04 December 2007

Tasers are safe? Oh. Never mind then...

I take it all back. Nothing bad about Tasering people. Just a few good natured 50,000 volt tickles and you're on your way.

Taser stun guns used by the police for law enforcement are safe - the injury rate is low and most injuries appear to be minor, a US study finds.

The electric disablers that hit their target with 50,000 volts are commonly used by US police and are increasingly being used by UK forces.

Human rights experts have expressed concern about the use of the stun gun.

But a Wake Forest University review of 1,000 US cases suggests the risk and severity of injuries is low.

Most injuries were mild, such as scrapes or bruises.

Three of the subjects suffered injuries severe enough to need hospital admission - two had head injuries suffered in falls after Taser use. The third was admitted to hospital two days after arrest with a medical condition of unclear relationship to the Taser.

Two subjects died but autopsy reports suggested neither death was related to the Taser.

Interim results on 597 of the cases were published in Annals of Emergency Medicine in September.

Lead researcher Dr William Bozeman, who received funding from the US National Institute of Justice for the work, said: "This is the largest study to date and the first to detail the medical effects of Tasers under real-world conditions.

"These results support the safety of the device. The injury rate is low and most injuries appear to be minor."

He stressed, however, that the Taser was a weapon and could clearly cause injuries and even deaths.

Amnesty International says Tasers have been linked to more than 70 deaths in America.

When Tasers are fired, two metal barbs connected to the weapon by a thin wire pierce the skin before the charge is delivered.

In the UK, police officers who carry guns have also carried Tasers since 2004. In September 2007, the Home Office extended permission to non-firearms officers in pilot areas.

Amnesty International's Arms Programme Director, Oliver Sprague, said: "Let's not be misled here. Tasers are dangerous electro-shock weapons.

"This is why we are urging the Home Office to review its decision and to ensure that only specialist firearms officers use the Taser in very limited circumstances and only as an alternative to shooting a lethal weapon."

A Home Office spokesman said: "The risk of life-threatening and other serious injuries is considered to be low.

"Tasers have contributed to resolving incidents without injury where otherwise there would have been a real possibility of someone being shot and killed.

"In some cases they have not needed to be fired: drawing them or arcing the Taser has been enough of a deterrent."

In England, a Taser has been used (drawn or fired) in service by the police 851 times, since April 2003.

Taser death in Canada airport

Still think Tasers aren't being misused?

Video footage has been released in Canada showing the last moments of an immigrant who died after being stunned with a Taser by police. Robert Dziekanski, 40, of Pieszyce, Poland, was restrained by police after becoming agitated at Vancouver International Airport on 14 October.Mr Dziekanski, who spoke no English, was declared dead at the scene by an emergency medical team.

The incident is being investigated by police, the airport and the coroner. Police spokesman Cpl Dale Carr said the video was just one piece of evidence, and urged people to wait for the results of the inquest. Mr Dziekanski, a construction worker, was emigrating to Canada to join his mother, who lived in the western province of British Columbia.

The incident has prompted a debate about the use of Taser stun guns by police in Canada. The Canadian Broadcasting Corporation says up to 18 people have died after being stunned by a Taser in Canada since 2003.

The video was shot by Canadian traveller Paul Pritchard and handed over to police, and has only just been returned to him.

It starts before the police arrive, with Mr Dziekanski seen through a glass wall in a customs area. He appears agitated, sweating and breathing heavily. Airport security officials and passengers watch from the other side.

Having landed 10 hours earlier, he is seen pacing back and forth through an automatic door, standing briefly in the doorway with a small folding table, and then later with a chair. At one point, he takes what looks like a laptop computer off a counter and throws it to the ground, and then throws the small table against the glass wall.

Four policemen then walk into view. They walk through the glass doors towards Mr Dziekanski, who turns his back on them. Witnesses say he appeared to pick up a stapler. Seconds later, Mr Dziekanski is stunned by a Taser and falls down screaming and convulsing.

He is stunned a second time, and then the police officers restrain him on the floor. Mr Dziekanski's screams die down, and he is seen lying still. A voice is heard saying "code red", which is code for a medical emergency.

An autopsy found no sign of drugs or alcohol in Mr Dziekanski's system, and failed to pinpoint the cause of death.

Walter Kosteckyj, the victim's family lawyer, said Mr Dziekanski's mother had seen portions of the video and had approved its release to the public. "She had a son in distress, he was looking for help, he was frightened, and he didn't get that help," Mr Kosteckyj said. He said he was disturbed by the video because Mr Dziekanski was not violent.

"I was expecting to see a confrontation, a discussion and things go sideways, then the tasering... That's not what you see," he said.

Mr Dziekanski, who had not flown before, had boarded a plane a day earlier in Germany, and arranged to meet his mother at the baggage carousel in the international terminal.

Neither of them knew the baggage carousel was inside a secure area, with no view of the public arrivals hall area, except for a short distance through sliding glass doors, Mr Kosteckyj said.

No airport, customs or security employees at the airport apparently tried to help either of them, he added. Eventually Mr Dziekanski emerged into the public area, but his mother had left after six hours and Mr Dziekanski apparently panicked, the lawyer said. Link

Pain-Blog Carnival

The always awesome How To Cope With Pain Blog has this month's pain-blog carnival up:

Your's truly was too busy working on our job search process to contribute...

Compulsions in Tourette's Syndrome

In An Anthropologist On Mars Oliver Sacks describes the compulsions of Tourette's Syndrome:
it is often difficult for Touretters, to see their Tourette's as something external to themselves, because many of the tics and urges may be felt as intentional, as an integral part of the self, the personality, the will. It is quite different, by contrast, with something like Parkinsonism or chorea: these have no quality of selfness or intentionality and are always felt as diseases, as outside the self. Compulsions and tics occupy an intermediate position, seeming sometimes to be an expression of one's personal will, sometimes a coercion of it by another, alien will. These ambiguities are often expressed in the terms people use. Thus the separateness of 'it' and 'I' is sometimes expressed by jocular personifications of the Tourette's: one Touretter I know calls his Tourette's 'Toby,' another 'Mr. T.' By contrast, a Tourettic possession of the self was vividly expressed by one young man in Utah, who wrote to me that he had a Tourettized soul.' [102]

15 November 2007

Gitmo operating manual

A never-before-seen military manual detailing the day-to-day operations of the U.S. military's Guantánamo Bay detention facility has been leaked to the web, affording a rare inside glimpse into the institution where the United States has imprisoned hundreds of suspected terrorists since 2002.

The 238-page document, "Camp Delta Standard Operating Procedures," is dated March 28, 2003. It is unclassified, but designated "For Official Use Only." It hit the web last Wednesday on Wikileaks.org.


The Camp Delta document (.pdf) includes schematics of the camp, detailed checklists of what "comfort items" such as extra toilet paper can be given to detainees as rewards, six pages of instructions on how to process new detainees, instructions on how to psychologically manipulate prisoners, and rules for dealing with hunger strikes.

"What strikes me is the level of detail for handling all kind of situations, from admission to barbers and burials," says Jamil Dakwar, advocacy director of the ACLU's Human Rights program. Dakwar was in Guantánamo last week for a military-commission hearing.

The Pentagon did not reply to a request for comment on the document.

Dakwar sees hints of Abu Ghraib in a section instructing guards to use dogs to intimidate prisoners. He also raises concerns over a section on the International Committee of the Red Cross, or ICRC, which indicates that some prisoners were hidden from Red Cross representatives.

The manual shows how the military coded each prisoner according to the level of access the Red Cross would have. The four levels are:

* No Access
* Visual Access -- ICRC can only look at a prisoner's physical condition.
* Restricted Access -- ICRC representatives can only ask short questions about the prisoner's health.
* Unrestricted Access

The No Access level troubles Dakwar.

"That actually raises a lot of concerns about the administration's genuineness in terms of allowing ICRC full access, as was promised to the world," Dakwar says. "They are the only organization that has access to the detainees, and this raises a lot of questions."

The ICRC does not make public reports about the conditions in prisons and gulags around the world, but instead meets privately with governments to persuade them to change their policies.

The manual also includes instructions on how to use military dogs to intimidate prisoners.

"MWD (Military Working Dogs) will walk 'Main Street' in Camp Delta during shifts to demonstrate physical presence to detainees," reads a directive in the "Psychological Deterrence" section. "MWD will not be walked through the blocks unless directed by the (Joint Detention Operations Group)."

The document was signed by Maj. Gen. Geoffrey Miller. According to media reports, Miller introduced harsh interrogation methods to Guantánamo, such as shackling detainees into stress positions and using guard dogs to exploit what the former head commander in Iraq Lt. Gen. Ricardo Sanchez referred to as "Arab fear of dogs."

Miller visited Iraq in 2003 to share the Guantánamo methods. Soon after that visit, the infamous Abu Ghraib photos were taken.

President Bush said in 2006 he wanted to close the Guantánamo Bay prison camp. The military is prosecuting some detainees under military-commission rules set by Congress, and trying to repatriate hundreds of others.
Link to Wired story
Link to Wikilinks

Link to pdf of document

02 November 2007

Acupuncture for back pain

Acupuncture 'best therapy for back pain'

By Nic Fleming, Science Correspondent

Acupuncture can provide significantly more relief from lower back pain than conventional therapies, scientists say.

