Russia's $165,000 per night space hotel

Russia's planned Commercial Space Station hotel may be a steal at $165,000 per night, but you may want to consider the $410,000 travel costs. Photo: Orbital Technologies SEE ALL 78 PHOTOS

Best Opinion: Nation, Business Insider

The image: Russian company Orbital Technologies wants to take luxury hotels to new hights — orbiting 217 miles above the Earth — by 2016. The proposed Commercial Space Station (CSS) would house seven guests in four cabins, including such space luxuries as precooked gourmet meals, sealed showers, and spectacular views of the home planet (see images below). Though the accommodations are more likely to evoke a high-tech dentist's office more than a chic Miami getaway, the space hotel will be "far more comfortable" than the even more spartan International Space Station, says Orbital chief executive Sergei Kostenko.

The reaction: "Russia may have lost the first space race to America," but it's dead set on winning the space-hotel race, says M.O. in Pakistan's The Nation. If you're lucky enough to make the trip, though, be aware that "aside from the spectacular view, there’s not much else to do, so you'd be wise to take a good book." Lucky, indeed, say Linette Lopez and Dina Spector in Business Insider. At about $165,000 per person for a five-night stay, and $410,000 for the trip up there on a Russian Soyuz rocket, "experiencing the final frontier from your bedroom window... won't be cheap."

Original here

Eat Like a Foodie at Home, Without Breaking Your Budget

Just because you enjoy great food doesn't mean you have to spend a lot of money dining out or buying upscale foods for delicious meals at home. With the advice of some noted chefs and food writers, you can elevate the level of your home-cooked meals even while working with a tight grocery budget, producing feasts that wow for just a few dollars per serving.

We'll show you where to shop and what to stock in your pantry to maximize your dollars-to-enjoyment ratio. We'll also show you how to save more on buying meat (often the most expensive part of the meal) and techniques and recipes for cooking up some exquisite dishes. Note: you don't have to consider yourself a "foodie" to use these suggestions—all you need to bring is a desire for great food.

Learn Techniques to Make the Most Out of Your Meals

Some cooking techniques like braising and slow cooking are very cost-effective and simple, producing flavorful meals; you can tenderize extremely tough—and inexpensive—cuts of meat with these techniques.

Make the Most Out of Cheap Proteins

The biggest cost savings you find may be on proteins, especially with today's rising meat prices. If you're not a vegetarian, the meat portion of the meal could very well make up the majority of your grocery budget (thus, it also follows that you can make the most out of your food budget by switching to a flexitarian diet or just eating a meat-less meal every once in a while).

Learning a few cooking techniques to enhance even cheap cuts of meat can help you turn a $5 steak into a $50 steak, so to speak:

Slow cooking: Even if you don't decide to hack your slow cooker into an off-the-charts sous vide cooker, a slow cooker can make even the toughest of meats tender and tastier. (Apparently you can also hack a beer cooler into a sous vide cooker.) Plus, the hands-off approach of using a slow cooker also means you can get flavor-packed meals without a lot of effort. You don't want just an everyday slow cooker meal though: foodie recipe search engine Punchfork can help you find more advanced slow cooker meals to make at home, like this carnitas recipe from TheKitchn that uses an inexpensive cut of pork: place a 6-8 pound pork butt (a.k.a., pork shoulder) in the slow cooker with some spices and tomato and orange juice and 8 hours later, you've got tender meat that falls off the bone.

Braising: Deb Perelman of the beautiful Smitten Kitchen food blog suggests we embrace braising. Cooked low and slow, ribs, briskets, pork shoulders, and so on "make incredible flavor-packed, stewy meals that can easily be spooned into tacos/served over rice or egg noodles and stretched to feed you for a week." Want recipes? Try Deb's knee-weakening braised beef short ribs or other braised recipes. Don't know what braising is? Previously mentioned cooking video library Cookblast has some videos and recipes for this slow cooking technique.

Salting: That $5 steak that tastes like it came from the very expensive steakhouse? It's all about salt. Basically, salt your steak like crazy at least 40 minutes before cooking (wash the salt off before) for the juiciest steak you've every made. You can intensify the flavor of all of your meats with wet and dry brining techniques—basically using salt to enhance the flavor of your meats by immersing them in a salty solution or just applying a dry salt rub directly.

