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An ethics issue: Physicians dispensing drugs for healthy people?  And for kids to study?

 
The American Academy of Neurology now says: Stop that.

Adderall and other ADHD medications, a disorder characterized by problems with attention and hyperactivity, are used as “smart drugs” or “study drugs” by students who find the pills give them a mental edge.  These drugs are among the most prescribed drugs in America.

Adderall is the only drug class that showed increased use in 2012, the federal survey reported.

 Nancy Shute posted on Shot this March 14, 2013 under “Neurologists Warn Against ADHD Drugs To Help Kids Study”

Ten milligram tablets of the prescription drug Adderall. The drug is used to treat ADHD and is used by some students to boost their academic performance.

Ten milligram tablets of the prescription drug Adderall. Jb Reed/Bloomberg via Getty Images

The brain docs are directing that advice first and foremost to their fellow physicians, the ones who have been writing all those scrips for people who don’t have ADHD, or who perhaps don’t think about all the pills their patients sell on the student black market.

“We don’t believe that doctors are supposed to be drug dispensers for healthy people,” says William Graf, a professor of pediatrics and neurology at the Yale School of Medicine. “This is an ethics issue.”

But the message is also being sent to teenagers and their parents, some of whom who might think that giving their child a little leg up for a big test isn’t such a bad thing. The buzz term for that? “Pediatric neuroenhancement.”

Prescribing ADHD drugs to children who don’t have the disorder is “not justifiable,” according to the American Academy of Neurology’s new position paper: Children’s brains are still developing, the paper says, and they don’t have the ability to weigh the risks and benefits of medication.

Prescribing study drugs is “inadvisable” in teenagers, a word chosen to reflect both teenagers’ growing autonomy, and the fact that the Academy can’t tell doctors what drugs they can and can’t prescribe.

The number of children diagnosed with ADHD rose 24 percent from 2001 to 2011, according to a study published earlier this year. Over the same time, the number of prescriptions for Adderall and other ADHD drugs has soared exponentially.

More pills in circulation means more pills that can be bought, borrowed, or snitched.

Various surveys report that 8 to 35% of college students say they have used stimulant pills to improve school performance.

The neurologists are not saying that stimulant drugs shouldn’t be used to treat ADHD, “We’re not touching that here,” Graf told Shots.

What they are saying is that doctors have a moral obligation to protect the best interests of the child — who doesn’t yet have legal control over health care decisions — and to prevent the misuse of medication.

Amphetamines like Adderall and Vyvanse can be addictive, which is why they’re classified as Schedule II controlled substances, along with Oxycontin and morphine.

Side effects can be as simple as insomnia, or as serious as sudden high blood pressure, irregular heartbeat, and seizures.

Other popular ADHD drugs like Concerta and Ritalin are methamphetamine  and are considered less risky. But they can cause a wide range of side effects including insomnia, aggression, mood and behavior changes, twitching, and shaking.

About 15% of 12th graders say they misuse prescription drugs, according to the 2012 Monitoring the Future survey, and about 6% say they’ve misused Ritalin or Adderall.

“As a society we have a pill for everything,” Graf says. “It’s one thing if you’re taking something from the Vitamin Shoppe. It’s another thing if you’re talking about amphetamines.”

Doctors should talk with patients and parents about why they feel the need for academic performance enhancing drugs. They should point out that there are other ways to deal with competition and anxiety.

“We have to get back to the basics,” Graf says. “Sleep, exercise, and social interaction.”

What are the Brain’s Survival Skills? And Fear beyond the Amygdala

Can scientists use the brain’s inherent survival mechanisms to develop better stroke treatment?

Strokes are a major cause of death and disability worldwide, with 150,000 people affected in the UK every year.

Most strokes happen when a blood vessel that supplies blood to the brain is blocked due to blood clots or fat deposits. Once blood is cut off from an area of the brain, brain cells are starved for oxygen and nutrients and start to die within minutes.

A new study in Nature Medicine, scientists at the University of Oxford reveal a novel way in which the brain protects itself in response to stroke.

Ranya Bechara posted on Feb. 27, 2013 “Stroke Vs Brain: Harnessing the Brain’s Survival Skills”

Current treatments for stroke are focussed on breaking up the clots, improving blood flow to the affected area, and ultimately reducing the brain damage caused by the stroke. However, the so called ‘clot-busters’ are only effective if given within one to two hours of the stroke.

Other ways of protecting the brain against stroke damage are in high demand.

