Some doctors are struggling with allowing Canadians to die on their own terms.
Here I share a powerful article by Krista Stevens.
Some doctors are struggling with allowing Canadians to die on their own terms.
Here I share a powerful article by Krista Stevens.
Round 2. Ding Ding.
The 2017 Scottish Crucible’s second lab was graciously hosted by Stirling University on June 1-2 and it rocked the campus. Literally. There was a blue man. A dinosaur. Drawing. Dancing. Sumptuous vistas. Oh yeah, there was a pretty nice castle too!
It began with this view.
Lab 2 was hosted by the irrepressible and commanding Sara Shinton. Honestly, sometimes the participants needed direction as they learnt the ins and outs of ‘brainstorming.’
(Or, as some of us called it: ‘thought-showering.’) No surprise, the phrase didn’t stick.
The thrust of Lab 2 was collaboration. We were enveloped in a cozy bubble, as Sara rightly put it.
How to work together! How to build lasting research partnerships to influence positive change! How to cut across fields and disciplines! The guest speakers were insipiring.
Being a drug historian, I have some thoughts about the tweet below but I’ll keep them to myself.
Chalk this up to aggressive dancing!
Day 2 included further in-depth training on how to develop and drive collaboration.
To start off with, we needed to draw out our research. No easy task.
However, there were other appearances.
For instance, a creepily self-satisfied Dragon…
An introspective blue dude…
But. But. But.
In my estimation, the most exhausting and rewarding of the weekend was…speed collaboration. Think speed dating, on steroids. (I am a drug historian).
The experience was supremely enjoyable. Also: Tiring. Amazing. Harrowing. Enriching. All of these. At the same time.
Minds were spinning.
Ding Ding. Bring on Round 3.
See the previous post on the Lab 1 here.
Or visit the Scottish Crucible here.
Apparently, I missed some yoga trends in my most recent post. There are others.
For example: beer yoga.
Beer Yoga is yoga…with, yes, beer. German yogis BierYoga are reportedly the major first innovators, offering classes and workshops after seeing it being taught at the Burning Man festival. Since January, the idea’s spread internationally. Here are two recent articles on beer yoga.
Then there’s Kilted Yoga, which is pretty self-explanatory.
Thanks to Maaike de Vries for pointing these out.
Health and fitness trends evolve. Technology and imperatives in business force change. Consumers in health want fresh ideas and products. From Tae Boe to Thighmasters. From Bowflex to Bodyblade and belt massagers. Yoga is no different.
Yoga is becoming increasingly popular in the United States. About 37 million Americans practiced yoga at the beginning of 2016 and more than 80 million Americans were likely to try yoga at some point in the year, according to a study in Yoga Journal.
With all these potential pupils, teachers innovate. They employ new techniques and tricks. They use props and blend practices. Here are some examples in 2017.
Say what you will about these types of yoga, they’re coming your way. (That is, if they haven’t already!)
Yoga Retreats & Vacations
From the Guardian newspaper. “You can’t move for downward dog opportunities these days. The explosion of yoga in western countries means there’s a studio on every other street and such a variety of styles and options, that choosing a holiday or retreat can be overwhelming. So where to start? It makes sense to try a weekend away before committing to a whole week. One possibility is to choose a teacher you know or like the sound of and see if they’re running anything that suits. Or you could pick a venue you fancy and see what teachers are hosting holidays there. Think about what you want too – some combine yoga with other activities (maybe good for those with non-yogi partners), some are vegan, some don’t ban booze – it’s always worth asking before you book.”
Here, mobile yoga studio have modified so that the “studio” travels to where the people may be…at work, shopping, at play, in the community. Yoga apps brings teachers right to your home!
From the New York Times: “Soul Stretch Mobile Yoga is a novel concept to the Cleveland area,” explains Rose Sabin, co-owner of the company with her daughter-in-law, Natalie Sabin. The mobile studio concept has worked well in other cities, “like Los Angeles, New York, Chicago” according to Sabin, “but this is Cleveland’s first mobile yoga studio.” Sabin’s goal for the company is two-fold: first, to bring yoga to the people by making it accessible and secondly, to help promote local businesses by bringing the unique offering of yoga class to a community business. As an advertising agency owner, Sabin understands all aspects of running a small business like certifications, insurance and marketing. She would like to help other business owners by allowing them to offer her company’s services and “expose more people to the beautiful, healing therapy of yoga.”
