text:
They are the eXtreme Games—X Games for short. The big show. Lots of pressure, lots of press, lots on the line. The action is already under way. We've got a couple staffers on the way to the epicenter of extremeness, so stay tuned for coverage as it happens. In the meantime, scope this gallery of last year's highlights and see what's on the minds of a couple of heavy-hitting X Games competitors as they head into the heat of competition. Join us in wishing all the riders good luck in Aspen over the next few days.
What are they thinking? Here is what a couple shreds said:
Scotty Lago: Superpipe & slopestyle
"Damn! There are so many pro-hos at X, I hope I stomp, so I can really pull some chicks."
Andreas Wiig: Slopestyle
"Trying to do my best and have a good time. Get ready for a couple of days of hard landings and doing stuff non-stop …"
Kelly Clark: Superpipe
"I'm excited for X Games, the pipe is 22-feet this year, which will be a fun change."
Stay tuned for complete X Games 13 Coverage. Here's a gallery from last year's X Games: X Games 12.


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Ojibwe member, Paulson, says it's all about the harvest, nature and community.
When you think of how Americans typically celebrate Thanksgiving, it's usually a big meal with lots of family and maybe even friends. But for Bill Paulson and the rest of the Ojibwe tribe on the White Earth Reservation, it's practically a year-round event.
"Every time we turn around, we're giving thanks," Paulson explained to a crowd of faculty, students and community members in the University of Minnesota, Crookston's Bede Ballroom Tuesday afternoon. He went on to say that they have big celebrations to give thanks at least six times a year, and it's very much a nature based-thing, as well as community.
Each year, many harvests take place, whether it be berries, maple, or wild rice. Everyone in the tribe contributes to a harvest, Paulson explained, and they make sure everything has been taken care of before moving on to the next thing. At the end of each harvest, they come together and share what has been gathered. The biggest harvest is the wild rice, which Paulson believes is why they have settled there. "We would take care of the wild rice, and the wild rice would take care of us," he said. The harvest is so big, they have wild rice "camps." When it's done, they invite others to share in the bounty.
It's all about "community," he said. "Native pride today is a sense of meaning, a sense of feeling in the community," he explained. In fact, the traditional pow-wows were meant to be social events. "The pow-wow as a social function was really about a celebration of the the year, when everything settled down," Paulson said. "People would come together from different communities, European, Native, whatever, for more than a day or two. They would bring the drums out...share stories, do dances, and they would sit and visit."
When it really comes down to it, what was Paulson's point? "There really is not just one Thanksgiving. So, if we're going to Thanksgiving, try to be thankful every day," he said.


text:
Teen Taylor Swift Lookalike Beaten by Bullies
Normally, looking like Taylor Swift wouldn't be a bad thing, since the singer is gorge. But an 18-year-old who recently became a professional T. Swizzle impersonator -- since there is a need for such things -- claims she was kicked in the face and beaten by bullies who are jealous of her looks. Oh no!
Xenna Kristian reportedly sustained bruising and a suspected broken jaw after being yanked from her chair by her ponytail and repeatedly kicked.
Kristian attends Walford and North Shropshire College in England but makes some paper by impersonating Swift. When her fellow students found out about her side gig, they attacked her. It's not like she resorted to hooking or stripping or other forms of adult entertainment to rake in some cash to make ends meet.
It sounds like her classmates were jealous since looking like T. Swiz inherently means you're pretty, and Kristian is able to have a cool job, since she books gigs at private parties and charity events due to her physical similarity to Swift. Most college students have to work on campus or at local retail, but not Kristian.
"Some girls at college had started making nasty comments, but it escalated really quickly," Kristian said, revealing that she decided to be a Swift impersonator after she was told repeatedly that she resembled the pop-country superstar. "The girl came up behind me and dragged me off my chair by my ponytail, then started kicking me in the face."
It was an ambush attack that Kristian did not expect, and while teachers did nothing, her friends intervened to pull a bully off.
Kristian's mother even pointed out that the girl had never before had a fight and that the hostility arose once the Swift gig came to light.
In all seriousness, beating someone up because of how they look is decidedly not cool.


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A friend of mine from college....
Teaches Phys Ed. in upstate NY, and makes about 80K a year (w/coaching).
Nice to know a nuculear planner can make 54K starting off!
Yeah, those pay rates are
Yeah, those pay rates are slightly alarming. I guess the state isn't really concerned about attracting the best and brightest nuclear planners.
Made me think of this one
The challenges!
I remember those. Bern, Switzerland was a traffic jam.
Yeah, back in the good ol' days
When you could have Godzilla stomp your city, before they had to replace it with a walking junkyard because of complaints, no doubt, from the Godzilla people.
Then again, arrgh, that stupid black-on-maroon code sheet you needed to never lose if you wanted to play. Kids today just have no idea how rough life was back then, harrumph.
There's an obscure blast from
There's an obscure blast from the past! That black-on-maroon sheet was a clever way to discourage piracy. I was about 11 years old and remember spending hours transcribing that sheet in order to use a copy that I got from a friend.
Ah, the good ol' days.
The long con
This is the second SimCity reference I've seen here in the last five days, Adam. I'm starting to suspect that you're a secret plant from EA, running viral marketing for their new game and playing the ultra-long con by hosting this website for years to lull us all into complacency.
My dream job
Traffic advisor in SimCity 4.
(No subject)
That's it
Now I'm motivated to start up the various version of SimCity when I get home and nitpick how well/poorly they design Boston.
EDIT - Or I can just use someone else's work.
SimCity (Amiga): http://hol.abime.net/1928/gamemap
SimCity (SNES): http://www.vgmaps.com/Atlas/SuperNES/SimCity-Scena...
And I'm sure everyone else knows about this:
The Nintendo version
had Bowser attacks, instead of Godzilla.
Yoga Teacher Wanted
For emergency nuclear planning. Must be able to prepare the population of MA to have adequate flexibility to bend over and kiss their asses goodbye in the event of an over stuffed fuel pool at Pilgrim losing power to circulating water system and going critical.
Oh, and to be able to swivel their necks to see the pathetic "evacuation route" signs while jammed in panicked traffic.
Talk about a useless job
Can you imagine trying to get off the South Shore in the event of a nuclear emergency at the George Burns of nukes?
Yes, by all means, keep fighting those wind turbines, Scituate!
In the last 20 years, more
In the last 20 years, more people have been killed by wind turbines than nuclear power plants. More people have been killed by organic bean sprouts than nuclear power plants. In the Three Mile Island 'disaster' no one so much as caught a cold.
Fukishima. Same design.
And it didn't have 4x as many spent fuel rods in the pool than it was designed for like Pilgrim does.
Bean sprouts and wind turbines won't render an entire region uninhabitable for thousands of years due to a single power outage.
Funny you should bring up
Funny you should bring up Fukushima. Thousands died from the tsumani. Not a single person was killed by the plant failure.
As to your fantasy of 'an entire region unihabitable' - you're been reading too many green fantasy stories. Chernobyl is a natural paradise today. The claims of damage are now widely accepted by scientists to have been inflated by orders of magnitude. Far, far greater harm is now known to have been done by the forced removal of the population than by the original meltdown.
This is very simple - I'll explain it so even you could understand it, if you'd let yourself. You've said you have kids? Which would you prefer - to see your child dead from eating organic sprouts, or to see them living near Chernobyl right now, where birds sing? C'mon Mom, what's your priority?
Funny,how close do you live
to the Plymouth nuke?
Call me when a severe
Call me when a severe earthquake and a tsunami are threatening to hit the Pilgrim plant within a couple of hours of each other. In the meantime, I'll be over here, in the real world, where our options for large-scale power generation are nuclear and coal, and where coal kills more people every year under normal operating conditions than a nuclear plant does in a full-scale meltdown.
