Look Again

Rude Awakening, Monsanto & Action Alerts (Spilling the Beans Newsletter)

Hakeem Alexander — Tue, 09 Feb 2010 23:43:00 GMT

A wise customer wanted to find out if the corn nuts she was eating were from genetically modified corn. She emailed the company and got quite a shock. It began:

"Thank you for your contact. We are not aware of any GMO-free corn in the US. We feel it is a ridiculous concern based on very poor science." Read the Blog

SOURCE LINK
http://www.responsibletechnology.org/utility/showArticle/index.cfm?objectID=4491

Monsanto: The World's Poster Child for Corporate Manipulation and Deceit

When Forbes magazine declared Monsanto as the Company of the Year for 2009, millions of surprised people were forced to reevaluate their opinions about a major corporation. Now they no longer trust Forbes. Read Part 1

Follow the whole series—Subscribe to Jeffrey Smith's RSS feed on The Huffington Post

Don't Buy It: Keep Cloned Meat off Grocery Shelves

The FDA has lifted a voluntary ban on allowing cloned animal products from entering the human food supply. Based upon flawed studies, the FDA has claimed that eating meat and dairy from cloned animals or their offspring is harmless to human health. Join Friends of the Earth in keeping it off the shelves.

Send a Letter to Congress › | Sign a Petition to Stores ›

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http://www.responsibletechnology.org/utility/showArticle/index.cfm?objectID=4491

Omega-3s beat depression (Naural News)

Hakeem Alexander — Tue, 09 Feb 2010 23:30:00 GMT

Tuesday, October 20, 2009
by Mike Adams, the Health Ranger
Editor of NaturalNews.com

(NaturalNews) You're probably already aware of the benefits of omega-3 fatty acids on cardiovascular health, but did you know that omega-3s are also extremely beneficial for moods and cognitive function? In fact, there's a tremendous amount of good evidence demonstrating that omega-3 fatty acids can help enhance brain function and prevent depression.

Below, we present a collection of supporting quotes and testimonials from authors and researchers in the natural health field. You'll find more of these quotes on NaturalPedia, the free online encyclopedia of natural health knowledge: www.NaturalPedia.com

Source Link
http://www.naturalnews.com/027285_omega-3_depression_fatty_acids.html

Omega-3s and depression

Can eating more omega-3s really boost our moods? The answer, based on the available scientific and clinical evidence, seems to be a cautious yes. There are four lines of evidence supporting the role of omega-3 essential fatty acids in depression. First, there are compelling population studies linking the eating of large amounts of fish (omega-3 fatty acids) to low rates of major depression. The second line of evidence includes neurochemical studies in animals (looking at brain chemistry).
- The Omega-3 Connection: The Groundbreaking Anti-depression Diet and Brain Program by Andrew L. Stoll

The omega-3 fatty acids are important not just for health; they're important for happiness, too. The omega-3 fatty acids EPA and DHA are found in high concentrations in fatty, carnivorous fish such as herring, mackerel, tuna, and salmon. (Smaller amounts are found in other fish.) In countries where more fish is consumed, there is a lower rate of depression. Omega-3 fish oils can elevate your mood. Besides their use for depression, studies have shown that fish oil is helpful for bipolar disorder, as well.
- Supplement Your Prescription: What Your Doctor Doesn't Know About Nutrition by Hyla Cass, M.D.

Jonathan Zeuss, who has no doubt that depression is "to a very large degree, a nutritionally caused disease," touts the benefits of omega-3 fatty acids. "They are absolutely crucial," he says. "There is a huge amount of evidence now linking omega-3 deficiency and depression. Around a quarter of the dry weight of our brains is made up of omega-3s and if you are deficient in them, the cells in your brain malfunction and you are much more likely to become depressed." Omega-3s are known as essential fatty acids.
- The Food-Mood Connection: Nutrition-based and Environmental Approaches to Mental Health and Physical Wellbeing by Gary Null and Amy McDonald

Dietary advice to lower cholesterol levels tends to increase the ratio of omega-6 to omega-3 and decreases the level of the essential omega-3 fatty acid, docosahexanoic acid. Population-based studies in various countries and the United States have indicated that decreased consumption of omega-3 fatty acids correlates with increased rates of depression. There is a consistent association between depression and coronary artery disease. Food Allergies Depression and fatigue have been linked with food allergies for over sixty-five years.
- Encyclopedia of Natural Medicine, Revised Second Edition by Michael T. Murray, N.D., Joseph E. Pizzorno, N.D.

Donald Rudin and other authorities believe a deficiency of the Omega-3 fat is a main cause of depression and other mental disorders. Omega-3 fats work to keep us mentally and emotionally healthy and strong in three ways: 1. Omega-3 fats act as precursors for the body's production of key prostaglandins. 2. Omega-3 fats provide the substrate for B vitamins and co-enzymes to produce compounds that regulate many vital functions. 3. Omega-3 fats provide energy and nourishment to our nerve and brain cells.
- The Facts about Fats: A Consumer's Guide to Good Oils by John Finnegan

The implications of omega-3 deficiency on the brain are profound and span the entire human life cycle. Beginning in pregnancy, premature birth and its potential neurologic complications may result from omega-3 deficiency. Babies who are bottle-fed or born from omega-3-deficient mothers will lack the omega-3 fatty acids necessary for optimal cognitive and visual development. Children deprived of omega-3s may have less ability to pay attention and control impulsive behavior and may be at higher risk for depression.
- The Omega-3 Connection: The Groundbreaking Anti-depression Diet and Brain Program by Andrew L. Stoll

But the importance of omega-3s for the brain hardly stops after infancy. Too little omega-3s have been linked to both attention deficit disorder (ADD) and depression. Research at Harvard has shown significant improvement in bipolar depression with large doses of omega-3supplements. And studies have strongly suggested that increased fish oil intake could reduce anger and hostility in alcoholics, troubled teenagers, and violence-prone prisoners. "Clearly omega-3 fatty acids are essential to good brain health," says my friend Daniel Amen, M.D.
- The Most Effective Natural Cures on Earth: The Surprising, Unbiased Truth about What Treatments Work and Why by Jonny Bowden, Ph.D., C.N.S.

In his excellent book The Omega-3 Connection, Harvard Medical School professor Andrew Stoller, M.D., answers his own question, "Can eating more omega-3s really boost our mood?" with the statement: "The answer, based on the available scientific and clinical evidence, seems to be a cautious yes." There are compelling population studies linking the consumption of large amounts of fish (omega-3 fatty acids) to low rates of depression. Controlled clinical trials of omega-3s in depression are under way at any number of research centers.
- The 150 Healthiest Foods on Earth: The Surprising, Unbiased Truth About What You Should Eat and Why by Jonny Bowden, Ph.D., C.N.S.

Depressed people have been reported to have lower omega-3 fatty acid levels (e.g., DHA) than people who are not depressed. Low levels of the other omega-3 fatty acid from fish, EPA, have correlated with increased severity of depression. In a double-blind trial, people with manic depression were given a very high intake of supplemental omega-3 fatty acids (enough fish oil to contain 9.6 grams of omega-3 fatty acids per day) for four months.
- The Natural Pharmacy: Complete A-Z Reference to Natural Treatments for Common Health Conditions by Alan R. Gaby, M.D., Jonathan V. Wright, M.D., Forrest Batz, Pharm.D. Rick Chester, RPh., N.D., DipLAc. George Constantine, R.Ph., Ph.D. Linnea D. Thompson, Pharm.D., N.D.

As Omega-3 fatty acid levels fall, rates of depression increase. In countries where fish is consumed frequently, Omega-3 fatty acid levels are high and rates of depression are low, even in areas of the world that don't get much sunlight. Note these "fat facts" as they relate to the brain: Depression has been linked to low levels of a fatty acid called phos-phatidylserine. A number of studies have made the correlation between depression and low levels of cholesterol.
- The Crazy Makers: How the Food Industry Is Destroying Our Brains and Harming Our Children by Carol Simontacchi

The high prevalence of depression in patients with coronary artery disease, alcoholism, multiple sclerosis, and postpartum depression might be linked by low concentrations of omega-3 fatty acids in nerve membranes," explains Dr. Hibbeln. "We're suggesting that deficient levels of the omega-3s in the nervous system may increase the vulnerability to depression, just as a deficient level in the circulation may increase vulnerability to heart disease." It's also possible that fat affects mood by regulating serotonin.
- Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition by Elizabeth Somer, M.A., R.D.

According to an article in Preventative Medicine, "Growing evidence likewise suggests a role for omega-3 fatty acids in helping to relieve disabling depression. Fatty acids may provide relief for people of all ages and genders who are afflicted by depression" (2006 January, pp. 4-13). In fact, one specific study reported in the American Journal of Psychiatry (June 1, 2006, pp. 1098-1100), reported that "children with depression benefit from omega-3supplementation."
- Antidepressants, Antipsychotics, And Stimulants - Dangerous Drugs on Trial by Dr David W Tanton, Ph.D.

This relative deficiency of omega-3 fats has potentially serious implications. Also, the consumption of too much omega-6 fat leads to high levels of arachidonic acid (AA). Higher levels of arachidonic acid can promote inflammation. When we have insufficient omega-3 fat, we do not produce enough DHA, a long-chain omega-3 fat with anti-inflammatory effects. High levels of arachidonic acid and low levels of omega-3 fats can be a contributory cause of heart disease, stroke, autoimmune diseases, skin diseases, depression, and possibly increased cancer incidence.
- Eat to Live: The Revolutionary Formula for Fast and Sustained Weight Loss by Dr. Joel Fuhrman

In fact, there is a sixty-fold difference in depression rates across countries from the highest (Japan and Taiwan) to the lowest (North America, Europe, and New Zealand) omega-3 fat consumption. Even postpartum depression decreases as women increase their consumption of fish. Many people also report a drop in mood when they switch too quickly to a low-fat diet. In addition, serious depression is seen in up to 70 percent of alcoholics. Studies on animals demonstrate that long-term alcohol consumption depletes omega-3 fatty acids in nerve tissue, but this is reversed after prolonged abstinence.
- Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition by Elizabeth Somer, M.A., R.D.

