This recent article in the NYTimes speaks about items sold as supplements which contin medications and other chemical compounds which may or can be hazzardous for human consumption. Unfortunately this article doesnt list the components of a formula called “Pai You Guo”. Serious side effects are listed in the article, and unfortunately the FDA is not able to monitor the safety of many products. Many products of concern are marketed for weight loss and sexual enhancement.

http://www.nytimes.com/2011/08/28/business/supplement-drugs-may-contain-dangerous-ingredients.html?_r=2&emc=tnt&tntemail0=y

For example “Pills marketed as male sexual enhancement supplements often contain sildenafil citrate, the active ingredient in Viagra, or its analogues. But these adulterated pills sometimes contain up to seven times the recommended dose, Mr. Levy says. Another danger: some of the analogues may have never been tested for safety in humans.” this is of concern for men taking medications in which sildenafil is contraindicated….

Though I would imagine products sold at GNC are likely safe, I personally have seen 3 patients in the past 2.5 years who bought weight loss/body building products which exacerbated mania (1) or psychosis (2). Two out of the three pts bought products from GNC.

The following article in the American Journal of Psychiatry on Seritonin and Spiritual Experiences is an extremely small (n=15) Swedish study, funded by the Swedish Research Council, limited to male subjects, which examined presynaptic serotonin receptors (which act as the breaks to serotonin release) and their relationship to self reported transcendent perceptions.

Te study  found an inverse relationship between the binding potential of these receptors and individuals self perception of transcendence.  The article also mentioned individuals differing quantities of serotonin receptor subtypes expression  may effect peoples overall religious expression.

The biochemical effects of serotonin is well understood via the abuse of LSD, mescaline, psilocybin and other hallucinogenic drugs which also cause its users to have ‘spiritual experiences’.

The following link is to e German website which provides information on 380 monographs on herbal medicines for licensed medical prescribing in Germany.  The American Botanical Council provides updated information following the Commission E’s collected information.  This is not entirely evidence based however appears to be a relatively good resource for information on herbal remedies, indications, side effects etc..

 

Enjoy

This month’s Lancet discusses the effectiveness of internet based CBT with a live/real-time therapist showing benefits which last 8 months.

Though unconventional, I am very supportive of this modality of treatment, particularly considering that younger generations are increasingly reliant on the internet to communicate with one another.

“computerised CBT programs, although effective, are inflexible, can be difficult to tailor to individual patient needs, and are associated with low rates of adherence. However, individual CBT can be offered by a therapist online, with instant messaging in which client and therapist communicate in real time with typewritten responses. Possible benefits from this approach include flexibility and optimum use of patient and therapist time, reaching client groups for whom travel to treatment centres is difficult for reasons of geography or disability, and access to foreign language therapists. Some evidence suggests that writing about traumatic events can lead to improvements in health. This approach is acceptable to patients with depression, and therapy without face-to-face contact could encourage greater disclosure.”

This takes ones ED skills of making quick assessments to a new height. Here people receive a few minutes with a psychiatrist or therapist with little or no follow up for a small fee and get their needs met.

I am amazed that it helps some people, but hey who am I to comment on what works for some. I suppose one can look at this as a kind of psychiatric outreach….

I’ve been trying to make sense out of the health care options available to Americans.  Click on this link to watch Dan Roam’s awesome slideshow which breaks the whole mess down into extremely simple digestible parts or view it from here:   Health care slide show

my 2 cents:

-the private insurance industry must either be tightly regulated or have non-profit (cooperative, government) competition, they’re a huge siphon of health care cost (in dollars and MD’s time) and have a conflicting interest in the health of a patient.

-insurance fraud on medicare and medicaid should be investigated and entirely dismantled. the racketeering rings which embezzle millions of American HC dollars yearly would better serve the poor, elderly or disabled whom they originally intend to treat

-tort reform instituted: in my not-yet-2 years of residency I cannot recall the numerous times I heard physicians say… ‘and we have to order xyz’ (to protect ourselves), sad but true…

-electronic medical records which are HIPAA protected and HIGHLY secure.  these records should provide limited information (meds, D/C plan, tests, imaging) to the highest level of health care providers (MD, PA, DNP/DnRP, etc…) FORGET pharmaceutical and insurance companies who will mine info for their profit oriented goals.  this system should trace every single person who logs into the system, what they look at, and hold them accountable (liable) for breaking HIPAA laws.  its ridiculous that medicine is decades behind the technology of the banking and legal professions.  a system like this would benefit larger metropolitan areas where pts may hospital jump, or recieve most of their care at one place but for various reasons receive emergent care at another hospital.  in the case of psychiatry, this can be an invaluable tool:  when pts come into the CPEP they often are not able to provide an accurate history.  Thus to know where a patient gets their care, what kind and their standing meds would be an asset in the goal of creating consistency in care and helping them get back on track.

-control pharmaceutical costs: stop direct to consumer advertising to start, make new medications AFFORDABLE

this whole argument is exhausting to listen to. i have a feeling that it drastic changes are not made we will only be ready as a society to make them when the system hits a critical stage.

Unless you’re that technologically saavy, have your finger on the pulse of subcultre  and happen to be a profound nerd for all things medical…. here are a few videos to entertain your spirit… advice for those not in medicine: dont take this seriously!

