Wednesday, December 21, 2005

Research: Machinery of the 'marijuana munchies'

One of the primary hazards of marijuana use is well-documented: the uncontrollable urge to consume a bag of Skittles, half of a leftover pizza, a pound of chocolate chips, and the freezer-burned date logs that have been around since Aunt Sarah came for a visit last October. Finally, some serious research on the munchies from some pointy-headed tokers at Columbia Univerisity:
In their studies, the researchers concentrated on the lateral hypothalamus (LH) of the brain, known to be a center of control of food intake. Their studies involved detailed electrophysiological measurements of the effects of specific neurons that they had identified in previous studies as being important in endocannabinoid signaling. Their studies revealed that activation of CB1 receptors, as by endocannabinoid molecules, induced these neurons to be rendered more excitable by a mechanism called "depolarization-induced suppression of inhibition" (DSI).

What's more, they found that leptin inhibits DSI. However, they found that leptin did not interfere with the CB1 receptors themselves. Rather, leptin "short-circuits" the endocannabinoid effects by inhibiting pore-like channels in the neurons that regulate the flow of calcium into the neurons. Such calcium is necessary for the synthesis of endocannabinoids.

In further studies of mice genetically altered to be leptin deficient, the researchers found the DSI to be more prolonged than in normal mice. Thus, they said, the findings "implicate this mechanism for leptin receptor/endocannabinoid signaling in contributing to the maintenance of weight balance…." The researchers also included that "upregulation of endocannabinoid signaling in the LH may explain, at least in part, the increased body weight consistent with a prior report of elevated endocannabinoids" in such leptin-deficient mice.

The researchers concluded that their findings "are consistent with the hypothesis that the integration of endocannabinoid and leptin signaling regulates the excitability of neurons on appetite-related circuits."

Link to press release (via Boing Boing)

Tonight, let's all burn a spliff to Young-Hwan Jo, Ying-Jiun J. Chen, Streamson C. Chua, Jr., David A. Talmage, and Lorna W. Role!

Monday, December 19, 2005

Health policy: $130 billion in regressive health coverage subsidies

In the NYT, Eduardo Porter points out that the federal government hands out a hefty subsidy for private insurance, much of it going to people who don't need help getting health coverage. I get it, and you probably do, too. It's the deal where you and I get to pay our share of our employer-provided health coverage from pre-tax earnings. It adds up to $130 billion or so-- enough, Porter points out, to turn Medicaid into something very close to universal coverage.

It's another maddening example of tax policy that seems to turn good social policy on its head: let's say I make $40,000 a year and you're my boss you make $140,000 a year. We're both on the company health insurance plan, which costs each of us $2,000 a year. If I can pay my share from pre-tax earnings, my marginal tax rate is maybe 20%, so I save $400 in taxes I would otherwise paid on that $2,000. You, however, have a higher marginal tax rate, maybe 35%, so you save $700. Lucky you-- the government gave you the same subsidy as me, plus a set of golf clubs. Not to mention the carribean cruise you got in added tax savings from the mortgage interest deduction for your McMansion.

For taxpayers, a penny saved is a penny earned, but for the government, a penny in tax revenue forgone through a tax deduction or exemption is a penny spent. Are we spending these pennies wisely?

It's enough to turn a blue-stater into a flat-taxer.
Although subsidizing health insurance may seem a worthy effort, a positive contribution to the goal of universal coverage, it is among the most inefficient spending in the nation's fiscal arsenal. 'If you had $150 billion to play with, you could come very close to universal coverage,' said David Cutler, an economics professor at Harvard. One reason that we are 45 million people short of that goal is that the money isn't being spent on them.

According to President Bush's advisory panel on tax reform, about half of the tax break for health insurance accrues to families making more than $75,000 a year. More than a quarter goes to families making over $100,000. These families would surely hate to lose the subsidy. For a family making $100,000 a year in, say, Los Angeles, the tax break cuts the cost of employer-provided health insurance by about 35 percent in federal and state income taxes. On a typical family policy costing $11,500 a year, that is equivalent to some $4,000.

Health Care for All, Just a (Big) Step Away - New York Times

Sunday, December 18, 2005

Puppy Love: Let's Dance!

