12/31/15

Medieval Alchemy

© algolonline | 123rf.com

© algolonline | 123rf.com

Three years after the publication of the fourth edition of the DSM in 1994, the US became the only country in the world to allow direct to the consumer advertising of pharmaceuticals. Now there’s New Zealand. Soon after the approval, pharmaceutical advertising was everywhere in the US. Over the next decade, from 1997 to 2007, drug companies tripled their spending on marketing. Everyday problems were being portrayed as unrecognized psychiatric disorders. The chair of the DSM-IV, Allen Frances, admitted they had failed to anticipate how easily their manual could be utilized to promote pharmaceutical sales. They were not able to stem the flood of “false demand” instigated by the marketing done by drug companies. “Within a few years, it was clear the drug companies had won and we had lost.”

We should have been far more active in educating the field and prospective patients about the risks of overdiagnosis. There should have been prominent cautions in DSM-IV warning about overdiagnosis and providing tips on how to avoid it. We should have organized professional and public conferences and educational campaigns to counteract drug company propaganda. None of this occurred to anyone at the time. No one dreamed that drug company advertising would explode three years after the publication of the DSM-IV or that there would be the huge epidemics of ADHD, autism, and bipolar disorder—and therefore no one felt any urgency to prevent them. . . . We missed the boat. (Allen Frances, Saving Normal, p. 74)

Frances said the evidence for this diagnostic inflation is clear. There has been a fortyfold increase in childhood bipolar disorder. Autism diagnoses have increased twentyfold. “Attention deficit/hyperactivity has tripled; and adult bipolar disorder doubled.” The result has been huge profits for the drug companies.

At the very top of the Pharma hit parade are the antipsychotics at a resounding $18 billion a year. Antidepressants produce a hardy $12 billion a year, despite the fact that many are now off  patent and sold in cheaper generic versions. Fifteen years ago, stimulants were a rounding error in drug company sales at a measly $59 million a year. Now with direct-to-consumer advertising and heavy marketing to doctors, sales have been juiced up to a hefty $8 billion a year. And because primary care doctors love to prescribe them, antianxiety agents are eight in sales among drug classes—even though they probably do much more harm than good. (Saving Normal, p. 105)

Patients regularly misdiagnosed themselves and asked their doctor for “the magic pill that would correct their chemical imbalance,” just as the advertisements suggested. And as requested, doctors prescribed the medications. “Patients who requested a drug they had seen advertised were seventeen times more likely to walk out of the office with a prescription.” Primary care physicians (PCPs), such as general practitioners, obstetrician-gynecologists and pediatricians, now prescribe most of the psychiatric drugs in the US.

Using data from August 2006 to July 2007, Ryan DuBosar noted in “Psychotropic drug prescriptions by medical specialty” that 59% of the psychotropic prescriptions were written by PCPs. Breaking down the drug by class, PCPs prescribed 37% of the antipsychotics, 52% of the stimulants, 62% of the antidepressants and 65% of the anxiolytics (anti-anxiety meds). Frances said: “Too often, drugs are used promiscuously in a way that approximates the quackish practice of medieval alchemists.”

On November 17, 2015, the American Medical Association (AMA) adopted a new policy that calls for a ban on direct to the consumer advertising of prescription drugs. The new policy calls for a physician task force and launching an advocacy campaign to promote prescription drug affordability.

The AMA Board Chair-elect, Patrice Harris, said the vote reflects concerns among physicians about Pharma’s commercially-driven promotions and the impact of marketing costs in escalating drug prices. She said direct-to-consumer advertising also created a demand for new and more expensive drugs, even when these drugs may not be appropriate. “Patient care can be compromised and delayed when prescription drugs are unaffordable and subject to coverage limitations by the patient’s health plan. In a worst-case scenario, patients forego necessary treatments when drugs are too expensive.”

Reporting for Reuters, Susan Kelly noted that the AMA did not say how the ban could be overturned. There have been a series of court decisions determining that the ads are a form of commercial speech protected by the U.S. Constitution. PhRMA, the largest trade group for the pharmaceutical industry in the US, said the ads increase consumer awareness of available treatments for diseases. PhRMa spokesperson, Tine Stow said: “Providing scientifically accurate information to patients so that they are better informed about their health care and treatment options is the goal of direct-to-consumer pharmaceutical advertising about prescription medicines.” REALLY?

Allen Frances said that Big Pharma seems to feel it is above the law. “Almost all of the companies have absorbed huge fines and even criminal penalties as punishment for their illegal sales practices. He published a chart in Saving Normal that he referred to as the drug company hall of shame. It contained information on fines and settlements by Pharma for off-label promotion (which is illegal at this time) as well as shady marketing and fraudulent misbranding. The sum total of the fines between 2004 and 2012 was $12.06 billion.

Yet a Pharma company has been in court attempting to assert that it has “a constitutional right to share certain information about its products with doctors.” The drug companies have been increasing their pressure on the FDA to relax its guidelines around off-label marketing. See “Pharma Goes to Court” for more on this issue.

Frances said it is our fault that we allowed drug companies to prey on our weakness. “Diagnostic questions should be decided by what is best for the patient, not what is best for the doctor or the APA [American Psychiatric Association] or Pharma or the consumer group.” All this could be reversed if we had the political will to do so. He proposed fourteen ways to tame Pharma. The top six were:

  • No more direct-to-consumer advertising on TV, in magazines, or on the internet.
  • No more drug company-sponsored junkets, dinners, promotional gifts, or continuing medical education for doctors or medical students.
  • No more financial support for medical professional organizations.
  •  No more beautiful salespeople congregating in the doctors’ waiting room.
  • No more free samples.
  • No more off-label marketing.

These changes strike at the heart of Pharma’s marketing strategy, so it won’t be easy to get Congress to approve the changes. Pharma outspends all other industries in its lobbying efforts. Since 1998, the pharmaceutical industry has spent $3,201,510,687 lobbying Congress. So far in 2015 Pharma has spent $178,863,490. Annually they outspend all other industries. You have to go back to 2005 to find annual spending under the to date figure for 2015. See OpenSecrets.org for more information on this issue.

12/28/15

Weaponized Marijuana

hc-synthetic-marijuana-0926-20120925-001William Wells, a homeless man living in New York City, first started using K2 about a year ago. “My brain is connected to the chemicals,” he said. “It will have you running down the block. It will have you fighting yourself. It will have you getting very violent. It will have you living like a bum. . . . I wish I could stop, but I can’t stop. I can’t stop.” An East Harlem resident said that K2 was being sold 24 hours a day in the area. “Every day I see people doing it right there on the street. It makes them stuck. They stand in one place for hours at a time.” Read more from the original article by Matthew Speiser here.

New York City Mayor Bill de Blasio signed legislation recently that banned the sale of synthetic cannabinoids, commonly known as K2 or spice. The law also bans the sale of synthetic stimulants known as bath salts. Not only are there possible civil and criminal penalties, the legislation authorizes the city to close down businesses that violate the law twice in a three-year period. The New York Times reported in September 2015 that the proposed ban would include selling any drug marketed as synthetic marijuana and any imitations with effects similar to the synthetic cannabinoids.

Authorities did begin to crack down on the sale and distribution of these new psychoactive substances (NPS). Ten defendants were charged and 90 bodegas (convenience stores) were raided. These included six retail outlets on 125th Street in Harlem, which has become ground zero for K2 use among the homeless in the City. Nicholas Casey wrote how:

Crowds of up to 80 or 100 homeless people come in on buses from a nearby shelter on Randalls Island, drawn by heroin recovery clinics nearby, and spend the day there under the influence of this cheaper narcotic. The block between Park and Lexington Avenues appears at times to be a street of zombies.

