Category: Medicine

Brain tumor causes uncontrollable laughter

On By A.P.In Bolivia, brain tumor, Burgos Zuleta, hamartoma, laughter, LiveScience, Medicine, Michael Moore, neurologist, Neurology, Neuroscience, neurosurgeon, neurosurgery, seizureLeave a comment

They say laughter is the best medicine. But what if laughter is the disease?

For a 6-year-old girl in Bolivia who suffered from uncontrollable and inappropriate bouts of giggles, laughter was a symptom of a serious brain problem. But doctors initially diagnosed the child with “misbehavior.”

“She was considered spoiled, crazy — even devil-possessed,” Dr. José Liders Burgos Zuleta, ofAdvanced Medical Image Centre, in Bolivia, said in a statement.

But Burgos Zuleta discovered that the true cause of the girl’s laughing seizures, medically called gelastic seizures, was a brain tumor.

After the girl underwent a brain scan, the doctors discovered a hamartoma, a small, benign tumor that was pressing against her brain’s temporal lobe.The doctors surgically removed the tumor, and the girl is now healthy, the doctors said.

The girl stopped having the uncontrollable attacks of laughter and now only laughs normally, the doctors said.

Gelastic seizures are a form of epilepsy that is relatively rare, said Dr. Solomon Moshé, a pediatric neurologist at Albert Einstein College of Medicine in New York. The word comes from the Greek word for laughter, “gelos.”

“It’s not necessarily ‘hahaha’ laughing,” Moshé told Live Science. “There’s no happiness in this. Some of the kids may be very scared,” he added.

The seizures are most often caused by tumors in the hypothalamus, especially in kids, although they can also come from tumors in other parts of brain, Moshé said. Although laughter is the main symptom, patients may also have outbursts of crying.

These tumors can cause growth abnormalities if they affect the pituitary gland, he said.

The surgery to remove such brain tumors used to be difficult and dangerous, but a new surgical technique developed within the last 10 years allows doctors to remove them effectively without great risk, Moshé said.

The doctors who treated the girl said their report of her case could raise awareness of the strange condition, so doctors in Latin America can diagnose the true cause of some children’s “behavioral” problems, and refer them to a neurologist.

The case report was published June 16 in the journal ecancermedicalscience.

Thanks to Michael Moore for sharing this with the It’s Interesting community.

http://www.cbsnews.com/news/girls-uncontrollable-laughter-caused-by-brain-tumor/

U.S. health care system ranks lowest in international survey

On By A.P.In healthcare, Medicine, Pete Cuomo1 Comment

The U.S. spends more money on health care compared with other industrialized countries, but Americans still get the least bang for their buck — and many still don’t have access to care — according to a report just published by the Commonwealth Fund. The report from the private health care research foundation examined data on expenditures, delivery and access to health care services among 11 industrialized countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S.

Overall, the U.K. and Switzerland were rated highest for factors that included quality, access, efficiency and equity of health care. The U.S., Canada and France overall ranked lowest. The U.S. was found to perform worst in areas concerning cost of care, efficiency, equity and overall health of its citizens, even though health care expenditures were highest per capita compared with the other 10 countries in the report.

In 2011, the U.S. spent $8,508 per capita in health care expenditures, compared with $3,405 per capita in the U.K., which was the country with the highest ranked health care system overall.

“Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking,” write the authors in the report. “The nation’s substantial investment in health care is not yielding returns in terms of public satisfaction or health outcomes.”

For quality of care assessment, the authors ranked countries in categories such as effectiveness, safety and coordination of care. Norway and Sweden performed lowest overall for these factors, while the U.K., Australia and Switzerland were rated highest.

Though the U.K. scored best in most categories, the country ranked second worst after the U.S. in terms of the health of its residents. This was based on factors such as adult and infant mortality rates, receptiveness to medical services and life expectancy at age 60. Citizens of France, Sweden and Switzerland were found to be healthiest overall.

The authors of the report note that the U.S. stands apart from other industrialized countries because it does not offer universal health insurance, meaning lower income individuals often don’t have sufficient access to health care — especially preventive medicine — compared with other countries.

However, universal health care has its drawbacks. In Canada, for example, health care may pose little financial burden but this often means patients must wait longer for needed services.

Though the Affordable Care Act in the U.S. has improved access to medical services for many in this country, researchers say is still too early to tell if these new health care policies will improve the overall health of Americans.

“These results indicate a consistent relationship between how a country performs in terms of equity and how patients rate other dimensions of performance: the lower the performance score for equity, the lower the performance on other measures,” the authors write in their report. “This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet needs for the average citizen.”

The report, now in its fourth year, used data from the Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults; the Commonwealth Fund 2012 International Health Policy Survey of Primary Care Physicians; and the Commonwealth Fund 2013 International Health Policy Survey. The report from 2013 is based on surveys of more than 20,000 adults about health care experiences in their respective countries. Additionally, the researchers incorporated data from the World Health Organization and the Organization for Economic Cooperation and Development.

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

http://www.cbsnews.com/news/u-s-health-care-system-ranks-lowest-in-international-survey/

Parkland psych ER is again scene of patient abuse

On By A.P.In antisocial personality, assault, Crime, Dallas, Dallas Morning News, Dallas Police Department, Human Behavior, Medicine, mental health, mental illness, Neuropsychiatric Disease, Parkland Memorial Hospital, Parkland Memorial Hospital psychiatric emergency room, psychiatrist, Psychiatry1 Comment

Parkland Memorial Hospital said the patient-gagging incident in the psychiatric emergency room was discovered on April 8 during a routine review of security video from March 16. Parkland notified the Texas health department within a day, it said, in compliance with regulations.

