Archive for the ‘Medical’ Category
Ayun Halliday has an Open Culture post with four interesting videos. Here’s the first:
The post begins:
If a 20-something, Yale-educated New Yorker reporter feels nervous stepping in to her first ever improv class, imagine the stakes for your average inmate, whose survival depends on a successfully monolithic projection of toughness and control.
Control is actually something the Actors’ Gang Prison Project seeks to cultivate in its incarcerated participants. The Actors’ Gang’s Artistic Director, Tim Robbins, who founded the radically experimental ensemble fresh out of college, notes a well-documented connection between an inability to control one’s emotions and criminal activity. . .
Read the whole thing. And take a look at the videos.
Another drug shows great therapeutic promise, reported at PBS by Caleb Hellerman:
In nearly a decade trying to recover from post-traumatic stress disorder caused by childhood abuse, Jessi Appleton compiled a medical chart that reads like a Chinese restaurant menu. Biofeedback. Neurofeedback. Anti-depressants. Anti-anxiety medication. She tried a popular treatment called Eye Movement Desensitization and Reprocessing (EMDR), where she spent hours letting her gaze follow a therapist’s hand as it moved through carefully prescribed patterns. She tried another gaze-based therapy, called brainspotting.
“EMDR helped the most, but I was hitting a wall,” says Appleton. “I was suicidal. I was like this ghost sort of thing, walking through life. And I felt like nothing was going to change.”
Then she tried a new experimental treatment: therapy under the influence of MDMA, better known as Ecstasy. Her therapist suggested she sign up to be part of a pilot study. After three sessions, she said, “I felt like my soul snapped back into place.”
Appleton, 32, was treated in Boulder, Colorado, in a study arranged and funded by the Multidisciplinary Association for Psychedelic Studies (MAPS), an organization that has long pursued a strategy of supporting rigorous scientific research into otherwise illegal drugs.
On Tuesday, the Food and Drug Administration (FDA) gave the treatment an important boost, when agency officials met with officials from MAPS to start clearing the way for one or more large-scale research studies. According to Rick Doblin, MAPS’ founder and executive director, officials with the FDA’s Division of Psychiatry Products will not require additional studies prior to launching a Phase 3 trial, a critical round of testing that determines whether a medical treatment can be approved for widespread use.
“It was a very collaborative discussion, in light of the need to develop new treatments for PTSD for veterans and others,” Doblin says. “They recognize that this is a novel treatment, combining psychotherapy and pharmacotherapy, and there’s nothing else like it right now.”
The FDA says that federal law and internal regulations prohibit the agency from commenting on studies about pending applications or drugs still in development.
Details will be worked out over the next several months, but Doblin says that Phase 3 is likely to include at least 230 patients treated at roughly a dozen sites around the country.
Doblin and Appleton’s lead therapist, psychotherapist Marcela Ot’alora, say the therapy component is crucial. After a handful of preparatory meetings, the patient takes the drug under the watchful eyes of a two-person treatment team — almost always a man and a woman. Across studies, the dosage varies, but it is typically between 75 and 125mg, enough to trigger a strong experience. Like others, Appleton wore eyeshades and spent several hours lying back on a small couch, mostly in silence.
“It’s a lot of inner dialogue,” Appleton recalls. “Sometimes you’re terrified, sometimes relaxed, sometimes it’s other emotions. It’s intense, and by the end it’s exhausting.”
Ot’alora says her role is mostly supportive. Echoing Appleton’s description, she says the drug seems to help patients let go of their inner critic, or inner demons. “That part of you becomes a witness, saying, ‘This is what’s happening to you, this is what happened to you and this is how it felt.’ It’s very matter of fact.” . . .
Read the whole thing. There’s quite a bit more.
Melissa Healy reports the good news in the LA Times:
In findings that could pry open a door closed for nearly half a century, researchers have found that psilocybin — a hallucinogen long used in traditional healing rituals — eases the depression and soothes the anxiety of patients contending with serious illness and the prospect of imminent death.
In two separate studies published Thursday, researchers report that trial subjects who received a single moderate-to-large dose of psilocybin got substantial and lasting relief from their profound distress. Among 80 cancer patients who participated in the two trials, as many as 4 in 5 continued to feel measurably less hopeless and demoralized six months after taking the drug than they had upon their recruitment.
And even years later, many reported they had gained — and retained — a profound sense of peace and meaning from the experience. Of 29 cancer patients who got psilocybin in a trial conducted at New York University’s Langone Medical Center, 20 rated it as “among the most meaningful” events of their life.
“This drug saved my life and changed my life,” said Dinah Bazer, a Brooklyn, N.Y., woman who was administered a single dose of psilocybin at a New York treatment center in 2011.
In the wake of treatment for ovarian cancer, Bazer said, her anxiety at the prospect of its return was “eating her alive.” Under the influence of a single high dose of psilocybin, Bazer said Wednesday, she became “volcanically angry” as she visualized her cancer as a dark mass bearing down on her. With an epithet, she then saw herself throwing it off.