We can do both
I'm right there usually with the environmental causes, but science trumps earth-friendliness - we can make *much* safer reactors now than there were in the past, but fear of the past...indeed, fear of things that never even directly impacted Americans...has kept us confined to a slow death by coal.
Natural gas-sourced power is a stopgap measure, but it's makes us the toad in the pot of water. Nuclear will solve the bulk of the needs, while solar/wind/geo can be used where feasible.
Self-terminating reactors like thorium/molten salt designs (which can consume those spent fuel rods!) are what we should be pursuing since they'll give us far better efficiency/scalability while we can work on improving solar designs for the future. They produce useful byproducts that won't require fifty houses of congress to decide where to put it.
Windfarms too, but at least we can put thorium reactors in places that won't offend anyone's pristine waterfront views.


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Construction Output in South Korea
Related Statistics
Hydraulic Cement Production in South Korea, Forecast 2017 - 2021
Employment - by economic activity, Industry including construction, All persons (Thousand Persons) in South Korea
Construction Index in South Korea
Employment - by economic activity, Industry excluding construction, All persons (Thousand Persons) in South Korea
Employment - by economic activity, Construction, All persons (Thousand Persons) in South Korea
Construction Output in other Countries
Main Construction Indicators
Number of issued building permits, it is an indicator of the construction sector's growth. A building permit is an authorisation to start work on a building project. As such, a permit is the final stage of planning and building authorisations from public authorities, prior to the start of work. Based on: Eurostat.
Number of new privately owned housing units completed. Is is an indicator of construction work actually completed within a given period of time or at a particular point in time. Based on: Organisation for Economic Co-operation and Development.
Value of output of the construction industry less the value of intermediate consumption (intermediate inputs) used in this industry. It can be expressed in millions or billions of national currency, or in percentage of GDP. Based on: Organisation for Economic Co-operation and Development.
Measure of the production in the construction industry.
Value of total spending in the construction industry, usually expressed in millions billions of national currency. It includes the cost of labor and materials, cost of architectural and engineering work, overhead costs, interest and taxes paid during construction and contractor's profts. Based on: US Census Bureau.
Number of new buildings on which construction has been started in a given period. Start of a construction occurs when excavation begins for the footings or foundation of a building. Based on: U.S. Census Bureau.
Number of buildings in a state of construction (up until they receive their certificate of occupancy), at a given date in a country.


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The Domestic Novel
Sadlier articulates explicit didactic goals in her prefaces to both The Blakes and Flanagans and >Bessy Conway. The plot of the former is closer than the latter to that of the typical domestic novel or romance described by Nina Baym, with a young and vulnerable heroine out alone in the wide world, for all intents and purposes orphaned, if not actually parentless, striving to make a way for herself while protecting her virtue (Baym, 22-50). None of Sadlier's novels conform completely to Baym's model, as Sadlier was not concerned with individual heroines such as Catharine Sedgwick's Hope Leslie or Susan Warner's Ellen Montgomery. Sadlier is concerned with classes of people -- Irish immigrants, and in particular Irish women in traditional Catholic homes. Even in a novel ostensibly about a single heroine, Sadlier does not limit herself to merely telling Bessy Conway's story; she peoples her novel with an entire village of Irish folk who immigrate together on the same boat. In Blakes and the Flanagans, Sadlier expands her scope beyond the families mentioned in the title to include an entire neighborhood. Sadlier is concerned with society in all of her novels, never with the quest of an individual self as is Augusta Evans in St. Elmo or Elizabeth Stoddard in The Morgesons. Sadlier's novels adhere to Baym's model of community orientation. Domestic novels, in her view, "were Victorian also in their perception of the self as a product, firmly and irrevocably embedded in a social construct that could destroy it but that also shaped it, constrained it, encouraged it, and ultimately fulfilled it" (Baym, 36). In a sense, Bessy Conway -- who follows "the dream of her young heart" (Bessy Conway, 7) to see America and so leave Ireland alone to emigrate to New York -- is an orphan figure. But in a larger sense, all of Ireland's immigrants are orphans, exiled from their country by fate and forever searching not for their mother, but their motherland. The entire first generation of immigrants in Sadlier's novels are all cast adrift on the shores of New York without their parents or support institutions. The only link with Ireland for these exiles is their Catholic faith. Being true to their faith is thus a way for these "orphans" to be true to their hearts and their values.
Return to the Sadlier Critical Introduction
Return to the Sadlier Home Page


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A biological basis for acupuncture, or more evidence for a placebo effect?
In the past, I have criticised science journalists for not providing enough background in their reports. Both news stories and scientific papers obviously focus on new events and achievements, but they do so in the knowledge that new discoveries stand on giant shoulders. For this reason, when I cover new papers for this blog, I try to describe some of the research that led up to it, a tactic that fits with the growing cries for more context in modern journalism.
And yet, it's perhaps churlish to expect this to be a routine part of science journalism when many scientists themselves don't take up the practice. I bring this up in the light of a new paper, published today in Nature Neuroscience, about the controversial topic of acupuncture. I was going to do this as a straight write-up but actually the omissions in the paper are probably just as interesting than the science within it.
The gist is this: Nanna Goldman from the University of Rochester Medical Center claims to have found a biological explanation for the pain-relieving effects of acupuncture. She worked with mice that had inflamed paws, and managed to alleviate their pain by using a needle to pierce a traditional acupuncture point near the knee. This painkilling effect only happened when she rotated the needles after insertion.
This effect depended on a chemical called adenosine, which typically surges in concentration after any stress or injury. Adenosine works by docking at a protein called the adenosine A1 receptor, which has well established roles in suppressing pain and is found on neurons that transmit pain signals. Indeed, other chemicals that stimulated this protein had the same pain-relieving effects as acupuncture. Drugs that prevent the body from breaking down adenosine led to even more potent pain relief. And mice that lacked the A1 receptor altogether experienced no pain relief from the needles.
Taken on its own merits, this is a nice piece of biochemistry. But what does it really tell us about acupuncture? Does it actually validate this ancient method as a way of relieving pain? After reading the paper, you might walk away with that idea that we're one step closer to understanding how a treatment with real medical benefits really works. It's littered with statements like "A1 receptor activation is both necessary and sufficient for the clinical benefits of acupuncture" and "medications that interfere with A1 receptors or adenosine metabolism may improve the clinical benefit of acupuncture". In the study's press release, lead scientist Maiken Nedergaard even says, "The new findings add to the scientific heft underlying acupuncture."
But these results have to be considered in the light of those that came before it. As mentioned above, new scientific discoveries stand on the shoulders of giants and in the case of acupuncture – one of the most well-researched of all "alternative therapies" – those shoulders are particularly large.
Many trials have demonstrated that acupuncture does have some pain-relieving effects – that is not in doubt. And as Steven Novella notes, unlike things like homeopathy or reiki, with acupuncture "something physical is actually happening… so it is therefore not impossible that a physiological response is happening". But the big questions are whether this effect is genuine of nothing more than a placebo.
To answer that, clinical trials have used sophisticated methods, including "sham needles", where the needle's point retracts back into the shaft like the blade of a movie knife. It never breaks the skin, but patients can't tell the difference from a real, penetrating needle. Last year, one such trial (which was widely misreported) found that acupuncture does help to relieve chronic back pain and outperformed "usual care". However, it didn't matter whether the needles actually pierce the skin, because sham needles were just as effective. Nor did it matter where the needles were placed, contrary to what acupuncturists would have us believe.