Police raids on 125th Street in July of 2015 led to confiscations of more than 8,000 packets of K2. But many of the stores continued selling the drug. The sheer number of users on the block has left police officers edgy. “It quickly can become a kind of group mentality where the officers, or even multiple officers, are outnumbered,” according to Tom Harnisch, commander of the 25th Precinct. NYPD Commissioner Bill Bratton described the drugs as “weaponized marijuana.”  He said: “This is a scourge on our society, affecting the most disadvantaged neighborhoods and our most challenged citizens. It affects teenagers in public housing, homeless in the city shelter system, and it’s quite literally flooding our streets.”

The New York Daily News filmed a six-minute documentary,”K2 in New York City.” It opens with a 20 second shot of a guy catatonically zoned out on K2. A homeless man who sells K2 held up a packet of “Trippy,” saying: “I want Obama to see this too.”  Another person said it was ten times worse than heroin. Against the background of two police officers standing by a person crying out on the sidewalk, a graphic noted that: “Between April 2015 and September 2015 there were more than 4,700 K2-related emergency room visits in NY state compared to just 230 during the same period in 2014.” Another man said that was how he got through the day, dealing with his misery and pain by doing the drug.

A woman said: “Don’t do it. If people haven’t done it … if I know for a fact that you haven’t smoked it, I will not let you smoke it. I wouldn’t ruin somebody’s life like that.” NYC paramedic Robert Kelly said it seems to be effecting mentally ill homeless people in the shelter systems; people that are known drug users. “Unfortunately it’s cheap; it’s easy to get.” US Attorney Preet Bharara announced an operation that seized over 200 kilograms of chemicals and an estimated 275,000 packets of finished product that would have totaled more than 2,700 kilograms of spice. A conservative estimate of the street value of that amount of spice is over $30 million dollars.

The Fix described this joint DEA and NYPD operation as targeting the sale of the drugs in all five NYC boroughs. Part of the operation raided five processing facilities and warehouses used to store and distribute the drugs. More than 80 bodegas were searched as part of the overall operation. DEA Special Agent in Charge, James Hunt said: “Synthetic cannabinoids are anything but safe. They are a toxic cocktail of lethal chemicals. . . . By investigating and arresting manufacturers and distributors of ‘spice’ in the city, we have cut off the accessibility for those feeding the beast.”

The NYC Department of Health and Mental Hygiene has an information page on K2 that describes some of the risks associated with K2 use. “Information for Consumers” said the most common adverse effects of K2 reported include: lethargy, confusion, drowsiness, respiratory depression, nausea, vomiting, tachycardia (increased heart rate), paranoid behavior, agitation, irritability, headache seizures, and loss of consciousness. Severe side effects could include acute renal failure and cardiovascular and central nervous system complications. “In rare instances, use of cannabinoids has been linked to death.”

John Lavitt opened his article for The Fix with a comment on how synthetic drug sales have allegedly fueled terrorism,  a claim which has some clear evidence for it. One of the name brands of synthetic marijuana named in The New York Daily News video described above, Scooby Snax, was involved in a DEA raid on a Birmingham Alabama warehouse in May of 2013. Sales from the product were linked to $40 million in wire transfers to Yemen. See “Strange Bedfellows: Terrorists and Drugs.” Also see “The Double-Edged Sword of Narco-Terrorism.”

12/24/15

A Not So Moral Molecule

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© kentoh | stockfresh.com

In 2005 Paul Zak was one of five authors listed for a study published in the journal Nature titled: “Oxytocin increases trust in humans.” They claimed that oxytocin influenced a person’s willingness to accept social risks that occur during interpersonal interactions. The results suggested “an essential role for oxytocin as a biological basis” of positive social behavior. But Zak was just getting started. By 2011 he had published a book about his further investigations of oxytocin and had acquired the nickname of Dr. Love because of his work on oxytocin and relationships. He claimed that oxytocin was the secret biochemical ingredient behind trustworthiness and human morality.

Be sure you get this. Zak is saying that trust, empathy and morality are causally influenced by oxytocin, a hormone secreted by the pituitary gland at the base of the brain.  In a 2011 TED talk entitled: Trust, morality—and oxytocin?, he said: “Within our own biology, we have the yin and yang of morality. . . . We don’t need God or government telling us what to do. It’s all inside of us.” There is a clear reductionistic assumption on what it means to be human behind his interpretation of the various studies of oxytocin done by him and others.  In The Moral Molecule, Zak said:

We are biological creatures, so everything we are emerges from a biological process. Biology, through natural selection, rewards and encourages behaviors that are adaptive, meaning that they contribute to health and survival in a way that produces the greatest number of descendents going forward. Oddly enough, by following that survival-of-the-fittest directive, nature arrives at many of the same moral conclusions offered by religion, namely, that it is often best to behave in a way that is cooperative and, for want of a better word, moral. Nature simply gets to the same place by following a different, and perhaps more universal path.

Science writer Ed Yong has been a particularly vocal critic of Zak’s claims about oxytocin. Here’s a sample of just three of his critical articles. Soon after The Moral Molecule was published, Yong noted in an article for Slate that the problem with the moral molecule idea is that it is a fable. “A more nuanced view of oxytocin is coming to light—one that’s inconsistent with the simplistic ‘moral molecule’ moniker.” He linked to one study that suggested oxytocin boots envy and gloating.

In 2014, for his blog, Yong wrote: “Oxytocin: Still not a Moral Molecule.” He said the  “rose-tinted view” of oxytocin as the “love hormone,” “cuddle chemical” or “moral molecule” was a sham. He said it was of a general social hormone that motivates us to seek out social situations or draws our attention to social cues. “The results can be positive if we find ourselves in the right situation. Change the context, and oxytocin can reveal a dark side to its influence.”

In November of 2015, now writing for The Atlantic, Yong reviewed the history since the fateful 2005 paper on oxytocin was published. While noting that several groups or individuals have shown that sniffing oxytocin can make people more generous, empathetic and constructive, Zak has “repeatedly and misleadingly promoted the substance as a ‘moral molecule.’” He then went on to show where several scientists have shown that the evidence for oxytocin’s positive influence was built on “weak foundations.” He quoted the lead author of the original Nature article on oxytocin as saying none of the other studies cleanly replicated their original one. “We have no robust replications of our original study, and until then, we have to be cautious about the claim that oxytocin causes trust.”

Yong raised the concern that some individuals are now using oxytocin as a therapeutic agent with humans. He ended his article commenting that after decades of work, the so-called “moral molecule” is still more of a mystery molecule. “And that mystery needs to be solved before it finds its way into the clinic.”

Helen Shen wrote a good review of the research into oxytocin for Nature in June of 2015, “Neuroscience: The Hard Science of Oxytocin.” She raised a concern that some doctors are using oxytocin off-label to treat a variety of problems. Shen quoted one of the researchers, Sue Carter, a neuroscientist at Indiana University in Bloomington, as saying that we don’t understand how this hormone work yet; or what happens to someone with repeated use. “This is not a molecule that people should be self-administering or playing with.”

Ed Yong’s concerns with Paul Zak and his simplistic promotion of oxytocin as the “moral molecule” does seem to be well founded. But I wondered how Zak could take such a strong position that morality has a biological foundation. Perhaps his own description of his early years in The Moral Molecule gives us a clue.

