by the British National Health Service, has appeared. It was (drumroll) a Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care.
The researchers enlisted GPs (family doctors) from across the UK, and got them to refer suitable patients to the study. Patients could be included if their doctors considered that they were depressed and had been for at least 8 weeks. They also had to be aged 18 or over, and they had to be rated between 12 and 19 on the HAMD, a scale used to measure the severity of depression. (Slightly oddly, they were also required to show at least some evidence of "somatic" symptoms - aches, pains, indigestion, that kind of thing. I'm not sure why.) Patients were excluded if they "expressed suicidal intent" or if they admitted to drug or alcohol misuse.
A total of 602 patients were referred to the trial, but of these only 220 actually took part; the rest either didn't want to do it or were unsuitable for whatever reason. It took the researchers nearly 4 years and heroic efforts to recruit those 220 people, including reimbursing doctors £45 for each patient referred. This kind of research is frustrating. This is probably why there's so little of it.The volunteers were randomly assigned to get supportive care alone, or supportive care plus the doctor's choice of SSRI antidepressant. "Supportive care" is basically a euphemism for "doing sweet F. A.". The GPs were meant to see the patients 5 times over a 12 week period; given that a typical GP consultation in the UK lasts about 10 minutes, the idea that this constitutes any kind of "care", supportive or not, is a bit of a joke.
What happened? Well, to cut a very long story short, the patients assigned to SSRIs did better than the ones assigned to supportive care alone. Hurrah! But they only did slightly better. After 12 weeks they had a mean HAMD score of 8.7 compared to 11.2 in the supportive care group. The SSRI group also did a bit better on some other measures of health, well-being and general satisfaction. The difference on the BDI, a self-reported measure of depression, was not significant however (13.0 vs. 15.1)
So does that mean antidepressants "work" in mild depression? Maybe. Maybe not. The most obvious issue, of course, is that there was no placebo group in this trial. So any benefit of the pills could have just been psychological. Gettingly randomly assigned to "supportive care" and condemned to twiddle your thumbs for 12 weeks is not going to make anyone feel better. Starting on antidepressants, on the other hand, feels like a fresh start. It gives hope. It's change you can believe in.
But if giving people pills makes them feel better, isn't that good enough reason to do it? Who cares if it's all the placebo effect? Well, there's some truth to that, but the problem is that patients included in this trial were a rather unusual bunch. In particular, they were people who agreed to be randomized to get antidepressants or not, i.e. they had no strong preference either for or against pills.
Given that an awful lot of people do have such a preference, we can't assume that these results apply to the average patient in the clinic. As the authors note (page 59, emphasis mine):
The tallies of surgery logs completed by a number of the study GPs at various points during the study showed that only around 1 in 10 patients with a new episode of depression were referred into the study, mainly because the rest did not fulfil the inclusion criteria, particularly in terms of a lack of equipoise about the benefits of drug treatment on the part of the doctor or patient or both.And of those 602 referred, only about a third actually took part, as mentioned above. So what we have here is a study on an unusual 3% of patients. What about the other 97%? We don't know. Still.
Or don't we? Well, it depends who "we" are. I suspect that a moderately competent doctor with experience treating depression probably does have a good idea of who is likely to benefit from drugs and who isn't. There's no substitute for real, hands-on clinical experience. There's more to life than trials...
T Kendrick, J Chatwin, C Dowrick, A Tylee, R Morriss, R Peveler, M Leese, P McCrone, T Harris, M Moore, R Byng, G Brown, S Barthel, H Mander, A Ring, V Kelly, V Wallace, M Gabbay, T Craig and A Mann (2009). Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care Health Technology Assessment, 13 (22)
Thursday, May 21, 2009
Singapore Prison Service (SPS)
I was invited to the Singapore Prison Service (SPS) Digital/New Media Training sessions on both 13 May and 21 May 2009. Walking into the room, I saw 'stars' ...... stars on the uniform of the officers. :)
These top officers are in charge of the fourteen prisons and drug rehabilitation centres (DRCs) that SPS manages in Singapore.