Recommended apps, courtesy of Healthline:
Live Music Yoga
Pretty straightforward. Here’s an example.
Yoga Therapy, according to the British Council for Yoga Therapy, is the use of Yoga where there is a specific health need or needs. It is framed this way:
“Yoga Therapy uses the tools that you would find in many Yoga classes; postures, working with the breath, meditation, awareness of the body and/or mind, relaxation, and these are directed to the needs and ability of the person concerned. The aim is to promote good health for the person as a whole – the emphasis of this work may be towards the body, the mind, the emotions or a combination of these. A health problem may be primarily in one of these aspects, for example, back pain caused by poor posture. Yoga Therapy would then focus on working with the body and Yoga postures. If the back pain is exacerbated by stress, then including Yoga to help calm the mind, for example breathing techniques, will be very useful too. Our health is a dynamic combination of body and mind. Long term physical conditions are commmonly associated with depression and a variety of feelings – sadness, loss, frustration, anger. Our emotional health affects our physical health too, although this is difficult to quantify. Yoga can bring us awareness of the body and mind; and more understanding of how to help the body, emotions or patterns of thinking and provides a practical approach to developing a positive state of health.”
For Georg Feuerstein in the Huffington Post, “Yoga therapy is of modern coinage and represents a first effort to integrate traditional yogic concepts and techniques with Western medical and psychological knowledge.”
According to the official website of AcroYoga, “it is a beautiful blend of ‘the wisdom of yoga, the dynamic power of acrobatics and the loving kindness of Thai massage’.” It was founded by Jenny Sauer-Klein and Jason Nemer in 2003. The 3 main aspects of this form of yoga are trust, playfulness and a sense of community. Acro Yoga constitutes 3 elements: the Solar Acrobatic Practice, the Lunar Healing Arts, and the Yogic Practices.
There are several benefits as described on Stylecraze.com, including:
What does 2018 hold?
That makes a lot of sense. Have you seen a change in which styles of yoga have been more popular over the years? I can’t necessarily track it through the decades, but I would say that vinyasa is more of a recent trend. Historically I think it was more Iyengar, more of that traditional track. What I’m seeing rising in popularity now is definitely the more restorative classes, like Yin. Part of that is because people are recognizing the greater benefits. There’s been a lot of research on what restorative can do for you beyond just stress relief. I’m also seeing a rise in the popularity of Kundalini...I think it’s really interesting and not necessarily what I would have anticipated.
Maybe a reaction to the it’s-all-about-sweat set. How do you feel about the crazy amount of commercialization around yoga in the past few years? Is it good or bad for yoga? Honestly, we get overwhelmed by the number of new products out there, and it’s hard to determine what’s good and what’s worth your dollars. And what’s so awesome about yoga is you really don’t need much to do it. It’s “have mat, will practice” pretty much. All the other stuff can be great and fun but is maybe not necessary. We hear all different opinions—some people really want to know what the best new yoga pant is and then some don’t, they just want to stick to the practice and be more traditional about it. I think it probably does get more people on the mat, though, and that’s a good thing.
Have a Fitbit? Do you pound the pavement? Hit the road? Do you do it for body? Or mind? Likely both!
In January 2017, psychotherapist William Pullen published a new book, Run For Your Life. It’s an interesting read.
Here’s a description of the work:
“Anyone who has ever gone for a run, jog or even a walk knows that uplifting, happy feeling they get at the end of their journey. Some call it the ‘runner’s high’, others put it down to endorphins, here William Pullen teaches us focus that incredible energy to experience our emotions in motion.
“In Run for Your Life, Pullen argues that we need a radical new approach to mindfulness – an approach which originates in the body itself. DRT offers just that.
