Quotulatiousness

June 23, 2015

QotD: The Physician

Filed under: Health,Humour,Quotations — Tags: , , — Nicholas @ 01:00

Hygiene is the corruption of medicine by morality. It is impossible to find a hygienist who does not debase his theory of the healthful with a theory of the virtuous. The whole hygienic art, indeed, resolves itself into an ethical exhortation, and, in the sub-department of sex, into a puerile and belated advocacy of asceticism. This brings it, at the end, into diametrical conflict with medicine proper. The aim of medicine is surely not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The true physician does not preach repentance; he offers absolution.

H.L. Mencken, “Types of Men 5: The Physician”, Prejudices, Third Series, 1922.

April 19, 2015

The latest “breakthrough” in helping schizophrenics take their medicine

Filed under: Health,Humour — Tags: , , , — Nicholas @ 03:00

Scott Alexander recently attended a local psychiatry conference, with some essential themes being emphasized:

This conference consisted of a series of talks about all the most important issues of the day, like ‘The Menace Of Psychologists Being Allowed To Prescribe Medication’, ‘How To Be An Advocate For Important Issues Affecting Your Patients Such As The Possibility That Psychologists Might Be Allowed To Prescribe Them Medication’, and ‘Protecting Members Of Disadvantaged Communities From Psychologists Prescribing Them Medication’.

As somebody who’s noticed that the average waiting list for a desperately ill person to see a psychiatrist is approaching the twelve month mark in some places, I was pretty okay with psychologists prescribing medication. The scare stories about how psychologists might prescribe medications unsafely didn’t have much effect on me, since I continue to believe that putting antidepressants in a vending machine would be a more safety-conscious system than what we have now (a vending machine would at least limit antidepressants to people who have $1.25 in change; the average primary care doctor is nowhere near that selective). Annnnnyway, this made me kind of uncomfortable at the conference and I Struck A Courageous Blow Against The Cartelization Of Medicine by sneaking out without putting my name on their mailing list.

But before I did, I managed to take some notes about what’s going on in the wider psychiatric world, including:

– The newest breakthrough in ensuring schizophrenic people take their medication (a hard problem!) is bundling the pills with an ingestable computer chip that transmits data from the patient’s stomach. It’s a bold plan, somewhat complicated by the fact that one of the most common symptoms of schizophrenia is the paranoid fear that somebody has implanted a chip in your body to monitor you. Can you imagine being a schizophrenic guy who has to explain to your new doctor that your old doctor put computer chips in your pills to monitor you? Yikes. If they go through with this, I hope they publish the results in the form of a sequel to The Three Christs of Ypsilanti.

– The same team is working on a smartphone app to detect schizophrenic relapses. The system uses GPS to monitor location, accelerometer to detect movements, and microphone to check tone of voice and speaking pattern, then throws it into a machine learning system that tries to differentiate psychotic from normal behavior (for example, psychotic people might speak faster, or rock back and forth a lot). Again, interesting idea. But again, one of the most common paranoid schizophrenic delusions is that their electronic devices are monitoring everything they do. If you make every one of a psychotic person’s delusions come true, such that they no longer have any beliefs that do not correspond to reality, does that technically mean you’ve cured them? I don’t know, but I’m glad we have people investigating this important issue.

February 9, 2015

Paradoxically, rising cancer deaths are a form of good news

Filed under: Britain,Health,Science — Tags: , , , , , — Nicholas @ 03:00

Last month, in his Times column, Matt Ridley explained why — until we discover a treatment for aging itself — rising cancer rates are a weird form of good news:

If we could prevent or cure all cancer, what would we die of? The new year has begun with a war of words over whether cancer is mostly bad luck, as suggested by a new study from Johns Hopkins School of Medicine, and over whether it’s a good way to die, compared with the alternatives, as suggested by Dr Richard Smith, a former editor of the BMJ.

It is certainly bad luck to be British and get cancer, relatively speaking. As The Sunday Times reported yesterday, survival rates after cancer diagnosis are lower here than in most developed and some developing countries, reflecting the National Health Service’s chronic problems with rationing treatment by delay. In Japan, survival rates for lung and liver cancer are three times higher than here.