The Chinese needle treatment was 74 per cent more likely to lead to a sustained reduction in pain or improved ability to function normally than physiotherapy, medication and advice on exercise, according to German researchers.

Acupuncture 'best therapy for back pain'
Scientists say both acupuncture and
‘sham acupuncture’ are beneficial

However, the study also found "sham acupuncture" — in which needles are applied away from points usually used in traditional Chinese medicine — to be almost as effective, suggesting that the positive effects may have more to do with the way the body deals with pain than with the specific points where the needles are applied.

Dr Michael Haake, of the University of Regensburg in Bad Abbach, whose research was published in the journal Archives of Internal Medicine, said: "Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contra-indications.

"The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment. The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system."

Dr Haake and colleagues carried out a clinical trial involving 1,162 patients who had experienced chronic low back pain for an average of eight years.

All participants underwent 10 half-hour sessions in five weeks. One group had acupuncture, while another had sham acupuncture.

The final group had conventional therapy consisting of a combination of medication, physical manipulation and exercise.

A successful response was defined as a 33 per cent reduction in pain or a 12 per cent improvement in ability to function normally. Both were assessed using questionnaires.

Six months after the trial was completed, 47.6 per cent of those in the real acupuncture group had responded to their treatment, compared to 44.2 per cent of the sham acupuncture group and 27.4 per cent in the conventional therapy group.

When a patient goes to see their GP about lower back pain in Britain, the doctor will firstly check for serious conditions, such as tumours or rheumatoid arthritis, before providing advice about exercise and the use of painkillers.

If the problem is not resolved within several weeks, patients are sometimes offered manipulation therapies including chiropractic, osteopathy or physiotherapy.

A survey of 2,240 people with back problems carried out by the charity BackCare in 2005 found that of those who had tried acupuncture 30 per cent said it had no effect, 41 per cent believed it provided only temporary relief and 19 per cent said it provided significant, sustained improvements.

Nia Taylor, the chief executive of BackCare, said: "We know from talking to patients that they are often dissatisfied with the attention they receive from their GPs. So-called alternative therapies such as acupuncture often provide longer consultation periods, and that in itself can be beneficial."

The NHS spends more than £1 billion per year on back pain, including £512?million for hospital treatment, £141 for GP consultations and £150 million on physiotherapy.

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01 November 2007

More waterboarding

Even with the fictional narrator this looks pretty horrifying.

Is it torture? Don't forget...

Video of waterboarding

Video of a reporter being waterboarded.

Watch the full story.

And, of course, don't forget this.

The heart of torture

No debate about whether something counts as torture should ignore this passage from Orwell's 1984.

"By itself," he said, "pain is not always enough. There are occasions when a human being will stand out against pain, even to the point of death. But for everyone there is something unendurable --something that cannot be contemplated. Courage and cowardice are not involved. If you are falling from a height it is not cowardly to clutch at a rope. If you have come up from deep water it is not cowardly to fill your lungs with air. It is merely an instinct which cannot be disobeyed. It is the same with the rats. For you, they are unendurable. They are a form of pressure that you cannot withstand, even if you wish to. You will do what is required of you." [284]

Waterboarding is torture

An extraordinary account of waterboarding and torture by a former SERE instructor.

Read the whole thing.

Last week the Attorney General nominee Judge Michael Mukasey refused to define waterboarding terror suspects as torture. On the same day MSNBC television pundit and former Republican Congressman Joe Scarborough quickly spoke out in its favor. On his morning television broadcast, he asserted, without any basis in fact, that the efficacy of the waterboard a viable tool to be used on Al Qaeda suspects.

Scarborough said, "For those who don't know, waterboarding is what we did to Khalid Sheikh Mohammed, who is the Al Qaeda number two guy that planned 9/11. And he talked …" He then speculated that “If you ask Americans whether they think it's okay for us to waterboard in a controlled environment … 90% of Americans will say 'yes.'” Sensing that what he was saying sounded extreme, he then claimed he did not support torture but that waterboarding was debatable as a technique: "You know, that's the debate. Is waterboarding torture? … I don't want the United States to engage in the type of torture that [Senator] John McCain had to endure."

In fact, waterboarding is just the type of torture then Lt. Commander John McCain had to endure at the hands of the North Vietnamese. As a former Master Instructor and Chief of Training at the US Navy Survival, Evasion, Resistance and Escape School (SERE) in San Diego, California I know the waterboard personally and intimately. SERE staff were required undergo the waterboard at its fullest. I was no exception. I have personally led, witnessed and supervised waterboarding of hundreds of people. It has been reported that both the Army and Navy SERE school’s interrogation manuals were used to form the interrogation techniques used by the US army and the CIA for its terror suspects. What was not mentioned in most articles was that SERE was designed to show how an evil totalitarian, enemy would use torture at the slightest whim. If this is the case, then waterboarding is unquestionably being used as torture technique.

The carnival-like he-said, she-said of the legality of Enhanced Interrogation Techniques has become a form of doublespeak worthy of Catch-22. Having been subjected to them all, I know these techniques, if in fact they are actually being used, are not dangerous when applied in training for short periods. However, when performed with even moderate intensity over an extended time on an unsuspecting prisoner – it is torture, without doubt. Couple that with waterboarding and the entire medley not only “shock the conscience” as the statute forbids -it would terrify you. Most people can not stand to watch a high intensity kinetic interrogation. One has to overcome basic human decency to endure watching or causing the effects. The brutality would force you into a personal moral dilemma between humanity and hatred. It would leave you to question the meaning of what it is to be an American.

We live at a time where Americans, completely uninformed by an incurious media and enthralled by vengeance-based fantasy television shows like “24”, are actually cheering and encouraging such torture as justifiable revenge for the September 11 attacks. Having been a rescuer in one of those incidents and personally affected by both attacks, I am bewildered at how casually we have thrown off the mantle of world-leader in justice and honor. Who we have become? Because at this juncture, after Abu Ghraieb and other undignified exposed incidents of murder and torture, we appear to have become no better than our opponents.

With regards to the waterboard, I want to set the record straight so the apologists can finally embrace the fact that they condone and encourage torture.

History’s Lessons Ignored

Before arriving for my assignment at SERE, I traveled to Cambodia to visit the torture camps of the Khmer Rouge. The country had just opened for tourism and the effect of the genocide was still heavy in the air. I wanted to know how real torturers and terror camp guards would behave and learn how to resist them from survivors of such horrors. I had previously visited the Nazi death camps Dachau and Bergen-Belsen. I had met and interviewed survivors of Buchenwald, Auschwitz and Magdeburg when I visited Yad Vashem in Jerusalem. However, it was in the S-21 death camp known as Tuol Sleng, in downtown Phnom Penh, where I found a perfectly intact inclined waterboard. Next to it was the painting on how it was used. It was cruder than ours mainly because they used metal shackles to strap the victim down, and a tin flower pot sprinkler to regulate the water flow rate, but it was the same device I would be subjected to a few weeks later.

On a Mekong River trip, I met a 60-year-old man, happy to be alive and a cheerful travel companion, who survived the genocide and torture … he spoke openly about it and gave me a valuable lesson: “If you want to survive, you must learn that ‘walking through a low door means you have to be able to bow.’” He told his interrogators everything they wanted to know including the truth. They rarely stopped. In torture, he confessed to being a hermaphrodite, a CIA spy, a Buddhist Monk, a Catholic Bishop and the son of the king of Cambodia. He was actually just a school teacher whose crime was that he once spoke French. He remembered “the Barrel” version of waterboarding quite well. Head first until the water filled the lungs, then you talk.

Once at SERE and tasked to rewrite the Navy SERE program for the first time since the Vietnam War, we incorporated interrogation and torture techniques from the Middle East, Latin America and South Asia into the curriculum. In the process, I studied hundreds of classified written reports, dozens of personal memoirs of American captives from the French-Indian Wars and the American Revolution to the Argentinean ‘Dirty War’ and Bosnia. There were endless hours of videotaped debriefings from World War Two, Korea, Vietnam and Gulf War POWs and interrogators. I devoured the hundreds of pages of debriefs and video reports including those of then Commander John McCain, Colonel Nick Rowe, Lt. Dieter Dengler and Admiral James Stockdale, the former Senior Ranking Officer of the Hanoi Hilton. All of them had been tortured by the Vietnamese, Pathet Lao or Cambodians. The minutiae of North Vietnamese torture techniques was discussed with our staff advisor and former Hanoi Hilton POW Doug Hegdahl as well as discussions with Admiral Stockdale himself. The waterboard was clearly one of the tools dictators and totalitarian regimes preferred.

There is No Debate Except for Torture Apologists

1. Waterboarding is a torture technique. Period. There is no way to gloss over it or sugarcoat it. It has no justification outside of its limited role as a training demonstrator. Our service members have to learn that the will to survive requires them accept and understand that they may be subjected to torture, but that America is better than its enemies and it is one’s duty to trust in your nation and God, endure the hardships and return home with honor.

2. Waterboarding is not a simulation. Unless you have been strapped down to the board, have endured the agonizing feeling of the water overpowering your gag reflex, and then feel your throat open and allow pint after pint of water to involuntarily fill your lungs, you will not know the meaning of the word.

