According to the New England Journal of Medicine, after thirty years of silence, authors of a standard clinical psychiatric bedside test have issued take down orders of new medical research. Doctors who use copies of the bedside test which will have been printed in some of their oldest medical textbooks are liable to be sued for up to $150,000. The New England Journal of Medicine makes the stark comparison that “Google, Apple, Facebook, and Twitter all use open-source software at the heart of their products” yet when it comes to medicine, developments are very often, very far from open-source. This case demonstrates the tragic state of affairs that even the ghosts of positively ancient abandoned copyrights for the very simplest of ideas can be used to block new medical work through legal bullying. The basic nature of the information that is protected in this case only begins to illustrate the harm that is really possible when even more powerful and innovative ideas are placed under lock and key for the rest of living memory.
“For three decades after its publication, in 1975, the Mini–Mental State Examination (MMSE) was widely distributed in textbooks, pocket guides, and Web sites and memorized by countless residents and medical students…
New England Journal of Medicine (29/12/2011)
The test which is the “evaluation of choice for most general doctors” now requires a payment of $1.23 per copy which is likely to prevent it’s use in both teaching and clinical settings. More worryingly still, a new 16 item test known as the “sweet 16″ developed at Harvard that is based on the original 30 item screening test has been taken down due to legal orders.
“This action, unprecedented for a bedside clinical assessment tool, has sent a chill through the academic community”
New England Journal of Medicine (29/12/2011)
This news is highly relevant in light of the ongoing SOPA scandal that is currently threatening the internet as we know it. Many fail to realise that copyright is valid 70 years after the death of the author and up to 120 years after the creation of the work. The use of copyright law to prevent the clinical use of medical tests and to prevent new medical tests being developed is something many of us would only expect to really happen in dystopian fiction. The fact of the matter is that it is happening in real life.
Newman, J., & Feldman, R. (2011). Copyright and Open Access at the Bedside New England Journal of Medicine, 365 (26), 2447-2449 DOI: 10.1056/NEJMp1110652
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Full Disclosure: A study published last month discovered that the inclusion of the word “love” in appeals for donations doubled the numbers of donations. This post is somewhat of a benevolant experiment, please do say if you think the use of the word love above led you to donate (you won’t get a refund, I would just be chuffed to find out). If you experience hoards of student fundraisers in the streets this Christmas telling you that they love you, now you know why! (Wow, now I feel like a right old Scrooge for letting that slip, so why not humour me, share the love and give a present this christmas to someone who needs it).
Guéguen, N., & Lamy, L. (2011). The effect of the word “love” on compliance to a request for humanitarian aid: An evaluation in a field setting Social Influence, 6 (4), 249-258 DOI: 10.1080/15534510.2011.627771 (PDF)
NB: Due to how the ONS report drug related deaths “tobacco deaths” include only deaths registered in England (not Scotland, Wales and Northern Ireland), while “alcohol deaths” include deaths from the whole of the UK. All other drug related deaths include deaths registered in England and Wales. There are also key differences in the way alcohol and tobacco related deaths are recorded when compared to other types of drug related deaths that suggest the numbers for alcohol and tobacco related deaths should be greater still (see footnote). Lodge your complaint to the ONS for failing to make all types of drug deaths comparable.
Below is a roundup of this year’s drugs news along with the latest available statistical data. All sources are open-access and are listed at the bottom of the page.
- The graph below shows the distribution of drug related deaths registered in the UK according to the Office of National Statistics.
- The stats fit in accurately with the Independent Scientific Committee on Drugs conclusion published in the Lancet last year that most popular illegal drugs are generally far safer than the big two legal drugs.
- The numbers fall drastically if you remove deaths involving poly-drug use.
- Excluding deaths caused by polydrug use shows that almost all deaths reported as mephedrone deaths, cannabis deaths and ecstasy deaths were misreported in the media. Most were caused by other drugs or mixing with other drugs (such as alcohol). The data in fact shows that there have only ever been two deaths in the UK solely caused by mephedrone (both last year). There were in fact only five deaths solely related to ecstasy and two deaths solely related to cannabis. This compares to 98 deaths solely caused by paracetamol and 157 deaths solely caused by antidepressants. The major insight from this data is that it is very often dangerous to mix your drugs and it is particularly dangerous to mix drugs with alcohol.
