Accidental Blogger

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  • Golden Eggs and Silver Bullets (Sujatha)

    Pills How many times have you opened up the newspaper or a magazine to see large colorful spreads advertising the latest prescription drug, followed by precisely formatted fonts cooing at you to 'Talk to your doctor to see if this is right for you', and pages of print so microscopic that you need an jeweller's loupe to read it?

    The problem is that yesterday's silver bullet, having been the goose that laid golden eggs for the big pharmaceutical companies,  now ends up causing more problems than it solved.

    Case in point #547 (or thereabouts): Rosiglitazone maleate (sold under brand name 'Avandia' and also in combination with other drugs).

    That Avandia presented an increased risk of fatal heart-related events isn't unknown. Concerns were raised as early as 1999, and more recently,  as this 2007 article shows.

    The diabetes drugs Actos and Avandia raise the risk of heart failure but do not increase the risk of heart-related death, U.S. researchers said on Thursday, confirming earlier findings.

    The popular drugs for treating type 2 diabetes have been the subject of numerous analyses — with more to come — as doctors attempt to weigh their risks following the May report that Avandia increased the risk of death by 64 percent and the risk of heart attack by 43 percent.

    Both Actos, made by Takeda Pharmaceutical Co Ltd (4502.T), and Avandia, made by GlaxoSmithKline (GSK.L) (GSK.N), already carry U.S. Food and Drug Administration "black box" warnings that they may cause or worsen congestive heart failure, a chronic condition in which the heart fails to pump blood efficiently.

    Note that the point of comparison was another similar drug pioglitazone, marketed as Actos. Both Avandia and Actos come from a class of drugs called thioazolidinediones. Their main function is act to reduce the insulin resistance in diabetics, operating at a cellular level to help improve the ability to absorb and use insulin to maintain the appropriate blood sugar values. Both come with a panoply of risks, all in 'black box warnings' of heart failure and other serious side effects.

    You can read about the whole sorry saga of how a blockbuster seller has
    degenerated into the next bête noire in a pretty good nutshell here.

    Now, several studies and years later, the jury is in, with a split verdict.

    After two days of contentious discussion, a federal advisory committee voted on Wednesday to keep the troubled diabetes drug Avandia (rosiglitazone) on the market, but with added restrictions for its use.

    Experts had expected the 33-member panel to recommend removing the drug altogether, based on evidence that Avandia, prescribed to control blood sugar in patients with Type 2 diabetes, increases risk of heart attack. That is a particularly worrisome side effect in this population, considering that diabetes itself raises the risk of heart disease.

    The panel's divided vote – with 12 members moving to ban the drug and 17 recommending that it continue to be sold with stricter warnings and limitations on use – could still be a devastating blow to the controversial 11-year-old medication. (Three members voted for no change, and one abstained.) The committee's recommendation will now go to the commissioner and deputy commissioner of the Food and Drug Administration (FDA), who will make a final decision on the drug's fate.

    Meanwhile, the makers of Actos lost no time in trumpeting their advantage over Avandia. They have taken out full page ads, black box warnings and all, in major newspapers across the country. 

    Takeda, in its response after the meeting and in an ad breaking today, is underscoring Actos' safety profile and stressing that Avandia's CV issues are not a class effect. The full-page promotion in today's New York Times notes, “Actos has been shown to lower blood sugar without increasing your risk of having a heart attack or stroke.”

    So, the goose laying the golden eggs is on its deathbed for one company, while it has taken a fresh lease of life for another. At least, till that silver bullet is proved to induce some other malady.

  • punitive calculus (prasad)

    The US State Department, on the Iranian woman who’s been sentenced to death for adultery: “Stoning as a means of execution is tantamount to torture. It’s barbaric and an abhorrent act.”

    If I understand correctly, in the State Department’s view, stoning to death > torture ( = waterboarding?) > execution, on the awfulness scale. There might be something a bit self-serving about this ordering.

