On science blogs this week: CARE

Health care reform could be reformed into oblivion. Arguments about the salmon Frankenfish are not sustainable. Plus merging addictions.

 

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REFORMING HEALTH CARE REFORM. Can't let the week go by without joining the jabber over R-day. That was yesterday, the day the first group of health care reforms from the new law, aka ACA (the Affordable Care Act) went into effect.

If you write about any aspect of medicine, this page should be among your bookmarks. It's the jumping-off point for Kaiser Health News's vast collection of resources on the law in particular and present-day health care in general. Among its most valuable contents is the timeline from the Henry J. Kaiser Family Foundation, KHN's parent and benefactor. The timeline is interactive, and shows when each of the law's raft of provisions will come into effect. (Many of the most important ones not until 2014.) It is also full of details about the provisions, and searching the timeline can be customized by topic. There are other timelines out there (and you can get to those from the KHN portal too}. but this one is the most thorough and grinds no political axes.

Also invaluable for us is this explanatory link roundup from Andrew Van Dorn at Covering Health, the blog from the Association of Health Care Journalists. And if you're one of those very visual people who is also pressed for time, Kate Pickert, who blogs at Time's Swampland, presents Kaiser's cartoon video, which she says will provide Most Everything You Need to Know About Health Reform in 9 Minutes.

At the moment, the scariest question about the law is whether its days are numbered. Yesterday the House Republicans formally released their Pledge to America, which vows repeal. Chris Fleming recounts the gory details at the HealthAffairs Blog. (In another post yesterday, Fleming announced the Health Affairs Facebook page, which I mention parenthetically for reasons entirely mercenary and to show that I have your best interests at heart. The post describes how the page will make available one of the journal's articles for free every Friday.)

At the Washington Post, blogger Ezra Klein puts a slightly hopeful spin on the Republicans' move, asking "Are Republicans afraid of taking on the health-care law?" He points out that their vow to retain the ban on discrimination based on pre-existing conditions contains a big fat loophole. The Klein analysis:

it shows the difficulty the GOP is going to have when they try to move the conversation from "should we pass Obama's health-care bill?" to "should we repeal, replace, or stop funding Obama's health-care law?" The bill is unpopular. But the component parts are popular. And even now, when Republicans have as much momentum as they're likely to get, they're afraid to say that they actually oppose what the bill does and they're just going to get rid of all of it. But though these sorts of word games might work when people are skimming your campaign pamphlet, they don't when you're actually writing legislation.

This classic example of cognitive dissonance — that citizens say they hate the law but love its provisions — produces the classic head-shaking response and deep sigh of frustration in some onlookers, and I'm one of them. KHN's Jenny Gold interviewed Democratic pollster Peter Hart, asking him what can be done about it. His gloomy response was essentially, "Not much." At least in the short term, before the November election.

But what if the short term is all there is?

THE FRANKENFISH PAPERS. Not quite clear why the genetically engineered salmon story has so captured the reportorial imagination. Maybe because the central figure is the classy, courageous, "heart-healthy" salmon, rather than some less-glamorous fish like, oh, the flat flounder. Or smelt.

In any case, discussion about whether the US Food and Drug Administration should allow genetically modified salmon to be marketed dominates many a keyboard. Paul Voosen of Greenwire fills you in on background and arguments about whether the modified salmon is some kind of threat.

Erv quotes from two news stories, one about the salmon deliberations and the other about starving kids in Pakistan. He calls it "a sick juxtaposition." But Omega666, one of the Erv commenters, notes:

Farmed Salmon eat 2 1/2 to 3 kg of fish for each kg of salmon produced. How exactly will farmed salmon, GM or otherwise, help feed the world?

That's a point that's routinely ignored — for example at biologist Ursula Goodenough's otherwise thorough (and link-rich) exploration posted at NPR's 13.7. Likewise, at Esquire.com's Eat Like a Man, Reason editor Katherine Mangu-Ward writes "In Defense of Frankenfish"

Instead of endangering the ecosystem, salmon 2.0 will protect it. Irresponsible human behavior caused overfishing and shortages, but clever human invention has discovered a way to fix these problems. As we learned to do in kindergarten, we're cleaning up our own mess. Don't worry, just dig in and feel good about your healthy dinner and your environmental impact.

Apparently nobody told her that salmon farming is yet another example of irresponsible human behavior. I had to consult a fish biologist to learn that salmon, whether equipped with the new DNA or sameold sameold, can't be farmed sustainably because they are top-of-the-food-chain predators.

At Spawning is Imminent, the fishy Dustin compares salmon farming to breeding lions for human food. Lionizing might well be a financially solid proposition in the short term, "because people love to eat lions." But it would also command a pretty penny in deer, rabbits, and other living lion chow. Says Dustin:

We can't stop aquaculture. It's really going to explode in the next 15-20 years. But, we can make responsible choices on what we farm and how we farm it . . . In my opinion, we should focus on things that can be farmed sustainably: Tilapia, oysters, other mollusks, carp, mullet, etc. We also need to explore other farming methods, specifically polyculture. If we focus on sustainable practices instead of profits, aquaculture can truly be beneficial for enhancement of wild stocks and for sustenance.

No word, alas, on how Dustin would persuade fish farmers to focus on sustainable practices instead of profit.

ADDICTION TO TURF WARS. An advisory committee at the National Institutes of Health is now the latest in a long line of respectable organizations that have urged the entirely sensible step of merging the two premier government agencies that study addictions, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA).

Whooee, turf's up at NIH again! You can bone up on the history of this long-running power struggle between NIDA and NIAAA, nicely summarized by Dirk Hanson at Addiction Inbox — although he is clearly a partisan of NIDA and its director Nora Volkow. And find lots of links to past arguments about merging these two institutes at the new blog site of the College on Problems of Drug Dependence. This blog is going to be a good place to watch the policy arguments as they happen. Thanks for the tip to Drug Monkey.

The merger is a good idea for many reasons, but has become particularly urgent in the past decade as neuroscience has shown over and over that addictions share many brain mechanisms whatever the addictive substance. (And even in cases where no substance is involved at all, like gambling.)

Some years ago a big wheel in addiction research told me it was not impossible that a single magic bullet, in the form of a (pharmaceutical) drug, might turn out to be effective against several forms of addiction. That hasn't happened yet, and may never, but there are already chemical approaches out there that are useful in dealing with more than one abused substance.

As it happens, this therapeutic overlap is true of more than addiction. Neuroskeptic explains that a similar phenomenon occurs more and more commonly in psychiatric treatments.

Antidepressants are used in depression, but also all kinds of anxiety disorders (panic, social anxiety, general anxiety), obsessive-compulsive disorder, PTSD, and more. Antipsychotics are also used in mania and hypomania, in kids with behaviour problems, and increasingly in depression, leading some to complain that the term "antipsychotics" is misleading. And so on.

I'm not sure exactly what this means for treatment of behavioral disorders and mental illness, let alone what it means for those of us who write about the science behind them. But one implication is that the "mental disease" classification system is in an even worse mess than the arguments over the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have indicated. (For a glimpse, see this old post from Gary Schwitzer's HealthNewsReview blog.)

But Neuroskeptic's post got me to wondering whether what it might mean is this: Maybe there are few (or no?) discrete categories of behavioral or mental diseases that can be defined by a highly specific set of physiological/chemical/cellular characteristics. That's an unsettling notion that I can't seem to get my brain around. But I can sure hear that notable insanity skeptic R.D. Laing laughing maniacally in the background.

September 24, 2010

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