Placebos can't cure diseases, but research suggests that they seem to bring some people relief from subjective symptoms, such as pain, nausea, anxiety and fatigue.
But there's a reason your doctor isn't giving you a sugar pill and telling you it's a new wonder drug. The thinking has been that you need to actually believe that you're taking a real drug in order to see any benefits. And a doctor intentionally deceiving a patient is an ethical no-no.
So placebos have pretty much been tossed in the "garbage pail" of clinical practice, says Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center. In an attempt to make them more useful, he's been studying whether people might see a benefit from a placebo even if they knew it was a placebo, with no active ingredients. An earlier study found that so-called "open-label" or "honest" placebos improved symptoms among people with irritable bowel syndrome.
And Kaptchuk and his colleagues found the same effect among people with garden-variety lower back pain, the most common kind of pain reported by American adults.
The study included 83 people in Portugal, all of whom had back pain that wasn't caused by cancer, fractures, infections or other serious conditions. All the participants were told that the placebo was an inactive substance containing no medication. They were told that the body can automatically respond to placebos, that a positive attitude can help but isn't necessary and that it was important to take the pills twice a day for the full three weeks.
More ...
http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo?
Thursday, October 27, 2016
Wednesday, October 26, 2016
Mice smell, share each other's pain | Science News
Pain is contagious, at least for mice. After encountering bedding where mice in pain had slept, other mice became more sensitive to pain themselves. The experiment, described online October 19 in Science Advances, shows that pain can move from one animal to another — no injury or illness required.
The results "add to a growing body of research showing that animals communicate distress and are affected by the distress of others," says neuroscientist Inbal Ben-Ami Bartal of the University of California, Berkeley.
Neuroscientist Andrey Ryabinin and colleagues didn't set out to study pain transfer. But the researchers noticed something curious during their experiments on mice who were undergoing alcohol withdrawal. Mice in the throes of withdrawal have a higher sensitivity to pokes on the foot. And surprisingly, so did these mice's perfectly healthy cagemates. "We realized that there was some transfer of information about pain" from injured mouse to bystander, says Ryabinin, of Oregon Health & Sciences University in Portland.
When mice suffered from alcohol withdrawal, morphine withdrawal or an inflaming injection, they become more sensitive to a poke in the paw with a thin fiber — a touchy reaction that signals a decreased pain tolerance. Mice that had been housed in the same cage with the mice in pain also grew more sensitive to the poke, Ryabinin and colleagues found. These bystander mice showed other signs of heightened pain sensitivity, such as quickly pulling their tails out of hot water and licking a paw after an irritating shot.
The results are compelling evidence for the social transmission of pain, says neuroscientist Christian Keysers of the Netherlands Institute for Neuroscience in Amsterdam.
More ...
https://www.sciencenews.org/article/mice-smell-share-each-others-pain?
The results "add to a growing body of research showing that animals communicate distress and are affected by the distress of others," says neuroscientist Inbal Ben-Ami Bartal of the University of California, Berkeley.
Neuroscientist Andrey Ryabinin and colleagues didn't set out to study pain transfer. But the researchers noticed something curious during their experiments on mice who were undergoing alcohol withdrawal. Mice in the throes of withdrawal have a higher sensitivity to pokes on the foot. And surprisingly, so did these mice's perfectly healthy cagemates. "We realized that there was some transfer of information about pain" from injured mouse to bystander, says Ryabinin, of Oregon Health & Sciences University in Portland.
When mice suffered from alcohol withdrawal, morphine withdrawal or an inflaming injection, they become more sensitive to a poke in the paw with a thin fiber — a touchy reaction that signals a decreased pain tolerance. Mice that had been housed in the same cage with the mice in pain also grew more sensitive to the poke, Ryabinin and colleagues found. These bystander mice showed other signs of heightened pain sensitivity, such as quickly pulling their tails out of hot water and licking a paw after an irritating shot.
The results are compelling evidence for the social transmission of pain, says neuroscientist Christian Keysers of the Netherlands Institute for Neuroscience in Amsterdam.
