Relevant and even prescient commentary on news, politics and the economy.

State of the Art for propranolol research

This article states state of the art research for propranolol for PTSD.

At this point in the research, though, it’s too early to tell how well beta blockers might work even as a therapeutic aid, Altemus said.

“There were two small studies that have already been done using propranolol for PTSD, where they treated people right when the accident happened — they found people in the emergency room. One study was done in France, and one was done in Boston,” she said. “They did find they were able to reduce the [emotional] intensity of traumatic memories by giving people propranolol for the first 10 days or so after an accident.”
But Altemus also pointed out that PTSD is rather rare, with less than 10 percent of accident victims experiencing the recurrent flashbacks, isolation and avoidant behaviors that are hallmarks of the condition. So, it wouldn’t make sense to hand out propranolol to everyone who’d suffered a traumatic event, she said.

According to the Associated Press, a study released Thursday by the US Army surgeon general’s office estimates that between 4 percent and 5 percent of returning Iraqi veterans with combat experience suffer from PTSD.
Funded by a grant from the National Institutes of Health, Altemus is currently working to recruit PTSD patients for a large-scale trial of propranolol — a tough job when effective interventions such as exposure therapy already exist. She said that as soon as she’s able to recruit the 60 people needed for the trial, results should be available within a year.

Dr. Altemus since September has obtained one subject a month by report.

Martin Luther King Day organization asks for action, not vacation and a three day weekend.

Dr. Martin Luther King, Jr. sought to forge the common ground on which people from all walks of life could join together to address important community issues. On January 21st, 2008, millions of Americans across the country will once again honor his legacy by taking part in a wide range of service projects—conducting food drives, painting schools and community centers, recruiting mentors for needy youth, and bringing meals to homebound neighbors, to name but a few.

In recognition of the 40th anniversary of Dr. King’s assassination, the Corporation for National and Community Service in 2008 is also pleased to join with other organizations in supporting a new initiative, “40 Days of Nonviolence: Building the Beloved Community.” Under this initiative, the King Day of Service will kick off 40 days during which families, schools, faith communities, and other organizations will plan service projects and educational activities promoting Dr. King’s message of nonviolence and social justice.

What are we going to do now? Your choice.

This article found on from AP describes a growing problem.

For as long as the United States has sent its young men – and later its young women – off to war, it has watched as a segment of them come home and lose the battle with their own memories, their own scars, and wind up without homes.
The Civil War produced thousands of wandering veterans. Frequently addicted to morphine, they were known as “tramps,” searching for jobs and, in many cases, literally still tending their wounds.
More than a decade after the end of World War I, the “Bonus Army” descended on Washington – demanding immediate payment on benefits that had been promised to them, but payable years later – and were routed by the U.S. military.
And, most publicly and perhaps most painfully, there was Vietnam: Tens of thousands of war-weary veterans, infamously rejected or forgotten by many of their own fellow citizens.
Now it is happening again, in small but growing numbers.
For now, about 1,500 veterans from Iraq and Afghanistan have been identified by the Department of Veterans Affairs. About 400 of them have taken part in VA programs designed to target homelessness.
The 1,500 are a small, young segment of an estimated 336,000 veterans in the United States who were homeless at some point in 2006, the most recent year for which statistics are available, according to the National Alliance to End Homelessness.
Still, advocates for homeless veterans use words like “surge” and “onslaught” and even “tsunami” to describe what could happen in the coming years, as both wars continue and thousands of veterans struggle with post-traumatic stress.
People who have studied postwar trauma say there is always a lengthy gap between coming home – the time of parades and backslaps and “The Boys Are Back in Town” on the local FM station – and the moments of utter darkness that leave some of them homeless.
In that time, usually a period of years, some veterans focus on the horrors they saw on the battlefield, or the friends they lost, or why on earth they themselves deserved to come home at all. They self-medicate, develop addictions, spiral down.
How – or perhaps the better question is why – is this happening again?
“I really wish I could answer that question,” says Anthony Belcher, an outreach supervisor at New Directions, which conducts monthly sweeps of Skid Row in Los Angeles, identifying homeless veterans and trying to help them get over addictions.
“It’s the same question I’ve been asking myself and everyone around me. I’m like, wait, wait, hold it, we did this before. I don’t know how our society can allow this to happen again.”
Mental illness, financial troubles and difficulty in finding affordable housing are generally accepted as the three primary causes of homelessness among veterans, and in the case of Iraq and Afghanistan, the first has raised particular concern.
Iraq veterans are less likely to have substance abuse problems but more likely to suffer mental illness, particularly post-traumatic stress, according to the Veterans Administration. And that stress by itself can trigger substance abuse.
Some advocates say there are also some factors particular to the Iraq war, like multiple deployments and the proliferation of improvised explosive devices, that could be pulling an early trigger on stress disorders that can lead to homelessness.
While many Vietnam veterans began showing manifestations of stress disorders roughly 10 years after returning from the front, Iraq and Afghanistan veterans have shown the signs much earlier.
That could also be because stress disorders are much better understood now than they were a generation ago, advocates say.
“There’s something about going back, and a third and a fourth time, that really aggravates that level of stress,” said Michael Blecker, executive director of Swords to Plowshares,” a San Francisco homeless-vet outreach program.
“And being in a situation where you have these IEDs, everywhere’s a combat zone. There’s no really safe zone there. I think that all is just a stew for post-traumatic stress disorder.”
Others point to something more difficult to define, something about American culture that – while celebrating and honoring troops in a very real way upon their homecoming – ultimately forgets them.
This is not necessarily due to deliberate negligence. Perhaps because of the lingering memory of Vietnam, when troops returned from an unpopular war to face open hostility, many Americans have taken care to express support for the troops even as they solidly disapprove of the war in Iraq.
But it remains easy for veterans home from Iraq for several years, and teetering on the edge of losing a job or home, to slip into the shadows. And as their troubles mount, they often feel increasingly alienated from friends and family members.
“War changes people,” says John Driscoll, vice president for operations and programs at the National Coalition for Homeless Veterans. “Your trust in people is strained. You’ve been separated from loved ones and friends. The camaraderie between troops is very extreme, and now you feel vulnerable.”