By MILES MOFFEIT AND BROOKS EGERTON

The psychiatric patient spat at Parkland Memorial Hospital staff as they strapped her into a chair. Then a nurse shoved a toilet paper roll into her mouth, while a co-worker put a sheet over her head.

“Blood stains can be seen on the toilet tissue” after its removal, says a police report that describes security camera footage. A follow-up report says a third employee warned the caregivers that their actions were “illegal.”

Texas health authorities are investigating the March incident — the first abuse in Parkland’s psychiatric emergency room to become public since the hospital hired a new chief executive. One nurse involved in the gagging was also involved in the 2011 restraint of a psych ER patient whose death triggered a federal investigation and virtual takeover of Parkland.

State health regulations prohibit restraint that obstructs a psychiatric patient’s airway or ability to communicate. A prior state enforcement action against Parkland requires hospital managers to report patient abuse within two days of becoming aware of it.

Parkland reported the gagging incident more than three weeks after it occurred. The hospital said managers didn’t know about it initially but acted promptly once they did.

“Employees on site did not elevate this incident appropriately,” Parkland spokeswoman April Foran said. The hospital fired two of five employees who were present during the restraint, she said. Two others resigned, and a fifth “received corrective action.”

Parkland, which collects hundreds of millions of dollars a year from Dallas County taxpayers, would not name the employees. But The Dallas Morning News confirmed the identities of two: Charles Enyinna-Okeigbo, the nurse who forced the toilet paper roll into the patient’s mouth, and Sherwin De Guzman, a supervising nurse.

Authorities have previously investigated both nurses: Enyinna-Okeigbo for domestic violence, and De Guzman in connection with the 2011 death of psych ER patient George Cornell. State and federal regulators found that Cornell was illegally restrained shortly before dying. They cited De Guzman for failing to supervise the technicians who subdued Cornell.

Parkland’s in-house police department investigated the March incident and asked the Dallas County district attorney’s office whether assault charges should be filed. A prosecutor said that the use of force was “unfortunate” but not criminal.

Both nurses declined to comment to The News. Enyinna-Okeigbo told police that he was merely trying to stop the spitting and was not angry with the patient, according to Parkland records.

UT Southwestern Medical Center, whose physicians supervise care at the public hospital, identified the psychiatrist in charge as Dr. Uros Zrnic. He “was not informed or aware of the incident until the videotape was reviewed” in April, UTSW said.

Terrified patient

Experts criticized Parkland after reading police reports on the latest incident at The News’ request.

“When a patient spits, it’s the last resort of a terrified human being, and being restrained like this is terrifying,” said Dr. Peter Breggin, a New York psychiatrist and former consultant for the National Institute of Mental Health.

“Trained mental health workers in this day and age know that spitting is a cause for staff to back off,” he said, adding that forcing objects into patients’ mouths can escalate violence. “There’s no excuse for this abuse.”

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said some Parkland psych workers “still don’t get it.”

“This is pretty outrageous when it was just a few years ago that these kinds of actions were supposed to trigger training and other safe approaches at Parkland,” Borel said. “Everything in the patient’s behavior indicates she was desperately trying to protect herself, and they were making it worse. They failed the patient miserably.”

The state health department hit Parkland in 2012 with a $1 million fine because of Cornell’s death and several other “egregious deficiencies.” It was by far the largest hospital fine in Texas history.

Under a settlement, the hospital paid $750,000. It can avoid paying the rest if, by later this summer, it demonstrates compliance with safety requirements.

Because of the gagging incident, regulators are investigating whether there have been more “significant, egregious deficiencies and a failure to correct them or an attempt to hide them,” said health department spokeswoman Carrie Williams. “It’s an open investigation, and there have been no findings in this case so far.”

Parkland also remains under a 2013 corporate integrity agreement with the U.S. Department of Health & Human Services. It requires periodic reports on patient safety, among other steps.

Compliance with that agreement is a top stated priority of Dr. Fred Cerise, Parkland’s new chief executive. He started work about a week after the March gagging incident.

Cerise and other hospital officials declined to be interviewed for this report. In written responses to questions, Parkland said “the event was discovered” on April 8 during a routine review of security video from March 16. Parkland notified the Texas health department within a day, they said, in compliance with state regulations.

Parkland also said that in addition to taking personnel actions, it now requires video reviews of restraints within 24 hours. But it would not say whether it previously had a schedule for reviewing the security videos, or why it took more than three weeks to detect the gagging incident.

Quick investigation

The criminal investigation lasted less than 48 hours before the case was closed as “unfounded,” police reports show. A News investigation last year found that Parkland police have a history of quickly closing cases in which hospital employees are accused of abuse.

The hospital released nine pages of reports on the investigation, blacking out the names of employees and the patient. It released no information about why the patient was in the psych ER or whether she was injured in the restraint incident. There is no indication in the records that police tried to interview the woman.

When asked, the hospital spokeswoman told The News that “Parkland made multiple attempts to locate the patient” but failed.

The reports contain conflicting versions of what led to strapping the patient to the chair.

Enyinna-Okeigbo told police the woman became “extremely agitated” while in a common area of the psych ER. He said he gave her medication to calm down, but it didn’t work. When staff then directed her toward seclusion rooms, she began to “spit, swing, and kick at the staff,” police wrote, summarizing Enyinna-Okeigbo’s account.

A fellow caregiver who was interviewed “does not recall seeing the patient strike or attempt to strike any staff members,” a police report says. This caregiver also said he didn’t recall seeing the toilet paper roll put into the patient’s mouth or any bleeding. He denied covering the patient’s face with the sheet. The police report noted that “video of the incident contradicts this.”