Count me among the many who thought dancing with dogs was just a goof from "King of the Hill." But no, it's real, and it's called "freestyle." I know I'm supposed to offer some kind of smart-ass remark here, but I'm stumped.
To maintain decorum, freestyle competitions keep the costuming of the animals to a minimum, though the handler can get away with dressing up like Charlie Chaplin for theatrical effect. And among the main organizations, including the Canine Freestyle Federation and the Musical Dog Sport Association, there are philosophical differences over freestyle moves and issues like attire and how much dancing the humans should do.

'We want the dog to be the star,' said Ann Priddy, a freestyle teacher in Richmond, Va., and the vice president of the Musical Dog Sport Association, which formed this year.

The efforts to define canine freestyle as it grows also include a possible name change. 'People think it's swimming,' Loren Jensen Carter, founder of a two-year-old regional group in Arizona called Sonoran Canine Freestylers, said of the name 'freestyle.' She is among those advocating 'K-9 dance sport' instead.

Link (free reg req'd)

Saturday, December 17, 2005

In the news: NYT on being sick and being employed

This is a must-read:
The Catch-22 of the American health care system is that while many people work 'for the insurance,' when they become too sick to work and are most in need of that insurance, they are most at risk of losing it. This is particularly true of workers at small companies, which are not covered by existing law. (The Family and Medical Leave Act, for instance, only applies to workplaces with 50 or more employees.)

One employee at such a company, who asked that her name not be used because she feared retribution from her former boss, learned the significance of this distinction the hard way when she had a brain tumor removed five years ago. Her employer, she said, 'told me that my tumor came at a really bad time for the company.' The woman had recently received a significant raise, $20,000. Her workplace was small - about a half-dozen employees - and a few months after her illness was diagnosed, the group's insurance premiums jumped. 'My raise was rescinded, to cover the increase,' she said.

At the very end of the article, there's a mention of an issue that's a big deal for me and probably for lots of people with MS. It's about the conundrum of working part-time, maybe to hang onto insurance or, in my case, to accommodate increasing fatigue, versus the resulting decrease in one's disability coverage.

I would love to go from full-time down to about 80%, maybe working half days a couple days a week. As it is, I sometimes feel like I'm only working at 80% even though I'm present at my desk for the full 40 (or more) hours each week. The problem is that going 80% decreases the amount of protection I have in the event I need to take disability. My disability benefit is calculated as a percentage of my income at the time I stop working. While I'm working full-time, my benefit would be 80% of my current salary. If I go 80% part-time, my benefit would be 64% (80% of 80%) of my current salary.

So the question becomes whether I think my family and I are better off if I work full-time until I keel over entirely or if I work part-time, cutting both my current income stream, and the income I'd get on disability. Fortunately, I'm confident that the decision is mine to make, that my employer would allow me to go to 80% if I chose. But I go back and forth: am I better off protecting that income stream, or do I stand a better chance over the long haul by reducing the energy I put into work and increasing the energy available for taking care of myself?
Link (free reg req'd)

Thursday, December 15, 2005

In the news: Stem cell researcher's pants on fire?

From the NYT:

SEOUL, South Korea, Dec. 15 - Hwang Woo Suk, the scientist who stunned the world by announcing breakthroughs in stem cell and cloning research, faked a landmark research paper, one of his South Korean co-authors said today in television and newspaper interviews. Dr. Hwang and his aides, who had vehemently defended the paper published in the journal Science in June, were not immediately available for comment on the assertion by Roh Sung Il, , one of Dr. Hwang's 24 co-authors for the June paper, that the scientific finding was falsified.

Mr. Roh, the administrator of MizMedi Hospital in Seoul, told the South Korean daily Hankyoreh that there were no authentically created stem cells presented for the Science paper, according to an article on the newspaper's Web site this evening. In an interview broadcast on MBC television, Mr. Roh said Dr. Hwang appeared to have created stem cell lines that were later destroyed because of a virus infection. Dr. Hwang took stem cell lines from Mr. Roh's laboratory that had nothing to do with Dr. Hwang's research and presented them for the Science paper, Mr. Roh said. He said that nine of the 11 stem cell lines in the study were faked and that the other two were dubious.

