Moorea is the laid-back South Sea isle of the travel brochures. And Cook's Bay is easily Moorea's scenic highlight, offering an unobstructed view into the island's interior.
Stunning Scottish Island
Easier Property.com recently featured the Isle of Taransay a breathtaking 3,445 acre island which is currently on the market for 2 Million pounds. Located in an exceptional setting in the Outer Hebrides, Taransay is made up of two islands connected together by a peninsula of sand, with spectacular white sandy beaches, rugged cliff faces and heather moorlands forming its remarkable and unspoilt landscape.
The island is steeped in history having been inhabited since about 300 A.D. when it was home to Celtic pagans. Throughout history it has been the site of fierce battles including the Massacre of Taransay in 1544, when the Morrisons of Lewis invaded. It was recently home to a different kind of battle as it was home to the television show Castaway. Here is what Easier Property had to say.
” The original buildings on the island were renovated and since 2002 have been used as self-catering holiday cottages.
The traditional farmhouse has been recently refurbished and combines comfortable modern accommodation with truly outstanding views across the beach. The old school chalet has also been upgraded to a high standard with open plan accommodation overlooking the bay, whilst the bothy offers more basic accommodation, ideal for a group of up to 10.
The island also offers the country sportsman an abundance of activity whilst protecting the biodiversity of the island, with hill lochs teaming with brown trout, first class coastal and sea fishing, as well as a herd of around 200 head of red deer providing some enjoyable and sustainable stalking. ”
For further information on the Isle of Taransay please visit: ckdgalbraith.co.uk
Fantastic Florida Island
Florida is a land of plenty when it comes to private islands and it is often a popular destination for individuals interested in purchasing a private island within US borders.
One of the newest islands to come on the market is Ormond by the Sea a 1.3 acre island located just north of Ormond Beach in Valusia County.
The island is high and dry and ready for development! The island is currently on the market for $500,000 OBO. For more information on Ormond by the Sea visit Private Islands Online.
Arctic Nomad’s Travel Photoblog
After taking trips to here and trips to there from time to time, Jarma is now on a round the world adventure. Not only has he written about his past journeys, he now documenting his current undertakings in words and in photographs. Join him as he explores the planet.
© Gretchen for TravelBlogs, 2011. |
Arctic Nomad’s Travel Photoblog |
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Post categories: Blogs
Post tags: Asia, cultural experiences, Europe, North America, photography, Round the world, South America
No medical issues – Toledo Blade
 Toledo Blade | No medical issues Toledo Blade FROM FAMILY FACEBOOK PAGE Enlarge The grandmother of a 6-year-old boy who died after collapsing at the Toledo Zoo said the boy had no previous medical issues. Nicholas Allore of Temperance was on a field trip with his Smith Road Elementary School ... Michigan kindergartner dies while on Ohio zoo field tripDetroit Free Press |
Fewer docs expected: Medicaid cuts could curtail medical school residencies – Charleston Post Courier
Fewer docs expected: Medicaid cuts could curtail medical school residencies Charleston Post Courier An upcoming Medicaid funding cut could cause South Carolina's medical schools to accept fewer hospital residents and eventually worsen the state's existing doctor shortages, an academic official from the Medical University of South ... |
Healthcare Reform: Solving the Medical Student Debt Crisis Through Human … – Huffington Post (blog)
Healthcare Reform: Solving the Medical Student Debt Crisis Through Human ... Huffington Post (blog) The perception of medical school debt encourages students to choose careers as highly paid specialists over less compensated primary care practitioners. And who can blame them? The current insurance reimbursement scheme incentivizes specialists with ... Producing More Primary-Care DoctorsNew York Times (blog) |
RIVERSIDE: No immediate movement on medical school expected – Press-Enterprise
Los Angeles Times | RIVERSIDE: No immediate movement on medical school expected Press-Enterprise UC Riverside's medical school remained in limbo on Friday, facing a possible year's delay in its planned startup. The school was due to open in 2012. Chancellor Timothy White continued to lobby state legislators for an annual ... Cooper Medical School wins initial accreditation | Philadelphia Inquirer ...Philadelphia Inquirer NJ's new medical school at Rowan University to begin recruiting studentsThe Star-Ledger - NJ.com Cooper Medical School of Rowan University receives preliminary accreditationNJ.com The Desert Sun -Los Angeles Times -Cherry Hill Courier Post all 53 news articles » |
Failed Flaxseed and Bad News Brownies
Well, it’s been a tough month for herbs since my last monthly soiree here at SBM.
Just last week at the American Society for Clinical Oncology (ASCO) meeting, a group out of the Mayo Clinic presented data from a study showing that a well-characterized flaxseed extract was ineffective against hot flashes in postmenopausal women. But as Steve Novella noted here earlier this week, negative clinical trials data on supplements rarely influence the behavior of those who continue to advocate for their herbal use.
Flaxseed, known to contain phytoestrogen compounds such as secoisolariciresinol diglucoside (SDG) and enterolactone, has been purported to relieve hot flashes.
But I think the hypothesis was flawed in the first place: while these compounds bind the estrogen receptor, they have largely been shown to be estrogen receptor modulators that act in a negative manner. Work from the group of Dr. Lillian Thompson at the University of Toronto has repeatedly shown in an estrogen-dependent animal model of human breast cancer that flaxseed components act in a predominantly anti-estrogenic manner. One might suspect that hot flashes would be made worse by flaxseed, although this was not the case in the study presented as ASCO.
However, flaxseed is definitely a great source of fiber and may have preventive effects in prostate cancer, but not through an estrogenic mechanism. Instead, another flaxseed component, the omega-3 fatty acid alpha-linoleic acid (ALA), reduces the conversion of testosterone to its more active form, dihydrotestosterone. This work comes from a former colleague at Duke University, Wendy Demark-Wahnefried, now at the University of Texas-M.D. Anderson Cancer Center.
Bottom line: A good understanding of the basic science of herbal medicines is absolutely essential to good clinical trial design.
Don’t Bogart My Brownies
A story that’s more likely to have been seen by SBM readers is Lazy Cakes, a dietary supplement-laden brownie intended as a sleep-aid (here’s an example from NPR). The implied undercurrent of this product, of course, is the longstanding tradition of baking marijuana into brownies to – uh – get baked. The packaging itself evokes memories of the Grateful Dead, Phish, and Widespread Panic – musical groups closely associated with marijuana use who the reader will identify with depending on their age. Their tagline, “Relaxation Baked In,” isn’t even a veiled association with this traditional herbal practice.
Lazy Cakes have created an uproar in part because they contain a dietary supplement with potential of central nervous system activity, melatonin. This naturally-occurring hormone is synthesized in the pineal gland and appears to regulate our circadian rhythms. The reader may best recognize melatonin for prevention of jet lag. It is, in simple terms, a sedative and appears to be more potent in younger people. National poison control centers report several thousand calls regarding melatonin each year, with the majority of reports of sedation in children who’ve gotten hold of a parents supplement. Here’s one example from the Texas Department of State Health Services.
Lazy Cakes might also be riding on the well-known Philadelphia-area delicacy, Tastykake. The fact that I have included Tastykake in a post about Lazy Cakes is most certainly not pleasing to this East Coast institution but I have yet to find anything in the Philadelphia press about this issue. By the way, these wonders of the food world fueled my childhood and my scientific training at the school known previously as the Philadelphia College of Pharmacy and Science.)