I was given 30 minutes per session to answer questions from these officers. No, they were not interrogation sessions. :) They were fun sessions where we learnt from one another and shared our thoughts on new media and how we can use it to engage the community.
Through both the sessions, I gained valuable insights into the work of the prison officers and have a better understanding of the organisation.
SPS hopes to steer the offenders towards being responsible citizens with the help of their families and the community. Our community needs to be more accepting, one that is willing to give ex-offenders a second chance at making good.
I am familiar with its Yellow Ribbon Project which gives ex-offenders a second chance - to help them find the hope to start afresh.
Meet the Blogger
Q&A with a top Singapore blogger. Opportunity to ask questions about motivation, working practices, blogging trends in Singapore, etc.
Photos - courtesy of Singapore Prison Service (SPS)
It's only natural that "positive results" are especially interesting. But "negative" results are still results. If you find that one thing is not correlated with another, you've found a correlation. It just happens to have a value of zero.
For every gene which causes bipolar disorder, say, there will be a hundred which have nothing to do with it. So, if you find a gene that doesn't cause bipolar, that's a finding. It deserves to be treated just as seriously as finding that a gene does cause it. In particular, it deserves to be published.
Sadly, negative results tend not to get published. There are lots of reasons for this and much has been written about it, both on this blog and in the literature, most notably by John Ionnidis (see this and this, for starters). A paper just published in Science offers a perfect example of the problem: Neural Mechanisms of a Genome-Wide Supported Psychosis Variant.
The authors, a German group, report on a genetic variant, rs1344706, which was recently found to be associated with a slightly raised risk of psychotic illness in a genome-wide association study. (Genome-wide studies can and do throw up false positives so rs1344706 might have nothing to do with psychosis - but let's assume that it does.)
They decided to see whether the variant had an effect on the brains of people who have never suffered from psychosis. That's an extremely reasonable idea, because if a certain gene causes an illness, it could well also cause subtle effects in people who don't have the full-blown disease.
So, they took 115 healthy people and used fMRI to measure neural activity while they were doing some simple cognitive tasks, such as the n-back task, a fairly tricky memory test. People with schizophrenia and other psychotic disorders often have difficulties on this test. They also used a test which involves recognizing people's emotions from pictures of their faces.
They found that -
Regional brain activation was not significantly related to genotype...Rs1344706 genotype had no impact on performance.In other words, the gene didn't do anything. The sample size was large - with 115 people, they had an excellent chance to detect any effect, if there was one, and they didn't. That's a perfectly good finding, a useful contribution to the scientific record. It was reasonable to think that rs1344706 might affect cognitive performance or brain activation in healthy people, and it didn't.
But that's not what the paper is about. These perfectly good negative findings were relegated to just a couple of sentences - I've just quoted almost every word they say about them - and the rest of the article concerns a positive result.The positive result is that the variant was associated with differences in functional connectivity. Functional connectivity is the correlation between activity in different parts of the brain; if one part of the brain tends to light up at the same time as another part they are said to be functionally connected.
In risk-allele carriers, connectivity both within DLPFC (same side) and to contralateral DLPFC was reduced. Conversely, the hippocampal formation was uncoupled from DLPFC in non–risk-allele homozygotes but showed dose-dependent increased connectivity in risk-allele carriers. Lastly, the risk allele predicted extensive increases of connectivity from amygdala including to hippocampus, orbitofrontal cortex, and medial prefrontal cortex.
...our findings establish dysconnectivity as a core neurogenetic mechanism, where reduced DLPFC connectivity could contribute to disturbed executive function and increased coupling with HF to deficient interactions between prefrontal and limbic structures ... Lastly, our findings validate the intermediate phenotype strategy in psychiatry by showing that mechanisms underlying genetic findings supported by genome-wide association are highly penetrant in brain, agree with the pathophysiology of overt disease, and mirror candidate gene effects. Confirming a century-old conjecture by combining genetics with imaging, we find that altered connectivity emerges as part of the core neurogenetic architecture of schizophrenia and possibly bipolar disorder, identifying novel potential therapeutic targets.