In the June paper, Dr. Hwang's team reported that it had cloned human embryos and extracted the 11 stem cell lines, which Dr. Hwang said matched the DNA of patients. That result seemed a major breakthrough because it raised hopes that scientists might one day help patients suffering from illnesses like Parkinson's disease or diabetes grow their own replacement cells to cure their ailments.

Link (free reg req'd)

Wednesday, December 14, 2005

Puppy love: FrankenFido?

Slate's William Saletan has an interesting angle on the news that scientists have sequenced the dog genome:
In the course of engineering dogs to look, feel, and act as we wanted, we ruined millions of them. We gave them legs so short they couldn't run, noses so flat they couldn't breathe, tempers so hostile they couldn't function in society. Even our best intentions backfired. Nature invented sexual reproduction to diversify gene pools and dilute bad variants. By forcing dogs into incest (which we ban among humans, in part for biological reasons), we defied nature. We concentrated each bad gene in a breed, magnifying its damage: epilepsy for springer spaniels, diabetes for Samoyeds, bone cancer for Rottweilers. That's why the dog genome is so nifty: We can find disease genes just by comparing one breed's DNA to another's.

Well, too bad for the dogs. But three cheers for us and our experiment. "The dog genome is a wonderful playground for geneticists," exults the New York Times. "A treasure trove," says the San Francisco Chronicle. "A convenient laboratory," agrees Reuters.

Man's best friend, indeed.

I'm a dog lover, and I can't imagine life without these critters. At the same time, I know that my species' love of dogs has resulted in the infliction of boundless cruelty on an animal that seems uniquely capable of perceiving that cruelty. If only we could explain to the dogs that we are equal-opportunity despots; that we can be just as cruel to other humans -- maybe then dogs wouldn't seem to take it so hard.


Tuesday, December 13, 2005

Research: Pain control by force of will?

I'm still working through the prerequisites to prior authorization for Lyrica. For the last week, I've been adding nortryptaline to my Neurontin, and I'm feeling a little doped-out. It's been harder than usual to stay awake at work after 3:30 or so , I'm unable to empty my bladder completely, and I haven't noticed any decrease in pain. Next week, it will be amitryptaline.

Meanwhile, from the London Times, an article about a pain-control technique using what I think you'd call a sort of bio-feedback:
Scientists in the United States have successfully taught eight patients to reduce pain from injuries by showing them live scans of their brains while they performed a set of mental exercises. The findings, from a team at Stanford University in California, have opened up the possibilities for treating chronic pain, which often responds poorly to standard therapy and leaves patients suffering throughout their entire lives.

Dr Mackey’s team used a new scanning technique, known as real-time functional magnetic resonance imaging, to capture live images of activity in a part of the brain called the rostral anterior cingulate cortex, that handles painful stimuli. As the patients watched the scans, they undertook mental exercises designed to alter brain activity and reduce pain. The goal was to train the brain to process pain in a different way, so that the patients would experience it less severely. The scans allowed the subjects to see what effect their thoughts were having on a small region of the brain, helping them to concentrate on changing its activity.

“We asked them to think about changing the meaning of the pain,” Dr Mackey said. “Instead of thinking of it as a terrible experience, to think of it as something relatively pleasant.” Over time, subjects showed an increased ability to modulate their pain. The study suggests that it may be possible to train people to change the way in which the pain centres of the brain process painful stimuli, making the perception of pain less intense.


Research: Azathioprine (Imuran) for MS

From WebMD:
Using magnetic resonance imaging, researchers showed that new brain lesions that indicate multiple sclerosis (MS) progression were reduced by more than half in 12 of 14 patients treated with the drug Imuran. The drug is now used primarily to prevent rejection in transplant patients and in the treatment of patients with rheumatoid arthritis and other autoimmune disorders. Imuran has been studied by MS investigators for several decades. Previous studies have shown that Imuran can reduce relapses in patients with multiple sclerosis. However, the new research is the first to show that the drug can slow disease progression by decreasing the presence of new lesions.