In this study, the research team from Oxford University (in collaboration with other researchers from Greece, Germany, and Canada, and the UK) decided to try a new approach. They investigated a phenomenon that has been known for years: some brain cells have an inherent defence mechanism that allows them to survive when deprived of oxygen.

These cells are located in the part of the brain responsible for forming memories: a pretty sea-horse shaped structure called the hippocampus.

The scientists analysed the proteins produced by these cells and found that the key to their survival is a protein called hamartin. This protein is released by the cells in response to oxygen deprivation, and when its production was supressed, the cells became more vulnerable to the effects of stroke.

Photo credit: http://www.vascularinfo.co.uk

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Original article is available here

Fear beyond the Amygdala
Ranya Bechara posted on Feb. 6, 2013

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For decades now, scientists have thought that fear could not be experienced without the amygdala. This almond-shaped structure located deep in the brain (pictured on the left).
The amygdala has been shown to play an important role in fear-related behaviours, emotions, and memories, and patients with damage to the amygdala on both sides of the brain were thought to be incapable of feeling afraid.
However, a recent study in Nature Neuroscience reports that these ‘fearless’ patients do experience fear if made to inhale carbon dioxide- a procedure that induces feelings of suffocation and panic.
The patients reported being quite surprised at their own fear, and that it was a novel experience for them!
Scientists behind the study have suggested that the way the brain processes fear information depends on the type of stimulus.
The results of this study could have important implications for people who suffer from anxiety disorders such as panic attacks and post-traumatic stress disorder (PTSD).
More details can be found here

Male Nurses Make More Money: Isn’t it normal and natural?

Hospital patients are more likely than ever to see a male nurse at their bedside — and odds are he earns more than the female nurse down the hall.

Men made up close to 10% of all registered nurses in 2011, according to a new Census report released today. That may not sound like much, but it’s up from less than 3% in 1970 and less than 8% in 2000.

Women still dominate nursing in terms of employment — but not in terms of earnings. The average female nurse earned $51,100 in 2011, 16% less than the $60,700 earned by the average man in the same job.

Ben Casselman posted in Real Time Economics (The Wall Street Journal)

It’s no mystery what is drawing men into nursing. Male-dominated professions such as construction and manufacturing hemorrhaged jobs during the recession and have been slow to rebound during the recovery.

The health-care sector, meanwhile, actually added jobs during the recession and has continued to grow since. All told, health-care employment is up by nearly 1.4 million since the recession began, while employment in the construction and manufacturing sectors is down by nearly 3.6 million.

Education and health workers have an unemployment rate of 5.4%, versus 7.9% for factory workers and 16.1% for construction workers.

The difference in earnings is partly due to the fact that men were more likely than women to work full-time. When looking only at full-time, year-round workers, the gap narrows, but it doesn’t disappear; female nurses working full-time, year-round earned 9% less than their male counterparts.

Getty Images

Part of the reason, the Census study suggests, is a previously documented phenomenon known as the “glass escalator” in which men earn higher wages and faster promotions in female-dominated professions.

In nursing, men are more concentrated in the highest-earning segments of the field. They make up 41% of nurse anesthetists, who earn nearly $148,000 on average, but only 8% of licensed practical nurses, who make just $35,000.

Even within a given field, men tend to earn more.

Among full-time, year-round registered nurses, women earned 7% less than men in 2011. The study’s authors note, however, that the wage gap is smaller in nursing than in the economy as a whole, where women earn on average 77 cents to the dollar, according to the Census report.

Men also appear to have an easier time getting hired, although the high demand for nurses means unemployment rates are low across categories — less than 2% for registered nurses, and even lower for more advanced professionals. Among licensed practical nurses, the only category with meaningful levels of unemployment, men had an unemployment rate of 4%, versus 5.1% for women.

Male nurses are more likely than female nurses to:

1.  Have a doctoral degree.

2. More likely to work evening or night shifts, and

3. More likely to be immigrants.

Female nurses are more likely to work in doctor’s offices or schools, and are far more likely to be over age 65 — a reflection of nursing’s status as a female-dominated profession until recently.

But overall, male and female nurses are demographically similar. The typical nurse of either sex is between age 35 and 54, has some college or a bachelor’s degree and works for a private-sector hospital.

Single magic mushroom ‘can change personality’ for the better?

A single dose of the chemical psilocybin (contained in a single magic hallucinogenic mushroom) may induce a person to witness mystical experience, after which this attitude of “openness” scores rises, and remains higher for up to a year after the tests.

