John, I've been following your work for years (including back in the old lemonodor years). I just wanted to say thank you here, for sharing your expertise for all on this topic, and for all the other tremendous work you've done. What an inspiration.
From my experience, having young kids is a very difficult time for relationships. Couple that with all the challenges around the pandemic and other current craziness, and things get even tougher.
From my experience also, as your child gets older that part of the stress tends to settle down and things feel better and relationships do generally improve.
Having said that, I'm a big fan of couples' counseling, which I think all couples can benefit from, regardless of the state of their relationship. IMHO, the ability to communicate is of primary importance, and it's not something that we're just born knowing how to do. One huge benefit from couples counseling is learning open communication with kindness.
Here's hoping things get better soon. Take care of yourselves!
I'm betting on some kind of glitch on the State Department website, but it's an interesting historical note that when Richard Nixon formally resigned in August 1974, he did so via a brief letter to then Secretary of State Kissinger.
I’m a physician. In addition to this president inciting a riot, this president and his supporters are complicit in using social media to promote unscientific, self-serving views that strike at the health of my patients and adversely affect American healthcare in general.
Looks like they are fixing this, but good grief, isn't anyone in Stanford's well-paid hierarchy looking out for these young doctors?
Residents, nurses, and other front-line healthcare workers should be receiving these inoculations TODAY.
Residents have enough stress without needing to demonstrate to force an organization to simply review the results of "algorithms" and do the right thing.
Your selective quotation misses the main point of Wallace's piece. He is wrestling with the ethics of causing gratuitous suffering.
The 'grasshopper' quote is Wallace actually quoting the Maine Lobster Promotion Council, possibly not an unbiased source for science. Wallace goes on to say:
Though it sounds more sophisticated, a lot of the neurology in this latter claim [grasshopper quotation] is still either false or fuzzy. The human cerebral cortex is the brain-part that deals with higher faculties like reason, metaphysical self-awareness, language, etc. Pain reception is known to be part of a much older and more primitive system of nociceptors and prostaglandins that are managed by the brain stem and thalamus.
Wallace goes on to write:
The basic scenario is that we come in from the store and make our little preparations like getting the kettle filled and boiling, and then we lift the lobsters out of the bag or whatever retail container they came home in …whereupon some uncomfortable things start to happen. However stuporous the lobster is from the trip home, for instance, it tends to come alarmingly to life when placed in boiling water. If you’re tilting it from a container into the steaming kettle, the lobster will sometimes try to cling to the container’s sides or even to hook its claws over the kettle’s rim like a person trying to keep from going over the edge of a roof. And worse is when the lobster’s fully immersed. Even if you cover the kettle and turn away, you can usually hear the cover rattling and clanking as the lobster tries to push it off. Or the creature’s claws scraping the sides of the kettle as it thrashes around. The lobster, in other words, behaves very much as you or I would behave if we were plunged into boiling water (with the obvious exception of screaming). A blunter way to say this is that the lobster acts as if it’s in terrible pain, causing some cooks to leave the kitchen altogether and to take one of those little lightweight plastic oven timers with them into another room and wait until the whole process is over.
There's a wealth of fascinating information including book series on deep space communication at the JPL DESCANSO
Deep Space Communications and
Navigation Center of Excellence:
President Obama just tweeted: "Cool clock, Ahmed. Want to bring it to the White House? We should inspire more kids like you to like science. It's what makes America great."
Dr. Kirsch's (a psychologist) work has been valuable, with some justified criticisms of antidepressant therapy and their trials. But his work did not show that antidepressants are clinically ineffective.
Dr. Kirsch's analysis showed that for mild depression treated with antidepressants, there is in fact an improvement in symptoms of depression based on rating scales like the Hamilton Depression Scale - but for mild depression, this improvement in the numbers doesn't necessarily translate into what you correctly identify as clinical significance. However, Dr. Kirsch's own "cutoff" for whether or not such a numerical increase constitutes "clinical significance" or not is itself just an arbitrary number that itself has been criticized.
Also, Kirsch's own metaanalyses (and other metaanalyses) show clearly that for moderate and severe depression (and other conditions), antidepressants are indeed clinically effective (in other words, yes, the benefits actually "mattered" from a patient's perspective), and, importantly, they are highly effective at preventing relapse.
They work, and work well.
In addition, there are a variety of reasons why many short-term clinical trials of antidepressants (which have made up the bulk of clinical trials of SSRIs, for example) are entirely different from the way physicians prescribe antidepressants (and other medications) clinically, and may underestimate their benefit even for cases of mild depression. The beneficial effects of antidepressants increase with longer exposure (i.e. exceeding the length of a six week clinical drug study), probably because of downstream neurotrophic factor(s) increases. Many trials of antidepressants limited dose adjustment or dose adjustment rate. Many clinical trials have excluded patients with severe symptoms or dual diagnoses because inclusion introduces a safety issue or may introduce too many variables. Also, physicians will switch patients to another antidepressant if there is no sign of early efficacy, and while one antidepressant may work very well (probably as a result of genetics), another will not work at all. Most studies focusing on one drug are not going to switch to another medication in the same class (for example, a serotonin reuptake inhibitor) during the trial, even though that's routinely done in clinical practice with good result.
Antidepressants work. Psychotherapy can also be helpful as a sole treatment for mild depression (although please note that psychotherapy has its own set of risks, costs, and drawbacks), and patients often get additional benefit by engaging in psychotherapy along with medication treatment. However, a psychologist or counselor treating a moderately to severely depressed person who fails to refer that patient for evaluation for treatment with an antidepressant would be risking a malpractice suit.