From an article in the New York Times (NYT):
“It’s a critical time for two important but still controversial areas of psychiatry: the search for a blood test or other biological sign of post-traumatic stress disorder [PTSD], which has so far come up empty, and the use of recreational drugs like ecstasy and marijuana to treat it.”
A study supported by Pfizer had one of its centers at New York University (NYU), where 14 of the 50 subjects were recruited. The study’s lead investigator was Dr. Alexander Neumeister, who has resigned from his post following the confirmation of allegations that claimed irregularities in the study. The university insisted that no patients were harmed in the study, but Dr. Neumeister had clearly violated study protocols and some patients felt whipsawed. One complained that he had been forced to discontinue his regular medications several times in the course of repeated false starts of his study participation.
The basic facts of the case:
“Dr. Charles Marmar, the chairman of the psychiatry department at N.Y.U., said that people working with Dr. Neumeister had reported concerns about the lab’s compliance with research standards. Once some of those issues were confirmed, Dr. Marmar said, the university placed Dr. Neumeister on leave, “and suspended all activity, suspended access to all accounts. I took control of those studies.” Dr. Neumeister later submitted his resignation.”
The drugs used in these studies had similarities to marijuana; others resembled “ecstasy”, a synthetic recreational drug (“drug of abuse”). Some drugs are “fatty acid amine hydroxylase” (FAAH) inhibitors which are compounds that prevent the body from breaking down anandamide, the body’s internal version of the active ingredient in marijuana. Anandamide has effects in the body similar to those of marijuana, that is, delta-9 tetrahydrocannabinol (THC) and related compounds. It is believed that the body’s internal self-regulation is mediated by compounds like anandamide; THC mimics the effects of anandamide. The body responds to anandamide through the cannabinoid receptors.
Numerous experimental compounds have been developed that are inhibitors of FAAH, and some of these have gone through clinical trials. One of these trials in Europe was stopped after six patients developed severe side effects and one died. Other trials were suspended as a precautionary measure after this disastrous trial. Other compounds are still being actively investigated, but none has reached clinical use.
Ecstasy, on the other hand, is 3,4-methylenedioxymethamphetamine (MDMA), a member of the substituted amphetamine class of drugs. Its only use is “recreational”, and it is said to have empathic and euphorogenic properties as well as heightening sensations. It also increases body temperature, blood pressure, and heart rate, and may cause dehydration as a result. Levels of serotonin, dopamine, and norephinephrine in the brain are increased.
Studies have been and are being done with low doses of MDMA to treat post-traumatic stress disorder. After its first discovery in the 1970’s, a number of psychotherapists used it “off-label” for various disorders, particularly PTSD. MDMA rapidly became a popular “recreational” drug among young people at dance parties. MDMA was first placed on Schedule I (“no accepted medical use and…”) in 1984 and has been actively attacked by the FDA since then. A number of adverse reactions and a few deaths were reported from “raves” (spontaneous dance parties.)
The controversial nature of the drugs (cannabis-like or cocaine-like in effect) makes research on human subjects difficult and dangerous. The case of the NYU study is an object lesson in the dangers of protocol violations. Dr. Neumeister was reported to have conducted “lax oversight”, falsified records (including forging signatures of researchers), and kept inaccurate case histories. One patient that NYT interviewed complained that there was no followup after the study was completed and he was “on my own” afterwards. NYU was said to have shut down eight clinical studies at its psychiatric research center and accepted Dr. Neumeister’s resignation.
There is a confused area between “recreational” drug use and therapeutic use to alleviate symptoms of anxiety, depression, and anomie in patients with known psychiatric disorders. In many cases, psychiatric patients will self-medicate with drugs, both prescribed and illegally obtained, for distressing symptoms. Drug use may relieve symptoms temporarily yet cause exacerbation due to withdrawal or overuse. Use of psychoactive drugs without close professional supervision can be dangerous; few clinicians and psychiatrists have the training to effectively supervise this type of treatment.
Custer’s Last Stand
140 years ago today, George Armstrong Custer and his batallion from the 7th Regiment of Cavalry were slaughtered by combined forces of the Lakota Sioux, Arapaho, and Northern Cheyenne at the Battle of the Little Bighorn (“Battle of the Greasy Grass” to the Sioux). Five of the twelve companies of the 7th Regiment were wiped out, including Custer, two of his brothers, a nephew, and a brother-in-law; the total casualties were 268 immediately killed and six who died later from wounds, with 55 severely wounded.
(A stone Buddha head in an antique shop)
The first major defeat for the prosecutor in Baltimore in the death of Freddie Gray has raised the specter of there being no policemen convicted in Mr. Gray’s murder.
The sad fact is that the prosecutor in Baltimore was attacking the wrong culprits based on a reasonable, but mistaken, theory as to the way in which he died. The video evidence immediately available, a cell camera view of him being dragged from the scene where he was tackled after a chase-down by a policeman on a bicycle, was on the news. This video shows that Mr. Gray was incapable of voluntary limb movement and could not support himself when he was first handcuffed and was being dragged to a police van.
What appears to have occurred (and it may take a medical point of view with emergency room experience to see Mr. Gray’s to us obvious paralysis) is that, in the process of being tackled after the policeman rode him down on a bicycle, Mr. Gray’s neck was broken. The failure of police personnel to realize this for a very long time was contributory negligence but the long ride in the police van wasn’t the cause of his injuries, only an aggravating factor.
The people of Baltimore will not be well served by the prolonged agony of these trials without justice as an end result. The policemen who were responsible for Freddie Gray’s death will go unpunished and the prosecutor’s office will be damaged. When will the people receive true justice?