The meta-analysis on PTSD 2008 had one conclusion that there was a paucity of studies done with veterans. One could argue this to some degree, but let me say there have been few studies funded by NIH and the VA that had enough money to be thorough for combat ptsd. More had been done for children, but the false memory people are still being well paid despite losing court battles.

PTSD itself had no publication devoted to it until 1985, so of course the ins and outs of what it is are in its infancy (concerning clinical studies). On the other hand, we know some very basic human needs are involved from a long historical experiment.

PTSD meta-analysis

Treatment of PTSD 2008 is a comprehensive meta-analysis of studies done for the government on treatments for PTSD. I will have some follow through later this week. The 212 page document is one of the more throrough I have seen, so I mention this for any readers who have time and are curious. No surprises but some great questions.

Propranolol had no research indicating efficacy for combat ptsd.

a little history from a couple months ago

The NYT has an article that offers some insight in Whitehouse thinking and wishes.

On one side, according to people familiar with the deliberations, is a powerful group of pragmatists, including Henry M. Paulson Jr., the treasury secretary; Joshua B. Bolten, the White House chief of staff; and Ed Gillespie, counselor to Mr. Bush. They argue that the need for a stimulus is urgent, but have expressed concern that the administration may have to scale back its ambitions for permanent tax cuts to get a package through Congress.
On the other side, these people say, are staunch economic conservatives like Keith B. Hennessey, the new director of Mr. Bush’s National Economic Council. They have reservations about the need for an economic rescue package and maintain that if the White House proposes one, it should use the plan as leverage to press lawmakers into making the tax cuts permanent.

As a whole, the economics team has also drawn criticism for overly optimistic economic predictions. At the end of November, on the same day that Ben S. Bernanke, the chairman of the Federal Reserve, hinted strongly that the Fed would lower interest rates to stave off a downturn in the economy, Mr. Paulson and Mr. Lazear offered a rosier economic forecast for 2008.
Mr. Lazear predicted “solid growth,” and Mr. Paulson said the economy remained “broadly healthy,” while adding, “I expect the expansion to continue.”
On Tuesday, Mr. Lazear defended those predictions, saying they were in keeping with what most economists believed at the time. But he also said that the economic team had known since August, when the housing crisis grew especially acute, that it might have to consider an economic rescue package.

Things seem to change really quickly. Too bad none knew what was coming in order to better plan a stimulus package. [sarcasm off]

Consumer credit default and spending change

The NYT reports that there is:

Strong evidence is emerging that consumer spending, a bulwark against recession over the last year even as energy prices surged and the housing market sputtered, has begun to slow sharply at every level of the American economy, from the working class to the wealthy.