More ...
https://www.sciencenews.org/article/mice-smell-share-each-others-pain?
Monday, October 24, 2016
How drugs intended for patients ended up in the hands of illegal users: ‘No one was doing their job’ - The Washington Post
For 10 years, the government waged a behind-the-scenes war against pharmaceutical companies that hardly anyone knows: wholesale distributors of prescription narcotics that ship drugs from manufacturers to consumers.
The Drug Enforcement Administration targeted these middlemen for a simple reason. If the agency could force the companies to police their own drug shipments, it could keep millions of pills out of the hands of abusers and dealers. That would be much more effective than fighting "diversion" of legal painkillers at each drugstore and pain clinic.
Many companies held back drugs and alerted the DEA to signs of illegal activity, as required by law. But others did not.
Collectively, 13 companies identified by The Washington Post knew or should have known that hundreds of millions of pills were ending up on the black market, according to court records, DEA documents and legal settlements in administrative cases, many of which are being reported here for the first time. Even when they were alerted to suspicious pain clinics or pharmacies by the DEA and their own employees, some distributors ignored the warnings and continued to send drugs.
"Through the whole supply chain, I would venture to say no one was doing their job," said Joseph T. Rannazzisi, former head of the DEA's Office of Diversion Control, who led the effort against distributors from 2005 until shortly before his retirement in 2015. "And because no one was doing their job, it just perpetuated the problem. Corporate America let their profits get in the way of public health."
A review of the DEA's campaign against distributors reveals the extent of the companies' role in the diversion of opioids. It shows how drugs intended for millions of legitimate pain patients ended up feeding illegal users' appetites for prescription narcotics. And it helps explain why there has been little progress in the U.S. opioid epidemic, despite the efforts of public-health and enforcement agencies to stop it.
More ...
https://www.washingtonpost.com/investigations/how-drugs-intended-for-patients-ended-up-in-the-hands-of-illegal-users-no-one-was-doing-their-job/2016/10/22/10e79396-30a7-11e6-8ff7-7b6c1998b7a0_story.html?
The Drug Enforcement Administration targeted these middlemen for a simple reason. If the agency could force the companies to police their own drug shipments, it could keep millions of pills out of the hands of abusers and dealers. That would be much more effective than fighting "diversion" of legal painkillers at each drugstore and pain clinic.
Many companies held back drugs and alerted the DEA to signs of illegal activity, as required by law. But others did not.
Collectively, 13 companies identified by The Washington Post knew or should have known that hundreds of millions of pills were ending up on the black market, according to court records, DEA documents and legal settlements in administrative cases, many of which are being reported here for the first time. Even when they were alerted to suspicious pain clinics or pharmacies by the DEA and their own employees, some distributors ignored the warnings and continued to send drugs.
"Through the whole supply chain, I would venture to say no one was doing their job," said Joseph T. Rannazzisi, former head of the DEA's Office of Diversion Control, who led the effort against distributors from 2005 until shortly before his retirement in 2015. "And because no one was doing their job, it just perpetuated the problem. Corporate America let their profits get in the way of public health."
A review of the DEA's campaign against distributors reveals the extent of the companies' role in the diversion of opioids. It shows how drugs intended for millions of legitimate pain patients ended up feeding illegal users' appetites for prescription narcotics. And it helps explain why there has been little progress in the U.S. opioid epidemic, despite the efforts of public-health and enforcement agencies to stop it.
More ...
https://www.washingtonpost.com/investigations/how-drugs-intended-for-patients-ended-up-in-the-hands-of-illegal-users-no-one-was-doing-their-job/2016/10/22/10e79396-30a7-11e6-8ff7-7b6c1998b7a0_story.html?
The First Fentanyl Addict | VICE
If the opiate crisis has taught us anything, it's that addiction affects everyone. An unprecedented surge in fentanyl-implicated death—across all incomes and backgrounds, obviously—has sparked public health emergencies across the US and Canada. With each fentanyl overdose reported, we're seeing ignorant assumptions about who uses drugs and why finally put to rest.