The reports quote another staffer as saying he saw the bleeding and thought the patient had been “struck by a nurse.” He described the scene as “very chaotic” and said employees lacked training for such situations.

The police description of video footage begins as the patient resists efforts to strap her into a restraint chair: “She appeared to be acting aggressively toward to the medical staff, including spitting on multiple occasions in the direction of the staff.”

Five staffers approached the woman, including one who “immediately placed the roll of toilet tissue over the patient’s mouth,” a report says. “The patient began to resist,” leading Enyinna-Okeigbo to “shove the end of the roll into the patient’s mouth, at one point even appearing to force the patient’s jaw open to completely insert the roll.”

Then another employee secured the sheet around the patient’s head, and the bloody toilet paper was removed from her mouth. Next, a surgical mask was put on the patient. It, too, later showed blood stains.

A Parkland officer met with Assistant District Attorney Craig McNeil on April 10 to discuss potential criminal charges against Enyinna-Okeigbo. “McNeil stated that he felt the culpable mental state exhibited was negligence, and the mental state that has to be met for assault is reckless,” a police report says. “Therefore, McNeil stated that he did not feel that [Enyinna-Okeigbo] met the culpable state to be charged with a crime.”

McNeil told The News he did not know why the hospital didn’t consider charges against the staff member who put the sheet around the patient’s head. Foran, the Parkland spokeswoman, said hospital police gave the DA’s office “complete details” of the incident and noted that prosecutors have “full discretion” about how to proceed.

No assault

The News became aware of the incident on May 28 and asked Parkland for all related police reports. That same day, a Parkland detective asked McNeil for a written explanation of his reasoning, which the hospital gave The News.

“The use of force against a patient in an altered mental state is always unfortunate and should be avoided,” McNeil wrote. But it “does not appear to have been done with the intent to harm the patient.”

In an interview with The News, McNeil identified Enyinna-Okeigbo as the nurse who stuffed the toilet paper roll into the patient’s mouth.

The prosecutor said that spitting could be considered assault because of the potential for disease transmission. In using that term, he said, he did not mean to suggest that the patient should be charged with assault but added: “You have the right to defend yourself.”

McNeil said he could not tell from the video why the patient had blood in her mouth. He said he saw no footage of the patient being struck.

McNeil handled a 2011 case in which security video showed Parkland psychiatric technician Johnny Roberts choking a patient into unconsciousness. The hospital fired Roberts, but grand jurors declined to indict him.

“I was not happy about that,” McNeil said. “I still don’t know why they did that.”

Troubled pasts

The News’ reporting of George Cornell’s death ultimately led to a regulatory crackdown and two years of round-the-clock federal monitoring of Parkland.

The hospital installed security cameras — the same ones that captured the recent gagging incident. It also promised to fire problem employees and retrain others, especially on patient restraints.

Parkland would not say whether Enyinna-Okeigbo or De Guzman received this training.

De Guzman left his job at Parkland at some point after Cornell’s death in February 2011. He returned to work later the same year, according to hospital employment data. Parkland would not explain his departure or return.

Cornell’s death also led to a federal civil rights lawsuit that’s still pending against the hospital, UTSW, De Guzman and other caregivers. In court records, Cornell’s family has noted ways that regulators found fault with De Guzman.

Enyinna-Okeigbo, who was hired at Parkland in 2005, was charged with misdemeanor assault of his wife in 2008.

Dallas County prosecutors initially proposed a deal under which he could plead guilty and serve probation, court records show. Instead, for reasons the records don’t explain, they dismissed the charge in exchange for his completion of an anger management class. He never entered a plea and has no conviction record.

Parkland would not say whether it was aware of the allegations against Enyinna-Okeigbo. The hospital said that before 2011 it conducted criminal background checks only on prospective employees. It said it now checks existing employees, too.

In 2013, Parkland hired privately owned Green Oaks Hospital to manage its psychiatric services. Green Oaks, which receives $1.1 million a year under the deal, declined to comment for this report. Parkland would not discuss the company’s performance.

http://www.dallasnews.com/investigations/20140614-parkland-psych-er-is-again-scene-of-patient-abuse.ece

Arizona store employee discovers brain tumor after he’s pistol-whipped

On By A.P.In Arizona, brain tumor, Crime, Dave Alsup, Ed Payne, Human Behavior, Jerimiah Willey, pistol-whip, ViolenceLeave a comment

brain tumor

By Ed Payne and Dave Alsup

Call it a mixed blessing — one that may have saved an Arizona convenience store employee’s life.

When Phoenix Circle K manager Jerimiah Willey was pistol-whipped during a robbery last month, he landed at St. Joseph’s Hospital with a head injury that required eight staples.

“He hit me in the head twice. … and then throughout the whole thing, he was nudging me with the gun,” Willey told CNN affiliate KTVK.

The hospital did a CT scan while he was there and discovered something far worse — a massive and potentially life-threatening brain tumor.

“They said that had this not been found and soon around the time that it was found, that he probably just would have gone to sleep one night and not been able to wake up,” his wife, Alisha Willey, told the affiliate.

He is recovering from the first of what’s expected to be three brain surgeries.

“It’s our understanding, that because of the size, we believe there’s going to be two more surgeries,” his mother-in-law, Rose Gould, told CNN.

The surgery has left him partially paralyzed, with slurred speech and some loss of hearing. He’s undergoing therapy.

Although the road ahead for the Willeys and their three children is uncertain, they’re hopeful that the slow-growing tumor is benign and was caught before it was too late.

A fund has been set up to help pay for the family’s medical expenses.

