Archive for the ‘Medical’ Category
Philip Smith reports in the Drug War Chronicles:
Florida state Rep. Kristin Jacobs (D-Coconut Creek) is a woman on a mission, albeit a strange and misinformed one. For the last three years, Jacobs has waged a lonely crusade in Tallahassee to ban kratom, the herb derived from a Southeast Asian tree and widely used for pain relief, withdrawal from opiates, and as a less harmful alternative to opiates.
She’s at it again this year, having just introduced a measure, House Bill 183, that would add mitragynine and hydroxymitragynine, the active constituents of kratom, to the state’s controlled substances list. And she’s invoking the specter of Hitler as she does so.
Saying the kratom ban was a “fall on the sword issue” for her, Jacobs railed against the people who have opposed her prohibitionist efforts, accusing them of Goebbels-like propaganda.
“They have a story,” she told the St. Peters Blog. “Just like Hitler believed if you tell a lie over and over again, it becomes the truth.”
Portraying herself as a bravely challenging a “lie machine… a powerful lobby with lots of money,” Jacobs warned against “Big Kratom.” “It’s not just what they’re doing here,” she said. “They’re doing the same thing around the country.”
“They” would be the American Kratom Association and the Botanical Education Alliance. The former was founded by Susan Ash, a 46-year-old who began taking kratom while being treated for dependence on prescription pain relievers and now takes a small dose daily to ease chronic pain and depression. She was so impressed with the results, she founded the group in 2015 to represent kratom consumers. The group now has more than 2,000 members and lobbies against efforts to ban the drug.
The latter is a small nonprofit organization “dedicated to educating consumers, lawmakers, law enforcement, and the media aboutstyl safe and therapeutic natural supplements including Mitragyna speciosa, also known as Kratom,” the group says on its web page. “Our mission is to increase understanding in order to influence public policy and protect natural supplements. Our vision is to create a society where every adult has the right to access safe and effective natural supplements.”
According to the American Kratom Association, “Kratom is not a drug. Kratom is not an opiate. Kratom is not a synthetic substance. Naturally occurring Kratom is a safe herbal supplement that’s more akin to tea and coffee than any other substances. Kratom behaves as a partial mu-opioid receptor agonist and is used for pain management, energy, even depression and anxiety that are so common among Americans. Kratom contains no opiates, but it does bind to the same receptor sites in the brain. Chocolate, coffee, exercise and even human breast milk hit these receptor sites in a similar fashion.”
Unsurprisingly, Jacobs disagrees. She calls the herb a “scourge on society” and says it “is an opiate,” breezily lumping it in with heroin and pain pill mills.
In Jacobs’ dystopian vision, she foresees babies born with withdrawal symptoms, emergency room doctors treating strung-out kratom junkies in the throes of withdrawal, and “addicts with glassy eyes and shaky hands” lurking about until the dreaded kratom overdose gets them. “How many more are going to die?” she asks.
Well, not many, actually. Like opiates, kratom relieves pain, slows bowel activity, produces euphoric feelings, and creates physical addiction and a withdrawal syndrome. But unlike opiates, it causes a pleasant, caffeine-type buzz in small doses and, more significantly, it is apparently very difficult — if not impossible — to overdose on it. The few deaths where kratom is implicated include poly-drug use, or as in a case reported by the New York Times, suicide by a young kratom user who was also being treated for depression.
“Direct kratom overdoses from the life-threatening respiratory depression that usually occurs with opioid overdoses have not been reported,” says Oliver Grundmann, clinical associate professor of medicinal chemistry at the University of Florida, told journalist Maia Szalavitz at Vice. Grundmann should know; he just reviewed the research on kratom for the International Journal of Legal Medicine.
Szalavitz also consulted Mark Swogger, an assistant professor of psychiatry at the University of Rochester Medical Center, who with his colleagues analyzed 161 “experience reports” posted by kratom users on the drug information site Erowid.org for a recent study in the Journal of Psychoactive Drugs.
“I think it’s pretty safe to say that kratom has at least some addiction potential. The data is fairly strong on that and our study also found that people are reporting addiction,” but “overall, we found that it’s really mild compared to opioid addiction and it didn’t seem to last as long.”