Paul Zak’s mother was a nun before she was his mother. She spent four years as a member of the Sisters of Loretto at the Foot of the Cross. He said she took him out of Catholic school because it wasn’t strict enough. He said his upbringing “left no doubt that we are all born in sin and driven by base passions that have to be tightly constrained and relentlessly monitored to keep us from behaving badly.” Zak called this the classic approach to governing human nature that has dominated Western history—a top-down approach full of “dos” and “don’ts.”  Supposedly his mother “based her child-rearing on the assumption that unselfish, moral behavior was impossible without the ever-present threat of punishment, and the more terrifying the better.”

Either Zak or his mother (perhaps both) had a very distorted sense of the theology of original sin. Following from this, was a rigidly legalistic understanding of how humans should morally govern themselves. It seems his portrayal of both his mother and the God he knew growing up was someone who was constantly watching in order to catch you in some misdeed. It would seem that “the ever-present threat of punishment” (physical abuse?) was used to instill an obedience based on fear. If Zak saw this approach as stemming from his mother’s belief in God, no wonder that as an adult, Zak turned to biology for the explanation of why humans are moral, empathetic and trustworthy.

In a powerful little book titled Escape From Reason, Francis Schaeffer described how science today is ruled by a belief in the uniformity of natural causes in a closed system. God, if He exists at all, is outside of the closed system of nature with no influence on—or explanatory power for—what occurs within the closed system of nature. Early scientists believed in the uniformity of natural causes—a philosophical presupposition necessary for anyone to do science. “But what they did not believe in was the uniformity of natural causes in a closed system.” This is what Schaeffer referred to as “modern, modern science.”

The realm of nature is closed to (autonomous from) any nonmaterial realm. God, freedom, love, morals are either irrelevant to what happens in nature and science, or must be explained by natural, scientific means. So Zak believes everything about humanity emerges from biology. There is an evolutionary explanation for why we are moral. “Nature arrives at many of the same moral conclusions offered by religion, namely, that it is often best to behave in a way that is cooperative and, for want of a better word, moral.” Schaeffer took this sense of biochemical determinism to its logical extreme and noted that if humans are determined, then what is, is right.

If all of life is only mechanism—if that is all there is—then morals really do not count. Morals become only a word for a sociological framework. Morals become a means of manipulation by society in the midst of the machine. The word morals by this time is only a semantic connotation word for nonmorals. What is, is right.

This happens, according to Francis Schaeffer, when a non-Christian view of nature excludes the possibility of an absolute or God from having any influence on the universe. “Without an absolute one cannot really have morals as morals.” Everything is then relative. “There is no circle inside which there is right, in contrast to that which is outside the circle and therefore wrong.” Without an absolute standard, there can be no such thing as “right” and “wrong.”

But for the Christian, this is not true. “God does exist, and He has a character; there are things which are outside the commandments He has given us as the expression of His character.”

So what about oxytocin? From a Christian perspective, it cannot be viewed as a moral molecule.  Morality cannot be fully understood or explained within a closed system of nature. However, there appears to be scientific evidence that oxytocin does play a role in social cognition. If the science behind this evidence is done presuming the uniformity of natural causes in an open system of nature—one that allows for the potential influence of something outside of nature upon things existing within nature—then there could be a Christian perspective of oxytocin as a biological correlate to positive social behavior or morality. In other words, moral behavior wouldn’t be caused by higher oxytocin levels, but could be associated with it.

12/21/15

What is Truth?

© olivier_le_moal | stockfresh.com

© olivier_le_moal | stockfresh.com

Over three years ago, Adam Bienkov wrote an article for The Guardian, “Astroturfing: what it is and why does it matter.” He noted how the use of “astroturf” groups was widespread and could be found internationally, across all walks of life—from book reviews to online surveys to big business and to local politics. He described astroturfing as: “The attempt to create an impression of widespread grassroots support for a policy, individual, or product, where little such support exists.” Astroturfers use multiple online identities and fake pressure groups to mislead the public into believing the position held by the astroturfer was the commonly held view.

Here is a TED talk by journalist Sharyl Attkisson on Astroturf and media manipulation. She said Astroturf was a perversion of grassroots. Astroturf is when political, corporate or other special interests disguise themselves and publish blogs, start facebook and twitter accounts, publish ads or letters to the editor or simply post comments online. Astroturf seeks to change your opinion by manipulating you. “Astroturfers seek to controversialize those who disagree with them.” Sometimes their strategy is to throw in so much confusing and contradictory information into the mix, that people are tempted to throw up their hands and disregard all of it—including the truth.

Complacency in the newsmedia combined with incredibly powerful propaganda and publicity forces mean we sometimes get little of the truth. . . . .  Surreptitious astroturf methods are now more important to these interests than traditional lobbying of Congress. There is an entire industry built around it in Washington.

One example she discussed at length was how Wikipedia was compromised by astroturfing editors. She also described how author Philip Roth was told he wasn’t a credible source to correct a factual error in Wikipedia about one of his own novels. When a medical study looked at medical conditions described on Wikipedia pages, and compared the descripption to actual peer-reviewed published research, “Wikipedia contradicted published research 90% of the time.”

She went on to describe an investigation she did a few years ago for CBS News on a story coming out that was done by the National Sleep Foundation (NSF). Her investigation showed that the study was actually a survey, conducted by the NSF. The NSF and the survey was sponsored in part by the makers of a new drug about to be released—Lunesta.  CBS was the only news outlet to report the connection.

This sounded a bit out there at first. But after I read the above information on astroturfing, it made sense. I saw where it fit with what I’ve read (and written here on Faith Seeking Understanding) about how some pharmaceutical companies market their drugs and some psychiatrists have perpetuated false beliefs about those drugs. If you want another source, read Psychiatry Under the Influence by Robert Whitaker and Lisa Cosgrove.  And then I realized I may have had some contact with astroturfers myself.

I wrote an article on June 6, 2015 on palcohol titled: “Hype Over Powered Alcohol.” Soon after my article was published online, I received an email whose sender identified himself as the creator of palcohol. After reading about astroturfing, I don’t believe the email was from Mr. Philips. Rather, it must have been from someone hired to do astroturfing for Lipsmark, his company. Philips was about to launch his product nationally. He didn’t have time to respond nastily to my article. The email opened with: “I wouldn’t call your publication Faith Seeking Understanding [my website’s name] unless understanding comes from misinformation.” The email went on to say:

You have so much misinformation in your article, I don’t even know where to begin. I can understand why you don’t have a Comments section at the end of your article because you would have people who know the truth pointing out the countless mistakes in your article. You should really do a better job on presenting factual, balanced information about a topic.

I do have a comments section and in my response to the person saying they were the creator of palcohol, offered to post it myself if he couldn’t. I never heard back.

Another time I wrote an article titled: “Medical Reform or Medicinal Con?” It noted the pending legislation in the Pennsylvania legislature for the legalization of medical marijuana. I suggested that the work to accept medical marijuana could be a first steppingstone for the legalization of recreational marijuana.

Someone who said they were “Stel1776” took an instant dislike to what I said and engaged me in a back-and-forth discussion that seemed to be more a way of using what I’d written to then post their pro marijuana position. Stel1776 first deleted his/her first post from my site. When I re-read it, it seemed to be an example of astroturfing. Disqus data on “Stel1776” indicated he/she had made 6,742 comments, 129 of which were flagged and 138 marked as “spam.”

When I published the first of three articles on the use of baclofen to treat alcoholism, my website’s facebook page had a comment from another facebook page named “Baclo Fen.”  The comment said: “If interested about baclofen (and other addictions) you can find all news here in this FB account …” Part 1 of my article was relating more of the history of baclofen treatment developed by Olivier Ameisen and it reported his rather positive outlook of it.  The next two articles were questioning and critical; I didn’t get any comments from “Baclo Fen.”