The concern with Lazy Cakes seems to be that each brownie contains 7.8 mg of melatonin, well above the generally recommended sleeptime dose of 1 to 3 mg. While there have been no controlled trials of Lazy Cakes, anecdotal reports suggest that the brownies do indeed have physiological action. From the NPR story:
“There is an effect with Lazy Cakes, but I wouldn’t say it’s comparable to marijuana at all,” says Niki D’Andrea, who bought one while at a shop that sells drug paraphernalia.
D’Andrea’s not shy about having tried both; it’s part of her job writing about subculture for the Phoenix New Times. She didn’t get high from the Lazy Cake, but she was shocked at how sleepy it made her.
“I really did go to bed for about, I think 10 to 12 hours after I ate that first Lazy Cake, so well, maybe I should have started with half,” D’Andrea says.
Actually, half is the recommended serving size. As if anyone ever just eats half a brownie.
Less attention has been given to the other herbal components: valerian and passionflower extracts.
Valerian (Valeriana officinalis L.) has been investigated for sleep-inducing and anti-anxiety effects. In fact, some of the same researchers who presented the ASCO work above on flaxseed conducted a Phase III trial of valerian extract in cancer patients. Published earlier this year in the Journal of Supportive Oncology, the study revealed that this valerian root extract had no effect on overall measures of sleep efficacy, although some beneficial effects were observed on secondary measures such as fatigue.
However, we have no idea what valerian might do together with this rather high dose of melatonin. Come to think of it, I have no idea how the manufacturer made a valerian-containing brownie even remotely palatable. I have a 16-year-old bottle of valerian root that I use for classroom demonstrations and it still smells of rancid gym socks. But, then again, baking valerian extract is likely to release some of these volatiles.
Less is known about passionflower (Passiflora incarnata). Even a Cochrane review of passionflower for anxiety was unable to come to a solid conclusion due to the low number of studies.
Another issue not addressed in most MSM reports is that the actual content of components can vary wildly from amounts listed on dietary supplement labels. In most cases, the products contain less but this inconsistency is concerning with a product that contains a human hormone well-known to induce sleep.
The bottom line: don’t mess with Lazy Cakes. As with any sedative drug – whether a supplement, prescription or over-the-counter – there’s always a concern for additive or synergistic effects with alcohol.
But rest assured that the uproar over Lazy Cakes will further fuel sales. And given dietary supplement regulations in the United States, I really don’t see this product being banned – although the manufacturer has added additional warnings about sedation and intended use by adults.
That’s right – a product featuring a sleepy brownie that resembles Spongebob Squarepants is intended solely for adults.
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Placebos as Medicine: The Ethics of Homeopathy
Is it ever ethical to provide a placebo treatment? What about when that placebo is homeopathy? Last month I blogged about the frequency of placebo prescribing by physicians. I admitted my personal discomfort, stating I’d refuse to dispense any prescription that would require me to deceive the patient. The discussion continued in the comments, where opinions seemed to range from (I’m paraphrasing) “autonomy, shmatonomy, placebos works” to the more critical who likened placebo use to “treating adults like children.” Harriet Hall noted, “We should have rules but we should be willing to break them when it would be kinder to the patient, and would do no harm.” And on reflection, Harriet’s perspective was one that I could see myself accepting should I be in a situation like the one she described. It’s far easier to be dogmatic when you don’t have a patient standing in front of you. But the comments led me to consider possible situations where a placebo might actually be the most desirable treatment option. If I find some, should I be as dogmatic about homeopathy as I am about other placebos?
Nicely, Kevin Smith, writing in the journal Bioethics, examines the ethics of placebos, based on an analysis of homeopathy. Homeopathy is the ultimate placebo in routine use — most remedies contain only sugar and water, lacking a single molecule of any potentially medicinal ingredient. Smith’s paper, Against Homeopathy — A Utilitarian Perspective, is sadly behind a paywall. So I’ll try to summarize his analysis, and add my perspective as a health care worker who regularly encounters homeopathy.
The first third of the paper is a concise summary of the scientific absurdity of homeopathy. Hahnemann’s “Law of Similars”, based on a single observation of the effects of quinine on malaria, is the basis for the non-scientific process of “provings” to match symptoms to substances. The results of provings are compiled in the Homeopathic Materia Medica, which homeopaths select their remedies from. (So now we have remedies based on products including “sleep”, Stonehenge, shipwrecks, ascending colons, light bulbs, and vacuum cleaner dirt.) Smith summarizes this law as:
More fundamentally, there is simply no plausible or rational basis for supposing that substances that produce particular symptoms can cure the same symptoms. The assumption that ‘like cures like’ places the onus on proponents of homeopathy to elucidate the special logic involved: to the knowledge of the present author, a satisfactory account of this logic has not been made.
Hahnemann’s second law, the “Law of Infinitesimals” is as absurd as the law of similars. That a product can gain potency and effect with dilution, and that effect persists (and even grows stronger) even after being diluted completely away defies physical laws. Smith points out the contradiction between the idea that water is touted to have a memory of the “proved” substance, yet has forgotten everything else that has every been dissolved in it:
The fact that physiological chaos does not ensure whenever we drink a glass of water provides a simple but powerful refutation of the ‘memory’ concept in homeopathy.
Smith then covers the research on homeopathy. Given its premise is implausible (or impossible), it is not surprising that the highest quality clinical trials have demonstrated no efficacy beyond placebo effects. Yet positive trials are to be expected from statistical effects alone. And when combined with bad design, weak blinding and other potential biases, it should not be surprising that a supportive clinical trials appear in the literature — and some even show up in Cochrane reviews. His conclusion is very much along the lines of the position taken by SBMers:
From Hume onward, it has been accepted that extraordinary claims require extraordinary evidence. Considering the extent to which the fundamental tenets of homeopath run counter to established rules of science and reason, empirical evidence in support of homeopathy would have to be particularly robust, in view of the fact that acceptance of homeopathy would entail a major epistemic scientific revolution.
So it’s implausible, the remedies contain no medicinal ingredients, and, not surprisingly, it works no better than a placebo. Yet it is popular, even among some physicians and scientists. But is it ethical? And here’s where we get to the meat of the ethical analysis.
Non-Invasiveness/Cost-effectiveness
Placebos, as commenters to my past post noted, do have one merit. If the alternative to antibiotics for a cold is homeopathy for a cold, then homeopathy is probably a better therapeutic choice, because “no treatment” is the preferred treatment. There are many medical conditions for which we have few effective medical therapies, and in some cases the impetus to prescribe a placebo may be simply to obtain the psychological (placebo) effects associated with their use. And given the habit (as I described last month) for some physicians to select impure placebos (those containing subtherapeutic or non-toxic ingredients), then isn’t a pure placebo like homeopathy sometimes preferable? Here’s where Smith gives homeopathy credit:
In cases where ineffective medication is considered to be in the best interests of the patient, which form of such medicine should be prescribed?
The answer to this question seems clear: the ineffective medicine that is the least invasive and least expensive should be used. On these criteria, homeopathy scores highly.
So in situations where a placebo is felt to be in the patient’s best interest, homeopathy might be felt to be favorable, particularly if an “impure” placebo has a greater potential for unwanted effects. But Smith makes a small error here: Homeopathy isn’t always the least expensive option – a point I’ll return to.
Holism
Holistic is a popular term among alternative medicine proponents and is usually used to deride science-based medicine, with the fallacious claim that various alternative treatments treat the “whole patient” while medicine does not. And as has been described elsewhere on this blog, the extended consultation offered by alternative medicine providers is probably the source of most if not all of the benefits of treatments. However the non-specific benefits of talk therapy, dialogue, empathy and reassurance are not limited to homeopathy, and can be incorporated into science-based practices. And importantly, since homeopathic “remedies” can be purchased in pharmacies and other stores without consultation, the “holistic” approach, and its benefits, are by no means certain when consultation is omitted. For these reasons, Smith rejects holism as providing any unique support for homeopathy.