A low dietary intake of omega-3 fatty acids may contribute to or worsen asthma symptoms, most likely due to increased inflammation. The ratio of omega-3 to omega-6 fatty acids has been shown to be low in asthma sufferers. Supplements may be useful in relieving symptoms in some asthmatics, although not all studies have shown beneficial effects. Recent research suggests that omega-3 fatty acid deficiency may also be linked to depression and aggression.
- The New Encyclopedia of Vitamins, Minerals, Supplements and Herbs by Nicola Reavley

Omega-3 fatty acids, powerful weapons in the fight against heart disease, may also help you win the battle against depression. Research shows that in countries where people eat a lot of fish, a good source of omega-3s, the incidence of depression is low. In one study, Japanese students who took a daily fish oil supplement for three months were less hostile and aggressive than their peers. Some experts warn that there are too many other cultural differences to be absolutely sure fish are helping to ward off depression. In the meantime, eating more fish can't hurt.
- Natural Cures and Gentle Medicines: That Work Better Than Dangerous Drugs or Risky Surgery by Frank K. Wood

One hundred grams of fresh purslane leaves (about 1 cup) can contain up to 300 to 400 mg of alpha-linolenic acid, the same omega-3 found in flaxseed. Purslane also contains small amounts of the longer-chain omega-3s (DHA and EPA), which are rarely found in anything but fish and fish oil. Omega-3 fatty acids are anti-inflammatory, heart-healthy fats that have been found beneficial in hypertension, type 2 diabetes, coronary heart disease, and depression. The more omega-3s we eat, the better!
- The 150 Healthiest Foods on Earth: The Surprising, Unbiased Truth About What You Should Eat and Why by Jonny Bowden, Ph.D., C.N.S.

Scientists don't know exactly how omega-3's protect against depression, but they do know that the fats are important to health of neurons, or brain cells. To get sufficient omega-3's to battle depression, Dr. Zuess recommends taking approximately 10 grams a day of DHA and EPA, which usually amounts to about 30 fish-oil capsules daily. Take them in divided doses with meals. This remedy is safe for long-term use.
- Alternative Cures: The Most Effective Natural Home Remedies for 160 Health Problems by Bill Gottlieb

Omega-3 fatty acids also aid in the prevention of emotional disorders, and a deficiency can contribute to severe depression. The brain is the top source of fatty acids in the body, and it requires the omega-3s for optimal functioning. Add one or two tablespoons of flaxseed oil to green leafy vegetable salads to get the full complement of daily omega-3 fatty acids.
- Food Swings: Make the Life-Changing Connection Between the Foods You Eat and Your Emotional Health and Well-Being by Barnet Meltzer, M.D.

Stoll suggests the omega-3 fatty acid in fish oil may slow down neurons in your brain, much like the drug Lithium, which is used to treat manic depression. Another research group from England noticed depressed people had less omega-3 fatty acids in their red blood cells than healthy people. The more severe the depression, the less omega-3. There is even evidence that EPA can help treat people with schizophrenia, a serious mental illness that can cause delusions, hallucinations, and disorganized behavior.
- Eat and Heal (Foods That Can Prevent or Cure Many Common Ailments) by the Editors of FC&A Medical Publishing

The part of the brain that Omega-3 effects is the learning ability, anxiety/ depression, and auditory and visual perception. The Omega-3 fats also aid in balancing the autoimmune system, and there seem to be a growing number of children with allergies, colic, and skin problems. There are also indications that Omega-3 fats play an ongoing role in brain function, healthy immune system function, and general growth throughout childhood and adolescence. One study revealed that Omega-3supplementation induced catch-up growth in a deficient, underdeveloped seven-year-old.
- The Facts about Fats: A Consumer's Guide to Good Oils by John Finnegan

Omega 3 Fails Depressed Heart Patients (Nutraceuticals World)

Hakeem Alexander — Tue, 09 Feb 2010 23:25:00 GMT

Clinical study results termed disappointing.

By Joanna Cosgrove

http://www.nutraceuticalsworld.com/contents/view/17622

Heart disease continues to reign as the number one cause of death in the U.S. and for heart disease patients also suffering from depression, the chances for death are even greater. Researchers have documented that one characteristic both conditions share is low levels of omega 3 fatty acids. It would stand to reason then that the addition of an omega 3 supplement to the existing depression medicine regimen of these patients might yield a benefit—not so, according to a recently published study.

The randomized, placebo-controlled study, which was published in the October 21 issue of the Journal of the American Medical Association (JAMA October, 21 2009;302(15):1651-1657), set out to determine whether omega 3s could improve the response to sertraline (Zoloft) in 122 patients with both major depression and coronary heart disease.

Following a two-week run-in period during which all patients were given 50 mg/d of sertraline, 62 (59 by the time the study concluded) randomly selected patients received 2 g/d of omega 3 fatty acid ethyl esters (930 mg of eicosapentaenoic acid [EPA] and 750 mg of docosahexaenoic acid [DHA]). The 60 (56) remaining patients received corn oil placebo capsules. This dosing lasted 10 weeks.

At the conclusion of the trial, patients were evaluated using the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Researchers were surprised to find no difference between the two groups when it came to the regression of their depression.

Lead study author Robert Carney, PhD, professor of psychiatry and director of the Behavioral Medicine Center at Washington University School of Medicine’s Department of Psychiatry in St. Louis, MO, said he was “very surprised” that the results of the study were so disappointing. “Omega 3 blood levels and dietary intake are low in depressed patients,” he explained. “Smaller studies showed big effect on depression when added to standard antidepressant treatment. We thought omega 3 may help explain the relationship between depression and heart disease (depression is a risk factor for cardiac events).”

He added that in hindsight the results could have been attributed to several factors. “Possibly [the] dose was too low or the DHA/EPA ratio may not have been optimal,” he said. “[It’s] hard to judge based on this and other published studies.”

He and his colleagues also conjectured whether higher doses of sertraline, or a different ratio of EPA to DHA, longer treatment, or omega 3 monotherapy could improve depression in patients with coronary heart disease, but that remains to be determined.

“We have much to learn about the relationship between omega 3 and depression and heart disease,” he said. “More clinical trials should be undertaken, but it is also important to understand the mechanisms that may explain how omega 3 is related to depression.”

Despite this study’s less than favorable outcome, Dr. Carney and his colleagues continue to be intrigued with this area. “We are currently exploring our data more carefully to decide our next step,” he said, when asked what their next step might be.

For now though, he said, there isn’t enough evidence to warrant this type of treatment recommendation to people with or without heart disease.

Traditional Herbal Medicines: Coriander (Coriandrum Sativum) [Global College of Natural Medicine]

Hakeem Alexander — Tue, 09 Feb 2010 23:21:00 GMT

By: By Moira Khouri NC, MH, HHP, CCP
Faculty Member of GCNM

Ancient Roots
Coriander is in the Apiaceae family (formerly umbelliferous), and is an herb that has been cultivated over thousands of years throughout the ancient world. Common names include Cilantro, Chinese parsley and Japanese Parsley. Coriander is native to Southern Europe and the Middle East. It is mentioned in the Bible, and was a favorite of the ancient Greeks, Romans and Hebrews. It is called Yan Shi in Traditional Chinese Medicine, the leaves are also called Wuh Seui or Yuen Sui and the seeds are also called Heung Seui and Hu Sui in China. The plant is called Dhanyaka in Sanscrit, the language of the ancient Ayurvedic Tradition of India, and Kuzhbare in modern Arabic. Its many medicinal uses have been documented by the Egyptians, Romans, and Greeks, Chinese and Indian healing traditions.

The name is thought to derive from the Greek koros for insect or bug, probably due to the appearance of the small light brown seeds. The Ebers Papyrus from 1550 BC references Coriander, and Hippocrates writes of it in 400 BC. Coriander was introduced to Britain by the Roman legions that carried the seeds with them. Pliny The Elder, the Roman who authored Naturalis Historia circa 77-79 AD praised Egyptian Coriander as the best and an antidote for the poison of the snake amphisbaena, and for healing sores, burns, carbuncles, sore ears, fluxes of the eye, cholera and intestinal parasites. It is believed to have been grown in the hanging gardens of Babylon. Charlemagne had it grown on the imperials farms in central Europe and it was used for love potions in the middle ages. It is even mentioned in the One Thousand and One Nights as an aphrodisiac.

Properties, Actions and Uses

In the Ayurvedic tradition, Coriander has a bitter, pungent taste with an astringent quality, and a cooling energy. It is tridoshic, being beneficial for balancing Pitta dosha (fire & water), Kapha dosha (water & earth), and Vata dosha (air & ether). The essential oil consists of the linalol called coriandrol (60 to 70%), geraniol, borneol and terpenes.

Coriander works on the digestive, respiratory and urinary systems. It is strengthening for the urinary tract and enhances digestion without aggravating Pitta. It strengthens liver function as a detoxifying herb. Coriander is antimicrobial and antibacterial, alterative, diaphoretic, carminative, diuretic, and stimulant, with a detoxifying and chelating effect, helping to remove heavy metals such as mercury and lead. Coriander seeds appear in herbal tea remedies for stomach ailments. The leaves known as Cilantro are juiced and taken internally for allergies, hay fever, and applied externally for itch, inflammation and skin rashes.

Cilantro may be prepared as a puree (like a raw Pesto sauce) by blending the Cilantro leaves, olive oil, ground almonds, fresh lemon juice and garlic in a blender. Take at three teaspoons a day to stimulate and cleanse the digestive system. It makes an aromatic addition to salads and is good added fresh to hot spicy dishes such as in Peruvian, Mexican, Asian, North African and Indian cooking and is one of the basic ingredients in Indian curry dishes. The ground seed balances the sweet and pungent spices in blends. This herb grows well in the temperate zones of the world. It is best used as finely ground dried seeds or fresh leaves, as the aromatic properties are reduced by drying. The leaves and stems may be chopped and frozen in ice cube trays or small containers for future use.

Nutrients

Coriander contains Vitamin C, and small amounts of Vitamin E, Calcium, Iron and Niacin (B3).

Sources:

The Yoga of Herbs, by Dr. David Frawley and Dr. Vasant Lad

Planetary Herbology, by Michael Tierra, CA, ND

An Ancient Egyptian Herbal, by Lise Manniche

The Spice and Herb Bible, 2nd Edition, by Ian Hemphill

Bikram Yoga: It’s Hot! (Global College of Natural Medicine)

Hakeem Alexander — Tue, 09 Feb 2010 23:18:00 GMT

By Jackie Christensen, BS, HHP, NC, MH
Faculty Member of GCNM

A man named Bikram Choudhury developed Bikram Yoga over 30 years ago. At the age of 13 Bikram won the National India Yoga Contest. He then went on to pursue an athletic career as a marathon runner and a champion weightlifter. Then at the age of twenty Bikram experienced a serious knee injury while weight lifting. European doctors told Bikram he would not walk again. In disbelieve he made his way back to India and his yoga guru, Bishnu Ghosh. After six months of yoga therapy his knee had totally recovered and through his own healing regime Bikram Choudhury created Bikram Yoga.