How to Save on Proteins

With the techniques above you can make cheaper cuts of meat, like pork shoulder, taste extraordinary, but here's how to save even more:

Process your meat yourself: For the most savings, buy your meat (and other foods) minimally processed. Serious Eats' James Kenji Lopez-Alt (who forever transformed my steak-cooking technique and subsequent lifelong enjoyment) says that his biggest tip is:

Buy your meat in the least processed form possible and learn how to do some very minimal butchering yourself. So don't buy boneless skinless chicken breasts. If you want them, buy a whole chicken, which ends up costing about the same price as you'd pay for its breasts alone, but then you end up with chicken leg meat for a whole extra meal, as well as a carcass with which you can make stock. Three meals for the price of one, and all you've got to do is learn how to break down a chicken.

Buying and learning how to cook cheaper cuts of meat is very useful as well. Pork shoulder, for example, to me tastes a hundred times better than a pork chop. You just have to be willing to cook it a little longer. It takes well to methods like braising, slow roasting, or grinding into mince.

He also recommends buying a meat grinder, because not only will it give you the freshest tasting burgers, it lets you use up leftover scraps of meat you'd normally throw out. (Ready to take the plunge? Serious Eats shows you how to buy, use, and care for a meat grinder and what to do once you've got one.)

Cheaper cuts: Katerina, who writes the Daily Unadventures in Cooking blog says that:

One of the well kept secrets of foodies is that the cheaper the cut of meat, the harder to cook but the more the flavour. Lamb shanks and neck? Pork belly? Octopus? Short ribs? As proteins, they all represent a cheap way to impress guests at home if you are willing to take the time to properly cook them.

For example, if you have some cheap pork shoulder, TheKitchn managing editor Faith Durand says you can really maximize the flavor of it by grilling before braising.

Clay Dunn, who writes the popular and informative Bitten Word blog with partner Zach Patton, generously offered these two preparation techniques:

One of the best, most versatile and most affordable cuts of meat you can find is a skirt steak. You can often grab it for about $2 per serving. Another plus: It's also one of the easiest cuts of meat to cook. Amp up the flavor by rubbing the steak with instant espresso powder and some cayenne pepper. Then just sear it in a stovetop pan over high heat for a couple minutes per side, let it rest for several minutes, and slice it against the grain. You can stretch your protein dollar even further by incorporating the skirt steak into a steak salad: It's fantastic tossed with fresh dark lettuces, green beans and a sweet vinaigrette.

Another favorite inexpensive protein of ours is chicken thighs. They're tasty and succulent — way more flavorful than white-meat breasts. And you can frequently find chicken thighs for about a dollar per serving. We always by these instead of chicken breasts. Sear them on all sides in hot oil, toss some chopped onions and fresh tomato into the pan, and throw the whole thing in a 375-degree oven for 16-18 minutes to roast. Delicious! Maximize the flavor — and your budget — even more by stirring in a few fresh basil leaves, chopped, right before you serve.

Buy from a farm directly: Brian Lee, who runs the EatDrinkMadison dining guide says you can save a lot of money by purchasing a side or ¼ beef (100 lbs.) from a farm. You'll need a separate freezer, most likely, or someone to share with you, but you can get quality, ethically-raised beef for between $3.50-$5.50 per pound from the farm versus three times that much or more from Whole Foods.

How to Save on Fresh Produce

Speaking of Whole Foods, you don't really need to shop there for any or all of your choice foods. Farmer's markets, or greenmarkets, offer fresh-from-the-farm foods, and as mentioned here at Lifehacker previously, shopping later in the day at a farmer's market can save you some extra cash. (Dunn said you can find some really great deals at farmer's markets if you buy the fruits and vegetables at the peak of the season—you could get a pint of berries for a third of what it would cost you at the grocery store.)

Joining a CSA (community supported agriculture) group may likewise be a worthwhile investment where you get a load of in-season veggies and/or fruits (or even eggs and flowers) for about $20-$50 a month.

Canning, freezing, and even layering in salt can extend your food's life as well.

