Dave Enjoys

I’m a huge fan of Newsweek. A few years ago Charity called in and supported NPR for one of their fundraising drives and we received a free one year subscription to Newsweek – we’ve kept it ever since. We both love to read Newsweek – finding it informative and oftentimes approaching issues from multiple perspectives.

Tonight I am sadly disappointed. I finally had a chance to read the Feb. 8 2010 issue with a promising cover story on antidepressants by Sharon Begley. I had expected, in common Newsweek fashion, to find an extended report on the overall story supplemented by articles from various perspectives – I was sadly mistaken. Begley’s article used recent controversial findings to smack around the efficiency of anti-depressants rather ferociously, then there was a small, one-page response from Robert Klitzman, a psychiatrist, author, and professor at Columbia University.

Jon Meacham, what happened here? Begley’s article highlights some interesting and thought-provoking research findings, but doesn’t seem to seriously consider the issues with the research findings. Klitzman’s article, while raising some important issues, is too short to offer a resource defense against Begley’s article. Klitzman’s use of personal, subjective experience is entirely worthwhile, but in an article this short it seems to overshadow the more scientific issues relating to researchers’ methodology in acquiring these results.

I haven’t had time to read the original research publications and probably won’t…nor am I a qualified mental health professional…but as an individual who has suffered from Obsessive Compulsive Disorder (OCD) and Major Depressive Episodes for all of my conscious life, I’d like to share a few observations:

• One must correlate not only the effectiveness of a single drug but the effectiveness of a class of drugs on the individual. For example, this study reflects that an individual in a clinical trial for say Prozac experiences only a 1% decrease in symptoms – similar or identical to a placebo effect. What the study does not correlate is how that same individual responds to different drugs used to treat the same disorder. For example – if this individual uses Zoloft, Paxil, etc. do they experience a more significant reduction in symptoms? One of the differences (for me) between Zoloft and Prozac is weight gain versus weight loss/stability. Future studies need to consider the effectiveness of a class of drugs in treatment of an individual versus an individual drug. Thus the question is, would any drug within this treatment class significantly reduce the symptoms of the sufferer? If so, this is a victory for “anti-depressants” in general. One cannot suggest that anti-depressants as a class are ineffective without considering their effectiveness as a class on the individual. Ineffectiveness in a case study of treatment of an individual with a single drug is not evidence that anti-depressants don’t work but that that specific anti-depressant doesn’t assist that individual.
• The lumping in of the varied forms of depression is a significant issue as well. There are significant differences between the forms and intensity of depression which is further complicated by coexisting disorders. Yes, situational depression (e.g. death of a friend or family member) is likely to resolve itself – but this is very different from the depression which simply sits upon a person like a funk – with no rhyme or reason. Dysthymic Depression has different implications than a sudden Major Depressive Episode.
• I’m not aware of anyone advocating that we pop anti-depressants like tic tacs and yet the article seems to indicate that these anti-depressants are being handed out to anyone who is experiencing a bit of grief. There is little disagreement, as far as I am aware, that medications are not a panacea for depression and that they should be utilized in moderation, in combination with other approaches, and for depression which appears to be ongoing and severely limiting rather than limited and minimal.
• Begley recommends psychotherapy as an effective alternative treatment, but that is a very general class – much more general than the anti-depressants mentioned. What sort of psychotherapy is being referred to? Psychoanalysis? Cognitive-Behavioral?

I would have liked to see someone like Peter Kramer who wrote the excellent book Against Depression write a response to Begley’s article (I think Klitzman is also fully capable of writing an article of such a nature given a more extended page count…I mention Kramer because he has written extensively on this subject). In the end, I simply want to suggest that Newsweek should be more careful in how they handle topics like this. It felt extremely one-sided and was not provided the depth or breadth I’ve come to expect from Newsweek.

The article raises good questions. We need to be considering the efficiency of our antidepressants. We need to be pushing for alternative treatments that don’t require the introduction of potentially harmful chemicals into our bodies. We need to smash any mentality that considers every blue mood an instance of depression and worthy of a few pills.

But where, oh where, where the articles talking about what sorts of psychotherapy are effective for treating depression? Where was the article even defining depression? Where were the articles talking about the efficiency of these same anti-depressants for other disorders – for example Obsessive-Compulsive Disorder? Where were the articles on how to improve our system?