Bikram Yoga is a series of 26 postures conducted over 90 minutes; it begins with one warm up breathing exercise, then progresses through 24 asanas or postures and finishes with one toxin eliminating breathing posture. The series of postures has been systematically formulated to work through the entire body. Each posture is completed twice and prepares the body for the next pose. The asanas and sequencing are designed to warm up and stretch every joint, muscle, ligament, tendon, vertebrae and organ of the body down to the cellular level. By moving fresh blood and oxygen to all areas of the body, all of the systems of the body are restored.

Bikram Yoga is also known as "Hot Yoga" because one of the requirements is for the room to be heated to be between 95 and 105 degrees Fahrenheit. The idea is that the higher temperatures will help the muscles to loosen more quickly therefore it making for a "deeper" practice with greater flexibility. Bikram yoga teaches you to control your thoughts and emotions in times of high pressure. The hot temperatures also cause students to sweat profusely during practice. All the sweating can help with weight loss and will increase metabolic rate. It also boosts the immune system, by indirectly purifying the blood and circulating the lymph system. Along with the recommended eight-to-ten glasses of water daily, yogis practicing this form should be mindful to consume enough water to replenish the body. Practitioners are advised to drink up to 16 ounces of water two hours before a Bikram yoga session and up to 40 additional ounces during and after the session. The room in which Bikram is practiced is mirrored to allow for greater body awareness and to refine and deepen our postures with easy self-correction. Students are encouraged to look at themselves in the mirror while practicing so they can see if any posture adjustments need to be made.

Bikram started opening yoga schools, firstly in India and then around the world. In Japan, Bikram researched with doctors at the Tokyo University Hospital and was able to prove the medical benefits of his yoga system. These findings were presented in 1972 at the International Medical Conference in Kyoto.

Within reason, anyone at any age can perform the poses, but this style of yoga does require the practitioner to be in better physical condition and have a high tolerance for heat. While the practice is somewhat controversial due to a number of injuries sustained by class patrons, it’s still a popular and beneficial exercise choice.

First brain cancer cell line sequenced (BioTechniques)

Hakeem Alexander — Tue, 09 Feb 2010 23:14:00 GMT

02/08/2010

Erin Podolak

Researchers have sequenced the popular research glioblastoma cell line U87.

Researchers from the University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center have completed the first genetic sequence of a brain cancer cell line. The line, U87, is a popular research model that is in use at UCLA and various other research institutions. According to UCLA, the sequence brings researchers one step closer toward personalized treatments based on specific molecular targets affecting this line.

FULL ARTICLE
http://biotechniques.com/news/First-brain-cancer-cell-line-sequenced/biotechniques-187734.html?utm_source=BioTechniques+Newsletters+%26+e-Alerts&utm_campaign=1b1588d5be-BioTechniques_Daily&utm_medium=email

Turning back time: Old stem cells rejuvenate in the presence of younger ones BioTechniques)

Hakeem Alexander — Tue, 09 Feb 2010 23:08:00 GMT

02/08/2010

Erin Podolak

The researchers, led by HHMI early career scientist Amy J. Wagers of Harvard Medical School, studied the hematopoietic stem cells in the blood of old mice that had been exposed for several weeks to the blood of young mice. The bone marrow stem cells in the old mice were reduced in number but became more effective at replenishing the blood system, which is characteristic of young stem cells.

FULL ARTICLE
http://biotechniques.com/news/Turning-back-time-Old-stem-cells-rejuvenate-in-the-presence-of-younger-ones/biotechniques-187821.html?utm_source=BioTechniques+Newsletters+%26+e-Alerts&utm_campaign=1b1588d5be-BioTechniques_Daily&utm_medium=email

Scientists map epigenome of human stem cells (BioTechniques)

Hakeem Alexander — Tue, 09 Feb 2010 05:24:00 GMT

02/05/2010

Natalie Goode

DNA methylation causes precise subunits of DNA to be chemically changed, which directs which areas of the genome are active and which ones are inactive. This process is critical to embryonic cells transformation from pluripotent stem cells to differentiated ones.

FULL ARTICLE
http://biotechniques.com/news/Scientists-map-epigenome-of-human-stem-cells/biotechniques-187722.html?utm_source=BioTechniques+Newsletters+%26+e-Alerts&utm_campaign=936fa8a769-BioTechniques_Daily&utm_medium=email

Cellular communication pathways caught in the act (BioTechniques)

Hakeem Alexander — Tue, 09 Feb 2010 05:19:00 GMT

02/05/2010

Erin Podolak

The ability to view the 3-D structure of these proteins could lead researchers to the development of drugs for conditions such as neurodegeneration, cancer, and cardiovascular disease based on the interactions of these proteins.

FULL ARTICLE AT THIS LINK
http://biotechniques.com/news/Cellular-communication-pathways-caught-in-the-act/biotechniques-187727.html?utm_source=BioTechniques+Newsletters+%26+e-Alerts&utm_campaign=936fa8a769-BioTechniques_Daily&utm_medium=email

Math as Mass Hypnosis: On Mortgage-Backed Securities, Maritime Warfare, and Medical Research (MedScape Today)

Hakeem Alexander — Wed, 27 Jan 2010 19:59:00 GMT

Andrew J. Vickers, PhD

The origins of our recent economic troubles are complex, but there is widespread agreement that people like me -- a statistician -- bear a large share of the responsibility. In brief, math types built statistical models to predict whether homeowners would default on their mortgages, which worked absolutely great until lots of homes started getting foreclosed. Then the models didn't work so well anymore. Banks had sold securities backed by mortgages, and the value of those securities depended on the probability that the mortgages would be repaid. The statistical models predicted a high probability of repayment, making the securities extremely valuable. When the models turned out to be wrong, a whole lot of investments suddenly became worth very little indeed.

Forecasting whether a homeowner will pay back a mortgage is, in theory, a relatively straightforward prediction problem. If you gave me 2 sets of historical data from US homeowners, one with details -- such as their size of mortgage, value of house, age, income, and assets -- and the other set showing whether the homeowner defaulted, I could run a logistic regression and build a pretty good statistical model to predict someone's chance of foreclosure. This would be particularly robust, given the millions of homeowners in the United States and the large data set.

The problems with the mathematical models started when banks started offering mortgages without knowing a borrower's assets or income. (These were called "NINjA" loans, as in "No Income? No Assets? Here is a loan anyway.") Models don't generally run very well unless you have good data to plug into the model; therefore, analysts were forced to make what amounted to an educated guess as to the chance that a NINjA loan would end in default. What really kicked the models into a tailspin was that housing prices then began to fall, dramatically increasing foreclosure rates. One theory as to what happened is that first banks made it easier to get a cheap mortgage, and this drove up house prices. Statistical models therefore predicted low rates of default, which encouraged more lending and higher house prices. When reality eventually kicked in and the bubble burst, house prices fell; borrowers went into foreclosure; banks lost money on mortgage loans; and the economy went pear-shaped.

All of this was pretty avoidable. Anyone on Main Street can tell you that something is going badly wrong when a housecleaner can borrow $700,000 to flip an apartment or when a mediocre condo is priced at 12 times the median income of the county in which it's located. The math types sitting on Wall Street were stuck with their data that they had input into models that said everything was going to be fine: The housecleaner's $700,000 was just a line on a spreadsheet, with a probability of default given by a nice neat formula.

Where Was That Very Loud Bang?

During the Second World War, convoys of supply ships would cross the Atlantic from the United States to the United Kingdom carrying soldiers, weapons, and other supplies. German U-boats would try to sink the convoys, and battleships protecting the convoys would attempt to sink the U-boats. The British Navy wanted to know how best to set exploding depth charges to have the best chance of hitting submarines, and therefore sent data to a couple of statisticians working at the War Office in London. The data consisted of the direction in which the depth charge had been fired relative to the direction of the ship and then whether the submarine had been hit. After a couple of months, the statisticians had gotten precisely nowhere in working out how best to target depth charges.

One of them, bravely enough, volunteered to go out on a battleship and observe a sea battle. He saw a bunch of depth charges fired off, the ship going in one direction and the wind in another, and then massive explosions. The data that the statisticians had been working with -- eg, "depth charge at 35° to starboard" -- were totally unreliable: Pretty much the only thing one could tell for sure was whether the depth charge went to the left or right. When the statistician got back to London and reanalyzed the problem, ignoring most of the data that he'd been sent, he solved it pretty quickly. This is one of the reasons I am writing this in English, rather than German.

My Formula Looks Great, So What's the Problem?

I was once asked to help design a phase 1 trial looking at the effects of a drug on immune function. The basic idea was to give patients different doses and see which had the best effect. As far as I could make out, there were 3 endpoints -- cytokines, T cells, and neutrophils -- so I essentially wrote a statistics section stating that we'd work out the best dose for each of the 3 endpoints and then compare them. When the trial was completed, I was sent a spreadsheet with over 600 data points per patient. It turns out that there are a number of different ways of measuring cytokines, T cells, and neutrophils, and the laboratory had done them all. As a result, I had to develop a different way of analyzing data on the fly, without reference to the protocol.

My problem was that I didn't understand the scientific content of the study because it included complex immune assays, such as "IFN-gamma production from CD45RO+ CD4+ cells, unstimulated." Therefore, I was no different from the Wall Street "quants" who had no insight into the securities that they were valuing --including $500,000 loans to semiemployed laborers-- or from the statisticians in the War Office who thought that huge explosions at sea could be pinpointed to within 5°.

Why Statisticians Prefer to Stick to Math

A common mathematical problem is figuring out when to leave home to catch a plane. You might figure that it takes 5 minutes to load the car, and that the 10 miles to the airport would be driven at 55 mph. Here is the formula:

Total time = Loading time + distance ÷ average speed × 60

This gives 5 + 10 ÷ 55 × 60 = 15.9 minutes. There is nothing wrong with the math here; it is 100% correct. However, if I used this formula to get my family to the airport, I'd miss my flight. It takes more than 5 minutes to load a bunch of children plus booster seats into a taxi, and you can't drive to John F. Kennedy International Airport through Brooklyn at 55 mph.

If you read statistics journals, you'll find a lot of papers that are the equivalent of tinkering with Total time = Loading time + distance ÷ average speed × 60. For example, an academic statistician might point out that the formula makes the assumption that variations in speed are logarithmically distributed, and develop new formulas for Gaussian, uniform, and Weibull distributions. However, unless the statistician running the formula knows me, my family, and my neighborhood, we're still going to be late.