The figures have been out for a couple of days, showing Trump only has a million or so in the bank, against Hillary’s 42 million; and the New York Times says that she has ten times the staff that he has. She has been putting out television ads all month and has $117 million in ads reserved (for from now until Election Day), as compared to Trump’s $700,000 in reservations. Either Trump is going to buy big in the future, at the last minute, or he’s not going to buy at all. Donald hasn’t aired a single television commercial since he became the last man standing in the Republican primary race. Hillary has aired at least $20 million in ads in the last month.
The problem is the lack of financing, apparently, leading to a lack of staff leading to a lack of financing. All sorts of problems have cropped up– for example, high level campaign managers have been refusing the offer to work for Trump, saying they’re afraid it would hurt their careers– and it doesn’t look as if Trump has anything on tap to work for him. Except that he has planned a series of speeches slamming Clinton, the first of which he delivered today.
Trump’s strategy is simple: he accuses Clinton of “theft” because she has run a large non-profit organization with her husband for many years and of being a “world-class liar” because she exaggerated the dangers facing her in a visit to Kosovo twenty years ago. The charges are inflammatory and not backed up with any reasoning or facts. No-one has been able to audit her non-profit and find “theft” however that is defined. Whether a non-profit that promotes political or humanitarian causes is inherently or indirectly responsible for theft of services or monies can be debated endlessly. What resonates is the charges by themselves, as if the evidence were obvious.
Trump is in the same position Romney was in before the Republican convention in 2012: burned out, out of money, and out of energy. History usually repeats itself, so Trump is very unlikely to win the race for president in November. We hope.
Cactus Flower
Here’s an article in Journal of the American Medical Association– Internal Medicine (JAMA IM) that shows a correlation between lunches provided to doctors and their prescribing habits… also reported in the New York Times (NYT)… I’d write more but my finger is really bugging me. Read the comments in NYT, many from doctors defending or castigating the practice.
More on The Three Body Problem
The novel I mentioned yesterday has already been made into a movie, which is due out in July. This Chinese production is in 3-D, which is appropriate, and looks to have plenty of CGI — needed for the scenes on the fictional planet described in the movie.
Incidentally, the actual Alpha Centauri star system is a three-star system, but it’s probably not as apocalyptic as described in the novel. It consists of two very sun-like stars close together, about as far apart as Pluto-Saturn and the Sun in an 80 year mutual orbit, and a third red dwarf, which is about 500 times as far as Neptune from the Sun. The red dwarf, if it is in a true orbit with the other two (uncertain), would have a 500,000 year orbital period. There is intense astronomical observation of this system due to its proximity to Earth (about 4.37 light years), but no definite planets have been seen, and anything larger than 4 Earth masses has been ruled out. (Wikipedia.)
The novel is more about human’s relationship to our planet and our mismanagement of it; the idea is that we are doing so poorly that an alien species is invited to give their expert advice on how to improve things. That doesn’t necessarily work out so well. Excellent book and I am impatient to read the second and third volumes.
Comment of the Day
James Lee
Arlington, Texas
This astute column reflects the bizarre, unprecedented nature of the current election. Ms. Roller and the professional comedians analyze and evaluate Trump as if the ability to mix humor with character assassination belonged in the mental tool kit of every effective president.
Trump’s heavyhanded approach to humor, combined with his inability to laugh at himself, do reveal much about his character and intellect. His insults directed at women, for example, which focus on their physical appearance or bodily functions expose a mind too often unaware that effective humor targets a person’s behavior, not her physical characteristics. And his failure to understand the barbs directed at himself stem from his discomfort with the painful process of self reflection. Trump ranks as the ultimate extrovert, because a willingness to turn his pitiless gaze inward would not reveal much of substance.
The fact remains, however, that no one would have written a column on a previous candidate analyzing his ability to deliver artful insults. Since Trump has demonstrated an ignorance of key issues worthy of Sarah Palin, along with a gross inability to craft intelligent policies, perhaps his skill as an insult comedian remains the only criterion by which to judge his fitness for high office. This would be akin to evaluating an Olympic sprinter on his ability to trip a competitor.
Clearly, the framers failed to include in the Constitution all the necessary qualifications for president.
This comment was one of those attached to an article about Drumpf (Trump) and his “insult comedy.” in the New York Times.
The Three Body Problem
“The Three Body Problem” is an exciting science fiction novel written in Chinese and suffused with the Chinese worldview. It was recently translated into English, and I just finished reading– only to discover that it is the first volume of a trilogy. This book is highly recommended. I am reminded of “The Martian”, another recent novel that became a movie– the novel was said to have been originally written online, on one of those “blogs.”
3 body problem is a celestial mechanics problem that has no solution according to math in book. Our nearest neighbor Alpha Centauri is actually a 3-sun system, and the book is about the final surviving planet (out of twelve) in the Alpha C. system. It seems that there is a civilization on that planet, and they are aware that they are likely to be destroyed by the erratic behavior of their system. Thus the dramatic tension essential to a good story.
Sorry but I still can’t type well due to large bandage on tip of important typing finger… back to “hunt and peck”… tip of finger is numb due to nerve severing by pruning shears.
Here, in New York Magazine, is an insightful article showing the similarities between Ronald Reagan, during his campaign, and the Donald– a Donald/Ronald comparison, if you will.
I can’t type very well because I have a bandage on my left index (second) finger as a result of a six-year-old’s attempt to cut of the tip of my finger with pruning shears, so I will just be pointing you to interesting arftgicles forf a while…
Conrad Theodore Seitz 