Then I had someone attempt to post a comment to advertise a spell caster in a comment attached to an article I wrote: “Diagnosing Spiritual Heart Problems.” And another time there was a comment from “Marowincyin” on an article titled: “Hepatitis Hostages” about the high cost of Solvadi and Harvoni, which treat Hepatitis C at a cost of over $1,000 per pill. Her suggested link led to a website advertising how to but these drugs overseas. Here’s the thing. If my little corner of the web can attract attention from astroturfers, imagine how widespread this phenomena really is.

Writing for Salon A.M. Gittlitz said: “I was a political astroturfer.” He described how he was hired through a Craigslist ad for “TV Press Rally Extras” to be at a rally. “The job will once again be to stand behind elected officials and cheer, hold signs, be enthusiastic. If you have already worked the previous event, the rules, payment, instructions, sign-in and EVERYTHING is the same, except location.” He was offered $20 an hour.

The marketing done by Shire for its drug Vyvanse to treat binge eating disorder has an astroturfing feel as well. Soon after Vyvanse was approved by the FDA to treat binge eating disorder, Monica Celes went on “Good Morning America” and “The Dr. Oz Show” to relate her person struggle with binge eating. Seles was a paid spokesperson for Shire. See “A Drug in Search of a Disorder” for more on this.

Sharyl Attkisson in her TED Talk gave a hypothetical scenario about the comprehensive marketing strategy with a cholesterol-lowering drug that illustrated the sophistication of this process. It means we can’t take things we read at face value anymore. Here is a case in point. “Bel Buca” has a Twitter account: @Belbuca. “Her” picture is of a young, attractive woman. But Belbuca is actually a new opioid pain management drug whose active ingredient is buprenorphine, a drug used in maintenance therapy for opioid addiction. Addicts I’ve known who have abused buprenorphine said it was harder to withdraw from than heroin.

Attkisson identified four ways to help spot astroturfing: 1) Inflammatory and charged language, such as: quacks, kooks, pseudo, conspiracy theorist. 2) Made up myths that are ‘debunked.’ 3) Attacking or controversializing people’s character or organizations instead of addressing the facts. 4) The ‘turfers’ reserve their public skepticism and criticisms for those exposing the wrong doers instead of directing that skepticism to the wrongdoers themselves.

In “Psychiatry, Diagnose Thyself! Part 1” I described what psychiatrist and former President of the American Psychiatric Association, Jeffrey Lieberman, had to say about anthropologist T.M. Luhrmann, journalist and write Robert Whitaker and The New York Times. His statements qualify as astroturfing, as he was clearly attempting to controversalize them by his remarks. He used charged language in his criticism, attempting to say Luhrmann portrayed psychiatry as philosophy or religion, and attacked both Luhrmann personally. When leaders within the field of psychiatry resort to such tactics to defend their profession, determining what is truth and what is rhetoric can be hard to distinguish. I’m grateful for Sharyl Attkisson’s suggestions.

12/18/15

Fingerprint Testing for Drugs

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© 5505292 | 123rf.com

A team of researchers has announced a non-invasive test that can detect cocaine through a fingerprint. Yes, you heard right, a fingerprint. This method can determine whether cocaine has been ingested, rather than just touched. The lead author of the study published in the September 2015 issue of Analyst, Melanie Bailey, said: “The beauty of this method is that, not only is it non-invasive and more hygienic than testing blood or saliva, it can’t be faked. . . . By the very nature of the test, the identity of the subject is captured within the fingerprint ridge detail itself.”

The research team was led by the University of Surrey (UK) and composed of other individuals from the Netherlands Forensic Institute (NL), the National Physical Laboratory (UK), King’s College London (UK) and Sheffield Hallam University (UK). When someone uses cocaine, it is metabolized in the body, producing benzolecgonine (BZE) and methylecgomine (EME). These chemical indicators are in fingerprint residue that can be tested through a procedure called desorption electrospray ionisation (DESI). You can read an abstract of the study here. After registering with RSC Publishing, you can gain free access to the study itself.

The drug testing industry is a multi billion-dollar worldwide industry. The testing process is routinely used by probation services, prisons, law enforcement and the courts. Drug and alcohol counseling centers use them as well. I recently had a counseling session at the outpatient drug treatment I work at that involved reviewing the results of a client’s urine screen. There has been increased interest in workplace drug testing. Identifying ways to drug test motorists are on the horizon. See “Warning All Bakehead Drivers” for information on marijuana breathalyzers.

Drug tests are usually done at this time by taking a blood or urine sample. But blood testing requires trained staff. Urine tests, if supervised, have privacy concerns. Unsupervised urine tests have created an industry of their own consisting of various ways to “beat” the test. Google the term “whizzinator,” if you’re curious about this. Additional limitations for blood and urine samples are they must be treated as a “bio hazards,” which increases the complexity of handling and storing and disposing them.

But a latent fingerprint can be taken quickly and transported easily. What’s more, “The identity of the donor is encapsulated within the fingerprint ridge detail, making the test impossible to falsify.” Two mass spectrometry techniques, desorption electrospray ionisation (DESI) and matrix assisted laser desorption ionization (MALDI) have been demonstrated to provide chemical images of compounds in latent fingerprints.

In the study by Bailey et al., latent fingerprints were obtained from five individuals who were attending a drug and alcohol treatment center. The fingerprints were deposited on clean glass slides before being shipped to two analyzing laboratories. The MALDI test successfully detected BZE.  At the time of the MALDI test, researchers were asked specifically to look only for BZE, the primary metabolite. The DESI test found detectable signals for cocaine, BZE and EME in a fingerprint sample. Bailey et al. concluded:

We have demonstrated the use of established and emerging analytical techniques for the analysis of cocaine and its metabolites in natural fingerprints. DESI was carried out under ambient conditions, and atmospheric pressure MALDI systems are also available. This, combined with the ability to analyse the sample in situ and with minimal sample preparation allows for very rapid sample throughput compared with chromatographic methods. The high sensitivity of the methods and selectivity to the analytes described has enabled us to detect metabolites of cocaine drugs from those who use illicit substances. Secondly, although the fingerprints are not spatially uniform, we are optimistic that these approaches can be developed for quantitative analysis of fingerprint residues.

Not surprisingly, there is at least one company in the UK who is already working to produce the world’s first handheld fingerprint drug-testing device. See how the following description fits with the above reported research. “Intelligent Fingerprinting specialises in the development of non-invasive diagnostic screening technology for fast and convenient point-of-care testing using fingerprints.” They expect to go into production with their hand-held devices sometime in 2015. The company was founded by David Russell in 2007, the same year he published an article describing a new method of fingerprinting: “Intelligent” Fingerprinting: Simultaneous Identification of Drug Metabolites and Individuals by Using Antibody-Functionalized Nanoparticles.” Russell pioneered nanoparticle technology research at the University of East Anglia.He is currently the company’s Chief Scientific Officer.

Non-invasive and easy-to-use, Intelligent Fingerprinting’s drug screening device eliminates the need for the specialist collection arrangements and biohazard disposal facilities associated with conventional drug testing methods involving blood, urine or saliva samples. The new technology is expected to revolutionise drug testing globally in many sectors including criminal justice, drug rehabilitation and the workplace.