You wouldn't have to spend much time in the statistician's department to understand why knowledge of Gauss is favored over knowledge of the scientific background of study, such as Brooklyn traffic patterns. The study that I analyzed looking at the immune drug was published in a specialist chemotherapy journal, and I was the seventh author out of 10. I don't think any statisticians read it. A paper published in The Journal of the Royal Statistical Society on extending the travel time formula for alternative parameterizations of the velocity distribution would have the statistician who wrote it as first author. Of course, plenty of statisticians read statistical journals. Authors of statistical papers become well known in the statistical community, and they get promotions and invitations to lecture because of their contributions to mathematical theory -- not their knowledge of the immune system. Making a fuss about data hardly endears statisticians to their scientific collaborators; there is often huge pressure to "just give us the P value."

I am all for advancing the science of statistics. Indeed, I've written papers proposing new statistical methods. However, at some point, theory has to link up with reality. Compare the statistician who went out to watch the naval battle, got a feel for the data, and helped to win the war, with the Wall Street statisticians who sat programming in their cubicles, never daring to set foot in a mortgage broker's office (let alone a battleship), and who brought much of the world economy to its knees.

If you liked this article, you'll love Andrew Vickers' collection of stories on statistics: "What is a p-value anyway?"

Disclosures

Assistant Attending Research Methodologist, Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosure: Andrew J. Vickers, PhD, has disclosed no relevant financial relationships.

"Sleeping Beauty" named Molecule of the Year (BioTechniques)

Hakeem Alexander — Wed, 27 Jan 2010 19:45:00 GMT

01/26/2010

Tracy Vence

The transposon was chosen by the International Society for Molecular and Cell Biology and Biotechnology Protocols and Research for enabling stable gene transfer in vertebrates.

The International Society for Molecular and Cell Biology and Biotechnology Protocols and Research (ISMCBBPR) has named “Sleeping Beauty” (S/transposase SB100X as Molecule of the Year 2009 as part of its annual competition.

According to the ISMCBBPR, Sleeping Beauty was chosen by voters because researchers have demonstrated its ability to enable robust, stable gene transfer in vertebrates. The synthetic transposon received the top honor over 14 other nominees, including runners-up sarcosine, human occludin protein, and mina. Each nominated molecule was featured during the past year in a peer-reviewed research paper that described the protocol used to decipher its role.

Diagram outlining the life cycle of the "Sleeping Beauty" (S transposon. Source: WikiMedia Commons.

SB, when combined with a transposase, mediates the stable integration and long-term expression of a gene of interest. A team of researchers—from the Max Delbrück Center for Molecular Medicine in Berlin-Buch and the Catholic University of Leuven, Belgium—demonstrated that SB/SB100X efficiently mediated gene transfer in human CD34+ cells enriched in hematopoietic stem or progenitor cells. The novel transposase was described in the June 2009 Nature Genetics paper, “Molecular evolution of a novel hyperactive Sleeping Beauty transposase enables robust stable gene transfer in vertebrates.”According to the researchers, SB/SB100X has the potential to improve current transfection methods used in functional genomics and gene therapy.

“The synthetic transposon ‘Sleeping Beauty’ and the corresponding hyperactive transposase SB100X bring about a revolutionary technology platform for genetic engineering in vertebrates,” the ISMCBBPR web site reads. “This molecule holds great promise for gene therapy as it addresses a major hurdle in gene therapeutic applications, especially those revealed by viral transduction approaches [and] site-specific integration.”

Seven presidents of international molecular and cellular biology and biotechnology organizations judged the competition. The judges considered each molecule’s potential for future contribution to biology or medical research.

Past awardees include anti-SAG 421-433 catalytic IgA, protein 4E1 , and the ligand Imidazoleacetic acid-ribotide.

Individual Interventions May Be More Effective Than Family-Based Therapy in Reducing Teen Alcohol Abuse (MedScape CME)

Hakeem Alexander — Wed, 27 Jan 2010 19:36:00 GMT

News Author: Deborah Brauser
CME Author: Charles P. Vega, MD

January 13, 2010 — Individual-only interventions have larger effect sizes than those that are family based in reducing adolescent alcohol abuse, according to results from a new meta-analysis.

In addition, although effect sizes decreased as length of follow-up increased, "behavior-oriented treatments demonstrated promise in attaining long-term effects," write Stephen J. Tripodi, PhD, assistant professor in the College of Social Work at Florida State University in Tallahassee, and colleagues.

"To our knowledge, this is the first known meta-analysis to examine interventions aimed at reducing alcohol consumption in adolescents," they add.

"One of our aims as scholars is to bridge the divide between research and practice," Dr. Tripodi told Medscape Psychiatry. "There is a lot of valuable information here for clinicians who work in alcohol treatment centers for adolescents and for clinicians who have adolescent clients with alcohol problems. While we clearly understand the inherent flaws in the concept of evidence-based interventions, we support the steps included in the process of evidence-based practice."

The study is published in the January issue of Archives of Pediatric and Adolescent Medicine.

High Rates of Teen Alcohol Abuse

According to the study, alcohol is the most frequently used substance among adolescents. Previous research shows that less than 50% of 8th graders have used alcohol, whereas 50% of 12th graders reported ever being drunk, 30% reported participating in binge drinking, and 3% drank daily.

Furthermore, the study authors also note that adolescent alcohol use disorders are associated with serious psychosocial problems, including increased rates of comorbid mental health disorders and neurocognitive deficits, reduced motivation, and increased risk for subsequent adult alcohol abuse.

Currently, alcohol-decreasing interventions are divided into 2 primary formats — treatment provided directly to the adolescent or to the family.

Individual treatments commonly use behavioral interventions, cognitively oriented therapies, and/or motivational interviewing.

Although past trials have shown reductions in adolescent alcohol use across individual treatment approaches, most research has evaluated family-based interventions — with several trials demonstrating effectiveness, report the study authors.

"With multiple studies evaluating the effects of [these] interventions, synthesis across the studies is necessary to gain a clear picture of overall effects," they write.

Paucity of Research

Dr. Tripodi reported that before getting his PhD degree, he worked at several agencies that provided both individual and family treatment for substance-abusing juvenile delinquents.

"I noticed at the time that all interventions offered were based on either the administrators’ opinions or past experiences but not on their current clients’ personal experiences and not based on the literature.

"Furthermore, the association between alcohol abuse and [psychosocial problems] is troublesome, so we thought systematically evaluating the literature on interventions aimed at lowering alcohol use would be beneficial for clinicians," he said.

For the study, the investigators assessed and compared the effectiveness of individual- vs family-based interventions. They evaluated 16 studies (10 individual-based, 5 family-based, 1 using both) from 1994 to 2008. The studies included patients between the ages of 12 and 19 years who completed a substance abuse intervention aimed at reducing or eliminating alcohol consumption.

The primary outcome measure was abstinence, frequency of alcohol use, and quantity of alcohol use measured between 1 month and 1 year on treatment completion.

Overall results showed that the interventions significantly reduced the adolescents' alcohol use (Hedges g = −0.61; 95% confidence interval [CI], −0.83 to −0.40; P < .001).

In addition, stratified analyses showed larger effects for individual treatment (Hedges g = −0.75; 95% CI, −1.05 to −0.40) vs those that were family based (Hedges g = −0.46; 95% CI, −0.66 to −0.26).

The range of standardized effects for reducing alcohol use for individual treatments ranged from −0.09 (95% CI, −0.45 to 0.27) for brief motivational interviewing to −1.991 (95% CI, −2.37 to −1.61) "for cognitive-behavioral therapy integrated with the 12-step approach," report the study authors.

Other effective treatments showing large effect sizes (>0.80) included multidimensional family therapy, brief interventions with the adolescent, and brief interventions with the adolescent and a parent.

Surprise Finding

"Surprisingly, individual-only interventions had larger effect sizes, [which] contrast previous work that finds family-based interventions to be the ideal mode of treatment for adolescents with alcohol use disorders," the investigators write.

"Unequivocal claims that individual-based treatment is more effective are not, however, warranted, as potentially confounding factors were not controlled for in stratified analyses. Furthermore, both types of treatment were statistically significant, and many of the specific interventions for both modalities contained large effect sizes," they add.

Although investigators found an overall "increased chance that treatment participants returned to preintervention levels of drinking when there was a longer follow-up period," both behavior treatment and multidimensional family therapy showed significant reductions in alcohol use at 12 months after treatment.

"Considering that these interventions focus on altering maladaptive behaviors, it appears that behavior-based treatment, whether individual or family based, is beneficial in attaining long-term change," the study authors write.

Limitations of the study included differing follow-up lengths and inclusion criteria that were purposely narrow. In addition, the investigators did not stratify results based on different types of control groups, which prevented them from comparing effect sizes for standard treatment vs waiting list control groups.

"Because of some of the limitations of the study, we don't want readers to generalize the results beyond the 16 studies included in this analysis," added Dr. Tripodi.

The research team is now working on a similar project looking at the effects of interventions that aim to lower marijuana use. "Broadly speaking, more experimental designs need to be implemented when evaluating the effects of interventions for substance-abusing adolescents," said Dr. Tripodi. "This will allow further meta-analyses to pool studies for specific interventions and identical outcomes."

A Valuable Contribution

"This is the first meta-analytic review that I am aware of that looked at experimental and quasi-experimental studies on the effect of individually based and family-based interventions in this age group. I think it's promising that [the investigators] saw that there were 5 different types of interventions that showed some type of reduction in alcohol use," said Ralph Hingson, ScD, MPH, director of the Division of Epidemiology and Prevention Research at the National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland. "This review is a valuable contribution to the literature."

However, Dr. Hingson, who was not involved with this study, cautioned that there are several questions that still need to be answered and pointed out that even the longest-term follow-up studies in this analysis did not go much beyond a year.

"Going forward, we need to ask: after one intervenes to try to reduce alcohol misuse among young people, in addition to short-term benefits, can this pattern of heavy drinking early on being associated with alcohol problems later in life be broken? I think that's the next research question that emerges from this particular study.

"Overall, I'd say this analysis is a positive step, and we hope it will continue to make progress," concluded Dr. Hingson.

The study was supported by a grant from the Donald D. Hammill Foundation. The study authors and Dr. Hingson have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:85-91.

Clinical Context

Alcohol use is very common among adolescents and is associated with multiple negative health and social consequences. The authors of the current study provide an overview of the epidemiology of teenage alcohol use. Many adolescents begin drinking alcohol early: 16% of eighth graders report having a drink in the previous 30 days. The comparative percentage among 12th graders is 44%, and 30% of 12th graders also report binge drinking; 3% of 12th graders describe daily alcohol consumption.

