Marijuana as wonder drug

March 3, 2007

From the Boston Globe:

A NEW STUDY in the journal Neurology is being hailed as unassailable proof that marijuana is a valuable medicine. It is a sad commentary on the state of modern medicine — and US drug policy — that we still need “proof” of something that medicine has known for 5,000 years.

The study, from the University of California at San Francisco, found smoked marijuana to be effective at relieving the extreme pain of a debilitating condition known as peripheral neuropathy. It was a study of HIV patients, but a similar type of pain caused by damage to nerves afflicts people with many other illnesses including diabetes and multiple sclerosis. Neuropathic pain is notoriously resistant to treatment with conventional pain drugs. Even powerful and addictive narcotics like morphine and OxyContin often provide little relief. This study leaves no doubt that marijuana can safely ease this type of pain.

As all marijuana research in the United States must be, the new study was conducted with government-supplied marijuana of notoriously poor quality. So it probably underestimated the potential benefit.

I have always found the ban on using marijuana for medical purposes ridiculous. I’m studying for a doctorate degree in medicine, and when I get there no so-called “moralist” or conservative politician is going to tell me that I can’t give a patient something I my training and the scientific evidence tell me that is the way to go.

With marijuana it is especially a problem, because anyone can grow it. You don’t have to buy it (well, at least initially from somebody!) and growing the plant is like growing any other plant. I have always believed that there is something else to it:

The pharmaceutical industry is scrambling to isolate cannabinoids and synthesize analogs, and to package them in non-smokable forms. In time, companies will almost certainly come up with products and delivery systems that are more useful and less expensive than herbal marijuana. However, the analogs they have produced so far are more expensive than herbal marijuana, and none has shown any improvement over the plant nature gave us to take orally or to smoke.

We live in an antismoking environment. But as a method of delivering certain medicinal compounds, smoking marijuana has some real advantages: The effect is almost instantaneous, allowing the patient, who after all is the best judge, to fine-tune his or her dose to get the needed relief without intoxication. Smoked marijuana has never been demonstrated to have serious pulmonary consequences, but in any case the technology to inhale these cannabinoids without smoking marijuana already exists as vaporizers that allow for smoke-free inhalation.

Be sure to read the rest of the article here. By the way, the piece was written by Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School, certainly not some ignorant hippie:

Hopefully the UCSF study will add to the pressure on the US government to rethink its irrational ban on the medicinal use of marijuana — and its destructive attacks on patients and caregivers in states that have chosen to allow such use. Rather than admit they have been mistaken all these years, federal officials can cite “important new data” and start revamping outdated and destructive policies. The new Congress could go far in establishing its bona fides as both reasonable and compassionate by immediately moving on this issue.

Such legislation would bring much-needed relief to millions of Americans suffering from cancer, AIDS, multiple sclerosis, arthritis, and other debilitating illnesses.


Low-Cost Antimalarial Pill Available!

March 2, 2007

A child finds out he got Malaria

God, finally some good news to cheer my day up!

A new, cheap, easy-to-take pill to treat malaria is being introduced today, the first product of an innovative partnership between an international drug company and a medical charity.

The medicine, called ASAQ, is a pill combining artemisinin, invented in China using sweet wormwood and hailed as a miracle malaria drug, with amodiaquine, an older drug that still works in many malarial areas.

A treatment will cost less than $1 for adults and less than 50 cents for children. Adults with malaria will take only two pills a day for three days, and the pill will come in three smaller once-a-day sizes for infants, toddlers and youngsters.

Needless to say, this is a very good thing, and a team effort as well:

“This is a good thing,” said Dr. Arata Kochi, chief of the World Health Organization’s global malaria program, who has publicly demanded that drug companies stop making pills that contain artemisinin alone because they will lead to resistant strains of malaria. “They’re responding to the kind of drug profile we’ve been promoting.”

[…]Sanofi-Aventis, the world’s fourth-largest drug company, based in Paris, will sell the pill at cost to international health agencies like the W.H.O., Unicef and the Global Fund for AIDS, Tuberculosis and Malaria.

The rollout of the drug is the result of a two-year partnership between Sanofi and the Drugs for Neglected Diseases Initiative, a campaign started by the medical charity Doctors Without Borders to find new drugs for tropical diseases.

Doctors Without Borders, better known by its French name, Médecins Sans Frontières, has long been one of the harshest critics of the pharmaceutical industry, charging that it spent billions on drugs like Viagra, Ambien and Prozac for rich countries and almost nothing on diseases killing millions of poor people.

But, recognizing that new drugs would have to come from the industry’s major players, Doctors Without Borders founded the initiative in 2003 and began seeking partnerships. This is the first to come to fruition.