Cancer is now the leading cause of death in Britain even though it is ever more survivable, with roughly half of people who contract it living long enough to die of something else. But what else? Often another cancer.

In the western world we’ve conquered most of the causes of premature death that used to kill our ancestors. War, smallpox, homicide, measles, scurvy, pneumonia, gangrene, tuberculosis, stroke, typhoid, heart disease and cholera are all much rarer, strike much later in life or are more survivable than they were fifty or a hundred years ago.

The mortality rate in men from coronary heart disease, for instance, has fallen by an amazing 80 per cent since 1968 — for all age groups. Mortality rates from stroke in both sexes have halved in 20 years. Cancer’s growing dominance of the mortality tables is not because it’s getting worse but because we are avoiding other causes of death and living longer.

It is worth remembering that some scientists and anti-pesticide campaigners in the 1960s were convinced that by now lifespans would be much shorter because of cancer caused by pesticides and other chemicals in the environment.

In the 1950s Wilhelm Hueper — a director of the US National Cancer Institute and mentor to Rachel Carson, the environmentalist author of Silent Spring — was so concerned that pesticides were causing cancer that he thought the theory that lung cancer was caused by smoking was a plot by the chemical industry to divert attention from its own culpability: “Cigarette smoking is not a major factor in the causation of lung cancer,” he insisted.

In fact it turns out that pollution causes very little cancer and cigarettes cause a lot. But aside from smoking, most cancers are indeed bad luck. The Johns Hopkins researchers found that tissues that replicate their stem cells most run the highest risk of cancer: basal skin cells do ten trillion cell divisions in a lifetime and have a million times more cancer risk than pelvic bone cells which do about a million cell divisions. Random DNA copying mistakes during cell division are “the major contributors to cancer overall, often more important than either hereditary or external environmental factors”, say the US researchers.

(Emphasis mine.)

To sum it up, until or unless medical research finds a way to stop the bodily effects of aging, cancer becomes the most likely way for all of us to die. Cancer is a generic rather than a specific term — it’s what we use to describe the inevitable breakdown of the cellular division process that happens millions or even trillions of times over our lifetime. As Ridley puts it, “even if everybody lived in the healthiest possible way, we would still get a lot of cancer.” I’m not a scientist and I don’t even play one on TV, but I suspect that the solution to cancers of all kinds are to boost our immune systems to more quickly identify aberrant cells in our bodies before they start reproducing beyond the capability of the immune system to handle. The short- to medium-term solution to cancer may be to make us all a little bit cyborg…

February 7, 2015

Is there a relationship between physical illness and depression?

Filed under: Health,Science — Tags: , , , — Nicholas @ 02:00

Last month, Scott Alexander tried to show the evidence, pro and con, on whether we have detected a causal relationship between physical ailments and depression:

Start with From inflammation to sickness and depression [PDF], Dantzer et al (2008), who note that being sick makes you feel lousy [citation needed]. Drawing upon evolutionary psychology, they theorize this is an adaptive response to make sick people stay in bed (or cave, or wherever) so the body can focus all of its energy on healing. A lot of sickness behavior – being tired, not wanting to do anything, not eating, not wanting to hang around other people – seems kind of like mini-depression.

All of this stuff is regulated by chemicals called cytokines, which are released by immune cells that have noticed an injury or infection or something. They are often compared to a body-wide “red alert” sending the message “sickness detected, everyone to battle stations”. This response is closely linked to the idea of “inflammation”, the classic example of which is the locally infected area that has turned red and puffy. Most inflammatory cytokines handle the immune response directly, but a few of them – especially interleukin-1B and tumor necrosis factor alpha – cause this depression-like sickness behavior.

[…]

Here are some other suspicious facts about depression and inflammation:

– Exercise, good diet and sleep reduce inflammation; they also help depression.

– Stress increases inflammation and is a known trigger for depression.

– Rates of depression are increasing over time, with the condition seemingly very rare in pre-modern non-Westernized societies. This is commonly attributed to the atomization and hectic pace of modern life. But levels of inflammation are also increasing over time, probably because we have a terrible diet that disrupts the gut microbiota that are supposed to be symbioting with the immune system. Could this be another one of the things we think are social that turn out to be biological?

