Posts about drugs

USA Health Care Crisis: Opioid Abuse

In 2014 about 34,000 deaths in the USA died in car crashes and about the same number of deaths resulted from gun violence, but more than 47,000 people died from drug overdoses.

Opioid abuse has greatly increased these deaths in the last decade. Chronic pain is a real problem we need to manage. But the current practices are leading to troubling results as are our methods for dealing with drug abuse (including illegal drugs such as heroin). Abusing prescription drugs such as addictive opioids and illegal drugs such as heroin are both leading to an increasing number of deaths in the last decade.

Worldwide somewhere between 26 and 34 million people are abusing opioids. More than 2 million of them are Americans abusing prescription opioids.

Heroin is an example of a non-prescription opioid.

Admissions for the treatment of abuses of prescription opioids constituted about 1% of [USA emergency room] admissions in 1997, and they made up 5% of admissions a decade later.

Related: President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic200,000 People Die Every Year in Europe from Adverse Drug Effects – How Can We Improve?The War on Drugs has been a Huge Failure with Massive Unintended Consequences (we need to use health care strategies to manage the problem not war strategies)Over-reliance on Prescription Drugs to Aid Children’s Sleep? (2007)

Using Diatom Algae to Deliver Chemotherapy Drugs Directly to Cancer Cells

I am thankful for scientists doing the time consuming and important research to find new ways to fight disease. Here is an interesting webcast discussing how chemotherapy is used to fight cancer and how scientists are looking to algae to deliver the chemotherapy drugs to better target cancer cells (while not savaging our health cells).

I am also thankful to the funding sources that pay for this research (and for cool explanations of science, like SciShow).

Read more about the genetically engineered algae kills 90% of cancer cells without harming healthy ones. The algae are a diatom and many diatoms look very cool.

Sadly the actual research paper (by government funded university professors) is published by a closed science publisher (when are we finally going to stop this practice that was outdated over a decade ago?). Thankfully those responsible for SciShow are much more interested in promoting science than maintaining outdated business models (in direct contrast to so many science journal publishers).

Related post on cool delivery methods for life saving drugs: Using Bacteria to Carry Nanoparticles Into CellsSelf-Assembling Cubes Could Deliver Medicine (2006)Nanoparticles With Scorpion Venom Slow Cancer SpreadNASA Biocapsules Deliver Medical Interventions Based Upon What They Detect in the Body

200,000 People Die Every Year in Europe from Adverse Drug Effects – How Can We Improve?

A new integrated computational method helps predicting adverse drug reaction more reliably than with traditional computing methods. This improved ability to foresee the possible adverse effects of drugs may entail saving many lives in the future.

Most computer tools employed today to detect possible adverse effects of compounds that are candidates for new medicines are based on detecting labile fragments in the drug’s structure. These fragments can potentially transform to form reactive metabolites, which can have toxic properties. This is what is known as idiosyncratic toxicity and is a big headache for the pharmaceutical industry, as it tends to be detected in late development stages of the drug and even when it is already on the market, often causing the drug to be withdrawn.

Jordi Mestres, coordinator of the IMIM and UPF research group on Systems Pharmacology at the Biomedical Informatics Program (GRIB) states ‘With this study we have contributed to complementing the detection of these quite unstable fragments, with information on the mechanism of action of the drug, based on three aspects: similarity to other medicines, prediction of their pharmacological profile, and interference with specific biological pathways. The optimal integration of these four aspects results in a clear improvement of our ability to anticipate adverse effects with higher confidence, which entails an extremely positive impact on society’.

In Europe, nearly 200,000 people die every year from adverse drug reactions, seven times more than in traffic accidents. An estimated 5% of hospitalisations are due to adverse effects and they are the fifth most common cause of hospital death. In addition, elderly people tend to take more than one drug at the same time, which multiplies the chances of suffering from adverse effects due to potential drug-drug interactions. In an increasingly aging society, this problem is becoming much more serious.