Study researchers say their findings are similar to other studies' results looking at the use of injectable interferon-beta and brain lesions in MS. But a spokesman for the National MS Society tells WebMD that larger studies are needed to prove this.
'If these findings are confirmed then we would have a less expensive oral medication that is of comparable benefit to the current treatments,' says John Richert, MD. 'These data show that it is worthwhile to invest the resources to try and prove that this drug alters disease progression.'

Link to WebMD article (the study will be pubished in the Archives of Neurology in December).

Update: Link to abstract for Imuran study

Compare this:
[Cost-utility analysis of relapsing-remitting multiple sclerosis treatment with azathioprine or interferon beta in Spain]

[Article in Spanish]

Rubio-Terres C, Dominguez-Gil Hurle A.

HERO Consulting, Health Economics and Research of Outcomes, Virgen de Aranzazu 21, E-28034 Madrid, Spain.

AIM: To carry out a cost-utility analysis of the treatment of relapsing-remitting multiple sclerosis (RRMS) with azathioprine (Imurel) or beta interferon (all, Avonex, Rebif and Betaferon). MATERIAL AND METHODS: Pharmacoeconomic Markov model comparing treatment options by simulating the life of a hypothetical cohort of women aged 30, from the societal perspective. The transition probabilities, utilities, resource utilisation and costs (direct and indirect) were obtained from Spanish sources and from bibliography. Univariant sensitivity analyses of the base case were performed. RESULTS: In the base case analysis, the average cost per patient (euros in 2003) of a life treatment, considering a life expectancy of 53 years, would be 620,205, 1,047,836, 1,006,014, 1,161,638 and 968,157 euros with Imurel, all interferons, Avonex, Rebif and Betaferon, respectively. Therefore, the saving with Imurel would range between 327,000 and 520,000 euros approximately. The quality-adjusted life years (QALY) obtained with Imurel or interferons would be 10.08 and 9.30, respectively, with an average gain of 0.78 QALY per patient treated with Imurel. The sensitivity analyses confirmed the robustness of the base case. The cost of one additional QALY with interferons would range between 413,000 and 1,308,000 euros approximately in the hypothetical worst scenario for Imurel. CONCLUSIONS: For a typical patient with RRMS, treatment with Imurel would be more efficient than interferons and would dominate (would be more efficacious with lower costs) beta interferon.

Link to abstract.

Monday, December 12, 2005

Darcy Wakefield dies at 35

A while back, I blogged a bit about Darcy Wakefield, a woman about my age who was diagnosed with ALS and then became a sometime commentator for NPR. Darcy Wakefield died on Saturday. She wrote her own obituary, which was published in the Portland Press Herald.

Medical marijuana: Researcher challenges federal monopoly on production

For decades, the federal government has been the nation's only legal producer of marijuana for medical research. Working with growers at the University of Mississippi, the National Institute on Drug Abuse has controlled both the quality and distribution of the drug for the past 36 years. But for the first time the government's monopoly on research marijuana is under serious legal challenge. The effort is being spearheaded by a group that wants to produce medicines from currently illegal psychedelic drugs and by a professor at the University of Massachusetts who has agreed to grow marijuana for the group if the government lets him.
"By controlling who can research marijuana and how they can do it, the DEA has greatly limited promising research that could lead to [government] approved medications," [Richard] Doblin [president of the Multidisciplinary Association for Psychedelic Studies (MAPS)] said. The problems, he said, are not limited to winning approval to buy the Mississippi marijuana. Doblin and other researchers contend that the government marijuana is low in quality and potency and could never be a stable source of basic ingredients if the Food and Drug Administration ever did approve a marijuana-based medication.

To me, this bears some resemblance to federal government funding restrictions on stem cell research: complex political and societal judgments about right and wrong stand in the way of research that, if successful in producing technology that reduces human suffering, would likely result in adjustments to those judgments. On the other hand, there's no sense in giving science a blank check just because its purpose is noble.

What to do?

Link to Washinton Post story.

