Tag Archives: Drugs

Ten Drugs – Thomas Hager

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Ten Drugs

How Plants, Powders, and Pills Have Shaped the History of Medicine

Thomas Hager

Genre: History

Price: $9.99

Publish Date: March 5, 2019

Publisher: ABRAMS

Seller: Harry N. Abrams, Inc.


Behind every landmark drug is a story. It could be an oddball researcher’s genius insight, a catalyzing moment in geopolitical history, a new breakthrough technology, or an unexpected but welcome side effect discovered during clinical trials. Piece together these stories, as Thomas Hager does in this remarkable, century-spanning history, and you can trace the evolution of our culture and the practice of medicine.  †‹Beginning with opium, the “joy plant,” which has been used for 10,000 years, Hager tells a captivating story of medicine. His subjects include the largely forgotten female pioneer who introduced smallpox inoculation to Britain, the infamous knockout drops, the first antibiotic, which saved countless lives, the first antipsychotic, which helped empty public mental hospitals, Viagra, statins, and the new frontier of monoclonal antibodies. This is a deep, wide-ranging, and wildly entertaining book.

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Ten Drugs – Thomas Hager

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"I Gotta Go and Hunt Criminals." On the Road With Ohio Highway Patrol.

Mother Jones

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We’re sitting in the middle of the highway looking for drug mules. Specifically, we’re at mile marker 174 of Interstate 80, which I learn is the interstate with the third most drug traffic in the country, and I’m in a highway patrol car next to a garrulous sergeant who has a square face and close-cropped blond hair and alternates between wads of chewing tobacco and sips of an energy drink. His eyes dart from car to car—sedans and SUVs and big rigs—looking for what, exactly, is hard to tell.

Beyond the shallow embankment on either side of the road are forests and farms and vineyards of northeast Ohio, and beyond that, the drug hubs of Detroit and Cleveland and Buffalo and New York City. “As I tell my guys, there’s bulk loads going by us multiple times a shift every day,” the sergeant says, eyes still on the cars. “Our job is to interdict drugs before they get to our community.” Or, as he puts it later: “I gotta go and hunt criminals.”

Ohio has one of the most robust highway drug seizure programs in the country, with 13,300 drug-related arrests last year—or about one every 90 minutes. In 2016, troopers seized 167 pounds of heroin—the equivalent to about 2 million doses on the streets—and 64,708 opiate pills. “Our approach is to stop a lot of cars,” says Lieutenant Robert Sellers, the public affairs commander for the highway patrol. “What we don’t want our troopers to do is walk away. We want to make sure that whatever they thought wasn’t right is right.”

The sergeant’s job is, in the split second that cars pass by, to look for telltale signs of drug couriers. It’s typical for people to see the car, slow down, and then speed back up once they’ve passed him—those are the people he’s not interested in. He’s not interested in people speeding, or the drivers who look confident and relaxed. He is interested in rental cars, overly cautious drivers who stay below the speed limit, people who look in their rearview mirrors at him as they pass by, cars with tinted windows, drivers who look like they’re scrambling to move or adjust something as they pass, cars with recent fingerprints on the trunk. Cars that move into the right lane or that are closely tailing another are also red flags—they’re trying to distance themselves from the patrol car and blend into their surroundings, says the sergeant. Ultimately, a lot of the job is based on gut instinct: After years of watching thousands of cars go by, “your intuition will tell you when something’s wrong,” says Sellers.

Comments like this make me uneasy: The operation seems like a perfect recipe for profiling. The sergeant makes clear that race is not something that goes into his calculation of red flags—as he says later, “If you do this job based on stopping a certain race or age group or gender, you’re not gonna succeed.” But I cringe a little when, as we pull over the one car that we’ll pull over that afternoon—a sedan that had been closely tailing another car, in the far right lane, with recent fingerprints on an otherwise dirty trunk—the window opens to reveal a black man. (The sergeant lets him go with a warning.)

“Our professional operations policy forbids bias-based policing,” said Sellers. The troopers go through annual implicit bias training as part of their continuing education, he added, and each month, supervisors check the arrest data of their troopers to gauge for abnormally high arrest rates by race. According to highway patrol data online, 14.4 percent of drivers during all Ohio highway patrol stops were black. African Americans make up 12.7 percent of the state’s population.