Jacobs’ inflammatory and ill-founded comments generated a quick and strong reaction from kratom advocates. . .
An extremely ominous sign: Republicans are avoiding constituents angry about the Affordable Care Act repeal
When Congress actively avoids the people that members of Congress are supposed to represent and whose interests the member of Congress is supposed to protect, the government becomes separated from the people. It’s no longer government for the people, and it’s no longer government by the people. I suppose it’s still a government “of” the people, but only some of the people: the wealthy and powerful and corporate, whose interests are primary to many members of Congress, and much more important than the interests of their constituents.
Matthew Rozsa writes in Salon:
The same Republican politicians who are planning to repeal the Affordable Care Act are doing everything they can to avoid potentially embarrassing confrontations with their constituents who will be affected by their actions.
Although 10 Republican legislators have held in-person town hall meetings since the start of the year, only one — Rep. James F. Sensenbrenner, R-Wisconsin — has scheduled any events for the future, according to The Washington Post.
“In this day and age, real-life town halls are very dangerous for all but the most seasoned politicians,” John Feehery, a former senior House Republican leadership aide, told the Post. “I think John McCain can get away with it and a few others, but most should stick to office hours, really good constituent service or tele-town halls.”
There are already signs that Republican congressmen would experience a major backlash if they faced their constituents. Rep. Mike Coffman of Colorado had to exit an event on Saturday from a backdoor due to chanting protesters. Rep. Cathy McMorris Rodgers of Washington faced shouts of “save our health care” during an event in her district on Monday. And — perhaps most memorable — on Friday House Speaker Paul Ryan of Wisconsin was confronted on a national cable show by a cancer survivor who insisted that the Affordable Care Act had saved his life.
Republicans have a great deal to lose if they repeal the Affordable Care Act without setting up a replacement plan to protect the 22 million Americans who would otherwise lose their health insurance. There are 6.3 million people in Republican-led districts who enrolled due to the marketplaces established by the Affordable Care Act — compared with only 5.2 million enrollees who reside in Democratic-led districts. . .
City devastated by OxyContin use sues Purdue Pharma, claims drugmaker put profits over citizens’ welfare
It’s pretty obvious that Purdue Pharma—along with many other pharmaceutical companies—is intensely concerned about profits and pretty much indifferent to patient welfare. (Martin Shkreli is the poster child for this, but he’s just the tip of the iceberg.) However, corporations in the US tend to escape any real punishment, generally just paying a fine that is a fraction of the profits realized—a cost of doing business seems to be how it’s treated.
Harriet Ryan reports in the LA Times:
A Washington city devastated by black-market OxyContin filed a first-of-its-kind lawsuit against the painkillers’ manufacturer Thursday, alleging the company turned a blind eye to criminal trafficking of its pills to “reap large and obscene profits” and demanding it foot the bill for widespread opioid addiction in the community.
The suit by Everett, a city of 100,000 north of Seattle, was prompted by a Times investigation last year. The newspaper revealed that drugmaker Purdue Pharma had extensive evidence pointing to illegal trafficking across the nation, but in many cases, did not share it with law enforcement or cut off the flow of pills.
One Los Angeles ring monitored by Purdue and highlighted by The Times’ investigation supplied OxyContin to gang members and other criminals who were trafficking the drug to Everett. At the height of the problem, in 2010, OxyContin was a factor in more than half the crimes in Snohomish County, and it ignited a heroin epidemic that still grips the region, officials said.
In a complaint in state Superior Court, city lawyers accused Purdue of gross negligence, creating a public nuisance and other misconduct and said the company should pay costs of handling the opioid crisis — a figure that the mayor said could run tens of millions of dollars — as well as punitive damages.
“Purdue’s improper actions of placing profits over the welfare of the citizens of Everett have caused and will continue to cause substantial damages to Everett,” the lawyers wrote. “Purdue is liable for its intentional, reckless, and/or negligent misconduct and should not be allowed to evade responsibility for its callous and unconscionable practices.”
Purdue has been sued hundreds of times over the past 20 years over its marketing of OxyContin to doctors and the drug’s risk of addiction to patients, but Everett’s suit is the first to focus narrowly on what the company knew about criminal distribution of the painkiller. . .