Alcohol use disorders in adolescents are associated with higher rates of mental health disorders and neurocognitive deficits, as well as an increased risk for alcohol abuse during adulthood. The current review and meta-analysis examines interventions that might reduce alcohol use among adolescents and prevent long-term consequences of alcohol misuse.

Study Highlights

Researchers examined controlled studies that focused on treatment to reduce alcohol use among patients between the ages of 12 and 19 years. Research published between 1960 and 2008 was considered.
Each included study was measured for methodological quality. The main study outcome was the relative efficacy of different types of intervention for alcohol use in adolescents, and these interventions were divided into individual and family-based treatments.
64 potentially relevant studies were identified, and 16 were included in the final review. Nearly all included research had been published after 2000, and 62% of studies were conducted in the United States.
69% of studies used objective verification of alcohol consumption outcomes, and 69% reported using collateral verification. Most research had a follow-up time of 6 to 11 months.
Dropout rates in the included research were generally high. There was minimal evidence of publication bias.
A pooled effects model demonstrated that treatment to reduce alcohol consumption among adolescents was generally effective to a moderate degree.
All individual measured interventions were significantly effective at reducing alcohol use.
Cognitive behavioral therapy integrated with a 12-step approach was associated with the greatest numerical effect in reducing alcohol consumption, and other interventions with a large effect size included brief motivational interviewing, active aftercare, multidimensional family therapy, and brief intervention with both adolescent and parent.
Integrated family and cognitive behavioral therapy, behavioral treatment, triple-modality social learning, multidimensional family therapy, and brief interventions involving only the adolescent had a medium effect on reducing alcohol consumption.
There were somewhat larger effects for individual vs family interventions in reducing alcohol consumption.
Interventions appeared less effective in studies with a follow-up period that exceeded 6 months.

Clinical Implications

Sixteen percent of eighth graders report consuming an alcoholic drink in the previous 30 days. The comparative percentage among 12th graders is 44%, and 30% of 12th graders also report binge drinking. Alcohol use disorders in adolescents are associated with an increased risk for alcohol abuse during adulthood.

The current meta-analysis suggests that all measured interventions reduced alcohol consumption by adolescents, including brief interventions. Individual-based treatment had a larger effect size compared with family-based interventions, and the treatment effect of interventions appeared to wane over time.

Therapy Without Force: A Treatment Model for Severe Psychiatric Problems (Daniel Mackler, LCSW) MindFreedom International

Hakeem Alexander — Wed, 27 Jan 2010 19:28:00 GMT

by Daniel Mackler, LCSW (www.iraresoul.com)

Introduction

The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes. Hand-in-hand with this skepticism comes the therapeutic model that says that “we know what is best for them” and that all of our decisions and our expertise, whether they like it or not, are “for their own good.”

But is this always the case?

When we trump a person’s right to make autonomous decisions we send him the message that he is incompetent. We teach him not to trust himself. We teach him that his experience is a pathology rather than an opportunity for self-study and growth. We teach him that his “symptoms” or “defenses” are a problem rather than a window into a world of deeper meaning and history. We teach him that life’s answers are outside of him, that the truth is not within him, and that his best bet is not to look within for guidance. How is this so different from the message that “mental illness” is a genetic, biological aberration and that the only hope for salvation is psychiatric drugs for life?

Although I do not wish to deny that many people credit the forced treatment they experienced as helpful, in that way that many people credit medication as being lifesavers, how much more might they have credited truly respectful and non-coercive caring that produced the same or even better results?

In this paper I will explore the various facets of coercive treatment for people with severe emotional problems, and explore how to be an optimally non-coercive therapist.

Types of Coercion

1) Forced Medication

The first and perhaps most common type of coercion faced by consumers labeled with severe psychiatric disorders is forced medication. (Here I also include other forms of forced biological treatment, such as forced electroconvulsive therapy.) This can take many forms—both overt and covert. The overt forms include forcing someone to take antipsychotics in order to get or keep his housing or other benefits, forcing someone to take antipsychotics in order to continue his participation in a work or mental health program (or in therapy itself), forcing someone to take antipsychotics in order to be granted release from a mental hospital, forcing someone to take medications, including injectible antipsychotics, under threat of being re-hospitalized (e.g. Involuntary Outpatient Commitment), and, in a hospital setting, physically restraining someone and injecting him against his will.

Although these forms of overt coercion vary in their intensity, they all share a common thread of denying a client his right of choice. Likewise, the coercion in these “treatments” squelch his self-respect and undermine his sense of self in a way that is metaphorically comparable to the bodily side effects of the drugs themselves.

Likewise, any therapist who participates in overtly forcing a person to take medication deals a crippling blow to the therapeutic alliance—if there was one to begin with. Similarly, any family member or friend who uses force to pressure someone to take medication strikes a blow at the foundation of trust in the relationship. If someone wishes to take psychiatric drugs on his or her own, and has fully informed consent about the drugs’ potential risks versus benefits, then it is his business to decide his own course of action. But if he (or she) wishes to avoid medications, then that too is his full right as a human being. It is no one else’s right to question him.

Meanwhile, covert forms of forced medication are, in many cases, similarly pernicious. A primary one involves the therapist pressuring the client to take antipsychotics in order to keep in the therapist’s good graces. Many people underestimate, or outright ignore, the psychological intensity of this. Clients, especially those who are vulnerable, lonely, isolated, and desperate for connection—which is not uncommon in people diagnosed with severe mental problems—may be so attached to their therapist that they will do almost anything to win his favor. Rejection by their therapist may be unthinkable to them—even provoking suicidal feelings in some—especially if they have a repeated history of abandonment by parental-like figures. This affords the therapist massive power to throw around his weight in the most subtle of ways—and apply coercive force simply with a withheld smile or a grumbled reply.

Another covert type of force involves the use of societal stigma—and unscientifically-based social mores. A person labeled with a psychotic disorder who refuses medication can meet all types of emotional resistance from friends, family members, peers, and even the television and newspaper. Together they can form a covert wall of force, psychologically pressuring the client to “do the right thing,” “face reality,” and “take your meds.” When the therapist gives any credence to these social norms—and does not overtly challenge the inappropriateness of those who preach its message—he subtly joins the norm himself. For this reason I am hesitant to support family therapies that place pro-medication family members on equal therapeutic footing with anti-medication consumers. So much coercive damage can be done to a client in the name of “respecting alternate points of view.” Isn’t it more appropriate for the therapist to side first and foremost with the client, and to respect his autonomy and boundaries no matter what?

2) Forced withdrawal from medication

This is the flip side of the previous form of coercion. In this scenario the seemingly “progressive” therapist uses the power of his role to pressure the client to stop taking his medications. Perhaps the therapist is even skilled and experienced at helping clients withdraw—and has successfully guided many through the process. His skill, however, is tainted if the decision to withdraw or taper does not come solely from the client. The therapist’s job is to present the potential pros and cons of medication—assuming, that is, that the client is interested in hearing them—and then to back off and let the client decide for himself.

I recently heard a story of a Scientologist who pressured a “resistant” mental health consumer to withdraw from her psychiatric medication. Although the woman had no intention of withdrawing, the coercion caused her to feel undermined, and thus emotionally damaged, as a person. And she did not even have a close relationship with the Scientologist! How much worse is it, then, when a trusted therapist uses the nurtured intimacy of the therapy hour to meet his own treatment ideals?

3) Forced Hospitalization

I consider forced hospitalization to be downright vicious, if only for the iatrogenic damages—damages caused by the treatment—of hospitalization itself. Although some credit hospitalization as a life-safer, too often I have seen clients choose to enter the hospital entirely on their own, free of coercion, and come out far less centered and happy than before they even went in. And how much worse is it when they are hospitalized against their will? The wealth of psychiatric survivor literature on this subject is enough to tell that tale.

So often a therapeutic relationship cannot stand the violation inherent in the therapist forcibly hospitalizing the client. It is a basic attack on the person’s freedom, on par with getting someone unfairly arrested, or, in the words of so many clients, metaphorical for being raped. (And that doesn’t even address the subject of the number of consumers who actually do get raped or physically assaulted during involuntary mental hospitalizations.)

On the flip side, many outpatient therapists lack the skill, training, or insight—or collegial support—to know how to remain therapeutic in the face of a “psychotic” or “acting out” client. But I argue that limitations in the ability of the therapist do not excuse the use of coercion. Ideally, the therapist’s limitations should place pressure on the therapist to find ways to become more therapeutic (a subject I will address later in the paper), though of course many therapists and many therapeutic systems fall short of the ideal. Instead they adopt treatment models based on coercion—or simply refuse to work with clients who are “too severely disturbed.” Likewise, other treatment providers stigmatize, criticize, or marginalize therapists who have the skills they lack. This stigmatization is convenient: it is much easier to pathologize the competence of a fellow clinician than to study and outgrow one’s own professional limitations. Denial, projection, and rationalization are by no means limited to one side of the couch.

4) Forced Therapy

All too often people are mandated to therapy. Mandates are an overt form of coercion, because choice has been removed from the equation. Although some people do benefit from mandated therapy, in the few beneficial cases I have observed the benefit came only once the client’s motivation for therapy eclipsed the intensity of the mandate, thus, in essence, negating it. Early in my therapeutic career I worked in various outpatient therapy clinics in New York City and was forced, as part of my job duties, to work with mandated clients, some of whom were deemed “psychotic.” These clients were mandated to work with me by a variety of sources, including mental health programs, psychiatrists, family members (who threatened to kick the client out of the house if he didn’t go to therapy), parole or probation officers (who threatened prison and demanded attendance records), housing programs (who threatened to kick the clients onto the street if they didn’t attend “therapeutic treatment”), and sometimes even by my own clinic itself, which would refuse to allow the client access to his psychiatrist (that is, psychopharmacologist) until he concurrently attended therapy.

This mandate almost assuredly rendered the therapy untherapeutic from the start, and incidentally, such clients, despite the mandate, generally had a much lower show-rate for sessions than my non-mandated clients. And should I be surprised? I myself personally hate being mandated to do anything, especially if I'm supposed to talk about my most personal issues with a complete stranger who is in the power position. (I was mandated to two sessions of psychotherapy at age thirteen and I still resent that therapist, twenty-five years later.)

Meanwhile, the way I helped mandated clients find value in the therapy was that I told them that the only goal I felt that was reasonable for the therapy was to help them get their mandate revoked, and I devoted all my energy to this end. I wrote letters for them—which I let them edit—detailing why they did not “need” therapy and why revoking the mandate would be the most therapeutic course. I told my mandated clients that I believed that if there were any hope of them getting anything useful out of the therapy it could only come from their choosing to attend on their own volition. Many appreciated this—and many, with my full support, dropped out of therapy the day their mandate was revoked. I invariably considered this a success, though I admit to having felt a much greater sense of satisfaction when they continued to come to therapy voluntarily following the revocation of the mandate. That was where the real therapy began.

