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Monday, November 30, 2009

Big Pharma Drama in Iceland

Icelandic academic and Neuroskeptic reader Steindór J. Erlingsson reports that thanks to his efforts, pharmaceutical company GlaxoSmithKlein (GSK) has stopped distributing a booklet promoting the monoamine hypothesis of depression to pharmacies and doctors offices in Iceland.

His report is here, and it has links to more details on the story, although these are in Icelandic, a language I'm unfortunately not familiar with. In a nutshell, Erlingsson says he spoke to the Icelandic Medical Director of Health who, after some back-and-forth and consultations with psychiatrists, contacted GSK.

On September 29th GSK announced that they
have received information that its information booklet on depression needs to be improved. The company views favorably well argued suggestions and as a result it is going to review the booklet.
They went on to say that the booklet, which had been around since 1999, should no longer be distributed. According to Erlingsson, the booklet made three claims:
1. An imbalance in the neurotransmitter serotonin causes depression. 2. SSRIs treat depression by correcting the serotonin imbalance. 3. Psychological treatment is ineffective in treating the serotonin imbalance.
Coincidentally, GSK are the manufacturers of paroxetine (Paxil, Seroxat), one of the best-selling SSRIs. Iceland, like most countries (except the US and New Zealand), bans direct-to-consumer advertising for drugs, but this kind of thing is not covered by such laws.

Personally I believe that serotonin probably is involved in some cases of depression. My views on the serotonin hypothesis of depression are therefore more favorable than those of many critics for whom the whole idea is a myth. But even so, I'm happy that to hear that this booklet has been withdrawn. Drug companies have no business promoting the serotonin hypothesis to the public.

First off, because it's controversial science. There's no "smoking gun" proof linking serotonin to depression. There's a lot of circumstantial evidence, but we don't really know how antidepressants work, or indeed how well they work, at all. For once, we should be "Teaching the Controversy". Most of the time when people say that, they're wrong, because they're talking about science which is rock solid, like the theory of evolution. The monoamine theory, however actually is controversial, which is why there are articles in major scientific journals criticizing it and others defending it.

Second, because the monoamine theory is certainly not true in any simple sense. Low serotonin levels cannot be the sole cause of depression because you can temporarily deplete someone's serotonin with a technique called tryptophan depletion and for most people, this does nothing at all to their mood. On the other hand about 50% of people who have suffered from depression in the past do get depressed again after tryptophan depletion, which is why I think there is some truth in the serotonin theory, but this shows that it's not a straightforward picture.

Third, the idea that only drugs can correct the "chemical imbalance" and psychotherapy can't is simply wrong. I don't know what the wording of GSK's booklet was, but from Erlingsson's summary, it sounds like it was giving people medical advice - you won't benefit from therapy - via leaflet, which is very irresponsible. Only a clinician with personal experience of an individual patient can say what treatment is best for them. Some people benefit from therapy, others do well on medication, and some people get better with no treatment at all. It sounds like GSK is behaving just as Oliver James did when he used the Guardian to recommend Freudian psychoanalysis over drugs and other kinds of therapy for postnatal depression. They're both wrong.

On the other hand, information leaflets telling people about depression and encouraging sufferers to seek professional help sound like a great idea to me, because many people with depression go undiagnosed and untreated and that's a real tragedy. But drug companies are unlikely to be the best people to provide such information.

Saturday, November 28, 2009

The Acting Brain!

The BBC promises us a look
Inside an actor's brain during a performance
Actress Fiona Shaw had an fMRI scan. Parts of her brain were more active while she was reading a poem by T. S. Eliot featuring dialogue than when she was merely counting. So what?

The fact that different parts of Shaw's brain were active whilst reading Eliot than when counting out loud is unsurprising. Different parts of the brain do different things - this is not news - and reading poetry is certainly very different from counting. This doesn't mean that "Fiona Shaw's brain appears to be adapted to acting", as the article says. If your brain was adapted to acting it would look like this:

All dressed up, skull in hand, ready to portray Hamlet - "Alas, poor Yorick..." Actually, brains generally do carry skulls around with them, so maybe there's something in it.

In fact, Shaw's brain presumably is adapted to acting - she's an actress. If you're able to do something, your brain must be able to do it, because you are your brain after all. In just the same way, my brain is adapted to being a neuroscientist and Barack Obama's brain is adapted to being President. This is not news either. However, the fMRI scan doesn't tell us anything about how Shaw's brain is adapted to acting.

We are told which areas of Shaw's brain lit up while she was reading poetry, and what this means -
Towards the front of the brain there is a part associated with "higher order" control of behaviour. Towards the top of the brain is a section which controls the movement of the hands and arms - even though she wasn't waving her arms about, she was apparently thinking about doing so.

And towards the back of the head is an area associated with complex visual imagery, even though she wasn't performing a complex visual task. The scan backs up work with professional impressionists, whose brains also conjure up visual images of the people they're imitating.

