Archive for the ‘Addiction’ Category

MASS killers like Elliot Rodger teach society all the wrong lessons about the connection between violence, mental illness and guns — and what we should do about it. One of the biggest misconceptions, pushed by our commentators and politicians, is that we can prevent these tragedies if we improve our mental health care system. It is a comforting notion, but nothing could be further from the truth.

And although the intense media attention might suggest otherwise, mass killings — when four or more people are killed at once — are very rare events. In 2012, they accounted for only about 0.15 percent of all homicides in the United States. Because of their horrific nature, however, they receive lurid media attention that distorts the public’s perception about the real risk posed by the mentally ill.

Anyone who watched Elliot Rodger’s chilling YouTube video, detailing his plan for murderous vengeance before he killed six people last week near Santa Barbara, Calif., would understandably conflate madness with violence. While it is true that most mass killers have a psychiatric illness, the vast majority of violent people are not mentally ill and most mentally ill people are not violent. Indeed, only about 4 percent of overall violence in the United States can be attributed to those with mental illness. Most homicides in the United States are committed by people without mental illness who use guns.

Mass killers are almost always young men who tend to be angry loners. They are often psychotic, seething with resentment and planning revenge for perceived slights and injuries. As a group, they tend to avoid contact with the mental health care system, so it’s tough to identify and help them. Even when they have received psychiatric evaluation and treatment, as in the case of Mr. Rodger and Adam Lanza, who killed 20 children and seven adults, including his mother, in Connecticut in 2012, we have to acknowledge that our current ability to predict who is likely to be violent is no better than chance.

Large epidemiologic studies show that psychiatric illness is a risk factor for violent behavior, but the risk is small and linked only to a few serious mental disorders. People with schizophrenia, major depression or bipolar disorder were two to three times as likely as those without these disorders to be violent. The actual lifetime prevalence of violence among people with serious mental illness is about 16 percent compared with 7 percent among people who are not mentally ill.

What most people don’t know is that drug and alcohol abuse are far more powerful risk factors for violence than other psychiatric illnesses. Individuals who abuse drugs or alcohol but have no other psychiatric disorder are almost seven times more likely than those without substance abuse to act violently.

As a psychiatrist, I welcome calls from our politicians to improve our mental health care system. But even the best mental health care is unlikely to prevent these tragedies.

If we can’t reliably identify people who are at risk of committing violent acts, then how can we possibly prevent guns from falling into the hands of those who are likely to kill? Mr. Rodger had no problem legally buying guns because he had neither been institutionalized nor involuntarily hospitalized, both of which are generally factors that would have prevented him from purchasing firearms.

Would lowering the threshold for involuntary psychiatric treatment, as some argue, be effective in preventing mass killings or homicide in general?

It’s doubtful.

The current guideline for psychiatric treatment over the objection of the patient is, in most states, imminent risk of harm to self or others. Short of issuing a direct threat of violence or appearing grossly disturbed, you will not receive involuntary treatment. When Mr. Rodger was interviewed by the police after his mother expressed alarm about videos he had posted, several weeks ago, he appeared calm and in control and was thus not apprehended. In other words, a normal-appearing killer who is quietly planning a massacre can easily evade detection.

In the wake of these horrific killings, it would be understandable if the public wanted to make it easier to force treatment on patients before a threat is issued. But that might simply discourage other mentally ill people from being candid and drive some of the sickest patients away from the mental health care system.

We have always had — and always will have — Adam Lanzas and Elliot Rodgers. The sobering fact is that there is little we can do to predict or change human behavior, particularly violence; it is a lot easier to control its expression, and to limit deadly means of self-expression. In every state, we should prevent individuals with a known history of serious psychiatric illness or substance abuse, both of which predict increased risk of violence, from owning or purchasing guns.

But until we make changes like that, the tragedy of mass killings will remain a part of American life.

Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College.

http://www.nytimes.com/2014/05/28/opinion/why-cant-doctors-identify-killers.html?_r=0

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Many of us can barely make it through the morning without first downing a cup of hot coffee. It’s become such a big part of our daily rituals that few actually give much thought to what it is that we’re putting in our bodies.

