Tag: medicine

An ingenious new treatment for schizophrenia

Posted on by Ashutosh Jogalekar

by Ashutosh Jogalekar

Molecular structures of xanomeline and trospium chloride. Note the positive charge (indicated by a +) on trospium chloride that restricts its actions to outside the brain.

Drugs for mental illness are notoriously hard. Human biology is complex, and the brain is even more complicated. We now have a good understanding of the basic mechanisms of neurotransmission, but the drugs we have for treating disorders like depression, anxiety and psychosis are often “spray and pray” approaches, either targeting the wrong mechanisms of dysfunction or targeting too many or too few. Antidepressants often stop working. Anti-anxiety medication can do little more than sedate. And many antipsychotic drugs have prohibitive side effects.

Nevertheless, there are rare cases when genuine breakthroughs occur in the field. Thorazine famously emptied out the cruel mental asylums of the 1950s and 1960s. L-DOPA provided genuine benefits for Parkinson’s patients. And there is no denying that the new generation of antidepressants works at least occasionally for a subset of patients. Last year one such potential breakthrough seemed to fly under the radar of breathless news dominated by politics and social issues. If its promise holds up, it could herald a new kind of treatment for schizophrenia.

As is well known, schizophrenia is a serious form of psychosis that is characterized by disordered thinking, hallucinations and impaired speech and expression. The disease profoundly impacts the quality of life of afflicted individuals, including being able to sustain social relationships and professional goals. In severe cases, as made infamous by the case of Michael Laudor, even high-functioning schizophrenics can become a fatal threat to themselves or others. Estimates of the prevalence of schizophrenia in the United States range from 0.25%-0.64%.

All drugs work by blocking or improving the function of proteins or receptors. Receptors in the brain include those that regulate the function of neurotransmitters like dopamine, serotonin and norepinephrine. Neuropharmacological drug discovery starts with identifying these receptors and then discovering molecules that selectively inhibit or activate them. For instance, most antidepressants are selective serotonin reuptake inhibitors (SSRIs) which increase the concentration of serotonin by blocking its re-absorbption and improving a sense of well-being. Read more »

Monday, May 23, 2022

Inverting the Medical Gaze

Posted on by Danielle Spencer

by Danielle Spencer

Name of Doctor: MD

Source and Reliability: MD is the primary source of information and appears to be self-reliable historian.

Summary: A 41-year old Caucasian man presents with decreased attention span and documented distraction. Patient reports that symptoms began “several years ago” and claims they were exacerbated by the introduction of the EMR. Lack of eye contact and frequent interruptions were documented. Denies loss of empathy. Denies malaise, burn-out, regret over not having pursued dermatological training or investment banking. Social history: physician in primary care practice.

A treatment plan was discussed at length with the MD.

Monday, September 30, 2019

This book should transform your outlook on cancer research

Posted on by Ashutosh Jogalekar

by Ashutosh Jogalekar

A few days ago I finished watching a new documentary on Bill Gates’ life and work. One of the episodes narrated the sad story of the death of his mother in the mid 1990s from late stage breast cancer. She was a great philanthropist and a doting parent who managed to see Bill get married just before she died. At that point her son was already one of the most successful and wealthiest individuals in the world, but with all his resources and wealth, her life could not be saved. Steve Jobs, another person who had access to every medical treatment that money can buy, died early from cancer. These two stories tell us how great the leveling effect of cancer is, taking poor and rich alike without discrimination. Like war, cancer is the father of us all.

Today breast cancer can be treated much better than it was in the 1990s. There are better drugs and better radiation treatment options available, but for resistant late stage breast cancer the prognosis isn’t much better. In fact, as Dr. Azra Raza who is a distinguished oncologist at Columbia University tells us in this eloquent, thought-provoking and immensely sobering book, what’s true for breast cancer is true for most other kinds of cancer except for a few rare exceptions. The hard hitting truth is that in spite of tens of billions of dollars fueled into research around the world done by some of the smartest people in the field, the truly relevant endpoint for cancer – the increase in someone’s life span – has not changed much even after thirty years. For instance, a study of FDA-approved drugs from 2002 to 2014 showed that these drugs extended people’s lives by an average of only 2 months. Dozens of Nobel Prizes have been given out for basic cancer discoveries, cancer ‘moonshots’ have been promoted by politicians, startups and hospitals working on cancer continue to spend countless dollars and hours on a cure for the disease, but the two things that matter most for patients and their loved ones – extension and quality of life – haven’t changed much.

To know why this depressing scenario persists, Raza offers a simple reason with a hard answer: we are focusing too much on late stage cancer treatment, when the disease has already progressed and spread throughout the body, and much less on early stage detection and prevention. In spite of purported cancer breakthroughs in the media, the treatment is essentially the same as it has been for decades – slash (surgery), poison (chemotherapy) and burn (radiation), a triad of interventions sounding like they have been imported from the Stone Age, used because we can’t use anything better. Read more »

Monday, July 9, 2018

The wisdom of John Wheeler and Oliver Sacks

Posted on by Ashutosh Jogalekar

by Ashutosh Jogalekar

A rare and happy coincidence today: The birthdays of both John Archibald Wheeler and Oliver Sacks. Wheeler was one of the most prominent physicists of the twentieth century. Sacks was one of the most prominent medical writers of his time. Both of them were great explorers, the first of the universe beyond and the second of the universe within.

What made both men special, however, was that they transcended mere accomplishment in the traditional genres that they worked in, and in that process they stand as role models for an age that seems so fractured. Wheeler the physicist was also Wheeler the poet and Wheeler the philosopher. Throughout his life he transmitted startling new ideas through eloquent prose that was too radical for academic journals. Most of his important writings made their way to us through talks and books. Sacks the neurologist was far more than a neurologist, and Sacks the writer was much more than a writer. Both Wheeler and Sacks had a transcendent view of humanity and the universe, a view that is well worth taking to heart in our own self-centered times.

Their backgrounds shaped their views and their destiny. John Wheeler grew up in an age when physics was transforming our view of the universe. While he was too young to participate in the genesis of the twin revolutions of relativity and quantum mechanics, he came on stage at the right time to fully implement the revolution in the burgeoning fields of particle and nuclear physics. Read more »