What’s that openness attribute?

Experimental psychologists define Openness as associated with imagination, artistic appreciation, feelings, abstract ideas and general broad-mindedness.

One trait among the major 5 traits, such as extrovert, neurotics, agreeableness and conscientiousness.

What’s more, None of the other 4 traits was altered during the year.

All that from a single dose.

Question: What if a person is injected with 2 doses or more? Kind of inadvertently?

Matt Blake posted in The Independence on 30 September 2011:

Forty-five years after Timothy Leary, the apostle of drug-induced mysticism, urged his hippie followers to “turn on, tune in and drop out”, researchers have found that magic mushrooms do change a user’s personality – for the better.

The fungi have long been known for their psychedelic effects, but far from damaging the brain, the hallucinogenic drug they contain enhances feelings and aesthetic sensibilities, scientists say.

The study, at Johns Hopkins University of Medicine in Baltimore, found that a single dose of psilocybin, the active ingredient in magic mushrooms, was enough to cause positive effects for up to a year.

“Psilocybin can facilitate experiences that change how people perceive themselves and their environment. That’s unprecedented.” said Roland Griffiths, a study author and professor of psychiatry and behavioural science at Johns Hopkins.

Users who had a “mystical experience” while taking the drug showed increases in a personality trait dubbed “openness”, one of the 5 major traits used in psychology to describe human personality.

Openness is associated with imagination, artistic appreciation, feelings, abstract ideas and general broad-mindedness.

None of the other 4 traits – extroversion, neuroticism, agreeableness and conscientiousness – was altered.

Under controlled scientific conditions, researchers gave 51 adults either psilocybin or a placebo in up to five 80-hour sessions. They were told to lie on a sofa with their eyes covered and listen to music while focusing on an “inner experience”.

Their personalities were screened after each drug session and also about a year later.

Of the 51 subjects, 30 had a mystical experience, after which their openness scores rose, and remained higher for up to a year after the tests.

The 21 who did not have a mystical experience showed no change.

Questions:

1. Can I deduce that the advent of a mystical experience expands the awareness of individuals to recognize differences and interactions in the environment?

2. Would more than a single dose affect negatively anyone of the 5 traits?

3. Would two doses extend the effects longer than one year?

4. If a person is prone to experience magical feeling, would hallucinogenic ingredients deteriorate his performance?

5. How addictive is magic mushroom?

6. If I add half the dose in a cigarette, what do you think might happen? Would addiction be switched from nicotine to psilocybin?

Flu Vaccine? Is it working for you? Any misconceptions?
The flu vaccine does NOT protect you from a cold. It protect you from influenza.
Even if you have gotten the flu vaccine in the past and “still gotten sick,” the flu vaccine was doing its job.

It just cannot protect you from all of the different cold viruses out there. Scientists are still working on the cure for the common cold.

Until then, it’s important to get protected from the virus that we do have something for, something that is much more serious than a cold – that is, influenza.

A published in Heartland Health Centers on December 19, 2012  under: 

The Facts about the Flu Vaccine

Every year I am surprised by all of the misconceptions surrounding the flu vaccine.

So I thought I’d take this opportunity to do some myth-busting. The flu vaccine protects you from influenza, an ever-evolving virus that can lead to hospitalization and even death.

There are 2 kinds of flu vaccines:

1. the flu shot and the nasal spray flu vaccine. The flu shot will NOT make you sick. It is made from inactivated or killed virus. This killed virus cannot infect you. Those killed particles do, on the other hand, make your body make antibodies to influenza. Consider antibodies to be like soldiers. These antibodies help you fight off the influenza virus in case you happen to catch it. At the first site of the influenza virus, these soldiers/antibodies immediately recognize the virus and help to protect your body.

2. The nasal spray flu vaccine is made of weakened virus, but even that does not cause the severe symptoms of influenza.

It CAN, in some people, lead to symptoms like muscle ache, headache, runny nose, wheezing and even fever. The nasal spray flu vaccine is for healthy 2 to 49 year olds, including women who are not pregnant.

Healthy means someone without a medical condition that predisposes them to the complications of influenza.

For example, the nasal spray flu vaccine is NOT suitable for someone with asthma. Your provider will figure out whether the shot or nasal spray is right for you.

So, who should get the flu vaccine?

Just about everyone who is 6 months old or older. The flu vaccine is NOT approved for those under 6 months of age.