It is amazing how often something that is scientifically known and demonstrated to work will be ignored in favor of approaches that in fact make the problem worse. (I blogged one interesting example a few days ago.) Iceland took some findings of behavioral science and applied them. Emma Young reports in Mosaic what happened:
Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.
The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”
Read the article for what they did and why. It really is a matter of asking basic questions: Why do teens get high? For the feelings. What causes the feelings? Brain chemistry. Can the same brain chemistry be triggered by other, more benign causes?
Well, there are sports, and learning things, and so on…
It’s quite a fascinating article, and note the many benefits of Iceland’s approach as compared to the approach the US uses (break into people’s houses, steal their possessions through asset forfeiture, lock people up, create cause for cop corruption, and so on). That is, not just lower use of alcohol, tobacco, and other drugs, but also the development of more skills and knowledge in teens (who soon will be adults, and probably more successful as a result of a more productive adolescence).
In the context of the article, watch again this video—but read the article first:
Paul Krugman blogs at the NY Times:
Another week of complete chaos on the health reform front. Dear Leader declares that he’ll give everyone coverage; Republicans explain that he didn’t mean that literally. CBO says the obvious, that repealing the ACA would lead to immense hardship for tens of millions; Republicans declare that this is wrong, because they will come up with an alternative any day now — you know, the one they’ve been promising for 7 years.
I’ve written about all of this many, many, many times. The logic of Obamacare — the reason anything aiming to cover a large fraction of the previously uninsured must either be single-payer or something very like the ACA — is the clearest thing I’ve seen in decades of policy discussion. But I don’t know if I’ve ever written out the fundamental principles that lie behind all of this.
So here we go: providing health care to those previously denied it is, necessarily, a matter of redistributing from the lucky to the unlucky. And, of course, reversing a policy that expanded health care is redistribution in reverse. You can’t make this reality go away.
Left to its own devices, a market economy won’t care for the sick unless they can pay for it; insurance can help up to a point, but insurance companies have no interest in covering people they suspect will get sick. So unfettered markets mean that health care goes only to those who are wealthy and/or healthy enough that they won’t need it often, and hence can get insurance.
If that’s a state of affairs you’re comfortable with, so be it. But the public doesn’t share your sentiments. Health care is an issue on which most people are natural Rawlsians: they can easily imagine themselves in the position of those who, through no fault of their own, experience expensive medical problems, and feel that society should protect people like themselves from such straits.
The thing is, however, that guaranteeing health care comes with a cost. You can tell insurance companies that they can’t discriminate based on medical history, but that means higher premiums for the healthy — and you also create an incentive to stay uninsured until or unless you get sick, which pushes premiums even higher. So you have to regulate individuals as well as insurers, requiring that everyone sign up — the mandate, And since some people won’t be able to obey such a mandate, you need subsidies, which must be paid for out of taxes.
Before the passage and implementation of the ACA, Republicans could wave all this away by claiming that health reform could never work. And even now they’re busy telling lies about its collapse. But none of this will conceal mass loss of health care in the wake of Obamacare repeal, with some of their most loyal voters among the biggest losers.
What they’re left with is . . .
Jason Kottke blogs:
I posted earlier about Atul Gawande’s piece in the New Yorker on the importance of incremental care in medicine. One of the things that the Affordable Care Act did was to make it illegal for insurance companies to deny coverage to people with “preexisting conditions”, which makes it difficult for those people to receive the type of incremental care Gawande touts. And who has these preexisting conditions? An estimated 27% of US adults under 65, including Gawande’s own son:
In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.
That’s 52 million people, potentially ineligible for health insurance. And that’s not counting children. Spurred on by Gawande, people have been sharing their preexisting conditions stories on Twitter with the hashtag #the27Percent.
The 27% figure comes from a recent analysis by the Kaiser Family Foundation:
A new Kaiser Family Foundation analysis finds that 52 million adults under 65 — or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act.
In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).
36% uninsurable in West Virginia! You’ll note that all 11 of those states voted for Trump in the recent election and in West Virginia, Trump carried the day with 68.7% of the vote, the highest percentage of any state. The states whose people need the ACA’s protection the most voted most heavily against their own interest.