  • Football, Fussball, Futbol aka Soccer

    The past one month has been an embarrassment of riches for sports fans 
    who love soccer and tennis. Being one  of them, I have been majorly
    distracted lately, mostly by the fast, furious and elegant action on the soccer
    fields of South
    Africa    . In fact, my favorite tennis tournament at Wimbledon went by without
    my paying too much attention to the earlier matches. (The tournament ended
    satisfactorily with two of my favorite players winning the men's and the
    women's championships.)  

    It is soccer which has been on my mind mostly. The first World Cup Soccer event
    in the continent of Africa has been full of drama, defined mostly by upsets.
    Several top teams have been toppled unexpectedly. Of the last four teams standing, three are
    from Europe and just one from South America where soccer is only next in line
    to the Vatican as an institution of influence. The only Latin American team
    still in contention is neither the fabled Brazil nor the flamboyant Argentina.
    It is Uruguay who will go up against the Netherlands in the first semi-final
    match today. This is the same Uruguay who beat the valiant Ghana team in a rather
    questionable way. (Why do the "hand of god" fouls always seem to favor South American teams?)  

    I am rooting for Germany, now that many other teams I
    felt kindly towards (US, Japan, Ghana ) have been ousted. Brazil's unceremonious defeat against the Netherlands was a bit of a shock, of course, but the Dutch squad is powerful. Normally I don't like most European teams and was very happy to see France, Italy and England make early
    exits (France, very early). However, Germany has earned my respect as the tournament has progressed. It
    is a young, diverse and disciplined team which actually plays like a
    "team" in seamless unison, which is why both their defense and offense have been
    impressive. They are also not carrying any baggage from previous tournaments.
    Consequently, they were unafraid of Argentina's formidable reputation
    and showed that in the one sided 4:0 whacking of Maradona's famed boys in blue and white. The bookies are giving better odds to Spain and the Netherlands. But I am sticking with Germany even though one of their best players got a
    second yellow card in the last game and will miss the semi-final against
    Spain.  We'll see.

    My partiality to a German win is actually rooted in a bit of self serving superstition. I didn't
    have much of a favorite going into the World Cup this year. When the games had barely begun, during a casual exchange with a friend about teams and predictions, I said that the 2010 World Cup would be won by "whoever beats Argentina." Now that Germany has handed Argentina a convincing drubbing, I am making that a serious prediction. We will soon find out if I have prophetic powers. But one thing I am dreading is that if Germany is the eventual champion, we are going to hear a barrage of WWII analogies of military precision, the Wehrmacht, the blitzkrieg and so on. Ugh!

    FIFA_world_cup_2010_logo

  • Focus on statutory laws also

    Ethan Leib (with Michael Serota) in USA Today, on the senate confirmation hearings of Elena Kagan.  

    The political rhetoric and popular media coverage of Elena Kagan's confirmation hearings has been filled with significant debate over matters of constitutional law. We've heard questions and answers (or non-answers) about the freedom of speech, about executive power, about balancing national security against constitutional rights, about guns, about religion, and about abortion. No doubt this form of inquiry is appropriate; senators are entitled to get some handle on Kagan's constitutional vision, even if President Obama's nominating her tells them most of what they need to know. Many of the Supreme Court's most controversial decisions involve questions of constitutional law, and they are the types of judicial opinions that are most salient to the public. The Senate Judiciary Committee has been appropriately doing due diligence for the people, whose interests they represent.
     

    But what the people and the senators doing the questioning should know — but seem not to — is that the Supreme Court's docket is chock full of very consequential cases for Americans' lives that do not involve constitutional interpretation at all. A quick look at the statistics published annually by the Harvard Law Review for the last three terms reveals that more than half of Justice Kagan's work on the Court would be filled with questions of statutory interpretation, or the way in which judges derive meaning from the text of statutes. And yet we spend very little time pressing justices-to-be on how they would interpret the primary set of legal rules that govern life in America.

    Kagan

  • Comic Relief (Sujatha)

    Some relief from the ‘Hollow and vapid charade‘ that Kagan once considered the proceeds of a Supreme Court justice confirmation hearing, I presume.