In this vein, I am generally hesitant to work with children, as so many are initially resistant to coming to therapy. Children lack the ability to give consent to be able to vote, to be able to drink alcohol, to have sex, to serve in the military, to be able to choose where they live, and in most cases to work. Thus I also question if children, in most cases, also lack the psychological ability to give consent to come to therapy. Are they not often, at some subliminal level—and sometimes a not-so-subliminal level—being coerced to come to therapy by someone, somehow?

At this point, being in private practice, I refuse to work with mandated clients. I only agree to work with people who come by choice—and not based on fear of even the most minimal external punishment. By agreeing to work with mandated clients I have come to realize that I cannot avoid being part of the coercive power structure. And my self-esteem cannot tolerate that.

5) Force used to prevent suicide (and harm to others)

This type of force is particularly complex. The standards of care of the mental health field insist that we therapists do all within our power to prevent our clients from committing suicide. Our licenses and our jobs rest on our commitment to stop clients from harming themselves (and others), at all costs. In some cases we have the “right” and even “responsibility” to pressure them to take medication or be locked up in the hospital. In other cases we have the “right” and “responsibility” to break therapeutic confidentiality and call their friends and family members and other treatment providers—who in turn might hospitalize them or have them arrested—even if we never got a signed release of information. We have the “right” and “responsibility” to call the police on them, to get them dragged away in handcuffs and straightjackets, to have their freedoms stripped away, and to treat them as objects—objects to save—not subjects. And we do this in the name of love and caring and therapeutic insight and professionalism.

Although at times our interventions might be loving and caring, at other times they are not—and are instead a chance for the therapist to act out his power. I personally wish to avoid using this power at all costs. In my ten years of being a therapist, and working with countless suicidal people, I have not yet hospitalized one—or broken his or her confidentiality. (And I have never had a client commit suicide—for which I am thankful.) Instead I deal with his or her suicidality—and struggle to find ways to try to alleviate it. I also begin with the basic assumption, which I often share with the client, that a person coming to therapy does not fully want to kill himself, because if he was so fully committed to killing himself he wouldn’t come to talk about it. He would simply do it. In this regard, I discuss his options, and place the onus of responsibility on him, which in and of itself can help to alleviate suicidality.

Although the practical reality of this is rarely so easy as the last half-paragraph might suggest, it is not impossible. It just requires creativity—and perhaps most of all it requires that the therapist be able to tolerate a huge amount of anxiety and uncertainty. Many therapists cannot or do not wish to do this, and in many cases I can understand why—because I often do not feel up to the task myself. The pressure on a therapist can be intolerable, not just because it is terrifying to ponder one’s emotional reaction to a client potentially murdering himself, but also terrifying to consider the legal and professional ramifications for a therapist who did not take forcible action to prevent it. For that reason I at times have serious doubts about the ultimate legitimacy of the whole mental health field. How can a therapist be expected to work therapeutically in a field that requires that when the going gets rough he become a coercive agent of the state?

Similarly, therapists are pressured to prevent clients from harming others. We are expected in many cases to use coercive force, which risks placing us in a double bind. Clients come to us vulnerable and desperate for help, and we do as we are taught in encouraging them to be open and honest about their actions, thoughts, and motives, yet at times we might be expected to hospitalize them or even indirectly have them arrested (such as through breaking confidentiality in warning a potential victim of theirs) if they become too honest and admit to certain unsavory thoughts or illegal actions. And if we don’t practice coercion, however subtle or justified this coercion might appear, and they do harm or kill someone else, then we may be held culpable—both by the state, the licensing boards, and our own ambivalent consciences. This can be hell on a therapist—and pressure those of us who eschew coercion to become therapeutic supermen and superwomen who push the envelope of the standards of care, racing therapeutically against time and ancient trauma to “undo” violent impulses. But might not this pressured race—which a client much surely sense, if only unconsciously—also be a form of coercion?

I understand and respect that therapists have to follow the laws of their state to prevent clients from harming others, and I am not arguing that we disregard these laws, but I do ask this: where do we draw the line in warning victims? And what constitutes a real danger to others, much less an imminent danger to others? And most importantly, I ask this: what else might we do to prevent a client harming others? This whole subject matter, which I have only dealt with minimally, is rife with complexity and frustration, and leads into the next subsection.

Struggling to Be a Non-Coercive Therapist

In the midst of a system laced with coercive mores, how can a therapist behave non-coercively, and thus therapeutically?

In the general sense, the best way to behave non-coercively is to be a more effective therapist—and, lacking that, to be able to connect the client with systems, agencies, groups, literature, clinicians, and peers who offer something that is effective. It is our job to struggle to understand where the client is coming from—and to understand his real needs. Psychosis and depression and anxiety and rage are symptoms of a deeper need. So are suicidality and homicidality. We therapists have a responsibility—a true responsibility—to uncover and empathize with our clients’ deeper needs, and then to help them find resolution.

The facile empathy of “loving clients back to health” is not curative in and of itself, and I have seen too many cases in which the therapist’s empathy evaporates when the client becomes “imminently” suicidal or floridly psychotic. Likewise, often such clients accept no surface empathy, either because it threatens their boundaries or because they know—through bitter experience—that it will do them no good. Thus our job is to go deeper—both with our clients and with ourselves.

Our job is to learn to know ourselves to our depths. When therapists have not done their own deeper work, which is all too common, their psyches cannot help but pressure them to turn away psychologically from clients who share deeper and more painful material—especially the metaphorical material labeled as psychosis. And when the mental health field as a whole has not done its deeper work, and bases its standards on more shallow or unscientific or flimsy or denial-laden theories, it rushes to coerce, to medicate, and ultimately to subdue those whose symptoms and very existences offer challenge.

Our job as therapists is to do our inner homework. When we do this we become less frightened of our clients and particularly of their symptoms. We instead gain a framework to understand where they are coming from, and if we lack that, which at times is not unreasonable, at least we have a framework for developing the ability to understand. Working with clients diagnosed with psychotic disorders may provide no better challenge for the therapist to go deeper within himself and to study his own comparable sides. This can be terrifying—and sometimes psychosis-provoking for the therapist himself—but what better way to derive true empathy for clients? There is a reason that so many of the most compassionate advocates for those diagnosed with psychotic disorders are psychiatric survivors themselves. And clients are by no means foolish when they say they would prefer to work therapeutically with someone who has been in their shoes. Don’t we all ultimately wish for this?

But again, this does not make the work of the therapist any easier. The challenge remains great. Life pressures the therapist to seek out better colleagues, better supervision, better referral networks, better peer support, better therapy, and better self-therapy. Doing therapy with people experiencing deep distress pressures the therapist—in a healthy, non-coercive way—to be more honest, more self-revealing, less rigid, less conventionally boundaried in the clinical sense, more compassionate, more self-questioning, more involved, more creative, and simply more real. If the therapist wants to go home at the end of the day and not think about his work till the next day, then he is in the wrong profession—or working with the wrong client population.

But there are times when a given client will be too much for even an experienced, compassionate, anti-coercion therapist. Perhaps the two make a poor therapeutic fit. Perhaps a particular therapist is excellent for one client but kicks up too much anxiety or other negative feelings in another. Or perhaps a given client needs more structure than a given therapist can provide. Or perhaps a client who is tapering off psychiatric drugs experiences so much upwelling rage or psychosis—the result of pre-existing problems or simply the biological reactions to drug withdrawal—that the therapeutic relationship becomes unworkable.

This can be particularly difficult for the therapist (not to mention for the client), not only because of the emotional intensity of the interactions but also because most dedicated, non-coercive therapists hate “giving up,” having long since prided themselves on being able to work with the “toughest clients.”

Personally, my model in these cases is to “give up”—and end the therapeutic relationship—but to do so without being coercive to the client. The key here is to do so as gently as possible, with as much warning as possible. My non-coercive model, as I have come to develop it, involves three stages, as follows:

Stage 1

The primary stage involves letting my clients know, ideally from the first therapy session—before the working relationship has even begun in earnest—the nature of my therapeutic limits. Each therapist has his own. Sometimes these can be left to assumption, but I find that with clients who are experiencing high degrees of emotional distress, it is therapeutically wiser to leave less to assumption. This helps set a clear foundation for the frame and boundaries of the therapy.

I tell clients what types of behavior I can tolerate in therapy and what types I cannot. For instance, I can tolerate a fair degree of yelling and screaming and insults and rage directed toward me—and I try to use this for therapeutic benefit—but I can only tolerate so much, and with so much volume. I work out of my apartment, and I have neighbors: I cannot risk them calling the police on me, or having the landlord revoke my lease. Also, I cannot tolerate client violence toward me—or threats of violence. As such I let them know upfront that that is a therapeutic deal-breaker.

Similarly, I have my own emotional limits: I can tolerate hearing about a significant degree of conflict from my clients—relayed words about their suicidality, rage, anger, paranoia, violence, etc.—but only to a degree. I have learned that sometimes I reach my limit and can tolerate no more—especially if a client is making no headway in curbing his behavior. When I find myself nearing my limits with a client—or even getting blips on my radar screen that I might be nearing my limits—I let the client know.

In this first stage I also discuss with the client his feelings about therapy. In some cases, if I feel it might become relevant later on—which it often does—I ask him about his point of view regarding such subject matters such as coercion, force, boundaries, suicidality, psychiatric hospitalization, psychiatric medication, and confidentiality. I try to provide a safe environment in which to discuss these topics to whatever degree both he and I feel it helpful. I feel that this to be vital in providing a client with real, mutually agreed upon informed consent—which to me is a prime ingredient in basic respect.

Likewise, I invite clients to ask me any questions they might have about my perspective on these topics—or any subject they feel is important, however uncomfortable—and I make it my business to be frank and honest. Also, I tell clients that they can feel free to give me fictional scenarios on various subjects (such as suicidality or homicidality) and ask how I might behave if such a scenario were to happen. Also, I welcome clients to re-open the discussion at any point in the therapy. If I don’t know his opinion on these subject matters early on and he doesn’t know mine, we risk forming our therapy relationship on very shaky ground—one that risks collapsing in ugly ways down the road. Having an open, flexible dialogue on these often taboo subjects can go a long way toward building appropriate and realistic therapeutic trust—which can prove invaluable not just for the therapy itself, but for the client’s whole life.