To help us break down the little-known things about caffeine, NPR’s David Greene spoke with Murray Carpenter, author of Caffeinated: How Our Daily Habit Helps, Hurts and Hooks Us. These are the things you probably aren’t thinking about as you wait in line at your local coffee shop.

Caffeine is a drug. Treat it as such.

In its essential form, caffeine is a bitter white powder derived from a natural insecticide found in some plants. Over the years, it became acknowledged as a drug after people independently discovered its stimulating effect.

But, Carpenter says, people often underestimate just how powerful that drug is. “A tablespoon — about 10 grams — will kill you,” he says, recounting the unfortunate story of a college student who went into a seizure and died after chasing down spoonfuls of caffeine with an energy drink.

Most of the caffeine in soft drinks comes from factories in China.

Naturally extracted caffeine is burned out from heated-up coffee beans. But most of the caffeine used in soft drinks is actually synthetically produced in Chinese pharmaceutical plants. After visiting one of these plants — the world’s largest, in fact — Carpenter can only describe it as “sketchy.”

“It was not what I expected,” he says. “It was sort of a rundown industrial park.”

And our favorite caffeinated beverage? Not coffee, but soft drinks.

“Despite the Starbucks on every corner [and] this sort of conspicuous coffee culture that we have today, we’re not drinking as much coffee as our grandparents did,” Carpenter says.

As coffee consumption has declined, our love of soft drinks has taken over. Today, eight of the 10 top-selling soft drinks are caffeinated. “If you look at, say, Coke, Diet Coke, Pepsi, Mountain Dew, Dr. Pepper, the only common denominator, besides carbonated water, is caffeine,” he says.

Sometimes, he says, caffeine can lurk in unexpected places — like orange soda.

Which brings us to the case of the supercharged Sunkist soda.

In 2010, a batch of Sunkist orange soda was bottled with a botched caffeine content. “These were sodas that should’ve had 41 milligrams of caffeine per 12-ounce serving, but they were blended with six times the labeled amount of caffeine,” Carpenter says. “So [there were actually] 240 milligrams per bottle.” That’s as much as three Red Bulls or 16 ounces of strong coffee, Carpenter notes in the book.

After Sunkist started getting complaints from consumers, it finally agreed with the Food and Drug Administration to voluntarily recall the 40,000 cases of supercaffeinated orange soda it had sent out.

“But my impression is that a lot of the people who consumed this and had some funny experiences with caffeine probably didn’t know what was going on,” he adds.

So what’s the takeaway? Drink in moderation.

Carpenter says three to four cups of coffee a day isn’t dangerous over the long term. That’s in line with what we’ve previously reported. Of course, if you’re experiencing symptoms like jitters or sleeplessness related to too much caffeine, cut back.

“For people who are using caffeine moderately … it’s probably perfectly healthy,” he says. “And we know there are some indications that we may even get some benefit out of long-term caffeinated coffee drinking.”

http://www.npr.org/blogs/thesalt/2014/03/13/289750754/wake-up-and-smell-the-caffeine-its-a-powerful-drug

wrie head

42-year-old Ibrahim Yucel has smoked for more than two-and-a-half decades, but he’s trying to give up the habit for his family’s sake. It hasn’t proven an easy task, though, so Yucel has developed a rather extreme way to help him kick the habit — every day, he dons a wire helmet that makes it impossible for him to smoke a cigarette. The Saw-style head cage doesn’t prevent Yucel from wanting a cigarette at work, but since the Turkish father of three leaves the keys to the locked helmet with his wife and kids every day, it does prevent him from following through on the craving.

http://www.geekosystem.com/smoking-head-cage/

stock market

Think of drug lords in America, and it’s likely that you’ll think of emotionally erratic men with harems of coked-up megababes on big yachts in Miami. Or, if you watch a lot of DVD box sets, terminally ill chemistry teachers or Idris Elba. One cliche that probably won’t spring to mind is a polite, educated ex-stockbroker from the UK’s industrial Cheshire.

