Demystifying Medicine One Month at a Time

Tag: research

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.

I Just Called to Say, “Hey! Check your Sugar!”

Time to say a thing or two about research. At academic medical centers (AMCs–what we used to call ‘teaching hospitals’) like GlassHospital, the holy trinity of mission is comprised of

  1. patient care
  2. teaching
  3. research.

I used to joke that at GlassHospital, our priority list was

  1. research
  2. research
  3. research
  4. —————–
  5. patient care
  6. teaching.

We’re moving away from this toward a more balanced vision. At present, heavy emphasis is placed by the National Institutes of Health (the big kahuna of medical research funding) on translational research.

Translation first meant taking “sciency” science, like cells and test tubes and petri dishes in labs, and trying to make the results clinically relevant (“at the bedside”). Now it’s come to include the concept of translating the research into meaningful impact in the community. The NIH has given a few AMCs (including GlassHospital) tens of millions of dollars to deliver on the promise of taking what we learn in the lab, the hospital, and the clinic, and disseminating it as far and as wide as possible.

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