“I was bathed in God’s love” for hours after that, said Bazer, who describes herself as an atheist. When the psilocybin’s hallucinatory effects wore off, she said, two years of intense anxiety were simply gone.
“This is a groundbreaking result,” said Dr. George Greer, medical director of the Heffter Research Institute, the nonprofit organization that funded the two trials.
Greer suggested that the “existential anxiety” of the terminally ill is only one of many conditions that psilocybin may one day treat. Others may include treatment-resistant depression, addiction to cocaine, alcohol or tobacco, obsessive-compulsive disorder and “demoralization” in long-term survivors of HIV, he said.
Johns Hopkins University psychiatrist Dr. Roland R. Griffiths, the lead author of one of the two studies, said the enduring relief provided by a single dose of psilocybin makes such treatment more akin to surgery than it does to the plodding, labor-intensive treatments that remain the mainstay of his profession.
“I really don’t think we have any models in psychiatry that look like” the effects demonstrated in the two trials, said Griffiths. “Something occurs and it’s repaired and it’s better going forward … very plausibly for more than six months,” he added. “In that sense it’s a new model.”
The publication of the two early trials, in the Journal of Psychopharmacology, marks an American return to research on the therapeutic use of hallucinogenic drugs after a hiatus of 50 years.
In the 1950s and ’60s, hallucinogenic drugs such as lysergic acid diethylamide — LSD — and psilocybin, which is found naturally in certain mushrooms, were widely used in U.S. biomedical research and in psychotherapy practices. But in 1966, as the psychedelic drugs gained a broad counterculture following in the United States, the U.S. government declared any use of the drugs illegal. By the 1970s, that ended all American research on their potential therapeutic benefits.
In recent years, a small clutch of American researchers, including the authors of the two new papers, have argued that such prohibitions might be preventing the discovery of better treatments for widespread and pressing psychiatric problems, including depression, addiction and post-traumatic stress disorder (PTSD).
With PTSD epidemic among U.S. combat veterans and drug addiction a national scourge, American officials have indicated a new willingness to allow research to proceed on psychedelic and other drugs long classified as having no legitimate medical use.
On Tuesday, the Food and Drug Administration gave its blessing to conducting large-scale clinical trials of an experimental medication — 3,4-methylenedioxymethamphetamine — better known as the party drug ecstasy.
Like LSD and psilocybin, ecstasy appears to hold promise as an adjunct to psychotherapy in the treatment of PTSD. If the resulting Phase 3 trials of ecstasy demonstrate their effectiveness, the next step could be FDA approval of ecstasy as a prescription drug. . .
The War on Drugs that Nixon initiated (against the advice of a presidential commission he formed) has done incalculable damage and blocked for decades the discovery of the benefits the drugs might bring. And I fear with Jeff Sessions as Attorney General we in for a big regression.
Later in the column:
In one of the trials, researchers used a very low dose of psilocybin, much lower than that required to induce hallucinations, as a placebo. In the other, they used the dietary supplement niacin. In each trial, all of the subjects got a high dose of psilocybin in one of two sessions. So all, in the end, experienced the full effects of the drug.
All subjects in both trials had been diagnosed with cancer, and with “existential anxiety or depression” resulting from the illness and the likelihood of an early death. Participants were extensively prepared for the expected effects of the psilocybin. To minimize adverse reactions, researchers closely monitored the subjects while they were under the influence of the drug or the placebo. Afterwards, psychotherapists encouraged the subjects to write down and reflect upon the experience.
Immediately after, as well as five weeks after their first session, subjects who got the psilocybin first looked much better than did those who got the placebo first. A wide range of standardized measures of depression, anxiety and quality of life showed that these subjects were less hopeless, less demoralized and less anxious.
Six months out, 87% of those in the trial conducted at New York University/Langone reported their life satisfaction and/or well-being had been improved by the experience. In the larger of the two trials, conducted at Johns Hopkins University, psilocybin produced “large and significant … increases in measures of quality of life, life meaning, death acceptance, and optimism” — effects that “were sustained at six months.”
Psilocybin’s side effects, meanwhile, were pretty tame. In the two trials, about 15% of subjects experienced nausea or vomiting when getting a high dose, and about 1 in 3 experienced some form of transient psychological discomfort. Many subjects’ heart rates and blood pressure rose, but none to a dangerous extent.
The potential use of psilocybin in patients diagnosed with life-threatening diseases comes at a moment when medical care at the end of life is a subject of growing concern among patients and physicians. Research finds it’s still common for dying patients to get painful and futile procedures. Palliative and hospice care, both aimed at easing the discomfort of the seriously ill, are growing specialties in American hospitals. An increasing number of patients, meanwhile, are demanding the right to die with a physician’s help.
As states debate these physician-assisted suicide bills, they should consider the implications of finding an effective treatment for the “existential distress” of the dying, said Dr. Craig D. Blinderman, a palliative care specialist at Columbia University Medical Center/New York Presbyterian Hospital.