Their diagnostic technique screens for drug metabolites found in “the minute traces of sweat” that can be found in a fingerprint. Currently, from a single fingerprint, one test screens for: amphetamines, benzodiazepines, cannabis, cocaine and opiates. Since the technique detects drug metabolites rather than the drug itself, “a positive result indicates that the person being screened has taken the drug and not simply touched a contaminated surface.” An image of the person’s fingerprint is taken as part of the drug screening technique. If needed, it can be used to confirm the identity of the person who was tested, thus minimizing the risk of cheating or the misidentification of samples.

The device’s diagnostic technique may be used to identify other types of metabolites and chemicals found in fingerprint sweat.  Research is ongoing into a variety of new applications for their technology.

There has been some strong US investment interest in the company. In 2012 Intelligent Fingerprinting received £2 million in US backing.  And in January of 2014, a consortium of private US investors put an additional £750,000 into the company. The additional funds allowed the company to accelerate the introduction of the device to the global market. “The ongoing support from investors validates our assertion that we have a technology with massive potential.”

If the technology can be demonstrated to do reliable, reasonably priced testing, this would be an effective tool in addiction counseling. The immediacy of the test results and its non-invasive nature are strong selling points. It certainly could be helpful to probation officers and the court system. And it definitely has a place for on-the-job testing. But there are some law enforcement situations I’m not sure it would benefit.

Unless there is some way to assess how much time has passed since a drug was used, the test would have limited use for testing drugged drivers. For example, knowing someone has used marijuana recently is different than knowing they used it in the past 2 hours. It may have a place as an initial field test in DUI traffic stops. But would it be used on drivers who had been stopped for just any traffic violation? If someone tested positive, say for cocaine, would that be enough for an arrest?

12/15/15

Created in the Image of God

© Paul Looyen | 123f.com

© Paul Looyen | 123f.com

“If as the Bible teaches, the most important thing about man is that he is inescapably related to God, we must judge as deficient any anthropology which denies that relatedness.” (Anthony Hoekema, Created in God’s Image, p. 4)

From the perspective of Christian theology, anthropology refers to the study of humanity in relationship to God. This is different from the social science of anthropology, which deals mostly with a comparative study of the physical and social characteristics of humanity across space and time. Christian anthropology has a self conscious, biblical starting point with God. But the social science of anthropology intentionally disregards any reference to God. So understanding what the significance that humans were “created in the image of God” (Genesis 1:27) is crucial for a biblical sense of human nature. The silence of social sciences like anthropology and psychology on this matter means to Anthony Hoekema that they are biblically deficient.

In his essay “Man in the Image of God,” John Murray said that humans are persons, and therefore self-conscious, rational, free, moral and religious agents. As moral agents, we are responsible. And we are under obligation to obey the will of God in every moment of our life because we were created in the image of God. “It is the metaphysical likeness to God that grounds obligation, and the fulfillment of obligation consists in conformity to the image of God.”

Being made in the image of God is used uniquely of human beings in Scripture and thus sets us apart from other creatures. Regardless of how humans anthropomorphize other animals, there is a radically different nature between a human being and a squirrel, a fish and even an ape. We may share over 98% of our DNA with chimpanzees, but we don’t share the image of God.

The Old Testament repeatedly speaks of God in terms of human life and experience. Various parts of the human body, such as hands, eyes and ears are attributed to Him; as also are physical actions such as laughing, smelling, whistling. God is said to feel the emotions of hatred, anger, joy and regret. Relational and socio-cultural aspects of being human are used in reference to God as well. God is a warrior; a shepherd; a refuge; a stronghold.

These and other anthropomorphisms “are by no means naturally reversible into thoughts of man sharing the shape of God.” They do not enable us to construct a picture of Yahweh’s physical appearance. God is pure spirit (John 4:24).  He is not part spirit and part body as humans are. “He is simple spirit without form or parts, and for that reason he has no physical presence. In The New Bible Dictionary, R.A. Finlayson said: “When we say that God is infinite spirit, we pass completely out of the reach of our experience. We are limited as to time and place, as to knowledge and power. God is essentially unlimited, and every element of his nature is infinite.”

Yet, if we didn’t speak of God in physical terms, we could hardly speak of God at all. So we must speak metaphorically or analogically of God. We look to what we know and understand in creation to get a glimpse of what God is like. And we do so because that is how God has revealed himself to us (Romans 1:19-20).

When Israel stood before God at Horeb, they heard the sound of words, but saw no form (Deuteronomy 4:12). When God appeared in theophanies, he was seen in human form, but without a suggestion this was anything but a temporary manifestation (Genesis 18). In Ezekiel’s vision of the glory of the Lord, although His likeness was human in appearance, from the waist up it was like gleaming metal. From the waist down, it was like fire (Ezekiel 1:26-27). Rather, these characteristics draw our attention to the personhood of God. In his article, “The Image of God in Man,” D. J. A. Clines said:  “Yahweh is depicted in human terms, not because He has a body like a human being, but because He is a person and is therefore naturally thought of in terms of human personality.”

But at the same time that human beings are to some degree like God, we are also creatures of God. So, to be created in the image of God means that we are created persons; we are simultaneously creatures and persons. Anthony Hoekema described this paradox as the central mystery of humanity. As creatures, we are totally dependent upon God who created us. God gives us breath and life and everything else. “In him we live and move and have our being.” (Acts 17:25, 28) As persons, made in his image and likeness, we can make decisions, set goals, and move in the direction of those goals. In this sense, Hoekema said we have “a kind of independence—not absolute but relative.” He urged us to keep both of these truths in focus within our theological understanding of humanity.

This image and likeness establishes humanity’s role on the earth and facilitates communication with the Divine. God gave us ears to show that He hears our cries; eyes to show He sees our plight (Psalm 94:9). Human beings are then theomorphic, meaning that we are made by God to be like God. This imaging is just that: a faithful and adequate reflection, but not a reproduction of God or any of his attributes. The personhood of humans is reflective of God’s personhood. It will have some correspondence; there will be real and true associations, but never identity of being.

As Cornelius Van Til puts it in An Introduction to Systematic Theology: “Man’s being is analogical of God’s being.” We do not have even the tiniest spark of a divine attribute within us. The Creator-creature distinction is inviolate: “Nothing can exist in man just as it exists in God.” For His thoughts are not our thoughts; his ways are not our ways (Isaiah 55:8-9). The Creator-creature distinction is thus theologically and philosophically essential to a right and proper view of human nature. So while there will be true and real correspondence between human nature and God (since we are made in His image and likeness), there cannot be identity of being.

So human beings are created persons, made in the image and likeness of God so that we can truly know Him. As creatures, we are not God and we depend upon Him for our very existence.  As persons, we are like God, who made us to reflect or image him. Aspects of our being which include our physical, emotional and psychological makeup are reflective of God’s personhood, but never identical to it. We cannot and should not emphasize one aspect of our being over another as we consider what it means to be made in the image of God. To do so would be in violation of God’s creative purposes.

Anthony Hoekema suggested that there were two general types of non-Christian anthropologies, idealistic and materialistic. Idealistic anthropologies consider human beings to be primarily spirit; and see the physical body as foreign to his or her real nature. In Platonic thought, what was real about a human being was his or her intellect or reason; which was viewed as a divine spark within the person that continued after the body died. So the body was a hindrance to the spirit and one was better off without it. In psychology, this understanding of human nature underlies the Gnosticism of Carl Jung’s writings. According to Hoekema, “Those who hold this view teach the immortality of the soul but deny the resurrection of the body.”