– SSRI antidepressants, like most medications, have about five zillion effects. One of the effects is to reduce the level of inflammatory cytokines in the body. Is it possible that this is why they work, and all of this stuff about serotonin receptors in the brain is a gigantic red herring?

– It’s always been a very curious piece of trivia that treating depression comorbid with heart disease significantly decreases your chances of dying from the heart disease. People just sort of nod their heads and say “You know, mind-body connection”. But inflammation is known to be implicated in cardiovascular disease. If treating depression is a form of lowering inflammation, this would make perfect sense.

– Rates of depression are much higher in sick people. Cancer patients are especially famous for this. No one gets too surprised here, because having cancer is hella depressing. But it’s always been interesting (to me at least) that as far as we can tell, antidepressants treat cancer-induced depression just as well as any other type. Are antidepressants just that good? Or is the link between cancer being sad and cancer causing depression only part of the story, with the other part being that the body’s immune response to cancer causes inflammatory cytokine release, which antidepressants can help manage?

– Along with cancer, depression is common in many other less immediately emotion-provoking illnesses like rheumatoid arthritis and diabetes. The common thread among these illnesses is inflammation.

– Inflammation changes the activity level of the enzyme indoleamine 2,3 dioxygenase. This enzyme produces kynurenines which interact with the NMDA receptor, a neurotransmitter receptor implicated in depression and various other psychiatric diseases (in case your first question upon learning about this pathway is the same as mine: yes, kynurenines got their name because they were first found in dog urine).

– Sometimes doctors treat diseases like hepatitis by injecting artificial cytokines to make the immune system realize the threat and ramp up into action. Cytokine administration treatments very commonly cause depression as a side effect. This depression can be treated with standard antidepressants.

– Also, it turns out we can just check and people with depression have more cytokines.

There’s also some evidence against the theory. People with depression have more cytokines, but it’s one of those wishy-washy “Well, if you get a large enough sample size, you’ll see a trend” style relationships, rather than “this one weird trick lets you infallibly produce depression”.

[…]

So in conclusion, I think the inflammatory hypothesis of depression is very likely part of the picture. Whether it’s the main part of the picture or just somewhere in the background remains to be seen, but for now it looks encouraging. Anti-inflammatory drugs do seem to treat depression, which is a point in the theory’s favor, but right now the only one that has strong evidence behind it has side effects that make it undesirable for most people. There’s a lot of room to hope that in the future researchers will learn more about exactly how this cytokine thing works and be able to design antidepressant drugs that target the appropriate cytokines directly. Until then, your best bets are the anti-inflammatory mainstays: good diet, good sleep, plenty of exercise, low stress levels, and all the other things we already know work.

January 25, 2015

Prescribing modern drugs for Richard III

Filed under: Britain,Health,History,Science — Tags: , , , — Nicholas @ 02:00

In Richard Lehman’s BMJ journal review, there was an amusing bit of interest to Ricardians:

King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination when it appeared online last September. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:

I, that am curtail’d of this faire Proportion,
Cheated of Feature by dissembling Nature,
Deform’d, unfinish’d, sent before my time
Into this breathing World, scarse halfe made up,
And that so lamely and unfashionable,
That dogges bark at me, as I halt by them.

(from The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Boʃworth Field by Wm Shakespeare c.1592, First Folio text 1623)

With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:

simvastatin 40mg to add 2 days to life and cause muscle aches
tramadol 50mg to fail to ease pain & cause dependency, falls, confusion
naproxen 500mg to cause GI bleeds and fluid retention
furosemide 20mg to reduce fluid retention due to naproxen
omeprazole 20mg to prevent GI bleeds, encourage C diff
senna 7.5mg to counter tramadol constipation
citalopram 20mg to cause serotonin syndrome with tramadol
trazodone 50mg for agitation due to serotonin, to worsen it & cause falls
gababentin MR 800mg to see if it will help pain
paracetamol 500mg because it hasn’t helped the pain
tamsulosin 400mcg for nocturia due to age and furosemide
lisinopril 5mg for “grade 2 CKD” due to furosemide & naproxen
Seretide inhaler for low FEV1 due to scoliosis
etc.