  • “The Chinese Cemetery”

    Sukrita Paul Kumar in the New Quest.

    The Chinese Cemetery

    The smile in the photograph
    Is no reflection of what lies
    In the dark hollow of the tunnels
    Behind cement squares in rows,
    Each, one-by-one in size
    Marked by dates, picture and name
    Of a tiny flash
    A dot of life in the universe

    Ashes in urns
    Ancestors as concepts
    In treasure vaults
    Wrapped in rituals
    Recycling memory
    year after year

    For the snow to melt
    And the river to flow

    Bones crackling
    In sacred pyre,

    The funeral 
    In The World of Suzie Wong
    Consumed the baby,
    and then, lapped up
    -the letter of introduction-
    “To whom-so-ever it may concern”,

    Flames are messengers
    Carrying the known
    To the unknown

    Life to afterlife

  • Caught Between Opium and Lithium

    I have been sitting on this link for more than a week although the story caught my eye on the same day that it came out.

    The current and future problems of the beleaguered nation of Afghanistan may go well beyond war, the Taliban, Al Qaida, US occupation, poverty and heroin trafficking. The land locked nation of rough and rugged terrain is apparently the repository of vast mineral wealth, including large quantities of lithium, an essential component of many electronic gadgets. But like an uninformed (and unstable) nouveau riche individual, a poor, backward, politically fractious, war torn country may find its sudden wealth to be a burdensome and even a lethal liability. Prosperity is as much about managing one's assets as it is about owning them. The savvy rich get richer when blessed with goodies and the poor often become bewildered, murderous and vulnerable when in possession of sudden new riches.

    The United States has discovered nearly $1 trillion in untapped mineral deposits in Afghanistan, far beyond any previously known reserves and enough to fundamentally alter the Afghan economy and perhaps the Afghan war itself, according to senior American government officials.

    The previously unknown deposits — including huge veins of iron, copper, cobalt, gold and critical industrial metals like lithium — are so big and include so many minerals that are essential to modern industry that Afghanistan could eventually be transformed into one of the most important mining centers in the world, the United States officials believe.

    An internal Pentagon memo, for example, states that Afghanistan could become the “Saudi Arabia of lithium,” a key raw material in the manufacture of batteries for laptops and BlackBerrys.

    The vast scale of Afghanistan’s mineral wealth was discovered by a small team of Pentagon officials and American geologists. The Afghan government and President Hamid Karzai were recently briefed, American officials said.

    While it could take many years to develop a mining industry, the potential is so great that officials and executives in the industry believe it could attract heavy investment even before mines are profitable, providing the possibility of jobs that could distract from generations of war.

    “There is stunning potential here,” Gen. David H. Petraeus, commander of the United States Central Command, said in an interview on Saturday. “There are a lot of ifs, of course, but I think potentially it is hugely significant.”

    The value of the newly discovered mineral deposits dwarfs the size of Afghanistan’s existing war-bedraggled economy, which is based largely on opium production and narcotics trafficking as well as aid from the United States and other industrialized countries. Afghanistan’s gross domestic product is only about $12 billion.

    “This will become the backbone of the Afghan economy,” said Jalil Jumriany, an adviser to the Afghan minister of mines.

    Or will it? Can Afghanistan manage its resources to benefit its citizens? Or will "outside help" be needed to school its leaders in wealth management and investment in its future? Will those benefactors even be interested in Afghanistan's prosperity and progress? Or is it in the interest of hungry consumer nations that the wealth be controlled by a few pliable lackeys while the general population remains ignorant, uninformed, miserable and act as a source of cheap labor to mine the minerals for a low price? Will Afghanistan become like Africa and Asia under European colonial rule? The "partners" it finds may be more interested in its gleaming natural wares than its welfare. This time around the "crooked" partners may not be just the obvious ones from the west, with their colonial pasts, craftiness and imperialistic designs. Fast developing and rapacious neighbors in the east, like China and India (especially, China) will  be salivating too.