Shaun “English Shaun” Attwood is an incredibly unlikely ecstasy kingpin. Growing up in Widnes, just outside of Liverpool, Shaun invested in the US stock market when he was young, made his millions, moved to Phoenix, Arizona, started throwing raves, and became a major drug supplier. While he wasn’t planning parties in the deserts of Arizona, he was working in direct competition with the Italian Mafia and alongside the New Mexican Mafia to supply millions of dollars’ worth of ecstasy to the ravers of mid-90s Phoenix.

His motivation for doing all this, besides the fact that partying for a living is a lot more fun than selling shares? He wanted to introduce Americans to the British rave culture he’d grown up with. Unfortunately, as is often the way when you’re handling millions of dollars of narcotics, Shaun was caught and ended up being sent to Maricopa County Jail, widely regarded as America’s toughest prison. Shaun’s been out of jail for a few years, so I called him to see if he’s still so keen to spread the love to the Yanks.

VICE: So you went from being a millionaire stockbroker to becoming a major drug dealer in Arizona. How did that happen?
Shaun Attwood: The Manchester rave scene made such a big impression on me that I decided to transfer that scene to Phoenix, Arizona, after moving over there. After becoming a millionaire as a young person, I had more money than common sense, so I didn’t see the law as an obstacle to my partying or a barrier to bringing tens of thousands of hits of ecstasy into America from Holland.

That was for the Mafia, right? Yeah, I was supplying ecstasy to the New Mexican Mafia. In the beginning, I didn’t know who they were, but it came about because I was a friend of a gang member’s brother. Years later, they were all arrested and the news headlines reported that they were the most powerful and violent Mafia in Arizona at that time, committing murder-for-hire and executing witnesses.

And you were in direct competition with the Italian Mafia member Sammy “The Bull” Gravano—what’s the story with that? Yeah. Years later in prison, his son, Gerard Gravano, told me that he’d been dispatched as the head of an armed crew to kidnap me from a nightclub and take me out to the desert. I’d avoided him that night because my best friend, Wild Man, had got in a fight, and we’d had to leave the club in a hurry.

Talking of clubs, how did the rave scene in America compare with the raves in England at the time? Oh, it was small at first. It took years to catch up. Ecstasy was very expensive—it was $30 a hit in the mid-90s.

Where did you put on your parties? The first one was in a warehouse in west Phoenix owned by the Mexican Mafia, but they were at various different locations after that.

Did selling drugs come after you started putting on raves? It seems like throwing raves is the perfect way of creating a solid customer base. Well, I was selling ecstasy before I started the raves, but they obviously provided more of a market.

How did you find it going from a high-pressure, high-income job to dealing and partying all the time? I enjoyed it at first. There was one rave where I booked Chris Liberator and Dave the Drummer. I remember hearing Chris Liberator’s beats and being mesmerized by the sight of thousands of people dancing to English DJs with the same blissful expressions that I had on my face when I first got into raving. I thought, This is it, I’ve realized my dream. But I started taking too many drugs and got incredibly paranoid because of all the risks I was taking.

That sounds like a familiar story. Did the police get on to you? It was inevitable. Dealing drugs leads to police trouble, prison, or death. I sowed the seeds of my downfall and take full responsibility for landing myself behind bars. Informant statements led to a wiretap, and 10,000 calls were recorded. I rarely spoke on the phone, but they caught me talking about personal use and many of my employees were referencing my name on the phone, which resulted in a conspiracy charge.

What did you make of the media dubbing your organization the “Evil Empire” when you were caught? Did you think it was a bit over the top? My heart went “badum, badum, badum” when I saw the cover of the Phoenix New Times with a portrait of me as Nosferatu on it, which was where they called it the “Evil Empire.” And the cover also had four of my co-defendants, including Wild Man and my head of security, Cody, in the foreground, with my arms encircling them like some evil puppeteer. I couldn’t believe it.

Was this when you were locked up already? It was before I’d been sentenced, and I was worried that there was going to be something in there that might damage my case. I read in there that the prosecutor had classified me as a serious drug offender likely to receive a life sentence, and I went into shock. I’d thought I was getting out, but I was now facing 25 years. If I’d got a life sentence I would have been 58 when I got out, basically at retirement age. But yeah, when I read the article, I felt like some arch-villain from the Marvel comics I collected as a child.