Other trials have found similar results. Going beyond individual studies and looking at all of the available evidence doesn't much change the verdict. Last year, scientists from the Nordic Cochrane review centre did an analysis of the available evidence and after considering the 13 trials that met their stringent quality criteria, they concluded:
"A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias… Our findings question both the traditional foundation of acupuncture, which is based on the existence of meridians and Qi sensations, and the prevailing hypothesis that acupuncture has an important effect on pain in general. If this hypothesis is wrong, and our results point to that, then acupuncture would seem to be unlikely to have an effect on pain related only to certain conditions, but further studies may examine this question."
Goldman doesn't really address any of these points. The introduction to her paper focuses on acupuncture's popularity, mentioning endorsements by the WHO, the NIH and, strangely, the US Internal Revenue Service. As to the bigger question about whether it is effective, there is no sign of the recent trials or reviews that I mentioned. Instead, she briefly says that the pain-killing effects of acupuncture are "well-documented" and that "Western medicine has treated acupuncture with considerable skepticism", citing only an editorial published in 1972.
As I've said, this is not an area that's lacking in earlier research to refer to or consider. The discussion is a bit better in that it at least references one trial which showed that acupuncture has no advantage over placebo sham-needle treatments. And if anything, the results seem entirely consistent with the idea of acupuncture as an elaborate placebo.
The tissue damage inflicted by the rotating needle triggers a local flood of adenosine. If the needle is stuck in the right general area, the extra adenosine reaches the receptors on the pain-transmitting neurons and shuts down their activity. There is no need to invoke 'qi' flowing through 'meridians'. Indeed, all sorts of injuries and stresses will lead to a burst of adenosine. And Goldman even says that sham needles, by stimulating but not breaking the skin, could still trigger a burst of adenosine, leading to the same pain-killing effects.
There has been so much previous work in this area that the question "How does acupuncture work?" is better replaced by "Why are acupuncture's effects largely indistinguishable from those of sham treatments?" The new study suggests some answers but it seems unfortunate to me that Goldman didn't include any sham-needle controls in her experiments.
Brian Berman, who has been involved in previous Cochrane reviews of acupuncture, agrees. He described the study a "very interesting" but said that "some sort of a placebo control is needed". Edzard Ernst, former professor of complementary medicine at the University of Exeter, has written extensively about acupuncture also concurs. He told me, "It's an interesting study but it proves nothing. We need independent replication, better controls and studies in humans."
This is the most frustrating part of what could have been a really fascinating study. Without building on the massive amount of work that's already been done on acupuncture, it is hard to know what to make the new and admittedly interesting results. I also wonder whether your average health journalist will know how this study fits into the bigger picture – whether it vindicates the use of acupuncture or whether it actually fits with a skeptical stance. But I suspect we won't have to wait long to find out.
PS: The paper notes that the authors have no competing financial interests that might have affected their work. However, it is worth noting that one of the co-authors, Jurgen Schnermann, is married to one Josephine Briggs. Briggs is the director of the National Center for Complementary and Alternative Medicine, an institute that has had its fair share of controversy in the past.
Update: Yeah, the mainstream media aren't really covering themselves in glory here. See Stuff and Nonsense for a summary. The Times probably has the best piece, in that it actually mentions previous trial data and has some great commentary from Edzard Ernst.
Reference: Nature Neuroscience http://dx.doi.org/10.1038/nn.2562
More on pain:
- Racial bias weakens our ability to feel someone else's pain
- When pain is pleasant
- The placebo effect affects pain signalling in the spine
- Doctors repress their responses to their patients' pain
- Thinking about money soothes sting of social rejection and physical pain
- Itch-specific neurons discovered in mice
- Pain in the eye of the beholder
Comments (59)
Fascinating analysis, Ed! You never cease to amaze
You are criticizing biochemists for not going outside their field to take into account the entire history of acupuncture research in order to put their research into context. You are criticizing the researchers for not testing sham acupuncture at the same time they tested traditional acupuncture.
Scientists rarely put their research into broader contexts, choosing to focus on what they really understand.
Science works in small, incremental steps. One reasonably obvious next step is for these researchers (or perhaps others) to test sham acupuncture.
Why pick on this particular paper? You have tens of thousands to choose from!
That PS kinda nails it, doesn't it?
I'm well aware that science progresses in small incremental steps, but this is why context is important. One needs to bear in mind work that has gone before so one can ask the right questions. And I'm not convinced that this has been done in this case.
As to why I'm writing about this paper: I found it interesting and irritating at the same time. And I wanted to analyse it in the context of existing research because I felt that (a) they hadn't and (b) the mainstream media were unlikely to
Rocky: It does not seem at all unreasonable to ask the paper's authors for context. This is not a study in some niche area of biochemistry. Is it obvious that the question itself was motivated by a social context in which acupunture has been theorized about. Why would it be reasonable to use that context to motivate your research, but then ignore it when presenting your results?
I also think it's important to answer the question of whether acupuncture works or not sooner rather than later – since public health dollars are now being spent on it in some Canadian provinces (British Columbia for sure; not sure in how many others) – and money to support our public healthcare system is being diverted largely from the education budget. In other cost-cutting measures, eye exams are no longer covered by the public healthcare system in that province (they used to be paid for every two years, despite the fact that 'heavy' computer users should probably have their eyes checked every year – and who isn't a heavy computer user in 2010)?
Ed: I am very dubious about acupuncture, although I know almost nothing of the research. That said, and the promise that I am really not trying to start a fight but rather to understand the point you are making, I am wondering how can a placebo effect work in mice? I am asking this because it seems to me that surely mice don't "believe" that acupuncture is going to work. If the "painkilling effect" really "only happened when she rotated the needles after insertion," as you report the paper says, then what is a placebo control going to be used for?
I agree that the promotion of acupuncture by the authors even in the introduction bis out of line and the non-disclosure of the spouse's interest is ethically suspect, whatever Nature Neuroscience's disclosure rules are. (That seems to me, however, to go to whether it would be worthwhile to see if the result could be duplicated by someone without an interest in the result, before accepting the results on their face.) But I just don't get how Berman would design a placebo control in mice in this context or what good talking about recent research in humans in this context does.
Great piece, as always.
But Ed,
why do you really need "placebo" control in an animal trial?
My thoughts on this are that acupunture is not a single thing, as Traditional Chinese Medicine assumes, but is actually different modalities.
I wrote the "FAQ" on acupuncture for the sci.skeptic NNTP newsgroup years ago, and at that time I believe there was reasonable evidence for acupuncture analgesia above and beyond expectancy effects. I don't know if the situation has changed significantly since then.
Analgesia stood out however as the only effect that had such evidence, and the mechanism was not clear. Not all of the supporting studies seemed to show mediation of the effect via naloxone as I remember, so this Nat Neuro data may actually help to explain the non-opioid analgesia, so in that context it may have real scientific value.
On the other hand, there are many things acupuncture is used for that are not analgesia, and as far as I know, no clear evidence for mechanisms for those beyond placebo, at least not any single overarching physiological theory. So, the claims of the article to have found "the mechanism" for acupuncture are ertainly dubious in the larger context.
Trying to catch up my reading on acupuncture analgesia, I came across this 2008 article in Pain Medicine reviewing studies testing various hypotheses of central mechanisms of acupuncture analgesia.
Now I realize very well that it is very problematic to distinguish centrally mediated opioid mechanisms of acupuncture from expectancy effects, so although I suspect there is something more than expectancy here, I won't try to make that argument.
However I do notice from reading between the lines here that they still recognize a non-opioid component to acupuncture analgesia, and this is where the Nature Neuroscience article might tell us something new.
kind regards,
"I also think it's important to answer the question of whether acupuncture works or not sooner rather than later "
It isn't in the least important. Complex question fallacy: 'Acupuncture' works for what medical condition(s) exactly?