Perelman also reminds us that good looks don't always matter when it comes to your fruits and veggies:

Don't be afraid of ugly produce (in fact, be more suspicious of the overly pretty stuff and what has to be added to the soil to get blemish free beauties); ugly tomatoes make great sauce

Full size

To get the most bang for your organic buck, you can also focus your spending on just those organic foods most prone to pesticide (e.g., with this organic food buying cheat sheet). If your main reason for buying organic is to avoid pesticides, foods like avocado and bananas, which have thick peels that aren't eaten, can be bought safely non-organic. Peppers, celery, peaches, apples, strawberries and other fruits and vegetables with thin or edible skins are better organic options.

Of course, you can also save a lot of money by starting your own vegetable garden, if you have the space. Cheap Vegetable Gardener has a chart of the most profitable vegetables/herbs to grow yourself. (Previously mentioned tools like Smart Gardener can help you set this up and grow your own food successfully even if you don't have a green thumb.)

Where to Buy Other Quality Food for Cheap

Beyond fresh produce and meats, you can save a whole lot more by shopping in unconventional places.

Look to ethnic grocery stores for better deals on spices, for example, or just the international aisle of your main grocery store, Dunn advises.

Online shops let you find specialty foods that you couldn't find in brick-and-mortar stores. International food market places like Foodzie, Zingerman's and Import Food offer specialty ingredients that can elevate your dish. As CNN reports, most foodmakers will also ship direct to you, for even more savings:

A pound of Humboldt Fog goat's-milk cheese, ordered off Zingerman's, will run you $35; the same amount from the cheesemaker, Cypress Grove, is $20.

How to Stock Your Gourmet Pantry/What to Buy

Sometimes, all it takes is that one key ingredient—a unique sauce or a condiment—to make your meal extraordinary. Investing your food money wisely lets you scrimp on some expensive items (like meats) while still getting a lot of flavor from your meal.

Stephanie Trahd at artisan foods marketpace Fooducopia says "It's much more affordable to take a cheaper cut of meat and dress it with a gourmet steak wash, than it is to buy a filet and only be able to afford a parsley garnish!"

Likewise, Chef Mark Estee, owner of Moddy's Bistro and Lounge and Burger Me in Truckee, CA, reminds us that having great staples in your pantry is important because "bad quality in, bad quality out." The staples he suggest you invest in: extra virgin olive oil, balsamic vinegar, sea salts, chutneys, and mustards.

Durand adds to the list nut oils like hazelnut and roasted walnut oil for delicious salads, and really likes this smoked olive oil featured on TheKitchn. (When cooking, stick to cheap olive oil to save cash, but for salads or drizzling over food, you may actually taste the difference in a higher-quality oil.)

Keeping basics in stock will also help you avoid the dine-out/take-out bug. Lopez-Alt says he always has on hand a collection of Chinese, Japanese, and South East Asian condiments and sauces ready to go, so all he has to do for a quick and savory meal is pick up a protein and boil some rice.

I'm with Perelman on splurging on milk, eggs, produce and meat; it's worth the extra cost to us to buy ethically raised and cleanly produced foods. But even then, you can still save even on organic produce, grass-fed beef, free-range eggs and the like using some of the shopping tips above.

Favorite Versatile, Inexpensive Meals

When asked what their most delicious yet cheap meals were, our food sources had so many great suggestions:

• Durand reminded me of the addictiveness of chickpeas when toasted as a snack, turned into fresh hummus or a spicy chickpea salad for lunch.
• You'll find great pizza cooking at Smitten Kitchen; Deb says you can "buy the softest, fanciest mozzarella" and toss in some proscuitto plus imported tomato puree to make a $5 meal for many.
• This recipe for Grilled Mussels with Herb Butter at Bitten Word is one of the least expensive dinners Clay and Zach say they've ever made, and it has a huge "wow" factor. Total cost of the meal for three people: under $15. (Besides being flavorful and inexpensive, mussels are also one of the most sustainable seafood choices, so this may be a great go-to recipe.)

How to Get More Value Out of Your Wines

If you agree with the old Andre Simon quote that "Food without wine is a corpse; wine without food is a ghost," you'll probably want some good vino with your home-cooked meal. For many people, a wine store filled with bottles upon bottles of wines of varying prices can be overwhelming.

