Take a minute out of your sunny friday afternoon to listen to Dan Bull‘s serenade to the NHS and the ridiculously catchy rhythmic critique of the proposed changes to the system by Sean “NxtGen” Donnelly (who is hoping to get the tune to number one when it’s released). Three cheers for political rap!

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Update: Serious methodological concerns have been raised about the Debattista paper, check out Neuroskeptic’s coverage here.

In 1996 we witnessed a computer beat the world chess champion, something many never thought would be possible. Is it possible that in 2011 a computer could actually beat psychiatrists in something as intrinsically human as diagnosing mental disorder and even deciding the most effective medication? According to preliminary results from research currently being conducted by a team at Stanford University this is already rapidly becoming a reality.Kasparov vs Deep Blue One Nanostep for Technology, One Quantum Leap for PsychiatryThe key question for psychiatrists today is not the naming of the disorder but deciding (when a prescription is necessary) which prescription is most likely to be effective. The wrong prescription can do much more harm than good. It is accepted that to a large extent psychiatrists still rely on trial and error. Unlike other areas of medicine, psychiatric problems tend to lack biomarkers that inform pharmacotherapy such as bacterial assays that guide antibiotic treatment or histological and genetic tests that guide chemotherapy. The massive STAR*D clinical trial of antidepressants demonstrated just how much of a lottery the choice can be.

lottery One Nanostep for Technology, One Quantum Leap for PsychiatryA study published in the January volume of the Journal of Psychiatric Research by a team at Stanford demonstrates a computer system that appears to be able to tackle this problem in the precribing of anti-depressant medicaton . The method used is called “referenced EEG” (rEEG). This uses mathematical algorithms to compare the brain patterns of a patient to a database of the brain patterns of previous patients with a similar condition and their treatment outcomes. Essentially the patient is given the treatment that is demonstrated to work best for patients with similar brain patterns.

computer doctor One Nanostep for Technology, One Quantum Leap for PsychiatryThis technique has been suggested before but only now is it seriously beginning to present a major challenge to the traditional method. In November a research group in Canada demonstrated an rEEG method that categorised depressive, bipolar and schizophrenia patients with 85% accuracy. A month later the same researchers published another paper demonstrating that the program successfully classified whether Schizophrenia patients would respond positively to clozapine, again in 85% of cases. Now the Stanford team led by Charles DeBattista has published preliminary findings that appear to demonstrate rEEG can select notoriously hard to predict depression medications with 65% accuracy. This is significantly higher than the 38% score achieved using the STAR*D approach which is widely considered best practice amongst Psychatrists.

The critically minded amongst you may well baulk at the methodological conundrums involved in comparing an rEEG diagnosis to a human one. If these results are valid, they are truly astounding. In 1949 Ash demonstrated that only 20% of Psychiatrists agreed on diagnosis, as recently as 1962 that figure was only 42%. More recently the “DSM” has assured agreement is now closer to 90%. Whether the DSM diagnosis is valid is another debate however. The suggestion that rEEG may be able choose an appropriate prescription after a human psychiatrist has performed a diagnosis certainly seems more tangible a possibility at this point in time.

It is important to recognise the findings are only preliminary. There are always methodological issues inherent in a pilot study that prevent results being as earth shattering as they may sound. The medications prescribed by the rEEG program were far more varied and qualitatively different from the limited selection of STAR*D. The issue may be that psychiatrists are exercising greater restraint in prescribing higher risk medication at the expense of better results. (This is in no way a criticism of psychiatrists, caution is obviously of paramount importance when dealing with such powerful medications.) Regardless, research groups around the world are joining the race to test and expand the method. Psychiatrists (and EEG technicians) will doubtless be awaiting these results with bated breath.

If this news came as a shock to you I’d recommend taking a look at the work of Ray Kurzweil, a remarkable professor who has made some amazing discoveries himself and continues to make astounding technological predictions.