“Whether the you are looking for strategies to cope with anxiety, anger, change, or decision-making, Run for Your Life offers carefully-tailored thought exercises (and talking therapies for pairs or groups) inspired by mindfulness and Cognitive Behavioural Therapy, specifically designed to be implemented whilst on a run or walk. The book is designed to offer space for you to reflect on your practice and see your progress as you run through life’s ups and downs.”
It immediately made me think of the first (silly) article I wrote as a PhD student in London.
(Man, it’s funny to recognize that eleven years have elapsed since the publication of the article above!)
The idea then was that running might alleviate some of the PhD blues. But Pullen has taken it to a whole new (and more) comprehensive level. His book is definitely worth a read.
How will the pharmaceutical industry be impacted under the Trump administration? Who’s the new FDA Commissioner? How will e-cigarettes be effected? How will the opioid crisis be impacted?
Trump’s FDA and “the United States of Oxy”
By Lucas Richert
The US Food and Drug Administration (FDA) may be headed for a major overhaul under the Trump presidency and the agency’s new head, Scott Gottlieb. At a recent meeting with pharmaceutical industry leaders, President Trump asserted that “we’re going to be cutting regulations at a level that nobody’s ever seen before.” His most recent statements, made at a White House confab, echoed loudly throughout the medical and pharmaceutical industries.
Just talk? It’s tough to say, yet supporters of pharmaceutical deregulation have long wanted to reduce bureaucracy and lessen oversight of drugs and devices. Critics, by contrast, contend the drugs market could be destabilized and public health undermined. The tricky task will be to strike the proper balance of speed and safety, as well product innovation and consumer protections.
Scott Gottlieb, a physician and regulator recently approved to lead the agency by the US Senate in a 57-42 vote, pledged he would lower prices, reduce approval times, and fight the widespread abuse of opioid painkillers. This kind of addiction, said Gottlieb, was “a public health crisis of staggering human and economic proportion.”
This rhetoric and attempted reforms at FDA are not new, but the devastating painkiller crisis certainly is.
Gottlieb’s critics noted that he was too closely tied with the pharmaceutical industry to tackle the opioid epidemic. “We are suffering this public health epidemic because big pharma pushed pills they knew were dangerous and addictive, the FDA approved them, Senator Ed Markey (D-Mass) told reporters. The United States had been turned into the “United States of Oxy,” Markey added.
The FDA approved OxyContin, a powerful opioid to treat severe pain, such as in the case of patients with terminal cancer. With mild pain, though, the FDA deemed the dangers of addiction too great, and has not allowed the marketing of Oxy for such pain.
Not able to solve the opioid alone, the FDA nonetheless will play an important role. He has made this case quite forcefully. However, Gottlieb’s critics (mainly Democrats) have pointed to his past views on the regulation of opioids. In particular, he has suggested that policies restricting pharmacies and drug distributors might burden innocent patients.
This will be one of the defining issues of his career.
The Food and Drug Administration’s move in May, 2016 to crack down on e-cigarettes brought regulation in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This had been highly anticipated after the FDA issued a proposed rule over two years ago.
“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell stated during the announcement of the new rules. She asserted, too, that health officials still didn’t have the scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and avoid the known ills of tobacco.
The Trump administration recently approved a delay in the FDA’s e-cigs guidelines. It was a decision that divided officials in the public health establishment. And it’s undoubtedly true that several Trump administration officials, including FDA chief Gottlieb, have connections to the e-cig and tobacco industry.
From March 2015 to May 2016, according to Bloomberg, Gottlieb was a director of Kure Corp., a Charlotte, North Carolina-based firm that distributes e-juices and vaping pens in coffeehouse-style lounges known as vaporiums. Of course, he had a financial interest in the company as of March, according to financial and ethics disclosures, and promised to sell his stake if confirmed as head of the FDA.
“How to regulate e-cigarettes is one of the most critical questions on tobacco regulation that the FDA is going to be facing in the coming years,’’ said Vince Willmore, a spokesman for Washington-based Campaign for Tobacco-Free Kids.
Vaping will also be a significant issue for Gottlieb and the FDA. Getting the regulation right matters – not just in the U.S., but places like Glasgow and Vancouver.