Placebo effects
In the research setting, placebo effects are any measured response in patients that receive the inert (placebo) treatment. But as has been noted on this blog, there are actually multiple elements and observations that sum into what’s described as “placebo effects.” Some of what can contribute to the apparent efficacy of a placebo may not be due to patient-reported outcomes: Researcher bias, poor blinding, and weak overall study design and conduct can all add to the measurement of, and subsequent conclusion that a placebo has effects. Even a disease’s natural history, or regression to the mean can lead one to conclude a correctly-timed placebo treatment is effective.
Smith does not dive deeply into placebo effects, but makes two arguments against homeopathy’s value as a placebo. First, he notes that placebo effects are generally restricted to subjective symptoms like pain and fatigue, with no evidence supporting any meaningful disease-modifying effects. This limits the usefulness of homeopathy to those conditions for which there is some evidence to show that there may be placebo effects. Smith then raises the ethical appropriateness of a key component of successful placebo use: in order for placebos to work, patients must believe something that is untrue. From a utilitarian perspective, Smith notes that lying may be acceptable when it (on balance) is an overall positive — that is, it generates a positive utility. However, patient autonomy must also be considered — the right for patients to make an informed decision about their treatments. Smith suggests that if you personally rank autonomy above the potential placebo benefits, then the use of homeopathy is untenable from an ethical perspective.
But are homeopaths deliberately deceiving their clients? Smith argues (and I agree) that most homeopaths genuinely believe “remedies” to be effective — so they are not acting in bad faith when they advocate their use. However, the fact remains that patients that are told that homeopathy is effective are being given information that is contrary to the scientific evidence. Consequently Smith describes their actions as “ethically unacceptable” regardless of their sincere (but wrong) beliefs.
But what about placebo use by health professionals? While routine use of placebos wouldn’t be considered ethically acceptable, Smith notes that reinforcing the efficacy of a conventional medication, in a way that could enhance potential placebo effects, is acceptable. This is a routine part of the pharmacist’s dialogue with patients – understanding and addressing concerns, summarizing therapeutic effects, and managing overall treatment expectations. It can be done in a non-deceptive way that should maximize the non-specific effects. But what about pure placebos? Smith gives the example of battlefield use of saline injections for pain as a circumstance where pure placebo use would be ethically acceptable. So in situations where no other options exist, perhaps. But as a matter of course, providing pure placebos would not be considered ethically appropriate.
Autonomy
What if patients elect to choose homeopathy, despite counsel that the product is inert? I’ve encountered this situation in the pharmacy: when asked for advice, I inform the patient that the product has no active ingredients and has no medicinal effects. They’re usually grateful for that, but sometimes my advice will be challenged or ignored, and they’ll purchase it anyway. In situations where it’s clear that the patient may be avoiding appropriate consultation or treatment, I may press my argument further. But once I’ve described the scientific evidence, and given my advice, I’m comfortable letting the patient make their own purchasing decision. And that’s consistent with Smith’s analysis:
If utility is generally maximized by allowing patient autonomy, then patients should be free to choose homeopathy. Secondly, exercise of autonomy provides psychological benefits for the agent: it is well accepted that denial of free choice, or coercion, results in reduced happiness in the subjects concerned.
Smith describes the challenge of drawing lines between paternalism and autonomy, concluding that restriction of autonomy is probably reasonable when the risk of self-harm is greater — which is consistent with the case for restricting drugs to “prescription-only” status. While risks of contamination and unwanted medicinal effects do exist, the more common and real risk is probably the avoidance of proper medical treatment — which is one of the major disutilities of homeopathy.
Failing to Seek Medical Care
While some might be willing to accept the use of homeopathy in cases where placebo effects are possible and probably adequate, most draw the line when homeopathy is positioned as a substitute for effective medical treatment. Yet that’s the case when homeopathy is promoted as malaria prophylaxis, a substitute for vaccination, or even as a treatment for HIV or tuberculosis. Probably the best approach to mitigating this risk, while promoting individual patient autonomy, is to ensure that adequate information is provided to patients so that they are well informed of the lack of medicinal ingredients and the demonstrated lack of efficacy, beyond placebo, for any condition. Smith questions the ability of CAM practitioners to provide reliable advice on efficacy, and describes the promotion of a therapeutic doctrine, rather than reliable advice, as “ethically unacceptable.” He further characterizes any harms resulting in those unable to give fully informed consent (e.g., children or non-competent adults) as “ethically indefensible.”
Waste of Resources
If you’ve never bought it before, homeopathy is not cheap: its prices are comparable to conventional products with active ingredients. Given the lack of efficacy, every dollar spent on homeopathy is a waste of resources, in that it could otherwise be put to more effective use — for plausible treatments, or anything else, for that matter. So from a utilitarian perspective, Smith argues that this expenditure is unethical. Smith notes that homeopathy may not just act as a substitute for other care due to its lack of effect: When the homeopathy fails to work, conventional care may subsequently be sought.
Smith makes the same ethical evaluation of research into homeopathy, where because of a lack of “logico-scientific validity”, human trials of homeopathy are ethically contentious and an inappropriate use of resources.
Credibility Issues
One of the issues that concerns me as a pharmacist is the veneer of credibility that homeopathy gains when it’s packaged and positioned alongside conventional medicine in pharmacies. I suspect that most consumers expect the products on pharmacy shelves to contain medicinal ingredients, and to have some sort of evidence to support their sale. If I substituted placebos for prescription drugs, I’d quickly lose my license to practice. And if I sold boxes of toothpaste or tissue that were empty inside, I’d probably be out of business pretty quickly. So I’m dismayed when I see pharmacies selling cough syrups without active ingredients, sending an unwarranted message of homeopathy’s effectiveness.
Another credibility issue arises from an educational perspective, when homeopathy is “integrated” into science and and medical education as well, increasing the perception that homeopathy has medical credibility. Smith sums it up:
“…inappropriate ‘approval’ for homeopathy serves as a disutility, as it will tend to magnify several negative outcomes, namely resource wastage, risk of patients failing to seek effective healthcare, and reduced patient autonomy through the promulgation of erroneous medical knowledge”
Smith goes on to note a number of other concerns documented repeatedly at SBM, including a weakening of a societal commitment to scientifically-established treatments, as well as the confusion of ineffective treatments such as homeopathy with treatments that he describes as genuinely complementary, such as mediation, relaxation, music and exercise — something that has been described here as the CAM Trojan horse.
Conclusion
So where does that leave us? Unfortunately we cannot simply sum up the arguments in a formula to give us the ethical answer. It seems clear that the ethical downsides to homeopathy outweigh its benefits under most circumstance I can envision. Smith uses the example of an ineffective defibrillator to point out that the use of such a device device in the context of medical care would be “morally unjustifiable.” He notes,
Because it is inherently ineffective, homeopathy cannot be ethically neutral. It follows that the purchase, deployment or promotion of homeopathy is morally unacceptable.
Perhaps there may yet emerge a framework where placebos can be ethically (and judiciously) justified. Homeopathy isn’t it. So what should health professionals do? For one, we should stop promoting homeopathy, and the sale of homeopathic remedies. We should advocate against the allocation of limited health resources to researching, facilitating or providing homeopathy. We should avoid giving homeopathy undeserved credibility by selling it alongside actual medicine, or allowing it to be sold without clear labelling that describes its lack of ingredients and effectiveness. And when we’re asked, we have an ethical responsibility to explain why we believe homeopathy is no ‘alternative” at all.
