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Confessions of a Closet Atheist is hosting the latest edition of the Humanist Symposium and invites you to a mind feed of the best of the brights:
Thank you for tuning your Feeds to tonight's presentation. As mandated by law, we are required to remind you not to engage in full-mind activities while driving, operating machinery, or performing any other task that may require the majority of your mental capacity to perform correctly. Remember, nourishing your mind can be dangerous if done without regard for your surroundings. Feed Safely™.
See original: Humanist Symposium #45 is Up [The Primate Diaries]
This project is behind schedule. The reasons, I hope, are forgivable. First off, there was just too much other stuff going on last week, to the point where, even though I've read several chapters of Suzanne Somers' new book (if you can call it that) Knockout: Interviews with Doctors Who Are Curing Cancer--And How to Prevent Getting It in the First Place (Random House website), I couldn't force myself to sit down in front of the computer, copy of Knockout in front of me in order to pick choice brain-necrosing quotes from. Besides, the whole issue of Desiree Jennings came up, as well as a major anti-vaccine troll infestation in the comments that resulted in hundreds upon hundreds more comments than this blog normally gets. Now I've had a taste of what PZ has to deal with every week, and I wonder how the heck he does it.
Be that as it may, it's time to move on from Chapter 1 of Knockout. When last we left Somers, she had described how she had been misdiagnosed with "full body cancer"'; how oncologists, going against every oncologist I've ever worked with would do, allegedly tried to bully her into taking chemotherapy without a biopsy-proven tissue diagnosis of cancer (oncologists in general are very, very reluctant to treat a patient with cytotoxic chemotherapy unless they have a biopsy showing that the patient has cancer and what tissue type that cancer is); and, most hilariously of all, the story of how Somers got mad at her oncologist when he asked her why she hadn't told him on steroids. That last story revealed just how deep Somers' pool of medical ignorance is, given that she denied being on steroids, even though right after that she pontificated about how the doctors were obviously "so out of touch with new medicine," have "no clue," and don't "understand cortisol replacement as part of the menopausal experience." I hadn't been aware that cortisol (hydrocortisone when given as an evil "allopathic' drug that is also, by the way, "bioidentical") was in Somers' witches' brew of "bioidentical hormones" designed to give her body levels of estrogenic hormones equivalent to that of a 25-year-old. Never mind that estrogens are steroid hormones, and cortisol is a corticosteroid that can suppress the immune system, the latter simple fact meaning that it it is quite possible that it was Somers' own fault that she got disseminated coccidioidomycosis (commonly known as Valley Fever) rather than a mild or asymptomatic version. I say that because, if Somers was taking large amounts of hydrocortisone--excuse me, cortisol--then she very well may have had steroid-induced immunosuppression that left her open to a disseminated infection when she happened to breathe in the fungus that causes the disease. True, she may have just been unlucky and aging (the latter of which is also a risk factor for disseminated disease) or breathed in a very large bolus (which is usually what happens when, for instance, there are outbreaks of valley fever in Army installations or among workers at large construction projects in areas where the fungus is endemic), but it was not at all unreasonable of her oncologist to link Somers' ingestion of hydrocortisone to her having developed the most serious version of Valley Fever.
Naturally, Somers blamed the oncologist for "not understanding." Arrogance of ignorance indeed!
With that background in mind, now it's time to move on to more of the book. Originally, I had planned to blog it chapter by chapter, but now I'll do it in multi-chapter chunks. The exceptions might be Dr. Nicholas Gonzalez and Dr. Stanislaw Burzynski, both of whom probably deserve posts of their own.
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The article I am discussing in
this post is the 2008 Heinz Lehmann Award paper, published in the
open-access Canadian journal, Journal of Psychiatry &
Neuroscience. It really covers two topics: translational
research, and antipsychotic polypharmacy in which one of the
antipsychotic medications is clozapine.
research is research that is intended to advance the process of
translating basic science into clinically useful knowledge. Clozapine
is the most effective antipsychotic drug we have. It typically is
used for persons with schizophrenia, who do not respond to other
medications. Polypharmacy is the practice of combining two or
more medications in the same person, at the same time.
The authors describe the process of translational research, and
illustrate the application of the process to a particularly vexing
problem in psychiatry. Even though clozapine is the most
effective drug, many patients who do not have a satisfactory
response. Clozapine carries more risk, compared to other
antipsychotics, of serious adverse effects. Polypharmacy
increases the risk.
When a person is not having a satisfactory response to clozapine, the
doctor and patient may be tempted to add another medication in an
effort to improve the response. But it would not make sense to do
that, unless the potential benefits outweigh the potential risk.
At present, little is known about either the potential benefits, or the
magnitude of the potential risk.
If the condition being treated were not serious, it would not make
sense to multiply the risk. However, schizophrenia can be
terribly debilitating, and can cause considerable distress. So we
really want to be able to solve this problem, but we want to solve it
with a reasonable risk-benefit balance.
translational research approach to poor treatment response in patients
with schizophrenia: clozapine-antipsychotic polypharmacy
William G. Honer, MD; Ric M. Procyshyn, PhD; Eric Y.H. Chen, MD; G.
William MacEwan, MD; Alasdair M. Barr, PhD
J Psychiatry Neurosci 2009;34(6):433-42.