FOR MORE ON E-CIGARETTES:
The writer Matthew Herper suggested recently how “talk of speeding up [drug] approvals for serious diseases first gained traction in the early 2000s.” Actually, the trend extends much further back. Debate about quickening drug approvals has a complex and compelling history.
The FDA under President Ronald Reagan, for instance, offers a useful tool to evaluate the Trump administration’s approach to the FDA and the drug industry.
In mid-January, as Mr. Trump awaited his inauguration and the transition team worked furiously to establish his cabinet and select suitable agency nominees, the FDA generated serious debate. Trump met with Jim O’Neill, a venture capitalist, and a close friend of PayPal’s Peter Thiel. He met with Balaji Srinivasan, a cofounder of genetics testing firm Counsyl.
Both men subscribed to the idea – now conservative doctrine, according to Forbes – that the FDA prevented a flood of new drugs from hitting the market. Neither held an M.D., which has been for years a prerequisite for the FDA’s top job. Yet, by 20 January the frontrunner for the Commissioner’s job was Gottlieb, who had made it known publicly he believed the FDA should trim bureaucratic red tape and approve drugs in a speedier fashion.
Trump ultimately settled on Gottlieb, whose selection was welcomed by the pharmaceuticals sector. His ties to industry were questioned by Democrats, but the vote wasn’t close.
The Gipper’s FDA
Ronald Reagan, whether as a candidate or later President of the United States, did not desire the dismantling of the FDA, but neither did he trust it. In his optimistic view, its authority, like that of many other regulatory agencies, simply needed curtailing.
In 1975, he told an audience at the American Enterprise Institute, a conservative think tank, that the FDA was hurting Americans, yet also made clear he did not wish to totally “eliminate the responsibility of the FDA…”
The problem, as Reagan saw it, rested in the restriction of freedom of choice for American consumers, since the agency had established itself “as the doctor and decided that they will tell us what medicines are effective.” He felt that a degree of regulation was necessary to protect Americans from each other, but the FDA had overreached and, as bureaucracies do, went beyond “protecting us from poisonous or harmful substances…”
In 1980, the Republican presidential ticket of Ronald Reagan and George Bush promised to change Washington. President Jimmy Carter represented failure, Republicans argued, be it botched rescue attempts and helicopter crashes in the desert, the loss of the Panama Canal, or an impotent economy. The jaunty and upbeat Reagan succeeded in shifting the policy discourse about the size and scope of federal government programs; harkening back to halcyon days, he moved the conversation about which government program to launch (or expand) to how much of a program’s or agency’s budget ought to be cut.
In 1981, the debate about drug regulation continued to polarize people; finding a middle ground was often difficult, and as the new administration took power, the outgoing FDA Commissioner Goyan articulated a consensus-oriented, centrist approach to drug regulation. Think tanks such as the Heritage Foundation and American Enterprise Institute promulgated changes to the FDA’s mission as a means of unleashing the once-mighty American pharmaceutical industry. This would fuel the U.S. industry and the greater economy.
For some, the FDA transcended presidential politics and ideology. It protected all Americans – conservative and liberal – as it carried out its duties. “My view,” said the bearded, grey, and somewhat feisty Jere Goyan, “is that government regulation needs to strike a balance between preserving the maximum freedom for individuals while at the same time establishing the rules that are needed for us to live together, to survive as a society.”
By voting for Reagan, Americans indicated they wanted “modifications” to the current models – reform rather than removal. “It would be a mistake,” Goyan argued, “a tragic one, to interpret the election results to mean that the public wants a lessening of the standards that provide the foundation for the food and drug industries in this country, standards that make our food and drug supply the best in the world.”
Often, his approach went unheeded, overwhelmed by disputes about individualism and consumer choice and bureaucratic incompetence. One the one hand, many Americans regarded FDA staff members “as a bunch of demented bureaucrats running amok,” even though the agency’s “balanced” regulation of drugs was both “socially valid and moral.”
On the other hand, the president of the Pharmaceutical Manufacturers Association illustrated an alternative. Lewis Engman felt that taking medicines, like smoking cigarettes, was a matter of personal choice. “Any time you interfere with the basic market system,” he said in 1981, “you’re in trouble…the consumer is his own best guardian.”