Anyone who lives with or takes care of a baby who is under 6 months old, should especially get a flu vaccine to reduce your risk of catching the influenza virus and spreading it to an already vulnerable infant.

Certain people are especially high risk for getting complications to the flu and, therefore, are even more in need of the vaccine.

This includes people with asthma, diabetes, lung disease, pregnant women and people 65 years old or older.

Remember, while the nasal spray flu vaccine is not suitable for a number of these patient populations, the flu shot is.

Also, people who live with or take care of these high-risk patients should get vaccinated, to help protect those most at risk.

Each season a new influenza vaccine is developed to protect you from whichever virus researchers think will be the most common strain that season, from each of the 3 most common kinds of influenza (influenza B, influenza A [H1N1] and influenza A [H3N2]).

So even if you got a flu shot last year or the year before, you still need one this year.

The influenza virus is always changing.

Thus, we need to get the vaccine every year to protect us from the newest strain. The flu season can start as soon as October and extend all the way into May (Think of if sort of like a school year).

So, it is NOT too late to get your influenza vaccine for this season.

Protect yourself. Protect your friends and family. Protect your community.

Say no to the flu by saying yes to the flu vaccine.

Tania Hossain, MD, MPH
Pediatrician

Dr. Hossain received her medical degree and completed her pediatric residency at Loyola University Chicago Stritch School of Medicine. She received her Master’s in Public Health, with a concentration in Maternal and Child Health from Boston University.

Dr. Hossain is dedicated to providing care to the underserved and helping to reduce disparities.

Her interests include newborns/infants, asthma, preventative medicine, obesity and eating disorders.

Dr. Hossain is fluent in Bengali and Spanish.

Community health centers compare well with private practices, researcher finds

Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.

The Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

MANDY ERICKSON published in the Stanford School of Medicine on July 10, 21012:

Randall Stafford

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California-San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.

Their study was published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.

The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.

Stafford and his colleagues analyzed records of 73,074 visits to private practices, FQHCs and FQHC Look-Alikes. Both FQHCs and Look-Alikes receive enhanced Medicare and Medicaid reimbursement; FQHCs also receive government grants.

The researchers acquired the records from the National Ambulatory Medical Care Survey, which the National Center for Health Statistics gathered between 2006 and 2008.

They evaluated the physicians’ adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. “We looked at fairly common conditions that are seen in primary care,” said lead author L. Elizabeth Goldman, MD, of UCSF.

The researchers found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures.

For the remaining five measures — use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients — the community physicians followed recommendations a higher percent of the time.

Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, “The fact that community health centers look better is perhaps surprising.”

“On the other hand, having worked in community health centers, I can see how it makes sense,” he added. “These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care.”

Stafford added that the government has provided the centers with technology that helps manage patient care, which may explain their superior performance. And they are generally larger than private practices: “Having a number of colleagues helps you develop better practices. In a solo practice, you have rare opportunities to debate the best way to practice medicine.”

When the researchers adjusted the data so that the patients’ characteristics were statistically equal, the community health center physicians performed better on three additional measures: aspirin for congestive heart failure, statins for congestive heart failure, and avoidance of benzodiazepine, which has serious long-term side effects, for depression.

(The statistical adjustment did not alter the balance in the other previous measures, and if anything, the magnitude of the difference increased in favor of the community physicians.)

The study was funded by awards from the Agency for Healthcare Research and Quality and the National Heart, Lung and Blood Institute. In addition to Stafford and Goldman, other researchers from UCSF and Johns Hopkins Medical School contributed to the study.

Information about Stanford’s Department of Medicine, which also supported this work, is available at http://med.stanford.edu/medicine.

RELATED NEWS

 Waiting for “Magic Bullets” Pills or focusing on Preventive Life-Style?

What would be your priority if you are still healthy, but fearing a “genetic disease” at the end of the rope?

1. Funding and accelerating research on preventive medicines and alternative life-styles that keep the  prospective “genetic disease” at bay, or

2. Funding pharmaceutical corporations for coming up with “Magic Bullet” pills for the disease you fear most?

The latest head lines sur­rounding the release of the National Alzheimer’s Plan, you’d lead you to con­clude that the likely solution to maintain life long brain health is simple: simply wait until 2025 for a “magic bullet” to be discovered, to cure (or end or prevent) Alzheimer’s disease and aging associ­ated with cognitive decline.