What was your time inside like? Early on, I was with lots of people who were arrested with me, including my large and fearless best friend and raving partner from my hometown of Widnes, Wild Man, who the gangs respected for his fighting skills. He looked out for me. I was split up from my co-defendants after the first year, so then I had to rely on my people skills, Englishness, education, etc., etc.

You wrote blogs inside as well, right? Yeah, that enabled me to make some powerful alliances with characters like T-Bone and Two Tonys, who was a Mafia mass murderer and was serving multiple life sentences. T-Bone was a deeply spiritual, massively built African American who towered over most inmates. He was a prison gladiator and covered in stab wounds. He was a good man to have on your side.

You’ve told me before about the trouble you had with the Aryan Brotherhood as well. Yeah, all the way through my incarceration, I was trying to dodge Aryan Brotherhood predators. They run the white race in the prison system. You have to do what they say or else you get smashed or murdered.

So I take it racism featured quite heavily in the prison that you were in? Yeah, it was completely racially segregated. The way it works there is that, as soon as you walk in, a soldier from your racial gang tells you the rules that are enforced by the head of each race. Disobedience means that you get smashed, shanked or murdered. The rules include stuff like not being able to sit with the other races at the dinner tables or exercise with the other races. But when it comes to drugs, the gangs all deal with each other regardless of race.

I bet there were some pretty nice characters in that environment. God, it was full of scary people. In super maximum security, I lived next door to a serial killer and my first cell mate was a satanic priest with a pentagram tattooed on his head. He was in for murder and was part of a cult that was drinking blood and eating human body parts. Fortunately, he was quite nice to me.

That’s good. So what are you doing with your life now? Are you a reformed character? Yeah, and I credit incarceration with sending my life in a whole new positive direction. I tell my story to schools across the UK and Europe to educate young people about the consequences of choosing the drugs lifestyle in the hope that they don’t make the same mistakes I did. The endless feedback that I get from students makes me feel that the talks are a better way of repaying my debt to society than the sentence I served.

Shaun has written two memoirs, Hard Time and Party Time.

http://www.vice.com/read/i-gave-up-stocks-to-throw-raves-and-sell-drugs

Thanks to SRW for bringing this to the attention of the It’s Interesting community.

soda-glass-120207

The simple choice of whether or not to mix liquor with a diet or regular soda may affect how intoxicated you get, a new study suggests.

In the study, men and women ages 21 to 33 who drank vodka mixed with diet soda had breath alcohol concentrations that were 18 percent higher after 40 minutes compared with people who drank the same dose of vodka mixed with regular soda.

In fact, after three to four drinks, people who used diet soda as a mixer had a breath alcohol level that exceeded the legal limit for an adult operating a motor vehicle. People who used regular soda in their drink did not.

What’s more, people who used diet mixers scored more poorly on a test of reaction time that people who used regular mixers, although both groups reported feeling similar levels of intoxication.

The study was small — just eight men and eight women participated — so more research is needed to confirm the findings. And although results from breath alcohol tests are usually consistent with those from tests of blood alcohol, there can sometimes be a discrepancy between the two methods, so the study should be replicated using blood alcohol tests, the researchers said.

But the findings suggest that diet mixers, although lower in calories, may have insidious effects, said study researcher Cecile Marczinski, an assistant professor of psychology at Northern Kentucky University.

People “think they’re saving some calories by drinking their alcohol with a diet drink, [but] it’s much more harmful to the body to have a high blood alcohol concentration,” Marczinski said.

During the study, the 16 participants came into the laboratory three times, and received either vodka mixed with Squirt, vodka mixed with diet Squirt, or a placebo (Squirt containing a very small dose of alcohol to mimic the appearance and smell of an alcoholic beverage.) Besides the placebo, each drink contained equal amounts of alcohol and mixer. The dose of alcohol in each individual drink was based on the participant’s body weight.

Regular mixers may slow down the time it takes a person to become intoxicated from drinking, the researchers said. Alcohol is absorbed by the body when it reaches the small intestine. But the stomach may treat the sugar in regular mixers as if it were food. As a result, the alcohol doesn’t reach the small intestine as quickly, Marczinski said. The artificial sweeteners in diet soda, on the other hand, may not delay stomach emptying, so the alcohol travels straight through to the small intestine, Marczinski added. An earlier study found that men who drank vodka mixed with a diet beverage had higher blood alcohol levels than men who drank vodka mixed with a regular beverage. Using an ultrasound, the researchers showed that the regular drink delayed stomach emptying, but the diet drink did not.