Impossible as it was to know how the new president would transform the FDA in early 1981, political pundits, economic analysts and pharmaceutical industry insiders suggested that Reagan meant less regulation, which meant industry growth. The President of the National Association of Retail Druggists (NARD), Jesse M. Pike, sent a congratulatory letter to Reagan. It emphasized how delighted NARD was to see him in the White House and just how his regulatory reform beliefs would be good for business. In Pharmaceutical Technology, James Dickinson wrote, “everyone expects life to be easier for industry under the new Reagan Administration.”
Apparently, the Washington cocktail circuit was rife with speculation about the new administration repealing the Kefauver-Harris 1962 drug efficacy requirements – a move that would further enhance prospects for industry growth. This was nonsense, according to knowledgeable policymakers and reporters. Still, the fact that the notion was even bandied about, however fancifully, represented a substantial change in the debate about drug regulation.
The press envisaged a pharmaceutical industry boom in the near future. Newspapers reported how “The Drug Business Sees a Golden Era Ahead” and that pharmaceutical associations were positively giddy. Rep. James Scheuer (D-NY) publicly denounced the agency’s over-cautiousness and emphasized the need for immediate reform. It was risk averse, to the detriment of sick Americans. Moxalactum, he argued, was an American-made antibiotic for pneumonia used by Marshal Tito in Yugoslavia – yet it was not available in the United States. The narrative Scheuer framed was that the FDA was protecting Americans to death – and this before the onset of the HIV/AIDS crisis.
Mounting enthusiasm about pharmaceutical growth in the wake of the Reagan election was palpable. Reports indicated that the pharmaceutical industry and investors were confident about the future – a golden era – in this new regulatory climate. There was bullishness about drug stocks in general, and many predictions that pharmaceutical companies would start to generate more and more earning in 1981 and 1982. Overall, these stories proved to be accurate.
Ronald Reagan, however, had pledged in 1980, with trademark sincerity, not to gut the FDA. Rather, he made oblique references to the agency’s storied history and resorted to prosaic comments about the danger of hidebound power-hungry bureaucracies. “There’s a certain amount of regulation that is always necessary to protect us from each other,” he told CBS’s Walter Cronkite. “And that I recognize. We don’t want to, for example, eliminate the responsibility of the FDA…”
Much can be gleaned from Reagan’s public statements about the Food and Drug Administration, but they fail to reveal the entire picture. On May 20, 1986, Reagan described a meeting between Paul Laxalt, Jack Dreyfus, and himself. Dreyfus, who had “spent $50 mil. of his own money” was attempting to have the epilepsy drug Dilantin approved and found a roadblock in the form of the FDA. According to Reagan’s personal diary: “The villain in the case is the Fed. Drug Admin & they are a villain.”
Red Herrings and Empowered Patients
Under the Trump administration, will the FDA play the villain role? President Trump will build on earlier Republican efforts to streamline the agency, whether these took place during Reagan or Bush presidencies. He has promised to remove barriers for overseas drugs and support ‘Right to Try’ laws, which will attempt to provide access to unapproved drugs. Indeed, some of these measures may help patients. And the Trump administration will be the right track if it can safely accelerate drug approvals, promote production and use of generics, and lower drug prices through increased competition.
Gottlieb and others have suggested they would radically restructure the drug approval process – even if that remains something of a red herring argument. QuintilesIMS Institute, among various other organizations, have determined that the total time between patent and approval has dropped 31% since 2008. Yale researchers hold that the FDA is already considerably faster than Europe and Canada when it comes to approving drugs.
Another area of regulation that ought to be monitored closely is advertising. Every other nation besides the US and New Zealand has concluded that advertising powerful drugs for treating complex illnesses makes no sense when your target market lacks the qualifications to fully grasp the risks. How will powerful painkillers be regulated in the years ahead.
The drug industry wants to empower patients, to invest them in the writing of prescriptions. Looking ahead, it will be important to watch the administration’s and FDA’s role in faciliating this.
FOR MORE ON PATIENT ACTIVISM
“The [industry] idea is that consumers are central players in their health management and therefore have a right to be informed of different drugs,” Lewis Grossman, a specialist in food and drug law, told the Los Angeles Times.