Saturday, December 10, 2005

Current events: Richard Pryor on MS 10 years ago

I was poking around for a story that would shed some light on what Pryor's experience of MS was like, and stumbled on an article by David Schumacher that appeared in Ebony in 1993. At this point, Pryor had only recently stopped working as an entertainer. Here's a bit of his diagnosis story:
"MS is a very strange disease. I didn't know anything was wrong at first, [it] just crept up on me. Then one very strange day [director Michael] Apted said, 'Richard, come here.' And I did. Well, I thought I did. My brain told my body, 'Go see what the fella wants.' But my body said, 'I'm gonna f--- with you a bit, Rich.' Apted thought I was joking around. He said, 'Come on, Richard, stop goofing around.' I told him, 'Well, I'm not! trying real... hard to get there!'

They sent me to this wonderful place called the Mayo Clinic for a checkup. They did all these tests on me... After a week, I was told I had MS, not an extreme case, not enough to kill me, but just enough so that I can't masturbate."


R.I.P. Richard Pryor

From the AP:
Richard Pryor, the caustic yet perceptive actor-comedian who lived dangerously close to the edge both on stage and off, has died, his ex-wife said Saturday. He was 65.

Pryor died of a heart attack at his home in the San Fernando Valley sometime late Friday or early Saturday, Flyn Pryor said. He had been ill for years with multiple sclerosis, a degenerative disease of the nervous system.

The comedian was regarded early in his career as one of the most foul-mouthed comics in the business, but he gained a wide following for his expletive-filled but universal and frequently personal insights into modern life and race relations.

His audacious style influenced an array of stand-up artists, including Eddie Murphy, Arsenio Hall and Damon Wayans, as well as Robin Williams, David Letterman and others.

A series of hit comedies in the '70s and '80s, as well as filmed versions of his concert performances, helped make him Pryor one of the highest paid stars in Hollywood. He was one of the first black performers to have enough leverage to cut his own Hollywood deals. In 1983, he signed a $40 million, five-year contract with Columbia Pictures.

His films included "Stir Crazy," "Silver Streak," "Which Way Is Up?" and "Richard Pryor Live on the Sunset Strip."


Thursday, December 08, 2005

Shiny shiny: RocketFM USB audio transmitter

I just got a nifty new gadget- it's an FM audio transmitter that plugs into the USB port on my desktop. It's a handy solution for those of us who want to pipe audio from the computer to other places in the house, but are too cheap to pop for AirPort. With shipping, it cost about 30 clams, and I had it working in a couple minutes.

The cool part is how easy it is to open the case and extend the internal antenna so that it becomes a three-inch external antenna, greatly improving the devices range. It's almost it was designed with this hack in mind.

If you're running WinXP or OS X, you can use the included software to change the frequency the device transmits on. I'm stuck in the dark ages with Win2K, and my machine wouldn't run the software, but the gizmo is still plug-and-play, it's just limited to one frequency- 88.1 FM.

Here's what I'm using it for as I write: time-shifting NPR programming. Where I live, my NPR affiliate only broadcasts All Things Considered until 6 pm. If I had my druthers, ATC would run until 7 or later so I could listen while I'm making dinner. Now, all I have to do is pull up an internet simulcast for a station that's further west--say, KCRW in Santa Monica--and I can time-shift my NPR. Plus, I get to hear about how awful the traffic is out there while I'm in my cozy little house having a glass of wine.

The audio quality isn't fabulous-- it's FM, and for listening to music, it's just not up to snuff. But I love getting NPR when I want it, and I think I'm going to enjoy listening to international stuff like the BBC, too.

Wednesday, December 07, 2005

Current events: Social Security benefits may be cut to pay off student loans

A ruling from the Supreme Court today says the government can dip into your Social Security benefits to recover unpaid student loans. I'm not familiar with the issue in the case, and I don't doubt that Congress authorized this kind of action. Here's what's interesting to me: Generally, it's incredibly difficult to escape student loan debt, but if you're permanently and totally disabled, the government will cancel your student loans. A few years back, the government tightened up the regulations on getting a disability cancellation, narrowing the definition of disabled and requiring a 3-year period of "conditional discharge," in which you need not make payments but the debt continues to exist. If you're still disabled after three years, the debt is cancelled.
Here's the problem: the IRS considers the amount of discharged debt to be income, for tax purposes. So maybe you manage to get out from under student loan debt, but then you end up suddenly owing the IRS a big chunk of tax money. And who would you rather have on your back: the Department of Education, or the IRS?

