I fixed it.

August 31, 2009

Ceviche and Tomato Confit in the bowl, Tomato Tartar with Mozarella, and Pomeganate French Soda

Ceviche and Tomato Confit in the bowl, Tomato Tartar with Mozarella, and Pomeganate French Soda

I made a ceviche a while ago and was not very pleased with it.  Then I got a suggestion from Dean of Alchemy Farms (my brother-in-law) and I worked out a new ceviche.  Pleased, I shared it with my roommate.  I originally wanted to make the  ceviche in the tomato confit I was making to pair it with.  I became wary of this after consulting some of my foody friends and decided to make tomato tartar, put it on some toasted ciabatta, and place with some fresh mozarella instead.  In the dish I put the ceviche on a bed of arugula and put some toasted ciabatta and tomato confit around it.  That was my compromise for not being able to marinate the sea bass in it.

Tomato Confit fresh out of the oven
Tomato Confit fresh out of the oven

The drink I paired it all with has a story.  I used to work at a cafe in a basement.  The owner of this cafe was Armenian and antisemitic (exhibited by by clear factual references to The Protocols of the Elders of Zion), but he was a pretty damn good cook of his region’s food.  Often making me (there was non turnning this guy down – he would get so excited about it) try new drinks (e.g. anise seed tea, english breakfast and clove tea) and new foods (e.g. pita with olive oil, za’atar, and labna).  The drink we had this night was kind of a pomegranate french soda.  Just a bit of pomeganate molasses, soda water, sugar, half and half, and ice.  Very good.  It has a pleasant tartness to it.

Sadly, while I fixed the ceviche, I did run into another problem: BLUE SCREEN OF DEATH.  My computer will only run in Safe Mode now.  I was planning on building another computer soon, but I was hoping this one would last me until I saved a few dollars to build the new one.  AHH!!! Lame!

Decartes’ (Other) Error

August 22, 2009

There is something called Descartes’ Error; it’s too hard for me to explain.  But Descartes did say that we should doubt everything, and that includes our senses.  Blasphemy!  Our senses are all we have to live by, and if I can’t be sure about them, how can I even be sure of my thinking or doubting since all I think or doubt is that which I perceive?  Well, that was enough armchair philosophy for the day.

You might expect that doubting your senses would induce you to check that pilot light once more (did you really see it was lit, or did you forget), but it turns out that perseverative checking, that is, looking at a word over and over again or looking at the pilot light now and now and now, can create a doubt of your senses, doubt of your memory, and dissociation of the self.

The study took healthy students and asked them to stare at a light or flame for a period of time. There were three staring sessions per student ordered by time (10 sec-10min-10sec) – some with gas-gas-gas, some light-light-light, some gas-light-gas, and finally some light-gas-light in order to see if changing stimuli changed derealization and uncertainty.  After the first and last staring session  the students completed a questionnaire that measured derealization and uncertainty.

It turned out that these healthy students who had no history of mental illness were induced to show symptoms extremely similar to patients with Obsessive-Compulsive Disorder (OCD).  Though not statistically significant, the students who stared at the same thing for all three sessions showed the symptoms more strongly.  I would guess that if the number of subject were increased this would come out to be a significant difference.  What the researchers found in this case was that uncertainty of memory and perception increased more than dissociation, but there was a moderately strong positive correlation between the two (pearson’s r=0.43).

Another interesting thing the authors talk about in the discussion is that OCD behaviors seem to be the person explicitly taking over and implicit process.   Most of the time people read words without conciously trying to read them – hence the stroop task for experiments which try to induce error – but in OCD it seems that individuals try to conciously take over this process.  The authors mention something that it is likely everyone has experienced – reading a word many times and suddenly, the word seems strange and foreign to you, for some reason it is odd that this word goes with the definition it has been given, why is it spelled that way, wait . . . what is the word?  Many of our brain processes actually work better in automatic than in forced overdrive: immediately think of 9 negative memories from your childhood.  Pretty hard.  But if you are promted by a stimulus suddenly a memory will come rushing back to you.