Highway patrol drug arrests so far in 2017 Ohio State Highway Patrol

If a car catches the sergeant’s eye, he’ll turn onto the road and floor it so he can get a better view. Are the people moving around in the back just toddlers? Did the car speed up after all? If, after this, he’s still interested, then he pulls them over, typically for a minor violation like going over the lane marker or tailing another car. He maintains his friendly demeanor as he talks to drivers through their windows, but he’s also looking for clues: Nervous, sweaty drivers, pill bottles—especially in a different name than the driver’s—the scent of marijuana, recent receipts from a different place than the driver says he or she has been. And if anything looks suspicious, a German shepherd hops out of a squad car to sniff around. The dogs, who live with their handlers when they’re not on duty, are trained to look at or scratch around the area where they smell drugs. The sergeant tells me the story of a recent seizure, when a driver insisted there weren’t drugs in the car, and yet the dog kept calmly staring at the rooftop carrier—where the troopers later found 14 pounds of marijuana.

The day I’m there, troopers in the area use the tactic to find a car with a bucket full of marijuana, and another with two quarts of marijuana Kool-Aid, which I didn’t know was a thing, even as a Californian. The day before, there was a couple in a 2016 Nissan Ultima with more than 200 OxyCodone pills. The state highway patrol website features a strangely captivating running tab of the seizures, complete with photos of drugs in trunks or duct tape packages. There’s also a regularly updated map of drug busts, with a web of tiny blue dots for each seizure.

Marijuana and marijuana Kool-Aid seized by Ohio Highway Patrol in March Ohio State Highway Patrol

Unlike so many tight-lipped cops that make the news, the sergeant is eager to show me his work, and rattles on about recent busts, complete with details of the weight and the type of drug and where in the car it was. He’s seen what drugs can do to families—he was adopted because of his mother’s substance abuse—and he gushes about his daughters, 15 and 20. A few years ago, he says, “I decided I needed a hobby—all I did was eat, sleep, and breathe drugs.” When I ask him what the hobby is, a sheepish grin crosses his face as he mumbles, “fish.” I assumed this meant he liked fishing, but no—he has 16 aquariums with all sorts of exotic fish at his house. After a long day, he’ll sit in the aquarium room—where it’s quiet and things move slowly and there is no addiction or violence—and just watch.

I like the sergeant, yet I can’t stifle the questions that keep popping up in my head as we’re sitting there, looking for criminals. In addition to the profiling concern, there’s the question of efficacy: Are the troopers finding drugs just because they’re making so many stops and drugs are so prevalent, or are they finding drugs because they’re focusing on the right cars? Which is to say, is this even working?

The sergeant says he doesn’t think much about that higher-level question—as he put it, “I’ve got one goal in mind: If they’ve got drugs, to get their drugs.” Sellers admits that efficacy is hard to prove, but he says, “We do know we’ve had an impact.” He notes the heroin seized last year: “That’s 2 million doses of heroin that we took off Ohio roads that were destined for Ohio communities.

And finally, there’s the concern about the casual nature with which troopers arrest and imprison. When he describes a trooper with a particularly high seizure rate whom we’re about to visit, the sergeant simply says, “He’ll probably have someone in handcuffs by the time we get there. He’s that good.” Indeed, he does—when we arrive a half hour later, the trooper has pulled over the car with four pounds of marijuana in a bucket. The troopers playfully compete with each other—as we’re leaving, the sergeant says, “Now we have to find five.” The sergeant routinely calls the drug couriers “bad guys,” as in “the bad guy is in the sergeant’s car.”

I press him on this “bad guys” thing—aren’t some of these folks just desperate people in desperate situations? His face softens and he begins to tell me about an arrest a few weeks ago—a man and young pregnant woman, who voluntarily produced a bag of marijuana and 10 Xanax pills. But watching the video of the couple in the back of the patrol car, the troopers noticed that the woman kept sticking her hands down her pants, adjusting something. When confronted about it, she tearfully reached into her vagina and pulled out a condom full of hundreds of pills. The sergeant shakes his head recalling this. “I would love to see her show up for court looking good, have her act together. But unfortunately, those kinds of endings don’t happen that often.”