Reference
Smith K (2011). Against Homeopathy – A Utilitarian Perspective. Bioethics PMID: 21320146
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Black Cohosh and Hot Flashes
Black Cohosh, an herbal “supplement” (i.e. unregulated drug) remains popular for the treatment of hot flashes and other autonomic symptoms resulting from menopause. This product is yet another good example of the double standard that the supplement industry and ideological promoters are allowed to employ.
The NCCAM website gives this summary:
Black cohosh, a member of the buttercup family, is a plant native to North America. It has a history of use for rheumatism (arthritis and muscle pain) but has been used more recently to treat hot flashes, night sweats, vaginal dryness, and other symptoms that can occur during menopause.
While the information is available if you look through the links below, their summary makes no mention of the fact that their own studies show black cohosh is ineffective. In their “at a glance” summary they characterize the scientific evidence as “mixed.”
The Natural Standard website is far worse. Although touted as a reliable source of scientific information on herbal supplements, they reveal a very biased editorial agenda. Here is their “bottom line” summary of Black Cohosh:
Black cohosh is one of the highest selling herbs in the United States and is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness (1;?2). Several controlled trials and case series have reported black cohosh to improve menopausal symptoms for up to six months. Although these initial studies are suggestive, they have been few in number and have universally suffered from methodological weaknesses.
They also state:
Since the Women’s Health Initiative Trial was halted early due to an excess risk of stroke and other adverse outcomes, millions fewer women are using prescription hormone replacement therapy. However, a 2005 survey has shown there has been no appreciable increase in alternative therapies, including black cohosh (13).
Why are they so concerned that women are not using black cohosh or other “alternative” therapies when the evidence does not support their efficacy?
Let’s take a look at the actual evidence. The best study to date is the 2006 double-blind placebo-controlled trial funded by the NCCAM. They compared Black Cohosh alone, plus with other herbs, plus with other herbs and soy, to standard hormone replacement therapy and placebo. The three herbal groups showed no significant difference from placebo, while the hormone replacement group did show significant improvement. The only exception was the soy group, which showed greater symptom intensity at 12 months. This is the best evidence to date and it was dead negative.
The authors of the study listed as a limitation:
The trial did not simulate the whole-person approach used by naturopathic physicians.
How is this a limitation? Where is the evidence that the “whole-person” approach of naturopaths has any basis in reality or provides any improvement in outcome? This is nothing but special pleading, an attempt to water down the significance of these negative results.
A 2008 systematic review of black cohosh and hot flashes concluded:
The evidence from these RCTs does not consistently demonstrate an effect of black cohosh on menopausal symptoms; a beneficial effect of black cohosh on peri-menopausal women cannot be excluded. The efficacy of black cohosh as a treatment for menopausal symptoms is uncertain and further rigorous trials seem warranted.
In other words — the evidence is negative, but we don’t want to give up yet because black cohosh is still popular. Of course, its popularity was manufactured by unfounded claims for efficacy, which have not held up under rigorous study.
It must also be noted that in the controlled trial all groups, placebo included, did show a decrease in the number of hot flashes over the year of the study. This likely reflects the natural course of symptoms (hot flashes do tend to resolve over time) and also the placebo effect in terms of noticing and reporting symptoms. The lesson from this is that any unblinded study of any treatment for menopausal hot flashes is likely to show a significant decrease in symptoms over time. This study emphasizes the virtual uselessness of unblinded studies in evaluating subjective symptoms, like hot flashes.
And yet, it is precisely these unblinded studies that proponents are using to argue that the evidence is “mixed” and that black cohosh deserves further study.
However, a more rational science-based evaluation would take into consideration the relationship between the rigor of the studies and the effect size. The most rigorous studies are negative — that is consistent with the null hypothesis — with the conclusion that black cohosh simply does not work for hot flashes.
Conclusion
If black cohosh were a pharmaceutical and not a supplement, I don’t think there would be much debate about its effectiveness. The data is essentially negative, which means that the only reasonable science-based recommendation is not to recommend black cohosh for hot flashes. Further study is not unreasonable, but neither it is needed.
However, the NCCAM and Natural Standard shy away from this recommendation. Natural Standard doesn’t even mention the negative evidence in their bottom line summary, but rather decry the fact that more women are not using black cohosh or other supplements. NCCAM resorts to their typical weasel statement that black cohosh “has a history of use” or “has been used for.”
For proponents, when it comes to supplements (or any so-called “alternative” modality), no evidence for lack of efficacy ever seems to be adequate.
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Another Anti-Vaccine Book
I was asked to review the book Make an Informed Vaccine Decision for the Health of Your Child by Mayer Eisenstein with Neil Z. Miller. Fortunately my public library had it so I didn’t have to buy a copy. Reading it was a painful déjà vu experience. I can honestly say it met all my expectations: I expected that its concept of “informed decision” would equate to deciding not to vaccinate, and that it would rely on the same tired old fallacious arguments that have been heard before and rejected by knowledgeable scientists. The only thing that surprised me was a warning/disclaimer statement that admitted
this book tends to find fault with vaccines, therefore readers are advised to balance the data presented here with data presented by “official” sources of vaccine information, including vaccine manufacturers, the FDA, CDC and World Health Organization.
The fact that the book omitted all that balancing data undermines its pretense that it is intended to help readers make a truly informed decision.
It regurgitates every argument of the anti-vaccine faction without fairly presenting the arguments for vaccines and without acknowledging that every anti-vaccine argument has been thoroughly rebutted. For instance, it repeats reporter Dan Olmsted’s myth that the Amish do not vaccinate and do not get autism.
It deceptively argues that deaths from vaccine-targeted illnesses were decreasing before the development of vaccines. Deaths were decreasing due to improving medical treatment and other factors, but the diseases were not going away: the incidence of the diseases had not decreased significantly. Graphs of the yearly incidence of diseases like measles, mumps, polio, diphtheria, pertussis, etc. all show a striking reduction after vaccines were introduced. The book does not present those graphs. The real proof of the pudding is that in various countries around the world, when vaccination rates dropped, the diseases returned; and when vaccination rates rose again, the diseases subsided. The book does not acknowledge those inconvenient facts.
It does rely heavily on horror stories, mainly drawn from VAERS (Vaccination Adverse Event Reporting System) data. For every vaccine it provides a list of cases reported to VAERS. It says these are “just a small sample of the potential side effects associated with vaccines.” This is deliberately deceptive. The fact that a case is reported to VAERS only means that an adverse event occurred after vaccination; it does not even establish a correlation with the vaccine (because we don’t know whether the event occurs with equal frequency in a control group), and it certainly doesn’t establish that the vaccine caused the event.
It claims that VAERS data show that Rotateq vaccine causes intussusception in children. It doesn’t mention that the CDC investigated those VAERS reports and found that the rate of intussusception after the vaccine did not exceed the expected background rate of intussusception in the population.
It cites cases of adverse reactions to diphtheria antitoxin; but antitoxin is never needed unless you get the disease, which is prevented by the vaccine. And then it recommends avoiding tetanus vaccine since a tetanus antitoxin is available. It fails to mention the adverse reactions to tetanus antitoxin and the fact that it will not be needed if the vaccine has prevented the disease in the first place. How could anyone think it is preferable to get tetanus and then treat it with antitoxin?