That prompting is called spreading activation in cognitive psychology.  There are memories, items, places, smells, tastes, etc. that are interlinked in our minds (we all know this already, but sometimes we can be oblivious to the obvious), when one of those things becomes reactivated it gives some activation to those ideas that surround it.  This is just an analogy, but think of each individual sense, like the taste of peanut butter as a neuron connected to 5 other neurons: Nelson’s chocolate peanut butter icecream, mom’s PB&J’s, PB in your hair, thai peanut sauce, and toast.  When you take the peanut butter out of the cupboard that one neuron gets activated and sends out a little spark to all those connected to it and all of a sudden you have a bunch of ideas about what to do with the PB, a craving for ice cream, and memories of eating PB&J with mommy in the park.

It turns out that taking that automatic process over with explicit functioning weakens it by raising performance standards and makes one less confident of one’s memory and/or perceptions.  Maybe Descartes was a bit OCD and that’s why he hated his senses.

The authors finish up the paper with the conclusion that the best therapy for OCD and checking behaviors are then Exposure and Ritual Prevention Therapies, which are already conducted with people with OCD.  However, this does shed new light on why they work, and it may allow clinicians to focus their energies on therapies that are more effective, thus making treatment a shorter period (and more appealling for insurance companies to pay for).

van den Hout, M.A., Engelhard, I.M., de Boer, C., du Bois, A., & Dek, E. (2008). Perseverative and compulsive-like staring causes uncertainty about perception. Behavior Research and Therapy, 46, 1300-1304.

Regimented

August 15, 2009

9am. 1pm. 5pm. 9pm.  And sometimes between those times.  Usually the psych meds are only given in the morning and evening, unless there are anxiolytics involved (anti-anxiety medications e.g. Ativan, Klonopin, Xanax, Valium), then the physical medications are given throughout the day.  The medications are scheduled like this because the psych meds have lots of side effects that can slow you down during the day e.g. drowsiness, dizziness, restlessness, agitation, etc.), so sometimes it is better to take them at night.

I kind of played a trick on you.  I’m actually going to talk about medication effectiveness and cost.  It is a huge deal with antipsychotics because some of the newer ones (“atypical” or “2nd generation” antipsychotics) can be extremely expensive.  We’re talking about thousands of dollars a month.  And any of you who pay taxes are footing the bill for them through Medicaid, which pays for about 75% of the antipsychotics used to treat people with psychosis in the U.S.  This frustrates me to no end, and not because I am mad about helping people stay sane, but because the pharmaceutical companies know they get their money from the government, and yet, they charge exorbitant amounts for their drugs.  The amount of money this comes out to every year: $10, 000, 000, 000.  Amount paid for by taxes via Medicaid: $7, 500, 000, 000.

The argument for many years has been that the second generation antipsychotics, though more expensive, cause fewer medical problems for the patients so the overall cost is reduced.  If it is true that the 2nd gen drugs cause fewer medical issues and do in fact reduce the symptoms of the mental illness, then it can be said that the patients are experiencing a higher quality of life.  Fantastic!  Only, that’s not how it works out.

The National Institute of Mental Health (NIMH) put up some major funding for a research project called Clinical Antipsychotic Trials of Intervention Effectiveness, affectionately called CATIE.  The investigation pitted four 2nd gen antipsychotics (generic names: olanzapine, risperidone, quetiapine, ziprasidone; trade names: zyprexa, risperdal, seroquel, geodon respectively) against a 1st gen (generic name: perphenazine; trade name: trilafon).  Following about 1500 patients over 18 months of treatment this is probably the most extensive antipsychotic test put out.  Even though this research may have cost a million dollars to conduct, if the results favor a cheaper drug and psychiatrists’ prescribing habits can thus be changed, think of how much it could save tax payers and the government.

The reason that such and extensive study was needed is that drug companies like to fund and publish only data that supports their chemical.  It’s bad advertising to put out a study that points out that your drug is less effective and causes more side effects than the other drug company’s drug.  Many of the studies that are published have issues with validity.  That is, they should not be applied to the patient population because of major flaws in how the study was conducted such as measuring effectiveness simply by levels of symptom management rather than quality of life, or measuring cost effectiveness only by taking into account direct health care costs to the patient, when leaving cost to the family out (family’s ability to work and play i.e. earn and spend, due to patients illness).  Sadly, the complete truth is not always what you get out of the studies, so an impartial party (or economically cheap party, in this case), needs to step in and do the comparisons.