“It’s hard to be thankful to somebody who was so violent,” Alisha Willey said. “I’m just very blessed that my husband is still alive and that it wasn’t over that morning.”

http://www.cnn.com/2014/06/13/us/arizona-beating-brain-tumor/index.html

Genetically Modified Mosquitos Could Eradicate Wild Populations By Only Producing Male Offspring

On By A.P.In Andrea Crisanti, Anopheles gambiae, cloning, DNA, gene, genetic modification, genetically modified, Imperial College London, Lisa Winter, malaria, Medicine, mosquito, Nature, Nature Communications, Nikolai Windbichler, Roberto Galizi, Science1 Comment

by Lisa Winter

Over 200 million people are infected by malaria each year, and the majority of the 627,000 deaths per year are children younger than five. The disease is carried by mosquitos who act as vectors for the parasite. It’s only transmitted to humans by female mosquitoes, as they’re the only ones who bite. A team of researchers led by Andrea Crisanti of the Imperial College London managed to genetically modify mosquitos to produce 95% male offspring, eliminating mosquito populations along with the risk of malaria. The results of the study were published in Nature Communications.

In most species of mosquito, the females need a blood meal in order to acquire the nutrients to create viable eggs. When she does, she can lay about 200 eggs at a time in water, and up to 3,000 eggs over the course of her lifetime. About half of those offspring will be daughters, many of whom will live long enough to produce that amount of offspring also. For humans living near mosquitos carrying the parasite that causes malaria, those numbers of female mosquitos present a very real threat.

But what if the numbers could be skewed so that the sex ratio favors males, who are harmless to humans? This is exactly what Crisanti’s team set out to do with Anopheles gambiae, a species of mosquito endemic to sub-Saharan Africa, where 95% of malaria deaths occur. The researchers modified the males with the enzyme I-Ppol, which excises the X chromosome during spermatogenesis. This renders sperm that would produce daughters to be non-functional, while the sperm that will create male offspring are unaffected. As a result, about 95% of the resulting offspring are male.

Next, modified males were introduced to five caged wild-type populations. As the males mated with the females, they passed along the same mutation until it dominated the population. For four of the five populations, it took only six generations for the mosquitos to die out due to a lack of females.

“What is most promising about our results is that they are self-sustaining,” co-author Nikolai Windbichler said in a press release. “Once modified mosquitoes are introduced, males will start to produce mainly sons, and their sons will do the same, so essentially the mosquitoes carry out the work for us.”

This study was the first to successfully manipulate mosquito sex ratios, and it was done in a big way. The researchers hope that this information will be used to develop genetic mutations to be used in the wild, bringing large populations of mosquitos to their knees.

“The research is still in its early days, but I am really hopeful that this new approach could ultimately lead to a cheap and effective way to eliminate malaria from entire regions,” added lead author Roberto Galizi. “Our goal is to enable people to live freely without the threat of this deadly disease.”

Of course, while eradicating the mosquitos would be fantastic for eliminating the threat of malaria, what other affects would it have? Wouldn’t there be harsh consequences for the ecosystem? After all, mosquitos have been on the planet for about 100 million years and represent 3,500 species. As it turns out, mosquitos wouldn’t really be missed if they were to disappear (http://www.nature.com/news/2010/100721/pdf/466432a.pdf). While mosquitos can act as pollinators as well as a food source for other animals, their absence would be merely a temporary setback before another species filled the niche. Of course, there is a gamble in assuming the replacement organism would be harmless.

“Malaria is debilitating and often fatal and we need to find new ways of tackling it. We think our innovative approach is a huge step forward. For the very first time, we have been able to inhibit the production of female offspring in the laboratory and this provides a new means to eliminate the disease,” Crisanti explained.

Each year, sub-Saharan Africa loses about $12 billion in economic productivity due to malarial infections. Considering developed areas in these countries have per capita incomes of about US$1500, this would have very real implications for the quality of life for people in those areas. Eliminating that disease would also allow doctors and hospitals to address other health concerns, and the environment would likely benefit from not having to use insecticides.

http://www.iflscience.com/health-and-medicine/gm-mosquitos-could-eradicate-wild-populations-only-producing-male-offspring

NIH Report Warns of Looming Physician-Scientist Shortage

On By A.P.In David Ginsburg, Dr. Lutter, Medicine, National Institutes of Health, NIH, NIH funding, physician, physician-scientist, Princeton University, Science, scientist, Shirley Tilghman, University of Michigan1 Comment

Recently the mainstream has come to embrace the fact that the job market for Ph.D. biomedical researchers is overcrowded. According to a new report from a working group of the National Institutes of Health (NIH) Advisory Committee to the Director (ACD), the job market looks very different for physician-scientists. In fact, “[t]here may not be enough [physician-scientists] to replace those preparing to retire,” Jocelyn Kaiser reports in a ScienceInsider.

The working group analyzed data on “M.D.-Ph.D.s, M.D.s, nurses, and other researchers with clinical training” collected from an American Medical Association (AMA) survey, finding—in stark contrast to trends in the number of biomedical Ph.D. graduates—that “[t]he number of physicians conducting research has declined 5.5% since 2003 to about 13,700 in 2012.” The working group also analyzed data from NIH and AMA and found that many NIH-funded principal investigators (PIs) are in their 60s and 70s, and that the number of PIs under 60 is declining.

The data have fueled concern for the future of the physician-scientist population. The need for younger physician-scientists is getting more attention because “we’re worried that they’re [physician-scientists are] going to dry up and this is going to be a serious problem,” said working group co-chair David Ginsburg of the University of Michigan, Ann Arbor, in a call with reporters, as quoted by Kaiser.