Waterboarding is a controlled drowning that, in the American model, occurs under the watch of a doctor, a psychologist, an interrogator and a trained strap-in/strap-out team. It does not simulate drowning, as the lungs are actually filling with water. There is no way to simulate that. The victim is drowning. How much the victim is to drown depends on the desired result (in the form of answers to questions shouted into the victim’s face) and the obstinacy of the subject. A team doctor watches the quantity of water that is ingested and for the physiological signs which show when the drowning effect goes from painful psychological experience, to horrific suffocating punishment to the final death spiral.

Waterboarding is slow motion suffocation with enough time to contemplate the inevitability of black out and expiration –usually the person goes into hysterics on the board. For the uninitiated, it is horrifying to watch and if it goes wrong, it can lead straight to terminal hypoxia. When done right it is controlled death. Its lack of physical scarring allows the victim to recover and be threaten with its use again and again.
Torture in captivity simulation training reveals there are ways an enemy can inflict punishment which will render the subject wholly helpless and which will generally overcome his willpower. The torturer will trigger within the subject a survival instinct, in this case the ability to breathe, which makes the victim instantly pliable and ready to comply. It is purely and simply a tool by which to deprive a human being of his ability to resist through physical humiliation. The very concept of an American Torturer is an anathema to our values.

That last paragraph reminds me of something...

More Taser misuse

Not cool.

LAist: OC Deputies Taser, Cuff 15-Year-Old Autistic Boy
Taylor Karras was reported missing by his mother yesterday, after running away from a Westminster social services facility where he was receiving therapy for autism.

Around 9:30 p.m., the 15-year-old boy was found just a block from his North Tustin home. Orange County Sheriff's deputies spotted Karras pushing a shopping cart in the street, chased him on foot, Tasered him once, and handcuffed him.

Only when a passing neighbor recognized Karras did the authorities realize he had been reported missing nearly ten hours earlier and that he had a disability.

Taylor Karras's mother, Doris, said she saw the entire incident and felt the police action was excessive. "He had been stopping at bus stops and reading the maps to find his way home," she said.

OC Sheriff Lt. Hal Brotheim claimed that Karras took off running through traffic when the deputies approached him. Traffic in unincorporated North Tustin at 9:30 p.m. on a Monday night. Link

Guard Tasers Man Holding Baby
In a confrontation captured on videotape, a hospital security guard fired a stun gun to stop a defiant father from taking home his newborn, sending both man and child crashing to the floor. Now William Lewis says his baby girl suffers from head trauma because she was dropped.

"I've got to wonder what kind of moron would Tase an adult holding a baby," said George Kirkham, a former police officer and criminologist at Florida State University. "It doesn't take rocket science to realize the baby is going to fall."

..."The Taser itself is a legitimate law-enforcement tool," said Kirkham, the criminologist. "The problem is the abusive use of them. They're supposed to be only used to protect yourself or another person from imminent aggression and physical harm. They're overused now." Link

Hog-tied woman tasered in jail
A Butterfield woman who allegedly was "hog-tied" and shocked multiple times with a Taser at the Barry County Jail is suing in federal court.

Melissa A. "Missy" Norman, 41, claims her civil rights were violated during a July 23 incident at the jail.

At least a half dozen officers from the Barry County Sheriff's Department and Cassville Police Department previously were placed on leave because of the incident, which is being investigated by the Missouri Highway Patrol.

None of the officers has been charged.

Norman "was handcuffed, leg shackled, hog-tied, blindfolded and tasered numerous times," according to a news release issued by her her attorneys, John Lewright and Robert Foulke.

Lewright said Monday the Taser incident was recorded by a video camera in the booking area, although he had yet to receive a copy of the recording. Lewright said he took the case — he normally focuses on criminal defense — because it "infuriated" him. The slow pace of the investigation into the woman's jail treatment and a delay in receiving the video have only added to that frustration, he said.

"If people hog-tied a dog and then took a cattle prod to that dog ... they would be federally prosecuted," he said.

The lawsuit claims: Norman's constitutional rights under the Fourth and Fourteenth Amendments were violated; the departments failed to properly supervise the officers; Norman was discriminated against under the Americans with Disabilities Act; and she was the victim of battery, negligence and infliction of emotional distress.
According to the lawsuit, Norman "was having personal difficulties" July 23 and contacted a law enforcement officer at his home. She was taken by ambulance to St. John's hospital in Cassville and given medicine to make her vomit.

Norman then left the hospital voluntarily but was later apprehended by a group of law enforcement officers, who "tackled, handcuffed, and leg-shackled" her, according to the lawsuit. The handcuffs and leg shackles were tied together behind her back while an officer "was digging his knee into Missy's neck so she could not breathe," the lawsuit said.

Norman allegedly was put into the back of a patrol car without a seat belt and taken to the Barry County Jail. Once there, a group of officers carried her into a booking area and allegedly taunted her. Norman "was terrified and started hitting her head," the lawsuit said.

The officers allegedly taped a towel around her head with duct tape, then began shooting her with a Taser multiple times. The lawsuit said that at one point the officers lifted Norman's shirt above her stomach to administer the Taser to her bare skin, causing burn wounds. Norman's screams of pain and pleas that the officers stop were repeatedly ignored, the lawsuit said.She eventually was placed in a jail cell but not released to a hospital until the next morning.

Six were punished for incident. Neither Epperly, the sheriff, nor McCullough, the police chief, returned phone calls seeking comment Monday.

Epperly — who was away at a conference at the time of the incident — said in an interview in July that Norman was emotionally disturbed and went to the home of an off-duty officer threatening suicide at about 10 p.m. the night of the incident.

Epperly said he was told officers tracked down Norman after she left the hospital out of concern for her safety.She became combative, he said, spat at and tried to harm officers, as well as herself. At the jail, Norman reportedly was hitting her head on the floor before a deputy used a Taser on her twice, the sheriff said. Link

At least the goat got away
DECATUR, Ala. (AP) - A nanny goat eluded police and a Taser stun after being spotted running into traffic in Decatur. Sergeant Jeremy Hayes said the goat, which occasionally ran onto roads, had been spotted repeatedly Sunday. He said Decatur police got three calls on the goat. Police didn't know where the goat came from and weren't sure where it was today. Lieutenant Frank DeButy said patrol officers tried zapping the goat with a Taser near Somerville Elementary school but missed as the goat was running full-stride.Hayes said police were having trouble catching the goat because they don't want to injure it. Link

H/T to Jesus' General

26 October 2007

In which Adam experiences a privation of calm

Some time ago my little girl, then three years old, dislocated her shoulder. I was alone in the house at the time. The pain was so intense that she became faint. I treated her the best I knew how, but kept holding the thought that just as soon as some one came I would run for help. She seemed to grow worse and cried very much. I undressed her and tried to twist the arm into place, but it caused such suffering that I began to get afraid. Then like a flash came the thought, What would you do if you were out of the reach of a practitioner? Now is your time to prove God's power and presence. With these thoughts came such a sense of calm and trustfulness that I lost all fear. I then asked the child if I should read to her; she said "Yes, mamma, read the truth-book." I began reading aloud to her from Science and Health. In about half an hour I noticed she tried to lift the arm but screamed and became very pale. I continued to read aloud and again she made an effort to put some candy into her mouth. This time I noticed with joy that she almost reached her mouth before she felt the pain. I kept reading aloud to her until my sister and two boys came in, when she jumped off her bed, so delighted to see her brothers that she forgot her arm. She then began to tell her aunt that she had broken her arm and mamma treated it with the truth-book. When this happened, it was about 10.30 A.M. and by 3 P.M. she was playing out doors as though nothing had ever happened.--Mrs. M. G., Winnipeg, Man Link

Someone please read to me from the truth-book and pour me a stiff drink. Heal me of the burning rage I feel.

12 October 2007

Why pains can't be privations

I've looked all over for someone making the most obvious and powerful objection to privation theories. Thank you Stanley Kane:
The difficulty is that pain seems clearly to be more than merely the absence of its contrary opposite. There is a marked difference between a limb which merely lacks feeling is numb or paralyzed or anesthetized and one that is racked with pain. In the former case it is quite plausible to say that is merely a privation of something, namely normal feeling, that under usual circumstances would belong to the limb. But it is clearly inadequate to describe a limb aching with pain as suffering merely a privation of good health or normal feeling. When pain occurs in the body, there is something new and different in a person’s experience which is not present when the body has simply lost feeling.

G.Stanley Kane, "Evil and Privation" Int J Phil Rel 11 (1980) 43-58

10 October 2007


From the OED definition of 'agony'. 1b is rather surprising, no?

The development of the senses in Gr. was:{em}1. A struggle for victory in the games; 2. Any struggle; 3. Mental struggle, anguish, e.g. Christ's anguish in Gethsemane. But the historical appearance of the meanings in Eng. was as follows:

1. a. Anguish of mind, sore trouble or distress, a paroxysm of grief. agony column, (a) the column of a newspaper that contains special advertisements, particularly those for missing relatives or friends, and thus often gives evidence of great distress; (b) a regular newspaper or magazine feature containing readers' questions about personal difficulties, with replies from the columnist; cf. problem page s.v. PROBLEM 7(b); agony aunt(ie), a familiar name for the (female) editor of an agony column (sense b); in extended use, an adviser on personal, psychological, etc., problems.

b. Hence, Intensity or paroxysm of pleasure.
a1725 POPE Odyssey x. 492 With cries and agonies of wild delight. 1877 MRS. OLIPHANT Mak. Flor. v. 138 He struck the marble in an agony of pleasure and content, bidding it ‘Speak’!