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"I Gotta Go and Hunt Criminals." On the Road With Ohio Highway Patrol.

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We’re Using the Strongest Antibiotics More Than Ever Before—and It’s Terrifying

Mother Jones

Pretend you found a mosquito in your bedroom. Would your first move be to kill the mosquito or to call in the exterminator to fumigate your whole house? Probably you’d start by killing the mosquito and, maybe, if his friends kept showing up, you’d try a few other things. If none of that worked, you’d eventually call in the big guns.

Doctors use the same approach when they treat infections with antibiotics: In general, they try to use the weakest possible drug that they know will be effective for a specific kind of infection. If that doesn’t work, they move on to the big guns—broad-spectrum antibiotics that can kill a wide range of bacteria.

But now, doctors are prescribing more broad-spectrum antibiotics than they ever have before—which leads researchers to speculate that first-line antibiotics aren’t working as well as they used to.

A new report from the Centers for Disease Control and Resistance tracked antibiotic prescriptions at 300 US hospitals. Between 2006 and 2012, overall antibiotic prescription rates remained the same. But prescriptions for carbapenems—a class of antibiotics used to treat infections that don’t respond to the usual drugs—jumped by an alarming 37 percent. Prescriptions of the extremely powerful antibiotic vancomycin—one of the only drugs effective against the scary skin infection, methicillin-resistant Staphylococcus aureus (MRSA)—increased by 27 percent.

Meanwhile, the use of fluoroquinolones, a very commonly prescribed class of antibiotics that isn’t nearly as strong as carbapenems or vancomycin—dropped by 20 percent.

The researchers think they can explain the rise in prescriptions of super-powerful antibiotic and the decline in use of less potent drugs: As bacteria develop resistance to the most commonly prescribed drugs, doctors have to call in the big guns more often. And if bacteria start developing resistance to the most powerful antibiotics, we’re really in trouble, as science journalist Maryn McKenna explained here.

One way to avoid that dire outcome is to make sure that doctors save the last-resort drugs for bacteria that other drugs can’t kill. The researchers note that “inappropriate antibiotic use increases the risk of antibiotic resistance and other adverse patient outcomes.”

But hospitals are not the only source of superbugs. As my colleague Tom Philpott has reported, an astonishing 80 percent of all US antibiotics go to the livestock industry, where meat producers regularly dose even healthy animals with them. This practice allows farmers to cram lots of animals into small spaces without sickening each other and makes them grow faster. It also spreads antibiotic-resistant genes to humans.

Although the FDA’s rules on livestock antibiotics are pretty permissive, in response to consumer concerns about superbugs, some meat companies are moving away from antibiotics on their own. Read Tom’s story of one company that chose to ditch the drugs here.

The good news: The FDA appears to be noticing the mounting evidence that our antibiotics are losing strength. Last week the agency signaled that it may soon limit how long farmers can use the drugs.

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We’re Using the Strongest Antibiotics More Than Ever Before—and It’s Terrifying

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Four Ways Research Has Reframed the Abortion Debate

Mother Jones

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There has been little or no publicly funded research on abortion in the United States, so for years basic information about abortion was lacking—from how often patients have complications to what happens to women who want the procedure but can’t obtain it. Many of the new abortion restrictions were justified by assertions that often had no scientific basis—for example that clinics were teeming with incompetent and unscrupulous doctors, that abandoned patients were flooding emergency rooms, or that the psychological damage caused by grief and regret after abortions often persist for years and ruin women’s lives. The research initiative became more urgent after the high court held in 2007 that in cases of “medical and scientific uncertainty,” legislatures could have “wide discretion” to pass laws restricting abortion. Since then, a primary objective of abortion rights supporters has been to establish a high level of medical certainty—both about the safety of the procedure and about what happens when a woman’s reproductive options are drastically curtailed or eliminated. Over the last 15 years, a number of academic institutions and private organizations have received funding for abortion research, and here are four areas where their work has changed the conversation:

Mental health

Since the 1990s, abortion opponents have worked to advance the idea that abortion causes long-lasting psychological damage based on a combination of personal stories and (widely disputed) statistical analyses showing a correlation between abortion and mental health problems. “Emotional harm” has been cited by legislators in passing parental consent, mandatory ultrasound viewing, and waiting-period laws.