Jsaon Mancebo, who writes the 20 Dollar Wine Blog, said the best strategy is to develop a relationship with a wine monger at a smaller wine shop, so he/she can get to know your style, palate, and price ranges. Regionally speaking:

The usual suspects for bargains in the past 10 years or so are Australia, Chile and Argentina, but recent economics make Spain, Portugal and even Italy VERY attractive now. Great Rioja, Alentejo and Barolo are certainly within reach! If you're normally only a red wine fan, try some rose' from Provence or white from the Langhe. There's lots to explore and great stuff to pair with the dishes you create!

Though you can find good wines at $10 or below, they're not as easy (i.e., super-easy) to find at $20. The sweet spot, Mancebo says, may be about $15-17.

I also like Lopez-Alt's answer: "It's the summer. I like having inexpensive, easy-to-drink wines, like a nice cold vinho verde."

"Foodie" Meals at Home: In a Nutshell

To sum up, you can save more but still get a lot of value and tastiness out of the foods you buy and make at home. The basic guidelines:

• Buy from less conventional/mass marketplaces. Explore ethnic markets, farmer's markets, and grow your own if you can
• Buy as much as you can whole and unprocessed
• Learn how to preserve your foods (e.g., how to store food properly in the freezer and fridge or food preservation techniques)
• Use all parts of the food if possible. Use chicken bones to make stock, toast pumpkin seeds, etc.
• Splurge on items that will enhance the rest of the meal and where a little will go a long way. Or focus on one quality ingredient in each dish.

Doing this may increase the quality of your meals at home to the point where you might even prefer dining in rather than out. Bon appetit!

Got your own tips for increasing the foodieness of your homecooked meals (on a budget)? We're all ears in the comments.
Photo by benicce / Shutterstock.

Original here

Over career, most doctors in US will face lawsuit

By Chelsea Conaboy

Most doctors in America will be sued at some point during their career, a Harvard study released yesterday in the New England Journal of Medicine has found. Physicians who perform high-risk procedures, including neurosurgeons and obstetricians, face a near certainty of being named in a malpractice case before they reach age 65.

Yet a relatively small number of claims, about 22 percent, result in payments to patients or their families.

Authors of the study, which examined 15 years of data, said it highlights the need for changes in malpractice law so that doctors and patients can resolve disputes before they resort to litigation, which often costs both parties money and heartache.

“Doctors get sued far more frequently than anyone would have thought, and in some specialties, it’s extremely high,’’ said Amitabh Chandra, an economist and professor of public policy at the Harvard Kennedy School and an author of the study. “In some sense, the payment is the least important part, because you can insure against it, but you can’t insure against the hassle cost.’’

The study looked at claims data for nearly 41,000 physicians from 1991 to 2005. The researchers found that 7.4 percent of physicians had a malpractice claim against them each year and that 1.6 percent had a claim that led to a payment each year.

The likelihood and outcome of lawsuits varied considerably across specialties. But the fact that even doctors in low-risk areas of practice, such as family medicine, had a 75 percent chance of being sued during their career is cause for concern, Chandra said.

Every time doctors are sued they face lost income from the time they spend out of the office fighting the case, said Dr. Alan Woodward, a retired emergency physician who is chairman of the Massachusetts Medical Society’s committee on professional liability. The threat to their reputation is a cause of major stress, and the anxiety can compromise the care they provide to other patients, he said.

Fear of lawsuits drives many physicians to practice defensive medicine - ordering more diagnostic tests than necessary, for example - or to retire early, Woodward said. And when doctors fear legal retribution, they are less likely to share information, with patients or internally.

“It creates a culture of secrecy and fear,’’ he said.

The small number of successful malpractice cases does not mean most are frivolous, said Chandra. It can be difficult to prove that an injury resulted from an avoidable error in patient care, he said.

“Many of us are coming to the conclusion that litigation is not the answer,’’ Chandra said.

Woodward met with Chandra yesterday and discussed the study, which included researchers from Harvard-affiliated Massachusetts General Hospital, the Rand Institute, and the University of Southern California. Woodward said it provides more evidence that government regulations should encourage doctors to talk openly with patients, apologize when warranted, and offer compensation when appropriate.