My kingdom for a bit of horse-sense.

December 6, 2014

Fran Tarkenton on the NFL’s long-standing drug problems

Filed under: Football,Health,Law — Tags: , , , , — Nicholas @ 10:57

In an interview with Jenny Vrentas, former Viking great Fran Tarkenton discusses this year’s crop of rookie quarterbacks (including the Vikings’ Teddy Bridgewater), the NFL’s ongoing disciplinary issues with Ray Rice and Adrian Peterson, the long-term issues with NFL doctors dispensing painkillers, and the advent of performance-enhancing drugs. On the issue of league discipline, he believes the league should not allow Rice or Peterson to play again:

VRENTAS: Are you saying the Vikings should move on from Peterson because of his age, or because of the child abuse case that led to his suspension?

TARKENTON: I followed the Clippers thing. That owner [Donald Sterling] didn’t get indicted for any crime, but the racial comments he made were totally inappropriate, and we took a stand. The whole world and the NBA, we have zero tolerance to racism. And I think that’s right. I agree with that. But I also think we ought to have zero tolerance to child abuse and domestic violence. I don’t think [Peterson] should play again in the NFL. I don’t think Ray Rice should play again. Either we have zero tolerance, or we don’t. And what is more egregious than domestic violence and child abuse? I don’t know of anything, unless you kill somebody.

VRENTAS: Peterson has not played since the child-abuse charges first surfaced in September, and now he’s been suspended for the rest of the season, pending appeal. Do you think the response shows that teams and the league are starting to take these issues more seriously?

TARKENTON: Kind of. They have been a little bit wishy-washy. [The Vikings] were going to play Adrian Peterson [before reversing course in September]. Other teams were going to play other players [involved in cases of domestic violence]. And the NFL was going to give just a two-game suspension to Ray Rice. I don’t think we’ve gotten beyond “win at any cost” yet. And I think we need to get there. We should have zero tolerance to racism. We don’t believe that, right? Is that more important than zero tolerance to domestic abuse and child abuse? Unless we as a society think that way, then we won’t make progress. And the whole domestic violence thing, that has been tolerated universally, but certainly in the NFL. We can’t tolerate that. All these behaviors that are so egregious continue. We need to set an example.

And on the topic of team doctors and the use of drugs to get players back into games (but which had potentially serious long-term health implicatons:

VRENTAS: You wrote a letter to the New York Times regarding painkiller abuse, in response to the DEA’s recent spot checks of NFL team medical staffs. This has been a subject you have been vocal about. What was your experience with painkiller use during your playing career?

TARKENTON: This has been going on forever. I was playing for the New York Giants, and I hurt my shoulder in a game against the Pittsburgh Steelers. I came in at halftime, and the doctor had a great big long needle, punched a few different places, and told me, “Show me where it hurts the worst.” I said, “Ow,” and he jammed a combination of xylocaine and cortisone into my shoulder. That’s not good for my shoulder, but he’s my team doctor. I don’t think he’s going to do something that hurts my career, right? He’s like my family doctor. If my family doctor tells me to take a pill, I’ll take a pill. So every Friday, I went on the subway from old Yankee Stadium, where we practiced, all the way down to lower Manhattan to St. Vincent’s Hospital, and they did the same thing they did at halftime. They shot my shoulder. It didn’t really help me, but it allowed me to play. Now, when I come back to Minnesota, my shoulder is worse. The year we played the Pittsburgh Steelers in the Super Bowl in New Orleans, my shoulder was already deteriorating, and I hurt it early in the season in Dallas. The rest of the year I could not throw a ball in practice; I could not throw a ball in warm-ups over 10 yards. When I got in the game, I could throw it maybe 40 yards, because my adrenaline was up, but there was nothing on it. But every Friday, guess what they shot me with? Butazolidin. That’s what they shot horses with. Shot me up every Friday, all the way to the Super Bowl. I retired at age 39, and I see my doctors down here [in Atlanta] because my shoulder is killing me. They say, “You’ve got the shoulder of a 75-year old man. You need your shoulder replaced.” I talked to a lot of the old guys — Roger Staubach, Otto Graham, Sammy Baugh, Johnny Unitas, Y.A. Tittle ­— and none of them had shoulders replaced. I had my shoulder replaced, because they shot me up. Where was the conscience back then? People say, “You knew what they were doing.” I knew what they were doing, but I didn’t think they would hurt me. I didn’t think my shoulder was going to fall apart.

