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Demystifying Medicine One Week at a Time

Mushrooms: Magic?

3/22/2013--Shelton, WA, USA Pioppini mushrooms (Agrocybe aegerita) from Fungi Perfecti. Paul Stamets, 57, is an American mycologist, author, and advocate of bioremediation and medicinal mushrooms and owner of Fungi Perfecti, a family run business that specializes in making gourmet and medicinal mushrooms. ©2013 Stuart Isett. All rights reserved.

©2013 Stuart Isett.

In ‘study of the week’ news, major media outlets reported on two small studies looking at the possible benefits of the chemical psilocybin, the ingredient found in psychedelic mushrooms.

Both studies were conducted in volunteers with cancer, who also had concomitant depression and anxiety–assumed related to their cancer.

The interesting headline-grabbing finding was that after a single dose (“trip”) with psilocybin, a majority of patients in both trials reported improved mood, decreases in mental health symptoms, and positive experiences with the drug (i.e. good trips).

Here’s the kicker: 6 months after their trips, without additional drug, many of the study participants still reported improved mental health.

Study 1 was conducted at NYU and involved 29 patients. The study found that at 6.5 months, “60-80% of the participants continued with clinical significant reductions in depression or anxiety.”

The second study was conducted at Johns Hopkins, involved 51 patients, and had similar findings. Note how the second study describes the orchestration of its sessions:

Psilocybin sessions

Drug sessions were conducted in an aesthetic living-room-like environment with two monitors present. Participants were instructed to consume a low-fat breakfast before coming to the research unit. A urine sample was taken to verify abstinence from common drugs of abuse (cocaine, benzodiazepines, and opioids including methadone)….

For most of the time during the session, participants were encouraged to lie down on the couch, use an eye mask to block external visual distraction, and use headphones through which a music program was played. The same music program was played for all participants in both sessions. Participants were encouraged to focus their attention on their inner experiences throughout the session. Thus, there was no explicit instruction for participants to focus on their attitudes, ideas, or emotions related to their cancer.

Both studies appeared in the Journal of Psychopharmacology. While I agree this news is of general interest, I think the media reporting on the studies is overly sensational. Many doubts remain about the safety of psilocybin. Cancer patients–and indeed the lay public–are vulnerable to this sort of unchecked hype. Issues unaddressed:

  • Negative effects of psilocybin (i.e. no reporting on any adverse effects)–which were listed in the studies
  • Cost
  • Alternatives
  • Small sample sizes in the studies

Overall, I’m glad that researchers are reconsidering ideas long thought too risky or out of bounds. But more science needs to be done before psilocybin is ready for mainstream use.

Gleaning up after Thanksgiving

food-bank-frontWith the holiday season upon us, our thoughts often turn to those in need — of food, clothing and shelter.

I recently attended the Oklahoma Food Security Summit and was struck by a presentation about the practice known as gleaning, a term I’d never heard before.

The U.S. Department of Agriculture defines gleaning “as the act of collecting excess fresh foods from farms, gardens, farmers’ markets, grocers, restaurants….or any other sources, in order to provide it to those in need.”

In other words, getting food that would otherwise go to waste to those in need. This is how many food banks originated.

I interviewed Katie Plohocky, co-founder and director of Tulsa’s Healthy Community Store Initiative about one of its programs called “Hands 2 Harvest,” which is a gleaning effort for much of Tulsa.

In a nutshell Plohocky gathers volunteers to go to local farms and harvest crops that would otherwise be left to rot or plowed under because of minor blemishes or lack of farm labor. She then either sells this produce in her mobile grocery or distributes it to the Community Food Bank of Eastern Oklahoma or other local food pantries.

One of the things Katie and I discussed was how food distribution often is misaligned between food available and folks’ needs. Seems like there should be an app for that…

Also because of the season, the ever-reliable Oklahoma Policy Institute posted this video debunking myths about food insecurity. Great minds, as they say…

Anxiety

How are you feeling post-election?

In the practice of medicine, we use validated questionnaires like the PHQ-9 to screen for depression or the GAD-7 to screen for anxiety.

My wife, a family doctor, administered the GAD-7 to a patient of hers this week; post-election, I started wondering how many Americans could be diagnosed with generalized anxiety disorder* right now.

Go ahead and take the quiz yourself:

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What’s your score?

A score of five or more indicates mild symptoms. Ten or more moves you to moderate. Fifteen or more means you are highly likely to have diagnosable anxiety disorder–what the experts call generalized anxiety disorder.*

If you’re in this highest category, think about getting help. You can start with your primary care physician. She can help you directly or refer you to other community mental health resources that can be helpful.

*Generalized Anxiety Disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.

  1. Restlessness or feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

Medical Revolution(s)?

9780465050642This week an essay in the New England Journal of Medicine asks if our collective learning to handle uncertainty should be ‘the next medical revolution.’ It caught my eye because many of the medical educators I follow on social networks were abuzz about it.

Coincidentally, I’m reading a fuller-length exploration of medical uncertainty, a book called “Snowball in a Blizzard,” by Steven Hatch, an infectious diseases doc at UMass.

Both the essay and the book remind us to have humility: though medical technology and scientific knowledge have leapt ahead and continue to hurtle forward, our profession’s abilities to diagnose, treat, or predict future health outcomes with precision remain stubbornly elusive.

The metaphor of the ‘snowball in a blizzard’ comes from the world of radiology–in particular mammograms. That’s what radiologists who read mammograms are looking for on the images they see. It’s challenging and inexact work. Often they miss tumors that are cancerous; to correct for this, it’s natural that radiologists need to be extra cautious and have women with anything even remotely suspicious follow up for more images and possibly biopsies. [With negative biopsies, such mammograms become known as ‘false positives.’]

I agree with the thesis that we should all become more comfortable with uncertainty. But it will be challenging.

As patients, we want our doctors and scientists to be able to give us predictions that are accurate.

  • Is this the right diagnosis?
  • Will this treatment work?
  • How long have I got?

As doctors, we wish we had greater ability to answer these questions.

As ‘consumers,’ we are fed an unending stream of media that tell us what we ‘should’ do, what we ‘need’ to be healthy, and what will make us live longer. Much of it never offers the necessary caveats about the inexactness of the science. This will be an uphill battle.

I was pleased to see a chapter in Hatch’s book devoted to health media, featuring Gary Schwitzer and his website HealthNewsReview.org. Gary has devoted his latter career to debunking medical hype. His site is well worth perusing.

We Used To Sell Cigarettes in Hospitals

nurse_1471846fNice article in STAT, a relatively new Boston Globe-affiliated publication devoted entirely to health care. Melissa Bailey reminds us that ‘candystripers’ used to sell cigarettes to patients to comfort them while hospitalized.

How quaint.

She goes on to point out 5 practices that will seem just as antiquated. Soon, we hope.

  1. Advising doctors NOT to say, “I’m sorry.” Hospitals still do this. It can be seen as an admission of guilt, the thinking goes.
  2. Have prescription labels that don’t indicate what the medicine is for. How smart. And not even close to standard at present.
  3. Not washing our hands in front of you every time. ‘Nuff said.
  4. Spending more time typing than talking and listening to you. We can hope, can’t we?
  5. Easily getting your medical records, without your having to pay, wait, fill out forms, or just be hassled like you’re asking for state secrets.

I think this is an excellent list. There are no doubt dozens more. (Why do we awaken people in the hospital so often?) What are your ideas for health care pet peeves you’d like to see abolished?

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