    The NYT article is not correct in stating that Afghanistan's buried treasures have been discovered for the first time by the US. It appears that prior "visitors" to the region were aware of them too and found it a daunting task to harvest the minerals efficiently and profitably.

    The lawless culture of poverty and its attendant perils are not a geographic phenomenon. Affluent countries have their share of the beaten and the abused, and their underprivileged are just as pathetic. But there are advocates and safety nets in politically advanced cultures, however inadequate, to raise awareness. Murder, mayhem, fraud and theft are punished by the law when brought to the attention of society. A country like Afghanistan (or the Republic of Congo) won't know where to begin protecting its resources and its citizens from gross abuse and exploitation from outsiders as well as its own leaders.

    Coming from India, the erstwhile "Jewel" in the British Raj's crown, it always sends shivers down my spine when vast natural resources of any kind are discovered in a poor, underdeveloped, politically fragmented nation. If the extent of the mineral wealth is indeed as rich and extensive as the NYT article suggests, get ready for "Blood Lithium" in your BlackBerry.

    Blackberry

  • 3 QD Science Prizes

    Top Quark
    3 Quarks Daily has announced the winners of the 2010 science blogging competition. All three articles are in biology and all are worth reading. Richard Dawkins judged the competition.

  • Anything for Gas (Sujatha)

    (Trailer of Gasland)

    There's a large industrial park close to my home, filled with large buildings and tasteful landscaping. All were empty last year; all are filled this year. They have been leased by companies seeking to drill for natural gas in the remnants of countryside and rolling hills, now crowded out by McMansion subdevelopments and strip malls.

    A large building sits near the wetlands nearby. Once host to a mental health facility, it has now been sold for a pittance to another developer, who hopes to remake it into mixed commercial and light industrial use. It abuts some of the most prolific wildlife in the area, all living in and around man-made wetlands created to provide sanctuary for wildlife displaced by highway building. The local mental health advocates now want to allow the natural gas companies to move in, drill for gas and turn over a portion of their profits to mental health. Meeting after local meeting has these advocates pitted against the environmental activists. It's a tug of war whose result is yet to be determined.

    It has been a slow awakening to the wealth of natural gas that is to be found in the Marcellus shale formation. After the coal ran out ( and this area is quite completely 'undermined' in the most literal sense.), nobody thought that there was anything worthwhile to extract, till new techniques such as fracturing or 'fracking' the shale to release the gas were developed. The downside is that millions of gallons of water are needed for the purpose, and mixed with toxic chemicals that form part of the 'fracking fluid', lots of elaborate mitigation and water purification methods are needed to render the waterways safe for use in drinking water supplies.

    The companies are already complaining about the regulations, suggesting that the millions of dollars they will spend on regulatory requirements and taxes would be better spent on creating 10,000 new jobs. But it would be a short-sighted choice. Luckily both the DEP and concerned citizens are taking a closer look, in the aftermath of the recent blowout at a Marcellus shale natural gas well in West Virginia.  What had happened not too long ago at Hickory PA, could now come to this part of the county.

    Here's what a Pittsburgh Post-Gazette article had a few days ago:

    "The industry noise began with a "blowout" on June 3 at a Marcellus
    Shale well outside Penfield in rural Clearfield County. That well,
    adjacent to the Moshannon State Forest, spewed natural gas and drilling
    wastewater contaminated with toxic chemicals into the air for 16 hours.

    On Monday, drillers hit a pocket of methane in an inactive deep mine,
    causing an explosion and fire that flared 50-feet high for four days,
    destroyed a drilling rig and burned all seven workers on the well pad,
    located in a farm field near Moundsville in West Virginia's northern
    panhandle.

    "We're horrified by the possibilities of that happening here," Ms.
    Borowiec said about Marcellus Shale wells planned for a pad 1,500 feet
    from homes in Upper Burrell. "The more research we do the more horrific
    it is, and I don't think a lot of people know what's going on."

    The Pennsylvania and West Virginia accidents at gas wells tapping
    into the mile-deep, gas-rich Marcellus Shale formation have alerted some
    for the first time to risks that accompany what some have termed a
    gas-drilling gold rush, and heightened serious safety and environmental
    concerns for others.