Yet, the practice of medicine should not be placed in the hands of amateurs and junk scientists. In the post-truth era, however, when an opioid epidemic soars and drug prices are hitting Americans in the pocketbooks, these “facts” could be lost in the noise.
Thanks for reading. For more, please follow the blog.
Lucas Richert is a Lecturer in History at the University of Strathclyde (Glasgow, UK). He is the author of Conservatism, Consumer Choice, and the Food and Drug Administration during the Reagan Era. He’s currently at work on a second book, tentatively called Strange Medicines: Drugs, Science, and Big Pharma in Culture.
An excellent post about science and comic books.
Since the re-emergence of science in Europe in the High Middle Ages down to the present the relationship between science and religion has been a very complex and multifaceted one that cannot be reduced to a simple formula or a handful of clichés. Many of the practitioners, who produced that science, were themselves active servants of their respective churches and many of their colleagues, whilst not clerics, were devoted believers and deeply religious. On they other had there were those within the various church communities, who were deeply suspicious of or even openly hostile to the newly won scientific knowledge that they saw as a threat to their beliefs. Over the centuries positions changed constantly and oft radically and any historian, who wishes to investigate and understand that relationship at any particular time or in any given period needs to tread very carefully and above all not to approach their…
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I just got back from Lab 1 of the Scottish Crucible. How to sum it up? So many ridiculously talented, clever, incredible people. From fish lice to fractals, to potato pathogens and Palimpsest. From diamond-based sensing to drug discovery, and so much more. Tsunamis and electric airplanes. Big data and biotransformations. Lasers and Norse poetry. And this doesn’t even cover half of it. These two days were mind-blowing, and I’m still reeling. What a privilege!
Special thanks to Vivenne Parry OBE, Dr Vicky Ingram, Dr Ruth Neiland, and Prof Alan Miller.
As I’m a story-teller (well, historian), what follows is a brief snapshot in Tweets.
Editors: Professor Matthew Smith and Dr Lucas Richert (University of Strathclyde, UK)
This article collection will examine how the relationship between socioeconomic factors and mental health has been and is understood in an array of different places and periods. Although much of the focus of current mental health research and clinical practice is on the neurological aspects of mental illness and psychopharmacological treatment, historical research demonstrates that a wide range of factors — from vitamin deficiencies such as pellagra, and infections such as syphilis to traumatic life events — have contributed to the onset and exacerbation of mental health problems. Among all these factors, one looms largest: socioeconomic status. On the one hand, socioeconomic inequality has been long recognised as a potential cause of mental illness, as the history of mental hygiene and social psychiatry during much of the twentieth century demonstrates. On the other hand, however, the mentally ill have also historically faced much socioeconomic hardship; today, a high proportion of the homeless and incarcerated in many countries suffer from mental illness.
By exploring this topic across time and place, this collection aims to provide a historical context for today’s mental health crisis, and also to inform current mental health policy, especially attempts to prevent or alleviate mental illness through social change.
Insights on a broad spectrum of themes are welcomed, including, but not restricted to
This is a rolling article collection and as such proposals and submissions will be welcome throughout 2017. However, full submissions received by November 1 will be considered for publication as part of the collection’s formal launch in 2018.
Please do think about submitting.
From the NIH. A post by Professor Erika Dyck on the history of LSD.
Circulating Now welcomes guest blogger Erika Dyck, PhD, Professor and Canada Research Chair in the History of Medicine at the University of Saskatchewan. Today, Dr. Dyck shares some insights on a recently digitized film in the Library’s collection highlighted in our Medical Movies on the Web project.
It’s the late 1960s. Teenagers, a hip voice clues us in, are always looking for kicks, and today’s teens express themselves with cool fashions, groovy hairstyles, and kooky pranks. Not so long ago, our narrator played the character of “Plato,” a troubled teenager, in the 1955 classic Rebel Without a Cause. In that film, Plato idolizes the reckless machismo of young Jim Stark (played by James Dean). In an epic display of bravado, Jim and another boy play a game of “chickie run” in which they drive their cars in parallel directly toward a cliff. Jim leaps…
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