2. spec. The mental struggle or anguish of Christ in the garden of Gethsemane.

3. The convulsive throes, or pangs of death; the death struggle. (med.L. agon mortis.) Seldom now used in this sense without qualification, as agony of death, mortal agony.

4. a. Extreme bodily suffering, such as to produce writhing or throes of the body.
b. transf. and fig.
1835-40 etc. [see PILE v.2 2b]. 1863 GEO. ELIOT Let. 23 Oct. (1956) IV. 111 We shall soon be in the agonies of moving. 1924 R. CAMPBELL Flaming Terrapin ii. 25 The mountains frown, Locked in their tetanous agonies of stone. 1932 W. B. YEATS Words for Music 2 Dying into a dance, An agony of trance, An agony of flame that cannot singe a sleeve.

5. A struggle or contest. (Rarely without some shade of the preceding senses.)

Link (requires subscription)

Thanks to the most awesome PDT for the reference.

08 October 2007

In which Adam experiences a privation of sanity

In an amazing display of how a mistaken theodicy can lead to idiocy, Anglin and Goetz write:
one must distinguish between pain as an evil (a privation of normal consciousness, an inability to enjoy the weather) and pain as an experienced quality (a strong stimulus, an overwhelming sensation). A pain is only an evil insofar as it is privative.

Sounds a bit weird. But let's hear some more...

The privationist must agree that the experienced quality of a pain is not a mere absence of something but this does not commit him to saying that it is a good. Instead he can maintain that it is neither good nor evil but a sort of neutral thing. Of course, the experienced quality of pain always entails a privation of our normal state of consciousness and it often signals a privation of our normal state of bodily well-being. It can result in fear or resentment which are tied up with yet other privations.

Wait for it...........

However, just insofar as it is an experienced quality, pain is not an evil. Indeed, in some cases, the absence of this experienced quality would be an evil. If you cut your finger it would be worse if you did not than if you did feel pain.


Someone please douse me with the distinction between intrinsic and instrumental value to put the fire in my brain out........


*Anglin and Goetz, "Evil is Privation" Int J Phil Rel 13: 3-12 (1982), p.5

26 September 2007

Expressing suffering

Virginia Woolf:
English, which can express the thoughts of Hamlet and the tragedy of Lear has no words for the shiver or the headache....The merest schoolgirl when she falls in love has Shakespeare or Keats to speak her mind for her, but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry. [On Being Ill, p.194]

Hobbes on pain

Hobbes on pain:

Of pleasure, or delights, some arise from the sense of an object present; and those may be called pleasures of sense....Of this kind are onerations and exonerations of the body; as also all that is pleasant, in the sight, hearing, smell, taste, or touch; others arise from the expectation, that proceeds from foresight of the end, or consequence of things; whether those things in the sense please or displease: and these are pleasures of the mind of him that draweth those consequences and are generally called JOY. In the like manner, displeasures, are some in the sense, and called PAIN; others, in the expectation of consequences, and are called GRIEF. [Leviathan I, VI, 12]

This endeavour, when it is toward something which causes it is called APPETITE, or DESIRE; the latter, being the general name; and the other oftentimes restrained to signify the desire of food....And when the endeavour is fromward something it is generally called AVERSION. [Leviathan, I, VI, 2]

10 September 2007

Augustine on privation

From the Enchiridion:

For what is that which we call evil but the absence of good? in the bodies of animals, diseases and wounds mean nothing but the absence of health; for when a cure is effected, that does not mean that the evils which were present --namely, the diseases and wounds-- go away from the body and dwell elsewhere: they altogether cease to exist; for the wound or disease is not a substance, but a defect in the fleshy substance --the flesh itself being a substance, and therefore something good, of which those evils --that is, privations of the good which we call health-- are accidents. Just in the same way, what are called vices are nothing but privations of natural good. And when they are cured, they are not transferred elsewhere: when they cease to exist in the healthy soul, they cannot exist anywhere else.

Enchiridion XI

Homework assignment: Pains seem to be evil in and of themselves. Yet pains are real and definite things. How can Augustine account for the badness of pain? Is Augustine committed to the view that insofar as they are real, pains are themselves good? If pains were to be bad as privations, what would they be privations of? Discuss.

02 September 2007

Reflex Sympathetic Dystrophy Syndrome

I mentioned Reflex Sympathetic Dystrophy Syndrome (RSDS) in an earlier post on the USC event. There's a lot of good information on the syndrome at the Reflex Sympathetic Dystrophy Syndrome Association website.

29 August 2007

Coping with pain

This site (and its blog) has lots of good material for sufferers of chronic pain and their friends/families/et al.
How To Cope With Pain: A guide to coping with pain.

The author's philosopher husband also occasionally contributes some nice posts oriented toward laymen:

USC Pain Run

This will be an important event. Normally I only run when chased, but I'll make an exception for this. Please help out however you can:
Dear Friends and Colleagues,

The USC Pain Center is planning an exciting event:

December 2, 2007, in Long Beach

for the support of education, research, and treatment of RSD

RSD (Reflex Sympathetic Dystrophy, aka Complex Regional Pain Syndrome) is a condition caused by a malfunction within the nervous system that causes chronic, burning pain. The condition can be severe and disabling.

Research, education, and most importantly, treatment efforts have been greatly hampered by a lack of awareness of this condition, even in the medical community. But RSD is not rare—estimates vary that between 200, 000 to 1.2 million Americans are currently suffering with this condition.

In order to garner as much support for this wonderful project as possible, we have one simple request of you. TO HELP SPREAD THE WORD, all you need to do is to forward this email/ letter to everyone you know.

Of course, you can also email us back at 5k@uscpain.org to get more information, to volunteer at the race, to help in the planning of the event, to help get corporate sponsors, to donate items, or even to make tax deductable contributions to “Keck School of Medicine of USC” (note “USC Pain Center” in the memo section). Or simply send us your email and/or regular mail addresses to be on our mailing lists.

Our hope is that this ‘grass roots’ level of support finally gets RSD the attention it deserves! Your help CAN make a difference. Thank you so much for your interest and support of this exciting event, and we sure hope you can be with us on race day – it promises to be a very special event!

Best regards,
Steven Richeimer, MD
Chief, Division of Pain Medicine

I'll post additional information as I get it.

20 August 2007

Brain imaging for pain in the courtroom

Law Professor Adam Kolber has an interesting paper on attempts to use brain imaging as evidence that a person is in fact in pain. The abstract:
Pain is a fundamentally subjective experience. We have uniquely direct access to our own pain but can only make rough inferences about the pain of others. Nevertheless, such inferences are made all the time by doctors, insurers, judges, juries, and administrative agencies. Advances in brain imaging may someday improve our pain assessments by bolstering the claims of those genuinely experiencing pain while impugning the claims of those who are faking or exaggerating symptoms. These possibilities raise concerns about the privacy of our pain. I suggest that while the use of neuroimaging to detect pain implicates significant privacy concerns, our interests in keeping pain private are likely to be weaker than our interests in keeping private certain other subjective experiences that permit more intrusive inferences about our thoughts and character

I expect to have a bit to say about this later when I've had the chance to digest the paper. And, yes, I'll share.

USC Pain Run

This will be an important event. Normally I only run when chased, but I'll make an exception for this. Please help out however you can:
Dear Friends and Colleagues,

The USC Pain Center is planning an exciting event:

December 2, 2007, in Long Beach

for the support of education, research, and treatment of RSD

RSD (Reflex Sympathetic Dystrophy, aka Complex Regional Pain Syndrome) is a condition caused by a malfunction within the nervous system that causes chronic, burning pain. The condition can be severe and disabling.

Research, education, and most importantly, treatment efforts have been greatly hampered by a lack of awareness of this condition, even in the medical community. But RSD is not rare—estimates vary that between 200, 000 to 1.2 million Americans are currently suffering with this condition.

In order to garner as much support for this wonderful project as possible, we have one simple request of you. TO HELP SPREAD THE WORD, all you need to do is to forward this email/ letter to everyone you know.

Of course, you can also email us back at 5k@uscpain.org to get more information, to volunteer at the race, to help in the planning of the event, to help get corporate sponsors, to donate items, or even to make tax deductable contributions to “Keck School of Medicine of USC” (note “USC Pain Center” in the memo section). Or simply send us your email and/or regular mail addresses to be on our mailing lists.

Our hope is that this ‘grass roots’ level of support finally gets RSD the attention it deserves! Your help CAN make a difference. Thank you so much for your interest and support of this exciting event, and we sure hope you can be with us on race day – it promises to be a very special event!

Best regards,
Steven Richeimer, MD
Chief, Division of Pain Medicine

I'll post additional information as I get it.