I think interactions is a hugely important area that needs a great deal more research. Doing so is very complex, which means it isn’t surprising so much more work is needed. The work of my father (and George Box and others) on multi-factorial experimentation is a powerful tool to aid this work (and that connection is likely one of the reasons I find the area of interactions so interesting – along with the realization there is so much benefit possible if we focus in that area more). Previous post on this Curious Cat Science and Engineering blog: Introduction to Fractional Factorial Designed Experiments.

The human and financial costs of adverse effects are very high. That is why the discovery of new medicines is increasingly focused more on predicting possible adverse effects at the initial stages of developing a new drug. This work hopes to contribute to setting the path toward a new generation of more reliable computational tools with regard to predicting the adverse effects of therapeutically-relevant small molecules. Advancing large-scale predictive safety at the pre-clinical phase is now becoming closer than ever, with expectations to lead to safer drugs for the entire population.

The research is published in closed science journal so I don’t link to it. I happily link to open science publications. Read the full press release which includes a link to the closed science journal.

Related: Lifestyle Drugs and RiskRoot Cause, Interactions, Robustness and Design of ExperimentsOne factor at a time (OFAT) Versus Factorial DesignsThe Purpose of Mulit-Factorial Designed Experiments11 Year Old Using Design of ExperimentsOver-reliance on Prescription Drugs to Aid Children’s Sleep?

Teixobactin – New Antibiotic Attacks Ability of Bacteria to Build Cell Walls

New class of antibiotic could turn the tables in battle against superbugs

The antibiotic, called teixobactin, kills a wide range of drug-resistant bacteria, including MRSA and bugs that cause TB and a host of other life-threatening infections.

It could become a powerful weapon in the battle against antimicrobial resistance, because it kills microbes by blocking their capacity to build their cell walls, making it extremely difficult for bacteria to evolve resistance.

It would be great if the exciting results carried through to real world results similar to the hope. Medical research is full of promising initial results that fail to deliver, however. We are at great risk if some new miracle anti-biotic isn’t found. Many people are investigating potential solutions.

Most antibiotics are isolated from bacteria or fungi that churn out lethal compounds to keep other microbes at bay. But scientists have checked only a tiny fraction of bugs for their ability to produce potential antibiotics because 99% cannot be grown in laboratories.

Lewis’s group found a way around the problem by developing a device called an iChip that cultures bacteria in their natural habitat. The device sandwiches the bugs between two permeable sheets. It is then pushed back into the ground where the microbes grow into colonies.

Working with a Massachusetts-based company, NovoBiotic, and researchers at the University of Bonn, [Kim] Lewis’s group screened 10,000 soil bacteria for antibiotics and discovered 25 new compounds. Of these, teixobactin was the most promising.

Though promising, Lewis said that years more work lie ahead before the drug could be available. Human clinical trials could begin within two years to check its safety and efficacy, but more development would follow that.

It is wonderful to read about the great work so many scientists are making in researching potential life saving drugs. Hopefully this antibiotic will save us from what will be catastrophic harm if some new antibiotic is not available soon.

Related: Search for Antibiotic Solutions Continues: Killing Sleeper Bacteria Cells (2013)New Family of Antibacterial Agents Discovered (2009)Potential Antibiotic Alternative to Treat Infection Without Resistance (2012)

Drugmakers Are Desperate to Know Why Placebos Are Getting More Effective

Fascinating article from Wired: Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today’s economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Potter discovered, however, that geographic location alone could determine whether a drug bested placebo or crossed the futility boundary. By the late ’90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail. Conversely, Prozac performed better in America than it did in western Europe and South Africa. It was an unsettling prospect: FDA approval could hinge on where the company chose to conduct a trial.