November 14, 2014

QotD: The difference between medicine and recreational drugs

Filed under: Health,Quotations — Tags: , , , — Nicholas @ 00:01

I do occasional work for my hospital’s Addiction Medicine service, and a lot of our conversations go the same way.

My attending tells a patient trying to quit that she must take a certain pill that will decrease her drug cravings. He says it is mostly covered by insurance, but that there will be a copay of about one hundred dollars a week.

The patient freaks out. “A hundred dollars a week? There’s no way I can get that much money!”

My attending asks the patient how much she spends on heroin.

The patient gives a number like thirty or forty dollars a day, every day.

My attending notes that this comes out to $210 to $280 dollars a week, and suggests that she quit heroin, take the anti-addiction pill, and make a “profit” of $110.

At this point the patient always shoots my attending an incredibly dirty look. Like he’s cheating somehow. Just because she has $210 a week to spend on heroin doesn’t mean that after getting rid of that she’d have $210 to spend on medication. Sure, these fancy doctors think they’re so smart, what with their “mathematics” and their “subtracting numbers from other numbers”, but they’re not going to fool her.

At this point I accept this as a fact of life. Whatever my patients do to get money for drugs — and I don’t want to know — it’s not something they can do to get money to pay for medication, or rehab programs, or whatever else. I don’t even think it’s consciously about them caring less about medication than about drugs, I think that they would be literally unable to summon the motivation necessary to get that kind of cash if it were for anything less desperate than feeding an addiction.

Scott Alexander, “Apologia Pro Vita Sua”, Slate Star Codex, 2014-05-25.

September 27, 2014

QotD: Laziness, and its cure

Filed under: Humour,Quotations — Tags: , , , — Nicholas @ 00:01

In the present instance, going back to the liver-pill circular, I had the symptoms, beyond all mistake, the chief among them being “a general disinclination to work of any kind.”

What I suffer in that way no tongue can tell. From my earliest infancy I have been a martyr to it. As a boy, the disease hardly ever left me for a day. They did not know, then, that it was my liver. Medical science was in a far less advanced state than now, and they used to put it down to laziness.

“Why, you skulking little devil, you,” they would say, “get up and do something for your living, can’t you?” — not knowing, of course, that I was ill.

And they didn’t give me pills; they gave me clumps on the side of the head. And, strange as it may appear, those clumps on the head often cured me — for the time being. I have known one clump on the head have more effect upon my liver, and make me feel more anxious to go straight away then and there, and do what was wanted to be done, without further loss of time, than a whole box of pills does now.

You know, it often is so — those simple, old-fashioned remedies are sometimes more efficacious than all the dispensary stuff.

Jerome K. Jerome, Three Men in a Boat (to say nothing of the dog), 1889.

August 24, 2014

QotD: Hypochondria

Filed under: Health,Humour,Quotations — Tags: , , , — Nicholas @ 00:01

It is a most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form. The diagnosis seems in every case to correspond exactly with all the sensations that I have ever felt.

I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch — hay fever, I fancy it was. I got down the book, and read all I came to read; and then, in an unthinking moment, I idly turned the leaves, and began to indolently study diseases, generally. I forget which was the first distemper I plunged into — some fearful, devastating scourge, I know — and, before I had glanced half down the list of “premonitory symptoms,” it was borne in upon me that I had fairly got it.

I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again turned over the pages. I came to typhoid fever — read the symptoms — discovered that I had typhoid fever, must have had it for months without knowing it — wondered what else I had got; turned up St. Vitus’s Dance — found, as I expected, that I had that too, — began to get interested in my case, and determined to sift it to the bottom, and so started alphabetically — read up ague, and learnt that I was sickening for it, and that the acute stage would commence in about another fortnight. Bright’s disease, I was relieved to find, I had only in a modified form, and, so far as that was concerned, I might live for years. Cholera I had, with severe complications; and diphtheria I seemed to have been born with. I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee.