Update 2/06/10: I’d like to thank Peter Kramer for taking the time to comment on this article and would like to point everyone’s attention to the several articles he has written in response to Newsweek’s article and the underlying research used in the article

• Here is an article for Slate that Kramer wrote explaining Irving Kirsch’s understanding of tianeptine and why it isn’t the clear-cut evidence Kirsch suggests. Kramer has some fairly strong words for Newsweek, “To set aside the testimony of animal model research, brain enzyme research, the new work on neurogenesis, and on and on—this stance has the whiff about it of science denial. It is one that a major magazine should have showcased cautiously, if at all, and only after having done some serious homework.”
• Here is another article for Slate in which Kramer evaluates the results of the recent JAMA study and demonstrates significant concerns acknowledged by the U. Penn researchers themselves concerning the efficacy of drawing conclusions on minor depression from this study.
• Finally, Kramer responds to arguments that individual responses to placebos are significant by noting that the test groups in studies reflecting this result oftentimes include a number of test subjects who don’t have the disorder – thus the apparent efficiency of placebos.

Tags: Antidepressant, begley, Clinical trial, Columbia University, klitzman, Major depressive disorder, mental health, Newsweek, Obsessive–compulsive disorder, Placebo

Over Christmas Break Steam (hey, guys, what about an affiliate program?  i should get paid for this promotion ) had some absolutely amazing sales on games – including some strategy war games (I mean like 80-90% off). I purchased four for around $25 total – Rome Total War, Rome Total War: Alexander, Take Command – 2nd Manassas, and Mosby’s Confederacy. I’ve tried the first two and last one – haven’t had a chance to try 2nd Manassas yet, though I heard great things about it when it came out originally. I really enjoyed playing Tilted Mill’s Mosby’s Confederacy so I’ve spent most of my available gaming time on that game (I just completed it).

Tilted Mill’s Mosby’s Confederacy is a combination strategic/tactical wargame (my favorite kind – thus my enjoyment of the Total War series). This game, however, is fairly simplistic compared to epics like Total War – it reminds me of the great classics by W.R. Hutsell (e.g. VGA Civil War Strategy). The game map covers only a relatively small area consisting of several towns and the surrounding areas in which Mosby actually traveled/fought/raided. At the strategic level one each turn gets to “develop” ones character (John Singleton Mosby) in a somewhat RPG element. Depending on the attribute you choose to enhance will effect how your character performs and what options for character development will be available on the next turn. At the town level you can upgrade a number of facets by using the reputation you earn in each battle. This can be utilized to increase support by the locals (increasing the radius in which they will fight for you), increase the size of stables, weapons cache storage, or hospitals, drill the soldiers in that town, upgrade your hospital, or upgrade the weaponry of your soldiers.

Each turn several missions are available. These missions revolve around several themes: destruction of enemy troops or capture of enemy munitions, horses, or officers – sometimes a combination of these. There are also special “star” missions which indicate a historically important endeavor Mosby undertook.

When one chooses a mission one can choose from the soldiers within reach of that location to participate in the battle. Each soldier receives experience as he enters into and successfully survives combat. Soldiers also develop characteristics – but this occurs automatically, rather than selectively as in the case of Mosby. Soldiers find a variety of specialties including sharpshooter, ranger, cavalry, and scout. You can provide the soldiers with horses if you have them available and must have enough munitions for your men (the more experienced men consume more ammunition).

Finally you are ready for battle. This is a real-time environment similar to that found in Sid Meier’s Gettysburg or many standard RTS games (e.g. the popular Commando series) – though it is on a small-scale compared to say Gettysburg. At the most you will have twenty men under your command. The battle ensues at a somewhat slow pace, one attempts to capture the various objectives and receives reputation points based on a number of factors (in addition to any munitions or horses captured in battle) – how many enemy troops were killed, how many surrendered, what objectives were accomplished, how many men died from your troop, etc. You are taken back to the main screen and can then use these reputation points, assign a new skill to Mosby, choose a new mission and so on.