These kinds of beliefs, often reinforced by doctors and advertisers, may explain the billions spent today by pharmaceutical companies on discover ing new compounds, and by consumers on supplements like ginkgo biloba.

The failures to produce bet­ter drugs and conflicts of interest are making many people ask “what is wrong with this picture”?

Alvaro Fernandez, named Young Global Leader by the World Economic Forum, co-authored  The Sharp Brains Guide to Best Fitness: 18 Inter views with Scientists, Practical Advice, and Product Reviews, to Keep Your Brain Sharp.

 posted “From Anti-Alzheimer’s “Magic Bullets” to True Brain Health“:

“We need a new culture of life long brain health to empower that 80% of the 38,000 adults over 50 who were surveyed in the 2010 AARP Member Opinion Survey. The report  indicated “Staying Mentally Sharp” as their top ranked interest and con­cern, not to mention youth, workers and elders facing cognitive and emotional challenges.

What’s the problem?

The “magic bullet” approach does Not reflect existing clinical evidence.  And it does Not account for the emerging neuroscientific thinking. And it does Not address the life long needs and demands of our citizens.

That’s why we need to shake the Etch-A-Sketch and create a new image of the future.

First, we need to draw our true objective: “is it to promote mental vitality and collec­tive wisdom or to declare war on Alzheimer’s plaques and tangles?

Those are two radically different objectives, leading to very different priorities.

For example, let’s imagine the implications of being able to maximize cognitive per­formance and to delay cognitive decline.

Second, let’s build on what we know today.

We know that 30% or more of the population with plaques and tangles do not manifest significant cognitive decline. This is a fact –often explained via the “Cognitive Reserve” theory. It is also a fact (ignored in the report’s presentation and related media coverage) that the most exhaustive systematic evidence review, performed in 2010 under the auspices of NIH, found that non pharmacological factors (such as physical exercise, cognitive engagement, cognitive training, and Mediterranean diet) seemed to protect better against cognitive decline.

“Magic pill” interventions such as (drugs, supplements such as vitamins and gingko biloba) had no such effect.

Third, let’s select the right frame-work and toolkit.

While biomedical research is indeed part of the solution, public health/education initiatives and technology innovation are equally important. 

The 2011 Sharp Brains Vir­tual Summit, which brought together more than 260 research, technology and industry innovators in 17 countries, high lighted the need to devote sufficient attention and resources to preventive brain health strategies across the entire life span, and the need to bring to market a new generation of reliable and inex­pensive assessment and monitoring strategies of cognitive and emotional health.

There is a need to target and deliver those preventive strategies in efficient ways. Innovative public education initiatives, such as Experience Corps and The Intergenerational School, may lead to better cognitive and health outcomes over the long-haul.

It simply makes no sense to put all our eggs in the biomedical basket. Each of this column’s co-authors is producing a different conference in June: Dr. White house and colleagues on “Healthy Environments Across Generations” (June 7–8, NYC) and Mr. Fernandez on “Optimizing Health via Neuro-plastic­ity, Innovation and Data” (June 7-14th, fully online).

There are a number of exciting and complementary approaches to “Staying Mentally Sharp” such as physical exercise, mindfulness meditation, bio-feedback, cognitive therapy and training, volunteering…

How can consumers make informed and relevant deci­sions today?

And how can they use these reenergized healthy brains to solve challenges like global climate change and economic stagnation?

More research is better than less, and we hope that the new funded trials will result in useful drugs. But neither policy-makers nor citizens should wait until then to foster and make lifestyle decisions than can maximize cognitive performance across the lifespan.

JFK challenged us not only to go to the moon, but to take proactive care of our physical fitness.

Perhaps the time has come for a serious open national conversation on true brain health and how the newly announced Alzheimer’s strategic plan must include healthier and brainer thinking than a war on Alzheimer’s plaques and tangles.

– Dr. Peter Whitehouse is a Professor of Neurology at Case Western Reserve University and co-author of The Myth of Alzheimer: what you aren’t being told about today’s most dreaded diagnosis.

Alvaro Fernandez, recently named a Young Global Leader by the World Economic Forum, is the co-author of The Sharp Brains Guide to Best Fit ness: 18 Inter views with Scientists, Practical Advice, and Product Reviews, to Keep Your Brain Sharp, an AARP Best Book, and producer of the 2012 Sharp Brains Virtual Summit: Optimizing Health through Neuro plasticity, Innovation and Data (June 7-14th, 2012).


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