Tom is skiing

But I might post after an apres-ski session. If so, please disregard the post. ;-)

Get rid of bad and mediocre researchers

I am sorry for the emotional title. I have come to the following two conclusions:

1) Bad or mediocre researchers are much worse than not having them at all. Often, any extra help even if not-very-skilled is welcomed. For example, in charities everyone can contribute towards the success of a charity, and tasks are often allocated by ability. And if not, this happens the next time around when new tasks are assigned and people have complained. But in research, you need two good scientists to undo the work of one bad or mediocre researcher. Not only do they not contribute towards advancing our knowledge, in fact they actually destroy knowledge. By producing one flawed article after the other, the research field is flooded with much useless, distorting and misleading information. I read so many studies on PDS, and I often find it hard to judge whether I can trust the results or not... This takes a lot of time, and is often inconclusive as I was not present at the experiment. Finally, bad or mediocre researchers often go or are pushed into managerial roles (often aided by superior political skills and self confidence as opposed to the good but nerdy scientist), which makes the situation even worse. Now, they have power and money to conduct bad research, and flooding the field and conferences with confusing ideas...

2) Often I read articles written by people who are clearly intelligent but completely miss the point as they lack the necessary insight. It is often not their fault. It is just that their education had not exposed them to the right experiences to be a good scientist, they lack mathematical understanding or good people from whom they can learn by discussing their ideas. They are like the victorious warrior, and then you have point out to them: Yes, congratulations, you have conquered the fortress, but it is the wrong one. They are not our enemies but stayed neutral. So we wasted 3 weeks of our time, 100 soldiers, but gained their eternal hatred. This is especially true for some therapists who turned researchers. They are clearly intelligent, but mixed with the wrong people and education (for being good researchers that is and not for being a good therapist).

OK. That's enough science jingoism from me. :-)

IFA 2006 in Dublin

The latest IFA announcement with new schedule and prices is out: download this pdf. The IFA (International Fluency Association) conference is one of the main conferences.

IFA 2006 is held in Dublin from 25th to 26th of July. And the price is not cheap - End of July is the main tourist period... But I am going to give two small seminar talks - so well worth the money... ;-) I will talk about shortcomings in the statistical setup of the Liddcombe trial, and a summary of How To Use The Internet For Research.

Anti-pagoclone

I have spoken extensively about Pagoclone, a drug that is currently undergoing trials for stuttering. One important issue is whether Pagoclone increases fluency, because anxiety is reduced or because somehow more control of the speech system exists. I believe that anxiety-reducing effects are a significant part of the effect. Not so much for low-stress situations, but for stressful situation.

I am wondering what happens if people get an anti-Pagoclone, e.g. if it reduces the level of X, then a drug that increases the level of X? If anti-Pagoclone does not cause stuttering in normal people, I would guess that anxiety-reducing effects are most important? Or not?

Robin on Liddcombe

Here are some additional-to-my comments by Robin Lickley on the Lidcombe RCT (Random Control Trial):

(1) If you (i.e., 'one') accept that the Lidcombe RCT shows a treatment effect, then you may conclude that some (not necessarily all all) of the Lidcombe treatment is effective. But you can't conclude that this means that Lidcombe Prog is better than other therapies, because there is no similar test of other therapies. As the Lidcombe BMJ paper suggests, the most that can be concluded is that Lidcombe is better than nothing.
I think this is just restating this risks in your point 3.

(2) An additional consideration that is overlooked just about everywhere concerns what/who is being treated and assessed.
Almost all discussion of the efficacy of this programme makes the assumption that it treats what it says (or implies) it's treating: that is, it's treating the disorder that would otherwise turn into persistent stuttering.
However, obviously, we can be reasonably sure that a lot of the kids in the treatment arm would have recovered spontaneously - they're the ones with transient stuttering (TS). It is not unreasonable to suggest that these TS kids could also benefit from treatment and recover faster than they would otherwise.

If it is the case that children with transient stuttering can benefit from therapy, then if you were able to identify a group of 54 kids with transient stuttering, divide them into 2 groups and treat one group with the Lidcombe programme, while leaving the others alone, you might just get very similar results as those reported in the BMJ.

In the most pessimistic view, it could be that transient stuttering and persistent developmental stuttering have different etiologies and require different interventions and that the various therapies for children who stutter are actually only effective in speeding recovery of those with transient stuttering and not effective at all in preventing the continuation of persistent developmental stuttering.