Materialistic anthropologies, which Hoekema said were more common today, see human beings as composed of material elements. Therefore his or her mental, emotional, and spiritual life is a simple by-product of this material structure. There is no “soul;” no immaterial aspect of human nature. So-called “mental” illnesses are simply biochemical imbalances. God is a projection of the human mind, which is itself wholly an evolutionary phenomenon. Both Sigmund Freud and B.F. Skinner articulated views of human nature consistent with materialistic anthropology.

These two categories of anthropology, idealistic, and materialistic, emphasize one aspect of humanity at the expense of others. Idealistic anthropologies accentuate one’s soul or reason, while minimizing the full reality of his/her material structure. Materialistic anthropologies absolutize the physical part while denying the reality of what we see as the “mental” or “spiritual” side of humans. Both of these errors proceed from a marginalization or denial of the existence of God; and a failure to consider how humans are related to Him. Where these anthropologies view one aspect of human existence to be ultimate and apart from any dependence upon God, they are guilty of idolatry. As Oswald Chambers has said, “The disposition of sin is not immorality and wrong-doing, but the disposition of self–realization—I am my own god.” So what motivates humans to do what we do—the same thing at times. We want to be independent from God.

An awareness of what it means to be created in the image of God and to hold to it even when non-Christian anthropologies seem persuasive in their explanatory power is essential for a biblical view of the modern social sciences. Its application extends beyond just anthropology and psychology to political science, economics, and history.

12/11/15

If I Get to Sixty Four

© Verbaska | Dreamstime.com

© Verbaska | Dreamstime.com

There is some surprising news going around about middle-aged white Americans and it has nothing to do about presidential politics and Donald Trump. Two Princeton economists published a report showing that the “all-cause” mortality rate for middle-aged whites (men and women) has dramatically increased between 1999 and 2013. This increase was largely driven by increased death rates from drug and alcohol poisonings, suicide, chronic live diseases and cirrhosis. While all education groups saw increases in mortality from suicide and poisonings, individuals with lower amounts of education had the most marked increases.

Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population.

Several news outlets have commented on this startling report, including The New York Times and NPR. Just a thought: I wonder how many of the reporters are white middle-aged Americans.

The Princeton economists are husband and wife: Dr. Angus Deaton and Dr. Anne Case. Deaton just won the 2015 Nobel Prize in Economics. They said they stumbled on their finding by accident. They were looking at health and mortality data from the Centers for Disease Control and Prevention (CDC) and other sources that asked people about their levels of pain, disability and general ill health. Deaton was looking at statistics on suicide and happiness. Case was investigating poor health, including chronic pain. She herself has suffered from chronic disabling lower back pain for 12 years.

Dr. Deaton noticed the high rates of suicide for middle-aged whites in national data sets, and that the all-cause mortality in this group was rising. He and Dr. Case realized suicides alone would not be enough to push up the overall death rates, so they began to look at other causes of death. “That led them to the discovery that deaths from drug and alcohol poisoning also increased in this group.” NPR quoted Deaton as saying: “Pretty quickly, we started falling off of our chairs because of what we found.”

 There was this extraordinary turnaround, which is sort of something like – you would say the ship’s been going in this direction for a very long time, and then all of a sudden, it just reverses and goes the other way. And when we saw this, that was the thing that sort of really thought, oh, my goodness, we have something here that we really haven’t seen before.

In their report, Case and Deaton said this increased mortality is only partly understood. Increased availability of opioid painkillers began in the late 1990s. The tighter control on opioid prescriptions could have led to some substituting heroin. At the same time there was increased availability, falling prices and better quality with heroin. However, the prevalence of pain, which the opioids were ostensibly to treat, can’t be pointed to as either a cause or an effect for the increase of opioid use. “Both increased rapidly after the mid-1990s.”

Speaking to NPR, Deaton noted how declining mortality statistics were typically viewed as one of those that indicated how well a nation was doing. The following figure, taken from the Case-Deaton report, shows a reversal of the decline in midlife mortality for US whites after 1998. Before that time, the mortality rate had been falling by 2% per year on average. After 1998, while other countries’ mortality rates continued to decline, US rates started to rise. No other country had a similar turnaround.

mortality ratesThey also looked at causes of death and found that three causes of death accounted for the reversal in mortality rates, namely suicide, drug and alcohol poisoning (accidental or intentional), and chronic liver diseases and cirrhosis. All three rose yearly after 1998. For comparison, they added mortality rates for lung cancer and diabetes. Notice how suicides are trending to surpass lung cancer as a cause of death in the near future. “Poisonings overtook lung cancer as a cause of death in 2011.” See the following figure, also taken from the Case-Deaton report.

mortality causeCase and Deaton suggested their findings could help explain recent large increases in Americans on disability. In conclusion, they expressed concern that those now in midlife could age into Medicare with worse health issues than the current elderly. This won’t be automatic, especially if the noted trends are brought under control. “However, addictions are hard to treat … so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded it.”

Ronald Lee, a professor of economics and demography and the director of the Center on Economics and Demography of Aging at the University of California, Berkley said: “Seldom have I felt as affected by a paper. It seems so sad.”

It seems quite apropos to whimsically close this article by listening to the Beatles song, “When I’m Sixty Four.” And who better to sing it given the above commentary than The Apollo Club, an all-white, mostly middle-aged choir.

12/8/15

Another Head for the Hydra

© Vladimir Korostyshevskiy | 123rf.com

© Vladimir Korostyshevskiy | 123rf.com

Belbuca sounds like it is the name for new Italian recipe from a famous chef. Bel Buca sounds like the name of an Italian pop star. But Belbuca is actually the name of a new FDA approved pain medication for chronic pain management from Endo International and BioDelivery Sciences.  And “Bel Buca” actually has a twitter account, with the picture of an attractive blue-eyed dark-haired woman posing as Bel. She doesn’t seem to tweet much, but she follows Dr. Oz and several health and medical accounts, probably to see what they say about the medication she was named after.

The FDA just accepted the New Drug Application for Belbuca in February 2015 and approved it on October 23, 2015. The fast turn around was because the opioid analgesic used for pain relief and the drug delivery mechanism were both approved by the FDA and used for other medications. The opioid is buprenorphine and the drug delivery technology is BioErodible MucoAdhesive (BEMA). BEMA technology is used with buprenorphine in Bunavail, a buprenorphine-BEMA drug from—no surprise—BioDelivery Sciences (BDSI).  Belbuca contains .05 and .1 the amount of buprenorphine in Suboxone and other buprenorphine products like Bunavail used to treat opioid addiction.

Chronic pain relief is a much wider (and more lucrative) market for BioDelivery Sciences, so the sales from Belbuca should easily outpace Bunavail in a short time. BDSI only recorded $1.5 million in sales through the first six months of 2015, according to Jason deBruyn of the Triangle Business Journal. Endo will commercialize, market and sell Belbuca. BDSI is a relatively small company without the sales force to effectively market a drug like Belbuca, which has a large target market. Herein lies the potential problem, from my point of view.

Methadone, the first opioid maintenance medication, began to be used for chronic pain relief in the mid-1990s. By 2009, methadone accounted for almost 1 of every 3 prescription pain medication deaths. Six times as many people died from methadone overdoses in 2009 as did in 1999. The problem seems to have been the result of the length of time it takes methadone to be converted into inactive metabolites within opioid-naïve individuals. See “The Consequences of Ignoring the Past” for more on the problems with methadone as a pain reliever.