In one study, Benedetti found that Alzheimer’s patients with impaired cognitive function get less pain relief from analgesic drugs than normal volunteers do. Using advanced methods of EEG analysis, he discovered that the connections between the patients’ prefrontal lobes and their opioid systems had been damaged. Healthy volunteers feel the benefit of medication plus a placebo boost. Patients who are unable to formulate ideas about the future because of cortical deficits, however, feel only the effect of the drug itself. The experiment suggests that because Alzheimer’s patients don’t get the benefits of anticipating the treatment, they require higher doses of painkillers to experience normal levels of relief.

Benedetti often uses the phrase “placebo response” instead of placebo effect. By definition, inert pills have no effect, but under the right conditions they can act as a catalyst for what he calls the body’s “endogenous health care system.” Like any other internal network, the placebo response has limits. It can ease the discomfort of chemotherapy, but it won’t stop the growth of tumors. It also works in reverse to produce the placebo’s evil twin, the nocebo effect. For example, men taking a commonly prescribed prostate drug who were informed that the medication may cause sexual dysfunction were twice as likely to become impotent.

Moreover, a pill’s shape, size, branding, and price all influence its effects on the body. Soothing blue capsules make more effective tranquilizers than angry red ones, except among Italian men, for whom the color blue is associated with their national soccer team—Forza Azzurri!

Medical research presents significant difficulties. The funding of the health care system also distorts behavior and pushes companies to focus on being able to justify selling drugs instead of focusing on finding effective solutions. Even without incentives distorting behavior, the challenges are difficult enough. Adding the distortions just makes it worse.

It is wonderful we have so many scientists accepting these challenges and spending their careers fighting the odds to help find us wonderful health breakthroughs.

Related: The Majority of Clinical Trials Don’t Provide Meaningful EvidenceSystem for Approving New Medical Options Needs ImprovementMedical Study Integrity (or Lack Thereof)Discussing Medical Study Results

CDC Again Stresses Urgent Need to Adjust Practices or Pay a Steep Price

Untreatable and hard-to-treat infections from Carbapenem-resistant Enterobacteriaceae (CRE) germs are on the rise among patients in medical facilities. CRE germs have become resistant to all or nearly all the antibiotics we have today. Types of CRE include Klebsiella pneumoniae Carbapenemase (KPC) and New Delhi metallo-beta-lactamase (NDM). By following the United States Center for Disease Control (CDC) guidelines, we can slow the penetration of CRE infections in hospitals and other medical facilities and potentially spread to otherwise healthy people outside of medical facilities.

The CDC has worked with hospitals to successfully apply these measures. The CDC worked with Florida to stop a year-long CRE outbreak in a long-term acute care hospital. With the improved use of CDC recommendations (such as educating staff; dedicating staff, rooms, and equipment to patients with CRE; and improving use of gloves and gowns) the percentage of patients who got CRE at the facility dropped from 44% to 0.

One travesty has been how poorly health care professionals have been about prescribe antibiotics wisely We need to improve and follow CDC antibiotics guidelines (stop the overuse of antibiotics) and use culture results (for patients undergoing treatment) to modify prescriptions, if needed. Antibiotic overuse contributes to the growing problems of Clostridium difficile (c-diff) infection and antibiotic resistance in healthcare facilities. Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate (per CDC web site).

Israel decreased CRE infection rates in all 27 of its hospitals by more than 70% in one year with a coordinated prevention program. The USA is at a critical time in which CRE infections could be controlled if addressed in a rapid, coordinated, and consistent effort by doctors, nurses, lab staff, medical facility leadership, health departments/states, policy makers, and the federal government.

As I have been saying for years the damage we are creating due to our actions around the use and abuse of antibiotics is likely to kill tens of thousands, or more people. Because the deaths are delayed and often not dramatic we have continued dangerous practices for years when we know better. It is a shame we are condemning so many to increased risks. The CDC, and others, are doing good work, unfortunately too much bad work is continuing in the face of evidence of how dangerous that is.