I felt rather hurt about this at first; it seemed somehow to be a sort of slight. Why hadn’t I got housemaid’s knee? Why this invidious reservation? After a while, however, less grasping feelings prevailed. I reflected that I had every other known malady in the pharmacology, and I grew less selfish, and determined to do without housemaid’s knee. Gout, in its most malignant stage, it would appear, had seized me without my being aware of it; and zymosis I had evidently been suffering with from boyhood. There were no more diseases after zymosis, so I concluded there was nothing else the matter with me.

I sat and pondered. I thought what an interesting case I must be from a medical point of view, what an acquisition I should be to a class! Students would have no need to “walk the hospitals,” if they had me. I was a hospital in myself. All they need do would be to walk round me, and, after that, take their diploma.

Then I wondered how long I had to live. I tried to examine myself. I felt my pulse. I could not at first feel any pulse at all. Then, all of a sudden, it seemed to start off. I pulled out my watch and timed it. I made it a hundred and forty-seven to the minute. I tried to feel my heart. I could not feel my heart. It had stopped beating. I have since been induced to come to the opinion that it must have been there all the time, and must have been beating, but I cannot account for it. I patted myself all over my front, from what I call my waist up to my head, and I went a bit round each side, and a little way up the back. But I could not feel or hear anything. I tried to look at my tongue. I stuck it out as far as ever it would go, and I shut one eye, and tried to examine it with the other. I could only see the tip, and the only thing that I could gain from that was to feel more certain than before that I had scarlet fever.

I had walked into that reading-room a happy, healthy man. I crawled out a decrepit wreck.

Jerome K. Jerome, Three Men in a Boat (to say nothing of the dog), 1889.

July 19, 2014

UPS capitulates, but FedEx will fight

Filed under: Business,Law,USA — Tags: , — Nicholas @ 10:21

Scott Greenfield on an interesting attempt by the US government to get private delivery firms to act as an unpaid arm of law enforcement:

    In the future, everyone will be a cop for 15 minutes.
    – Apologies to Andy Warhol

And if you don’t fulfill your duty, the government will indict you. United Parcel Service decided it was a better business move to pay off the government, at a price tag of $40 million. Federal Express refused. The government has now indicted FedEx for its refusal to capitulate.

[…]

The indictment relates to internet “pharmacies,” that ship drugs to people who may have no prescription and without having been treated by a physician. Not all internet pharmacies are evil, and not all prescriptions filled are wrongful, but the government nonetheless demands that delivery companies be not only its eyes and ears, but its arms and legs, in this battle of its war against crime. If only corporate America would faithfully serve its master, it would make law enforcement’s job so much easier.

The indictment is the typical slinging together of vague back-end anecdotes which, when the salient details are studiously omitted, create the disturbing appearance of complicity, if not exactly wrong-doing. After all, shouldn’t a delivery company know that it’s being used by criminals? Because it’s their responsibility to spy on packages, or see into the hearts of recipients, or know each back office deal of their customers?

Ironically, it’s not that FedEx wants to deliver contraband, but that the government refused to cooperate.

H/T to Amy Alkon for the link.

May 14, 2014

Another area for freedom of choice – the “right to try”

Filed under: Bureaucracy,Health,Science,USA — Tags: , , , — Nicholas @ 11:32

Amity Shlaes talks about a movement to allow more freedom of choice, but in an unusual and tightly regulated sector:

For decades now the Food and Drug Administration has maintained an onerous and slow approval process that delays the debut of new drugs for fatal diseases, sometimes for years longer than the life span of the patients desperate to try them. Attorneys and scholars at the Goldwater Institute of Arizona have crafted legislation for the states that would allow terminally ill patients to try experimental drugs for cancer or degenerative neurological diseases earlier. These “Right to Try” bills are so scripted that they overcome the usual objection to delivery of such experimental drugs: safety. Under “Right to Try,” only drugs that have passed the crucial Phase 1 of FDA testing could be prescribed, thereby reducing the possibility of Thalidomide repeat. Second, only patients determined to have terminal cases would be eligible to purchase the drugs, making it harder to maintain that the drug will jeopardize their lives.