And there’s a lot more. Worth reading.
That’s from a very interesting Open Culture post by Dan Colman, which begins:
There’s a political disconnect in the United States. We have two political parties, each now living in its own reality and working with its own set of facts. The common ground between them? Next to none.
How to explain this disconnect? Maybe the answer lies in the theory of “cognitive closure”–a theory first worked out by social psychologist Arie Kruglanski back in 1989.
“People’s politics are driven by their psychological needs,” Kruglanski explains in the short documentary above. “People who are anxious because of the uncertainty that surrounds them are going to be attracted to messages that offer certainty.”
He sips a soda, then continues, . . .
But watch the documentary. It’s just 7 minutes.
Sarah Kliff has an excellent article in Vox that explains exactly when the US prescription drug prices are out of control and why prescription drug prices in other countries are much more reasonable. (It’s due to different government approaches and roles.) The article is copiously illustrated with stick figures, and it begins:
Let’s say you’re at the doctor. And the doctor hands you a prescription.
The prescription is for Humira, an injectable medication used to treat a lot of common conditions like arthritis and psoriasis. Humira is an especially popular medication right now. In 2015, patients all around the world spent $14 billion on Humira prescriptions — that’s roughly the size of Jamaica’s entire economy.
Let’s say your doctor appointment is happening in the United Kingdom. There, your Humira prescription will cost, on average, $1,362. If you’re seeing a doctor in Switzerland, the drug runs around $822.
But if you’re seeing a doctor in the United States, your Humira prescription will, on average, run you $2,669.
How does this happen? Why does Humira cost so much more here than it does in other countries?
Humira is the exact same drug whether it’s sold in the United States, in Switzerland, or anywhere else. What’s different about Humira in the United States is the regulatory system we’ve set up around our pharmaceutical industry.
The United States is exceptional in that it does not regulate or negotiate the prices of new prescription drugs when they come onto market. Other countries will task a government agency to meet with pharmaceutical companies and haggle over an appropriate price. These agencies will typically make decisions about whether these new drugs represent any improvement over the old drugs — whether they’re even worth bringing onto the market in the first place. They’ll pore over reams of evidence about drugs’ risks and benefits. . .
Continue reading. And do read the whole thing.
The US system is badly out of whack. To see how badly, take a look at this BBC article by Greg Dunlop, which begins:
US executive Martin Shkreli became a symbol of greed when he raised the price of a tablet of Daraprim from $13.50 (£11) to $750.
Now, Sydney school students have recreated the drug’s key ingredient for just $20.
Read the whole thing. It’s short.
Kevin Drum lays it out:
The Washington Post tells us this morning that we have another new member of the incoming cabinet:
Trump picks fierce Obamacare critic as health and human services secretary
His name is Tom Price, a Republican member of Congress from Georgia, and the fact that he’s a “fierce” critic of Obamacare doesn’t really faze me. He’s a Republican, after all. Anyone Trump picked would be a fierce critic of Obamacare.
However, there is something different about Price: he actually has a replacement plan. Not a white paper, but actual legislation. Sarah Kliff runs down Price’s plan here, but I want to pull back from the details and focus on the bigger picture instead.
You’ve probably heard a million times that Obamacare relies on a three-legged stool. If you want universal coverage, you have to require insurers to cover everyone, even those with pre-existing conditions. That’s guaranteed issue. But that will wreck the insurance pool: it will have too many sick people, who will rush to buy coverage, and not enough healthy people. So you also need to provide an incentive for healthy people to join your plan. In Obamacare, that’s the tax penalty for going without insurance. Finally, once you’ve done that, you have to provide financial help for the poor, since they can’t afford full-price coverage no matter how much incentive you give them. In Obamacare, that’s the subsidies.
This is not just an Obamacare thing. It’s true of all health insurance. Take the employer market that most of us are familiar with. Everyone who works for a company that offers health coverage gets it. That’s guaranteed issue. It’s pretty cheap and the price is deducted painlessly from your paycheck. That’s an incentive for everyone to join. And the company provides the insurance either free or at a very discounted price. That’s the equivalent of Obamacare’s subsidies.
So how does Price’s plan work? He mandates that insurance companies cover even those with pre-existing conditions. That’s guaranteed issue. However, insurers are only required to take you on if you maintain continuous coverage. That’s a huge incentive for healthy people to buy insurance, since if you skip it for a year you might not be able to get coverage if you get sick. Finally, he offers tax credits based on age to everyone, and a high-risk pool for those who still can’t afford insurance. That’s very similar to Obamacare’s subsidies.
So what’s the problem? Why shouldn’t Democrats ditch Obamacare and accept Price’s substitute? Or to flip things around, why should Republicans bother with this? If they’re just going to get a different version of Obamacare from Price, why not skip the whole thing? . . .
Do read the rest of the column. It’s grim. We’re so screwed.