It's like the 'Homeopathy' crap. Are we supposed to test every possible substance in the entire chemical universe – from cincona bark to essence of shipwreck (all diluted out of existence of course) – and for all possible conditions, no matter how vaguely specified, which the homeopaths suggest they might (in substantial quantities) cause, before concluding that there was never any good reason to test *any* homeopathic nonsense 'remedy' in the first place?
I think not.
Why? Because neither 'Acupuncture' nor 'Homeopathy' exist as well motivated, well specified coherent and plausible ideas in the first place. Both pretend to be complete general 'systems of medicine' or highly condition specific particular interventions, depending on which question they are trying to evade at the time.
I guess the placebo effects in mice issue would be best addressed by considering how they assessed pain relief in the mice. Placebos don't just mean that people expect to feel better – as pointed out elsewhere, acupuncture involves physical stimulation and in humans, the effects of acupuncture do not differ from the results seen with sham needles that don't break the skin (i.e. it is the tactile stimulation that has an effect). Pain is notoriously difficult to measure objectively in humans and in non humans other measures (avoidance, physiological stress responses) are typically reported. As far as I can see it is a physiological change being discussed in all the reports of this paper (i.e. adenosine levels) and as Ed says, there is no indication that a control (e.g. sham needles) has been included. The fact that rotation of the needles is important also seems to be attributed to the adenosine changes.
Recently, in a different context (that is, the context of a very sore back), I browsed research on acupuncture and piriformis syndrome–a sciatic-pain problem. One study I found came from a Chinese source–an institution practicing clinical acupuncture, which obviously believes in the technique's basic efficacy–where a comparison was made between acupuncture treatment for piriformis-muscle pain with and without rotation of the needles. Both techniques seemed to provide relief of symptoms, as compared to a control group, but the rotated needles provided relief with fewer treatments in a shorter period of time. This study, like the one in Nature Neuroscience–like any study–only shows what it shows. But it certainly suggests that there may be something to the adenosine theory deserving of more work. Certainly one can criticize science journalists for over-hyping stuff, but I don't think any individual researcher is responsible for what journalists make of one study. And just as I'm suspicious of any overgeneralizing of one study, I'm suspicious of Ed Young's overgeneralizing his criticism of the research design of specific studies into a glib dismissal of a whole topic of research. I've been reading–and sometime professionally editing–medical research for decades, and I'd suggest that playing the "placebo effect" card is often a lazy, knee-jerk substitute for actually analyzing a study's methods and results. (And it can lead to really weird stuff like studies of "sham surgery" that are riddled with logical holes and, to me, are a huge waste of time, money, and the ethical capital of science.)
Leaving the poor little buggers alone would be the best relief,though, wouldn't it?
I have recently had acupuncture. Perhaps it is because my acupuncturist merges Western and Eastern techniques and works on athletes for muscle strains, but several of the needle insertions do in fact cause muscle "jumps" and "ripple effects" of contraction and relaxation. I experienced soreness afterward — as if I had worked out — and the problem areas I wanted loosened up were in fact loosened up considerably. So it does matter where the pins are placed if the acupuncturist is targeting a particular muscle group where there has been high tension and low blood circulation. The skepticism of the author tends to suggest that he has never had acupuncture, but the argument he is making is akin to arguing a hot stone treatment (having hot stones rubbed against tight or sore muscles) cannot possibly improve circulation or reduce stress. It's just silly.
"The paper notes that the authors have no competing financial interests that might have affected their work. However, it is worth noting that one of the co-authors, Jurgen Schnermann, is married to one Josephine Briggs. Briggs is the director of the National Center for Complementary and Alternative Medicine, an institute that has had its fair share of controversy in the past."
Not to worry. That must just be a placebo financial conflict.
Good job, Ed !
The "sham needle" study is interesting, but also shows the researchers lack of knowledge concerning acupuncture theory, as both acupoint and acupressure involve the stimulation of pressure points without actually piercing the skin. In fact, there are a kind of acupuncture needle called Teishin needles which are not intended to puncture the skin, and seem to not be substantially different than the "sham needle." As such, the "sham needle" would not be recognized by the TCM community as a true control – rather, the efficacy of the "sham needle" would seem to confirm that both acupuncture – which requires a license and board certification – and acupressure, which does not, are both viable treatment options.
The more interesting part of the study for me is that the actual point of insertion (or non-insertion) didn't seem to matter. This certainly deserves further investigation.
But I know well enough that my own personal experience is completely irrelevant here when it comes to addressing whether this technique actually works. This is why we have randomised clinical trials.
No, that is not true. The technique works on some people. The question is whether the technique can be shown to work across various persons in a reliable manner under experimental conditions. If someone stabs one of your muscles with a pin and it causes a reflexive spasm throughout the entire muscle group, that just happened. You do not need a double-blind randomized clinical trial to prove that it happened.
"The technique works on some people."
So does a Placebo!
And this is why when as a kid when I skinned my knee I would bite my knuckle. Same effect. I don't need to pay some one to do this when I can stimulate my own adenosine.
Interesting piece Ed. Thanks.
On a broader sweep, it got me thinking about the placebo effect. I know this isn't an original thought, but assuming that the placebo effect is significant in pain relief, then isn't this a valid piece of a medical practitioner's arsenal for treating patients? Or, in other words, is it right, ethically or Hippocratically, for a Dr. to knowingly defraud their patients with whatever works (yes, even homeopathy if the patient believes it works) to elicit a placebo effect? I'm not pro-alternative remedies, but if the placebo is a sufficiently strong effect isn't it worth deliberately eliciting this response if it helps?
I'm not a doctor, but I have been a patient. The thing is, you can get a very strong placebo effect just from having a doctor talk to you or touch you. That kind of placebo is fine, as is having a doctor reassure you that you're going to be OK. If doctors only prescribe actual effective treatments, then you get a strong placebo plus real medicine. BTW, I got this idea from a book about placebos, but I unfortunately can't remember the name of either the book or the author. There are over a thousand books on 'placebo effect' on Amazon!
On the other hand, plugging in 'sham treatment' pulled up several books on acupuncture. Just sayin'.
So does a Placebo!
Right, except I'm not referring simply to needle insertion, but needle insertion to stimulate muscle contraction or relaxation. That is quite different than simply piercing the body all over (without doing any muscle work), and my point is that you do not need a double-blind study to tell you that you just experienced muscle spasms. Many acupuncturists treat athletes for muscle strains and sports injuries — focusing on that self-selected group would determine the physiological effect of acupuncture, not taking in random members of the general population (who may receive no benefit, or no benefit greater than a placebo, because they don't need it).
"That is quite different than simply piercing the body all over (without doing any muscle work), and my point is that you do not need a double-blind study to tell you that you just experienced muscle spasms."
That's true – it's an interaction simple enough and an effect size large enough to make such studies unnecessary. But so what? The detection of a muscle spasm is not evidence of a clinically desirable outcome in the case of muscle strain any more than the sight of a drop of blood is evidence of a successful vaccination injection.
""That is quite different than simply piercing the body all over (without doing any muscle work), and my point is that you do not need a double-blind study to tell you that you just experienced muscle spasms."
True, but as phayes also said, "The detection of a muscle spasm is not evidence of a clinically desirable outcome," which is precisely my point. You can convince yourself that you feel better and/or are improving (clinically speaking) from experiencing muscle spasms, but a hard look at the data proves that you're just lying to yourself.
The detection of a muscle spasm is not evidence of a clinically desirable outcome in the case of muscle strain any more than the sight of a drop of blood is evidence of a successful vaccination injection.