Overall – the game is very enjoyable. I do have a few small complaints:

• You cannot save your game while in tactical battles. This is probably purposed to increase the difficulty of the game (no saving a certain point in the battle and trying over and over to obtain better results) but is annoying if you need to stop the game and work on something else for a while in the midst of a battle (you have to start the battle all over).
• I have a fairly powerful computer that runs games well – but I experienced a slow decrease in performance during tactical battles the longer I played Mosby’s Confederacy. I suspect some sort of memory leak. I found that this seemed to occur most frequently if I increased the time speed in tactical battles. At regular speed it did fine, but speeding the time progression caused the units to move faster at first but eventually (after 10-45 mins.) the graphics would become choppy, the interface non-responsive, and even playing at the slower speed could be painful.
• The documentation for the game consists of perhaps four or five pages – this is very disappointing. There is little information on the various attributes of soldiers, whether terrain/cover affects combat (I would hope so), and what the effects of putting a sharpshooter on a mount is or what having a cavalryman walk on foot is. Additionally I did not see any documentation on how to wisely utilize swords or bayonets – though both are available.
• For most gamers outside of war strategy games this game probably has tons of playability – but for individuals who are used to the weeks and weeks (or months) to beat strategy games – Mosby’s Confederacy is so short, nor does it offer significant incentive for repeating the game again after completion (and fairly abruptly ends with a statement of your stats but little indication of how you did compared to the absolutely best possible).

This said, I’m more than satisfied with my purchase (I think it was $2.50 or $5) – I probably wouldn’t spend $13 on it (but I’m a cheapskate, I usually wait a year or two after a game comes out before purchasing it – except for Battlefront/Fury Software’s Strategic Command 2). If you have a hankering for Civil War combat – its a worthwhile purchase…I’m hoping that Tilted Mill will take the opportunity to make similar games using the same engine. It seems that with refinement this engine could even be used to create a grand strategy of the civil war – but I’d be especially interested in seeing more games similar to Mosby – perhaps focusing on the war west of the mississippi (arkansas, kansas, california) or Stonewall Jackson’s campaign in the valley.

Tags: American Civil War, Civil War, fun, historical, inexpensive, John Mosby, Real-time strategy, Rome Total War, Rome Total War: Alexander, rpg, rts, Sid Meier, Stonewall Jackson, Strategy game, tactical, Tilted Mill

Disclaimer:

When it comes to discussions about nationalized healthcare, cost reductions, and other major political issues – I generally don’t feel qualified to comment. With this post I’m stepping out on a limb – and my qualifications(1) for doing so are probably still lacking. I welcome your feedback. I’m more than happy to be proved wrong – this is just want seems logical (and obvious?) to me.

Delimiters:

In this post I am not going to argue for or against nationalized healthcare, rather I am going to discuss alternative methods of reducing costs/improving treatment. This is not because I disagree with nationalized healthcare(2) but rather because I see these steps as being a natural first step in any attempts at cost reduction/treatment improvement.

Automation:

Each year I (try to) go for a physical with my doctor. I don’t enjoy it – but it allows me to find out if there is something major and obvious wrong with me. It takes a lot of time to see a doctor. After setting up the appointment one generally has to leave work and travel to the doctor. Being the anti-travel person that I am, that isn’t too big of a hazard – my doctor is five minutes drive from my house, ten from my work. Still – its a nuisance.

Once I arrive, no matter how early or late, I always end up waiting and waiting (and waiting and waiting). Generally I am surrounded by others like me who are healthy and present for routine maintenance as well as those who are ill. Unfortunately, this means I am in a closed air enclosure with several individuals who are hacking and sneezing – throwing contagious germs around the room. I don’t harbor any hard feelings – I do the same when I am ill and I go to the same place to get treatment…but still, the risk is that I will leave with more wrong with me than when I entered.

The doctor’s examination includes fairly routine processes. He checks my height and weight. Checks my blood pressure, listens to my heart beat, pays attention for any abnormalities in my breathing, checks my mouth, ears, and nose – amongst other questions and proddings. Much of this process is actually carried out by one or more nurses (including the occasional bleeding for blood tests).