22 July 2007

Snail venom: Boo

Following up on the last post, the darker side of snail venom:

Powerful New Poison found in Deadly Sea Snails
By Aaron Rowe EmailJuly 11, 2007 | 8:00:00 AMCategories: Biology, Medicine & Medical Procedures

Conusparius Spies with a penchant for exotic poisons can add a new one to their list – snail venom.

For more than 23 years, Professor Baldomero M. Olivera has been studying snail venom. This week, his team at the University of Utah reported their discovery of a completely unique neurotoxin in Conus parius, a mollusk that hunts along the coast in the Philippines.

Some sea snails produce poisonous darts to hunt small fish and defend themselves. For the past 35 years, scientists have been studying these powerful neurotoxins. All of them are peptides, short strings of amino acids that make up miniature proteins.

Cone snail venoms are more than an elaborate tool for assassination. In 2004, one of those toxins was approved by the FDA to treat chronic pain. Some day, they may be used to treat a variety of neurological disorders including Alzheimer's and Parkinson's.

In the journal Biochemistry, Baldomero and his colleagues Russell Teichert and Elsie Jimenez compared this new poison to the others that have been identified in the past two decades. All of them impair the function of neuromuscular nicotinic acetylcholine receptors. In other words, they inactivate a protein found in the nerve cells that control muscle movement.

To identify the unique neurotoxin, the biologists cut out the venom ducts from several snails, froze them, pulverized them, and then extracted the peptides from the pulp with a mixture of water and the solvent acetonitrile. They purified the peptide and used a machine to determine its amino acid sequence. Later, they injected mice and goldfish with the purified peptide to prove that it is in fact the deadly poison. They were right. A tiny amount would kill goldfish within ten minutes and mice within thirty.

Perhaps this new poison will also find its way into the hospital -- or at least the next James Bond film.

HT: Slashdot

19 July 2007

Snail venom: Yay

A bit old and a topic I've posted on before, but relevant:

Dr Jon-Paul Bingham, of Clarkson University, has an unusual note on his file at the local hospital in New York State.

If he is admitted unconscious, they are to check to see whether he has been harpooned by a deadly snail.

Every week, he milks lethal marine molluscs called cone shells for their venom, using a condom, barbecue tongs and a fish. If anything goes wrong, though, it is no laughing matter.

Cone shells look like a seaside souvenir from the tropics. You find them in places like the Great Barrier Reef or Hawaii. The shells themselves are sometimes two to three inches long, often with striking patterns which make them collectable.

These snails will produce millions of changes in their toxins that they use to kill their prey
Dr Jon-Paul Bingham, Clarkson University
The snails inside are not all poisonous but the fish-eating ones are right up there with snakes and scorpions in the danger stakes. If you get stung by one of them, there will be enough venom in your system to kill up to 15 people; but it is not entirely hopeless.

"Get on a life support system. There have been cases where people have survived," Jon-Paul says helpfully.

Biological 'kit bag'

It is quite an overkill for a little marine animal whose usual dinner is no bigger than a goldfish, but what grips scientists is not the potency of its venom but the complexity.

Cone snail (Clarkson)
On a par with snakes and scorpions
"These snails will produce millions of changes in their toxins that they use to kill their prey," Jon-Paul tells the BBC Radio 4 programme Danger! Venomous Snails.

"If they don't make these changes, they can be at an evolutionary disadvantage, so the snails have become good pharmaceutical chemists. It is these compounds that we are trying to harness to use as specific medicines."

One of these compounds is already at work. Just over a year ago, the US Federal Drug Agency approved the first of a new type of painkiller - Prialt® - which can work in cases where ordinary drugs fail. The drug has also been approved for use in Europe.

It blocks a particular channel in nerves which communicates pain signals to the brain. The original toxin behind the drug was discovered in the lab of Professor Baldomero Olivera, at the University of Utah, and he's excited about the future.

In close-up: The cone snail's harpoon
"There's an explosion of data about neuroscience and what can go wrong," he says.

"We'd like to understand and affect many different molecules in the normal brain. Using very specific toxins that wipe out the function of just one thing in the nervous system, lets us do that.

"We see applications in epilepsy, stroke and cardiovascular conditions. Some are in development and one has reached clinical trials."

Just the beginning

Another way of stopping strokes and heart attacks is to cut down on smoking. Snail toxins might help here, too.

Professor Bruce Livett, of the University of Melbourne, Australia, is looking at how they affect the nicotinic receptor - the very thing that gets a hit when you puff on a cigarette.

A drug to inhibit that might help you stop smoking, but this research is already tackling severe pain in diabetic patients.

Some species are threatened because of the actions of collectors
There could even be applications in Alzheimer's or Parkinson's disease, says Bruce, but one thing bothers him: we should take time to get to know the snail, not just its venom.

"There's a whole world of invertebrate biology out there far more advanced than our own mammalian biology," he says.

That is where Jon-Paul Bingham's work has been important. By developing his way of milking the snails, Jon-Paul keeps the animals alive in his lab and learns more about them.

He does not need to dissect the "goose that lays the golden egg" to study its venom. He analyses their venoms and then synthesises the compounds he finds for further work.

His hope is to set up a library of venoms to help other researchers get access to this field. He sees potential for snail toxins to be used in everything from agriculture to anti-fouling paints against marine worms.

Cone shells research appears to be advancing much more quickly than your average snail.

Danger! Venomous Snails was broadcast on BBC Radio 4 on Monday 27 March. It can still be heard at the Listen again page.


16 July 2007

Balkan et al. on toture

The legal blog Balkanization has compiled a list of all their posts on torture here. Definitely worth checking out.

13 July 2007

Mirror-touch synethesia

From The Week (not online so no link)
They feel your pain
Some people can feel others' pain --literally. When those with a rare condition called mirror-touch synethesia see another person being touched or hurt, they actually feel the sensation themselves. There are several types of synesthesia, a neurological syndrome that causes senses to cross paths in the brain. For some synesthetes, for instance, specific colors create distinctive sounds in their head. Experts had heard only ancedotal accounts of mirror-touch synethesia until neuroscientist Sarah-Jayne Blakemore discussed the phenomenon at a seminar in 2003. "There was a woman in the audience who asked 'doesn't everyone experience that? Isn't that completely normal?" Blakemore tells Nature. Since then, Blakemore has studied 10 other mirror-touch synesthetes. All of them have overactive mirror neurons, which are the brain cells that allow us to see an action and comprehend it enough to be able to mimic it. "I have never been able to understand how people can enjoy looking at bloodthirsty films," says Alice, one of Blakemore's study subjects. "I can feel it."

Two comments:
(1) To some extent all of us do this. For example, one of my students tells me that once her boyfriend accidentally pulled her hair and yipped 'Ouch!' before she said anything. He claimed that it actually hurt him when he did it (I'm presuming that he doesn't have this condition).

(2) In general, I've always thought synesthesia is one of the coolest neurological conditions. A friend with perfect pitch tells me that he can tell if a note is off by its color --for example, A 440 seems red to him. That sounds very cool (though I'm not sure how much I'd like to have the version discussed here).

10 July 2007

Next up: Sharks with lasers

Following up on the previous post on non-lethal technology, the universe has decided to laugh at me.

Armed autonomous robots cause concern
10:32 07 July 2007

NewScientist.com news service

A MOVE to arm police robots with stun guns has been condemned by weapons researchers.

On 28 June, Taser International of Arizona announced plans to equip robots with stun guns. The US military already uses PackBot, made by iRobot of Massachusetts, to carry lethal weapons, but the new stun-capable robots could be used against civilians.

"The victim would have to receive shocks for longer, or repeatedly, to give police time to reach the scene and restrain them, which carries greater risk to their health," warns non-lethal weapons researcher Neil Davison, of the University of Bradford, UK.

"If someone is severely punished by an autonomous robot, who are you going to take to a tribunal?" asks Steve Wright, a security expert at Leeds Metropolitan University, UK.


And the kicker is that its made by iRobot, maker of my beloved Roomba. My cats have been telling me there's something evil about that thing for years.

29 June 2007

Hello, Goodbye Gun

ABC News
Non-Lethal Weapon Makes Targets Feel Like They're on Fire
Active Denial System Called 'Holy Grail' of Crowd Control but Raises Ethical Questions

Dec. 8, 2006 —

"If you're a soldier dealing with an unruly mob, you don't have a lot of options," says Noah Shachtman, editor-in-chief of Defensetech.org. "You have the M-16 option, the bullhorn option, and there's not that much in between."

That is, until now. A new non-lethal weapon developed by the Department of Defense intends to give soldiers a third option in these situations.

The ADS, or Active Denial System, fires an invisible beam that penetrates the top 1/64th of an inch on a target's skin, hitting sensitive pain receptors and causing a burning sensation some have likened to being dipped in molten lava.

When the target steps out of the beam's path, the pain goes away instantly, causing no permanent damage and leaving no marks, bruises or burns.

Some military experts are calling it the Holy Grail of crowd control. But critics fear that after incidents like the Abu Ghraib prison torture scandal, the potential for the technology to be used for more sinister means is simply too great.

"The big concern is exactly what it's going to be used for and do we want a weapon that simply causes pain because there are all sorts of ways that this could be misused," said David Hambling, who has monitored the ADS and other non-lethal technologies and written the book "Weapons Grade: How Modern Warfare Gave Birth to Our High-Tech World."