The new finding “helps people to make an informed decision” about the mixer they chose for their alcohol, said Emma Childs, an assistant professor in the University of Chicago’s Department of Psychiatry, who has researched the effects of alcohol on physiology and behavior, and was not involved in the study.

http://www.livescience.com/26885-diet-soda-alcohol-mixers-intoxication.html

sn-epigenetic

Cigarettes leave you with more than a smoky scent on your clothes and fingernails. A new study has found strong evidence that tobacco use can chemically modify and affect the activity of genes known to increase the risk of developing cancer. The finding may give researchers a new tool to assess cancer risk among people who smoke.

DNA isn’t destiny. Chemical compounds that affect the functioning of genes can bind to our genetic material, turning certain genes on or off. These so-called epigenetic modifications can influence a variety of traits, such as obesity and sexual preference. Scientists have even identified specific epigenetic patterns on the genes of people who smoke. None of the modified genes has a direct link to cancer, however, making it unclear whether these chemical alterations increase the risk of developing the disease.

In the new study, published in Human Molecular Genetics, researchers analyzed epigenetic signatures in blood cells from 374 individuals enrolled in the European Prospective Investigation into Cancer and Nutrition. EPIC, as it’s known, is a massive study aimed at linking diet, lifestyle, and environmental factors to the incidence of cancer and other chronic diseases. Half of the group consisted of people who went on to develop colon or breast cancer 5 to 7 years after first joining the study, whereas the other half remained healthy.

The team, led by James Flanagan, a human geneticist at Imperial College London, discovered a distinct “epigenetic footprint” in study subjects who were smokers. Compared with people who had never smoked, these individuals had fewer chemical tags known as methyl groups—a common type of epigenetic change—on 20 different regions of their DNA. When the researchers extended the analysis to a separate group of patients and mice that had been exposed to tobacco smoke, they narrowed down the epigenetic modifications to several sites located in four genes that have been weakly linked to cancer before. All of these changes should increase the activity of these genes, Flanagan says. It’s unclear why increasing the activity of the genes would cause cancer, he says, but individuals who don’t have cancer tend not to have these modifications.

The study is the first to establish a close link between epigenetic modifications on a cancer gene and the risk of developing the disease, says Robert Philibert, a behavioral geneticist at the University of Iowa in Iowa City. “To the best of my knowledge, no previous genome-wide epigenetics study has taken such efforts from initial discovery to replication to experimental validation,” adds Lutz Breitling, an epidemiologist at the German Cancer Research Center in Heidelberg, Germany.

The work may lead to new ways to asses cancer risks from smoking. “Previous research into smoking has often asked people to fill out questionnaires, … which have their obvious drawbacks and inaccuracies,” Flanagan says. The new study, he says, may make it possible for doctors to quantify a person’s cancer risk simply through an epigenetic analysis of their DNA.

http://news.sciencemag.org/sciencenow/2012/12/smoking-smothers-your-genes.html

Thanks to Dr. Rajadhyaksha for bringing this to the attention of the It’s Interesting community.

 

How far should doctors go in attempting to cure addiction? In China, some physicians are taking the most extreme measures. By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.

In 2004, the Ministry of Health in China banned this procedure due to lack of data on long term outcomes and growing outrage in Western media over ethical issues about whether the patients were fully aware of the risks.

However, some doctors were allowed to continue to perform it for research purposes—and recently, a Western medical journal even published a new study of the results. In 2007, The Wall Street Journal detailed the practice of a physician who claimed he performed 1000 such procedures to treat mental illnesses such as depression, schizophrenia and epilepsy, after the ban in 2004; the surgery for addiction has also since been done on at least that many people.

The November publication has generated a passionate debate in the scientific community over whether such research should be published or kept outside the pages of reputable scientific journals, where it may find undeserved legitimacy and only encourage further questionable science to flourish.