But there was a time when fentanyl was almost exclusively used by a very small group, and it had nothing to do with Margaret Wente's idea of a "typical drug addict" or poverty or organized crime. What the general public is oblivious to—but the medical community knows—is how fentanyl addiction took its roots in anesthesiology before it made its way into the mainstream.
Dr. Ethan Bryson, associate professor in the anesthesia and psychiatry departments at the Icahn School of Medicine at Mount Sinai, New York, believes it was anesthesiologists who, familiar with fentanyl's pharmacology and abuse potential, first began misusing the opioid.
"If you look at the history of morphine, cocaine, and heroin, these were all drugs which were initially developed for legitimate medical purposes, but subsequently became recreational pharmaceuticals," Bryson told VICE. "They were all experimented on with people with that access. That's well documented in history."
More …
http://www.vice.com/read/the-first-fentanyl-addict?
But there was a time when fentanyl was almost exclusively used by a very small group, and it had nothing to do with Margaret Wente's idea of a "typical drug addict" or poverty or organized crime. What the general public is oblivious to—but the medical community knows—is how fentanyl addiction took its roots in anesthesiology before it made its way into the mainstream.
Dr. Ethan Bryson, associate professor in the anesthesia and psychiatry departments at the Icahn School of Medicine at Mount Sinai, New York, believes it was anesthesiologists who, familiar with fentanyl's pharmacology and abuse potential, first began misusing the opioid.
"If you look at the history of morphine, cocaine, and heroin, these were all drugs which were initially developed for legitimate medical purposes, but subsequently became recreational pharmaceuticals," Bryson told VICE. "They were all experimented on with people with that access. That's well documented in history."
More …
http://www.vice.com/read/the-first-fentanyl-addict?
Wednesday, October 19, 2016
He ate a pepper so hot it tore a hole in his esophagus - The Washington Post
A ghost pepper's heat is described in terms normally reserved for carpet bombings. Its heat is measured at 1 million units on the Scoville scale, a per-mass measure of capsaicin — the chemical compound that imbues peppers with heat — that until recently was a world record. Peppers that pass the 1 million mark are called superhot; as a rule they are reddish and puckered, as though one of Satan's internal organs had prolapsed. To daredevil eaters of a certain stripe, the superhot peppers exist only to challenge.
When consumed, ghost peppers and other superhots provoke extreme reactions. "Your body thinks it's going to die," as Louisiana pepper grower Ronald Primeaux told the AP in October. "You're not going to die."
But, demonstrated by a rare though severe incident reported recently in the Journal of Emergency Medicine, superhot peppers can cause bodily harm. A 47-year-old man, unnamed in the case study, attempted a super-spicy feat — eating a hamburger served with a ghost pepper puree — and tore a hole in his esophagus.
More ...
https://www.washingtonpost.com/news/morning-mix/wp/2016/10/18/he-ate-an-extremely-spicy-ghost-pepper-hours-later-doctors-found-a-hole-in-his-throat/?
When consumed, ghost peppers and other superhots provoke extreme reactions. "Your body thinks it's going to die," as Louisiana pepper grower Ronald Primeaux told the AP in October. "You're not going to die."
But, demonstrated by a rare though severe incident reported recently in the Journal of Emergency Medicine, superhot peppers can cause bodily harm. A 47-year-old man, unnamed in the case study, attempted a super-spicy feat — eating a hamburger served with a ghost pepper puree — and tore a hole in his esophagus.
More ...
https://www.washingtonpost.com/news/morning-mix/wp/2016/10/18/he-ate-an-extremely-spicy-ghost-pepper-hours-later-doctors-found-a-hole-in-his-throat/?
Tramadol: The Opioid Crisis for the Rest of the World - WSJ
GAROUA, Cameroon—Not long ago, a Dutch neurobiologist announced a surprising discovery: A root used by rural West African healers to treat pain contains an apparently natural version of a man-made opioid.
The root from northern Cameroon had such high levels of a painkiller called tramadol that mice given an extract and placed on a hot plate didn't feel their feet burning at first.