This compares to 81,400 tobacco deaths and 8,644 alcohol deaths last year. The ONS records alcohol and tobacco deaths differently from “drug deaths” so suicides and deaths such as road traffic accidents while under the influence aren’t actually included in the alcohol death statistics but they are included in the drug death statistics making the real disparity even wider than is apparent here (more on this in the footnote).
- According to the ONS data, in 2010 there were more helium deaths than cannabis, ecstasy, mephedrone and GHB related deaths combined. Helium is an inert gas which kills when people use helium to deprive themselves of oxygen. The recent explosion in helium deaths from under two per year until 2008 to 32 last year appears to be due to it’s recent promotion as a form of suicide.
- In 2010 deaths involving cocaine, amphetamines and ecstasy dropped significantly, repeating the previous year’s abrupt downturn following a steep upwards path for ten years.
Evidence from the military suggests this was the direct effect of the exploding UK mephedrone market. The background to this is a year on year rise in military cocaine detection since 2000 followed by a 50% drop in cocaine detection in the military in 2008 which continued through 2009. Mephedrone was banned in the summer of 2010 due to a moral outcry in the tabloids. If we infer that the mephedrone boom was the reason for the fall in illegal drugs deaths last year then we should prepare to see a rise in cocaine, amphetamine and ecstasy deaths this year perhaps returning to pre-mephedrone levels by 2013.
- In November one study (PDF) in the North West of England reported on the increasing “indiscriminate use” of “unidentified white powders” described as “bubble” overtaking mainstream drugs in popularity.
It found that self reported use of “bubble” was higher than for mephedrone or amphetamines. 18% of people asked reported having taken “bubble”, amphetamine use in the past month crashed to 3% compared to 9% for bubble. “Survey respondents were not only unclear about, but also apparently unconcerned about the speciﬁc chemical identity of the stimulant white powders they consume”… “a considerable number of respondents were adamant that they had never heard of mephedrone but that they had taken Bubble”.
- In July, the tragic death of Amy Winehouse shocked the world, largely because the cause of death was an overdose of alcohol rather than of the illegal drugs she was infamous for indulging in.
- In August the UK experienced the worst rioting in our history. The reasons for the riots were undoubtedly complex but there is little doubt that drug laws played a part.
According to DOH statistics the proportion of young people that have used drugs is 44.1%. There are 11,728 people currently jailed in the UK for drug offences and a prison sentence is still the most common outcome for someone convicted of drug dealing. In the past year 228,425 people were convicted of possession of a drug and 39,966 were convicted of dealing.
Drugs are second only to “violence against the person” as the primary reason for imprisonment in the UK. According to the MOJ riot statistics 10% of those convicted of taking part in the riots had a previous drug conviction, this compares to 3.6% who were previously convicted of robbery, 5% previously convicted of burglary and 6% previously convicted for violent offences. The UK’s drug laws have criminalised a significant proportion of our society, resulting in millions of people who are permanently unable to find employment and seem to think they have nothing more to gain from being a part of society. In the UK you are 6 times more likely to be arrested for drug offences if you are black, and you’re also 11 times more likely to be imprisoned despite there being no difference in levels of drug use between races. The enforcement of the drug laws may be the foundation of the adversarial attitude taken by a large proportion of people in the UK towards the police.
- In October we witnessed the sad death of Steve Jobs, known for his ground-breaking innovations at Apple computers. He famously described LSD as being “one of the two or three most important things he has done in his life.”
- Have you ever wondered whether the old urban myth that one in five bank notes has traces of cocaine on it is true? This month the police answered that question. The proportion of bank notes with cocaine on them has risen to 11% (up from 4% in 2005).