Some advocates, including the consumer group Health Care for All, have been trying for at least four years to get a law passed in Massachusetts making such apologies inadmissible in court; such laws exist in many other states. The hope is that doctors will feel more secure in talking about a patient’s care and even admitting an error. The patient could still pursue a case based on the medical evidence.

Previous studies have shown that patients are less likely to sue when they receive an apology and explanation from their doctor.

Brian Rosman, research director of Health Care for All, said everyone will benefit if patient-doctor communication is divorced from legal proceedings. That would allow doctors and hospitals to deal more directly with the root cause of an error.

“Fixing this problem can also improve the quality of care,’’ he said.

The medical society has been working with Beth Israel Deaconess Medical Center, using a $273,782 federal grant, to design a plan for a system that would encourage apologies and compensation, when justified, in Massachusetts. The plan is set to be released this fall.

The group has interviewed dozens of people representing patients, hospitals, the legal community, and doctors.

Woodward said that nearly universal support exists for a system that encourages doctors to apologize.

Woodward said the medical society, along with the hospital and other partners, have applied for a three-year grant of about $3 million to create pilot projects at Baystate Health in Western Massachusetts and Beth Israel Deaconess and to launch a statewide campaign educating patients and doctors.

He is also working with lawmakers to draft legislation requiring malpractice cases to go through a six-month vetting period in which the physicians would share all pertinent medical records with the patient and analyze whether an avoidable error occurred.

Litigation plays an important role in exposing errors and getting patients the help they need, said medical malpractice lawyer Jeffrey Catalano, vice president of the Massachusetts Bar Association. But, he said, it is often inefficient.

He supports what is referred to as the apology law.

“The devil’s in the details, but it has a lot of promise,’’ said Catalano, who represents patients.

Catalano said out-of-court reviews should be overseen by a third-party attorney and that patients’ lawyers should be allowed to participate to ensure their clients’ rights are protected.

Chandra and his coauthor, Dr. Anupam B. Jena of Mass. General, said they hope their study will dispel the fear that many doctors have of big payouts. Their study found just 66 claims that resulted in payments exceeding $1 million. Average claims by specialty ranged from $117,832 in dermatology to $520,923 in pediatrics.

Original here

Food Surprise! Subsidizing Healthy Food Helps Kids Lose Weight

• 
  

It seems obvious to anyone who's ever paid money for something: Make things cheaper, especially things people absolutely need, and you'll sell more of them. And yet it seems the U.S. government has yet to grasp that lesson. For decades now, America has been struggling with rising obesity, but rather than invest in subsidizing healthy foods for citizens, the government has instead dumped tens of billions of dollars into corn subsidies. What that's done is give rise to vast stockpiles of corn syrup, corn chips and soda, all on the taxpayer's dime. Whereas more than $15 billion in subsidies went to corn, cotton, rice, wheat and soybeans in 2009, only $825 million went to fruits and vegetables. We're not just getting fat, we're paying to do so out of both hands (once with our taxes and once at the store).

A new report (PDF) from the U.S.D.A.'s Economic Research Service outlines exactly how damaging these subsidies are on America's children. Working on behalf of Michelle Obama's "Let's Move" campaign against youth obesity, a team was able to ascertain that just a 10-percent decrease in the price of lowfat milk for one quarter was associated with a .35-percent drop in children's BMIs. Similarly, lowering the cost of dark green vegetables by 10 percent saw a .28-percent BMI drop. And the effect worked both ways: When the price of sweets fell, BMIs increased.

It's important to note that BMI is often attacked as a bad way to measure a person's health, but until there's a better metric that can be applied generally in these types of studies, BMI will have to do. Also, if you're thinking that a .35-percent drop doesn't seem like a lot of weight, you're right. But it's an important start, and one whose impact could be larger if we enacted subsidies cutting health-food prices by more than just 10 percent.

Let this be a reminder that poor people, who are more overweight than the wealthy, shouldn't be written off as pigs who stuff their kids full of empty calories every night. The simple fact is that unhealthy food costs less, and cost is of primary importance when you're on a very limited budget.

Original here

Opposites attract? Apparently not, according to study

• Partners are drawn to individuals in a similar 'league' and of the same desirability

By Daily Mail Reporter

When it comes to love, there are no hard and fast rules though many people follow the age-old theory that opposites attract.