It cites Andrew Wakefield’s studies allegedly linking the MMR vaccine to autism and his unsupported speculations that single vaccines are preferable. It mentions that his Lancet study was retracted, supposedly only because a British medical panel had concluded that he had violated ethical rules. It quotes Wakefield’s disingenuous protestation that the allegations against him were unfounded. It fails to mention that he had falsified data in his study and that he was stripped of his medical license. It also favorably cites the Geiers’ discredited research; the book was published before one Geier was stripped of his license and the other Geier was prosecuted for practicing medicine without a license.
It admits that removing thimerosal from vaccines did not decrease the rate of autism, but it claims that autism was increased by thimerosal added to flu vaccines and by the amount of aluminum in vaccines.
It bewails all those antigens injected into “pure, innocent” babies.
I won’t belabor all the other misconceptions in the book: we’ve heard them all before.
Eisenstein has not only an MD but a JD and an MPH. He has not let his scientific training interfere with his prejudices. He directs Homefirst Health Services, an organization that promotes home births, discourages immunization, provides vaccination waivers to everyone on the general principle that vaccines are harmful, sells natural supplements (profits from recommending them), offers HCG treatment (proven to be useless) for obesity, and claims there are virtually no autistics among its patients. Dr. Eisenstein is also billed as Assistant Medical Director of Alternative Medicine Integration and he has appeared on the Oprah Winfrey show; regular readers of this blog will recognize that “integration” and Oprah are both red flags for non-scientific medicine. He doesn’t think much of conventional medicine. He dismisses mammograms as never having saved even one minute of life, and another of his statements is calculated to really make Dr. Gorski’s blood boil:
Scientists also looked at breast cancer treatments: mastectomy, simple mastectomy, radial [sic] mastectomy. There was no benefit on outcome of survival.
This is a terrible book. It is dishonest, misrepresents the facts, and is likely to persuade the average reader not to vaccinate, thereby putting the rest of us at risk from decreased herd immunity. The average reader has no way of knowing what is wrong with its claims or what has been omitted. Unfortunately, its flaws will only be apparent to those of us who are able to recognize the book as merely another polemical restatement of discredited anti-vaccine propaganda.
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The ultimate in “integrative medicine,” continued
It’s been a recurring theme on this blog to discuss and dissect the infiltration of quackademic medicine into our medical schools. Whether it be called “complementary and alternative medicine” (CAM) or “integrative medicine” (IM), its infiltration into various academic medical centers has been one of the more alarming developments I’ve noted over the last several years. The reason is that “integrative” medicine is all too often in reality nothing more than “integrating” pseudoscience with science, quackery with medicine. The most popular modalities that medical schools and academic medicine centers can’t seem to resist are acupuncture and various forms of “energy” healing, such as reiki and therapeutic touch. Unfortunately, when you “integrate” something like reiki or therapeutic touch (TT), which basically assert that there is mystical, magical energy source (called the “universal source” by reiki practitioners, for example) that practitioners can tap into and channel into patients for healing effect, you are in essence integrating a prescientific understanding of the world with science, religious faith healing (which, let’s face it, is all that reiki is), and magic with reality.
Why would medical institutions ostensibly based on science do that?
I don’t know, but I know it’s happening. There are many forces that conspire to insert sectarian versions of medicine into bastions of scientific medicine. These include cultural relativism leading to a reluctance to call quackery quackery; financial forces such as the Bravewell Collaborative, which funds a number of IM programs at academic centers; the National Center for Complementary and Alternative Medicine (NCCAM); and a variety of other factors. It’s been a depressing slide, and periodically I wonder just how much more pseudoscience can be “integrated” into medical schools and academic medical centers or how much further medical schools can go in pandering to nonsense. I’m not wondering anymore, at least for now, not after learning about a cooperative agreement between Georgetown University and the National University of Health Sciences:
National University of Health Sciences (NUHS) has announced a new cooperative arrangement with the Graduate Program in Complementary and Alternative Medicine at Georgetown University Medical Center in Washington D.C., which will benefit students preparing for careers in health care and integrative medicine.
Faculty at the two schools will now work together to help students seeking advanced degrees in health care, by advising students of the benefits of each other’s programs and providing preferential seating and advanced standing in each other’s programs when appropriate.
Take a look at the NUHS website. Look at its offerings: chiropractic, naturopathy, traditional Chinese medicine, acupuncture, massage therapy, and “biomedical science,” which, given all the other woo being taught at NUHS, I have to wonder about. Just take a look, too, at the curriculum for obtaining a doctor of naturopathy degree. It’s full of homeopathy, traditional Chinese medicine, hydrotherapy and, of course, naturopathy. I must admit, however, to some amusement when I saw that there is a course entitled, “Evidence Based Practice: Critical Appraisal of the Biomedical Literature.” Quite frankly, if this course truly taught evidence-based practice, then it would teach that all that homeopathy taught in other courses is nonsense, along with naturopathy itself.
Fat chance of that happening, not with “integration” like this:
Program directors at Georgetown selected NUHS as a top-tier institution providing educational excellence in its professional degree programs, thus meriting Georgetown’s recommendation for its graduates seeking professional degrees. According to Aviad “Adi” Haramati, who co-directs the program with Hakima Amri, PhD, the academic affiliation is intended to “…break down the silos that hold the disciplines apart and create relationships between the disciplines and the educational institutions that prepare the nation’s future healthcare providers.”
Great. Just what we need: “breaking down silos” separating pseudoscience from science-based medicine. That’s exactly what’s happening here, and Georgetown is leading the way, so much so, in fact, that this is not the first time it has forged a partnership with an institute dedicated to teaching pseudoscience and quackery. If you want to see another example of this sort of “integration,” behold this academic “integration” model championed by Georgetown University, this time with the infamous school of naturopathy, Bastyr University:
A model inter-institutional relationship may help bridge the chasm that separates health professions education in conventional academic health centers from institutions educating students for the distinctly licensed integrative practice (“CAM”) professions. Says one leader: “I believe we are poised to make an important advance in how the future training of health professionals may evolve.” The speaker is Adi Haramati, PhD, integrative medicine leader at Georgetown University, describing a new relationship between Georgetown and Bastyr University relative to Bastyr’s naturopathic medical program and Georgetown’s MS CAM program. Haramati and his co-director Hakima Amri, PhD are exploring similar relationships with chiropractic schools and other health professions institutions. The developers “would like nothing more” than to see this bridge-building relationship be used as a model for other academic health centers and CAM institutions.
That’s right. Georgetown is partnering with schools of pseudoscience in order to train the next generation of CAM practitioners. It’s not enough to team up with the naturopaths. Even several months ago, when Georgetown first teamed up with a naturopathic school, Dr. Haramati had been envisioning teaming up with chiropractic schools. That’s what the NUHS is, mostly, and the agreement between Georgetown and NUHS seems to be the first step towards realizing the vision he presented at the time he teamed up with Bastyr.
But it’s more than that. More than five years ago, Georgetown decided that CAM should be “integrated” into its curriculum to the point where it was made part of its medical school curriculum. However, Georgetown went way beyond simply having a lecture or two on CAM here and there and offering clinical electives to fourth year medical students in CAM. That wasn’t enough. The vision was far more bold and—dare I say, given what’s happened in the last five years?—forward-looking. What Georgetown offered was what it referred to in its own brochures as:
The “seamless” weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the “anatomy of acupuncture” in the gross anatomy course for first-year students. The same lecturer explores acupuncture’s application in pain relief in the neuroscience course.