- A massive longitudinal study last month found that intelligent people are far more likely to take drugs including cocaine, cannabis, ecstasy, amphetamines and magic mushrooms. IQ scores were recorded at the age of five years old, drug use was recorded at the ages of fifteen and thirty.
“The odds of cannabis use were threefold higher for boys and 4.6-fold higher for girls in the top third compared to the bottom third”
- Also this year there have been a number of huge international reports calling for an end to the war on drugs. The Global Commission on Drugs formed by former presidents and experts delivered a resolute conclusion:
“End the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others. Challenge rather than reinforce common misconceptions about drug markets, drug use and drug dependence.” (PDF) The same resolution was handed out in a letter signed by over sixty world leaders, professors, doctors, MP’s and public figures.
- Last year 7283 tonnes of cannabis was seized worldwide.
- Last year 42 new drugs were detected in circulation.
- Finally, in December the Australian government released data demonstrating that 80% of searches conducted after a dog sat next to a person found nothing.
In 2006 the ONS adjusted their methods for recording alcohol related deaths (but not drug deaths) to “only includes deaths where the cause is specifically related to alcohol consumption and is also the underlying or main cause of death”…. “apart from deaths due to accidental poisoning with alcohol, the definition excludes any other external causes, such as road traffic deaths and other accidents, and suicides and homicides where alcohol may have played a role in the circumstances leading to death. The definition also does not include any proportions of causes where alcohol has been shown to have some causal link.”
Deaths related to drug poisoning as reported by the ONS also include amongst other factors “deaths related to mental and behavioural disorders due to drug use” and “intentional self-poisoning by drugs”
Nutt, D., King, L., & Phillips, L. (2010). Drug harms in the UK: a multicriteria decision analysis The Lancet, 376 (9752), 1558-1565 DOI: 10.1016/S0140-6736(10)61462-6
Measham,F. Moore, K. Østergaard, J. (2011). Mephedrone, ‘‘Bubble’’ and unidentiﬁed white powders: the contested identities of synthetic ‘‘legal highs” DRUGS AND ALCOHOL TODAY, 11, 137-146 (PDF)
Editorial team (2010). The EMCDDA annual report 2010: the state of the drugs problem in Europe. The European Monitoring Centre for Drugs and Drug Addiction, also published in Euro surveillance :European communicable disease bulletin, 15 (46) PMID: 21144426 (PDF)
Update (01/02/2012): Both Science and Nature have agreed to redact the papers.
The journals Nature and Science have this week been drawn in to conflict with the US government. The US National Science Advisory Board for Biosecurity has asked the journals to redact studies by two research groups who have created a new form of H5N1. The artificial strain can be spread between ferrets – typically a sign that the virus could spread between humans. The journals are objecting to the request, arguing that the information is valuable for public health.
The debate is set to be a ferociously contested one, with strong arguments on both sides and the legal territory completely without precedent. With one of the labs based in Rotterdam and one of the labs based in Wisconsin the question of jurisdiction is significant. The case made by the journals is that the mutated H5N1 virus could be used to create a vaccine. The paper would allow thousands of research labs around the world to work towards creating a vaccine for the virus. Scientists are predicting that the virus is likely to mutate soon without assistance so it is argued that the more people that are working on a vaccine the better.
Over 500 people have now been infected with H5N1 and 60% of those infected have died. The only reason we have not already witnessed a pandemic is that currently the virus can only be spread between birds. Birds can infect humans but the virus cannot currently be passed on to another human. This state of affairs will inevitably come to an end in the future when the virus mutates naturally. The argument is that when the virus mutates we will need to have a vaccine already made otherwise we will witness deaths of biblical proportions. There may be little time to waste, only yesterday in Hong Kong, 17,000 chickens were killed and a 21 day ban on poultry trading was enforced after a bird was found to be infected.
The research could however be a double edged sword. The strain that has been created is potentially a weaponised virus and the US government is likely to do everything in its power to prevent this research getting in to the wrong hands. Publishing the documents introduces the risk of the mutated version being released by a rogue lab. On the other hand restricting the research could prevent the knowledge being used by research groups that could create a vaccine.