The results were unsurprising to me.  Perphenazine was consistently cheaper than all of the 2nd gen antipsychotics, by about $200-$300 a month.  Over time, the difference between perphenazine and the 2nd gens did close, but it still remained significantly lower.  And the reason the costs closed in near one another is because people with schizophrenia generally discontinue taking their medications after some time (after about 18 months, you can count on 70% of a given population of people with schizophrenia discontinuing their medications due to a delusion or believing they are healthy now).  In the case of this study, those people taking perphenazine were then switched to a 2nd gen medication, but were kept track of as the “perphenazine group.”  In the end, the total amount saved by the perphenazine group was about $300-$600 per person.  The great part: along with olanzapine, perphenazine outperformed all the other 2nd gen medications and olanzapine is going to go generic any time now, which means the other highly effective drug is going to be cheap too.  The one benefit that olanzapine had was that people were likely to stay on it longer than perphenazine (9.2 months compared to 5.6 months).

The problem with olanzapine is that the weight gain issue is well . . . huge.  I know residents that came into Andrew Residence at 150 lbs and are now weighing in somewhere around 300 lbs.  Because of this they are also either shooting insulin frequently, or taking metformin (trade name: glucophage), which is a non-insulin dependent diabetes mellitus (NIDDM) drug.  It turns out that a metformin prescription may help control weight gain if it is prescribed right with the antipsychotic though, which is what I plan on researching next.

Polsky, D., Doshi, J.A., Bauer, M.S., & Glick, H.A. (2006). Clinical trial-based cost-effectiveness analyses of antipsychotic use. American Journal of Psychiatry, 163, 2047-2056.

Rosenheck, R.A., Leslie, D.L., Sindelar, J., Miller, E.A., Lin, H., Stroup, T.S., McEvoy, J., Davis, S.M., Keefe, R.S.E., Swartz, M., Perkins, D.O., Hsaio, J.K., & Lieberman, J. (2006). Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. American Journal of Psychiatry, 163, 2080-2089.

Raw Fish and Fat

August 7, 2009

Another one of those meals my friends might be freaked out about.  I made ceviche!  I stopped over at Coastal Seafoods for my fish and picked up two large scallops, four monster shrimp, and a third of a pound of sea bass.  I asked the totally suave and hip dude behind the counter, “how often d’you guys get your fish order?”  After a piss-pore attempt to stiffle his scoff he said “Everyday.”  Apparently, I should have assumed as much.

Ceviche

I came home and peeled my shrimp of their shells, butterflied them, and removed that thread of a vein down their spines.  Then I sliced the scallops thinner because I was not sure that the lime would penetrate the whole crustacean and “cook” it all.  The sea bass I tried to slice on the diagonal like a sushi chef, but dull knives are quite the hindrence.  All of this went in a bowl with some red onion ribbons and diced jalapeno.  I poured lime over the top and let it cook in the fridge for a couple hours.

The plating was not as pretty as I imagined, but the fish and crustaceans had turned that creamy white color that told me they were done.  We dug in a little before I remembered the picture taking.  My guests always get a kick out of this and poke fun.  Sadly, the texture disconcerted me a bit and I was a bit scared of the food, but I ate anyway trusting my chefery and . . . I am still well!  No sickness.  Thanks be to citric acid!

The Minneapolis Farmer’s Market proudly displays its banner of “The Largest Open Air Market in the Upper Midwest.”  I frequently spend mornings there just browsing.  Sometimes I talk with a vendor about a product after eating one of the “child’s” hot dogs only to find out 5 minutes later I have a glob of mustard sitting on my whiskers above my upper lip.  There is just something so awesome about going to an open market and scarfing street food down your gullet.  But I digress.

Leeks in Cream and salt and pepper

Leeks in Cream and salt and pepper

I got 6 leeks with some the most intense flavor I have had from leeks a short while ago for only $2.  A steal, I say!  I chopped their tops, sliced their bottoms, and flayed their insides (cut them in half, lengthwise).  After cramming them into a baking dish I sprinkled some kosher salt and cracked some pepper over them.  Now for the disgustingly delicious part: I poured 1.5 cups of heavy whipping cream over them.  Shutting them in the oven for 40 minutes at 375°F makes them come out tender and lovable.  So simple and so fricken delicious.