Kaiser notes that some of the working group’s recommendations for fixing these problems echo those of the 2012 Biomedical Workforce Working Group of the ACD, led by Princeton University molecular biologist Shirley Tilghman: Enrich training programs, and give more weight to proposals from young researchers. “It also recommends creating a category for physician-scientists within the so-called kangaroo, or K99/R00, awards—two-stage awards that include a training grant and research support,” Kaiser writes.

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

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2014_06_10/caredit.a1400145

New Report Blasts DEA For Spending 4 Decades Obstructing Marijuana Science

On By A.P.In cannabinoids, cannabis, Cannabis sativa, DEA, Dr. Lutter, drug abuse, Drug Enforcement Agency, drug policy, Drug Policy Alliance, Drugs, Ethan Nadelmann, marijuana, Matt Ferner, Medicine, Multidisciplinary Association for Psychedelic Studies3 Comments

by Matt Ferner

The Drug Enforcement Administration has been impeding and ignoring the science on marijuana and other drugs for more than four decades, according to a report released this week by the Drug Policy Alliance, a drug policy reform group, and the Multidisciplinary Association for Psychedelic Studies, a marijuana research organization.

“The DEA is a police and propaganda agency,” Ethan Nadelmann, executive director of the Drug Policy Alliance, said Wednesday. “It makes no sense for it to be in charge of federal decisions involving scientific research and medical practice.”

The report alleges that the DEA has repeatedly failed to act in a timely fashion when faced with petitions to reschedule marijuana. The drug is currently classified as Schedule I, which the DEA reserves for the “most dangerous” drugs with “no currently accepted medical use.” Schedule I drugs, which include substances like heroin and LSD, cannot receive federal funding for research. On three separate occasions — in 1973, 1995 and again in 2002 — the DEA took years to make a final decision about a rescheduling petition, and in two of the cases the DEA was sued multiple times to force a decision.

The report criticizes the DEA for overruling its own officials charged with determining how illicit substances should be scheduled. It also criticizes the agency for creating a “regulatory Catch-22” by arguing there is not enough scientific evidence to support rescheduling marijuana while simultaneously impeding the research that would produce such evidence.

A spokesperson at the DEA declined to comment on the report.

The feds have long been accused of only funding marijuana research that focuses on the potential negative effects of the substance, but that trend appears to be changing.

According to The Hill, the National Institute on Drug Abuse has conducted about 30 studies to date on the potential benefits of marijuana. NIDA oversees the cultivation, production and distribution of marijuana grown for research purposes at the University of Mississippi in the only federally legal marijuana garden in the U.S.– a process through which the only federally sanctioned marijuana studies are approved.

The joint report comes less than two weeks after the House approved three amendments taking aim at the DEA and its ability to enforce federal marijuana and hemp laws in states which have legal marijuana operations and industrial hemp programs. The medical marijuana amendment was sponsored by Rep. Dana Rohrabacher (R-Calif.).

“Nobody should be afraid of the truth,” Rohrabacher said Wednesday. “There’s a lot of other drugs that have harmful side effects. Is the downside of marijuana a harmful side effect? Or is there a positive side that actually does help? That needs to be proven.”

The federal government’s interest in marijuana certainly appears to be growing. Since 2003, it has approved more than 500 grants for marijuana-related studies, with a marked upswing in recent years, according to McClatchy. In 2003, 22 grants totaling $6 million were approved for cannabis research. In 2012, that number had risen to 69 approved grants totaling more than $30 million.

“The DEA has obstructed research into the medical use of marijuana for over 40 years and in the process has caused immeasurably suffering that would otherwise have been treated by low-cost, low-risk generic marijuana,” Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies, said in a statement. “The DEA’s obstruction of the FDA approval process for marijuana has — to the DEA’s dismay — unintentionally catalyzed state-level medical marijuana reforms.”

Currently, 22 states and the District of Columbia have legalized marijuana for medical use. Eight other states — Alabama, Iowa, Kentucky, Mississippi, South Carolina, Tennessee, Utah and Wisconsin — have legalized CBD oils, made from a non-psychoactive ingredient in marijuana frequently used to treat epilepsy, for limited medical use or for research purposes.

A number of recent studies have shown the medical potential of cannabis. Purified forms may attack some forms of aggressive cancer. Marijuana use also has been tied to better blood sugar control and may help slow the spread of HIV. One study found that legalization of the plant for medical purposes may even lead to lower suicide rates.

Nadelmann said the DEA has “demonstrated a regular pattern of abusing its discretionary powers.”

“We believe this authority would be better handled by another government agency in the health realm, or even better still, by an organization that is truly independent, perhaps something that involves the National Academy of Sciences,” he said. “We will be working to encourage greater congressional oversight and also to call for reforms of federal law.”

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

http://www.huffingtonpost.com/2014/06/11/dea-blocks-marijuana-science_n_5482367.html

Mysterious kidney disease plagues Central America

On By A.P.In Central America, chronic kidney disease of unknown origin, CKDu, Costa Rica, creatinina, El Salvador, Elizabeth Landau, Guatemala, Jason Glaser, Juan Salgado, kidney, La Isla Foundation, Medicine, Nicaragua, Reina Turcios-Ruiz, sugarcane1 Comment

kidney 3

By Elizabeth Landau

Juan Salgado was 16 when he started cutting sugarcane, in a town near the Pacific coast of Nicaragua in 1966.

His symptoms began about 35 years later: Fever. Headaches. Poor appetite. Feelings of faintness. For no obvious reason, his kidneys were severely damaged, to the point that doctors said he couldn’t do agricultural work anymore. Many of his friends had it worse.