That is true. But the argument was that the point of insertion does matter when the desired outcome is to stimulate a particular muscle group. If you are going to claim there is no physiological effect other than minor trauma that causes a rush of adenosine, then you have to deal with the fact that athletes with muscle strains who have muscle groups stimulated by local insertions report reduced tension from acupuncture. A muscle spasm is not necessarily therapuetic — nor did I make that claim. But a muscle spasm is a physiological effect that is not an increase of localized adenosine.
You can convince yourself that you feel better and/or are improving (clinically speaking) from experiencing muscle spasms, but a hard look at the data proves that you're just lying to yourself.
This is a logical leap a field afar from what I said and insulting. It has nothing to do with science.
Regarding the safety of traditional medicine the WHO states:
"There is some evidence that seems to support the use of traditional and complementary medicine – for example, acupuncture in relieving pain, yoga to reduce asthma attacks, and tai ji techniques to help elderly people reduce their fear of falls. WHO does not currently recommend these practices, but is working with countries to promote an evidence-based approach to addressing safety, efficacy and quality issues."
This falls well short of a WHO endorsement of acupuncture. Acupuncture organisations sometimes claim WHO endorsement on the back of a document published by the WHO in 2003. This document claimed that acupuncture had been proved to be of benefit for 28 medical conditions. This claim, however, was based on a hopelessly flawed systematic review which systematically excluded negative or neutral sham-controlled studies.
The 1997 NIH consensus statement on acupuncture (not a statement of the NIH, but a snapshot opinion of a 12 member panel) found the evidence of efficacy for pain to be unclear. Only for adult postoperative and chemotherapy nausea and vomiting did they find clear evidence that acupuncture was efficacious. The bulk of published research on acupuncture was found to be of poor quality.
@7. DK Fennell & @8. Daniel R Hawes,
You need a placebo control because the acupuncture treatment involves handling the animals. There is a well-known effect (although I cannot provide a reference at present) that sociable animals like mice do better on health and activity indicators when handled by people. As long as the contact is not traumatic, mice like human contact.
Therefore a placebo control adds the human touch without the needle penetration. Without it, the mice may be responding physiologically to contact rather than to acupuncture.
Surely if the adenosine is produced as a direct result of the needle piercing the skin, that isn't a placebo effect, it's a side effect.
Surely the questions are: is this mechanism is correct? Can it be harnessed clinically? and do the special magic points have any effect on pain relief (and also which ones, and are any other points beneficial)?
"But the argument was that the point of insertion does matter when the desired outcome is to stimulate a particular muscle group."
That was your argument, and it is uncontroversial, but it is also irrelevant and, in particular, does not support your strawman in #15 and your assertion in #20 that Ed Yong was incorrect about the need for RCTs.
You can forget about "meridians". Those were made up by a Frenchman as a learning aid, to help him organize where the points are, and have never been a part of Chinese medicine as practiced in China. Qi, therefore, is not there posited to follow meridians. Qi is said to flow, and we know of real substances in the body that flow, most particularly blood, and what it carries, including oxygen, hormones, platelets, T-cells, and probably many other things yet to be identified.
Science begins with observation. The paper reports careful observations, and avoids unwarranted conclusions. We can't avoid having hopes and expectations for any particular research project, but they're not science. Science can only happen when you don't pretend to know everything already. It's sad when people who style themselves "skeptics" start out by assuming they already know as much as they need to.
I thought Phayes a little harsh. Traditional Chinese Medicine may be based on different health beliefs, but that does't mean we shouldn't look at observable &/or replicable effects.
I agree with those who say placebo control is silly in mice.
@Nathan 33
Yes we know that blood flows. Flow implies regulation. The blood flows through channels due to controlled contractions of the heart. Mechanical energy is all that is required to explain the flow of blood.
Science begins with the desire to understand what is not understood. We observe blood and the channels within which it flows and the cause of the flow. Qi is said to be energy. Where are the observations? How and where does it flow? What observations justify the claim that Qi exists?
Science avoids unwarranted conclusions. Science avoids the conclusion of Qi and meridians.
More accurately we ought to say that the veins and arteries carry the blood. Blood doesn't carry those things you mention – those things compose blood.
@Phil 34
Placebo control in clinical trials is essential. And we now have a number of trials showing categorically that it does not matter where or whether needles are inserted.
Animal tests, in and of themselves, can only offer clues for the effect of a medical treatment on humans. Does this study tell us something we don't already know about the effect of acupuncture on humans? If so, what exactly? Because we then need to find out whether the same effect is found in humans – in placebo controlled clinical trials.
This study alone and by itself is meaningless.
Orac over at Respectful Insolence has written an excellent article on this study.
He makes many of the same popints that you make about the lack of non-skin piercing controls and also discusses the fact that in the mice the site of needle insertion is far closer to the site of pain than it would be in humans, allowing a stronger local effect.
Your own commentary was much appreciated, Ed.
With Orac's help I now see that the new clue from this study is not limited to suggesting further clinical tests of acupuncture. What is suggested is the generic testing of A1 receptor agonists close to nerve tracts local to a source of pain. Twisting needles around randomly (i.e. at non-local, prescribed acupuncture points) is unlikely to be the most effective method of obtaining an analgesic effect, if this study is meaningful.
It just might be possible that the slight superiority of "de qi" acupuncture (stimulated needling) over sham acupuncture, which has been found in a number of studies, could be explained by this study.
I browsed through the study, and the Methods section did not mention that the researchers were blinded. I think this could be a potential source of bias when evaluating the mice's negative responses to the force and heat applied to their paws. I am not familiar with how these negative responses are measured, but I suppose it would be something like trying to remove the paw from the force or heat—an observation that could easily be contaminated by bias. (A researcher might see a non-pain-related slight twitch as a negative response, for instance, knowing that the mouse has not had acupuncture, or may be less likely to see it as a negative response in those that had acupuncture.)
I concur that it would be nice to have more controls for this study. I also wonder if the placebo effect itself (or one of the wide ranges of placebo effects) is caused by adenosine. If so, then finding this would only show that acupuncture is a placebo, in that many placebos work through this mechanism.
DK said:
"I am wondering how can a placebo effect work in mice? I am asking this because it seems to me that surely mice don't "believe" that acupuncture is going to work. If the "painkilling effect" really "only happened when she rotated the needles after insertion," as you report the paper says, then what is a placebo control going to be used for?"
Placebo effects are not just effects of beliefs about treatments, though many placebo effects are. For instance, some placebo effects are almost certainly the results of bias or poor study design. We see an effect only because of the poor quality of the study. Examples could be effects caused by researcher bias (researchers are unblinded, or using poor definitions of efficacy, or cherry-picking results), ignoring the natural history of a disease (symptoms tend to improve over time, and this could be misinterpreted as a medical effect), and various other issues.
Also, placebo responses that are the result of conditioning could also be generated in animals. However, this study appears to have tried to control for that by giving the mice five minute breaks.
To state the obvious: The Chinese Medical system is not based on Western Medicine (it is not science based) so why is it people expect it to fit in to sciences boundaries. Now I know that you all believe that science can (if not now eventually) explain everything but this is nonsense. Is research in chinese medicine important? for some I guess, for me it doesn't matter, whether science proves it works or not is not important.
Am I for or against is also not important I am just perplexed at why the scientific world thinks it can put another system into science and get answers they can understand. It's the same for meditation.
Thousands of years of knowledge, intelligence and wisdom can only work if there is a scientific explanation otherwise it's a placebo effect – arrogant????
p.s. I study western clinical medicine!
@ Terra: Who says we all believe science can explain *everything*?
Orac's article and Novella's article are both insightful and informative. Along with this blog post by Ed Yong, these are some of the most interesting analyses I've seen of acupuncture analgesia research in a long time. Thanks very much for starting this useful discussion of the Nature Neuroscience piece!