I can almost hear you thinking 'we need brain imaging studies on kids in order to differentiate', but behavioral studies can also be revealing.
Cheers,
Robin

Sex, drugs & stuttering

Pagoclone is turning out to be a wonder drug. Now Indevus, the company that owns Pagoclone, wants to test the drug to prevent "un-blocking", namely premature ejaculation!! So if you are a pre-ejaculating stutterer, Pagoclone solves two problems in one go! Seducing her with smooth speech, and standing power...

Here is the text:

Indevus Pharmaceuticals, Inc. (NASDAQ: IDEV) today announced that it has filed a New Patent Application with the U.S. Patent Office covering the use of pagoclone as a treatment for premature ejaculation (PE). The patent filing is based on evidence of pharmacologic activity contained in the Company's existing clinical databases.

"Premature ejaculation is one of the most common sexual dysfunctions in men, affecting approximately 30% of the adult male population," stated Glenn L. Cooper, M.D., chairman, president and chief executive officer of Indevus. "There are currently no approved oral drugs in the United States for the treatment of PE. The normal ejaculatory response is controlled by multiple neurotransmitters, including serotonin and GABA. There is evidence that drugs that stimulate or increase the levels of GABA in the brain may delay the ejaculatory response."

"Pagoclone is a selective, non-sedating GABA-A receptor partial agonist, studied extensively in the past for anxiety disorders and currently being studied by Indevus in a Phase II trial for the treatment of stuttering," continued Dr. Cooper. "We have found evidence within our existing database that patients have described ejaculatory delay on pagoclone. Based on these observations and the pharmacologic rationale, we intend to form an internal project team to explore the clinical and regulatory path to proof of concept studies of pagoclone as an on-demand oral therapy for men with PE. Pagoclone for PE would be an excellent strategic addition to our urology and men's health franchise."

REVIEW: Comprehensive Stuttering Therapy

I am reviewing Phillip Roberts' Comprehensive Stuttering Therapy. His success at achieving lasting fluency compelled him to write this book in order to help other stutterers. He is very successful at providing a wealth of useful advice to the person who stutters and wants to achieve greater fluency. And most pleasantly, at the right pitch. He shares his views, experiences, and advice but never in a dogmatic way: "This book should be of great help to most stutterers but I cannot guarantee it will work for everyone. There is a slim possibility that ... you might not notice any improvements. If such ... don't give up. You can consult a speech pathologist or search the Internet... If there is a will there is a way." He does not promise an instant cure without hard work: "This book should allow you to improve your fluency and eventually totally eliminate stuttering from your life. You were probably dreaming of a therapy that would enable you to control stuttering in just a few days and might somewhat disappointed to read that it will a longer period of time...". And, he understands the greatest threat to a lasting improvement: "Achieving fluency is a daunting task but maintaining fluency is not easy either... it is very likely that you will relapse sooner or later."

His work is divided into three parts: theoretical descriptions of stuttering, therapy for adults and teenagers, and therapy for children. By far, the biggest part consists of advice to adult stutterers. He proposes a set of 30 exercises focusing on two different areas Valsalva Control, and Changing Your Behaviors, Perceptions, and Feelings. I wholeheartedly agree with the exercises in the second section, but I still remain to be convinced about his emphasis of the Valsalva control, but to be fair, I haven't tried. I will discuss it in a future post.

So is his approach superior to others? You might as well ask whether this diet better is than that diet, and the answer is: Every diet works if you do what they say. This is the crucial point of his approach, too. You need to be highly motivated, focused, and patient. You need to have an obsessive drive to change your outlook and your behaviour; and not fear challenges. I feel that he could do more to cover this most crucial aspect. Sure, there is no secret potion to generate motivation, but he might have addressed tools like auto-suggestion. For example, he could have suggested sentences the reader should read aloud every evening or morning.

Another weak point is his theoretical descriptions. He did a good job in showing how our feelings and behaviours are linked. He exclusively deals with the symptoms of PDS, and how they reinforce the severity of stuttering. But he completely and utterly ignores the scientific research into PDS. I think his book will be of greater value if he adds one or two sections to inform the reader of the nature and origin of stuttering. Things like % of population that stutters, skewed sex ratio, genetics, 80% of kid recover. Sure, our understanding is not perfect, but to put PDS in perspective.