The latest study is the third published since 2003 in Stereotactic and Functional Neurosurgery, which isn’t the only journal chronicling results from the procedure, which is known as ablation of the nucleus accumbens. In October, the journal World Neurosurgery also published results from the same researchers, who are based at Tangdu Hospital in Xi’an.

The authors, led by Guodong Gao, claim that the surgery is “a feasible method for alleviating psychological dependence on opiate drugs.” At the same time, they report that more than half of the 60 patients had lasting side effects, including memory problems and loss of motivation. Within five years, 53% had relapsed and were addicted again to opiates, leaving 47% drug free.

(MORE: Addicted: Why We Get Hooked)

Conventional treatment only results in significant recovery in about 30-40% of cases, so the procedure apparently improves on that, but experts do not believe that such a small increase in benefit is worth the tremendous risk the surgery poses.  Even the most successful brain surgeries carry risk of infection, disability and death since opening the skull and cutting brain tissue for any reason is both dangerous and unpredictable. And the Chinese researchers report that 21% of the patients they studied experienced memory deficits after the surgery and 18% had “weakened motivation,” including at least one report of lack of sexual desire. The authors claim, however, that “all of these patients reported that their [adverse results] were tolerable.” In addition, 53% of patients had a change in personality, but the authors describe the majority of these changes as “mildness oriented,” presumably meaning that they became more compliant. Around 7%, however, became more impulsive.

The surgery is actually performed while patients are awake in order to minimize the chances of destroying regions necessary for sensation, consciousness or movement.  Surgeons use heat to kill cells in small sections of both sides of the brain’s nucleus accumbens.  That region is saturated with neurons containing dopamine and endogenous opioids, which are involved in pleasure and desire related both to drugs and to ordinary experiences like eating, love and sex.

(MORE: A Drug to End Drug Addiction)

In the U.S. and the U.K., reports the Wall Street Journal, around two dozen stereotactic ablations are performed each year, but only in the most intractable cases of depression and obsessive-compulsive disorder and after extensive review by institutional review boards and intensive discussions with the patient, who must acknowledge the risks. Often, a different brain region is targeted, not the nucleus accumbens. Given the unpredictable and potentially harmful consequences of the procedure, experts are united in their condemnation of using the technique to treat addictions. “To lesion this region that is thought to be involved in all types of motivation and pleasure risks crippling a human being,” says Dr. Charles O’Brien, head of the Center for Studies of Addiction at the University of Pennsylvania.

David Linden, professor of neuroscience at Johns Hopkins and author of a recent book about the brain’s pleasure systems calls the surgery “horribly misguided.”  He says “This treatment will almost certainly render the subjects unable to feel pleasure from a wide range of experiences, not just drugs of abuse.”

But some neurosurgeons see it differently. Dr. John Adler, professor emeritus of neurosurgery at Stanford University, collaborated with the Chinese researchers on the publication and is listed as a co-author.  While he does not advocate the surgery and did not perform it, he believes it can provide valuable information about how the nucleus accumbens works, and how best to attempt to manipulate it. “I do think it’s worth learning from,” he says. ” As far as I’m concerned, ablation of the nucleus accumbens makes no sense for anyone.  There’s a very high complication rate. [But] reporting it doesn’t mean endorsing it. While we should have legitimate ethical concerns about anything like this, it is a bigger travesty to put our heads in the sand and not be willing to publish it,” he says.

(MORE: Anesthesia Study Opens Window Into Consciousness)

Dr. Casey Halpern, a neurosurgery resident at the University of Pennsylvania makes a similar case. He notes that German surgeons have performed experimental surgery involving placing electrodes in the same region to treat the extreme lack of pleasure and motivation associated with otherwise intractable depression.  “That had a 60% success rate, much better than [drugs like Prozac],” he says. Along with colleagues from the University of Magdeburg in Germany, Halpern has just published a paper in the Proceedings of the New York Academy of Sciences calling for careful experimental use of DBS in the nucleus accumbens to treat addictions, which have failed repeatedly to respond to other approaches. The paper cites the Chinese surgery data and notes that addiction itself carries a high mortality risk.