Can we please be honest here? Whatever one thinks about the justifiability of this weapon or its purposes, we can all agree that it will, without a doubt, be used for torture. That's not necessarily a conclusive argument against it --one can also avoid marks with a car battery and jumper cables. But that's the reality.

The ADS looks like a flat radar dish mounted on a military Hummer. Engineers are also developing an airborne, shipboard and hand-held version as well. Operators use a focused camera that shows exactly where the beam will hit and fire on targets from afar, keeping the device and the soldiers around it out of range of small arms fire.

"If you've ever used a blow dryer on your hair, and if you leave the blow dryer in one place for too long, you have to move it away -- it's very similar to that effect," said Susan LeVine, principle deputy for policy and strategy at Defense Department's Joint Non-Lethal Weapons Program.

An apt analogy, I'm sure.

The device uses millimeter waves that are much easier to control than microwaves but have a similar effect -- they heat things up.

LeVine insisted that millimeter waves are not nearly as harmful as microwaves -- though both can cause cancer. She said extensive testing has proven that the device isn't dangerous beyond the pain it generates.

"It does not penetrate or reach deep into the body, so it's not going to affect your internal organs or pacemaker -- it's only going to touch the outermost surface of the skin," she said. "This is by far the most researched non-lethal weapon in the history of the Department of Defense."

According to LeVine, there are no know long-term side effects and the weapon doesn't cause cancer. She also said that due to the instinctive reaction to close one's eyes and turn away from the heat the beam generates, it has shown no negative effect on a target's eyesight.


LeVine said that testing the ADS on more than 600 volunteers over the last 12 years showed that it makes people run away, leading to David Hambling nicknaming it the "Goodbye Gun."

"When you feel that millimeter wave energy, you get a heating sensation, a clear distinct sensation that you know somebody's telling you to stop your actions and get out of the area," said LeVine.

But what if you're stuck in a crowd? Trapped on the ground or simply unable to get out of the weapon's path?

LeVine said that's not possible due to the operator's training and the camera used to target the device. She said the operator will see what is happening.

And obviously we can trust the operator to not blast the innocent. Obviously she won't be tempted to hold the beam on someone for just a bit longer than necessary. Of course she'll let them up to run away. I'm sure none of us would misuse the weapon when the unruly mob we're trying to control is threatening our injured comrades.

Sarcasm aside, I'm certain that I myself would be very tempted to misuse the weapon in some of the situations its proponents envision. Now, maybe its an option that soldiers should have. If I were in the crowd, I'd rather be tortured for a few moments than shot full of 5.56mm holes. But let's be honest about the fact that it will be misused and misused a lot.

Also, how long do you think it'll be before civilian police forces have these mounted on the roof of every squad car? I'm sure cops won't ever teach the smart-mouthed some respect or disburse nefarious-looking groups with a blast or two.

After all, its not like loud-mouths in libraries are getting Tasered


Uh oh. Apparently I'm a purveyor of filth:
Online Dating
This rating was determined based on the presence of the following words:
* pain (348x)
* torture (43x)
* sex (16x)
* cocaine (9x)
* drugs (8x)
* bomb (6x)
* abortion (4x)
* kill (2x)
* death (1x)

I've only used 'pain' 348 times?!?!?!?!

26 June 2007

Pharmacology bleg

I have a request for any of you who know about the pharmacology of antidepressants. I have a friend who is taking Wellbutrin (bupropion) for smoking and codeine for chronic pain. I'm curious whether the combination may be attenuating the effect of the codeine and thus whether he should talk to his doctor about changing the codeine dose or switching medications.

Here's why: Codeine itself isn't really an analgesic. It is a substrate of a polymorphic P450 enzyme CYP2D6, and is metabolized to the more potent drug morphine. Some SSRI's like fluoxetine inhibit CYP2D6 activity. Thus combining prozac with codeine can attenuate its effects (see below).

What I'd like to know is whether bupropion might have the same effect on codeine metabolism. But I can't find anything directly on the topic.

From this chart of the various enzymes involved, it looks like that might be the case. But then I found this in the Wikipedia entry on buproprion

As bupropion is metabolized to hydroxybupropion by CYP2B6, drug interactions with CYP2B6 inhibitors (paroxetine, sertraline, fluoxetine metabolite norfluoxetine, diazepam, clopidogrel, orphenadrine and others) are possible. The expected result is the increase of bupropion and decrease of hydroxybupropion blood concentration. The reverse effect (decrease of bupropion and increase of hydroxybupropion) can be expected with CYP2B6 inducers (carbamazepine, clotrimazole, rifampicin, ritonavir, St John's Wort and others).

Hydroxybupropion (but not bupropion) inhibits CYP2D6 and is a substrate of that enzyme. Significant increase of the concentration of some drugs metabolized by CYP2D6 (venlafaxine, desipramine and dextromethorphan, but not fluoxetine or paroxetine) when taken with bupropion has been observed.

So I need your help. Can anyone point me in the direction of studies on bupropion and codeine? Or maybe just explain this in a way I can understand?

For your enjoyment, here are a few studies of fluoxetine and codeine that I came across in looking for an answer.

Inhibition by fluoxetine of cytochrome P450 2D6 activity.
Otton SV, Wu D, Joffe RT, Cheung SW, Sellers EM
Clin Pharmacol Ther. 1993 Apr ; 53(4): 401-9

Potent inhibition of cytochrome P450 2D6 (CYP2D6) in human liver microsomes by fluoxetine and its major metabolite norfluoxetine was confirmed (apparent inhibition constant values, 0.2 mumol/L). Several other serotonergic agents were also found to be competitive inhibitors of this genetically polymorphic enzyme. The O-demethylation ratio of dextromethorphan that expressed CYP2D6 activity in 19 patients receiving fluoxetine fell in the region of the antimode separating the O-demethylation ratio values observed in 208 extensive metabolizers from 15 poor metabolizers of a control group of healthy subjects. Inhibition of CYP2D6 activity in patients undergoing treatment with fluoxetine or other serotonin uptake inhibitors could contribute to toxicity or attenuated response from concurrent medications that are substrates of this enzyme. Other in vitro studies indicated that CYP2D6 catalyzes the O-demethylation of oxycodone to form oxymorphone. This reaction was inhibited by fluoxetine and its normetabolite in liver microsomes from both extensive and poor metabolizer individuals, indicating that these compounds are not selective inhibitors of CYP2D6 activity.

Treatment of codeine dependence with inhibitors of cytochrome P450 2D6.
Fernandes LC, Kilicarslan T, Kaplan HL, Tyndale RF, Sellers EM, Romach MK
J Clin Psychopharmacol. 2002 Jun ; 22(3): 326-9

Codeine is O-demethylated by cytochrome P450 2D6 (CYP2D6) to form the more potent drug morphine, accounting for much of codeine's analgesic and dependence-producing properties. Because morphine production can be decreased by inhibition of CYP2D6, the authors hypothesized that CYP2D6 inhibition could be used to treat codeine dependence. A randomized, double-blind, placebo-controlled trial was conducted. All patients received brief behavioral therapy. Two weeks of baseline monitoring were followed by 8 weeks of daily treatment with fluoxetine or quinidine (two potent CYP2D6 inhibitors) or placebo. Thirty patients were assessed (all white, age 40 + 12 years using 127 + 79 mg/day of codeine [mean + SD]), and 17 entered treatment. Eight patients remained in the study by treatment week 8. Quinidine > fluoxetine > placebo inhibited CYP2D6 as reflected in the change of the O-demethylation of dextromethorphan, a specific CYP2D6 probe. At treatment week 8, placebo, quinidine, and fluoxetine reduced mean daily codeine intake by 57%, 56%, and 51% of baseline intake respectively; there was no difference among treatment groups. In this small sample, CYP2D6 inhibitors did not appear to have a useful role in the treatment of codeine dependence.

25 June 2007

The Daily Headache: Newsweek on Chronic Pain Research & Treatment

A potentially helpful blog for chronic headache sufferers :
The Daily Headache

15 June 2007

Torture in Iraq

Do not read this excerpt from Monstering: Inside America's Policy of Secret Interrogations and Torture in the Terror War (Carroll & Graf) if you've just eaten.

12 June 2007

Some links

A nice set of posts on pain from the blog the Transparent Eye.

And, in case I haven't linked to them before, check out the blog Psychology of Pain

07 June 2007

Sensory deprivation torture

From Salon:
The CIA's favorite form of torture
By Mark Benjamin

Jun. 07, 2007 | According to news reports, the White House is preparing to issue an executive order that will set new ground rules for the CIA's secret program for interrogating captured al-Qaida types. Constrained by the 2006 Military Commissions Act, which contains a strict ban on abuse, it is anticipated that the order will jettison waterboarding and other brutal interrogation techniques.


The answer is most likely a measure long favored by the CIA -- sensory deprivation. The benign-sounding form of psychological coercion has been considered effective for most of the life of the agency, and its slippery definition might allow it to squeeze through loopholes in a law that seeks to ban prisoner abuse. Interviews with former CIA officials and experts on interrogation suggest that it is an obvious choice for interrogators newly constrained by law. The technique has already been employed during the "war on terror," and, Salon has learned, was apparently used on 14 high-value detainees now held at Guantánamo Bay.