By contrast, the genetic association with connectivity is modest (see the graphs above - there is a lot of overlap), and very difficult to interpret, since it is clearly not associated with any kind of actual differences in behaviour.
And yet this positive result got the experiment published in no less a journal than Science! The negative results alone would have struggled to get accepted anywhere, and would probably have ended up either unpublished, or published in some rubbish minor journal and never read. It's no wonder the authors decided to write their paper in the way they did. They were just doing the smart thing. And they are perfectly respectable scientists - Andreas Meyer-Lindenberg, the senior author, has done some excellent work in this and other fields.
The fault here is with a system which all but forces researchers to search for "positive results" at all costs.
Esslinger, C., Walter, H., Kirsch, P., Erk, S., Schnell, K., Arnold, C., Haddad, L., Mier, D., Opitz von Boberfeld, C., Raab, K., Witt, S., Rietschel, M., Cichon, S., & Meyer-Lindenberg, A. (2009). Neural Mechanisms of a Genome-Wide Supported Psychosis Variant Science, 324 (5927), 605-605 DOI: 10.1126/science.1167768
Wednesday, May 20, 2009
A highlight of Mensa Singapore's 20th anniversary Gala Dinner is its community outreach programme. Mensa Singapore is working with NorthLight School (NLS) which takes in students who have repeatedly failed their PSLE (elementary school exams) and prepares them for lifelong learning and employability so the students can make positive contributions to the community.
An introductory post on NorthLight School by Daniel
I was at NLS to take photos of the students' art work which will be for sale at the dinner to raise funds for its needy students.
A class of students were having their Food Preparation and Service Course. They rose to greet us as we entered the room. In this course, they learn basic food preparation, F&B service, house-keeping and customer servicing skills relevant to the hospitality industry.
The students are encouraged to do community service like painting, fix light bulbs and doing minor repair works for an elderly activity centre nearby.
Underprivileged students formed the bulk of the intake each year. Each needy student needs an average of S$400 per year in assistance.
If you are moved by the mission, you can do your part to contribute to the students’ assistance fund. Your contribution will go into providing the meal coupons, transport allowance and school uniform to the needy students.
Buy an art piece by NLS students or send your donations to :
2 Dunman Road
Tel: 6580 6490
Donors are eligible for a tax-deductible receipt
Mensa Singapore 20/09 Gala Dinner
5 June 2009 (Friday)
7pm (To be seated)
NUSS Suntec City Guild House
3 Temasek Boulevard, #05-001
Suntec City Mall
$50/ pax (Mensa member)
$60/ pax (Public)
NLS students will be performing at the dinner. Art works of the students will be available for purchases.
Do give them your support and encouragement.
First Commenter - Renny
Monday, May 18, 2009
After a brief visit to a goat farm, we went over to the dragon fruit farm next door. Despite the hot weather, families with elderly grandparents and young children in tow were scattered all over the farm. The kids were happy to have a huge open space to run about.
We were happy just to breathe in the fresh air and be close to Nature, taking in deep breaths of the lovely smell of the earth as we walked past a farm worker who was preparing a vegetable plot.
Besides their main crop of dragon fruit trees, several types of fruits and vegetables are also grown on the farm. There are maize, beans, pineapple, passion fruits, bananas, a few varieties of melons and gourds ...... just to name a few.
I was fascinated by the rows of red long bean plants grown on the farm. I have not seen them in our local markets.
The farm owner brought the seeds over from Thailand and started growing them on his farm.
I was told the red long beans contain more iron and taste sweeter.
Visitors can buy freshly picked vegetables and fruits from the farm. We were surprised to see purple sweet potato leaves.
Curious, I bought one bunch each of the red long beans and purple sweet potato leaves. The red long beans turned a dark green colour when cooked. They are crunchy and taste sweeter than the normal green ones. I have yet to cook the purple sweet potato leaves. :)
Spring Orchard Dragon Fruit farm
1 Lim Chu Kang Lane 4