Khodayari-Rostamabad A, Reilly JP, Hasey G, Debruin H, & Maccrimmon D (2010). Diagnosis of psychiatric disorders using EEG data and employing a statistical decision model. Conference proceedings : … Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference, 2010, 4006-9 PMID: 21097280

Khodayari-Rostamabad, A., Hasey, G., MacCrimmon, D., Reilly, J., & Bruin, H. (2010). A pilot study to determine whether machine learning methodologies using pre-treatment electroencephalography can predict the symptomatic response to clozapine therapy. Clinical Neurophysiology, 121 (12), 1998-2006 DOI: 10.1016/j.clinph.2010.05.009

Charles DeBattista, Gustavo Kinrys, Daniel Hoffman, Corey Goldstein, John Zajecka, James Kocsis, Martin Teicher, Steven Potkin, Adrian Preda, Gurmeet Multani, Len Brandt, Mark Schiller, Dan Iosifescu, Maurizio Fava (2011). The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression.  Psychiatric Research, 15 (12), 64-75 DOI: The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression

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I’d like to dedicate this post to Dr. Ben Goldacre who inspired me to begin this blog with his absolutely outstanding Bad Science Blog.

Ecstasy? I’m sorry, I thought it was Crystal Meth!

rb editors selection Bad Science: Idiots and Ecstasy

Drug “education” pamphlets routinely state ecstasy causes “brain damage” and “Parkinson’s disease”. There is no valid evidence for the former in humans and the little evidence that exists regarding the latter actually suggests the precise opposite. The Parkinson’s claim is based on a study published by researchers at Johns Hopkins University which has been retracted. The reason for the retraction was that the monkeys who the study were based on were “accidentally” injected (yes, injected) with crystal meth  instead of ecstasy. These were not the only things wrong with this study…

thestupiditburnsmini Bad Science: Idiots and Ecstasy

Due to our insane drug laws crystal meth and ecstasy could feasibly “get mixed up” on the street by an insane or idiotic drug dealer. In a lab however you’d have to be criminally incompetent to allow this mistake to happen, scientists don’t just have stacks of crystal meth and ecstacy lying around. Despite ecstasy being taken by millions every weekend the law makes it practically impossible for scientists to get their hands on it for research especially with humans. In this respect the use of non-humans is not unusual. No well controlled trials (let alone randomized controlled trials) have ever been done with humans on most illegal drugs.

monkeycage Bad Science: Idiots and Ecstasy

Another odd thing about the Johns Hopkins study was that the monkeys were injected three times with intervals of three hours. Ricuarte, the author of the study himself conducted a study in 1988 that demonstrated that injecting doubles the toxicity of MDMA however this was not discussed in this study and the title of the study actually states “a common recreational dose”. It was also a strange conclusion for the scientists to suggest that ecstacy causes Parkinson’s without addressing their staggering finding that two of their ten monkeys dropped dead before they could be given their third dose. It’s as if they think that at raves its perfectly normal for one in five ecstasy users to inject themselves with ecstasy and then promptly drop dead.

crystal meth oops findings Bad Science: Idiots and EcstasyThe dosage in the study though high compared to recreational doses, isn’t however particularly out of the ordinary for animal MDMA research. The study cites a key study by the US National Institute for Drug Addiction (NIDA) that injected monkeys with twice the dose they used, noon and night for 4 consecutive days (based on their calculation of mg per kilo, the equivalent for a 75kg human would be six grams of pure MDMA over four days, taken at breakfast and bed time. Most MDMA users probably wouldn’t see that much MDMA in their lifetimes). This dosage and timespan is so nuts that the fact that all of the monkeys in the study didn’t drop dead immediately should suggest ecstasy is a pretty safe drug. Instead the NIDA study is one of the assortment of studies used to support the claim that ecstasy causes brain damage. Of course ecstasy causes damage to animals if you inject hideous amounts of it on a twice daily basis for days on end. Neither studies bother explaining why they are injecting the monkeys rather than using the normal method of oral administration.

monkeyeyes Bad Science: Idiots and Ecstasy

These papers echo researchers in the US who famously blasted cannabis smoke at monkeys through gas masks every day for 90 days with so much smoke that many died from carbon monoxide poisoning or suffocation.