But now a study has found that more often that not, similarity rules the day.

Researchers at Berkeley found that people are drawn to potential romantic partners if they are of their own or similar league and desirability, which they called the 'matching hypothesis'.

Hot: The Berkeley study found that the more popular the individual the more a similarly popular individual would be attracted to them

Of course personality traits and common interests play a factor but for that instant attraction, like is drawn towards like, putting paid to the phrase, 'You're out of my league'.

For their research, the authors of the study turned - as most singletons do today - to online dating sites.

More...

• The couple who found the secret to wedded bliss... live in separate homes

They measured the popularity of more than 3,000 heterosexual users of a site and looked at the popularity of each.

Popularity was defined by the number of opposite-sex individuals who had sent unsolicited messages to a user.

Findings: The authors of the study said individuals on the dating market will assess their own self-worth and select partners whose social desirability equals their own

Analyses indicated that high-popularity users contacted other popular users at a rate greater than would be expected by chance.

Similarly, the less popular users of the site also contacted other low-popularity users.

The researchers then conducted a follow-up study of more than a million users and found a similar result - when it comes to dating, potential mates stick to someone in their own league.

Like attracts like: Couples are said to be attracted to each other due to their level of desirability

The authors found that: 'Individuals on the dating market will assess their own self-worth and select partners whose social desirability approximately equals their own.

'Using data collected in the laboratory and from users of a popular online dating site, the authors found evidence for matching based on self-worth, physical attractiveness, and popularity, but to different degrees and not always at the same stage of the dating process.

'The most striking prediction is that undesirable individuals will choose undesirable partners.'

Original here

News of the World's best ever front pages Read more: http://www.asylum.co.uk/2011/07/08/news-of-the-world-best-front-pages/#ixzz1Rm8UZqBO

By Sam Parker

Last week, James Bond baddie Rupert Murdoch and his evil henchman James Murdoch surprised us all by announcing that today will be the last time ever that the News of the World goes to print.

In the wake of still-growing phone-hacking scandal, the News International overlords decided the popular rag's time was up, while curiously standing by Rebekah Brooks, the woman who presided over the whole messy business in the first place.

And so, as 200 largely blameless journalists, sales people, designers and finance staff walk the plank to save their superiors, we take a moment to celebrate the News of the World's most memorable front page splashes.

From celebrity sex scandals to sporting corruption via loads of stuff that made the royal family whince, we might not have always liked what it had to say but nothing raised our eyebrows quite like the News of the World. Click below for our highlights.

Original here

In Defense of Antidepressants

Enlarge This Image

Leo Jung

Enlarge This Image

Leo Jung

IN terms of perception, these are hard times for antidepressants. A number of articles have suggested that the drugs are no more effective than placebos.

Last month brought an especially high-profile debunking. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

For instance, not long ago, I received disturbing news: a friend had had a stroke that paralyzed the right side of his body. Hoping to be of use, I searched the Web for a study I vaguely remembered. There it was: a group in France had worked with more than 100 people with the kind of stroke that affected my friend. Along with physiotherapy, half received Prozac, and half a placebo. Members of the Prozac group recovered more of their mobility. Antidepressants are good at treating post-stroke depression and good at preventing it. They also help protect memory. In stroke patients, antidepressants look like a tonic for brain health.

When I learned that my friend was not on antidepressants, I suggested he raise the issue with his neurologists. I e-mailed them the relevant articles. After further consideration, the doctors added the medicines to his regimen of physical therapy.

Surprised that my friend had not been offered a highly effective treatment, I phoned Robert G. Robinson at the University of Iowa’s department of psychiatry, a leading researcher in this field. He said, “Neurologists tell me they don’t use an antidepressant unless a patient is suffering very serious depression. They’re influenced by reports that say that’s all antidepressants are good for.”

Critics raise various concerns, but in my view the serious dispute about antidepressant efficacy has a limited focus. Do they work for the core symptoms (such as despair, low energy and feelings of worthlessness) of isolated episodes of mild or moderate depression? The claim that antidepressants do nothing for this common condition — that they are merely placebos with side effects — is based on studies that have probably received more ink than they deserve.