I wish this were a joke, but it’s not. The “anatomy” of acupuncture? Which “anatomy,” given that the magical, mystical meridians along which a life energy that science can’t detect allegedly flows? Teaching such material in anatomy class is indeed the ultimate seamless “integration” of pseudoscience with science, quackery with science-based medicine. Breaking down silos, indeed. Fast forward five years, and here is the vision for true “integration” in medical education towards which Georgetown is working with Bastyr (and now, NUHS), in which it isn’t just Georgetown but Georgetown teaming up with institutions of quackery:
Student A completes an academic Masters of Science program at a highly esteemed academic health center. He or she is wondering her/his future. The program focused on the science of complementary and integrative medicine. But what does the individual’s future hold? Go on to medical school? Personnel with the program lay out options. Among them, without prejudice: Have you considered this naturopathic medical school?
Meantime, Student B is considering naturopathic medical college. The field of complementary and alternative medicine intrigues. But is he or she ready to make the jump for that 4-year, residential commitment? Is naturopathic medicine or regular medical school or chiropractic medical education what they want? Personnel with the naturopathic medical program say: You might consider this year-long Masters of Science in complementary and alternative medicine at this academic health center.
The basis of this relationship between Bastyr and Georgetown, we hear, is a new “respect” being shown towards CAM modalities, and this is the way that the joint program will be structured:
The fundamental aim of this program is to provide students with competencies in three areas: grounding in science (especially systems and cell physiology), introductory exposure and understanding of CAM disciplines and philosophies, and the ability to rigorously assess the state of evidence regarding safety and efficacy of various CAM therapies.
Let’s see. Science…good. We like to see medical students exposed to science. Exposure to CAM disciplines…not so good. Don’t get me wrong. I very much believe that medical students should be taught about CAM modalities, but they should be taught about them from a the perspective of the state of the science, the evidence, and clinical trials. They should be taught about skepticism and critical thinking. They should be taught about how various CAM remedies, such as herbal medicines, interact with pharmaceuticals. That is not what this program sounds like, as a science-based perspective leads to the conclusion that the vast majority of CAM either hasn’t been shown to work or has been shown to work. If such weren’t the case, CAM wouldn’t have the word “alternative” in it.
Let me just put it this way. When this program claims to teach students how to “rigorously” assess the state of evidence regarding the safety and efficacy of various CAM therapies, the word “rigorously” applied to such teaching doesn’t mean the same thing that “rigorously” means when scientists actually do rigorously assess the evidence. What it usually means is buying into the aforementioned philosophy of various CAM disciplines and then proceeding from there. Either that, or it means what Harriet Hall likes to call Tooth Fairy science, which refers to doing research on a phenomenon without first establishing that the phenomenon exists first. In essence, it’s like studying the Tooth Fairy. You can measure how much money she leaves under the pillow. You can study whether she leaves more or less money for the first or last tooth. You can get a whole lot of data that appear reproducible. You might even get data that is statistically significant. But at the end of the day you haven’t actually established that the Tooth Fairy actually exists.
A better metaphor for research into CAM modalities like reiki, TT, or homeopathy is hard for me to imagine. After all, reiki is nothing more than faith healing that substitutes Eastern mysticism for Christian beliefs. TT is basically reiki lite, where even the Eastern mysticism is stripped down to vague New Agey-sounding ideas like channeling “energy” into patients through their hands. (You know, whenever I picture reiki or TT, I visualize one of my favorite comic book characters of all time, Dr. Strange, casting a spell. In fact, as has been suggested before, that’s the only real way I can see of making homeopathy work: a fictional Sorcerer Supreme and Master of the Mystic Arts casting a spell.
But, wait, I hear: What about something that’s less highly improbable? Homeopathy is obviously utter nonsense. So are reiki and other “energy” therapies. What about herbal medicine? What about manipulative therapies (leaving aside the dubious philosophical underpinnings of some such therapies, like homeopathy, which similarly appeal to “energy flow” through various locations)? Well, there’s already a branch of pharmacology that can study herbal remedies. It’s called pharmacognosy, and it isolates the active fractions of natural products and studies them, just as pharmacologists have done for decades, if not centuries. There’s nothing “alternative” in that that needs to be “integrated” into science-based medicine. Similarly, manipulative therapies are not beyond the reach of science to study rigorously, either. However, to do such studies it is necessary first to verify that a phenomenon exists, which can be done using the scientific method. What I fear will happen in this new Bastyr-Georgetown integration will be Tooth Fairy science. There’ll be a lot of data, but it won’t mean anything.
The other purpose of this integrated program is explicitly promotional of CAM. It explicitly seeks the “integration” of quackery with science-based medicine. Don’t believe me? Check out this vision:
The Georgetown agreement with Bastyr, and those Haramati and Amri are seeking with other schools, are terrific steps, laying scaffolding toward the vision, articulated at NED and embraced by ACCAHC, of “a healthcare system that is multidisciplinary and enhances competence, mutual respect and collaboration across all CAM and conventional healthcare disciplines.”
Georgetown is the trailblazer in “integrating” quackery into science-based medicine, but, although it’s first, it won’t be the last. This is a well-coordinated, longstanding effort on the part of CAM advocates, in which they actively lobby for such partnerships and such “integration” with science-based practitioners. Indeed, the Academic Consortium for Complementary and Alternative Health Care supports what it calls the Center for Optimal Integration, which explicitly works towards the sorts of partnerships that Georgetown has undertaken with Bastyr and NUHS.
Personally, I don’t see how “integrating” CAM into science-based health care would enhance competence, but then that’s just the nasty reductionist in me who rejects the false dichotomy of “alternative” medicine. After all, “alternative” medicine is nothing more than medicine that either hasn’t been shown to work or has been shown not to work. “Alternative medicine” that works is no longer “alternative.” It’s just medicine. Naturopathy is a hodge-podge, a grab bag of all sorts of unscientific and pseudoscientific medical treatments, most of which fall squarely into the “alternative” camp in every definition, particularly the ones about either not working or not having been demonstrated to work.
Unfortunately, when it comes to quackademic medicine, the false dichotomy lives, and institutions like Georgetown are betraying science-based medicine by being so open to the point of its brains falling out—and partnering with Bastyr to integrate nonsense with sense, pseudoscience with science, and quackery with medicine.
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What I Know: Hosting & BBQ
Last week, Thomas talked about his summertime passion, and it immediately got me thinking of mine. There are two things I know in this world: Hosting and Barbeque. They may be on the opposite ends of the spectrum, but both integral parts of the SoftLayer culture.
Being Texas born and bred, I hear stories that my first baby bed was actually a refinished barrel pit, and at the tender age of 4, I started my first fire right where I used to lay my head. By the age of 7, I graduated from grilling to smoking, and by age 10, I was expected to have mastered the art of mixing fire, smoke and the perfect rub to deliver a baby back rib so tender that you have no choice but to ‘slap yo mama!’
I have to admit that I am not an official member of the 3 Bars Barbeque team, but my ribs and steaks have been taken on the road to multiple parts of Texas, and they’ve won contests in Memphis for their fall-off-the-bone tender texture and their “mmm mmm good” flavor. I can’t really divulge my award winning recipe, but I can share my cooking method used to achieve that fall off the bone rib.
You’ve got to understand that smoking takes time. I generally allow one hour per pound on a nice rack of baby back ribs. In SoltLayer operations terms, for a 6lb rack of ribs, that means you’d have time to register a new domain name, provision a RHEL 5 Cloud Compute Instance, provision 2 dedicated database servers (1 in Dallas and 1 in San Jose), configure the CCI as a Web server, clone the CCI once in Dallas and once in San Jose, order eVault and add a second vault for redundancy, add local load balancing to both sites, use the previously registered domain name and set up Global Load balancing between the IPs of both local load balancers, setup rsync between web servers for one website and configure MySQL replication between your two new database servers (and you’d still have just enough time to configure the eVault backup that you ordered about 5.5 hours previously).