While there are some supposed biochemical advantages of buprenorphine over methadone, there is still a real potential for abuse, overdose and death with buprenorphine. It is a partial opioid agonist, meaning it binds to the mu opioid receptor and activates them, but not to the same degree as full agonists like heroin and methadone. It is by activating the mu opioid receptor that opioids exert their analgesic, euphoric and addictive effects. At a certain point, the effects of burprenorphine is said to reach a ceiling and not increase further. Nevertheless, buprenorphine has the potential for abuse and misuse.  See “Is Buprenorphine Just Another Head for the Hydra of Opiate Addiction?” Also see the FDA medication guide for Belbuca.

At lower doses and in individuals who are not dependent on opioids, full agonists (like heroin or methadone) and partial agonists (like buprenorphine) produce effects that are indistinguishable. As doses are increased, both full and partial agonists produce increasing effects.

The adverse reactions highlighted in the Belbuca medication guide include nausea, constipation, headache, vomiting, dizziness and somnolence (drowsiness). Using them along with central nervous system (CNS) depressants may cause “profound sedation, respiratory depression and death.” Benzodiazepines may increase buprenorphine-induced respiratory depression.

The medication guide distinguishes between “CNS depressants” and “benzodiazepines” when they actually fall within the same category as CNS depressants. Benzodiazepines such as diazepam (Valium) and alprazolam (Xanax) and non-benzo sleep medications such as zolpidem (Ambien), eszopicione (Lunesta) and zalepon (Sonata) are all CNS depressants. And by the way, respiratory depression is what happens when someone overdoses on opioids, opiates or a combination of these drugs and the other CNS depressants like benzodiazepines. The accidental overdose potential of buprenorphine does not have a ceiling effect if it is used in conjunction with other CNS depressants like Ambien or Xanax.

When the target market for buprenorphine is dramatically increased from that of individuals seeking medication assisted treatment (MAT) for opioid/opiate addiction to that of individuals with chronic pain issues, there will be an increase in individuals with “buprenorphine-induced respiratory depression,” overdose and death. I expect that what happened when methadone was released to the wider market of chronic pain to be replicated with buprenorphine. Additionally, the discontinuation (withdrawal) syndrome from burprenorphine is anecdotally more severe than heroin and methadone. Regularly over the years I’ve worked with opioid/opiate addicts who have told me they had a much harder time coming off of buprenorphine than heroin or methadone.

The FDA is also looking to approve buprenorphine to treat depression. At this time, the buprenorphine drug formula is only designated as “ALKS-5461” by Alkermes. See “The Coming Depression Apocalypse” for more on this issue. Be aware of the potential adverse reactions and negative consequences from using buprenorphine for chronic pain relief or depression. As bad as the pain or depression can be, don’t jump from the frying pan into the fire with buprenorphine. If you think I’m overstating the risk, go to an open Narcotics Anonymous meeting and strike up a conversation with someone who has misused burprenorphine or who has simply tried to taper off of it after an extended time of using it for MAT.

We now have two approved medical uses for buprenorphine and it’s likely we’ll soon have a third. “Is Buprenorphine Just Another Head for the Hydra of Opiate Addiction?” is looking prophetic. Buprenorphine had just grown a second head and is the process of adding a third head for the Hydra of opiate addiction.

12/4/15

The Brain and God

© NejroN | 123f.com

© NejroN | 123f.com

Have you ever wondered what happens in your brain when you pray or meditate? Andrew Newberg, who is a neuroscientist did wonder. Working with psychiatrist Eugene d’Aquili in the early 1990s, he began using SPECT (single photon emission computed tomography) to photograph brains during religious experiences. They found volunteers from three very different religious groups: Tibetan Buddhist monks, cloistered nuns and Pentecostals who speak in tongues. “If the brain houses such things as souls, they did locate them: Everywhere.”

Newberg first scanned the brains of the monks and the nuns. Their frontal lobes, the part of the brain Newberg referred to as “the attention area” lit up. The thalamus, which is a pea-sized area that sits at the top of the brain stem, also lit up. Among other things, the thalamus sends sensory information to the frontal cortex where “heavy thinking” occurs. “Whatever was happening in meditation, the thalamus was making it feel very real.” But the real surprise was elsewhere in the brain. The parietal lobe, the part of the brain that helps orient us in relation to the things around us, shut down. “The neurological changes were significant and very different from how the human brain normally functions.”

Their sense of time and space was suspended as they entered the peak of their transcendent experiences. The response was almost identical when the nuns prayed and the monks meditated.  An article by John Barry shows a photo of the baseline and meditation states of a praying nun with the parietal lobe showing more yellow, meaning less blood flow activity during meditation. Here is an abstract for the original article in which Newberg published his findings. Here is a later study where Newberg looked at changes in the brain during two different meditation practices done by the same individuals.

This evidence confirmed our hypothesis that the benefits gleaned from prayer and meditation may have less to do with a specific theology than with the ritual techniques of breathings, staying relaxed, and focusing one’s attention upon a concept that evokes comfort, compassion, or a spiritual sense of peace. Of course, the more you believe in what you are meditating or praying about, the stronger the response will be.

However, when Newberg did brain scans on members of a Pentecostal church while they spoke in tongues (glossolalia), there were very different neurological effects. During centering prayer and meditation, there is an increase of frontal lobe activity and a corresponding decrease of parietal lobe activity. Activity in the limbic areas of the brain decreases. This combination generates “a peaceful and serene state of consciousness.” With glossolalia, the frontal lobe activity decreased—the opposite of what happened with the nuns and the monks. Parietal lobe activity increased and frontal lobe activity decreased.

Instead of focusing one’s attention on a specific phrase or ideal [as in centering prayer or meditation], which increases activity in the frontal lobe, the practitioner surrenders voluntary control—and thus a significant degree of ordinary consciousness—by deliberately slowing down frontal lobe activity. This, in turn, allows the limbic areas of the brain to become more active, which neurologically increases the emotional intensity of the experience.

There were changes in several brain structures with the Pentecostal individuals, suggesting there is complex brain activity occurring during glossolalia. Interestingly, both the nuns and the Pentecostals felt the study demonstrated that God could intervene and directly influence the brain.

In an article for the journal Zygon, Newberg said that a number of researchers claim that “because there is a neurological correlate for a religious phenomenon, there is nothing more to that phenomenon.” He observed that the presence of neurobiological activity during a religious phenomenon does not necessarily mean it caused the phenomenon. “That is, if the brain activity changes during a mystical communion with God, it is not clear whether the brain activity caused that experience or responded to that experience.”

In How God Changes Our Brain, Newberg said his research has shown that different parts of the brain produced different experiences of God. These experiences then affect the way we perceive or think about God, the world around us, our minds and even our lives. The frontal lobes “provide us with a logical concept of a rational, deliberate, and loving God.” The limbic system generates an emotionally meaningful experience of God. “If either part of the brain malfunctions, unusual thoughts and perceptions can occur.”

At the other end of the neurological spectrum, if both the frontal cortex and the emotional centers of the brain remain inactive when a person contemplates God, God will hold little meaning or value. This is what we believe happens in the brains of nonreligious individuals, and our preliminary brain-scan studies with atheists points in this direction.

Newberg himself is not religious. He’s Jewish by birth, but does not actively practice Judaism. Nevertheless, his brain research into spiritual and religious practices is fascinating. It is also consistent with a biblical understanding of what’s happening. Newberg himself is helpful here. He commented that a correlation between neurobiological activity and religious phenomenon isn’t necessarily causative. It could be a response to the religious phenomenon. For the biblical Christian, that would be God: “In the beginning God created the heavens and the earth” (Genesis 1:1).