“I know, many, many workers who were colleagues of mine, who have already died, and I know also many who are not capable of working anymore because of the disease,” said Salgado, now 65, who worked near the town of Chichigalpa, Nicaragua.

The disease is known by scientists as “chronic kidney disease of unknown origin,” or CKDu. In rural communities in Nicaragua, it’s “creatinina,” the Spanish word for creatinine, a biomarker of kidney strength.

At least 20,000 people have died prematurely from this mysterious disease in Central America in the last two decades, according to one estimate, but the real scope of the problem is unknown. The illness is not related to diabetes or hypertension — drivers of kidney disease in the United States — and affects primarily young men.

The disease is concentrated on the Pacific Coast in male agricultural workers, especially those cutting sugarcane. El Salvador, Nicaragua and Costa Rica seem to be hotbeds of the illness.

Scientists believe that a multitude of factors could be contributing to the disease, but that there’s likely at least one factor that is job-related. Making matters tricky, the sugarcane industry has been a provider of funding for major studies on the illness, raising concerns that companies could be influencing the results.

In Salgado’s opinion, the Nicaraguan sugarcane industry players “know well the cause of this disease.”

Jason Glaser, a documentary filmmaker and community advocate, is not as sure. It is not yet clear to scientists and industry leaders what is causing this increased incidence of kidney disease.

La Isla Foundation, which Salgado co-founded with Glaser in 2008, is dedicated to improving the well-being of sugarcane workers with the disease and promoting prevention, and is collaborating with researchers to better understand what’s causing this enigmatic illness. The organization is convening a meeting in July with CDC representatives, and researchers from various institutions to explore possibilities for more research.

“This is a complex problem,” said Dr. Reina Turcios-Ruiz, resident adviser at the Centers for Disease Control and Prevention’s Central America Regional Office in Guatemala. “It’s going to take some time to find an answer, but I think it’s important that we stick to it.”

“None of the scientific investigations that have been made have established a link of causality between the sugar activity in Central America, and therefore our company, and CKD,” Ariel Granera Sacasa, spokesperson for Nicaragua Sugar Estates Limited, said in an e-mail. Nicaragua Sugar Estates Limited is the company that owns Ingenio San Antonio, where Salgado worked for decades.

What is CKDu?

In the United States, a typical patient dies of chronic kidney disease their 70s or 80s, said Daniel Brooks of Boston University School of Public Health. But in Central America, men often get it in their 20s or 30s, and die by their 40s or 50s.

There are no early-stage signs. When patients experience symptoms such as fatigue, pain and high blood pressure, “a lot of the kidney function is already gone,” said Brooks, who has been studying the illness.

“In order to be able to help people, they (screenings) need to be done on people who are asymptomatic,” he said.

Stage 3 is considered chronic kidney disease, Brooks said. Stage 5 is “end-stage” — where the only way to stay alive is to be on dialysis or get a transplant. Different people progress at different speeds.

Kidney dialysis and transplant — both expensive undertakings — are not accessible to many people in Salgado’s region of Nicaragua.

“The people who are mainly affected are poor workers, typically in agricultural situations,” Brooks said. “There’s really not much availability of the treatment options.

“Most people just live ’til they die.”

Out in the fields

Why Pacific regions of Central America are especially affected is a mystery. So is the specific connection to sugarcane cutting.

“Some studies have indicated that greater than 20% of men may have it in the areas where people are employed in sugarcane,” Brooks said, although there are also high rates of the disease reported in miners and stevedores.

To some familiar with the disease, it seems clear that something about sugarcane working conditions is relevant.

“This epidemic is an occupational disease with possibly one or more yet unknown environmental components interacting with occupational dehydration,” said Catharina Wesseling, researcher at the Universidad Nacional in Heredia, Costa Rica, and the Karolinska Institute in Stockholm, who has studied the disease. “The unknown factor(s) may be a pesticide, arsenic, an infectious agent, use of nephrotoxic drugs, or other environmental pollutants. But there is no room for much doubt that chronic dehydration is one major factor.”

Wesseling was co-author on a 2012 study measuring markers of kidney function, including creatinine, in 256 men and 408 women in five communities in El Salvador. They found a correlation between markers of decreased kidney function and people who performed labor on lowland sugarcane and cotton plantations. Men had a higher prevalence, but women may still be at risk, the study authors said.

In a hot climate, performing physically intense labor, agricultural workers are probably facing dehydration, Turcios-Ruiz said. What’s more, it’s common for the workers to drink sugary soft drinks as they toil, which some mice studies suggest could be an exacerbating factor in kidney failure.

“Acute dehydration has been linked to acute kidney injury. But there has not been evidence that repeated dehydration is related to chronic kidney injury,” Turcios-Ruiz said.

There could be a genetic explanation, researchers said. It’s possible that genetics could interact with environmental risk factors, such as those encountered in agricultural work, Wesseling said.

One of Brooks’ next studies will look at genetic susceptibility or predispositions that could affect the likelihood of developing CKDu. Another study will test children and adolescents for kidney damage before adulthood.

Funding controversies

It is troubling that the sugarcane industry is financing research into the causes of CKDu, Wesseling said, because companies have been very resistant to the idea that working conditions could be related.

So far, Wesseling’s research has not incorporated industry funding. She has partnered with La Isla Foundation to study the disease further.

She and colleagues are looking to do a study that will test different hydration and rest-time protocols. You can’t do an intervention without the cooperation of the sugarcane companies, she said. “But you need independent sources to be able to keep your independence.”