Stage 2

If, at some point in the therapy, I find that I am becoming too overwhelmed or uncomfortable by the client’s actions or behavior to be able to function effectively as his therapist, I share this openly with the client. In this second stage, I let him know that the agreed-upon frame in which we are operating may not be enough to tolerate what he is experiencing. I remind the client of my previously stated limits as a therapist, in order to build continuity with that foundation.

Sometimes clients, despite our initial discussions, have the erroneous belief that they can say or do whatever they want in session—that the therapeutic environment is a place where they can totally be themselves, with no consequences whatsoever. Although the degree of consequences can vary with different therapists, it is our job to communicate our limits as clearly and consistently as possible. Otherwise we risk blindsiding clients with consequences that can seem arbitrary, unexpected, and unfair. On the other hand, effective communication of our limits can actually prove to be therapeutic in and of itself, not just because it places the onus of responsibility on the client, but because it reminds the client that the entire world operates within limits. All actions have consequences, and therapy can be an optimal place to explore this reality.

Meanwhile, to return to the particulars of the second stage, if I am becoming overwhelmed by a client, I use my anxiety and apprehensions—after I have analyzed them within myself and feel confident that they are well-founded and not overly laced with my own denial—as an attempted wake-up call for the client. Here therapy offers him an opportunity to study his life and see if he can make changes that involve adopting, or considering adopting, a healthier lifestyle, or at the least a healthier perspective. Sometimes this works.

Other times it does not. In some cases I have been accused by clients of trying to coerce them into changing—to make me happy and to keep the therapy alive. In a sense this might appear to be true—which might seem contradictory to the point of this paper—but I view it differently. From my perspective when a client takes steps that break the agreed-upon therapeutic frame it is he who bears the primary responsibility. He is making a choice, be it conscious or unconscious, through his action, and it is actually he who is abandoning the therapy: breaking the therapeutic contract, as it were. So in a sense he is coercing me to change the stated and mutually agreed upon frame of the therapy—a frame which I think is quite liberal and therapeutically reasonable. My resistance to changing the frame is less a coercion of him than a reflection of his coercion of it.

But like all things that are complicated in therapy, sometimes there are counterintuitive solutions, and that is where I feel the onus is on me to be creative. Sometimes a client who is challenging the frame of the therapy needs to come more often. Often in the second stage I offer the client the opportunity to come and see me more often—and sometimes this goes a long way to quelling anxiety—his and mine! Other times I suggest that the client expand his support network beyond the therapy relationship. (I will address this more in the next stage.) Sometimes the pressure on the one-on-one therapy relationship is simply too great—and when the client builds a broader, more holistic support system, the tension in the therapy can abate significantly.

Stage 3

The third stage of my non-coercive model happens when a client is simply unable or unwilling to operate respectfully within the stated frame of the therapy. Here I feel I cannot continue the relationship as it has been going. I do not force him to do anything, and instead use the only option at my disposal: I pull back, all the while making it clear that this is what he is forcing me to do, against my desire. I do not hospitalize, call police, call case managers, punish, pressure medication, or suggest medication.

Instead I simply let him know that he, through his actions, has damaged our relationship to the degree that I have no choice but to withdraw from it. But in the same way that I counsel people to avoid abrupt withdrawal from psychiatric drugs, I myself avoid, if at all possible, abruptly withdrawing from a therapeutic relationship—in order to avoid abandoning him. I give as many warnings as I can, I state the reasons for my actions as clearly as possible, and in some cases I discuss with the client the possibility of postponing therapy for a period of time—a week, two weeks, even a month if necessary—to give him a chance to see if he can be more reasonable in working toward keeping alive his relationship with me.

If I do postpone the therapy I offer him as many other alternatives as possible so that he might find ways to help himself in the meantime. Some of the alternatives might include: referrals to other therapists, referrals to group therapy, referrals to day programs, referrals to activity groups, referrals to peer support services, referrals to case managers or direct support services, referrals to Twelve Step Programs (such as AA, Narcotics Anonymous, Gamblers Anonymous, Al-Anon, even Double Trouble), and referrals to substance abuse programs. Often, before pulling away, however, I offer clients conjoint meetings in therapy with other important figures in their lives—people from their personal and professional support network—in order to discuss these potential changes and explore ways of finding clients more appropriate levels of assistance.

My goal during this third stage, and the previous stage as well, is to help the client feel respected—and to minimize the damage not just to our therapeutic alliance, but to the work we have accomplished thus far. Often I have heard clients tell of a wonderful relationship they had with a past therapist being called into question by the therapist’s poor handling of a crisis or therapeutic “termination.” Sometimes clients suffer for years over these mishandled endings—and consequently lose great degrees of trust and faith in humanity. As such, I strive to be as respectful to clients on the last day of therapy as on the first—and all the more so if the therapy relationship is ending under less than ideal circumstances.

And sometimes things do not go ideally. Sometimes the client can take the therapist’s withdrawal from the relationship as an attack on his sense of self. This is most pronounced when the client has placed strongly idealized parental-like expectations onto the therapist. Sometimes clients, especially when they themselves are in the throes of extreme emotional distress, have a difficult time understanding the anxiety and conflicts they can induce in a therapist, and can even feel betrayed and undermined when they discover that their therapist is not an ideally parental “god,” but instead all-too-human.

The betrayal they feel from the therapist can translate to them as a form of therapeutic coercion. Perhaps the client, especially the client who feels the therapy is his primary lifeline, says, “Your commitment is to help me, and at my moment of greatest need you are rejecting me because I'm not behaving in the way you want! You’re forcing me to change my way of behaving to suit you—and I don’t like being coerced to change! You lied to me!”

When then is the therapist to do? This, of course, is complex, because sometimes the client in this situation has so little empathy for the position of the therapist that it is difficult for the therapist to reach him in a way that he finds satisfying or understandable. Here I simply do my best and try to be as honest and forthright as possible, though I have never found this to be easy. I let him know that the primary rejection of the therapy has come from him—though I acknowledge that perhaps a different therapist might have handled the situation more effectively, and if I am sorry then I let him know. (Often I am very sorry.) But at the same time I do not shy away from the reality that through his decisions he is actually rejecting himself, and in many cases is following the model of much of his own traumatic history of rejection.

I encourage him—and at times even plead with him—to look more closely at his actions and thoughts and behavior and history so that he might better understand why I am pulling away. I often point out that I am rarely the first person in his life to pull away from him under such circumstances. (Often he agrees.) Usually I am just one in a long string of failed interpersonal relationships—and that I have no desire to participate in repeating this pattern of his. I tell him that as much as I might like to save him from himself, doing this is neither my ability nor my responsibility. I let him know that it is not a therapist’s job to carry the full psychic burden of the therapy—or even the majority of the burden—even if the client thinks that that is what he is paying for. The therapist’s ultimate job is to help place the locus of control back in the center of the client. The responsibility for the client’s salvation—assuming the client is an adult—is his, and if he cannot do it, especially after I have given the relationship my best, then he must face his own consequences.

Although the client in this situation might feel that I am pressuring him to begin taking psychiatric drugs—especially if he has heard that message repeatedly throughout his life—that is not my stand: my stand is the client has to take more responsibility to be more mature. This might involve coming to therapy more often or more on time, getting better sleep, eating better, exercising more, paying bills more regularly, avoiding prostitutes or anonymous sex, watching less TV, avoiding fighting or arguing with others, being more respectful to his neighbors or friends, making new friends, going to more support groups, meditating more, seeking out spiritual outlets, doing fewer drugs, drinking less alcohol and caffeine, managing his budget better, and often simply doing more therapeutic work and self-reflecting outside of the therapy session.

It is worth noting that my withdrawal from clients is quite uncommon, and I only use it as an option of last resort. But it is an option, and it is not coercive, because unlike coercion it is neither intrusive nor undermining of autonomy. Instead, as horrible and painful as therapeutic withdrawal can be, it provokes autonomy. And ultimately, whether the client uses this provocation toward autonomy to his benefit or not—now or in ten years’ time—is up to him. But it is not the therapist’s job to force him to become autonomous. It is only the therapist’s job to respect him.

References

Hall, Will (2007). Harm Reduction Guide to Coming Off Psychiatric Drugs. Published by The Icarus Project and Freedom Center, but see also: theicarusproject.net/HarmReductionGuideComingOffPsychDrugs

Harding, Courtenay (1987). The Vermont Longitudinal Study of Persons with Severe Mental Illness. American Journal of Psychiatry 144: 727-734.

Harrow, M. and T. Jobe (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of Nervous and Mental Disease. 195(5): 406-14.

Hornstein, G. (2009). Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. New York: Rodale.

Jackson, Grace (2009). Drug-Induced Dementia: A Perfect Crime. Bloomington, IN: AuthorHouse.

Jackson, Grace (2005). Rethinking Psychiatric Drugs: A Guide for Informed Consent. Bloomington, IN: AuthorHouse.

Read, J., P. Fink., T. Rudegeair, V. Felitti, C. Whitfield (2008). “Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model.” Clinical Schizophrenia and Related Psychoses. October, 2008: 235-254.

Whitaker, Robert (2002). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, MA: Perseus Publishing.

What Should We Do About Medical Marijuana? (Medcape International Medicine)

Hakeem Alexander — Wed, 27 Jan 2010 04:49:00 GMT

Sandra A. Fryhofer, MD
Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians, Philadelphia, Pennsylvania

You may well wonder what marijuana has to do with staying well. After all, the new report by the American Medical Association's (AMA) Council on Science and Public Health says that "marijuana is the most common illicit drug used by the nation's youth and young adults."^[1] Some people get hooked on it. If marijuana becomes more readily available for medical use, will increased nonmedical use follow? As a primary care physician and as the mother of 2 college students, this concerns me. In fact, I had a very negative view of physician organizations even talking about medical marijuana until recently, when I read this new report.

History of Medical Marijuana

Marijuana is a botanical derived from the Cannabis sativa plant. It is probably one of the oldest psychotropic drugs known to man, with origins in central Asia. Marijuana contains more than 400 chemical compounds, including more than 60 cannabinoids. The main psychoactive cannabinoid is believed to be tetrahydrocannabinol (THC).

The pharmacologic properties of marijuana were first described by Irish physician William O'Shaughnessy in 1839. The drug was touted for its anti- inflammatory, antispasmodic, anti-asthmatic, anticonvulsant, and sedative properties. Almost incredibly, given its current reputation, marijuana was once listed in the United States Pharmacopeia.^[2] The Marihuana Tax Act of 1937 marked the beginning of federal restrictions. Medical users were taxed a dollar an ounce. Recreational users were hit with a tax of $100 per ounce.

