Happy Anniversary Encephalon!

Double congrats go to Mo the Neurophilosopher. Not only has the Encephalon neuroscience blogging carnival seen it’s first year anniversary, Encephalon masterbrain Mo has been welcomed aboard the scienceblogs.com network! His scienceblog can be found here.

It’s been nearly 3 months since I last wrote anything here and I should probably give a few updates. I was recently in Chicago for every brain imager’s annual favorite, the Organization for Human Brain Mapping conference. All in all, I really enjoyed the conference and the city. A few highlights:

- Marcus Gray from University College London had an interesting poster entitled ‘A cortical potential for cardiac function’ (now in PNAS). From the abstract:

Emotional trauma and psychological stress can precipitate cardiac arrhythmia and sudden death through arrhythmogenic effects of efferent sympathetic drive. Patients with preexisting heart disease are particularly at risk. Moreover, generation of proarrhythmic activity patterns within cerebral autonomic centers may be amplified by afferent feedback from a dysfunctional myocardium. An electrocortical potential reflecting afferent cardiac information has been described, reflecting individual differences in interoceptive sensitivity (awareness of one’s own heartbeats). To inform our understanding of mechanisms underlying arrhythmogenesis, we extended this approach, identifying electrocortical potentials corresponding to the cortical expression of afferent information about the integrity of myocardial function during stress. We measured changes in cardiac response simultaneously with electroencephalography in patients with established ventricular dysfunction.

- Gray’s work is somewhat representative of a general emphasis on biomarkers and predictive imaging at this year’s conference.

- This year, diffusion tensor imaging, (DTI), dynamic causal modelling (DCM), multi-modal imaging, as well as lie-detection were in vogue. I remember resting-state fMRI being the cat’s meow at the 2005 conference in Toronto. Oh the times, they are a changin’…

- I think everyone’s favorite memory from the conference program was that of a video involving monkeys and robots. Enough said.

- On other studies, Dr. Nicholas Schiff had a very interesting talk on limited states of consciousness in the clinic. You may remember Dr. Schiff’s name splashed in the headlines last summer on a very interesting case of a man who ‘woke up’ after being in a minimally conscious state. Yes, DTI pops up here too. Dr. Schiff recently talked at a workshop on neuroethics and limited states of consciousness as part of ongoing work at Stanford’s Neuroethics unit.

There are many more highlights but I should leave off now. What I will leave off with is a note that the 27th edition of Encephalon will be hosted right here in two weeks time. That’s Monday, July 16th. If you’d like to contribute, don’t be shy, send in any post you may have that’s neuro-related!

Send an email to: encephalon[dot]host[at]gmail[dot]com.

Things that I would be particularly interested in reading relate to blogging and funding. If you have an opinion as to how science blogging could be a tool (or not) for raising awareness about the need for funding, or have some interesting statistics, please send it in! The debate over stem cell research is certainly important, but I’d be interested in something that looks at the issue more broadly (many of you out there can sympathize with the penny pinching scientists are forced to endure, or end up finding financial pressures destructive). Another issue that caught my attention at the OHBM town hall meeting involved a debate about whether or not the conference should consider holding a future meeting in Cuba. Posts related to conferences and political pressures would also be well received. i.e. Should scientists be concerned about conferences being held in countries with conflicting political ideals? Could scientific conferences be held in more developing countries to bring attention to overlooked research programs?

And now for some brainial stimulation of the broab:

Scull on Foucault

Despite his fitting name, Andrew Scull is not in neuro. He is, however, a professor in the Department of Sociology at UCSD with psychiatry on the brain. Now aside from tickling my allusion fancy, Professor Scull has written several books, of which I can say I’ve at least thumbed through one: Madhouses, Mad Doctors and Madmen: Social History of Psychiatry in the Victorian Era. The thumbing was done for my History of Modern Medicine course which, in and of itself, was as inspiring as it was eye opening. That said, Professor Scull’s book is a favourite work of mine that comes to mind particularly as I near the end of my degree (along with Henri Ellenberger’s The Discovery of the Unconscious).

