Tuesday, October 31, 2006

Do pharmaceutical companies hinder sub-typing?

As I said before, I went to a talk on Genetics Of Complex Traits. I asked a question at the end (despite my stuttering :-). She presented work where they found statistical signals on 4-5 genes for a disorder. I asked her what this finding means. Does it mean that you need all 5 genes for the disorder to develop or just one of them or a combination? She said that this cannot be found out by the statistical analysis but by trial and error in the mixing of the compound impacting the genes in a medication.

Then I asked about sub-typing. Couldn't it be that there are 5 subtypes and each one caused by 1-2 genes. She said that sub-typing is very difficult to do. Apparently, pharmaceutical companies don't like to do research on sub-typing, because they prefer to sell a general compound for everyone rather than just for a subset where they make less money!

Genetics of complex traits

Yesterday, I went to a talk on Genetics of Complex traits. I learned a lot about the least advances in genetics. The progress is driven by two fields: new technologies to extract DNA and map the genes from samples, and new statistical methods to extract more information from the gene maps. In the future, we can expect much faster gene mapping and more squeezing out information from gene maps.

So we expect more advances for stuttering. The beautiful thing about genetics of stuttering is that you dont care about stuttering at all! You just talk your stutterers and test them. No need to define what a stuttering incident is, how to measure severity, and so on. No ideological bagagge, you just analyse the sample and see what's happening.

Monday, October 30, 2006

Getting rid of a habit: finally

Some time ago, I reported on my experience to get rid of a habit: see here.

I used to be really bad in swimming crawl, because I had problems with getting the breathing mechanism right. I used to choke when water came in my mouth.

Now it is completely gone. I do not choke any more when breathing doing crawl, because I unlearned a habit.

I am wondering how much bad habit is part of stuttering? Surely, we have habits in stuttering. How can you find out how much is habit and how much is underlying difficulties? Can you say that the more you practise the less stuttering? What are the criteria to distinguish between conditions based on a bad habit or based on more underlying difficulties?

Thursday, October 26, 2006

Disclaimer to reports on Pagoclone

My last post was a report of a first-person experience of taking Pagoclone. I am a bit uncomfortable that readers might consider the very positive report as solid evidence for the efficiency of Pagoclone as a medication to reduce stuttering.

There are several issues to consider:

1) A first-person experience is certainly a fact. The person truly does experience what he is reporting.

2) HOWEVER, the interpretation of what he is experiencing and why he is experiencing is an interpretation of reality. He has a theory on what is happening with him. And this is NOT, and I say it again is NOT, necessarily correct. His interpretation, his theory, could be wrong. An example: A man gives a woman flowers. She experiences positive feelings, and interprets that he likes/loves her. Her experience of being given flowers and the feelings associated are true. She also experiences her interpretation of this act, but (as many women know) her interpretation might well be completely wrong and he is just a womanizer!

3) Human often fall prey to logical fallacies, and that's why their interpretation is not be trusted in general, UNLESS the effects reported are very very strong and very many say it. But even then... But their experiences as such are mostly reliable. They truly did experience what they report.

4) Reports are "dangerous" due to the selection bias. Pagoclone might have no effect at all, and lets assume stuttering fluctuates greatly over time (as it does). Then BY CHANCE some will experience a decline in stuttering at the same time as taking Pagoclone. And they and the readers of the reports might associate this correlation with a casual link even though it is just a pure coincidence.

Tuesday, October 24, 2006

Experience of Pagoclone

A reader has sent me this report on his experience on Pagoclone:

The drug hasn't completely 'cured' me, but has helped tremendously. What I say to the folks in the clinic is -- am I supposed to sound like the folks on tv? So nice and so polished? Sometimes I do. Sometimes after a caffeine high, I just rip through my speech like an auctioneer.

I'm also getting a little more bold. I talk to people in public who I wouldn't have a year ago. At the pizza place, I now ask to change marinara sauce to garlic. Also, I never suffered from anxiety. I'm very laid-back. I have a rough time saying my name and introducing myself. But it's gotten a little better. I still drag out my first syllable, but it's not as long as it used to be. And I'm able to jump right into whatever I need to say so the listener doesn't think twice about it. Honestly, I feel that maybe the drug is relaxing me a bit more. That it's sort of forcing me to slow down my verbal output. It's strange. And as you said about the placebo effect, it's uncertain about what else is happening after I start speaking more fluently -- confidence builds, words are easier, I start smiling more, etc.