Related: CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006)Key scientific articles on Healthcare Associated Infections via CDCOur Dangerous Antibiotic Practices Carry Great RisksDangerous Drug-Resistant Strains of TB are a Growing Threat

How Caffeine Affects Your Body

From the video by Alex Dainis: Caffeine prevents adenosine from slowing down your nervous system, by binding to the same receptors adenosine would. Caffeine also stimulates the production of adrenaline. And it increases the amount of dopamine present. The average half life of caffeine in the human body is about 6 hours.

Related: Does Diet Soda Result in Weight Gain?Mental Pick-Me-Ups: The Coming BoomRitalin Doesn’t Show Long Term Effectiveness for ADHD

I have been curious about the caffeine content of various drinks and writing this post is a good enough reason to actually look it up.

  • expresso (2oz) 100 mg (varies – 60 mg to 180 mg)
  • coffee (8oz) 100 mg – this can vary quite a bit, 50 to over 100 mg is common. Brewed coffee has more caffeine 100-200 mg.
  • Red Bull (8.2 oz) 80 mg
  • tea (8oz) 20 to 80 mg (depending on strength and type, can also be higher, green tea is on the lower end)
  • Mountain Dew (12 oz) 54 mg (diet has 54 mg also)
  • Diet Coke 46 mg (regular Coke 34mg)
  • Pepsi 38 mg, Diet Pepsi 36 mg

Sprite, 7Up and some root beers have no caffeine.
Chocolate can also be a significant source of caffeine – dark chocolate can have over 80 mg per 100 g (approximately 4 ounces).

Man in Coma for 7 Years was Given a Sleeping Pill and Woke Up

Lazarus pill miracle for E Cape man, 9 September 2012

After reading a report in City Press last month, his wife, Nomfundo, insisted that he be given a prescription for the sleeping pill Stilnox, which has the opposite effect on those with brain injuries.

It worked – and brought him out of a seven-year coma.

But on August 12, family friend Nceba Mokoena came across an article in City Press about a miracle recovery made by another car crash victim, hundreds of kilometres away in Gauteng.

Louis Viljoen was given the sleeping pill by chance by his mother, Sienie.

She had noticed he wasn’t sleeping peacefully and asked her doctor if she could give him half a sleeping tablet. After she did, Louis opened his eyes and said “Hello Mamma”, his first words in five years.

Very cool anecdote and example that modern medicine has many miraculous cures but the medical system can’t always use them as well as we would hope. Even with all the knowledge we have today just getting that information into the right doctor’s minds is very hard. And the complexity of diagnoses and interactions makes medical care still an art as well as a science.

So is this just some freak accident. Partially, in the mother giving her son a sleeping pill to reduce his seeming restlessness in the coma. But the effect of Stilnox in bringing coma victims out of a coma has been documented previously.

Reborn from persistent vegetative state, 12 September 2006

Four three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die.

Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.

Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it’s as if a light comes on. His father asks him if he is, indeed, in pain. “No,” George smiles, and his family burst into tears.

It all sounds miraculous, you might think. And in a way, it is. But this is not a miracle medication, the result of groundbreaking neurological research. Instead, these awakenings have come as the result of an accidental discovery by a dedicated – and bewildered – GP. They have all woken up, paradoxically, after being given a commonly used sleeping pill.

Medical care is still today an extremely difficult area where highly trained and continuously learning doctors still have a great deal of trouble keeping up with the latest medical knowledge.

Related: Hospital Reform, IHI’s efforts to get good practices adoptedNorway Reduces Infections by Reducing Antibiotic UseMajority of Clinical Trials Don’t Provide Meaningful EvidenceContinual LearningPhysical Activity for Adults: Inactivity Leads to 5.3 Million Early Deaths a Year

Dangerous Drug-Resistant Strains of TB are a Growing Threat

Drug-resistant strains of TB are out of control

The fight against new, antibiotic-resistant strains of tuberculosis has already been lost in some parts of the world, according to a senior World Health Organisation expert.

Dr Paul Nunn, head of the WHO’s global TB response team, is leading the efforts against multi-drug resistant TB (MDR-TB). Nunn said that, while TB is preventable and curable, a combination of bad management and misdiagnosis was leaving pharmaceutical companies struggling to keep up. Meanwhile, the disease kills millions every year.