All very plausible - this is a nice convincing story to explain what these brain areas are doing while reading a passage of poetry in which people are talking to each other. It makes perfect sense. But the problem is, so would anything else.

Suppose that Shaw's hippocampus had lit up as well. That's involved in memory. She's remembering having read T. S. Eliot before! What if she's never read him? Well, the hippocampus must be forming a new memory. Her medial prefrontal cortex is activating? Clearly, that's the emotional impact of reading this masterpiece of modernist poetry. And so on. These areas did not, in fact, light up, but if they had, it would have made perfect sense too.

The point is that we all know what kinds of things go on in our heads while reading poetry - visual imagery, memories, emotions etc. And each brain region has numerous functions, many of which are sufficiently vague ("social cognition", "emotion") to cover almost anything, especially if you allow that a brain area can activate whenever someone is merely thinking about doing something rather than actually doing it. So whatever blobs appear on the brain, it's easy to invent a story linking these to the whatever task is going on.

It's like astrology. Astrological "readings" always seem accurate because they can be made to fit anyone. Actress Fiona Shaw is a Leo and Leo's have "a flair for drama. In fact, many Leos are attracted to the theatre, the performing arts and public relations". It fits so well! Actually, I made a mistake with my dates, she's a Libra. No problem, "Libra is among the most sociable of the signs...drawn toward creative endeavours." - obviously a born actress. And so on. (She's actually a Cancer.)

Perhaps it's unfair to criticize this experiment. It was a demonstration of fMRI technology for the "Wellcome Collection's new exhibition on identity". The scan was for educational purposes only, it wasn't meant to be proper science.

The problem is that a lot of what is meant to be rigorous science consists of this kind of thing. The Discussion sections of many fMRI papers are full of stories linking whatever brain regions happened to be activated to whatever the task in the experiment was. Most fMRI studies today are more sophisticated than simply scanning normal people doing some task, but the same kind of post-hoc storytelling can be applied to areas of the brain that light up differently in mentally ill people compared to healthy people, or areas that light up in response to a drug, etc.

Of course this doesn't mean that these stories are false. Shaw's visual cortex probably did activate because she was mentally imagining the people and the scene she was reading about - that explanation's good enough for me. The point, though, is that we don't really know, because whatever the fMRI data was, we could have made an equally convincing story having seen it.

What we need are hypotheses made up before doing the experiment, which can then be tested and verified, or falsified, on the basis of the data. As I wrote a couple of months back:
Much of today's neuroimaging research doesn't involve testable theories - it is merely the exploratory search for neural differences between two groups. Neuroimaging technology is powerful, and more advanced techniques are always being developed... the scope for finding differences between groups is enormous and growing.

Exploratory work can be useful as a starting point, but at least in my opinion, there is too much of it. If you want to understand the brain you need a theory sooner or later. That's what science is about.

Friday, November 27, 2009

EastCoastLife /HP Printer Giveaway - PH

PhotoHunt Theme - Technology

The HP TouchSmart 300 PC that I bought at "Nothing but HP for me" event was finally delivered to me. YEAH!

A few days later, I was asked to review the HP Photosmart Premium All-in-One C309g printer (SGD $369.00). I was told only EastCoastLife and another 2 bloggers from Singapore are selected for this review. 

It’s been an enjoyable experience so far – the touch enabled screen is pretty fuss-free. My son, nieces, nephews and I have so much fun as we explore the creative uses of this printer. Gosh, technology is so amazing these days! I will post our artwork in future posts. :)

The printer usually goes missing from my study room as it is wireless. grrr..... I find it in the most unlikely place - the kitchen! My son has been creating some dishes for his restaurant and he's designing a new menu. I hope it will still be in workable condition when I return the printer to HP. :P

Amelia and her colleagues at Waggener Edstrom, the PR company who gave me this review opportunity,  made me this lovely EastCoastLife scrapbook to show what the printer was capable of.

 My very own EastCoastLife scrapbook!

 EastCoastLife /HP Printer Giveaway

HP Photosmart Plus All-in-One with TouchSmart B209a
worth SG$269.00

This contest is open to Singapore residents only. One lucky winner will be announced on 4th December 2009 and I will personally deliver the printer to you.

Question : What does my son do?

Send in your answer with your name, NRIC (Identification number), address to my email :
eastcoastlife at gmail dot com

 Good luck!

First Commenter - Ian

Inside the Service Industry: Customer Profiles!

Working in a restaurant is pretty interesting; some days it's an absolute hell to go through but other days I actually kinda like it. Most of the people I work with are fantastic and even though my feet are killing me at the end of the day, it's nice to cop a (free!) drink and cigarette and whinge about the day and our customers. I've noticed some trends in the type of people that walk through

Thursday, November 26, 2009

Mori Girl fashion, an introduction to the lastest street fashion who knew how to make a buzz

Written by Valerie Fujita
Image sources: Spoon, Mori Girl Papier

Is this just a trend or a real phenomenon? Tokyo has seen a new and apparently powerful fashion appeared, two years ago if we go back to its origins, but only really appearing since last spring and definitely acquired this last autumn. And if Mori Girl fasfhion appeared about 3 years and a half ago and that Fur Fur (brand based on the Mori Girls concept) exists for 3 years and made an impression in the fall 2008 on podiums, the Mori Girl style is now better recognized and has its voice (or even voices).