Representatives in Colorado, Louisiana, and Missouri approved the “Right to Try” measure unanimously. Citizens of Arizona will vote on the effort to circumvent the FDA process this fall.

Why the popularity? The phrase “Right to Try” appeals especially in a nation that senses all too well the reductions in freedom that come as the Affordable Care Act is implemented. The recent success of The Dallas Buyers’ Club, a film about a man who procured experimental drugs for AIDS patients, also fuels the “Right to Try” impulse. Some of the popularity comes from our culture of choice. In Colorado, where citizens have choice about abortion, and now the choice to use marijuana, they may also get what seems an elemental choice, that to try to save their own lives.

But of course “Right to Try” also sails because of the frustration of tragedy. Years ago a man named Frank Burroughs founded the Abigail Alliance after conventional options failed to cure his 21-year-old daughter’s cancer. Abigail’s oncologist tried to get Abigail newer drugs, Erbitux or Iressa from AstraZeneca, the company with which Pfizer hopes to merge. But the drugs were not available in time to save the girl. The Abigail Alliance is attempting on the federal level what Goldwater is trying for states: The federal bill’s name is the Compassionate Care Act. “Those waiting for FDA decisions, mainly dying patients and those who care for them, view the agency as a barrier,” co-founder Steve Walker explained simply. And who can disagree? Many of the supporters of “Right to Try” or the Abigail Alliance are businesspeople or scientists who are motivated to honor ones they have lost to illness; others are racing to save sick family who are still living. Yet others labor for patients in particular or science in general.

May 7, 2014

“I’ve been an oncologist for 20 years, and I have never, ever seen anything like this.”

Filed under: Business,Health,Science — Tags: , , , — Nicholas @ 15:30

In Forbes, Matthew Herper looks at how Novartis is transforming itself in an attempt to conquer cancer:

“I’ve been an oncologist for 20 years,” says Grupp, “and I have never, ever seen anything like this.” Emily has become the poster child for a radical new treatment that Novartis, the third-biggest drug company on the Forbes Global 2000, is making one of the top priorities in its $9.9 billion research and development budget.

“I’ve told the team that resources are not an issue. Speed is the issue,” says Novartis Chief Executive Joseph Jimenez, 54. “I want to hear what it takes to run this phase III trial and to get this to market. You’re talking about patients who are about to die. The pain of having to turn patients away is such that we are going as fast as we can and not letting resources get in the way.”

A successful trial would prove a milestone in the fight against the demon that has plagued living things since dinosaurs roamed the Earth. Coupled with the exploding capabilities of DNA-sequencing machines that can unlock the genetic code, recent drugs have delivered stunning results in lung cancer, melanoma and other deadly tumors, sometimes making them disappear entirely – albeit temporarily. Just last year the Food & Drug Administration approved nine targeted cancer drugs. It’s big business, too. According to data provider IMS Health, spending on oncology drugs was $91 billion last year, triple what it was in 2003.

But the developments at Penn point, tantalizingly, to something more, something that would rank among the great milestones in the history of mankind: a true cure. Of 25 children and 5 adults with Emily’s disease, ALL, 27 had a complete remission, in which cancer becomes undetectable. “It’s a stunning breakthrough,” says Sally Church, of drug development advisor Icarus Consultants. Says Crystal Mackall, who is developing similar treatments at the National Cancer Institute: “It really is a revolution. This is going to open the door for all sorts of cell-based and gene therapy for all kinds of disease because it’s going to demonstrate that it’s economically viable.”

H/T to Megan McArdle for the link.

November 29, 2013

We’re from the FDA, we’re here to help you

Filed under: Bureaucracy,Government,Health,Science — Tags: , , , — Nicholas @ 09:19

Nick Gillespie on the mindnumbingly awful exercise of FDA regulatory power in shutting down personal DNA testing company 23andMe:

Personal genetic tests are safe, innovative, and the future of medicine. So why is the most transparent administration ever shutting down a cheap and popular service? Because it can.