Upcoming research by Brooks and colleagues will be partially funded by the sugarcane industry, with the money channeled through the CDC Foundation, a nonprofit established by Congress to connect the Centers for Disease Control and Prevention to other groups and individuals, Brooks said.

“The donors have no involvement in the research beyond providing funding. The CDC Foundation is administering the grants,” according to the CDC Foundation.

There are conflict of interest policies to maintain independence from the funding source, Brooks said. Also, an external advisory board will be established to review the studies.

“CDC is providing technical assistance to Boston University on investigations into chronic kidney disease. Some of these investigations are funded through the CDC Foundation, others are not,” Turcios-Ruiz said.

Brooks’ previous studies also received industry funding — specifically, from Nicaragua Sugar Estates Limited and a professional group to which it belongs, the Comite Nacional de Productores de Azucar.

La Isla Foundation would like to work with sugarcane companies on improving working conditions, provided they acknowledge that working conditions could be contributing to the illness, “and need improvement independent of that,” Glaser said.

What can be done?

The rise of CKDu in Central America, on top of conventional cases of kidney disease, is “overwhelming local health care systems to the point of collapse,” Wesseling and colleagues wrote in 2013 in the American Journal of Public Health. The disease is incredibly expensive, and will break the bank of any ministry of health, said Turcios-Ruiz.

Nicaragua Sugar Estates Ltd. has followed recommendations from Boston University to update its protocols on hydration, rest and shade, Granera Sacasa said, and health and security personnel on the fields has doubled to implement these policies. The company is developing a program that “includes adequate hydration, balanced diet and pauses in the work process to avoid overexertion and fatigue.”

Some sugarcane companies have even started screening employees for the kidney disease biomarker before they start work, Brooks said.

La Isla Foundation is working on evaluating treatment programs and helping improve the quality of health care for people with the disease.

Nicaragua’s health system is “overwhelmed and underfunded,” said Dorien Faber, public health project coordinator for La Isla Foundation. In El Salvador, Faber and Glaser are looking at how adequate care can be delivered to patients with low resources.

“There are two to three funerals a day when people drop off during the dry season,” said Glaser. “It’s just a burden for the people. We want to do something that has nothing to do with politics.”

Nowhere else to work

Salgado is lucky compared to many with CKDu. He has never been on dialysis or needed a kidney transplant. He still has occasional fluctuations in blood pressure, but a low-fat diet and less physical exertion away from the sugarcane fields, have prevented severe kidney failure, according to his colleagues.

Salgado said he receives social security of about $150 a month because he had been working for so long, but did not receive any compensation from his company, he said.

Three of his sons — ages 26, 29, 33 — work in sugarcane. Two operate machines, one is a cutter. His daughter’s husband, who is like a son to him, works in irrigation.

“There is nowhere else to work,” he said. “The whole agricultural area is sugarcane.”

With few jobs in the area, Salgado’s sons have little choice, but he fears for their health.

“I’m afraid because I’ve seen so many young people who are already in advanced stages,” he said.

“I know many young people of almost the age of my children, who have already left Ingenio San Antonio and can no longer work, and who have an advanced illness, and who are truly already candidates for dying.”

http://www.cnn.com/2014/06/11/health/kidney-disease-ckdu/index.html

Losing Weight May Require Some Serious Fun

On By A.P.In Exercise, Medicine, mental health, metabolism, Nature, ObesityLeave a comment

If you are aiming to lose weight by revving up your exercise routine, it may be wise to think of your workouts not as exercise, but as playtime. An unconventional new study suggests that people’s attitudes toward physical activity can influence what they eat afterward and, ultimately, whether they drop pounds.

For some time, scientists have been puzzled — and exercisers frustrated — by the general ineffectiveness of exercise as a weight-loss strategy. According to multiple studies and anecdotes, most people who start exercising do not lose as much weight as would be expected, given their increased energy expenditure. Some people add pounds despite burning hundreds of calories during workouts.

Past studies of this phenomenon have found that exercise can increase the body’s production of appetite hormones, making some people feel ravenous after even a light workout and prone to consume more calories than they expended. But that finding, while intriguing, doesn’t fully explain the wide variability in people’s post-exercise eating habits.

So, for the new study, published in the journal Marketing Letters, French and American researchers turned to psychology and the possible effect that calling exercise by any other name might have on people’s subsequent diets.

In that pursuit, the researchers first recruited 56 healthy, adult women, the majority of them overweight. The women were given maps detailing the same one-mile outdoor course and told that they would spend the next half-hour walking there, with lunch to follow.

Half of the women were told that their walk was meant to be exercise, and they were encouraged to view it as such, monitoring their exertion throughout. The other women were told that their 30-minute outing would be a walk purely for pleasure; they would be listening to music through headphones and rating the sound quality, but mostly the researchers wanted them to enjoy themselves.

When the women returned from walking, the researchers asked each to estimate her mileage, mood and calorie expenditure.

Those women who’d been formally exercising reported feeling more fatigued and grumpy than the other women, although the two groups’ estimates of mileage and calories burned were almost identical. More telling, when the women sat down to a pasta lunch, with water or sugary soda to drink, and applesauce or chocolate pudding for dessert, the women in the exercise group loaded up on the soda and pudding, consuming significantly more calories from these sweets than the women who’d thought that they were walking for pleasure.

A follow-up experiment by the researchers, published as part of the same study, reinforces and broadens those findings. For it, the researchers directed a new set of volunteers, some of them men, to walk the same one-mile loop. Once again, half were told to consider this session as exercise. The others were told that they would be sightseeing and should have fun. The two groups covered the same average distance. But afterward, allowed to fill a plastic bag at will with M&M’s as a thank-you, the volunteers from the exercise group poured in twice as much candy as the other walkers.