Marijuana was removed from the United States Pharmacopeia in 1942, but it was still available legally for medicinal use until 1970.^[2] That's when the Controlled Substances Act was passed, classifying marijuana , along with heroin and LSD as a schedule I drug -- the most restrictive category. .

The Endocannabinoid System

Since then, an explosion of research has unlocked the mysteries of the endocannabinoid system, which helps explain marijuana's myriad effects. From modulating neurotransmitters to regulating immune system cells and organs, the endocannabinoid system can affect appetite regulation, energy metabolism, obesity, pain and inflammation, gastrointestinal motility, and central nervous system disorders.

Debate Over Marijuana's Classification As a Schedule I Controlled Substance

The Controlled Substances Act of 1970 classified marijuana as a schedule I drug: a controlled substance with a "high potential for abuse" and "no currently accepted medical use."^[3] But is that characterization really accurate?

Two previous AMA council reports, in 1997 and 2001, concluded that sufficient evidence existed to support further research on the potential use of marijuana in treating medical illness.^[1] For example, marijuana has been used to treat cachexia, neuropathy, or chronic pain in patients with HIV; intractable nausea and vomiting in patients on chemotherapy; and neuropathic pain and spasticity in patients with spinal cord injury.

In 1999, the Institute of Medicine recognized the medical potential of synthetic and plant-derived cannabinoids and recommended further research.^[4] Other physician organizations like the American College of Physicians (ACP) agreed. In their 2008 policy statement, the ACP, like the AMA, supports "rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana."^[5] Why is consideration of reclassification important?

Reclassification would make it easier to conduct research. Reclassification would remove the red tape of a Drug Enforcement Administration (DEA) schedule I license requirement. The AMA council report states: "The future of cannabinoid-based medicine lies in development of botanical drug substances ... but that cannot happen without bona fide research. Reclassification of current marijuana scheduling could expedite that process."^[1] Both the AMA and the ACP urge federal review of marijuana's schedule 1 classification.

Some marijuana derivatives are already available. Dronabinol (Marinol® is 100% pure synthetic THC, marijuana's most psychoactively potent ingredient, and is classified as schedule III. It is approved by the US Food and Drug Administration (FDA) for treating recalcitrant chemotherapy-induced nausea and vomiting, and as an appetite stimulant for patients with HIV. Nabilone (Cesamet™, classified as schedule II is an FDA-approved synthetic analogue approved to treat chemotherapy-induced nausea and vomiting. Both are oral preparations, which have some potential disadvantages, including slow absorption and slow onset of action. In addition, some patients are too sick to take these medications.

Smoking as a delivery system works more quickly at providing relief. Several studies conducted in the 1970s and 1980s using FDA-approved protocols found that smoked cannabis was just as effective -- and in some cases even more effective -- than oral THC.^[6] Granted, smoking anything is not good for you. In certain situations, however, such as for compassionate use, for comfort at end of life, or as a last resort to relieve symptoms, the long-term effects of smoking don't matter.

Safeguarding doctors and patients from prosecution. Reclassification would also keep doctors who are simply trying to do the right thing out of jail. Thirteen states already have passed laws or referenda making marijuana available for medical use: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington.^[6] But those are state, not federal, laws.

During the Bush administration, doctors and patients were caught between a rock and a hard place. Federal agents would raid medical marijuana distributors for violating federal statutes, even though what they were doing was in compliance with state laws. On October 19, 2009, the Obama administration announced an attitude quite different from its predecessor's approach. The New York Times reported a memorandum giving federal prosecutors more wiggle room when marijuana is used for medicinal purposes. The justice department said: "It will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws on medical marijuana." However, Attorney General Eric H. Holder Jr. went on to say there would be no tolerance for "drug traffickers who hide behind claims of compliance with state law to mask activities that are clearly illegal."^[7]

Additional Concerns About Marijuana

Marijuana has as many adverse effects as it has nicknames. Marijuana is known by numerous names, including Mary Jane, pot, grass, weed, and bambalacha. It can trigger severe adverse reactions, including acute anxiety, panic, confusion, dysphoria, paranoia, delusions, and hallucinations. It also can cause acute cardiovascular effects, such as increased heart rate and drops in blood pressure.

Marijuana use impairs short-term memory, attention, motor skills, reaction time, and the organization and integration of complex information. In the long term, smoking marijuana may lead to lung damage and chronic bronchitis.

Will facilitating medical use encourage nonmedical use? One criticism of medical marijuana laws is that they might increase nonmedical use. This is a valid concern, and one I worry about. Two facts in particular in the AMA council report drive home this point:

Marijuana is the most common illicit drug used by the nation's youth and young adults; and
Of those who use cannabis, 4%-9% fulfill diagnostic criteria for substance dependence

The AMA report continues, "even if marijuana is prone to nonmedical use, that does not obviate its potential for medical product development. In fact, many "legal" pharmaceutical products that are used for pain relief, palliation, and sleep induction have more serious acute toxicities than marijuana, including death."^[1]

Philosophically, I agree that further research and easier access for medical use are good things if marijuana can help alleviate patient suffering. As a primary care physician and a mother, however, I worry that becoming too lax with restrictions might make it easier to obtain for nonmedical use. The AMA report also reminds us that "whether or not cannabis is a gateway drug to other substance misuse is controversial." That's what makes this issue hit close to my home and my office.

I'm interested in hearing your take on medical marijuana. Please post your comments on the message board. I also invite you to look for Medicine Matters video blog series, which is addressing medical marijuana.

References

American Medical Association Council on Science and Public Health. Report 3. Use of Cannabis for Medical Purposes. November 2009. Available at: www.ama-assn.org/ama1/pub/upload/mm/443/csaph-report3-i09.pdf Accessed January 7, 2010.
MacDonald J. Medical marijuana: informational resources for family physicians. Am Fam Physician. 2009;80:779-783. Abstract
US Food and Drug Administration. Inter-agency advisory regarding claims that smoked marijuana is a medicine. April 20, 2006. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643. Assessed January 7, 2010.
Joy JE, Watson S Jr, Benson JA Jr, eds. Marijuana and Medicine. Assessing the Science Base. Washington, DC: National Academy Press; 1999.
American College of Physicians. Supporting research into the therapeutic role of marijuana. Position paper 2008. Available at: www.acponline.org/advocacy/where_we_stand/other_issues/medmarijuana.pdf. Accessed January 7, 2010.
Kalant H. Medicinal use of cannabis: history and current status. Pain Res Manag. 2001;6:80-91. Abstract
Stout D. US won't prosecute in states that allow medical marijuana. The New York Times. October 20, 2009:A1.

European Parliament to Investigate WHO and “Pandemic” Scandal

Hakeem Alexander — Sat, 02 Jan 2010 05:39:00 GMT

Finally...This is Great news!!!...C
European Parliament to Investigate WHO and “Pandemic” Scandal

By F. William Engdahl

Global Research, December 31, 2009

The Council of Europe member states will launch an inquiry in January
2010 on the influence of the pharmaceutical companies on the global
swine flu campaign, focusing especially on extent of the pharma‘s
industry’s influence on WHO. The Health Committee of the EU Parliament
has unanimously passed a resolution calling for the inquiry. The step
is a long-overdue move to public transparency of a “Golden Triangle”
of drug corruption between WHO, the pharma industry and academic
scientists that has permanently damaged the lives of millions and even
caused death.

The parliament motion was introduced by Dr. Wolfgang Wodarg, former
SPD Member of the German Bundestag and now chairman of the Health
Committee of PACE (Parliamentary Assembly of the Council of Europe).
Wodarg is a medical doctor and epidemiologist, a specialist in lung
disease and environmental medicine, who considers the current
“pandemic” Swine Flu campaign of the WHO to be “one of the greatest
medicine scandals of the Century.”[1]
The text of the resolution just passed by a sufficient number in the
Council of Europe Parliament says among other things, “In order to
promote their patented drugs and vaccines against flu, pharmaceutical
companies influenced scientists and official agencies, responsible for
public health standards to alarm governments worldwide and make them
squander tight health resources for inefficient vaccine strategies and
needlessly expose millions of healthy people to the risk of an unknown
amount of side-effects of insufficiently tested vaccines. The "bird-
flu"-campaign (2005/06) combined with the "swine-flu"-campaign seem to
have caused a great deal of damage not only to some vaccinated
patients and to public health-budgets, but to the credibility and
accountability of important international health-agencies.”[2]

The Parliamentary inquiry will look into the issue of „falsified
pandemic“ that was declared by WHO in June 2009 on the advice of its
group of academic experts, SAGE, many of whose members have been
documented to have intense financial ties to the same pharmaceutical
giants such as GlaxoSmithKline, Roche, Novartis, who benefit from the
production of drugs and untested H1N1 vaccines. They will investigate
the influence of the pharma industry in creation of a worldwide
campaign against the so-called H5N1 “Avian Flu” and H1N1 Swine Flu.
The inquiry will be given “urgent” priority in the general assembly of
the parliament.

In his official statement to the Committee, Wodarg criticized the
influence of the pharma industry on scientists and officials of WHO,
stating that it has led to the situation where “unnecessarily millions
of healthy people are exposed to the risk of poorly tested vaccines,”
and that, for a flu strain that is “vastly less harmful” than all
previous flu epidemics.

Wodarg says the role of the WHO and its the pandemic emergency
declaration in June needs to be the special focus of the European
Parliamentary inquiry. For the first time, the WHO criteria for a
pandemic was changed in April 2009 as the first Mexico cases were
reported, to make not the actual risk of a disease but the number of
cases of the disease basis to declare “Pandemic.” By classifying the
swine flu as pandemic, nations were compelled to implement pandemic
plans and also the purchase swine flu vaccines. Because WHO is not
subject to any parliamentary control, Wodarg argues it is necessary
for governments to insist on accountability. The inquiry will also to
look at the role of the two critical agencies in Germany issuing
guidelines on the pandemic, the Paul-Ehrlich and the Robert-Koch
Institute.

Bravo!

F. William Engdahl is author of Full Spectrum Dominance: Totalitarian
Democracy in the New World Order. He may be contacted through his
website, www.engdahl.oilgeopolitics.net.

Notes
1. Rainer Woratschka, Schweinerei mit der Grippe, Der Tagesspiegel,
16 December, 2009, accessed in http://www.tagesspiegel.de/politik/international/Schweinegrippe-Europarat;art123,2976433
.
2. Dr. Wolfgang Wodarg, Motion for a Resolution and a Recommendation:
Faked Pandemics - a threat for health, accessed in http://www.wodarg.de/english/2948146.html
.

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