Smoking Monkey Bad Science: Idiots and Ecstasy

You may wonder why these scientists behaved so appallingly. When the World Health Organisation (WHO) was commissioned to conduct the largest ever study of cocaine use it concluded that cocaine was safer than alcohol and tobacco and generally very useful. The US representative to WHO threatened to withdraw US funding for all their research projects and interventions unless the organisation “dissociated itself from the conclusions of the study” and cancelled the publication (leaked WHO report here). Professor Nutt, the UK head of the Government’s advisory council on drugs (ACMD) was sacked for saying the exact same thing about Ecstasy.

gagged science1 Bad Science: Idiots and Ecstasy

When practically the entire ACMD resigned in outrage last year and the leaders of the medical and legal establishment came out in full support of the scientists, the Government’s reaction was to propose a bill that will remove from law any remaining remnants of their influence. The bill is currently in the final stages of becoming law. Professor Nutt’s replacement, war-on-drugs puppet Dr. Raabe was such a fruitcake that the Government had to remove him before his first day at work after after it emerged he was also at war with homosexuals, abortion, contraception and well basically everything.

raabe Bad Science: Idiots and Ecstasy

Only one randomised controlled trial of ecstasy has ever been conducted. Last year 15 PTSD patients who were extremely resistant to psychotherapy and existing medications were treated with MDMA. The study concluded that ecstasy was not only safe but extremely effective for this purpose. There has been one vaguely controlled study of ecstacy users. It was completed a month ago, independently with a $1.8m NIDA grant. It demonstrated absolutely no cognitive impairment even in heavy ecstasy users. It is still completely free and open access so get it while it’s hot. It’s important to remember however that the sample sizes in these studies are tiny, until a controlled study is conducted with a decent sample size it will be impossible to say definitively how safe ecstasy is.

Fun fact: No scientist in recorded history has EVER suggested ecstasy drains spinal fluid. A number of ecstasy studies involved draining spinal fluid of users in search of evidence of harm. Leaking spinal fluids isn’t caused by ecstasy, it’s caused by spinal taps. So will the anti-drug organisations please recall their bullshit pamphlets. This pamphlet by the Australian Federal Police for example reads like a comedy of errors written by a chimp. Ecstasy probably doesn’t kill if pure and used properly. Misinformation definitely kills. Good day.

Edit: If you think the botched Johns Hopkins paper is no longer relevant, I’d like to point out that the authors of this study are the only scientists cited to support the claim that ecstasy causes brain damage on the US Government (2010) Ecstasy “fact sheet”. The paper is an incredibly biased and uncritical review of what is mostly their own research (they cite 10 of their own papers), the review was published the year before the botched study.

Click here to read last week’s article on why a multi-billion dollar industry is paying advertising agencies  to spread misinformation about drugs.

Key References

Ricaurte, G. (2002). Severe Dopaminergic Neurotoxicity in Primates After a Common Recreational Dose Regimen of MDMA (“Ecstasy”) Science, 297 (5590), 2260-2263 DOI: 10.1126/science.1074501

Mithoefer MC, Wagner MT, Mithoefer AT, Jerome I, & Doblin R (2010). The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of psychopharmacology (Oxford, England) PMID: 20643699

Halpern JH, Sherwood AR, Hudson JI, Gruber S, Kozin D, & Pope HG Jr (2011). Residual neurocognitive features of long-term ecstasy users with minimal exposure to other drugs. Addiction (Abingdon, England), 106 (4), 777-86 PMID: 21205042

Insel TR, Battaglia G, Johannessen JN, Marra S, & De Souza EB (1989). 3,4-Methylenedioxymethamphetamine (“ecstasy”) selectively destroys brain serotonin terminals in rhesus monkeys. The Journal of pharmacology and experimental therapeutics, 249 (3), 713-20 PMID: 2471824

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A research group in Brighton is looking for healthy participants to test technology that allows the blind to see using a form of echolocation. The device effectively converts video in to sound waves in real time allowing the individual to form an image in their mind of what is around them. Check out their site here! There’s a fascinating explanation of how it works as well as some jaw dropping youtube videos. Damn, I’m so gutted I’m not in Brighton right now.