The abrupt pullback raises the possibility that the country may be experiencing a rare decline in personal consumption, not just a slower rate of growth. Such a decline would be the first since 1991, and it would almost certainly push the entire economy into a recession in the middle of an election year.
There are mounting anecdotal signs that beginning in December Americans cut back significantly on personal consumption, which accounts for 70 percent of the economy.

Citicorp just canceled my credit card for $133 of 60 day overdue. I had switched to e-mail only billing and they became spam. Oops. Given that I had a long and superb track record that earned them money for a long time, I do not like being layed off with the other 7000 employees. So much for loyalty, and so much for a 39 cent stamp and little reminder. My appeal fell on deaf ears.

Andrew Leonard at Salon takes the savvy and well educated, knowledgeable movers and shakers to task for their whining about free markets and oversight. It reminds me of:

1. Too big to fail, which may be true, but stay with the same management?

2. DolB can sell discounted flowers to all the readership using their on-line names and persona’s, and accept our thanks and promises, but next month no money? It is our fault? Morally, yes, but as a businessman he can yell at us all he wants, but it is his business. So then he can borrow from a guy from Dubai to make things right by letting him in on a percentage of his business. Duh…

3. OldVet’s post on Japan is another marker.

Anyway, is it time to say whatever the stated philosophy was, the real practice has made a mess of the world-wide econonomy? No bailouts by the fed is replaced by soveriegn funds? Are they big enough?

Best evidence pitfalls

The New England Journal of Medicine reports this abstract about unreported clinical trials of pharmaceutical companies.

Background Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.
Methods We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set.
Results Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.
Conclusions We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients.

This may be good for sales, but witholding limitations from doctors at least in theory is bad medicine. Of course, there are other difficulties.

Post flambe

OMB Watch has an article on talk of a stimulus package and what it should not do. Actually, it does propose an idea, but I left that out. To quote:

“During his speech at the Union League Club of Chicago on Jan. 7, Bush reiterated the importance of continuing his current policies to address what he calls recent economic “challenges.” However, he emphasized that new initiatives are unnecessary to address the damage from the housing and financial crises. Bush called for extending his first-term tax cuts, few of which, if any, would have any impact on current economic signals.

Meanwhile, Paulson, in his speech before the New York Society of Security Analysts, Inc., said the administration would consider an economic stimulus package but would not provide any details. This is why some speculated that Bush might announce something during the State of Union address.

It is important that policy makers ignore calls for a repetition of the failed 2001-2003 Bush tax cuts and adhere to sound economic principles as described by Summers and Orszag. Even worse would be calls for extension of those same tax cuts as a short-term solution for current fiscal problems. Permanent tax cuts for the wealthy and corporations would do little to immediately stimulate the economy or direct economic aid to those most affected by an economic slump while ultimately putting a drag on the economy in the long term through sustained budget deficits.

(The views expressed are those of mine alone and should not be attributed to the trustees, officers, or staff of the Brookings Institution or the Tax Policy Center. Much of this talk draws upon joint work with William Gale of Brookings, Robert Greenstein and Richard Kogan of the Center on Budget and Policy Priorities, Robert Rubin of Citigroup, and Allen Sinai of Decision Economics, Inc. I also thank Robert Cumby of Georgetown University, Peter Diamond of MIT, Doug Elmendorf and David Wilcox of the Federal Reserve, Robert Bixby of the Concord Coalition, and Maya MacGuineas of the New America Foundation for helpful discussions.)

Psycological Kevlar

Psychological Kevlar Act of 2007
introduced by Patrick Kennedy was to help PTSD and brain trauma research expand.

It has come to my attention that the DoD is thinking about using propranolol as a prophylactic to help reduce ptsd symptoms during conflict and after. I had found this articlefrom a wife of a soldier who had killed himself, and who had testified in a Dec. 12, 2007 congressional hearing on suicide among veterans that is apparently on the rise. She has a strong and passionate viewpoint, but that is not for the post.

Propranolol (brand name Inde by Wyeth) is used for a number of diagnosis not related to ptsd. In addition it is used in the psychological Anxiety area as a beta blocker among other uses, for example for rape victims ptsd to help defuse the intensity of the experience in order to work in therapy. Its efficacy is still experimental and not encouraging.

Failing to locate such information, I am wondering if readers may have leads. While an econ blog, many here are also veterans. Thanks. Further information is coming if warranted. I have e-mailed relevant experts that I know.