To make it simple, Mori Girl (Forest girl) fashion describes a “girl who looks like living in the Forest”. The origin of the name « Mori Girl » that became some kind of label was launched by Choco, the moderator of the Mixi (Japanese social network, as Myspace, Facebook…) Mori Girl group (that counted this September about 35 000 members) after she has been said by one of her friend « you look like a girl in the forest”.If it appears that Mori Girls are noticeable in Harajuku, their shopping customs are mostly in shops selling antiques and second hand clothes, in the neighborhoods of Kouenji, Shimokitazawa or Daikanyama, as they cultivate a special taste for antiques.

Roughly, the silhouette of a Mori Girl could be described by wearing a loose pleated “one-piece”, tights or leggings, low-heeled round toes shoes. Their special characteristic of accumulating layers of clothes (one-piece, cardigan, scarf, turtle neck…) to drape the body is very common, and has been made to hide the body lines. It might be some kind of answer to the too sexy way to dress of Shibuya Kei (Shibuya belonging group). They prefer natural colors and earth colors like beige, white, dark green, dark blue, dark red. They prefer cotton and natural materials, and even if they wear chemical fibers, they try to limit this custom. It seems that wearing cotton and natural fibers helps to acquire the natural loose and soft silhouette, and to keep a lively and fresh look. They like fur, fluffy hats, knitwears, small gold things rather than silver, antique watches, frills, floral retro patterns and animal motifs, leather bags, basic turtleneck, puff-sleeves, blouses, antique keys, rosarios… Their make-up, hair and nails also must look natural: they are pale skin complexion, don’t use a heavy make-up, only cheeks are two big pink round shapes, they have short nails, the hair is usually loose, or loosed permed hair with a straight fringe.

Even if in some way, we could say that they borrow codes from natural kei (brands like Bulle de Savon) for natural materials, yurukaji kei (Gomme) for draped style or even lolita kei (Jane Marple) for frills and round toes shoes, they shouldn’t be taken for belonging to any of these groups. Rumors say that to be called a Mori Girl, one’s should respect at least 60 rules.

The style started to appear in magazines very recently. Spoon edited a first Mori Girls dedicated magazine in March 2009, “Mori Girl A to Z” and the first volume of the Mori Girls magazine, Mori Girl Papier went out at the end of November. Fudge magazine also welcomes the movement by offering each month more fashion reports about Mori Girls. Spoon magazine chose the actress Yu Aoi as the perfect incarnation of the Mori Girl ; as Mori Girl magazine chose to interview the singer Meg (that appeared in Japan Expo 2009 edition for a show with Laforet Harajuku).

We can say, after we had an overview, that this fashion is becoming a phenomenon. As it was pretty obscure before, nothing in English has been posted for more than 6 months. Now that magazines like Fudge, Spoon and Mori Girl Papier are talking about the movement we will have a better understanding of that fashion. Mori Girl is not a simple trend anymore. And as it plays on the natural grounds, it plays also on the analog ones. The Mori Girl fashion could also be interesting on a social point of view, because it’s not only about style but also about acts and customs. We can also notice a special dedicated blog (in Japanese) 森ガール and a list of books and magazines to be found on Amazon Japan.

Wednesday, November 25, 2009

Mental Illness vs. Suicide

Do countries with more mental illness have more suicides?

At first glance,
it seems as though the answer must be "yes". Although not all suicides are related to mental illness, unsurprisingly people with mental illness do have a much higher suicide rate than people without. So, all other things being equal, the rate of mental illness in a country should correlate with the suicide rate. Of course, all other things are not equal, and other factors might come into play such as the quality of mental health services. But it still seems as though there should be a correlation, albeit not a perfect one, between mental illness and suicide.

I decided to see whether or not there is such a correlation. The World Health Organization (WHO)
provides the relevant data here. There have only ever been three studies attempting to measure rates of common mental illnesses internationally (1,2,3), and all three were run by the WHO. The WHO also collates national suicide rates (here) for most countries, although a few are missing. No-one seems to have published anything looking for a correlation between these two sets of numbers of before, or if they did, I've failed to find it.

So what's the story? Take a look -

In short, there's no correlation. The Pearson correlation (unweighted) r = 0.102, which is extremely low. As you can see, both mental illness and suicide rates vary greatly around the world, but there's no relationship. Japan has the second highest suicide rate, but one of the lowest rates of mental illnesses. The USA has the highest rate of mental illness, but a fairly low suicide rate. Brazil has the second highest level of mental illness but the second lowest occurrence of suicide.