Diagnosis Wenkeback

and from the skilled residents across the Park at Mt Sinai: Mo Pages Mo Problems

UAB ER Rap

And if you’re an older nerd: Waking up is Hard to Do

laughter can sometimes be the best medicine

Been away from writing on the blog for a bit, without going into a lot of detail it can be explained with one word: residency

Instead of trying to play catch up with all the changes that have occurred in the past several months, I’ll just jump right into the present. Stay tuned…

Sometime last year I was suprised to learn of the abuse of ‘neuro-enhancing’ drugs in college students via a friend of mine whos daughter is a college freshman.  A recent article in The New Yorker cites that up to 25-35% of  college students used off label prescription stimulants once (in the previous year to the survey).

This 10 page well written article covers many topics, of which safety and ethics interest me the most, but here are a few thoughts I have as a result….

-the article appears positively weighted regarding how stimulants improve cognitive functioning, however why are healthy academically average or above average individuals so troubled by an imperfect memory, is it such a terrible human quality to live with?

-the long term effects of using these medications in this manner is undetermined at this time, people reading this article or considering such a practice must not overlook its tremendous ease in becoming habit forming= a MAJOR problem

-this article bring attention to some people’s concerns (fear?) around characteristics associated with aging, focusing on the ‘negative’ aspects (memory loss) and apparrent attraction to an instant solution (a pill).  Do advocates of youthful charactistics incorporate life style changes (clean diet, gentle exercise, stress management, etc) to support this way of life?

-off label use of medication, particularly if its addictive, seems like something medical experts would be very conservative about. Is the support of stimulant use by some scientists and medical professionals financially influenced?

-I am very curious of the emerging field ‘cosmetic neurology’ mentioned int he article, which utilized medications to ‘enhance’ human functioning

-another curious segment of humanity has emerged:  the subscribers of the “ImmInst”, aka  Immortality Institute forums, where people aggregate to discuss methods for life-extension and the benefits of cognitive enhancers using technology and science.  The ancient quest for immortality is alive.

-people in this article appear more interested in increasing their competitive edge over others (in their class, profession, or in another country) and making deadlines they normally would not be able to achieve without the drug, to what end do we wish to push ourselves? Whats wrong with not being able to do it all?

-one psychiatrist reframed the family’s request for their son’s school performance to be assisted…. and examined their motivations: do they want their son to fit into the world, or do we all want to make this world a better place for everyone live in?

What would you do if your child was in college or preparing for a standardized exam, and 30% of his/her classmates were using neuro-enhancing drugs to improve their scores?

As one person said, “It’s fundamentally a choice you’re making about how you want to experience consciousness”. If one would like to expand or ‘advance’ their consciousness, might I suggest meditation? It has many fewer side effects….

I’ve disappeared for a while due to the demands of my rotations but am back to write some more commentaries on integrative medicine, health and wellness. Its good to be back!

I like to follow NY State Attorney General Andrew Cuomo’s work busting criminal activity, because the stories associated with the crima are at times truly unbelievable.  Lately, hes had a lot of mess to clean up in our Empire State and if you endorse the reduction of white collar crime, hes your guy.  

This week hes all over the 700 member Millionaries club at Merrill Lynch, which reflects a small number of the 39,000 employees who recieved over a Million dollars each in bonuses before they were bought by Bank of America. Merrill distributed $3.9 BILLION in bonuses, even though they were getting 50 Billion in bailout money. 

WFT!

PLEASE, Mr Cuomo, stop the insanity!

 

other great cases of his:

making Aetna repays students…

The Bernie Madoff disaster…

the MTA retirement directly into disability scam…

the list in endless, keep p the good work Mr Attorney General.

This month Psychosomatic Medicine published a very small cross sectional study examining pain perception and the potential analgesic effect of mindful Zen meditation.   Although the study size was small (n=13), the subjects had greater than 1,000 hrs of meditation and discovered some positive effects of Zen meditation.

Results indicated: meditators required nigher temperatures to elicit pain  and reported decreased pain intensity compared to control (reported no change). In meditators, pain modulation corresponded to a slowed respiratory rate.  The article thought the mindfulness-related results may be in part explained by changes in respiratory rates.

The study concluded:

Zen meditators have lower pain sensitivity and experience analgesic effects during mindful states. Results may reflect cognitive/self-regulatory skills related to the concept of mindfulness and/or altered respiratory patterns.

Its a preliminary study which suggests further investigation regarding the application of mindfulness meditation in pain management.

Here’s a nice little article from the NIH on meditating for health purposes with a bibliography.

I would love to see a unified digital health record system, however I’m against the current on line medical record proposal because it doesnt abide by  HIPAA laws (a brief explanation here)   In the mean time to digitize records, i plan on using a scanner, store my docs on my home computer, stick it on a thumb drive and bring it to my doc’s office until we develop a safe national system!

Google apparently is feverishly denying rumors that its interested in selling its (your) medical record info.

Every time I revisit the topic of parasitology since medical school, my stomach turns…. In the UK, they’re exploring the use of ‘bugs’ with various inflammatory conditions like; hay fever, asthma, IBD, Alzheimer’s, atherosclerosis, some forms of depression and cancer… and other conditions like diabetes.

I thought you’d never ask!