In 2008, Diana Greene Foster, a demographer and associate professor at the University of California-San Francisco, launched the Turnaway Study to examine what happens, emotionally and economically, to women who have had abortions and also to those who wanted abortions but couldn’t have them. Nearly 1,000 women seeking abortions in their first and second trimesters were recruited from 30 facilities in 21 states. About a quarter had been turned away because they just missed their clinic’s gestational limit (10 to 24 weeks). Researchers followed up every six months for five years. The key findings: Most women had abortions because they didn’t think they could afford another child, and they often turned out to be right. Of those who did have the procedure, 95 percent said it was the right decision, and their feelings—positive or negative—faded over time. Having an abortion did not lead to depression, PTSD, or other mental health problems, the project found. But being denied an abortion did seem to keep women tethered to abusive partners.

Complications

In justifying Targeted Regulation of Abortion Provider laws, or TRAP laws, abortion opponents have often argued that complication rates are high—up to 10 percent—and that clinics and doctors need to be held to especially rigorous standards. Two large-scale studies from California, though, appear to counter those claims.

One study looked at whether abortions could be performed safely by health care professionals without medical degrees. Nurse practitioners, certified midwives, and physician assistants received training, then were allowed to do first-trimester vacuum-aspiration abortions at 22 sites. After monitoring more than 11,000 procedures over four years, the researchers found little difference in the rate of complications between doctors and non-doctors, which was low for both groups—0.9 percent for physicians and 1.8 percent for non-physicians. In 2013, California legislators voted to let non-doctors perform the procedure.

In a more recent study, UCSF researchers analyzed billing data for 55,000 abortions and follow-up care covered by California’s Medicaid program, known as Medi-Cal. (California is one of 17 states that covers abortion and aftercare for Medicaid recipients.) The data showed that 6.4 percent of women who had abortions visited an emergency room within the following six weeks, but fewer than 1 percent of those visits were related to the abortion. Major complications, defined as hospitalizations, surgeries, and transfusions, occurred in fewer than one-quarter of 1 percent of all abortions.

Medication abortion

Abortion foes have watched with alarm as medication abortions have risen to nearly a quarter of all pregnancy terminations in the United States. Lawmakers have advanced measures that clamp down on how clinics prescribe the drugs and counsel patients.

One type of law has required doctors to follow outdated FDA guidelines from the 1990s for the abortion drugs mifepristone and misoprostol. Much research—some produced by the nonprofit Gynuity Health Projects, which is funded by the Susan Thompson Buffett Foundation—has shown that the drugs should be taken in lower doses and could be used later in the first trimester than those guidelines indicated. Over conservatives’ vociferous objections, the FDA revised the label in March.

Meanwhile, after Planned Parenthood in Iowa began using videoconferencing to counsel rural patients on how to use abortion drugs, the state tried to prohibit the practice. In June 2015, the Iowa Supreme Court rejected that ban. A key piece of evidence was a study of 450 Iowa women by the Buffett-funded Ibis Reproductive Health that found no statistical difference in complication rates for telemed patients versus women who met with doctors in person.

Other abortion restrictions

Beyond TRAP laws, researchers are studying the effect on women that other types of state laws that restrict abortion are having.

Many of these efforts are ongoing, but a new study of Utah’s 72-hour waiting-period law, which legislators said would give abortion seekers a chance to change their minds, found that it increased costs and logistical hassles but did not persuade most women. Of 300 patients surveyed, only 8 percent decided not to terminate their pregnancies, and most had been leaning in that direction anyway. Meanwhile, the average amount of time the surveyed women had to wait to have abortions wasn’t 72 hours, but eight days.

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Four Ways Research Has Reframed the Abortion Debate

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John Oliver does the lord’s work on dumb science articles

John Oliver does the lord’s work on dumb science articles

By on May 9, 2016Share

If your Facebook feed is anything like mine, you probably see a lot of posts with the words “study finds” in the headlines. Here are a few examples, taken from a quick search of Facebook on Monday morning:

Study Finds Monkeys With Smaller Testicles Scream Louder to Compensate
Study Finds Cheese Triggers the Same Part of the Brain as Hard Drugs
Study Finds Smelling Farts Makes You Live Longer

These are just a few examples of the Study Finds Industrial Complex, in which the media takes scientific studies — some of which aren’t even valid in the first place — adds a layer of bullshit, and then delivers them to our televisions and Facebook feeds. John Oliver takes bad science writing to task in the latest episode of Last Week Tonight.