Leigh: Where do you suppose this translation "energy", for Qi, comes from? Do you imagine that Chinese people think they are saying "energy" when they say "Qi"? Or does it seem more likely that somebody made up the translation who knew practically nothing about any sort of medicine, or anatomy?
— +++ —
As proud as we are of the Science our ancestors took up whole from the writings of al Haytham, half a millennium after he invented it in the 11th century, it remains that the Chinese wrote of blood circulation (and of an essential component of air distributed through the body by it) fifteen centuries before Harvey rediscovered it. Science makes discovering and winnowing facts more efficient, but observation comes first. People had observation and reasoning, and used them successfully, long before al Haytham codified science, and longer still before English-speakers could bring themselves to be bothered with science.
The West has achieved a lot, lately, but very late. It still has plenty to be embarrassed about, and there's still far more left to learn than is known. The only people who will be discovering the former are the ones who don't think they already know everything.
Qi is commonly translated as "energy". If it doesn't mean energy what does it mean? It is said to flow. Something undefined is said to flow. Where to and where from? And now, what?
We know that the blood flows because we can see it flowing out of bodies when we cut ourselves. You are saying that something invisible – but not energy – flows; but not in invisible channels. What use is any of this? Where are the observations which support it?
Harvey's experiments and reasoning epitomise the modern scientific method. In order to **demonstrate** the circulation of the blood you have to do pretty much what Harvey did. He did, however, have the benefit of having studied under Fabricius, who in turn had the benefit of having studied the works of Galen. To get the true picture is is no easy task. To guess is one thing, to demonstrate is quite another. One cannot properly appreciate Harvey's achievement without reading "Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus". Harvey shows that the circulation of the blood is not only a fact of human biology but a fact of the animal world.
It is science as we know it, and because it is, we now **know** that the blood circulates. History does not show that we knew this to be a fact before Harvey.
Nathan, the reason I love science is because I am so ignorant and really don't like being so. I believe most – if not all – scientists would say the same.
That acupuncture has some physiological effects should not be in doubt. I suspect a weak biological effect combined with placebo explains why some patients find it helpful for pain.
I think the question should not be 'does acupuncture help relieve pain', but rather how potent an analgesic is it? Or to put int another way, is it any better than paracetamol for long-term relief of pain?
Leigh: Air is invisible. Oxygen is invisibly different from other parts of air.
The ancient Chinese performed dissections, as Harvey did, and thereby came to understand the roles of arteries and veins. They understood that something was extracted from air and distributed through the body through the arteries, although they didn't have any way to know it was oxygen, per se. To insist that only Europeans could have discovered important facts of anatomy is incompatible with Science (because the cornerstone of Science is that anyone can repeat results by repeating observations) but entirely compatible with bigotry. The Chinese used a different language to report their results. Relying on ignorant translations can only lead you astray.
Mystics can abuse any literature. Can you conclude anything about quantum mechanics from what mystics say about it?
I have no trouble accepting that Chinese physicians may have observed phenomena, and learned how to act on their observations, that we have not, yet; different circumstances lead attention in different directions. It's certain, too, that some concocted stuff as spurious as the phrenologists, and Freud, did, less than a century ago, because that's how people are.
They've been sticking little needles in people for many centuries, and studying the results. What would be surprising would be if there were no surprising results.
Nathan, I hope you are not accusing me of bigotry. If I suggested that only Europeans could have discovered important facts of anatomy, let alone insist on it, I would certainly be a bigot Since I suggest no such thing I fail to see what point you are making.
Area you accusing me of being a bigot, and if not, what point are you making?
Can one conclude anything about the circulation of the blood – Harvey's circulation – from the Neijing?
That's right Ed science is the only truth! You absolutism is right where is should be!
Considering that paracetamol/acetaminophen is the leading cause of acute liver failure in the United States and UK, it stands to reason that acupuncture could very well be "better" for long-term pain management than indefinitely popping 2000 mg a day.
@Ed Young
I don't particularly see how being myopic about non-western traditions of knowledge is a particularly desirable trait for a medical practitioner. Perhaps you could explain why you seem to think it is.
Medicine isn't always concerned with what is "scientific." It is, however, concerned with what is effective. Electroconvulsive therapy is highly effective for treating severe depression. Scientists still aren't sure why that is – or even what electroconvulsive therapy actually does – but that doesn't stop it from being prescribed to 1 million people a year. And scientific study has demonstrated that acupuncture is highly effective for treating osteoarthritis of the knee – if nothing else – whether or not there is a scientific explanation for that efficacy.
Given that paracetamol accounts for most overdoses – intentional or not – it is hardly surprising that it is the cause of most cases of acute liver failure. The drug is not the guaranteed form of painless suicide that some hope for.
Acupuncture is safer than a drug overdose; a prescribed dose of paracetamol is safer than a dirty needle.
Dudestan's real question, then, is whether a safe course of acupuncture is as effective or better than a prescribed course of paracetamol. This must be determined in placebo controlled trials.
Leigh: I am not accusing you of anything. I'm satisfied that you have just been misled (as most of us had been, myself included) by abominable translations, to believe falsehoods ("meridians", "energy") about the practice of Chinese medicine. Judging by the excellent article you reference (thank you) Chinese practitioners suffer far more from abysmal transcriptions of their own foundational documents. It's remarkable they can do anything, under the circumstances.
We know China had the beginnings of an industrial revolution similar in many details to Europe's, but in the 15th century, along with a mathematical efflorescence, and then abandoned them both. But for an accident of history, Eastern science would have been the standard we measure against. Jared Diamond blames unification: each time the Empire went astray, it took all of China with it, while bits of Europe went in every direction at all times, with nothing useful abandoned by everybody at any time.
Nie Jin-bao cites "two influential contemporary editions" of the original classic texts:
Nanjing College of Chinese Medicine, ed., Huangdi Neijing Suwen:
Translation and Commentary, Second Edition, Shanghai: Shanghai Science and Technology Press, 1981; and Nanjing College of Chinese Medicine, ed., Huangdi Neijing Lishu: Translation and Commentary, Shanghai: Shanghai Science and Technology Press, 1986.
Although you describe Jin-bao's article as excellent, the influential editions to which he refers are, you claim, abysmal transcriptions. As a description of the circulation of the blood they are considerably worse than abysmal. They simply don't equate in any way, shape or form.
So which transcription is not abysmal? Which transcription decribes something recognisably like Harvey's demonstration of the circulation of the blood? Full reference, please.
Apologies to Nie Jing-bao. I spotted the error seconds after the time check!
I'm a skeptical acupuncturist, and am blogging about these sorts of issues, referencing the oldest classics of Chinese medicine as well as modern skeptical books such as Trick or Treatment and Snake Oil Science. Qi is more readily understood as breath and oxygen than it is as "energy." Modern Chinese use the word Qi in chemistry for "gas," such as "hydrogen qi" and "nitrogen qi." The ancient texts talk about inhaling and exhaling Qi and modern TCM says "the blood carries the Qi." You can read more of my take on it here: http://ancientway.com/blog/?p=201 If I had seen the Cochrane Collection systematic reviews of acupuncture in 1992, I would have become a research scientist, not an acupuncturst. But here I am, so I get to write about ancient Chinese demonology, psychedelic drug use, toxic herbs, and crazy acupuncture offshoots. Perhaps I'll still be a research scientist some day.