Oh and one last thing. . .
Atul Gawande suggests in his New Yorker article that medicine is barking up the wrong tree.
By 2010, Bill Haynes had spent almost four decades under attack from the inside of his skull. He was fifty-seven years old, and he suffered from severe migraines that felt as if a drill were working behind his eyes, across his forehead, and down the back of his head and neck. They left him nauseated, causing him to vomit every half hour for up to eighteen hours. He’d spend a day and a half in bed, and then another day stumbling through sentences. The pain would gradually subside, but often not entirely. And after a few days a new attack would begin.
Haynes (I’ve changed his name, at his request) had his first migraine at the age of nineteen. It came on suddenly, while he was driving. He pulled over, opened the door, and threw up in someone’s yard. At first, the attacks were infrequent and lasted only a few hours. But by the time he was thirty, married, and working in construction management in London, where his family was from, they were coming weekly, usually on the weekends. A few years later, he began to get the attacks at work as well.
He saw all kinds of doctors—primary-care physicians, neurologists, psychiatrists—who told him what he already knew: he had chronic migraine headaches. And what little the doctors had to offer didn’t do him much good. Headaches rank among the most common reasons for doctor visits worldwide. A small number are due to secondary causes, such as a brain tumor, cerebral aneurysm, head injury, or infection. Most are tension headaches—diffuse, muscle-related head pain with a tightening, non-pulsating quality—that generally respond to analgesics, sleep, neck exercises, and time. Migraines afflict about ten per cent of people with headaches, but a much larger percentage of those who see doctors, because migraines are difficult to control.
Migraines are typically characterized by severe, disabling, recurrent attacks of pain confined to one side of the head, pulsating in quality and aggravated by routine physical activities. They can last for hours or days. Nausea and sensitivity to light or sound are common. They can be associated with an aura—visual distortions, sensory changes, or even speech and language disturbances that herald the onset of head pain.
Although the cause of migraines remains unknown, a number of treatments have been discovered that can either reduce their occurrence or alleviate them once they occur. Haynes tried them all. His wife also took him to a dentist who fitted him with a mouth guard. After seeing an advertisement, she got him an electrical device that he applied to his face for half an hour every day. She bought him hypnotism tapes, high-dosage vitamins, magnesium tablets, and herbal treatments. He tried everything enthusiastically, and occasionally a remedy would help for a brief period, but nothing made a lasting difference.
Finally, desperate for a change, he and his wife quit their jobs, rented out their house in London, and moved to a cottage in a rural village. The attacks eased for a few months. A local doctor who had migraines himself suggested that Haynes try the cocktail of medicines he used. That helped some, but the attacks continued. Haynes seesawed between good periods and bad. And without work he and his wife began to feel that they were vegetating.
On a trip to New York City, when he turned fifty, they decided they needed to make another big change. They sold everything and bought a bed-and-breakfast on Cape Cod. Their business thrived, but by the summer of 2010, when Haynes was in his late fifties, the headaches were, he said, “knocking me down like they never had before.” Doctors had told him that migraines diminish with age, but his stubbornly refused to do so. “During one of these attacks, I worked out that I’d spent two years in bed with a hot-water bottle around my head, and I began thinking about how to take my life,” he said. He had a new internist, though, and she recommended that he go to a Boston clinic that was dedicated to the treatment of headaches. He was willing to give it a try. But he wasn’t hopeful. How would a doctor there do anything different from all the others he’d seen?
That question interested me, too. I work at the hospital where the clinic is based. The John Graham Headache Center, as it’s called, has long had a reputation for helping people with especially difficult cases. Founded in the nineteen-fifties, it now delivers more than eight thousand consultations a year at several locations across eastern Massachusetts. Two years ago, I asked Elizabeth Loder, who’s in charge of the program, if I could join her at the clinic to see how she and her colleagues helped people whose problems had stumped so many others. I accompanied her for a day of patient visits, and that was when I met Haynes, who had been her patient for five years. I asked her whether he was the worst case she’d seen. He wasn’t even the worst case she’d seen that week, she said. She estimated that sixty per cent of the clinic’s patients suffer from daily, persistent headaches, and usually have for years. . .