Some technical notes: Two of the three surveys, the ICPE (2000) and the WMHS (2004), sampled the whole population of each country. The other one, which was also the earliest, the PPGHC (1993), surveyed people attending family doctors. Because this is a slightly different approach, I used the ICPE and the WMHS for the plot above, although the results from the PPGHC are very similar (see below).

The ICPE sampled 7 countries and the WMHS sampled 14, but 4 countries were included in both surveys, so there's a total of 17 countries. I've used the mean of the ICPE and the WMHS for those 4 countries where we have data from both, for the rest I've used whichever is available. For the suicide rates, the WHO gives data for various different years, so I've used 2002, or the nearest available year, since this is between 2000 and 2004. For two countries, Lebanon and Nigeria, the WHO do not report suicide rates. For China, rates of mental illness are given in both Beijing and Shanghai.

The studies used structured diagnostic interviews to try to measure the percentage of people suffering from mental illness in the 12 months before the interview. As I've said previously, this -
attempts to study a random sample of the population of a certain country. In order to establish whether each person is mentally ill or not, they use structured diagnostic interviews. These consists in asking the subject a fixed ("structured") series of questions, and declaring them to have a certain mental disorder if they answer "Yes" to a given number of them.
In this case the structured question interview was called the CIDI and it used DSM-IV criteria. You can check it out here. Example question:
You mentioned having periods that lasted several days or longer when you felt sad, empty, or depressed most of the day. During episodes of this sort, did you ever feel discouraged about how things were going in your life? (YES, NO, DON’T KNOW, REFUSED)


The rates from the population surveys (ICPE & WMHS) don't correlate with suicide but they do correlate with the rates from the PPGHC survey of people attending family doctors. The association here is very strong, with a correlation r = 0.693. The only outlier is the US. This is despite the fact that a decade elapsed between the first survey (1993) and the other two (2000, 2004).

This is important because it shows that the mental illness surveys are measuring something about these countries, something which is stable over time. They're not just producing random junk results. But whatever they're measuring, it's not related to suicide.


What does this mean? You leave a comment and tell me. But here's my take.
I've often expressed skepticism of population surveys and their (very high) estimates of mental illness, and of the dubious political conclusions certain people have tried to draw from them, but even so, I was surprised to find no correlation at all with suicide. I'd say that any meaningful measure of mental illness should correlate with suicide. These surveys, using the CIDI, don't, so to me they're not meaningful.

One thing to bear in mind about these numbers is that they deal with "common" mental illnesses like depression, substance abuse and anxiety. They leave out the most severe disorders such as schizophrenia. Also, people in psychiatric hospitals, in prison, and the homeless, will not have been included in the studies because they sample "households". That could be why there's no association with suicide, but if so then these surveys are missing a very important aspect of mental health.

The surveys do seem to measure something, but I don't think it has much to do with mental illness. This is just a guess but I suspect they're measuring willingness to talk about your emotional life to strangers. At least stereotypically, the Chinese and the Japanese are known as more reserved in this regard than Brazilians and Americans.
So it's no surprise that when you ask people a load of personal questions, the "rates of mental illness" seem to be lower in Japan than in America. This doesn't mean Americans are really more ill, just more open.

I've been talking about surveys looking at differences between countries, but if these are flawed, then so are surveys looking at just one country.
For example, many studies have looked at mental illness in the USA using similar methods to these. But can we trust these methods bearing in mind that if you ask the same questions in, say, Belgium you get less than half the estimated rate despite it having double the number of suicides? Taken to its logical conclusion, maybe we know little about the prevalence of "common mental illness" anywhere.

ResearchBlogging.orgSartorius N, Ustün TB, Costa e Silva JA, Goldberg D, Lecrubier Y, Ormel J, Von Korff M, & Wittchen HU (1993). An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'. Archives of general psychiatry, 50 (10), 819-24 PMID: 8215805

WHO (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization, 78 (4), 413-26 PMID: 10885160

Demyttenaere K, & et Al (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 291 (21), 2581-90 PMID: 15173149

Monday, November 23, 2009

Schizo Weather, Tons of Bugs, and a Non-Beach Party

We apparently had 40 degree Celsius weather a few days ago, which would kind of explain why I felt like I had woken up in an oven, rolling about in my own sweat in bed and kicking my boyfriend's limbs off me. Oh, to have air-conditioning...or even a fan would have done the trick. I could put a bag of ice in front of it...So off I trooped to my nearest and most beloved shopping center, Broadway.

Brain Damage, Pedophilia, and the Law

An intriguing and tragic story of brain damage is reported in the latest issue of Neurocase: Klüver-Bucy syndrome, hypersexuality, and the law.

The authors are Devinsky, Sacks, and Devinsky - Sacks being neurologist and author Dr. Oliver Sacks. Their anonymous patient, a 51 year old married American man, is currently serving a jail sentence for downloading child pornography. But he's not your average pedophile.