“It occurs basically when the health system screws up,” said Nunn. “Treating TB requires a carefully followed regime of medication over six months. In places where health services are fragmented or underfunded, or patients poor and health professionals ill-trained, that treatment can fall short, which can in turn lead to patients developing drug-resistant strains. It’s been estimated that an undiagnosed TB-infected person can infect 10 others a year.

We tend to do a poor job of dealing with systemic effects of poorly functioning systems. Direct present threats get out attention. And we are decent at directing brain power and resources to find solutions. We are not very good at dealing with failures that put us in much worse shape in the long term. For small threats we can wait until it becomes a present threat and then deal with it. There are costs to doing this (economic and personal) but it can be done.

Some problems though become enormously complicated to deal with once they become obvious. Global climate change, for example. And often, even once they are obvious, we won’t act until the costs (economic and in human lives) are very large. It is possible that once we decide to get serious about dealing with some of these issues that the costs (economic and in human lives) will be catastrophic.

The failure to use anti-biotics medicine properly is a very serious threat to become one of these catastrophic societal failures. While tuberculosis failures may be larger in poorer countries, rich countries are failing probably much more critically in the misuse of anti-biotics (I would guess, without having much evidence at my fingertips to back up my opinion. I believe the evidence exists I am just not an expert). These failures have huge costs for all of humanity but we are risking many premature deaths because we systemically fail to deal with issues until the consequences are immediate.

Related: Extensively Drug-resistant Tuberculosis (XDR TB) (2007)What Happens If the Overuse of Antibiotics Leads to Them No Longer Working?Antibiotics Too Often Prescribed for Sinus WoesOveruse of Antibiotics (post from 2005)CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006)

Ritalin Doesn’t Show Long Term Effectiveness for ADHD

From the New York Times opinion piece, Ritalin Gone Wrong, by L. Alan Sroufe is a professor emeritus of psychology at the University of Minnesota’s Institute of Child Development:

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear… At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

As I have written before I am skeptical of the amount of drug use our health care system encourages: Lifestyle Drugs and Risk.

Related: Long Term ADHD Drug Benefits Questioned (2009)Nearly 1 million Children Potentially Misdiagnosed with ADHD in the USADiet May Help ADHD Kids More Than DrugsOver-reliance on Prescription Drugs to Aid Children’s Sleep?Epidemic of Diagnoses

Diet May Help ADHD Kids More Than Drugs

Diet May Help ADHD Kids More Than Drugs

Kids with ADHD can be restless and difficult to handle. Many of them are treated with drugs, but a new study says food may be the key. Published in The Lancet journal, the study suggests that with a very restrictive diet, kids with ADHD could experience a significant reduction in symptoms.

The study’s lead author, Dr. Lidy Pelsser of the ADHD Research Centre in the Netherlands, writes in The Lancet that the disorder is triggered in many cases by external factors — and those can be treated through changes to one’s environment. “ADHD, it’s just a couple of symptoms — it’s not a disease,” the Dutch researcher tells All Things Considered weekend host Guy Raz.

The way we think about — and treat — these behaviors is wrong, Pelsser says. “There is a paradigm shift needed. If a child is diagnosed ADHD, we should say, ‘OK, we have got those symptoms, now let’s start looking for a cause.’ ”

According to Pelsser, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food. Researchers determined that by starting kids on a very elaborate diet, then restricting it over a few weeks’ time. “It’s only five weeks,” Pelsser says. “If it is the diet, then we start to find out which foods are causing the problems.”

Teachers and doctors who worked with children in the study reported marked changes in behavior. “In fact, they were flabbergasted,” Pelsser says.

Related: Nearly 1 million Children Potentially Misdiagnosed with ADHD in the USALifestyle Drugs and RiskOver-reliance on Prescription Drugs to Aid Children’s Sleep?Epidemic of Diagnoses
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