The most widely publicized debunking research — the basis for the Newsweek and New York Review pieces — is drawn from data submitted to the Food and Drug Administration in the late 1980s and the 1990s by companies seeking approval for new drugs. This research led to its share of scandal when a study in The New England Journal of Medicine found that the trials had been published selectively. Papers showing that antidepressants work had found their way into print; unfavorable findings had not.

In his book “The Emperor’s New Drugs: Exploding the Antidepressant Myth,” Dr. Kirsch, a psychologist at the University of Hull in England, analyzed all the data. He found that while the drugs outperformed the placebos for mild and moderate depression, the benefits were small. The problem with the Kirsch analysis — and none of the major press reports considered this shortcoming — is that the F.D.A. material is ill suited to answer questions about mild depression.

As a condition for drug approval, the F.D.A. requires drug companies to demonstrate a medicine’s efficacy in at least two trials. Trials in which neither the new drug nor an older, established drug is distinguishable from a placebo are deemed “failed” and are disregarded or weighed lightly in the evaluation. Consequently, companies rushing to get medications to market have had an incentive to run quick, sloppy trials.

Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression.

THIS improvement may have nothing to do with faith in dummy pills; it is an artifact of the recruitment process. Still, the recoveries are called “placebo responses,” and in the F.D.A. data they have been steadily on the rise. In some studies, 40 percent of subjects not receiving medication get better.

The problem is so big that entrepreneurs have founded businesses promising to identify genuinely ill research subjects. The companies use video links to screen patients at central locations where (contrary to the practice at centers where trials are run) reviewers have no incentives for enrolling subjects. In early comparisons, off-site raters rejected about 40 percent of subjects who had been accepted locally — on the ground that those subjects did not have severe enough symptoms to qualify for treatment. If this result is typical, many subjects labeled mildly depressed in the F.D.A. data don’t have depression and might well respond to placebos as readily as to antidepressants.

Nonetheless, the F.D.A. mostly gets it right. To simplify a complex matter: there are two sorts of studies that are done on drugs: broad trials and narrow trials. Broad trials, like those done to evaluate new drugs, can be difficult these days, because many antidepressants are available as generics. Who volunteers to take an untested remedy? Research subjects are likely to be an odd bunch.

Narrow studies, done on those with specific disorders, tend to be more reliable. Recruitment of subjects is straightforward; no one’s walking off the street to enter a trial for stroke patients. Narrow studies have identified many specific indications for antidepressants, such as depression in neurological disorders, including multiple sclerosis and epilepsy; depression caused by interferon, a medication used to treat hepatitis and melanoma; and anxiety disorders in children.

New ones regularly emerge. The June issue of Surgery Today features a study in which elderly female cardiac patients who had had emergency operations and were given antidepressants experienced less depression, shorter hospital stays and fewer deaths in the hospital.

Broad studies tend to be most trustworthy when they look at patients with sustained illness. A reliable finding is that antidepressants work for chronic and recurrent mild depression, the condition called dysthymia. More than half of patients on medicine get better, compared to less than a third taking a placebo. (This level of efficacy — far from ideal — is typical across a range of conditions in which antidepressants outperform placebos.) Similarly, even the analyses that doubt the usefulness of antidepressants find that they help with severe depression.

In fact, antidepressants appear to have effects across the depressive spectrum. Scattered studies suggest that antidepressants bolster confidence or diminish emotional vulnerability — for people with depression but also for healthy people. In the depressed, the decrease in what is called neuroticism seems to protect against further episodes. Because neuroticism is not a core symptom of depression, most outcome trials don’t measure this change, but we can see why patients and doctors might consider it beneficial.

Similarly, in rodent and primate trials, antidepressants have broad effects on both healthy animals and animals with conditions that resemble mood disruptions in humans.

One reason the F.D.A. manages to identify useful medicines is that it looks at a range of evidence. It encourages companies to submit “maintenance studies.” In these trials, researchers take patients who are doing well on medication and switch some to dummy pills. If the drugs are acting as placebos, switching should do nothing. In an analysis that looked at maintenance studies for 4,410 patients with a range of severity levels, antidepressants cut the odds of relapse by 70 percent. These results, rarely referenced in the antidepressant-as-placebo literature, hardly suggest that the usefulness of the drugs is all in patients’ heads.