See, ain’t that the way to do things? Major disagreements, but communication is still open, and compromise. I know a government or two that could apply these principles into practice.


Hell Just Froze Over – Mandatory HPV Vaccination in Texas?

February 3, 2007

Did hell just froze over because of Texas?

Yes my friends, apparently hell just froze over:

HOUSTON, Feb. 2 — Texas on Friday became the first state to require all 11- and 12-year-old girls entering the sixth grade to be vaccinated against a sexually transmitted virus that causes cervical cancer.

Averting a potentially divisive debate in the Legislature, Gov. Rick Perry, a Republican, signed an executive order mandating shots of the Merck vaccine Gardasil as protection against the human papillomavirus, or HPV, starting in September 2008.

Mr. Perry’s action, praised by health advocates, caught many by surprise in a largely conservative state where sexual politics is often a battleground.

“I had no idea; I was absolutely caught off guard,” said Representative Jessica Farrar, Democrat of Houston, who sponsored a bill to require the vaccinations starting this September. “Normally, the governor does not take things like this upon himself, although I’m glad he did.”

If you live in Texas and see some snow falling, it is not due to global warming, it is because Gov. Rick Perry – a stalwart conservative republican who is against abortion and stem-cell research – finally recognized that doing the right thing is not such a hard thing to do:

“Requiring young girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs,” said Mr. Perry, who was re-elected to his second full term last November.

And it is official as well:

It is Republican Gov. Rick Perry who issued an executive order directing the state’s Health Human Services Commission (HHSC) to get ready to administer the HPV vaccine in girls at noted ages before they enter sixth grade.

The order, effective September 2008, also directs HHSC and the Department of State Health Services (DSHS) to “make the vaccine immediately available to eligible young females through the Texas Vaccines for Children program for young women ages 9 to 18, and through Medicaid for women ages 19 to 21,” says the statement of the governor’s office on its website.

See? It wasn’t that hard. Good for you, Gov. Perry. So every parent must vaccinate their school-aged girls with Gardasil, right? Wrong:

Under the order, girls and women from 9 to 21 eligible for public assistance could get free shots immediately. The governor’s office said parents could opt out of the school program “for reasons of conscience, including religious beliefs.”

Ahh, I see. So at least he didn’t completely screw over his conservative friends. I wonder what is the point of having a mandatory vaccination program if parents can opt out because of religious beliefs, but I digress. Time and education will eventually replace misinformation and stereotypes.

But I wonder, did Gov. Perry did this out of the goodness of his conservative heart, or because the scientific evidence finally convinced the guy? If by “scientific evidence” you mean “my former Chief-of-Staff, who is now a lobbyist for Merck, told me this would mean truckloads of money for them and for me”, then yes, he was convinced:

Is Perry’s order politically motivated? No one knows. But, USA Today has reported today that Perry has several ties to Merck, the maker of the HPV vaccine, and Women in Government, a not-for-profit organization comprised of state woman regulators, which some watchdog has claimed is too cozy with Merck.

Media has reported that Women in Government is quite active in promoting the Merck’s vaccine, which analysts say is positioned to make Merck more than billion dollars a year. According to USA Today, Mike Toomey, Perry’s former chief of staff, serves as one of the drug company’s three lobbyists in Texas. Perry’s current chief of staff’s mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a head of Women in Government.

“Perry also received $6,000 from Merck’s political action committee during his re-election campaign,” USA Today says.

Ah, now everything seems to make sense. A conservative politician from Texas is opposed to everything this vaccine stands for, and knows he can lose his conservative base over this, but he can make up those votes from the other side, and make a ton of money for his friends at Merck in the process.

Now let me play Devil’s Advocate for a moment. Is there a conflict of interest here? Very likely. But are Gov. Perry’s actions regarding mandatory HPV vaccination wrong? Well, no. Merck does make the damn vaccine, and a generic will not become available in a long time. This vaccine represents a huge leap forward for women’s health. At around $400 for 3 shots over an 8-month period, it is expensive, and most health plans will NOT cover it. But while preventing cervical cancer is morally and medically correct, it is not exactly sound fiscal policy:

Mr. Perry says it makes sense to use the vaccine to prevent cervical cancer which would otherwise cause a large burden on medical expenditure. But does this mandatory inoculation of the HPV vaccine really save medical costs?

On average, a 5-year treatment for a case of cervical caner would cost $11,000, early studies show. For a 5-year span, about 5800 new cases of the disease are expected to be diagnosed in Texas, which means the medical cost for five years is 63.8 millions or 12.8 million a year.