Take the fart-sniffing article: The source is a 2014 study that found that treating distressed mouse cells with a compound called AP39 could protect mitochondria. If the authors of the article read the actual study — instead of the countless articles misinterpreting a quote in a press release —  they would have noticed it had nothing to do with farts, or smelling them. Nothing.

Bad science writing is especially prevalent with studies of food, which — on a regular basis — tell us that coffee/wine/chocolate/etc. can cure cancer/obesity/depression/etc., despite mounds of conflicting evidence. As Oliver points out, not only do these studies give us poor guidelines for how to live, they have also led lots of folks to mistrust science and think that climate change isn’t real or vaccines cause autism.

Regardless, Study Finds You Don’t Want To Miss This Show. Watch above.

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John Oliver does the lord’s work on dumb science articles

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The FDA Is Giving New Cancer Treatments a Break

Mother Jones

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For a variety of reasons, I’ve never spent much time on the internet reading or conversing about multiple myeloma. A few days ago, however, I had reason to think I should educate myself a bit more. Among other things, I discovered that within the space of two weeks in the second half of November, the FDA had approved no fewer than three new treatments. I suppose this can’t be anything but coincidence, but then another coincidence piled on top of that: a New York Times piece about Richard Pazdur, the oncology chief at the FDA. Three years ago, his wife was diagnosed with ovarian cancer:

In her struggle with cancer and ultimately her death in November, Ms. Pazdur had a part, her husband and a number of cancer specialists now say, in a profound change at the F.D.A.: a speeding up of the drug approval process. Ms. Pazdur’s three-year battle with cancer was a factor, they say, in Dr. Pazdur’s willingness to swiftly approve risky new treatments and passion to fight the disease that patient advocates thought he lacked.

….Since Ms. Pazdur learned she had ovarian cancer in 2012…the average decision time on drugs by Dr. Pazdur’s oncology group has come down to five months from six months….“I have a much greater sense of urgency these days,” Dr. Pazdur, 63, said in an interview. “I have been on a jihad to streamline the review process and get things out the door faster. I have evolved from regulator to regulator-advocate.”

Many factors are driving him, he continued. “Was Mary’s illness one of them? Yes,” he said. But in 2012, he added, Congress also passed a law that gave the F.D.A. more money and a new pathway to work more closely with drug makers when a medicine may save lives. Another important change in the same period, he said, was a surge in advances in genetic research that made some medications more effective and easier to test.

“The drugs simply got better,” Dr. Pazdur said.

Again, I suppose this is mostly coincidence. But I still wonder if Mary Pazdur’s cancer played a role in all these multiple myeloma treatments getting approved recently? If so, her death may eventually play a role in saving—or extending—my life. A butterfly flaps its wings….

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The FDA Is Giving New Cancer Treatments a Break

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We’re Eating Less Meat—But Using More Antibiotics on Farms Than Ever

Mother Jones

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The meat industry’s massive appetite for antibiotics just keeps growing. That’s the takeaway from the Food and Drug Administration’s latest annual assessment of the issue, which found that agricultural use of “medically important” antibiotics—the ones that are prescribed to people when they fall ill—grew a startling 23 percent between 2009 and 2014. Over the same period, the total number of cows and pigs raised on US farms actually fell a bit, and the number of chickens held steady. What that’s telling us is that US meat production got dramatically more antibiotic-dependent over that period.

Even more disheartening, medically important antibiotic use crept up 3 percent in 2014 compared to the previous year—despite the FDA’s effort to convince the industry to voluntarily ramp down reliance on such crucial medicines. True, the FDA’s policy, which was first released in 2012, contained a “three-year time frame for voluntary phase-in.” One might have hoped, however, that by 2014, the needle would point downward, not implacably upward.