The other round of media articles questioning antidepressants came in response to a seemingly minor study engineered to highlight placebo responses. One effort to mute the placebo effect in drug trials involves using a “washout period” during which all subjects get a dummy pill for up to two weeks. Those who report prompt relief are dropped; the study proceeds with those who remain symptomatic, with half getting the active medication. In light of subject recruitment problems, this approach has obvious appeal.

Dr. DeRubeis, an authority on cognitive behavioral psychotherapy, has argued that the washout method plays down the placebo effect. Last year, Dr. DeRubeis and his colleagues published a highly specific statistical analysis. From a large body of research, they discarded trials that used washouts, as well as those that focused on dysthymia or subtypes of depression. The team deemed only six studies, from over 2,000, suitable for review. An odd collection they were. Only studies using Paxil and imipramine, a medicine introduced in the 1950s, made the cut — and other research had found Paxil to be among the least effective of the new antidepressants. One of the imipramine studies used a very low dose of the drug. The largest study Dr. DeRubeis identified was his own. In 2005, he conducted a trial in which Paxil did slightly better than psychotherapy and significantly better than a placebo — but apparently much of the drug response occurred in sicker patients.

Building an overview around your own research is problematic. Generally, you use your study to build a hypothesis; you then test the theory on fresh data. Critics questioned other aspects of Dr. DeRubeis’s math. In a re-analysis using fewer assumptions, Dr. DeRubeis found that his core result (less effect for healthier patients) now fell just shy of statistical significance. Overall, the medications looked best for very severe depression and had only slight benefits for mild depression — but this study, looking at weak treatments and intentionally maximized placebo effects, could not quite meet the scientific standard for a firm conclusion. And yet, the publication of the no-washout paper produced a new round of news reports that antidepressants were placebos.

In the end, the much heralded overview analyses look to be editorials with numbers attached. The intent, presumably to right the balance between psychotherapy and medication in the treatment of mild depression, may be admirable, but the data bearing on the question is messy.

As for the news media’s uncritical embrace of debunking studies, my guess, based on regular contact with reporters, is that a number of forces are at work. Misdeeds — from hiding study results to paying off doctors — have made Big Pharma an inviting and, frankly, an appropriate target. (It’s a favorite of Dr. Angell’s.) Antidepressants have something like celebrity status; exposing them makes headlines.

It is hard to locate the judicious stance with regard to antidepressants and moderate mood disorder. In my 1993 book, “Listening to Prozac,” I wrote, “To my mind, psychotherapy remains the single most helpful technology for the treatment of minor depression and anxiety.” In 2003, in “Against Depression,” I highlighted research that suggested antidepressants influence mood only indirectly. It may be that the drugs are “permissive,” removing roadblocks to self-healing.

That model might predict that in truth the drugs would be more effective in severe disorders. If antidepressants act by usefully perturbing a brain that’s “stuck,” then people who retain some natural resilience would see a lesser benefit. That said, the result that the debunking analyses propose remains implausible: antidepressants help in severe depression, depressive subtypes, chronic minor depression, social unease and a range of conditions modeled in mice and monkeys — but uniquely not in isolated episodes of mild depression in humans.

BETTER-DESIGNED research may tell us whether there is a point on the continuum of mood disorder where antidepressants cease to work. If I had to put down my marker now — and effectively, as a practitioner, I do — I’d bet that “stuckness” applies all along the line, that when mildly depressed patients respond to medication, more often than not we’re seeing true drug effects. Still, my approach with mild depression is to begin treatments with psychotherapy. I aim to use drugs sparingly. They have side effects, some of them serious. Antidepressants help with strokes, but surveys also show them to predispose to stroke. But if psychotherapy leads to only slow progress, I will recommend adding medicines. With a higher frequency and stronger potency than what we see in the literature, they seem to help.

My own beliefs aside, it is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.

As for my friend, he had made no progress before his neurologists prescribed antidepressants. Since, he has shown a slow return of motor function. As is true with much that we see in clinical medicine, the cause of this change is unknowable. But antidepressants are a reasonable element in the treatment — because they do seem to make the brain more flexible, and they’ve earned their place in the doctor’s satchel.

Peter D. Kramer is a clinical professor of psychiatry at Brown University.

Original here