Link to NYT story on today's ruling (free reg req'd)

Journal: Are there wheelchairs in heaven?

This morning, I caught the tail end of a commentary on NPR by Ben Mattlin. Mattlin's a lifelong quadriplegic, and spoke about attending a funeral for a friend who, while also a quad, ended up there as a result of a motorcycle accident. At the funeral, there was talk about how Mattlin's friend was, in death, freed from his wheelchair; how, in heaven, he was restored to his pre-injury body, he was "in a better place." Mattlin was stung- did they mean that his friend was better off dead than in a wheelchair?

Mattlin notes that people who become disabled often find that they experience a depth and intensity to life that they didn't feel pre-disability. I'm probably one of those people. But if offered the choice, would I trade depth and intensity for good health? Absolutely.

What does that mean about my view of disability? For all of my convictions about rights of the disabled, about the worth of a person who is disabled, I have to admit that I see myself as something less than a whole person. Because of MS, there's something missing, something that used to be there that isn't any more, and that hole isn't filled by depth and intensity.

Is this a problem?

Tuesday, December 06, 2005

Journal: First, something cheaper

Yesterday, I was back at the pain clinic for an appointment with the nurse practitioner who does medication management. It was a follow-up visit I'd scheduled months ago, but the timing ended up being just about perfect. For the last month or so, I'd been feeling more than a little bit unraveled: the pain was starting earlier in the day, it was more intense, it was spreading from my legs to the bottoms of my feet. I was struggling to concentrate at work, and I noticed I was avoiding social contacts, I was avoiding physical activity, I was irritable and depressed. I also started to notice that as I was trying to fall asleep, my legs were playing this odd involuntary soccer match, which I was told was a consequence of the large quantities of Neurontin that I've been taking for the last couple years.

So I was happy to hear the nurse practitioner say that there's a brand-spanking-new drug available to treat neuropathic pain called Lyrica (pregabalin), that they've had good luck with it, and that it has fewer side effects than Neurontin. I was not happy, though, to learn that Navitus, the pharmacy benefit manager for my HMO, would not pay for Lyrica unless and until I've tried 1) Neurontin + imipramine, 2) Neurontin + nortryptaline, and 3) Neurontin + amitryptaline.

Now, I understand the valuable function that pharmacy benefit managers serve in the system in ensuring that the HMO's pharmacy dollars are spent wisely. I understand that if the HMO paid every time somebody wanted the latest-and-greatest drug, maybe a drug that was advertised on TV, instead of trying effective, cheaper alternatives first, my premium would be a lot higher than it is.


I wish I could talk to one of the medical directors at Navitus. I wish I could explain that over the last three or four years, I've been through a succession of drugs to deal with the ever-increasing burning pain in my lower extremities, that I started out with imipramine, tried a handful of different anticonvulsants before settling into a Neurontin habit that has me taking a pill every 2 1/2 hours, on the suggestion of my neurologist, shelled out a few hundred bucks to try acupuncture, started meditating and doing yoga, and I still feel like pain has been a significant factor in the way I've lived my social and professional life. I still feel like most difficult part of living with MS for me is not the end of the physical, active life I used to live, not the indignities of bladder problems or sexual dysfunction, or the looming uncertainty of increasing disability in the future; the most difficult part right now is that every day at about 3:30 in the afternoon, my legs start to burn so badly that I want to chop them off.

So I need to wait. Maybe it will turn out that the neurontin + tricyclic combination is effective and doesn't leave me feeling dopey and sluggish. Maybe, but I'm still mad as hell.

technorati tag:

Monday, December 05, 2005

In the news: Teri Garr on NPR

Today on NPR, Terry Gross spoke with Teri Garr about her career (including dancing in 9 Elvis movies) and about MS. I've read some critical comments about how Garr handles her MS in public. I haven't seen her TV appearances, so I'm not sure what the issue is, but I really enjoyed this interview. If Garr has become the Designated MS Celebrity Ambassador, it's a role she plays with grace and humor, and a little ambivalence.

She's got a book out, of course, called "Speedbumps." Garr says she was going to call the book "Does This Wheelchair Make Me Look Fat?" I'm guessing she's already used that joke in her TV appearances.