And here we come up against the first-cause argument for the existence of God by Thomas Aquinas.  But I’ll leave that for another time. For further discussion of this topic by philosopher Peter Kreeft, try here. Scroll to the bottom for a ink to an audio lecture on “Arguments for God’s Existence” that includes the text of Kreeft’s article, “The First Cause Argument.”

12/2/15

Deep Brain Problems

© ktsdesign | 123rf.com

© ktsdesign | 123rf.com

Danielle Egan opened her article for Mad in America on the adverse effects of deep brain stimulation (DBS) with a quote from a DBS patient named Jim: “I just want the thing out. . . . It could be harming my brain and it’s certainly doing a lot of psychological harm to me. It’s a very real presence and I can feel the wires under my skull and at my neck. After two years of this, I just want to be done with it.” Jim is one of around 272 people worldwide who have had these experimental implants to treat psychiatric disorders such as depression, OCD and Tourette’s syndrome.

Egan has been investigating DBS and writing about individuals who have had the surgery for a number of years. Jim is just one of several people she’s met and interviewed. You can read about several of these individuals on her website under the “neuroscience” heading of her blog. The first DBS surgical procedure for depression occurred in 2003. It has been used and approved previously as a treatment for movement disorders like Parkinson’s. At first, the news about this technique was almost wildly positive. See “Deep Brain Jolts.”

In a 2005 interview for the NPR program “All Things Considered,” Dr. Helen Mayberg, reported that four out of six patients were relieved of intractable depression with her DBS procedure. “At six months, the four patients that responded to this treatment were actually near remission … meaning they weren’t just better, they were well.” Mayberg and her research colleagues reported their finding in the March 2005 issue of Neuron. Reporting on Mayberg’s research for Scientific American, John Horgan attended a lecture she gave in March of 2014 where she was still describing promising results. But according to Horgan, she “buried the lead” by mentioning midway through her talk that a multi-center trial of her method of DBS had been halted by the FDA.

This meant that the FDA suspended the BROADEN trial because it failed a “futility analysis,” meaning it did not appear to have a reasonable chance of improving upon current treatments.

As Egan related in her article, advocates of DBS still have no clear sense of what its mechanism of “therapeutic” action is, even though it has been studied since the 1980s. When treating depression, Mayberg’s method targets an area of the brain known as the subgenual cingulate gyrus (Cg25). In theory, DBS is reversible; so it was thought to be a better way to inhibit brain activity than the permanent lesions of psychosurgery. But so-called “micro-lesions” from the surgery and the DBS implants have been found. Long-term studies of Parkinson’s patients treated with DBS have shown they have DBS-related scar formation in their brains. There have been serious mood, behavior and personality changes documented as well.

These include suicide, depression, apathy, fatigue, mania and serious impulse control issues, such as hypomania, aggression, addiction (to gambling, shopping, drugs, alcohol) and hypersexuality, sometimes resulting in criminal behaviour, including pedophilia.

Because of the area of the brain targeted by DBS treatment for psychiatric disorders, the cerebral cortex, the risks are likely to be more pronounced than with Parkinson’s. Within the cerebral cortex are a variety of cognitive functions, such as learning, sorting and rationalizing input from the inner and outer world. It is also the seat of human personality, with associations to mood, decision-making, impulse control and other behaviors.  The Cg25 area is also thought to be linked to self-esteem, motivation, reward-based thoughts and moral decision-making. “Clinical studies have linked tissue damage in the Cg25 with disinhibition, which is associated with frontal lobe brain damage causing poor impulse control.”

Mayberg et al.’s 2005 study did post-operative PET scans showed decreased activity in the Cg25 area, which was believed to be a positive inhibiting effect. But blood flow increased in other areas, especially the brain stem, where mechanisms like heart rate, breathing anxiety and euphoria are regulated. Other studies have shown these blood flow changes to be connected to mania, dementia, psychosis and dissociation.

Returning to Jim, he had no idea that the sponsor of the BROADEN clinical trial he was in terminated it because it failed to reach a benchmark of a 50% response rate as measured by the Hamilton Depression Scale. Beside his cognitive issues, Jim had extreme sleep problems that began about six months post-implant. Eventually he sought out a sleep disorder specialist who diagnosed him with REM Behavior Disorder. This means the brain functions just as it does during consciousness, without the muscle paralysis that come with REM sleep.

“I’d have night terrors and catatonic sleep, like narcolepsy; it would just come over me in the middle of the day and I’d have 20 minutes to get somewhere safe before it took over and knocked me out; my wife couldn’t even wake me up. That happened four or five times per week.”

Eventually Jim returned to his study center to have the device turned off. His thinking began to clear up. His sleep problems almost disappeared. “But I want this thing out.” When he signed up for the trial, his consent from said that DBS was reversible by removing the implant. But when he registered for the followup study, its consent form said: “In some cases the device is not removable.” The complexity of the frontal cortex with its connection with so many other regions of the brain seems to be the reason. The surgeon explained that the leads (wires) from the device may be too tense and “they might have to leave them there.”

Jim had his “explant” surgery, a four-hour surgery instead of a routine one-and-a-half hour outpatient procedure. “I guess the surgeon had to do a bit of prying.” A part of the device that fits into the skull gave the surgeon trouble because bone and tissue had knitted together around it. His head was throbbing; as was the skin around where the pacemaker had been implanted in his chest. I feel like the DBS broke my brain; it broke something in me. . . . But I need to put what happened behind me. I’m just relieved it’s out.”

After John Horgan published his March 2014 story mentioned above, he was contacted by Steve Ogburn, who had also been a patient in the BROADEN trial. He quoted Steve as referring to himself as ‘colatteral damage’ from the study in a May 2014 article. Steve had his surgery at Stanford in November of 2012. He developed severe head pain three months into the study. The leads were 18 inches too long, and had been coiled up in his chest and the top of his head. He could feel them externally. He had “bowstringing” a condition where scar tissue forms around the leads. This has been documented in others DBS cases and can cause permanent complications. He had problems with shoulder and jaw muscle atrophy, spinal accessory nerve palsy and occipital nerve palsy. Steve is pursuing a lawsuit against St. Jude (the medical device company), Stanford University, Stanfords’s IRB (institutional review board), and the neurosurgeon who did the DBS implant. You can watch a 15-minute video of Steve telling his story. A link is embedded in Danielle Egan’s article and in Horgan’s May 2014 article.

In July of 2015 John Horgan reported on a second DBS clinical trial failure, now with the medical device developed by Medtronic. A team from Massachusetts General Hospital led by Darin Dougherty tested 30 subjects with treatment resistant depression; half received DBS and half received a placebo treatment. There was not a significant difference in response rates between the DBS and the placebo subjects. Dougherty said: “The bottom line is that we can’t separate out active treatment from placebo.”

“The Dr. Peter Breggin Hour” podcast for 9.30.15 was a conversation between Peter Breggin and Danielle Egan on many of the issues discussed here and covered in her Mad in America article. The podcast is also available free through iTunes. Egan said in the podcast that after she learned of the original Canadian trial study conducted by Dr. Mayberg (before she went from Canada to Emory University in Atlanta), she tried repeatedly to contact the individuals involved in the Canadian study with no success. It was only in 2015 after Steve Ogburn helped, was she able to interview some of those individuals.

DBS is not going away, despite what is reported here. Emory University published a press release touting the positive results of Mayberg’s continued research with DBS. A woman has a new life, “After three decades of severe depression and trying nearly every treatment, deep brain stimulation helped [her] reclaim her life and regain the ability to feel joy.” Horgan noted that the press release didn’t mention the two failed DBS clinical trials.