I've had absolutely no side effects from this as all. Then again, this is all just me. Your mileage will, of course, vary. I think once the next phase of this trial is over, I might get off the drug for a bit just to see what happens. I'm curious about the confidence effect. And the fact that I'm maybe thinking about slowing things down a lot more to make it easier. I'm also talking to my son more -- and not stuttering. He might have an effect.

Monday, October 23, 2006

Stuttering in Asia

Stuttering is relatively constant across cultures, suggesting that it is a generic problem of speech function rather than a culture-induced one.

Check out Jhong Ren's blog on Asia and stuttering.

Sunday, October 15, 2006

Similar in stuttering??

I just read an article that discusses how inefficient information transfer between regions could be at the origin of autism.

Could this mechanism be at play in stuttering, too?

Tuesday, October 10, 2006

Transfer practise in the virtual world?

Felix wrote to me:

I have found a new study about Reality Virtual and stuttering. I believe it could be very useful for the treatment of stuttering. For the example, desensibilization, learning better the cancellations, pull-outs and onset,…etc,.etc..

The study are is, “Frequency of stuttering during challenging and supportive virtual reality job interviews”.

Link to article is here.

What is your opinion? In the future can there exist a commercial software to treatment the stuttering? Not only in interviews, but also in the bus, underground, nice girl ;-)

I have looked at the article and, to be honest, I am not convinced. It could well be useful to practise speech techniques in a safe environment. But you can do the same in group therapy with the other real participations. In any case, you still need to go out there and practise in real life situations.

And I am not sure I would be as excited by a virtual girl than by a real girl!! :-) But maybe we can have Lara Croft as the virtual girl and we need to try to chat her up! For female stutterers, I am happy for the software maker to make a digital copy of me... :-) Or alternatively, they can practise their techniques by phoning me: 00352 26835033.

Defects somewhere on the medial system?

In a previous post, I put the idea forward that thinking in terms of a defect somewhere on a circuit is a more natural way of thinking about stuttering. It naturally includes the possibility that different malfunctions are causing stuttering and that they all have roughly the same basic symptoms (because they have malfunctions on the same circuit).

The best candidate of such a circuit might be the medial premotor system (the basal ganglia and SMA). Per Alm has put this forward in his PhD thesis. I have written about it extensively, for example here. Roughly, the brain has two parallel dual premotor systems: the medial for automatic speech (where we emphasise on content of speech), and the lateral (where we emphasise on the form of speech). Of course, if we assume that the malfunction can be anywhere along the medial system (and the fibers connecting it to speech/language regions), we will not be able to get clear experimental observations as for each defect another region is affected?

Monday, October 09, 2006

The logical fallacy of NLP

Neuro-linguistic programming (NLP) is quite fashionable and controversial nowadays. It is a personal development framework based on supposedly the latest knowledge of neuroscience. It is interesting because there are many new stuff coming out of neuroscience which might help someone to change and improve their life. However, there is so much pseudo-scientific concepts floating around and so many crackpot arguments and discussions. It is a bit of a shame, because I strongly believe that understanding our brain better gives us more efficient tools to change behaviour and attitudes.

NLP is applied to many different areas. And of course, people are now using it in stuttering. Probably the most well-known advocate is Bodenhamer. There are several things that get a bit on my nerves:
1) He and others are mis-using NLP. It is fine to propose methods and frameworks to change behaviour and attitude. But they are pushing it by claiming that stuttering is cognitive rather than physiological: see website.
2) They have no proof for their theory in fact genetics and brain imaging strongly disproved their case.
3) There is no study that shows that their approach is effective.
4) They seem to believe that if you really really want you can achieve anything by re-wiring your brain. But there are clear physical limits in your ability to do so.
5) Why are they so dogmatic? It would be very easy to combine both views i.e. that is physiological and secondary effects and social handicap are strongly modulated by cognitive thought processes which can be changed with NLP or other methods.

Wednesday, October 04, 2006

Poll: Results

Thanks a lot for your voting!

I have to admit that I am surprised by the outcome. More than half of you would take Pagoclone even for only moderate impact. Of course, you might not be representative for the general stuttering population.

I was guessing that about 10% would take Pagoclone (or another medication), but it seems to be more.