The man's problems began at the age of 19 when he -
first suffered attacks of déjà vu ... They became much more frequent – as many as 20 attacks a day – and much more complex, the déjà vu now being followed by a cascade of other symptoms: sharp pains in the chest and sensations of breathlessness; alterations of hearing; occasional musical hallucinations – he would always hear a particular song ‘as clearly as if it were being played in the next room’...
Tests showed that these strange sensations were the result of epilepsy, and that the seizures originated in the right mesial temporal lobe, an area of the brain involved in memory and emotion. Temporal lobe epilepsy is relatively common, and it's a fascinating topic in itself, as the symptoms often include hallucinations and other odd experiences such as a powerful sense of déjà vu.

As time went on the symptoms worsened, and anticonvulsant drugs didn't help, so at age 33, the patient had surgery to remove the part of the brain where the seizures were starting. Tests on the brain tissue removed in the operation showed the presence of a brain tumour (ganglioglioma). However, a few months later, the seizures returned, worse than before. So, at age 39, he had a second operation to take out even more of his right temporal lobe. That's when his real trouble started -
Approximately a month after surgery, behavioral changes of irritability, hyperphagia [increased eating] and hypersexuality (including coprophilia) developed. He became more sexually active with his wife and masturbated more often. Compulsively, he began to watch adult pornographic images and videos on the internet when his wife slept.
The unfortunate patient's symptoms are a rare example of Klüver-Bucy Syndrome (KBS) in man. Here's the very first account of it -
He no longer clearly understands the meaning of the sounds, sights, and other impressions that reach him. His food is devoured greedily, the head being dipped into the dish, instead of the food being conveyed to the mouth by the hands. He reacts to all kinds of noises, even slight ones – such as the rustling of a piece of paper – but shows no consequent evidence of alarm or agitation and displays tyrannizing proclivities towards his mate.
That's a description of a lab monkey, written in 1888 by British neuroscientists Sanger Brown and E. A. Schaefer. Compare it to the patient's own words about what happened to him -
My appetite for food and sex increased dramatically. I had greater mood swings. I wanted sex constantly. Every day. I was very easily stimulated and began to touch myself regularly. I began to request sex daily from my wife. If I wasn’t having sex with my wife, I masturbated. This behavior increased over time. I became more emotionally labile, obsessive–compulsive... I become distracted so easily that I can’t get anything started or done.
It's a classic example of KBS, although the patient only had his right temporal lobe damaged, whereas in monkeys KBS usually follows removal of both the left and the right temporal lobes. Also, it's interesting that the symptoms only started a month after the surgery.

The patient's appetite for sex (and food) was insatiable, and this became his downfall -
Some websites solicited him to view and purchase child pornography. He became obsessed with this and eventually purchased and downloaded pornographic images of prepubescent females engaged in sexual activities from the internet. He was ashamed and secretive about these activities, not discussing the pornography or masturbation with his wife or with anyone else.
In 2006, he was arrested. A psychiatrist prescribed an antipsychotic, quetiapine, and an antidepressant, sertraline. His sexual obsessions disappeared, and according to his wife, "he became much warmer and loving but the medications shut off his libido... sex became non-existent."

The patient was subsequently charged with 'knowingly and wilfully possessing material which contained at least three images of child pornography'. He plead guilty. Dr Devinsky told the court that the right temporal lobe damage was the "major contributing factor to the patient’s hypersexuality and viewing of child pornography" and that he was, therefore, not responsible for his actions. Oliver Sacks agreed, saying a letter that he was
. . . a man of superior intelligence and of real moral delicacy and sensibility, who at one point was driven to act out of character under the spur of an irresistible physiological compulsion resulting from his brain injury. A recurrence of such behavior is extremely unlikely given his character and insight... He is strictly monogamous.
The prosecution, however, argued that he was in control of actions, because he was able to avoid acting inappropriately in public, and they sought the maximum sentence possible - 20 years. They said that
the patient’s hypersexual behavior in some situations but not others was evidence for volitionally controlled criminal behavior; that it was incompatible with a neurological cause. For example, he downloaded and viewed child pornography at home but not at work.
The judge, however, accepted that the patient's medical condition was a mitigating factor in the case. He sentenced him to 26 months imprisonment, 25 months home confinement, and 5 years under supervision - the minimum punishment allowable by law.

Should he have been punished at all? Devinsky, Sacks, and Devinsky don't think so: "Was he criminally responsible? Did his behavioral actions warrant imprisonment? We believe the answer is no to both questions."

But the case raises difficult questions about free will and responsibility. At first glance, it seems as though the man's brain damage didn't directly make him download the child porn, but merely gave him an "urge" to do so. Don't we have the ability to choose whether or not to follow our urges? Isn't that what "free will" is?

On the other hand, damage to the same parts of the brain causes strikingly similar symptoms in monkeys. An alien scientist observing life on earth might well conclude, from cases like this, that all the species of monkeys on this planet are very similar - including humans. You damage a certain part of their brains, and their behaviour changes in a predictable way. Most of us humans would say that other monkeys don't have "free will" - but then how are we so sure that we do?