In its infinite wisdom, the Food and Drug Administration (FDA) has forbidden the personal genetic testing service 23andMe from soliciting new customers, claiming the company hasn’t proven the validity of its product.

The real reason? Because when it comes to learning about your own goddamn genes, the FDA doesn’t think you can handle the truth. That means the FDA is now officially worse than Oedipus’s parents, Dr. Zaius, and the god of Genesis combined, telling us that there are things that us mere mortals just shouldn’t be allowed to know.

23andMe allows you to get rudimentary information about your genetic makeup, including where your ancestors came from and DNA markers for over 240 different hereditary diseases and conditions (not all of them bad, by the way). Think of it as the H&M version of the haute couture genetic mark-up that Angelina Jolie had done prior to having the proactive mastectomy that she revealed this year.

[…]

Peter Huber of the Manhattan Institute, a conservative think tank, has an important new book out called The Cure in the Code: How 20th Century Law is Undermining 21st Century Medicine. Huber writes that whatever sense current drug-approval procedures once might have had, their day is done. Not only does the incredible amount of time and money — 12 years and $350 million at a minimum — slow down innovation, it’s based on the clearly wrong idea that all humans are the same and will respond the same way to the same drugs.

Given what we already know about small but hugely important variations in individual body chemistry, the FDA’s whole mental map needs to be redrawn. “The search for one-dimensional, very simple correlations — one drug, one clinical effect in all patients — is horrendously obsolete,” Huber told me in a recent interview. And the FDA’s latest action needs to be understood in that context — it’s just one more way in which a government which now not only says we must buy insurance but plans whose contours are dictated by bureaucrats who arbitrarily decide what is best for all of us.

November 24, 2013

A life reconstructed

Filed under: Health,Science — Tags: , , , — Nicholas @ 12:28

In the New York Times, Mary Lou Jepson talks about the near-total loss and recovery of her life:

In my early 30s, for a few months, I altered my body chemistry and hormones so that I was closer to a man in his early 20s. I was blown away by how dramatically my thoughts changed. I was angry almost all the time, thought about sex constantly, and assumed I was the smartest person in the entire world. Over the years I had met guys rather like this.

I was not experimenting with hormone levels out of idle curiosity or in some kind of quirky science experiment. I was on hormone treatments because I’d had a tumor removed along with part of my pituitary gland, which makes key hormones the body needs to function.

[…]

In my experience it can be difficult to find a doctor to help a patient do this. I believe it is only partly because of the shortage of endocrinologists, doctors who specialize in the hormonal systems. Some doctors seemed not to believe that every hormone mattered. How many other patients like me have failed to find their ideal balance of medications?

There is evidence that careful tuning of these hormones can lead to dramatic personal and professional outcomes. Doctors and patients should consider replacement of every known hormone that is missing. New neurochemicals are identified by researchers every few years and should be studied as possible additions to the mix.

And access to these medications should not be hindered. As it stands today, some of the hormones I need daily to stay alive and to thrive can be, and frequently have been, blocked at the whim or neglect of a doctor’s office, insurance company or pharmacy. And still, 18 years after my surgery and despite great advances in endocrinal science, I need to fight to get them.

Disputes between organizations on whether prescriptions, test results or proper forms were transmitted or not. Communication breakdowns. A Kafka-esque nightmare of constantly needing another approval. It can take weeks to be notified of a rejection.

H/T to Tim O’Reilly for the link:

August 8, 2013

Medical marijuana – “We have been terribly and systematically misled for nearly 70 years”

Filed under: Health,Media — Tags: , , , — Nicholas @ 10:29

ThinkProgress reports that CNN’s Dr. Sanjay Gupta has changed his position on the medical use of marijuana:

CNN’s Chief Medical Correspondent Dr. Sanjay Gupta reversed his position on marijuana’s health benefits and apologized for his previous stand against it in an article Thursday for CNN. In 2009, Gupta penned an op-ed advocating against marijuana, where he advised as a doctor that “marijuana isn’t really very good for you.” At the time, he was in the running for an appointment to Surgeon General.

Since then, additional research and his work on a documentary have convinced him otherwise.

“I apologize because I didn’t look hard enough, until now,” he said. “I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.”

[…]

“We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.”

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