  • HSD, FSD, “Honey, I Have A Headache” : More malarkey from drug companies

    I hope the FDA stops this drug approval process in its tracks. The birth control pill was something women needed. This one they don't. Making up a malady where one does not exist, is the game the pharmaceutical companies like to play. But will the FDA go along?  Will women?

    Ever since Viagra met blockbuster success in 1998, the drug industry has sought a similar pill for women.

    Now, a German drug giant says it has stumbled upon such a pill and is trying to persuade the Food and Drug Administration that its drug can help restore a depressed female sex drive. The effort has set off a debate over what constitutes a normal range of sexual desire among women, with critics saying the company is trying to turn a low libido into a medical pathology. …

    There is no dispute that some women have a depressed level of sexual desire that causes them anguish. Boehringer cites a condition — hypoactive sexual desire disorder — that is included in the Diagnostic and Statistical Manual of Mental Disorders, a reference book for psychiatrists and insurers.

    But many experts say that unlike sexual dysfunction in men — which has an obvious physical component — sexual problems in women are much harder to diagnose. And among doctors and researchers, there is serious medical debate over whether female sexual problems are treatable with drugs. Some doctors advocate psychotherapy or counseling, while others have prescribed hormonal drugs approved for other uses.

    There is also debate over how widespread hypoactive sexual desire disorder actually is among women. The medical literature, including articles in the prestigious New England Journal of Medicine, indicate numbers above 10 percent, but such studies have been financed by drug companies.

    Critics say Boehringer’s market campaign exaggerates the prevalence of the condition and could create anxiety among women, making them think they have a condition that requires medical treatment.

    “This is really a classic case of disease branding,” said Dr. Adriane Fugh-Berman, an associate professor at Georgetown University’s medical school who researches drug marketing and has studied the campaign. “The messages are aimed at medicalizing normal conditions, and also preying on the insecurity of both the clinician and the patient.”

  • Beyond Hope and Change – Prayer!

    President Obama's "BP Speech"from the Oval Office on Tuesday night disappointed on several levels. To put it mildly, Obama spoke without focus, conviction or determination. In a vapid speech full of generalities about making BP pay, changes in our energy habits and the strength of Americans to deal with adversities, we heard very little that was new. We did not hear of concrete plans to clean up the mess in the Gulf of Mexico or any legislative steps that the administration plans to take to ensure that similar disasters will be prevented in the future. The president spent unnecessary moments of an already brief address in telling us that Energy Secretary Stephen Chu is a Nobel Laureate, Admiral Thad Allen of the US Coast Guards has forty years of experience, the Secretary of Navy is a "son of the Gulf" and that five and a half million feet of boom have been laid out to contain the spread of oil. He also assured us that he has " established a National Commission to understand the causes of this disaster and offer recommendations on what additional safety and environmental standards we need to put in place."

    Most irritating for me was this pablum at the end of Obama's speech:

    It is a faith in the future that sustains us as a people. It is that same faith that sustains our neighbors in the Gulf right now.

    Each year, at the beginning of shrimping season, the region's fishermen take part in a tradition that was brought to America long ago by fishing immigrants from Europe. It's called "The Blessing of the Fleet," and today it's a celebration where clergy from different religions gather to say a prayer for the safety and success of the men and women who will soon head out to sea some for weeks at a time.

    The ceremony goes on in good times and in bad. It took place after Katrina, and it took place a few weeks ago at the beginning of the most difficult season these fishermen have ever faced.

    And still, they came and they prayed. For as a priest and former fisherman once said of the tradition, "The blessing is not that God has promised to remove all obstacles and dangers. The blessing is that He is with us always," a blessing that's granted "even in the midst of the storm."

    The fishermen pray for protection against storms at sea. I hope our lawyerly president is not confusing corporate malfeasance with natural calamities. And if he is, he ought to know that prayers don't always protect against the Act of God.