Links: I've previously blogged about drugs to increase libido and the question of free will. The Neurocritic has a great post on neurology and sex from a few weeks back. Finally, perhaps the most important question raised by this case is what would the Paedofinder General say?

ResearchBlogging.orgDevinsky J, Sacks O, & Devinsky O (2009). Kluver-Bucy syndrome, hypersexuality, and the law. Neurocase : case studies in neuropsychology, neuropsychiatry, and behavioural neurology, 1-6 PMID: 19927260

Sunday, November 22, 2009

Hakka Food Fair - RT

Nanyang Khek Community Guild is organizing a series of activities to celebrate its 80th anniversary. I attended  its Hakka Food Fair on Sunday.

I was there at 11am and the venue was packed with people from the Hakka community and visitors from all over the island. All the food stalls were doing a roaring business, and several stalls had already sold out their food. The Food Fair was supposed to end at 3 pm but by 12 noon, most of the food was sold out!

Late comers were disappointed. There will be another Food Fair next year. Come early. :)

 Hakka Thunder Tea

Traditional Hakka food like the Hakka Thunder Tea, Ginger Chicken Stew and Hakka Abacus dish are must-haves at this fair.

Don't expect thunder to strike when you eat this Thunder Tea. In Hakka 'Lui' means to grind (mix) while in Mandarin it means 'Thunder'. :P

I have yet to try this famous Hakka dish which is supposed to be good for my health and is recommended to be eaten on a regular basis.

Famous Hakka Abacus Seed Dish

How can you miss this popular dish if you want to get rich!? :P This traditional Hakka dish is eaten during festive celebrations such as Chinese New Year, Dragon Boat Festival and the Mid-Autumn Festival for prosperity. Nowadays it is easily available in certain parts of the island.Huat (Prosperity)  every day!

Traditional Hakka Ginger Chicken Stew

I managed to grab the last bowl of this healthy Ginger Chicken Stew!! hehe..... I drank this traditional Hakka stew a long time ago, made by the Hakka mother-in-law of a cousin. She passed away and I have not tasted this dish until now.

This particular bowl of Ginger Chicken Stew was so strong that I was practically walking on air (drunk, mabot) after drinking it. Oh, and I was perspiring like crazy due to the abundant ginger in the stew. :P It was good for my health. 

Many of these nutritious and tasty dishes sold at this food fair are specialties of the members and are not easily available on the market.

I bought the Hakka cookbook (recommended retail price S$16) published by Nanyang Khek Community Guild and some popular Hakka preserved dried vegetables and red mushrooms. I am going to learn how to cook some Hakka dishes. Yeah!

Nanyang Khek Community Guild
20 Peck Seah Street Singapore 079312 TEL:62210605 62226590

First Commenter -Tekkaus

客家美食节- 南洋客属总会创会80周年会庆活动

Hakka Food Fair 客家美食节

客家美食节 - 本地历来规模最大的一个族群传统美食会 - 于11月22日假客总大厦外的柏城街举行。宏茂桥集选区国会议员蓝彬明医生应邀出席美食节。

除了七大会所与宗乡总会,各下属客属参加美食节,还 特别邀请其他种族的人参加。16间客家菜馆和3家酒楼,为大家带来客家经典美食。另外还第一次呈现永定客家美食,特别从中国运来的“永定五大干”首 次与会售卖,并且与制作好的客家菜谱一同出售,所有售卖的款项一并捐给慈善单位。




熙熙攘攘,热闹非凡 - 人山人海的柏城街

工委会把一些传统客家食谱编成精美《客家食谱》(S$16), 与会售卖。

随着社会的发展,生活环境的改变、语言传延不易,海外华人普遍面对原有族群文化和意识日渐薄弱的现象,因此发扬和传承族群优良传统文化一直是各地宗乡社团的重任。他们有责任也有义务负起弘扬各文化的任务, 促进华侨华人事业发展和文化素质的提高,争取华侨华人的正当权益和福利,鼓励华侨华人融入新加坡社会,提高其社会地位和经济实力,为新加坡的政治、经济、文化和社会发展作出卓越贡献。


Another Drug to Treat Drug Addiction

Today I was going to blog this paper, which says that you can predict which kids will grow up and be criminals by measuring their Pavlovian fear conditioning at age 8. In Mauritius. But The Last Psychiatrist already said everything I was going to.

Luckily, there's another article in the American Journal of Psychiatry about crime in a tropical country for me to write about - Randomized, Double-Blind, Placebo-Controlled Trial of Vigabatrin for the Treatment of Cocaine Dependence in Mexican Parolees.

The study found that a drug called vigabatrin helped Mexican cocaine users to stay clean. The addicts were all on parole from jail. They "were poor and unemployed or underemployed, and none had permanent telephone numbers", had a mean age of 30, and had been using cocaine, including crack, for 9 years on average. A difficult population, then.