In Texas, there are about 6.31 millions people now under age 18, meaning the number of girls who are required to receive the HPV vaccine each year is about 0.35 million. The total number of girls to receive the vaccine is 1.76 million, meaning that Merck can rake in 630 million dollars in five years or 126 million dollars in the vaccine sales in Texas alone with Mr. Perry’s order.

The cost for the first year would be double the price tag as girls both at age 11 and 12 will receive the vaccine. The calculation is based on the price of the vaccine at $360 per girl.

It seems that this state mandatory vaccination can save about 700 women’s lives a year in Texas at a cost of 126 million dollars a year spent on the preventive vaccine. These 700 women would otherwise need 7.7 million dollars for treatment of their cervical cancer.

Perry’s order can save some women’s lives, but it does not save money.

I am not saying that vaccinating women with Gardasil is not worth it – it is. It does make sense from a public health point of view, because cervical cancer it is the second most common cancer in women after breast cancer. Gardasil, the HPV vaccine, will definitely be most valuable in the developing world, where most women don’t have access to a yearly PAP smear. But the big fight, the one that will set the precedents for other countries to follow, is taking place in the United States and Texas, of all places, just landed a knockout blow.


Top 10 Most Underreported Humanitarian Stories of 2006

January 11, 2007

Severe malnutrition still a problem

This great report comes from Doctors Without Borders, also known as Medicins Sans Frontieres, one of the best humanitarian organizations around, and winners of the 1999 Nobel Peace Prize as well.

According to the press release of the article:

New York — The staggering human toll taken by tuberculosis and malnutrition as well as the devastation caused by wars in the Central African Republic (CAR), Sri Lanka, and Democratic Republic of Congo (DRC), are among the “Top Ten” Most Underreported Humanitarian Stories of 2006, according to the year-end list released today by the international humanitarian medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF).

The ninth annual list also highlights the lack of media attention paid to the plight of people affected by the consequences of conflict in Haiti, Somalia, Colombia, Chechnya, and central India.

“Many conflicts worldwide are profoundly affecting millions of people, yet they are almost completely invisible,” said MSF Executive Director Nicolas de Torrenté. “Haiti, for example, is just 500 miles from the United States and the plight of the population enduring relentless violence in its volatile capital Port-au-Prince received only half a minute of network coverage in an entire year.”

According to Andrew Tyndall, publisher of the online media-tracking journal The Tyndall Report, the 10 countries and contexts highlighted by MSF accounted for just 7.2 minutes of the 14,512 minutes on the three major U.S. television networks’ nightly newscasts for 2006. Treating malnutrition, tuberculosis, and Chechnya were mentioned, but only briefly in other stories. Five of the countries highlighted by MSF were never mentioned at all.

These issues were given all of 7 minutes of airtime – how noble of the mainstream media, which prefers spending its time say, badgering a Senator over a poorly executed joke.

In no particular order, here is the top ten. You can read the entire report here by the way, but the links below correspond to the specific sections of the report. You can read the whole thing, or just what interests you.

Somalia – Somalis Trapped by War and Disaster
Central African Republic – Fleeing Violence in the Central African Republic (CAR)
Tuberculosis – Increasing Human Toll Taken by Tuberculosis
Chechnya – Consequences of Bitter Conflict in Chechnya
Sri Lanka – Civilians Under Fire in Sri Lanka While Assistance is Limited
Malnutrition – Effective Strategies for Treating Malnutrition Not Implemented
Democratic Republic of Congo – Congolese Endure Extreme Deprivation and Violence
Colombia – Living in Fear in Colombia
Haiti – Violence Rages in Haiti’s Volatile Capital
Central India – Clashes in Central India


Hi-Tech Healthcare in Iraq, Minus the Healthcare

January 11, 2007

The Rationalization of Healthcare in Iraq

This article is a great read, and it comes courtesy of Corp Watch. I love the specials these guys publish. Last year, on October to be precise, they broke the story about how the Kuwait contractor than is building the U.S. embassy in Iraq is smuggling low-paid South Asians into Iraq – slave labor basically – to save themselves a few bucks, with the U.S. State Department turning a blind eye, which is ironic to say the least because they publish a yearly “Trafficking in Persons” report.

Now, they have a special on Iraq’s broken healthcare system. It’s quite long, with plenty of interviews, stories and excellent sourcing, and while its main focus is corruption, they do cover most of the basics, like how non-governmental organizations (NGOs) are trying to operate in Iraq, and how all of the promised hospitals – including the Basra Children’s Hospital, which was highly touted by Laura Bush and Condi Rice – are not being completed, or not being built at all.