Needless to say I was happy to see Scull’s review of the newly translated edition of Michel Foucault’s History of Madness. More to the point, I was happy to see it was a scathing review. A quote:

Narrowness of this kind is not confined to footnotes. Foucault’s isolation from the world of facts and scholarship is evident throughout History of Madness. It is as though nearly a century of scholarly work had produced nothing of interest or value for Foucault’s project. What interested him, or shielded him, was selectively mined nineteenth-century sources of dubious provenance. Inevitably, this means that elaborate intellectual constructions are built on the shakiest of empirical foundations, and, not surprisingly, many turn out to be wrong.

Scull concludes his article, stating that

The back cover of History of Madness contains a series of hyperbolic hymns of praise to its virtues. Paul Rabinow calls the book “one of the major works of the twentieth century”; Ronnie Laing hails it as “intellectually rigorous”; and Nikolas Rose rejoices that “Now, at last, English-speaking readers can have access to the depth of scholarship that underpins Foucault’s analysis”. Indeed they can, and one hopes that they will read the text attentively and intelligently, and will learn some salutary lessons. One of those lessons might be amusing, if it had no effect on people’s lives: the ease with which history can be distorted, facts ignored, the claims of human reason disparaged and dismissed, by someone sufficiently cynical and shameless, and willing to trust in the ignorance and the credulity of his customers.

Oh yes, Foucault is finally fully translated into English. Me thinks it’s about time.

Excerpt from ‘The Bell Curve’

The Bell Curve:  What happens when patients find out how good their doctors really are? by Atul Gawande

Once we acknowledge that, no matter how much we improve our average, the bell curve isn’t going away, we’re left with all sorts of questions. Will being in the bottom half be used against doctors in lawsuits? Will we be expected to tell our patients how we score? Will our patients leave us? Will those at the bottom be paid less than those at the top? The answer to all these questions is likely yes.

Recently, there has been a lot of discussion, for example, about “paying for quality.” (No one ever says “docking for mediocrity,” but it amounts to the same thing.) Congress has discussed the idea in hearings. Insurers like Aetna and the Blue Cross-Blue Shield companies are introducing it across the country. Already, Medicare has decided not to pay surgeons for intestinal transplantation operations unless they achieve a predefined success rate. Not surprisingly, this makes doctors anxious. I recently sat in on a presentation of the concept to an audience of doctors. By the end, some in the crowd were practically shouting with indignation: We’re going to be paid according to our grades? Who is doing the grading? For God’s sake, how?

We in medicine are not the only ones being graded nowadays. Firemen, C.E.O.s, and salesmen are. Even teachers are being graded, and, in some places, being paid accordingly. Yet we all feel uneasy about being judged by such grades. They never seem to measure the right things. They don’t take into account circumstances beyond our control. They are misused; they are unfair. Still, the simple facts remain: there is a bell curve in all human activities, and the differences you measure usually matter.

I asked Honor Page what she would do if, after all her efforts and the efforts of the doctors and nurses at Cincinnati Children’s Hospital to insure that “there was no place better in the world” to receive cystic-fibrosis care, their comparative performance still rated as resoundingly average.

“I can’t believe that’s possible,” she told me. The staff have worked so hard, she said, that she could not imagine they would fail.

After I pressed her, though, she told me, “I don’t think I’d settle for Cincinnati if it remains just average.” Then she thought about it some more. Would she really move Annie away from people who had been so devoted all these years, just because of the numbers? Well, maybe. But, at the same time, she wanted me to understand that their effort counted for more than she was able to express.

I do not have to consider these matters for very long before I start thinking about where I would stand on a bell curve for the operations I do. I have chosen to specialize (in surgery for endocrine tumors), so I would hope that my statistics prove to be better than those of surgeons who only occasionally do the kind of surgery I do. But am I up in Warwickian territory? Do I have to answer this question?

The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average? If we took all the surgeons at my level of experience, compared our results, and found that I am one of the worst, the answer would be easy: I’d turn in my scalpel. But what if I were a C? Working as I do in a city that’s mobbed with surgeons, how could I justify putting patients under the knife? I could tell myself, Someone’s got to be average. If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right?

Except, of course, there is. Somehow, what troubles people isn’t so much being average as settling for it. Everyone knows that averageness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child’s pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we expect averageness to be resisted. And so I push to make myself the best. If I’m not the best already, I believe wholeheartedly that I will be. And you expect that of me, too. Whatever the next round of numbers may say.