They were given either vigabatrin, or placebo, every morning for 7 weeks, and their cocaine use was measured with urine samples twice a week. If they managed to stay clean for 3 straight weeks, that was counted as successful treatment. What happened? In the placebo group, almost no-one managed to get clean - just 4 out of 53 (7.5%). But in the people on vigabatrin, 14 out of 50 made it (28%):

Now there's two ways of describing this result. You could say, as the authors did, that "nearly four times as many subjects taking vigabatrin achieved full end-of-trial abstinence", which makes it sound amazing. Four times as many, woo! Or you could say that only 1 in 5 people were helped by the drug - not so good. But hey, it's still a result. And it's a lot more impressive than the "cocaine vaccine".

Interestingly, many of the cocaine addicts were alcoholics too, and in the vigabatrin group 10 of them (43%) also achieved abstinence from alcohol, vs just 1 (6%) in the placebo group.

What's vigabatrin? It's an anticonvulsant used in some countries - including Mexico but not the U.S. - to treat severe forms of epilepsy. Like most anticonvulsants, it works on the neurotransmitter GABA which inhibits neural firing; specifically, vigabatrin prevents GABA from being broken down by an enzyme in the brain. In laboratory experiments, it stops rats and mice from enjoying the effects of cocaine, probably because it blocks the ability of cocaine to increase dopamine levels.

That all sounds promising, but there's a catch. Vigabatrin causes "a tardive peripheral visual field defect that is typically asymptomatic and neither progresses nor resolves upon treatment cessation" as the paper tells us. In other words, prolonged use causes permanent loss of peripheral vision, i.e. "tunnel vision". This can be severe in some cases. They tested for it, and it didn't happen to anyone in this study, but that's probably because it was a short trial and the cumulative total dose was about 10% of the amount that's thought to cause problems: 130g vs. 1,500g. Long-term treatment might be more of an issue.

So why use vigabatrin, when there are plenty of other anticonvulsants that don't permanently damage your eyes? This is the first placebo-controlled trial of vigabatrin but there have been many trials of other anticonvulsants for cocaine dependence and they generally didn't work. So maybe vigabatrin is unique and more effective than other drugs of its kind. Only time, and bigger trials, will tell.

ResearchBlogging.orgBrodie, J., Case, B., Figueroa, E., Dewey, S., Robinson, J., Wanderling, J., & Laska, E. (2009). Randomized, Double-Blind, Placebo-Controlled Trial of Vigabatrin for the Treatment of Cocaine Dependence in Mexican Parolees American Journal of Psychiatry, 166 (11), 1269-1277 DOI: 10.1176/appi.ajp.2009.08121811

Friday, November 20, 2009

Yummy Birds - PH

PhotoHunt theme : Birds

Yummy roasts from Singapore!

One must-have activity for my foreign guests when they visit Singapore is to go Geylang (a red-light district) to visit my favourite chicken and duck stall. I'm referring to edible barbequed birds

The Chinese refers to a hooker as 'Chicken' and a gigolo, 'Duck'. lol .... er.... some of the guys do request for the the other version. :P

I have never eaten a Bishop's Nose (chicken backside). It's too gruesome for me.....  but the guys wiped out all the chicken backsides that night  ewww......

Chef carving a Peking Duck

Another yummy way of serving a duck is the famous Peking Duck dish. The Peking Duck is traditionally carved in front of the diners. The thin, crispy skin is eaten with pancakes, spring onions, and sweet bean sauce. The remaining meat and bones may be made into a soup.

Bird Flu!? I just have to eat less birds......

First Commenter - oceanskies

Thursday, November 19, 2009

Banned In China

The BBC have run a profile of a Chinese rock band who've been banned from the radio for criticizing the government.

How sad, we think. But we're not very surprised. We all know that the authoritarian Chinese regime doesn't respect human rights and civil liberties. Naturally they would want to a silence the free, peaceful voice of democratic youth in the form of rock music...

Except it turns out that the band are criticizing the Chinese government for being too nice:

"Taiwan is ours, Tibet is ours. Compromising with the United States and Japan is a disgrace".

"Our lyrics are aimed at our government," says Mr Liu. "It takes a very tough line towards its own people. But outside China it is very soft. When your people are being bullied by others, you should stand up for them. Right now they are being very soft."

I'm reminded of what happened in Algeria when an Islamist party won the first round of the democratic elections in 1991. The military promptly seized power, canceled the elections, and banned religious political parties. Military coups and authoritarianism are generally considered bad. But are they still bad when the people they're suppressing are extremists?

Wednesday, November 18, 2009

One Pill Makes Your Libido Larger

It's every man's dream - a pill to make women want more sex. According to Boehringer Pharmaceuticals, that dream could be a reality in a few years, in the form of the strangely-named flibanserin. But is it the latest wonder-drug or just a glorified sleeping pill? Read on.

Flibanserin was originally developed as an antidepressant, but in clinical trials against depression it reportedly failed to perform better than placebo. The standard for getting approved as an antidepressant is low, so this is quite an achievement.