A year later, German rivals came up with a different explanation for the unusual plant. Inexpensive, imported tramadol is so heavily abused in northern Cameroon that it seeps from human and animal waste into the groundwater and soil, where vegetation absorbs it, wrote Michael Spiteller and Souvik Kusari, chemists at the University of Dortmund.
Farmers in Northern Cameroon told the researchers that they take double or triple the safe dosage, and feed tramadol to cattle to help them pull plows through the scorching afternoon sun.
More ...
http://www.wsj.com/articles/tramadol-the-opioid-crisis-for-the-rest-of-the-world-1476887401
The root from northern Cameroon had such high levels of a painkiller called tramadol that mice given an extract and placed on a hot plate didn't feel their feet burning at first.
A year later, German rivals came up with a different explanation for the unusual plant. Inexpensive, imported tramadol is so heavily abused in northern Cameroon that it seeps from human and animal waste into the groundwater and soil, where vegetation absorbs it, wrote Michael Spiteller and Souvik Kusari, chemists at the University of Dortmund.
Farmers in Northern Cameroon told the researchers that they take double or triple the safe dosage, and feed tramadol to cattle to help them pull plows through the scorching afternoon sun.
More ...
http://www.wsj.com/articles/tramadol-the-opioid-crisis-for-the-rest-of-the-world-1476887401
Thursday, October 13, 2016
The shocking pain of American men - The Washington Post
Once upon a time, nearly every man in America worked. In 1948, the labor-force participation rate was a staggering 96.7 percent among men in their prime working years.
That statistic has been steadily declining ever since. Today, about 11.5 percent of men between the ages of 24-54 are neither employed nor looking for a job. Economists say that these people are "out of the labor force" — and they don't figure into statistics like the unemployment rate.
This demographic trend has been the subject of much noise and consternation lately. Nicholas Eberstadt, a demographer at the conservative American Enterprise Institute, calls the development a "quiet catastrophe: the collapse, over two generations, of work for American men."
Eberstadt concedes that he can't pinpoint the precise causes, but he implies that the problem, at its root, emanates from some kind of moral or societal dysfunction.
"Time-use surveys suggest [these men] are almost entirely idle," Eberstadt wrote in a Wall Street Journal op-ed a few weeks ago. "Unlike in the past, the U.S. is now evidently rich enough to carry them, after a fashion," he added.
Princeton professor Alan Krueger, a former chief economist at the Department of Labor and former chairman of Obama's Council of Economic Advisers, has taken a look at the same data — but he came away with a different conclusion.
What stood out to him is that a lot of these men say they are in considerable pain.
In a recently released draft of his paper, which he will present at a Federal Reserve conference in Boston on Friday, Krueger finds that 44 percent of male, prime-age labor force dropouts say they took pain medication the day prior — which is more than twice the rate reported by employed men.
More ...
https://www.washingtonpost.com/news/wonk/wp/2016/10/13/a-record-number-of-men-arent-working-this-might-finally-explain-why/
That statistic has been steadily declining ever since. Today, about 11.5 percent of men between the ages of 24-54 are neither employed nor looking for a job. Economists say that these people are "out of the labor force" — and they don't figure into statistics like the unemployment rate.
This demographic trend has been the subject of much noise and consternation lately. Nicholas Eberstadt, a demographer at the conservative American Enterprise Institute, calls the development a "quiet catastrophe: the collapse, over two generations, of work for American men."
Eberstadt concedes that he can't pinpoint the precise causes, but he implies that the problem, at its root, emanates from some kind of moral or societal dysfunction.
"Time-use surveys suggest [these men] are almost entirely idle," Eberstadt wrote in a Wall Street Journal op-ed a few weeks ago. "Unlike in the past, the U.S. is now evidently rich enough to carry them, after a fashion," he added.
Princeton professor Alan Krueger, a former chief economist at the Department of Labor and former chairman of Obama's Council of Economic Advisers, has taken a look at the same data — but he came away with a different conclusion.
What stood out to him is that a lot of these men say they are in considerable pain.
In a recently released draft of his paper, which he will present at a Federal Reserve conference in Boston on Friday, Krueger finds that 44 percent of male, prime-age labor force dropouts say they took pain medication the day prior — which is more than twice the rate reported by employed men.