What were we talking about again? Oh yeah, I promised a “cooking method” lesson:
1. Get Your Ribs
Everyone dresses their meat differently … Some prefer to marinate, some don’t. I find that it doesn’t make much of a difference, so I usually will remove my ribs from the fridge and rinse the before setting them aside to allow them to warm to room temperature. While that’s happening, I continue the rest of the process.
2. Prepare the Pit
I like to use a smoker pit grill … You know, something this:
I like to use split wood logs instead of flavored charcoal & wood chips. The wood you use is up to you; I usually do either hickory or mesquite and occasionally a log or two of apple (Beware that Mesquite burns very hot and is harder to stabilize at a consistent temperature when adding more wood to the fire later). Stack and light your fuel of choice in the smoker’s firebox – the only place where you will have a fire … The only thing that belongs in the pit is the meat and the smoke generated by the firebox.
Once you get your fire started, let it burn for a while so it can stabilize. You want the pit area to stay at a constant 225F ~ 250F. If you have enough prep time, you can also soak your wood logs for a couple of hours before you start your fire. This will cause the wood to burn slower and produce a slightly stronger smoke flavor in the ribs. This will also cut down on the amount of wood you “burn” through.
3. Prepare Your Ribs
While your fire is doing its thing and creating some good smoke, you can trim and season your ribs. Trim the membrane from the underside of the rack and season the meat with a dry rub (since it’s better suited for longer cook times).
4. Start Cooking
Once your pit has stabilized at the perfect temperate, it’s time to add the ribs. I use a rib rack just so I don’t have to flip the ribs while they’re in the pit, but if you don’t have a rib rack, place your ribs on the opposite side of the pit from the firebox bone side down (you have to ensure that the fire doesn’t reach your precious rack of ribs. If you are not using a rib rack, you will want to flip them about an hour and a half into cooking.
5. Keep Cooking
I use the 3–2–1 method when smoking: 3 hours on grill, remove the ribs, wrap them in foil, 2 hours on the grill in foil, remove the foil, and one more hour on the grill. By the time you get to that last hour, you’ll already find it difficult to flip the ribs as the meat will start falling off the bone. If your seasoning is top notch, you won’t need sauce, but the last hour is the time to baste if you want a different flavor in the mix. The 3–2–1 time frame is a loose guide to follow … You’ll need to keep an eye on the ribs to make sure they are not cooking too fast and that you’re keeping the flame away from the meat, and you may need to adjust times if your temperature exceeds 250F.
6. Remove the Ribs
Remove your ribs from the pit and allow them to rest for about 15 minutes before your cut them. This break will allow the juices to redistribute throughout the meat.
7. Enjoy!
No instructions necessary.
Following these rules, you’ll have a great rack of ribs, and if you took time while the ribs were cooking to order and provision that solution I talked about at the top of the post, you’ll have an amazing high-availability two-tier hosting solution by the time you take your first bite!
-Harold
MySQL Slow? Check for Fragmentation.
Let’s say you have a website and you notice that any calls to your MySQL database take longer to render. If you don’t have a Database Administrator (DBA), this can be pretty frustrating. SoftLayer’s Managed Hosting line of business employs some of the best DBAs in the country and is one of the only managed hosting providers that offers MySQL and MsSQL DBA services, and I don’t just say that because I’m one of them … We’ve got the certifications to prove it. 
Given my area of expertise, I wanted to share a few some simple tips with you to help you tweak variables and improve the performance of your MySQL server. Given that every application is different, this isn’t necessarily a one-size-fits-all solution, but it’ll at least give you a starting point for troubleshooting.
First: Get mysqltuner.pl. This is a fine script by Major Hayden that will give you some valuable information regarding the performance of your MySQL server.
Second: Look for fragmented tables. What are fragmented tables? If there are random insertions into or deletions from the indexes of a table, the indexes may become fragmented. Fragmentation means that the physical ordering of the index pages on the disk is not close to the index ordering of the records on the pages or that there are many unused pages in the 64-page blocks that were allocated to the index. The symptoms of fragmented tables can be that table can take more disk space than needed or the results may return slower with more disk I/O than needed. INNODB users need to check the fragmentation often because when INNODB marks data as deleted, it never overwrites the blocks with new data … It just marks them as unusable. As a result, the data size is artificially inflated and data retrieval is slowed.
Fortunately, there is a way to see your table fragmentation and that is to run a query against the information_schemea to show all tables that are fragmented and the percentage of fragmentation:
SELECT TABLE_SCHEMA, TABLE_NAME, CONCAT(ROUND(data_length / ( 1024 * 1024 ), 2), 'MB') DATA, CONCAT(ROUND(data_free / ( 1024 * 1024 ), 2), 'MB')FREE from information_schema.TABLES where TABLE_SCHEMA NOT IN ('information_schema','mysql') and Data_free < 0;
Fixing the fragmentation is easy, but there are a few caveats. When defragmenting a table, it will lock the table, so make sure you can afford the lock. To fix fragmented tables, you can simply run optimize table <table name>; to rebuild the table and all indexes or you can change the engine of the table with alter table <table name> engine = INNODB;
I have written a simple bash script in bash to go through, defragment and optimize your tables:
#!/bin/bash MYSQL_LOGIN='-u<user name> --password=<passowrd>' for db in $(echo "SHOW DATABASES;" | mysql $MYSQL_LOGIN | grep -v -e "Database" -e "information_schema")do TABLES=$(echo "USE $db; SHOW TABLES;" | mysql $MYSQL_LOGIN | grep -v Tables_in_) echo "Switching to database $db" for table in $TABLES do echo -n " * Optimizing table $table ... " echo "USE $db; OPTIMIZE TABLE $table" | mysql $MYSQL_LOGIN >/dev/null echo "done." donedone
You’d be surprised how much of an impact table fragmentation has on MySQL performance, and this is an easy way to quickly troubleshoot your database that “isn’t as fast as it used to be.” If you follow the above steps and still can’t make sense of what’s causing your database to lag, our Managed Hosting team is always here to work with you to get your servers back in shape … And with the flexibility of month-to-month contract terms and the ability to add managed capabilities to specific pieces of your infrastructure, we have to earn your business every month with spectacular service.
-Lee
Technology Partner Spotlight: Postling
Welcome to the next installment in our blog series highlighting the companies in SoftLayer’s new Technology Partners Marketplace. These Partners have built their businesses on the SoftLayer Platform, and we’re excited for them to tell their stories. New Partners will be added to the Marketplace each month, so stay tuned for many more come.
- Paul Ford, SoftLayer VP of Community Development
We invite each of our featured SoftLayer Tech Marketplace Partners to contribute a guest post to the SoftLayer Blog. As Kevin mentioned in the interview above, Postling‘s David Lifson will be sharing some social media tips and tricks in a separate blog in the near future. To learn more about Postling, visit http://www.postling.com/.
Summer Tips to Clean Your Ride
Remember this? Your car does.
Now that Memorial Day officially marks the beginning of summer and the temperature is creeping back up, it’s time to take care of that neglected car that battled the cold winter and the spring rains. Outside of work, a lot of fellow SLayers are into cars … Some show them off, others focus on making them faster. And given the fact that we are professionally obsessive about keeping our data centers clean and tidy, that obsessiveness is pretty evident in how hard we work to keep our cars clean.