seeing with ears Seeing With Your Ears

The Voice1 Seeing With Your Ears

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Today I made a tough decision, I decided to accept google ads so I can upgrade my servers. I was horrified to see the first advert to appear was for an American company spreading misinformation about drugs, I find this particularly offensive because I’m aware that misinformation about drugs may well kill infinitely more people than drugs themselves. I’ll provide the evidence for that statement in this blog post and  I’ll also explain why a multi-billion dollar industry is paying advertisers to feed you misinformation about drugs.

drugs are bad Public Service Announcement: <STRIKE>Drugs</STRIKE> Misinformation Kills

My instinctive response was to block the advertiser but I can’t censor every unscrupulous advertiser that Google pops on my site so I’ve decided to be up front about this, give you the facts and let you join the dots.  If a product has to be marketed heavily you should already be suspicious, if information has to be marketed you should be down right terrified. By all means see what they’ve got to say, but never trust claims that are not backed up with evidence that is reported elsewhere and always check the sources. Internet advertising is not like television advertising which has basic quality controls. Anyone can pay to put an advert online and you must consider what their motivation is. I’ll do my bit by ensuring all adverts are clearly labelled  so you don’t get them confused with content.

Red Bull, Pilsner and The Tragic Case of Leah Betts

Misinformation Kills3 1024x207 Public Service Announcement: <STRIKE>Drugs</STRIKE> Misinformation Kills

Leah Betts died in 1995 from water poisoning after drinking 14-15 pints of water in 90 minutes. She did this after being misinformed that it is essential to drink  large amounts of water after taking ecstasy.  After her death newspapers wrongly reported that she was killed by contaminated pills (to this day the guilty newspapers never corrected these lies). The alcohol and energy drink industry who  were afraid that ecstasy was damaging their market share quickly jumped on the case. The makers of Red Bull and Pilsner funded a £1 million bill board campaign. Since it just displayed a picture of a dead body with no explanation of who was behind it, the general public naturally assumed it was run by the health service, this was very far from the case.  The PR company that Red Bull hired for £5 million aimed to market Red Bull as a  “substitute for taking ecstasy”. This was largely done with a million pounds worth of pictures of a dead girl’s body. The campaign perpetuated the lies that led to the death of Leah Betts and did nothing to prevent the incident happening again. Millions take ecstasy every weekend and the few deaths that happen every year are in most cases caused by severe dehydration or drinking excessive amounts of water, neither of which are a result of ecstasy but symptoms of misinformation.

If you take ecstasy you should just drink normal amounts of water and use the toilet as normal. Ecstasy is an anti-diuretic which makes you feel like you don’t need to use the loo. Avoid alcohol which is a depressant so actually negates the effect of ecstasy, it also puts unneccessary strain on the liver and dehydrates you. The required dose of ecstasy is extremely low, less than a tenth of a gram. This is all information that no ad campaign bothered telling people. Meanwhile a £1.8 Million US Government funded study this year concluded there are no long term effects on the brain caused by ecstasy use. The elephant in the room? Alcohol on the other hand has long been a confirmed a neurotoxic drug with far greater potential for addiction and greater potential for harm than ecstasy. Alcohol kills many times more people in a week than ecstasy does in a year. The drinks industry doesn’t spend millions on misinformation campaigns for nothing, the prospect of a drug that can make someone capable of drinking water at a nightclub makes them absolutely piss themselves (please excuse the pun).

How Mephedrone got confused with Methadone

Mephedrone or Methadone Public Service Announcement: <STRIKE>Drugs</STRIKE> Misinformation Kills

Mephedrone is a recently synthesised drug that was initially quite unpopular due it’s relatively unpleasant after effects. To date no only one coroner world wide has ever formally attributed a death to Mephedrone. In 2008, a profoundly ridiculous story by vice magazine popularised Mephedrone after the reporter claimed to insuffulate six grams of the drug. For a start this was criminally irresponsible as this drug has never been tested on humans and this is nearly a hundred times the dose recommended by users (who will recommend it to be taken orally anyway). Not even Charlie Sheen would go “banging seven gram rocks” of this stuff let alone suggest it in a magazine read by those with a collective reading age of a boiled egg. For the record no one should “bang” seven grams of anything, ever, unless they happen to be a beetle (the bugs not the rockstars).