text:
So of course, we start this final ode to an era with Mike Yates looking at some cows. Perhaps there so we can have one last fond look at Darkest Mummerset. Barry Letts then wrenches us into as different a situation as possible, with the Doctor and Brigadier staring listlessly at the entertainers of a working man's club well behind the times. Meantime he's directing it so tamely that we don't even see any of it on screen (leaving us to wonder what on earth a belly dancer could have been doing that the Brigadier thinks should be adapted for military manoeuvres). There's no story reason why we couldn't have just started with Clegg's entrance into the lab...which is where we go into the toe-curling Brighton seaside anecdote with the Brigadier's watch that sounds like the start of a blue joke. Miniskirts we've seen, gooey-eyed puppy love for Jo, yes, but now we've crossed the border from kitsch to something both more plausible and more embarrassing. Lethbridge-Stewart has been getting more and more silly as of late (to be honest, Benton has better lines here than his superior officer, barring the adlibbed addition at the end), so it's a bit of a jolt in tone. Still, Nicholas Courtney does his best to keep our sympathies with his character, and this is the story when we're finally told our crusty Brigadier's first name.
There is a sense of inevitable change in the air. There's plenty of discourse in fandom about the "cosy UNIT family" (and you'd think that with the Master around, someone would have added the word "nuclear" at some point), but the very fact of the regeneration rather overshadows the fact that we've already come to the practical end of this era and the stories that can be told in this register. Watch the two Pertwee opening sequences back-to-back; we've gone from 60s psychedelic to 70s camp (and yet the same sequence suddenly makes perfect sense when you have Tom Baker's face instead of a full-body pan over animated Pertwee). For all that people consider Sarah Jane the best companion ever, if Elizabeth Sladen had left at the end of Season Eleven she'd have been regarded as the other bookend to the much more exciting Jo.
Which would have been a pity; her on-and-off approach of going out and doing her own thing for most of the story is a much better expression of feminism than some of the women's rights dialogue she was saddled with earlier this season (even "The Ambassadors of Death" didn't start with Liz Shaw starting off after the aliens herself; Davies liked this setup so much he got the frission down pat in "Partners in Crime"). Too bad it's undermined by the spider possession business, but even the Doctor falls victim to that and she's the only character who shakes off the spider of her own accord.
And there's Yates, of course. The events of "The Green Death" seem to have left him with the need for something to believe in some positive good rather than militaresque defense for defense's sake, as per his last appearance, and yet he feels impelled to question the first real alternative he investigates. It's a truism that Barry Letts put Buddhist tropes on the show, and oversaw the one period of the programme that featured a strong military presence (not his idea, but that of the outgoing producers), but the sheer oddness of that combination isn't often considered. Mike's characterisation did a lot of the work in demonstrating this storytelling shift the last two years, so it's only sensible that this is his final appearance as well. Given Cho-Je's theory about his compassion, it seems fairly clear that he's not going back to UNIT whatever else happens...
There should be more to say on Tommy than there is, considering that he gets a subplot and a cliffhanger to himself, but the name tells you all you need to know. His subplot is borrowed wholesale from the Who rock opera by the same name (and lest you think that the Production Team might have possibly overlooked it, Jon Pertwee had performed in the 1973 stage version. As the Doctor, of course.). Tommy's trajectory has to be toned down to suit a family show and made less cynical and more hopeful, and there's a nasty undertone about what the definition of "normal" and mental health constitute. Still, the moment when Sarah has it in her power to end the story right in Episode Three and doesn't because she isn't paying attention to the plot token Tommy is waving in her face – and never ever recognises what she's done – is well handled and not belaboured. (It's also amusing to ponder what difference there is between Jo and Tommy if he had the crystal for about a day and she for months on end, as to why she isn't a genius, but perhaps that would explain the self-assured globe-trotter who pops up in the Sarah Jane Adventures).
Robert Sloman, aware of Barry Letts' liking for Eastern mysticism and Buddhism in particular, attempted to pen a story that would handle some of these concepts. In practice this translated into plundering vocabulary and concepts from Buddhism so that people talk about regeneration literally and use meditation for time travel. Which isn't hugely different from how Doctor Who uses other religions and ideologies (pagans in "The Daemons," Christianity in lots of Hartnell historicals), but it is ironic that the story text proper tells us that using religion just for the ends it will net you may be hazardous to your health. Luton and all his compatriots die precisely from having misused the mandala and chant for their own ends, as the horrified Cho-Je points out (thought experiment: a version of Luton played by Delgado would have done much to justify the episode two chase and made more sense of his large amount of screen time. Keep this in mind next time you watch it.). This also serves as a convenient get-out for K'anpo's apparent indifference to his abbey guests using his teachings for their own ends; it's a neatly moral universe where evil brings destruction upon itself, but what usually goes in Doctor Who as an unstated trope becomes literalised here for both humans and spiders. Barry Letts had helped Sloman write the story, but also wanted to cast all his favourite actors; as should be obvious, neither Kevin Lindsay or George Cormack were remotely Tibetan. Even considering that they're playing a Time Lord, this could have been thought through a little more...it's worth remembering that the race-fail in "The Talons of Weng-Chiang" didn't take place in a vacuum.
The Regeneration Boxset is due for release 24th June 2013, and is available to order from the BBC shop now.


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Lisa Ling Felt Like a 'Complete Failure' After She Had a Miscarriage — So Sad!
TV reporter Lisa Ling reveals that she suffered a miscarriage. It's devastating news — and our hearts go out to her!
According to the Associated Press, Lisa Ling, 37, opens up for the very first time on The View (where she worked from 1999 to 2002) set to air tomorrow (December 10) about her miscarriage six months ago, revealing that when she lost the baby, "I felt more like a failure than I'd felt in a very long time." Losing a baby has got to be one of the worst feelings in the world. HollyMoms, if you've suffered that kind of loss, how did you cope?
Lily Allen lost her baby when she was six months pregnant
In an emotional segment, she goes on to say that she was "sort of cavalier" about the pregnancy, and that the baby was nine weeks old when doctors discovered that the fetus no longer had a heartbeat. How tragic! "We actually [hadn't] been trying that long," she says. "I don't know that I took it as seriously as I should have because it happened so fast. But then when I heard the doctor say there was no heartbeat it was like bam, like a knife through the heart." Our hearts go out to the TV reporter.
Guiliana Rancic is going through IVF after losing her first baby
Lisa, who has been married to oncologist Paul Song since 2007, says she is "devastated" about the possibility of another miscarriage down the line. Can you relate HollyMoms? What advice/words of wisdom do you have for Lisa?
Cher opens up about her miscarriage 'nightmare'
In an effort to reach out to other women who've suffered miscarriages or carried other secrets around with them, Lisa and a business partner have started the Secret Society of Women, where women can talk about their experiences anonymously. "We're a confidential community where you can share your deepest thoughts and secrets about relationships, sex, body image, health, work, family or anything else on your mind," says the site. It's nice to know that there's somewhere for grieving women to go. Check it out and tell us what you think!
–Alison Prato
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Click here if you want to navigate away from this site quickly.
Greater Manchester Police operates a Domestic Violence Disclosure Scheme (DVDS) or "Clare's Law" as it is more commonly known.
This gives members of the public a formal mechanism to make enquires about an individual who they are in a relationship with, or who is in a relationship with someone they know, where there is a concern that the individual may be violent towards their partner.
This information may be disclosed via a request from a member of the public ("right to ask") or by an agency where a proactive decision is made to consider disclosing the information in order to protect a potential victim ("right to know").
If police checks show that the individual has a record of violent offences, or there is other information to indicate that you, or the person you know is at risk, the police will consider sharing this information.
The aim of the scheme is to increase public safety and afford victims of domestic abuse with better protection by helping people make a more informed decision on whether to continue a relationship. It also provides help and support to assist individuals when making that choice.