DBS, however, is quite different from ablation.  Although it involves the risk of any brain surgery, the stimulation itself can be turned off if there are negative side effects, while surgical destruction of brain tissue is irreversible. That permanence—along with several other major concerns — has ethicists and addiction researchers calling for a stop to the ablation surgeries, and for journals to refuse to publish related studies.

Harriet Washington, author of Medical Apartheid:  The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, argues that by publishing the results of unethical studies, scientists are condoning the questionable conditions under which the trials are conducted. “When medical journals publish research that violates the profession’sethical guidelines, this serves not only to sanction such abuses, but to encourage them,” she says. “In doing so, this practice encourages a relaxing of moral standards that threatens all patients and subjects, but especially  the medically vulnerable.”

(MORE: Real-Time Video: First Look at a Brain Losing Consciousness Under Anesthesia)

Shi-Min Fang, a Chinese biochemist who became a freelance journalist and recently won the journal Nature‘s Maddox prize for his exposes of widespread fraud in Chinese research, has revealed some of the subpar scientific practices behind research conducted in China, facing death threats and, as the New York Times reported, a beating with a hammer. He agrees that publishing such research only perpetuates the unethical practices. Asked by TIME to comment on the addiction surgery studies, Fang writes that publishing the research, particularly in western journals, “would encourage further unethical research, particularly in China where rewards for publication in international journals are high.”

While he doesn’t have the expertise to comment specifically on the ablation data, he says “the results of clinical research in China are very often fabricated. I suspect that the approvals by Ethics Committee mentioned in these papers were made up to meet publication requirement. I also doubt if the patients were really informed in detail about the nature of the study.” Fang also notes that two of the co-authors of the paper are advertising on the internet in Chinese, offering the surgery at a cost of 35,000 renminbi, about $5,600.  That’s more than the average annual income in China, which is about $5,000.

Given the available evidence, in fact, it’s hard to find a scientific justification for even studying the technique in people at all. Carl Hart, associate professor of psychology at Columbia University and author of the leading college textbook on psychoactive drugs, says animal studies suggest the approach may ultimately fail as an effective treatment for addiction; a 1984 experiment, for example, showed that destroying the nucleus accumbens in rats does not permanently stop them from taking opioids like heroin and later research found that it similarly doesn’t work for curbing cocaine cravings. Those results alone should discourage further work in humans. “These data are clear,” he says, “If you are going to take this drastic step, you damn well better know all of the animal literature.” [Disclosure:  Hart and I have worked on a book project together].

(MORE: Top 10 Medical Breakthroughs of 2012)

Moreover, in China, where addiction is so demonized that execution has been seen as an appropriate punishment and where the most effective known treatment for heroin addiction— methadone or buprenorphine maintenance— is illegal, it’s highly unlikely that addicted people could give genuinely informed consent for any brain surgery, let alone one that risks losing the ability to feel pleasure. And even if all of the relevant research suggested that ablating the nucleus accumbens prevented animals from seeking drugs, it would be hard to tell from rats or even primates whether the change was due to an overall reduction in motivation and pleasure or to a beneficial reduction in desiring just the drug itself.

There is no question that addiction can be difficult to treat, and in the most severe cases, where patients have suffered decades of relapses and failed all available treatments multiple times, it may make sense to consider treatments that carry significant risks, just as such dangers are accepted in fighting suicidal depression or cancer.  But in the ablation surgery studies, some of the participants were reportedly as young as 19 years old and had only been addicted for three years.  Addiction research strongly suggests that such patients are likely to recover even without treatment, making the risk-benefit ratio clearly unacceptable.

The controversy highlights the tension between the push for innovation and the reality of risk. Rules on informed consent didn’t arise from fears about theoretical abuses:  they were a response to the real scientific horrors of the Holocaust. And ethical considerations become especially important when treating a condition like addiction, which is still seen by many not as an illness but as a moral problem to be solved by punishment.  Scientific innovation is the goal, but at what price?
Read more: http://healthland.time.com/2012/12/13/controversial-surgery-for-addiction-burns-away-brains-pleasure-center/#ixzz2ExzobWQq

Thanks to Dr. Lutter for bringing this to the attention of the It’s Interesting community.