Of course, Iraq is a land of opportunity, if you are a war profiteer big-name contractor. Take the above mentioned Basra Children’s Hospital. According to CorpWatch:

(all emphasis is mine)

Cancer Hospital Remains Unfinished

Most prominent among the long list of failures is the Basra Children’s Hospital, which was intended as crown jewel of U.S. aid to Iraq. Instead, it has become a showcase for everything that went wrong. In August 2004, USAID awarded the $50 million contract to build the Hospital to Bechtel, a San Francisco-based engineering company, one of the largest engineering companies in the world, which has become synonymous with the building of nuclear power plants, gold mines and large projects like the new Hong Kong airport.

The idea was to create a state-of-the-art facility to treat childhood cancer, a pressing need in a city where cancer rates have skyrocketed following the first Gulf War. (Contested data link the rise in cancer to extensive U.S. use of depleted uranium weaponry in the region.)

The facility, championed by the First Lady Laura Bush and Secretary of State Condoleezza Rice, looked suspiciously like a political propaganda effort. And as with much U.S. aid, it was designed with little local consultation: the city lacked clean water and already has a leukemia ward where lack of funding means that each bed is shared by two or three children.

The hospital was planned by Project Hope, a charity headed by John P. Howe III, president of the University of Texas, San Antonio, and a Bush family friend. Project Hope had built similar hospitals in Poland and in China. Howe pushed the project after Rice and Bush invited him to visit Iraq to assess the country’s healthcare system.

Before construction began in August 2005, the project attracted skeptics, who were concerned that it was a white elephant. Republican Congressman Jim Kolbe criticized the project: “Why build a hospital for kids, when the kids have no clean water?” the Arizonan asked. But it went ahead: No new technology would be spared in this showcase facility featuring with 94 beds, private cancer suites, CAT scans, a linear particle accelerator for radiation therapy, no.

But like every so many U.S.-initiated projects, the money to build this fancy facility would disappear when things went wrong. A year after the August 2005 groundbreaking, the project became a target for attacks, according to the company. The price tag rose from $50 million to an estimated $169.5 million. Cliff Mumm, president of the Bechtel infrastructure division, predicted that the project would fail. “It is not a good use of the government’s money” to try to finish the project,” Mumm told the New York Times. “And we do not think it can be finished.”

In July 2006, Bechtel was asked to withdrew from the project, which is now on hold. USAID spokesman David Snider’s cheerful spin on the stall was that the contract did not actually require the company to complete the hospital. “They are under a ‘term contract,’ which means their job is over when their money ends … (so) they did complete the contract.”

So Bechtel got to keep the money – U.S. taxpayer’s money – and the hospital is “on hold”. Because corporate profits are way more important than sick children.

Lets take another contractor: Parsons Global, a Pasadena, California-based engineering company.

The convoy of flat-bed trucks picked up its cargo at Baghdad International Airport last spring and sped north-west, stacked-high with crates of expensive medical equipment. From bilirubinmeters and hematology analyzers to infant incubators and dental appliances, the equipment had been ordered to help Iraq shore up a disintegrating health care system. But instead of being delivered to 150 brand-new Primary Health Care centers (PHCs) as originally planned, the Eagle Global Logistics vehicles were directed to drop them off at a storage warehouse in Abu Ghraib.

Not only did some of the equipment arrive damaged at the warehouse owned by PWC of Kuwait, one in 14 crates was missing, according to the delivery documents. The shipment was fairly typical: Military auditors would later calculate that roughly 46 percent of some $70 million in medical equipment deliveries made to the Abu Ghraib warehouse last spring had missing or damaged crates or contained boxes that were mislabeled or not labeled at all.

Not that it really mattered. Just over three weeks before the April 27th delivery, the U.S. Army Corps of Engineers had canceled the construction of 130 of the 150 PHCs for which the materiel was intended. As a result, the equipment that could help diagnose and treat Iraqi illness (and escalating bomb or gun injuries) now sits idle waiting for someone to figure out what to do with it.

[…]But if Iraqis have failed to benefit from the idle PHCs, the $70 million contract to supply them has been a shot in the arm for Parsons Global. The Pasadena, California-based engineering company reaped a $3.3 million profit according to an audit report issued by the Special Inspector General for Iraq Reconstruction (SIGIR), an independent U.S. government agency. And that is in addition to the $186 million that U.S. taxpayers shelled out to Parsons to build dozens of clinics that have yet to dispense a single aspirin.

Again, go read the entire article here. There is much to discuss, so feel free to comment away. Is it any wonder why Iraqis want us out of Iraq?