If you require further information about the Domestic Violence Disclosure Scheme or wish to make a request for information under it, please contact Greater Manchester Police on 101 or the Domestic Abuse Helpline, on 0161 636 7525.
Alternatively, you can click on one of the links below to download an information leaflet:


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Zis is your airportdirektor speaking. All ze papers are reporting already about ze screw ups in my new airport. I am ankry about zis. You are mean, mean people, and zerefore I vud like to say ze following. Boo.
Howeffer, in the greater pooblic interest of your mutterland, I am klarifyink ze misconceptions zat have formed in your kopfs, vun by vun, as follows:
1. I don't give a spaetzle what you sink about konnektivity to my airport. Take your time, its not like you can go anyvere else to fly. Muhahaha.
2. You haff problem vith ze old airport klosing. I belief zere are two solutions for zis problem.
(a) My vay
(b) Ze high vay.
Ze answer to 2(b) is NH7. Let us not go there. Getting to my airport is your business. You can get to my airport by megic carpet for all I care. Auf weidersehen HAL. You vill not be missed here at Deffanahalli.
3. I vos not eating bratwurst ven ze conveyor belt in ze beggege claim died ze moment it vos svitched on. In fect, I vos pacing the floor boards composing my next indignant press release on how my airport operations haff been kompletely rheady for months.
4. I haff been constantly warning my staff to use the aerobridches only to connect people from terminal to flight. Not as slippery slide (whee!) for zeir personal enchoyment. However, zey are refusing to listen. I zerefore recommend zat all you lazy esses undergo an intensmountaineeringtrainingprogram like I haff, to enable you to board ze plane using a series of rope laddahs. Zis is ze only vay fohvard, konsidering ze benne-mudde's zat we have operating ze aerobridch zese days. Jooseless fellows I tell you.
5. You vont me to build train to come to ze airport? Vot silliness. Vosh your face and think lochically. If you haff train, vy must you come already to ze airport? Vell okay, if you insist, giff me money and I vil build train for you. I vill not hire my aerobridch operators to drive train, do not vorry.
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Yes and now back to my bratwurst.


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MAXWELL AIR FORCE BASE, Ala. — The Civil Air Patrol will continue to perform emergency and disaster response missions authorized by the Air Force during the federal government shutdown.
CAP annually participates in 90% of America's inland search and rescue missions. CAP saved 32 lives in 2012 while conducting 700 search and rescue missions, nine of which were attributed to the expertise of CAP's cell phone forensics and radar experts.
Additionally, during the past year CAP conducted more than 50 disaster relief operations, including damage assessment flights during recent Colorado flooding, the Oklahoma tornadoes and Hurricane Sandy.
"The Air Force depends on Civil Air Patrol to perform these critical missions," said CAP National Commander Maj. Gen. Chuck Carr.
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For more information: GoCivilAirPatrol.com


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First up in the Week of Composition is Dan Rouse's "Ripple" quilt. We can all learn much from Dan when it comes to composing a quilt.
Tell us about this quilt.
"The Ripple quilt began last spring when Robert Kaufman Fabrics distributed charm packs to the quilt guild and challenged us to make quilts using only solids. About the same time Accuquilt sent me a fabric cutter to try out. As it turns out, combining solids from all (dusty) shades of the rainbow, and block-based quilt design are both outside my comfort zone, so I decided to wrap it up into one challenge.
I tried several layout options, and wasn't pleased with any symmetrical tile patterns. The colors don't have a lot of umph, and it just came off a bit sleepy. I ended up separating the units into one group colored centers and neutral edges, and a second group with neutral centersand colored edges. I then subdivided each of those groups into 8 piles by hue. Finally, I paired hues to make 8 block groups."
Playing with the units I settled on the idea of water droplets hitting a pond, creating ring wavelets that soon disappear. I arranged the units around a central circle, filling with additional Kona snow as necessary. The quantity of drunkard's path units was limited by the size of the fabric pack. This constraint became an opportunity to create a deconstructed sense of fragility in an otherwise stark composition.
The quilting uses several different colors, with all of the concentric circles around any drop in the same color. The colors are light blue, light ochre, moss green, deep red, and white. The drops overlap in different amounts. Some drops have more rings than others. Some of the quilted drops are set completely in the white background, with no drunkard's path blocks, hinting at drop rings that have all but faded away."
What do you consider when composing your quilts?
"I'll start with something I don't consider very much at all. I never start with a specific print or fabric collection. Rather, I start with a design idea, shape, or geometry, and find fabrics that work with that idea. With very few exceptions I have an clear idea what I want the quilt to look like before I consider a single fabric. The Ripple quilt was unusual for me in that I started with a pack of fabric and a drunkard's path block as initial constraints, and didn't compose the quilt until all the blocks were sewn.
To achieve the design it is essential to have contrast. The stronger and simpler the contrast, the easier it is to read the design. With more levels or gradation of contrast, the design becomes more delicate and achieves a sense of depth. A high level of contrast clearly defines positive and negative space, ideally giving a sense of foreground and background.
There are lots of tools to achieve contrast. Value, or the relative lightness or darkness of a color, is an important compositional tool for quilters. Color hue is also very important.
Scale is all about size relationships and creating appropriate balance between the size of fabric prints, individual pieces, and positive and negative space.
Finally, rhythm is a key element in an interesting quilt. By arranging the elements with a sense of rhythm you direct the viewers eye across and around the quilt and create a sense of energy and movement in a static object. I use all the above concepts to varying degrees to achieve rhythm. I think the Ripple quilt is a good example of rhythm. The irregular construction and placement of the drop formations creates multiple paths and loops for the eye to follow, with the overlapping concentric quilting suggesting connections between adjacent elements, so the viewer doesn't feel she 'knows' the quilt at first glance."
Tell us a bit about yourself and your quilty history.
By profession I am a landscape designer, working mostly in residential gardens in the San Francisco Bay Area. I have years of training and practice in a design field.
For the most part I am a self-taught sewer and quilter. My mom taught me how to use a sewing machine when I was a kid, but I lost interest and didn't sew anything for years until the 2006 Gee's Bend exhibit at the De Young piqued my interest. Inspired by the confident use of color and playful improvisational technique, I immediately purchased two books on quilt making. Alas, the books sat for a few more years before I finally started sewing in 2009. But now I'm hooked. I've been sewing quilts non-stop ever since, and recently started teaching classes at my LQS.
Dan is a member of the East Bay Modern Quilt Guild and you can find him and his amazing work on his blog, Piece and Press.


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Film fans check out Palatine's Blue Whiskey fest
When Fremd High School grad Michael Noens founded the Blue Whiskey Independent Film Festival four years ago, his mission was to present the Chicago area with riveting and creative independent films from across the globe with one thing in common: a strong, powerful story.
Film enthusiasts are getting just that.
By the time the festival wraps up Sunday, more than 30 shorts and feature-length films will have been screened at the Cutting Hall Performing Arts Center, 150 E. Wood St., Palatine.
Most are followed by a Q-and-A session with the director, either in-person or via Skype to countries including France and Norway.
"We've been getting a bit more attention and a bigger crowd than in the past," marketing director Ashley Alysa France said. "We passed out 3,000 programs in the community and in Chicago, so word is getting out."
For more information about the Blue Whiskey Independent Film Festival and tickets, call (847) 202-5229 or visit bwiff.com. And be sure to check out our Time Out! section.


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Generally applicable to all audiences.
We are not looking for a stand alone logo but a logo that is incorporated in the name SendLove. The color palette should be gender neutral as should the font. It is best to shy away from reds or pinks unless they are subtly incorporated into the design. On the continuum from serious to jovial, SendLove's logo should be slightly right of middle. Subtle, fun but not showy.
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