  • Alice Neel: Beyond Portraiture

    I usually keep an eye on any interesting exhibitions that come to town. But I very nearly missed the fabulous Alice Neel – Painted Truths that was showing at the Houston Museum of Fine Arts since March.  Fortunately someone on Facebook brought it to my attention a few days ago. Even then I was hard pressed to find time since I was busy getting ready for a trip last week. I got back home on the 12th. The exhibition closed at 7pm on Sunday, the 13th of June. I managed to get to the MFAH yesterday at 6 and was able to catch the show in the last hour of the last day. The extensive retrospective was spectacular indeed. Unfortunately there was no time for a second round past the paintings. 

    From the MFAH write up on Alice Neel:

    One of the great American painters of the 20th century, Alice Neel (1900-1984) is best known for her psychologically acute portraits. Intimate, casual, direct and personal, satirical at times, they chronicle the social and economic diversity of mid-20th-century American life.

    Having consciously set out to chronicle the zeitgeist of her time, Neel painted friends and family, as well as the celebrated artists and writers of her day, such as Andy Warhol, Frank O´Hara, and Meyer Shapiro.

    Alice Neel: Painted Truths both traces the evolution of Neel´s style and examines themes that she revisited throughout her career, including her social and political commitment, her stylistic evolution, and her reversal of the typical artist/model gender roles, maternity, and old age.

    Alice Neel is most famous for the people she drew and is therefore often classified as a portrait artist. The advent of photography made portrait painting a redundant art, in some people's opinion. But an artist like Neel can shift the conversation about portraiture to a startling level of insight and creativity – no skillful photography could have made her work redundant. Her work was the result of a detached yet incisive eye - a commentary on the emotional inner life of her subject, yet unerringly correct in capturing their physical likeness. (see # 3 below - Neel's depiction of Andy Warhol)  She also showed a wicked touch in assessing some of her sitters. A pair of portraits of a woman named Ellie Poindexter shows one flattering image meant for the consumption of the subject and another representing what Neel "really" thought of Poindexter. I cannot find the former anywhere on the web but you can see the "honest" version (# 4 in the line up) among the images below. 

    Alice Neel pat-whelan2 Alice Neel - moth-chil-nancy-olivia Alice Neel- andy-warhol Alice Neel - ellie-poindexter 1 Alice Neel- 1   
     
    For a description of Alice Neel's turbulent life see here  and for a large sampling of her work, see the gallery here. Am I correct in getting the distinct impression that the artist was kinder to her male subjects than she was to the women she painted? 

  • That was then and this is now!

    Remember Louisiana Governor Bobby Jindal chiding the federal gov't for monitoring volcanoes and intruding in the lives of citizens under the pretext of helping them?  Among the many boring things he said, here are a couple:

    The strength of America is not found in our government. It is found in the compassionate hearts and enterprising spirit of our citizens…..

    and 

    While some of the projects in the bill make sense, their legislation is larded with wasteful spending. It includes $300 million to buy new cars for the government, $8 billion for high-speed rail projects, such as a "magnetic levitation" line from Las Vegas to Disneyland, and $140 million for something called "volcano monitoring."  Instead of monitoring volcanoes, what Congress should be monitoring is the eruption of spending in Washington, D.C. 

    Well that was in 2009, four years after Katrina and one year before petroleum giant BP's mismanagement unleashed an oily, toxic underwater volcano close to the Louisiana shore. Now, with a coastal catastrophe at hand, Jindal said this:

    We have been frustrated with the disjointed effort to date that has too often meant too little, too late to stop the oil from hitting our coast,” Louisiana Gov. Bobby Jindalsaid during a Monday news conference at Port Fourchon with Homeland Security Secretary Janet Napolitano and Interior Secretary Ken Salazar.

    “BP is the responsible party, but we need the federal government to make sure they are held accountable and that they are indeed responsible. Our way of life depends on it,” Jindal said.

    Nothing like a disaster to make the resolute "get government out of our lives" types to come down from their libertarian high horse. (If only all Tea Partiers were as honest as this man :-)

    Bplogo (BP logo redesigned by Greenpeace)