Since today is a holiday in the US, I want to take a break from the down-and-dirty server stuff to give you a quick glimpse at what many SLayers are doing today: Cleaning their rides. Like a lot of the technical troubleshooting we do, it’s best to stick to a particular flow of steps to cover all the bases and get the best outcome. The following steps are the ones I take to bring back the showroom-floor shine. Since the typical car detail can run anywhere from $50-$300 this is a great way to save money every month … so you can order another server or upgrade the hardware on an existing one. 
What You’ll Need
- Bucket
- Soap
- Sponge or Microfiber or Sheepskin Glove
- Clay Bar
- Wax and Foam Wax Applicator
- Quik Detailer
- Glass Cleaner
- Tire Shine – Optional
- Microfiber Towels – The more the merrier
- Beer (or beverage of choice) – Optional … also the more the merrier
- Bonus: Swirl Remover – If you’re using a rotary buffer
- Bonus: Finishing Polish
Note: In all steps where washing is involved, rinse first to get any loose dirt off then gently scrub and rinse off. Car should be parked in the shade to avoid water spots. All steps after clay barring MUST be done in the shade.
Step 1: Washing the Wheels
Make sure your brake rotors have cooled before hitting them with cold water, otherwise you could risk warping them. Because of the dirt and grime wheels get, I recommend using a separate bucket and sponge for this step.
Step 2: Washing the Rest of the Car / Drying
Always work from the top of the car to the bottom, and the best practice is to do one panel at a time.
Frequently rinse your sponge or glove to release the dirt it picks up.
When scrubbing the side panels, it’s better to go up and down instead of side to side or in circles.
Drying panels as soon as you’ve rinsed them helps prevent water spots.
Step 2.1: Tire Shine (Optional)
Try to keep Tire Shine on the tires only. If you get it on the wheel, it’ll just allow dirt and/or brake dust to attach to the wheel.
Don’t overdo this or it will just splash back onto your car when you start driving.
Step 3: Clay Bar
Spray Quik Detailer onto surface and gently rub the clay bar from side to side.
Fold the clay bar between sprays. This keeps the clay bar surface clean.
Dry leftover Quik Detailer with a microfiber towel.
Step 3.1: Swirl Remover then Finishing Polish (optional)
Best when used with a rotary buffer at high speed.
If doing by hand, using pressure, apply in small circular motions.
Remove with a microfiber towel.
Step 4: Wax
Using either a foam wax applicator or rotary buffer on low speed, apply wax as thinly as possible, otherwise it will be harder to remove.
When the surface looks hazy, remove with a microfiber towel.
Step 5: Quik Detailer & Glass Cleaner
Use Glass Cleaner on windows and mirrors.
Quik Detail the whole car again.
These steps clear off any leftover dust from waxing as well as remove any water spots from water that may have crept out after waxing.
Step 6: That’s All!
Crack open a beer and gaze at your beautiful car … *wipe drool off of face*.
The process can take as long as several hours to complete depending on how bad your car needs a cleaning. If this process has been completed recently, you can skip Steps 3 and 4, as clay barring is only needed ~2-3 times a year and waxing every 2-3 months.
If you’re like us and you love showing off your car, after it gets all dolled up, post a link to a picture of it here in the comments!
-Tommy
Bringing Home Data Center Security
Look at any time period in mankind’s history, and you’ll come to the undeniable conclusion that technology changes the daily lives people in any society. With the evolution of technology, our lives have gotten so much easier. Consider all the little luxuries and conveniences available now to get tasks done in the workplace and home. Unfortunately, our rapid technological advancements aren’t necessarily exclusive to the “good guys” … The “bad guys” are benefiting from new technologies as well. Crime and theft have become more sophisticated, and as a result, more technological advancement has to be pursued in security, and it’s pretty remarkable to see some of the security measures and technologies put in place by companies like SoftLayer.
The day I started working here, I thought I was actually joining the CIA. I had to undergo several procedures to gain access to all the facilities: I had my photo taken and my fingerprints scanned before I registered for multiple key cards. The first job I had out of college only required its employees to have a single key card that allowed entrance through one door with access to all areas. Needless to say, it was a lot different to work in such a secure environment.
To give you an idea of what kinds of security we have at our data center, I’ll walk you through my daily experience. I step into our lobby and am usually greeted by multiple security guards behind what appears to be bullet-proof glass. I have to pass a fingerprint scanner and numerous secured door checkpoints to get into the office. Every move is under the scrutiny of video cameras recording every square inch of the building. Big Brother is always watching, and for SoftLayer customers, that should be reassuring.
The facility’s security reminds me of the movie Minority Report, and while those security measures may seem unnecessary or excessive, they’re actually just visible evidence of SoftLayer’s focus on the importance of security both online and in the physical realm.
Thinking about safety, I’ve also started considering heightening security at my home with a few security cameras. Some of my friends joke that this consideration is a sign of impending paranoia, but the “better safe than sorry” mantra should always be kept close to heart when it comes to protecting valuables. Apparently, I’m not alone in my home security research … A day after writing a good portion of this article, I came to work and in the morning a coworker told me he’d recently bought a security camera with night vision for personal use. I didn’t expect such a coincidence, and of course I enthusiastically replied to my coworker that I was thinking about making a similar purchase.
In closing, I’d like to ask you if you’ve entertained the idea of increasing security in your own home, and if so, do you have any suggestions about what equipment to purchase and features that prove useful? I doubt I’ll go as far as hiring security guards and installing fingerprint scanners, but you never know!
-Danny
Startup Series: Teens in Tech Labs
In my 3 Bars 3 Questions interview with Kevin a few weeks ago, I touched on the Community Development groups goals as we work with startups, incubators and customers in our Technology Partners Marketplace, and last week I had the chance to visit a young, up-and-coming incubator in the Bay Area: Teens in Tech Labs. Among some of their other projects, Teens in Tech is launching the Teens in Tech Incubator – a program built on the idea that entrepreneurship doesn’t have a start age.
The incubator program lasts a little over eight weeks and is very hands on, in terms of mentor and adviser involvement. Each team invited to participate will be paired up with a group of mentors and advisers that will help during the process.
At the end of each week of the eight week program, the Teens in Tech staff will meet with each company to go over how their week went and what they think will help further build their business. Every other week, Teens in Tech will organize a dinner and have a guest speaker present to the teams … And it gives the teams a chance to interact with each other outside of building their product.
At the end of the eight weeks, the teams will present their startups to a group of Venture Capitalists, influencers, members of the press and others at an event called “Demo Day.”
Teens in Tech CEO Daniel Brusilovsky invited me to join him on a quick tour of their brand new office space in Mountain View, CA, and I made sure to grab my camera to capture the environment before the team and the incubator participants moved their stuff in:
We’re happy to support Teens in Tech, and we’re looking forward to seeing some of the amazing companies that’ll come from the best and brightest entrepreneurs under 18 years old!
3 Bars | 3 Questions: SoftLayer Culture
In the first 7 episodes of the 3 Bars | 3 Questions series, you’ve had the chance to meet some interesting people who work for SoftLayer. In the last installment, Paul Ford chose “The Mitch” as the next participant, and that’s a bit of a curve ball. “The Mitch” isn’t exactly a SoftLayer employee, but he is a character born out of the Softlayer culture, so he qualifies for an interview:
Given our company culture and the time our team spends together in the office, these kinds of jokes are pretty common, and works is a lot more fun as a result. If you want to join the “tens” of fans referenced in the video, find “The Mitch” on Facebook and “Like” accordingly.
If you want to get your very own (extremely rare and valuable) personalized copy of “The Mitch,” mail your head shot to “The Mitch” c/o SoftLayer Technologies, 4849 Alpha Road, Dallas, TX 75244. And yes, employees who haven’t been lucky enough to receive a print are eligible to participate as well.