Charlie Sheen Banging Seven Gram Rocks Public Service Announcement: <STRIKE>Drugs</STRIKE> Misinformation Kills

Despite these crazy reports, despite the substance being shipped by the kilo after it’s shoot to star status by the red tops, despite the excesses never seen with ecstasy, no coroner in the UK has ever attributed a death to mephedrone. In March 2010 two men died after taking Government issue heroin substitute, Methadone. The Daily Fail wrongly reported this as Mephedrone and the red tops followed suit. If this was a typo it was a very convenient typo that was never corrected. The police swallowed the tabloid bait hook, line and sinker and disregarded desperate pleas by drug experts to wait for the post-mortem and held an international press conference that day declaring parliament must act to make mephedrone illegal. Like lap dogs the Government got right down to it, basing the decision on evidence which by that point had been confirmed by their own police force, coroner and Advisory Council on the Misuse of Drugs (ACMD) to be misinformation. By the point of the decision so many of the remaining Goverment experts on the ACMD had resigned in protest that the council was completely legally defunct. (Which actually technically makes the ban defunct according do the Misuse of Drugs Act. Don’t quote me on that, I’m not a lawyer. This is incidentally, why the law is being changed to make the ACMD irrelevant)

The government responded by taking a blunderbus approach and banning mephedrone and a shedload of other chemicals that just happen to look like mephedrone. All these chemicals, many of which don’t even exist yet are effectively permanently written off for medical research despite most probably having completely different properties to Mephedrone. Well what do you expect when you have politicians that think they’re chemists?

wormhole Public Service Announcement: <STRIKE>Drugs</STRIKE> Misinformation KillsHere is a picture of a wormhole to illustrate the infinite stupidity of making a range of chemicals that don’t even exist yet permanently illegal because their chemical formula looks  like a chemical that sounds (nothing) like another chemical that killed two teenagers because they mixed said other chemical with alcohol.

Edit: Some people thought the above was a joke. This is no joke. Endless chemicals and their hypothetical derivatives that do not exist yet are now illegal only because if they existed they would be similar to drugs that are far safer than alcohol and tobacco and in the case of mephedrone because it sounded like methadone. There was no scientific consultation and no research is planned.  Intelligent, honest, hard working people who care about their personal health are rapidly being pushed either in to the criminality of illegal drugs or the unknown artificially accelerating frontiers of “legal highs”. This policy has the unfortunate side effect of categorically preventing new frontiers in medicine.

Fun fact: While mephedrone was legal cocaine deaths dive bombed for the first time in history.

Misinformation Campaigns  Actually Promote Drug Use

Below is a report by the RSA that references a wealth of research that demonstrates that the Government’s current method of restricting information and promoting the “Just Say No” message actually increases drug use. It concludes that the only way to reduce the dangers of drugs is to provide accurate and balanced information on drugs.

Illegal Drugs, Communities and Public Policy – Drugs – Facing Facts

Accurate and honest information on drugs can be found on the website of the Independent Scientific Committee on Drugs, made up of former members of the ACMD who resigned in protest at the lies they were expected to tell. Due to the fact that academic research on recreational use is effectively prohibited by law and the Government’s FRANK website doesn’t actually contain any useful information, the crowd sourced data bank “Erowid” remains one of the only sources for drug information.

Halpern JH, Sherwood AR, Hudson JI, Gruber S, Kozin D, & Pope HG Jr (2011). Residual neurocognitive features of long-term ecstasy users with minimal exposure to other drugs. Addiction (Abingdon, England), 106 (4), 777-86 PMID: 21205042

Nutt DJ, King LA, Phillips LD, & Independent Scientific Committee on Drugs (2010). Drug harms in the UK: a multicriteria decision analysis. Lancet, 376 (9752), 1558-65 PMID: 21036393

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