Now, my suggestion is simple, why not work on devices like the Zeo which can perform most of this sort of monitoring automatically? Granted, the Zeo is only for sleep – but why can we not make multifunctional devices that can monitor our blood pressure, heart beat, breathing, and any of dozens of other health factors? It seems that both the Apple iPhone and the Verizon/Motorola/Google Droid would be able to serve as perfect multifunctional devices for such a purpose (in addition to their many current uses). I’m not a big fan of having something implanted in me (call it Revelation/666 syndrome if you must) but I see no reason why such devices could not be used once a day/week in a few moments or with a small wireless bandaid type patch to monitor our health.

This automation would provide us with numerous benefits such as:

• Reduced visits to doctors for regular physicals, increasing our work productivity/time off for recreation.
• Increased monitoring of our vitals – alerting us to health issues in days instead of weeks or months.
• Reduced exposure to environments with significant amounts of communicable health issues.
• Advanced analysis of our health vitals to determine patterns of health that are disconcerting and need review.

Let me give a few examples of how a device like this might function:

• Jane is fairly healthy. She uses her multifunction device once a week. It gives her peace of mind that her main vitals continue to operate within normal bounds. She doesn’t spend as much time worrying about whether this or that minor issue might be part of a bigger dilemma.
• John uses his device daily. The device notes over a months time that John has significant blood sugar spikes around noon every Friday and this is accompanied by extreme bouts with sleepiness throughout the day. The device alerts John and John is able to change his dieting habits to reduce the sugar intake reducing his sleepiness.
• Mary has chronic heart problems. While family bought her one of those devices that calls 911 if pressed they still worry about her constantly…until she received a multifunction device. She keeps a wireless patch on her all the time – which covers her vitals. It lets her know when she is working too hard and in danger of bringing on a heart incident and will even call 911 if she keels over – without her interaction.

Analysis:

I know some people are afraid of having their records kept electronically. I could explain why I don’t think this is a major concern but perhaps another time(3). The keeping of electronic records instead of traditional paper records would offer several significant benefits:

• Medical offices could (with permission) share information instantaneously. No more waiting days or weeks to get paperwork transferred from one office to another.
• Medical offices could communicate with one another electronically and share results to coordinate better treatment plans.
• A significant reduction in the amount of paperwork could be made. Individuals could give HIPAA consent via an e-sign form rather than through the useless bundles one receives at each doctor.
• The data could be analyzed anonymously to garner important health information and to look for patterns invisible to the naked human eye. Think about it – we could find that individuals who now live in every state in the union and are suffering from stomach cancer all originally lived in the small town of (put name here). While this might not solve their health problems it could launch an investigation to discover that (name toxin) is present in (name location – e.g. elementary school).
• Further, the efficiency of treatments, the possibility of causes, the analysis of diseases could all be significantly expedited by such a process. The data could be anonymized and then made available for legitimate researchers to utilize in performing research (e.g. such as World Community Grid projects).

Pre-Treatment:

A lot of expense and time is caused by the inability to discover issues before they occur. What if we could monitor our health? What if we could be alerted (and allow our medical professionals to be alerted) before a major issue arises? If our spiking cholesterol levels were managed before they became a crisis? If our hearts failing functionality was noted before it resulted in a heart attack? If our liver and kidney function could be monitored?

Severity Monitoring:

I get sick somewhat often with minor bugs – a stomach bug, a cold, a virus. Annoying but not life threatening. In my line of work (IT) sometimes its really important to get a project done and while I personally am of the opinion that it is better to stay home and heal before returning to work many others in my field (and the American culture in general) are not. Sometimes even I succumb to the pressure to be present when feeling under the weather. What if I could cough into a small device attached to my multifunction and receive feedback on what sort of cold or virus I have? If its just the common cold I take some dayquil and am good to go – but if its strep, bronchitis, or the flu – well I stay home and see a doctor. How many epidemics could be prevented or reduced?

Conclusion:

I am not arguing for or against nationalized healthcare. I do wonder why there is not more effort in the areas I have outlined above – by governmental and private agencies – to utilize technology to solve these issues. I recognize that these solutions will have minimal effect on what some are especially concerned about (I am concerned as well) – the masses who are unable to receive affordable healthcare coverage. I suppose my thought is that if we can reduce the burden on the overall system, reduce our costs overall, this would provide more time and finances to direct towards those who have a need (whether that is on a governmental, religious, local, or personal level) while creating a sustainable system for future generations.