More ...
https://www.washingtonpost.com/news/wonk/wp/2016/10/13/a-record-number-of-men-arent-working-this-might-finally-explain-why/
Wednesday, October 12, 2016
How naked mole rats conquered pain—and what it could mean for us | Science | AAAS
Although it has a face—and body—that only a mother could love, the naked mole rat has a lot to offer biomedical science. It lives 10 times longer than a mouse, almost never gets cancer, and doesn't feel pain from injury and inflammation. Now, researchers say they've figured out how the rodents keep this pain away.
"It's an amazing result," says Harold Zakon, an evolutionary neurobiologist at the University of Texas, Austin, who was not involved with the work. "This study points us to important areas … that might be targeted to reduce this type of pain."
Naked mole rats are just plain weird. They live almost totally underground in coloniesstructured like honey bee hives, with hundreds of workers servicing a single queen and her few consorts. To survive, they dig kilometers of tunnels in search of large underground tubers for food. It's such a tough life that—to conserve energy—this member of the rodent family gave up regulating its temperature, and they are able to thrive in a low-oxygen, high–carbon dioxide environment that would suffocate or be very painful to humans. "They might as well be from another planet," says Thomas Park, a neuroscientist at the University of Illinois, Chicago.
Gary Lewin, a neuroscientist at the Max Delbrück Center for Molecular Medicine in the Helmholtz Association in Berlin, began working with naked mole rats because a friend in Chicago was finding that the rodent's pain fibers were not the same as other mammals'. In 2008, the studies led to the finding that naked mole rats didn't feel pain when they came into contact with acid and didn't get more sensitive to heat or touch when injured, like we and other mammals do. Lewin was hooked and has been raising the rodents in his lab ever since. They are a little more challenging than rats or mice, he notes, because with just one female per colony producing young, he never really has quite enough individuals for his studies.
So instead of studying the whole animals, he began isolating single nerve cells from the mole rats and investigating them in lab dishes to track the molecular basis of the rodent's pain insensitivity. The pain pathway is kicked off when a substance called nerve growth factor is released by injured or inflamed cells. This factor binds to a protein on the pain-cell surface, a so-called receptor named TrkA, which relays the "pain" message throughout the cell. In us and other mammals, that message increases the activity of a molecular pore, called the TRPV1 ion channel, causing the cell to become more sensitive to touch or heat. "So the cell says 'It hurts more,'" Lewin explains.
But that doesn't happen in naked mole rats. Lewin evaluated the workings of the animal's pain pathway components by mixing them with those of standard rats and putting the combinations in immature frog eggs. For example, the naked mole rat TRPV1 channel sensitized the egg to acid and heat when the rat TrkA was put into the egg cell with it. Thus, Lewin and his colleagues narrowed down the breakdown in this pathway to the TrkA receptor itself. The naked mole rat version of TrkA failed to activate the ion channel as efficiently as the rat version of TrkA, Lewin and his colleagues reveal today in Cell Reports.
More ….
http://www.sciencemag.org/news/2016/10/how-naked-mole-rats-conquered-pain-and-what-it-could-mean-us
"It's an amazing result," says Harold Zakon, an evolutionary neurobiologist at the University of Texas, Austin, who was not involved with the work. "This study points us to important areas … that might be targeted to reduce this type of pain."
Naked mole rats are just plain weird. They live almost totally underground in coloniesstructured like honey bee hives, with hundreds of workers servicing a single queen and her few consorts. To survive, they dig kilometers of tunnels in search of large underground tubers for food. It's such a tough life that—to conserve energy—this member of the rodent family gave up regulating its temperature, and they are able to thrive in a low-oxygen, high–carbon dioxide environment that would suffocate or be very painful to humans. "They might as well be from another planet," says Thomas Park, a neuroscientist at the University of Illinois, Chicago.