A former top CIA official predicted to Salon that sensory deprivation would remain available to the agency as an interrogation tool in the future. "I'd be surprised if [sensory deprivation] came out of the toolbox," said A.B. Krongard, who was the No. 3 official at the CIA until late 2004. Alfred McCoy, a history professor at the University of Wisconsin-Madison who has written extensively about the history of CIA interrogation, agrees with Krongard that the CIA will continue to employ sensory deprivation. "Of course they will," predicted McCoy. "It is embedded in the doctrine." For the CIA to stop using sensory deprivation, McCoy says, "The leopard would have to change his spots." And he warned that a practice that may sound innocuous to some was sharpened by the agency over the years into a horrifying torture technique.

Sensory deprivation, as CIA research and other agency interrogation materials demonstrate, is a remarkably simple concept. It can be inflicted by immobilizing individuals in small, soundproof rooms and fitting them with blacked-out goggles and earmuffs. "The first thing that happens is extraordinary hallucinations akin to mescaline," explained McCoy. "I mean extreme hallucinations" of sight and sound. It is followed, in some cases within just two days, by what McCoy called a "breakdown akin to psychosis."


Just like waterboarding, Massimino said, extreme sensory deprivation techniques "push people beyond the brink of what they can bear, physically and mentally. Once you understand that, the veneer of acceptability -- the myth that 'it's not torture, it's just harsh' -- completely falls apart." But compared to the outcry over physical torture, she described a "deafening silence" about techniques like sensory deprivation.

The issue, said Massimino, is that sensory deprivation is relative -- she compared it to a "rheostat." Former CIA executive director Krongard made the same point about sensory deprivation's variability, saying that the techniques exist on a spectrum. The term could refer to anything from being left alone in a room to being subjected to complex get-ups combining goggles, earmuffs, mittens and darkened cells that quickly drive subjects into psychotic states.

On the low end, said Krongard, sensory deprivation techniques would pass muster with most observers. But he admitted that taken to extremes, some methods "would not pass anybody's muster." Sensory deprivation techniques taken to extremes would clearly violate the Geneva Conventions, according to international law experts, and would appear to be illegal under the Military Commissions Act, which bans "severe or serious mental pain and suffering." McCoy stated that based on his experience tracking down and interviewing subjects from the CIA's early research, some subjects never fully recover.

Sensory deprivation has apparently already been employed during the so-called war on terror. The prevalence of its use has been hinted at in images of alleged terror-plotter Jose Padilla and of detainees at Guantánamo shown wearing blacked-out goggles and earmuffs -- basic deprivation tools intended to soften prisoners up mentally by plunging them into a sensory void. A source familiar with the 14 high-value detainees interrogated at the CIA's so-called black sites and transferred to military custody at Guantánamo late last year, said the CIA appeared to have used some form of sensory deprivation techniques on most, if not all, of those 14 high-value detainees.

But the CIA's reliance on sensory deprivation goes all the way back to the early days of the Cold War. It is a big part of the CIA's 1963 "KUBARK" interrogation manual, obtained in 1997 by the Baltimore Sun. That agency manual describes sensory deprivation as a central tenet of coercive interrogations. For particularly rapid results, the manual endorses the use of a "cell which has no light (or weak artificial light which never varies), which is sound-proofed, in which odors are eliminated, etc." Following that plan, the manual says, "induces stress; the stress becomes unbearable for most subjects." The manual adds, "The subject has a growing need for physical and social stimuli; and some subjects progressively lose touch with reality, focus inwardly, and produce delusions, hallucinations, and other pathological effects."

As proof, the KUBARK manual refers to a raft of CIA-sponsored Cold War research on sensory deprivation, including studies at McGill University in Montreal and the National Institute of Mental Health. Subjects in that research were placed in isolated water tanks or confined to silent rooms on soft mattresses, wearing blacked-out goggles and earmuffs. In one study, subjects experienced "visual imagery somewhat resembling hallucinations" within three hours. In another study, only 6 of 17 subjects could last 36 hours on a mattress in a quiet tank that prohibited movement. The stress is described in the KUBARK manual as "unbearable."

The dark world of CIA-sponsored sensory deprivation research is plumbed in depth in the book "A Question of Torture: CIA Interrogation From the Cold War to the War on Terror," written by McCoy. "They've been doing this for 50 years," McCoy explained. His book discusses more CIA-sponsored research at McGill by Dr. Donald O. Hebb, who during the same era placed 22 college students in small, sound-proof cubicles, wearing translucent goggles, thick gloves and a U-shaped pillow around the head. Most subjects quit within two days and all experienced hallucinations and "deterioration in the capacity to think systematically."

The theory behind the CIA's fascination with sensory deprivation, McCoy said, is that subjects are so starved for stimulation that they will even crave interaction with their interrogator. "The idea is that they break down and then they cling to the interrogator, because you are hungry for stimulus," McCoy explained.


Bauer, who was the most forward-deployed Army interrogator during Operation Desert Storm, said sensory deprivation can drive people to come up with lies "based on ending the harsh treatment. That is not an effective way to conduct intelligence collection operations."


If the White House chooses to go the sensory deprivation route, it is unclear what, if anything, Congress could do to put a stop to it. There are limited tools available to the Senate Intelligence Committee, the committee with direct oversight of the agency, to step in. As one committee aide explained, "We don't have a veto over it."

-- By Mark Benjamin
Copyright ©2007 Salon Media Group, Inc.


18 May 2007

NIH Pain Consortium conference

The NIH's Pain Consortium just held a conference. Looks like lot's of interesting stuff went on.

Here's the agenda. The videocast of it is archived here. Or, if you're a nerd like me, you can grab the podcast and listen to it at the gym.

Thanks to new friend and philosopher extraordinaire J.T. for the tip.

12 May 2007

Acupuncture and migraine

Doubt cast on needle therapy for migraine

By Nic Fleming, Health Correspondent
Last Updated: 1:05am BST 04/05/2005

Acupuncture is no better at reducing migraines than fake treatment, researchers say today.

A study involving more than 300 patients found the healing method did reduce headaches, but only by the same amount as placing needles at non-acupuncture points.

Recent studies have shown the needle treatment to be effective for relieving pain and improving function in osteoarthritis sufferers.

The treatment is becoming increasingly mainstream and is offered on the NHS following patient demand.

Some 10 per cent of Britons - two-thirds of them women - suffer from migraines and tens of thousands are believed to have acupuncture.

Dr Klaus Linde, of the centre for complementary medicine research at the Technische Universität in Munich, reports the findings in the Journal of the American Medical Association.

Using information from patients' diaries, the researchers found the average number of days a week when patients in their acupuncture group had moderate or severe headaches dropped from 5.2 before treatment to three after.

Those in a sham acupuncture group also had 2.2 fewer days with headaches, down from five to 2.8 days. The research contradicts previous studies.

One published in the British Medical Journal last year suggested migraine patients who had acupuncture had 22 fewer days of headaches per year, made 25 per cent fewer visits to their GP and used 15 per cent less medication than those on standard NHS treatment.

George Lewith, a senior complementary medicine research fellow at Southampton University, dismissed the new research.

He said: "This is a badly conceived study that just adds more confusion to the debate because it uses non-site specific acupuncture as a control."


20 April 2007

Torture on 24

Not a good thing
U.S. Army Brigadier General Patrick] Finnegan told the producers that “24,” by suggesting that the U.S. government perpetrates myriad forms of torture, hurts the country’s image internationally. Finnegan, who is a lawyer, has for a number of years taught a course on the laws of war to West Point seniors—cadets who would soon be commanders in the battlefields of Iraq and Afghanistan. He always tries, he said, to get his students to sort out not just what is legal but what is right. However, it had become increasingly hard to convince some cadets that America had to respect the rule of law and human rights, even when terrorists did not. One reason for the growing resistance, he suggested, was misperceptions spread by “24,” which was exceptionally popular with his students. As he told me, “The kids see it, and say, ‘If torture is wrong, what about “24”?’ ” He continued, “The disturbing thing is that although torture may cause Jack Bauer some angst, it is always the patriotic thing to do.”

Gary Solis, a retired law professor who designed and taught the Law of War for Commanders curriculum at West Point, told me that he had similar arguments with his students. He said that, under both U.S. and international law, “Jack Bauer is a criminal. In real life, he would be prosecuted.” Yet the motto of many of his students was identical to Jack Bauer’s: “Whatever it takes.” His students were particularly impressed by a scene in which Bauer barges into a room where a stubborn suspect is being held, shoots him in one leg, and threatens to shoot the other if he doesn’t talk. In less than ten seconds, the suspect reveals that his associates plan to assassinate the Secretary of Defense. Solis told me, “I tried to impress on them that this technique would open the wrong doors, but it was like trying to stomp out an anthill.”

28 February 2007

Pain's Evils

I just found out that my paper Pain's Evils will be published in Utilitas. Since this is my first major publication in a top tier journal, I'm quite a happy Adam. Once I figure out the copyright issues, I'll post a copy of the paper on my website. If you're interested in the interim, let me know and I'll send you a copy.