I eagerly await your thoughts and feedback. Thanks for your time and consideration of my ramblings!

Notes:

(1)In this instance my qualifications consist in their entirety of (a) reading Newsweek weekly, (b) keeping current on major headlines [including healthcare] via Yahoo, and (c) reading/skimming a wide variety of rss feeds covering a gamut of tech/health topics.

(2)I disagree with those who utilize (Christian) Scripture as a argument against socialized medicine. I see no such impetus in Scripture. On the other hand, I find myself less optimistic about the effectiveness of governmental organizations than many more liberal minds (in Christian circles, Jim Wallis comes to mind).

(3)In brief, (a) privacy is an illusion – our information is already available, perhaps just not centralized and (b) I have nothing to hide – so why hide it? You want to know I struggle with Obsessive-Compulsive Disorder? Now you know. Finally, as outlined above I think the benefits are huge (and outweigh the negatives).

Requests for Comment:

Here are a few people who I’d like to hear their thoughts on this post: Dana Blankenhorn (ZDNet), Jim Wallis (Sojourners), Ed Dobson, Tosca Lee (Demon: A Memoir), Michael Arrington (TechCrunch), Jason Calacanis (Mahalo), the folks over at Zeo.

Tags: automation, Blood pressure, Conditions and Diseases, doctor, health, Health insurance, healthcare, physician, smart devices, World Community Grid, zeo

Figured I’d share with everyone some interesting articles I’ve stumbled across recently. Enjoy!

• Five Features We Want to See in Ubuntu (Kevin Purdy, Lifehacker). Techiness: 3
• MySQL Connector for OpenOffice.org 1.0 GA (Frank Schoenheit, Sun). Techiness: 5
• Could One Laptop Per Child be a Bad Thing? (Dana Blankenhorn, ZDNet). Techiness: 2
• ShoreTel Gives Skype’s Enterprise Plans a Lift (Larry Dignan, ZDNet). Techiness: 4
• IBM’s North Carolina Smart-Grid Trial Shaves Power (Martin LaMonica, CNET). Techiness: 1
• AT&T Poised to Roll Out 3G MicroCell Service (Steven Sande, TUAW). Techiness: 2
• Conserve Surge Protector Saves Energy, Money (Adam Pash, Lifehacker). Techiness: 1
• Tungle Makes Cross-Calendar Scheduling Simple (Jason Fitzpatrick, Lifehacker). Techiness: 2
• Credit Card Terminals for iPhone (John Burke, TUAW). Techiness: 2
• Seagate Doubles the Capacity, Doubles the Bandwidth for Barracude XT (Scott M. Fulton, III, BetaNews). Techiness: 3.

Tags: Adam Pash, CNET Networks, ibm, iphone, MySQL, OpenOffice.org, Sun Microsystems, TUAW

For those who are interested in website design / management ScrewTurn Wiki will probably be of interest. Free, open source (GPLv2), and under constant development ScrewTurn Wiki is a ASP.NET wiki application. I use it on my freewargamer site.

Why would I suggest ScrewTurn as worth a turn or two? Well:

• It depends on whether you are looking for a Windows based stack or a Linux based stack. There are lots of options out there for Linux based stacks – but for Windows there are far fewer.
• As mentioned above its free, open source, and licensed under the well-known, widely utilized GPLv2.
• ScrewTurn also seems to be under continuous development with regular releases and well supported forums…and its not some new project that just popped out of the woodwork – its been around for a while.
• Its extremely easy to setup. Anyone who can learn how to purchase some shared hosting and use an FTP client can get ScrewTurn up and running within minutes.
• It supports a good variety of databases (e.g. MSSQL and MySQL) but also allows for flat filesystem site creation (what I use on freewargamer). This makes setup/management even simpler and reduces the requirements in a shared host (which usually limit or don’t provide database access).
• The UI is simple and easy to use. Its intuitive.
• It has WYSIWYG editing of articles.
• It supports Active Directory integration!

The list could go on – but check it out for yourself. Enjoy! (P.S. they recently released the final version of 3.0 which is pretty awesome).

Tags: active directory, file system, free, GNU General Public License, hosting, Linux, Microsoft Windows, MySQL, opensource, Operating system, ScrewTurn Wiki, shared hosting, wiki, windows