Gary Lewin, a neuroscientist at the Max Delbrück Center for Molecular Medicine in the Helmholtz Association in Berlin, began working with naked mole rats because a friend in Chicago was finding that the rodent's pain fibers were not the same as other mammals'. In 2008, the studies led to the finding that naked mole rats didn't feel pain when they came into contact with acid and didn't get more sensitive to heat or touch when injured, like we and other mammals do. Lewin was hooked and has been raising the rodents in his lab ever since. They are a little more challenging than rats or mice, he notes, because with just one female per colony producing young, he never really has quite enough individuals for his studies.
So instead of studying the whole animals, he began isolating single nerve cells from the mole rats and investigating them in lab dishes to track the molecular basis of the rodent's pain insensitivity. The pain pathway is kicked off when a substance called nerve growth factor is released by injured or inflamed cells. This factor binds to a protein on the pain-cell surface, a so-called receptor named TrkA, which relays the "pain" message throughout the cell. In us and other mammals, that message increases the activity of a molecular pore, called the TRPV1 ion channel, causing the cell to become more sensitive to touch or heat. "So the cell says 'It hurts more,'" Lewin explains.
But that doesn't happen in naked mole rats. Lewin evaluated the workings of the animal's pain pathway components by mixing them with those of standard rats and putting the combinations in immature frog eggs. For example, the naked mole rat TRPV1 channel sensitized the egg to acid and heat when the rat TrkA was put into the egg cell with it. Thus, Lewin and his colleagues narrowed down the breakdown in this pathway to the TrkA receptor itself. The naked mole rat version of TrkA failed to activate the ion channel as efficiently as the rat version of TrkA, Lewin and his colleagues reveal today in Cell Reports.
More ….
http://www.sciencemag.org/news/2016/10/how-naked-mole-rats-conquered-pain-and-what-it-could-mean-us
Saturday, October 08, 2016
Lancet Global Burden of Disease Highlights Back Pain - The Atlantic
The newest iteration of the Global Burden of Disease study, which tracks the prevalence of deaths and diseases worldwide, contains some good news: On average people are living about a decade longer than they were in 1980. But there's a catch: Health hasn't improved as fast as life expectancy overall, which means that for many, those long, final years are spent hobbled by illness and disability.
The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called "Disability Adjusted Life Years." DALYs, as they're abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn't spend living your #bestlife—because you were sick or dead.
In rich countries, the number one cause of these DALYs is not surprising: ischemic heart disease, which is associated with well-known Western issues like high cholesterol and obesity. But the number two condition is a little strange: plain, old-fashioned, ever-present, low back and neck pain.
Even when you include poor and middle-income countries, low back and neck pain went from ranking 12th as a cause of DALYs globally in 1990 to ranking fourth in 2015, the most recent year. In most countries, it was the leading cause of disability. DALYs from low back and neck pain increased by more than 17 percent from 2005.
The things that make us low-level miserable are now more likely to be simple aches and pains, rather than frightening, communicable diseases like diarrhea. That's encouraging, but it's still a little sad. People all over the world increasingly live long, great lives, only to spend their golden years slathered in IcyHot.
More ...
http://www.theatlantic.com/health/archive/2016/10/how-back-pain-took-over-the-world/503243/?
The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called "Disability Adjusted Life Years." DALYs, as they're abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn't spend living your #bestlife—because you were sick or dead.
In rich countries, the number one cause of these DALYs is not surprising: ischemic heart disease, which is associated with well-known Western issues like high cholesterol and obesity. But the number two condition is a little strange: plain, old-fashioned, ever-present, low back and neck pain.
Even when you include poor and middle-income countries, low back and neck pain went from ranking 12th as a cause of DALYs globally in 1990 to ranking fourth in 2015, the most recent year. In most countries, it was the leading cause of disability. DALYs from low back and neck pain increased by more than 17 percent from 2005.
The things that make us low-level miserable are now more likely to be simple aches and pains, rather than frightening, communicable diseases like diarrhea. That's encouraging, but it's still a little sad. People all over the world increasingly live long, great lives, only to spend their golden years slathered in IcyHot.
More ...
http://www.theatlantic.com/health/archive/2016/10/how-back-pain-took-over-the-world/503243/?
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