I want to conclude my review with a quotation from his book: "He sent a copy... to his parents, and they wrote back: This is the kind of book we wish we had read years ago when you started stuttering. During all those years, stuttering was a total mystery to us". I wish I had read his book during my teenage years for dealing with my stutter: advice for treatment and a positive attitude. But his book would have done nothing to inform me about the nature of stuttering. And PDS is still a mystery to me.

Talking too much

We always complain that we are not able to talk a lot due to our stuttering. But I am not sure the opposite, namely talking incessantly, is a good thing either. I went swimmming this evening, and there was a guy in the changing rooms (lockers' for the US readers just in case they ask me why I want to change rooms like the lady at the hotel reception did in NY). He was alone, and he was talking to himself, and to everyone else in the changing rooms even though he didnt know anyone and no-one replied to him. He was obsessively talkative, and much of what he said was small talk intermixed with more meaningful speech. He noticed that I looked at him a bit strangely. Then he pointed to a scar and said: I had an car accident as a teenager. So I just asked him: "Are you OK now?" And he said: "I am fine." But then I replied: "But you are talking all the time. And you only started to do this after your accident, right? You cannot control yourself not talking!" And he looked at me, and said: "Yes, it is true. I am not the same as before the car accident. But I guess that is life." And then I said something, but I stuttered. His face suddenly brightened up and he said: "But you too have problems!". So I tought: "Oh my God, I am outed again", and left for the swimming pool with my best wishes for his getting better. At least, I did make him happier with my stuttering. Not often that this happens! :-)

Perfectly Fluent

Research always looks at people who stutter. Some researchers look at fluent people who are dysfluent: like Robin Lickeley does. I would like to look at the TV or radio presenter who are never dysfluent. Admittedly, there are some who are also a bit dysfluent, but there are some that are PERFECTLY FLUENT. Their speech is just sooo smooth and gently flowing... a joy to listen to. Clearly they are the antipodes to the stutterers. And in the middle, the vast majority of people who are a bit dysfluent or have hesitant speech. We stutter, and they anti-stutter.

What makes them so fluent? A higher level of concentration? A bigger brain area? We should put them under the brain scans, and then compare their brain activity with the PDS people. Shouldn't such a design give us even clearer signals??? Currently, controls are "normal" people who have some dysfluencies, and the difference between them and the people with PDS might be less clear than for perfectly fluent people.

Shell's Stutter

Today, I received a review copy of Stutter published with Harvard University Press. The author is Marc Shell, professor for Comparative Literature and English at Harvard University, and a stutterer himself. Prof Shell is famous enough to have his own Wikipedia entry.

A cheeky theoretical physicist, which also happen to be the author of this blog, is already looking forward to writing a review on Stutter in his third foreign language commenting on work by a professor of English at Harvard! :-)

As I am unfortunately also lazy, you might have to wait a few weeks... So in the mean time, you can get more details or buy the book: here.

Busy

I am busy...

So here some challenge for you.

You can ask God five questions about PDS, and he will answer them. What would they be?

A disability?

Einar has asked me whether I think stuttering is a disability. In short, the answer depends on your definition of disability! :-)

Here are some thoughts. PDS is not your stereotypical disability because

1) PDS is not a very apparent, 100% permanent and constant-in-severity physical or mental disability like being blind, deaf, no leg, legs paralysed. (But then again most blind and deaf people are actually not 100% blind or deaf, and their blindness and deafness fluctuates over time!)

2) a person with PDS is not (viewed as) a powerless victim of his or her destiny. There is a sense in that you can undo or reduce the disability. PDS falls under the category of diets, giving up smoking, drug addiction, poverty: if you really really worked hard, you can overcome your disability. But the majority fails.

3) people with PDS are able to do what they claim they cannot do, namely speak fluently! So how can they claim to be disabled. The disability only comes in them being unable to consistently speak fluently.

4) PDS is not life threatening in a natural environment and its severity clearly dependent on the complexity of and necessity of verbal skills in social interactions. 100'000 years ago PDS was far less important, as physical strength linked to fighting and hunting skills where far more important. In effect, dyslexia or dyscalculia did not even exist!!! However, a standard disability meant a rapid decline of your survival chances. Actually our future looks brighter again due to email and chatting via Messenger. Computers and the Internet have helped us in our fight against imperialistic chatterboxes!!! I am waiting for the day that human communication is via brain waves. Then we are going to crush them with our brain waves. :-)