Note, too, that the last time the FDA saw fit to release numbers on human antibiotic use, in 2011, the total stood at about 3.3 million kilograms. The chart below tells us that farms now using nearly 9.5 million kilograms—nearly three times as much. The news comes in the wake of warnings from the American Academy of Pediatrics, the World Health Organization, and the Centers for Disease Control that the meat industry’s drug habit contributes to a growing crisis in antibiotic-resistant pathogens that kill 23,000 people each year in the United States and 700,000 globally. Then there was the recent news that in China—which has patterned its meat industry on the antibiotic-ravenous US model—a strain of E. coli had evolved on hog farms that can resist a potent antibiotic called colistin, considered a last resort for pathogens that can resist all other drugs.

Here are the numbers:

FDA

Link: 

We’re Eating Less Meat—But Using More Antibiotics on Farms Than Ever

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Here Are Your Chances of Getting an Antibiotic-Resistant Infection After Surgery

Mother Jones

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An eye-opening study published today in The Lancet Infectious Diseases medical journal shows just how many people acquire antibiotic-resistant infections after common procedures: Up to half of infections after surgery and a quarter of infections after chemotherapy are caused by resistant bacteria—meaning that they are significantly more difficult, if not impossible, to treat.

“A lot of common surgical procedures and cancer chemotherapy will be virtually impossible if antibiotic resistance is not tackled urgently,” said Dr. Ramanan Laxminarayan, a study co-author and director of the Center for Disease Dynamics, Economics, and Policy. “All of us at some point have to get a surgery or a root canal or a transplant, or perhaps go through chemo at some point in our lives. But how well these turn out depends on how well the antibiotics used to keep infections away during surgery work.”

Infections during and after surgeries and chemotherapy are common, so it is standard practice to give these patients antibiotics. But as the drugs are overused or misused, antibiotic resistance rates have risen. The Lancet authors conducted a meta-analysis of literature reviews on the efficacy of antibiotics after 10 of the most common surgeries in the United States. They found antibiotic-resistant bacteria to be causing 39 percent of infections after cesarean sections, 51 percent of infections after pacemaker implants, and 27 percent of infections after blood cancer chemotherapy.

If the efficacy of antibiotics drops 30 percent—a rate that the authors see as realistic given the current overuse of antibiotics—then infections from surgeries and chemotherapies could result in 120,000 more infections and 6,300 more infection-related deaths each year in the United States.

Dr. Laxminarayan suggests a multipronged solution to the problem: Doctors need to be trained on when (and when not) to prescribe antibiotics and how to minimize infections after common surgeries. Americans need to stay up to date on vaccines in order to reduce the need for antibiotics in the first place. If you’re getting surgery, he says, choose hospitals and surgeons with low infection rates—hospitals are required to publicly report these numbers in many states. (More from the Centers for Disease Control and Prevention, here).

Taken from:

Here Are Your Chances of Getting an Antibiotic-Resistant Infection After Surgery

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The Internet Is Making Us Sicker

Mother Jones

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The placebo effect, as we all know, is the mechanism by which we sometimes feel better even when we’re given meds that later turn out to be sugar pills. The mere expectation that we will get better somehow helps us actually get better. The most eye-popping example of the placebo effect is probably this one here.

But there’s also a dark side to this. I don’t know if it has an official name, so let’s call it the anti-placebo effect.1 Basically, it means that your mind can invent miserable side effects from taking medication merely because you know that certain side effects are possible. Take cholesterol-lowering statins, for example:

At the Mayo Clinic here, Dr. Stephen L. Kopecky, who directs a program for statin-intolerant patients, says he is well aware that middle-age and older adults who typically need statins may blame the drugs for aches, pains and memory losses that have other causes. He also knows his patients peruse the Internet, which is replete with horror stories about the dangers of statins.

Yet he, like other doctors, also thinks some statin intolerance is real despite what clinical trials have shown. The problem: In the vast majority of cases, there is no objective test to tell real from imagined statin intolerance.

So there you have it: the internet is making us sicker. Does it make up for this by also making us healthier? I have my doubts. It is a spawn of evil.

And no, you still can’t take mine away. However, this is one of the reasons why I’ve avoided reading about multiple myeloma on the internet. I figure it’s unlikely to help, and might very well hurt.

1Turns out it’s called the nocebo effect. How about that?

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The Internet Is Making Us Sicker

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