The BBC today described flibanserin as the "Female Viagra", which is rather confusing, because it's meant to increase sexual desire, which is one thing Viagra (sidenafil) doesn't do. The reason for the Female Viagra headline is that, as Professor John Thorp says:
"It's essentially a Viagra-like drug for women in that diminished desire or libido is the most common feminine sexual problem, like erectile dysfunction is in men"
Yes, one in ten women suffer apparently from "Hypoactive Sexual Desire Disorder" (HSDD) as Boehringer Pharmaceuticals helpfully informs us. And “As many as two out of every 10 women describe some degree of decreased sexual desire" according to the unfortunately named Dr Charles de Wet, Boehringer medical director for the UK.

HSDD is a diagnosis in the DSM-IV, the American Psychiatric Association's listing of psychiatric illnesses, and it's been recognised as a disorder since 1980. It is not, however, a very popular diagnosis yet. There are only 60,000 Google hits for it, as opposed to 1,600,000 for "major depression" and, er, 90,000 for "neuroskeptic". Odd for a disorder apparently plaguing at least 10% of women.

Indeed, some people say that it's no more than a label invented by psychiatrists who didn't understand women and then promoted by drug companies in order to sell drugs. This is almost certainly true, but it's also a bit simplistic, because there are people who perceive themselves as suffering from low libido, and if flibanserin really helps them, that's surely a good thing.

How is flibanserin supposed to work? According to a paper on the Pharmacology of Flibanserin, it's a serotonin receptor 5HT1A agonist and a 5HT2A antagonist. This makes it a kind of cross between the antidepressants nefazadone and buspirone. Neither of these are widely used as antidepressants because they're not considered highly effective. Flibanserin is also a weak dopamine D4 receptor partial agonist. This might underlie its aphrodisiac properties, because drugs which increase dopamine levels are known to enhance motivation and libido (or indeed cause problematic hypersexuality.) In rats and mice, flibanserin has sedative effects and enhances the effects of other sedatives. It also has antidepressant-like effects in some tests but not all. Drug geeks can click the image on the left for more details.


Now for the big question - does it actually work? Well, there have been no published clinical trials yet. At all. The trials in depression, where it failed to work, have never been published. Hmm. However, four trials in "Hypoactive Sexual Desire Disorder" were recently completed and the results were presented yesterday at a sexual medicine conference in Europe (ESSM) in the form of three posters (1,2,3). The trials were known as - groan - VIOLET, ORCHID, DAISY and DAHLIA. I probably don't have to tell you that they were all funded by Boehringer Pharmaceuticals.

The main poster is Efficacy of flibanserin 100 mg qhs as a potential treatment for Hypoactive Sexual Desire Disorder in premenopausal women which pools the data from three trials with a total of about 1,400 women. They found that taking flibanserin 100 mg every night had small beneficial effects. Relative to placebo, it increased the number of "satisfying sexual encounters" by 0.7 per month. It also improved scores on questionnaire measures of sexual function, a bit.

In any trial like this you have to ask whether there is result cherry-picking going on. Maybe they asked dozens of questions about the women's sex lives, and they're only telling us about the minority where the drug seemed to work? People often do that but in this case, the Clinical Trials Register suggests there was no funny business of that kind. It also shows that there have been no trials using 100mg which weren't included in the poster, so the trials themselves weren't cherry picked either. That's reassuring. But it looks like the effects were only significant when all three trials were pooled - one poster shows the results of the ORCHID trial alone, and most were non-significant.

What about the side effects? There's a whole poster about them. 100 mg flibanserin nightly caused 14% of patients to drop out due to side effects, vs 7% in the placebo group - so an extra 7% decided it wasn't worth it. It caused dizziness, nausea, fatigue, somnolence - and bizarrely, also insomnia. Notably, 50mg daily was much worse than 100 mg nightly, which suggests that taking this at night, rather than in the morning, is a good idea. But given what it is meant to treat, you'd want to do that anyway, right?

But this leads onto my biggest problem with these findings. It's obvious from the side effects data that this drug is a sedative - it makes you tired and sleepy. The animal data confirm this. It's much more likely to put you to sleep than it is to make you enjoy sex in any given month. Off the top of my head, I suspect its sedative properties are a result of its 5HT2A antagonism.

Any sedative can increase sexual desire, as anyone who has ever been to a bar will know. So whether this drug actually has an aphrodisiac effect, as opposed to just being a sleeping pill, is anyone's guess. To find out, you'd need to compare it to a sleeping pill, say, Valium. Or a couple of glasses of wine. Until someone does that, we don't know if this drug is destined to be the next big thing or a big disappointment.

Edit: Just noticed that Dr Petra Boynton has a fantastic post about the background to flibanserin and the manufacturer's apparent attempt to recruit her to write about HSDD.



Borsini F, Evans K, Jason K, Rohde F, Alexander B, Pollentier S (2002). Pharmacology of flibanserin. CNS drug reviews, 8 (2), 117-42 PMID: 12177684