Finally, to examine whether real-world exercisers behave similarly to those in the contrived experiments, the researchers visited the finish line of a marathon relay race, where 231 entrants aged 16 to 67 had just completed laps of five to 10 kilometers. They asked the runners whether they had enjoyed their race experience and offered them the choice of a gooey chocolate bar or healthier cereal bar in consideration of their time and help. In general, those runners who said that their race had been difficult or unsatisfying picked the chocolate; those who said that they had fun gravitated toward the healthier choice.

In aggregate, these three experiments underscore that how we frame physical activity affects how we eat afterward, said Carolina O.C. Werle, an associate professor of marketing at the Grenoble School of Management in France, who led the study. The same exertion, spun as “fun” instead of “exercise,” prompts less gorging on high-calorie foods, she said.

Just how, physiologically, our feelings about physical activity influence our food intake is not yet known, she said, and likely to be bogglingly complex, involving hormones, genetics, and the neurological circuitry of appetite and reward processing. But in the simplest terms, Dr. Werle said, this new data shows that most of us require recompense of some kind for working out. That reward can take the form of subjective enjoyment. If exercise is fun, no additional gratification is needed. If not, there’s chocolate pudding.

The good news is that our attitudes toward exercise are malleable. “We can frame our workouts in different ways,” Dr. Werle said, “by focusing on whatever we consider fun about it, such as listening to our favorite music or chatting with a friend” during a group walk.

“The more fun we have,” she concluded, “the less we’ll feel the need to compensate for the effort” with food.

Fasting for three days can regenerate entire immune system, study finds

On By A.P.In ageing, aging, fasting, Food, immune system, Medicine, Sarah Knapton, Science, starvation, Valter LongoLeave a comment

A person’s entire immune system can be rejuvenated by fasting for as little as three days as it triggers the body to start producing new white blood cells, a study suggests.

By Sarah Knapton

Fasting for as little as three days can regenerate the entire immune system, even in the elderly, scientists have found in a breakthrough described as “remarkable”.

Although fasting diets have been criticised by nutritionists for being unhealthy, new research suggests starving the body kick-starts stem cells into producing new white blood cells, which fight off infection.

Scientists at the University of Southern California say the discovery could be particularly beneficial for people suffering from damaged immune systems, such as cancer patients on chemotherapy.

It could also help the elderly whose immune system becomes less effective as they age, making it harder for them to fight off even common diseases.

The researchers say fasting “flips a regenerative switch” which prompts stem cells to create brand new white blood cells, essentially regenerating the entire immune system.

“It gives the ‘OK’ for stem cells to go ahead and begin proliferating and rebuild the entire system,” said Prof Valter Longo, Professor of Gerontology and the Biological Sciences at the University of California.

“And the good news is that the body got rid of the parts of the system that might be damaged or old, the inefficient parts, during the fasting.

“Now, if you start with a system heavily damaged by chemotherapy or ageing, fasting cycles can generate, literally, a new immune system.”

Prolonged fasting forces the body to use stores of glucose and fat but also breaks down a significant portion of white blood cells.

During each cycle of fasting, this depletion of white blood cells induces changes that trigger stem cell-based regeneration of new immune system cells.

In trials humans were asked to regularly fast for between two and four days over a six-month period.

Scientists found that prolonged fasting also reduced the enzyme PKA, which is linked to ageing and a hormone which increases cancer risk and tumour growth.

“We could not predict that prolonged fasting would have such a remarkable effect in promoting stem cell-based regeneration of the hematopoietic system,” added Prof Longo.

“When you starve, the system tries to save energy, and one of the things it can do to save energy is to recycle a lot of the immune cells that are not needed, especially those that may be damaged,” Dr Longo said.

“What we started noticing in both our human work and animal work is that the white blood cell count goes down with prolonged fasting. Then when you re-feed, the blood cells come back. So we started thinking, well, where does it come from?”

Fasting for 72 hours also protected cancer patients against the toxic impact of chemotherapy.

“While chemotherapy saves lives, it causes significant collateral damage to the immune system. The results of this study suggest that fasting may mitigate some of the harmful effects of chemotherapy,” said co-author Tanya Dorff, assistant professor of clinical medicine at the USC Norris Comprehensive Cancer Center and Hospital.

“More clinical studies are needed, and any such dietary intervention should be undertaken only under the guidance of a physician.”

“We are investigating the possibility that these effects are applicable to many different systems and organs, not just the immune system,” added Prof Longo.

However, some British experts were sceptical of the research.

Dr Graham Rook, emeritus professor of immunology at University College London, said the study sounded “improbable”.

Chris Mason, Professor of Regenerative Medicine at UCL, said: “There is some interesting data here. It sees that fasting reduces the number and size of cells and then re-feeding at 72 hours saw a rebound.

“That could be potentially useful because that is not such a long time that it would be terribly harmful to someone with cancer.

“But I think the most sensible way forward would be to synthesize this effect with drugs. I am not sure fasting is the best idea. People are better eating on a regular basis.”

Dr Longo added: “There is no evidence at all that fasting would be dangerous while there is strong evidence that it is beneficial.

“I have received emails from hundreds of cancer patients who have combined chemo with fasting, many with the assistance of the oncologists.

“Thus far the great majority have reported doing very well and only a few have reported some side effects including fainting and a temporary increase in liver markers. Clearly we need to finish the clinical trials, but it looks very promising.”

http://www.telegraph.co.uk/news/uknews/10878625/Fasting-for-three-days-can-regenerate-entire-immune-system-study-finds.html