12 February 2007

Meditation resources

As we've seen here before, meditation can be an effective component to treating many types of chronic pain. From a new friend, here are some nice resources:

Mindful Awareness Research Center at UCLA; Podcast resources

www.mbsr.mass.edu: Mindfulness Based Stress Reduction; CD and book resources

www.contemplativeprayer: Christian Based Contemplative Prayer Information

www.contemplativemind.org: Introduction to a range of contemplative practices

Dershowitz on institutionalizing torture

Want to torture? Get a warrant Alan M. Dershowitz, Tuesday, January 22, 2002

AMERICAN law enforcement officers were ever to confront the law school hypothetical case of the captured terrorist who knew about an imminent attack but refused to provide the information necessary to prevent it, I have absolutely no doubt that they would try to torture the terrorists into providing the information.

Moreover, the vast majority of Americans would expect the officers to engage in that time-tested technique for loosening tongues, notwithstanding our unequivocal treaty obligation never to employ torture, no matter how exigent the circumstances. The real question is not whether torture would be used -- it would -- but whether it would be used outside of the law or within the law.

Every democracy, including our own, has employed torture outside of the law.

Throughout the years, police officers have tortured murder and rape suspects into confessing -- sometimes truthfully, sometimes not truthfully.

The "third degree" is all too common, not only on TV shows such as "NYPD Blue," but in the back rooms of real police station houses. No democracy, other than Israel, has ever employed torture within the law. Until quite recently, Israel recognized the power of its security agencies to employ what it euphemistically called "moderate physical pressure" to elicit information from terrorists about continuing threats.

This "pressure" entailed putting the suspect in a dingy cell with a smelly sack over his head and shaking him violently until he disclosed planned terrorist attacks. Israel never allowed the information elicited by these methods to be used in courts of law as confessions. But it did use the information to prevent terrorist acts.

Several attacks were prevented by this unpleasant tactic. In a courageous and controversial decision, the president of the Israeli Supreme Court wrote a majority opinion banning the use of this tactic against suspected terrorists.

The Israeli Supreme Court left open the possibility, however, that in an actual "ticking bomb" case -- a situation in which a terrorist refused to divulge information necessary to defuse a bomb that was about to kill hundreds of innocent civilians -- an agent who employed physical pressure could defend himself against criminal charges by invoking "the law of necessity."

No such case has arisen since this court decision, despite numerous instances of terrorism in that troubled part of the world. Nor has there ever been a ticking bomb case in this country.

But inevitably one will arise, and we should be prepared to confront it. It is important that a decision be made in advance of an actual ticking bomb case about how we should deal with this inevitable situation.

In my new book, "Shouting Fire: Civil Liberties in a Turbulent Age," I offer a controversial proposal designed to stimulate debate about this difficult issue. Under my proposal, no torture would be permitted without a "torture warrant" being issued by a judge.

An application for a torture warrant would have to be based on the absolute need to obtain immediate information in order to save lives coupled with probable cause that the suspect had such information and is unwilling to reveal it.

The suspect would be given immunity from prosecution based on information elicited by the torture. The warrant would limit the torture to nonlethal means, such as sterile needles, being inserted beneath the nails to cause excruciating pain without endangering life.

It may sound absurd for a distinguished judge to be issuing a warrant to do something so awful.

But consider the alternatives: Either police would torture below the radar screen of accountability, or the judge who issued the warrant would be accountable. Which would be more consistent with democratic values?

Those opposed to the idea of a torture warrant argue -- quite reasonably -- that establishing such a precedent would legitimize torture and make it easier to extend its permissible use beyond the ticking bomb case.

Those who favor the torture warrant argue that the opposite would be true: By expressly limiting the use of torture only to the ticking bomb case and by requiring a highly visible judge to approve, limit and monitor the torture, it will be far more difficult to justify its extension to other institutions.

The goal of the warrant would be to reduce and limit the amount of torture that would, in fact, be used in an emergency. This is an issue that should be discussed now, before we confront the emergency.

So, let the debate begin. . Alan M. Dershowitz is a Harvard law professor and a former member of the O.J. Simpson ""Dream Team.'' Last Sunday, he appeared on ""60 Minutes'' to make a case for legal torture. His latest book is ""Shouting Fire: Civil Liberties in a Turbulent Age'' (Little Brown, 2002).


Tortured torturer

From the Washington Post, a confession by a former torturer:

An Iraq Interrogator's Nightmare

By Eric Fair
Friday, February 9, 2007; A19

A man with no face stares at me from the corner of a room. He pleads for help, but I'm afraid to move. He begins to cry. It is a pitiful sound, and it sickens me. He screams, but as I awaken, I realize the screams are mine.

That dream, along with a host of other nightmares, has plagued me since my return from Iraq in the summer of 2004. Though the man in this particular nightmare has no face, I know who he is. I assisted in his interrogation at a detention facility in Fallujah. I was one of two civilian interrogators assigned to the division interrogation facility (DIF) of the 82nd Airborne Division. The man, whose name I've long since forgotten, was a suspected associate of Khamis Sirhan al-Muhammad, the Baath Party leader in Anbar province who had been captured two months earlier.

The lead interrogator at the DIF had given me specific instructions: I was to deprive the detainee of sleep during my 12-hour shift by opening his cell every hour, forcing him to stand in a corner and stripping him of his clothes. Three years later the tables have turned. It is rare that I sleep through the night without a visit from this man. His memory harasses me as I once harassed him.

Despite my best efforts, I cannot ignore the mistakes I made at the interrogation facility in Fallujah. I failed to disobey a meritless order, I failed to protect a prisoner in my custody, and I failed to uphold the standards of human decency. Instead, I intimidated, degraded and humiliated a man who could not defend himself. I compromised my values. I will never forgive myself.

American authorities continue to insist that the abuse of Iraqi prisoners at Abu Ghraib was an isolated incident in an otherwise well-run detention system. That insistence, however, stands in sharp contrast to my own experiences as an interrogator in Iraq. I watched as detainees were forced to stand naked all night, shivering in their cold cells and pleading with their captors for help. Others were subjected to long periods of isolation in pitch-black rooms. Food and sleep deprivation were common, along with a variety of physical abuse, including punching and kicking. Aggressive, and in many ways abusive, techniques were used daily in Iraq, all in the name of acquiring the intelligence necessary to bring an end to the insurgency. The violence raging there today is evidence that those tactics never worked. My memories are evidence that those tactics were terribly wrong.

While I was appalled by the conduct of my friends and colleagues, I lacked the courage to challenge the status quo. That was a failure of character and in many ways made me complicit in what went on. I'm ashamed of that failure, but as time passes, and as the memories of what I saw in Iraq continue to infect my every thought, I'm becoming more ashamed of my silence.

Some may suggest there is no reason to revive the story of abuse in Iraq. Rehashing such mistakes will only harm our country, they will say. But history suggests we should examine such missteps carefully. Oppressive prison environments have created some of the most determined opponents. The British learned that lesson from Napoleon, the French from Ho Chi Minh, Europe from Hitler. The world is learning that lesson again from Ayman al-Zawahiri. What will be the legacy of abusive prisons in Iraq?

We have failed to properly address the abuse of Iraqi detainees. Men like me have refused to tell our stories, and our leaders have refused to own up to the myriad mistakes that have been made. But if we fail to address this problem, there can be no hope of success in Iraq. Regardless of how many young Americans we send to war, or how many militia members we kill, or how many Iraqis we train, or how much money we spend on reconstruction, we will not escape the damage we have done to the people of Iraq in our prisons.

I am desperate to get on with my life and erase my memories of my experiences in Iraq. But those memories and experiences do not belong to me. They belong to history. If we're doomed to repeat the history we forget, what will be the consequences of the history we never knew? The citizens and the leadership of this country have an obligation to revisit what took place in the interrogation booths of Iraq, unpleasant as it may be. The story of Abu Ghraib isn't over. In many ways, we have yet to open the book.

The writer served in the Army from 1995 to 2000 as an Arabic linguist and worked in Iraq as a contract interrogator in early 2004.


H/T Digby

08 February 2007

Period pain


Ibuprofen beats acetaminophen for period pain

NEW YORK (Reuters Health) - Although both ibuprofen and acetaminophen reduce menstrual pain, ibuprofen appears to have more potent effects, according to investigators from the West Virginia University School of Medicine, Morgantown.

Although ibuprofen is accepted as an effective treatment for painful periods, or dysmenorrhea, Drs. M. Yusoff Dawood and Firyal S. Khan-Dawood note in the American Journal of Obstetrics and Gynecology, there is still controversy about the usefulness of acetaminophen. Acetaminophen, the active ingredient in Tylenol, is known as paracetamol in several countries.

To investigate further, the duo conducted a small trial involving 12 women with dysmenorrhea who were given three different treatments in random order for three different periods: 1000 milligrams of acetaminophen, 400 milligrams of ibuprofen, or an inactive placebo, four times daily for three days.

The women rated the active medications as being more effective than placebo. "However," Dr. Dawood told Reuters Health, "it appears that ibuprofen has a greater effect and patients also preferred it."

SOURCE: American Journal of Obstetrics and Gynecology, January 2007