The academic, moral and legal arguments combined with the international nature of the dilemma and the colossal implications of the decision make the case particularly extraordinary so we’re unlikely to see a decision any time soon. Potentially this is time that could be used to make a vaccine so if the virus mutates all on it’s own it will be a cruel irony that it was human nature rather than mother mature that prevented us from making a vaccine.
What do I think? I’m not in a position to make that decision but my two cents would be that the decision should fall very far in one way or the other. There are countless examples of the Streisand Effect, which dictates that if information is suppressed it spreads much faster and further than it would if it wasn’t. Based on the examples we have already seen the fact that scientists want this data available and the US government doesn’t suggests that once the data is privately released, someone somewhere will inevitably leak it. If they are going to keep this secret, they are going to have to do it properly.
After my experimental annotated case study of “the worst piece of drugs reporting I have ever read” resulted in two take-downs (The Metro & The Hull Daily Mail) and one correction (The Independent), I’ve decided to do the same for a piece recently published by the Mother-ship of shoddy journalism, the Daily Mail. Just hit play and use the scroll wheel on your mouse to zoom in and out as you as you please.
For the full audio visual experience of how reading the Daily Mail makes me feel, try scrolling around the article while playing the video below. If reading the Daily Mail makes you feel the same way, please join the newly launched Daily Mail Demolition Squad.
For further reading check out the coverage by UKCIA. Peter Reynolds at Clear UK is awaiting a response on a PCC complaint, you can help speed up the process by making a complaint yourself. The original article “Just ONE cannabis joint ‘can bring on schizophrenia’ as well as damaging memory” appeared in the Daily Mail on 26th October 2011.
Kucewicz MT, Tricklebank MD, Bogacz R, & Jones MW (2011). Dysfunctional prefrontal cortical network activity and interactions following cannabinoid receptor activation. The Journal of neuroscience : the official journal of the Society for Neuroscience, 31 (43), 15560-8 PMID: 22031901 (PDF).
Update (29/01/2012): This nomination won the Orwellian Prize for Journalistic Misrepresentation!
I have submitted this piece for the Orwellian prize for journalistic misrepresentation which uses the scoring system below:
* Factual error in the title: 3 points
* Factual error in a subtitle: 2 points
* Factual error in the body of the article: 1 point
Nominated article: http://www.dailymail.co.uk/health/article-2053486/cannabis-joint-cause-psychiatric-episodes-similar-schizophrenia-damaging-memory.html
Misrepresented source article: (PDF)
Nominator: Neurobonkers (neurobonkers at gmail dot com)
Total: 23 Points
[Just ONE] (3) [cannabis joint] (3) [‘can cause psychiatric episodes] (3) similar to schizophrenia’ as well as [damaging memory] (3)
[Strongest evidence yet, claim scientists] (2)
Rats used in experiments
By TAMARA COHEN
Created 10:21 PM on 25th October 2011
[Smoking] (1) [just one cannabis joint can bring on symptoms of schizophrenia] (1), a study has found.
Researchers at the University of Bristol have, [for the first time, looked in detail at the changes in the brains of cannabis users] (1).
[They found the drug disrupts the same parts of the brain as the psychotic illness, those associated with memory and decision-making] (1).
Scientists at the University of Bristol [found that even one cannabis joint could trigger schizophrenia] (1)
Cannabis abuse has previously been linked with increased rates of schizophrenia but [this is the strongest evidence yet that the drug mimics its effects](1).
The [scientists studied rats who had been given the active ingredient of cannabis] (1) – [in a similar dose to a person smoking a joint](1).
Using electrodes embedded into their brains – which cannot be done in humans – they found those who had the drug were ‘significantly impaired’ in carrying out tasks for up to two hours afterwards.
[If this dose of cannabis has the same effect on humans, just one joint could significantly change their behaviour] (1).
Dr Matt Jones, the lead author of the study said: ‘Cannabis is making normal people behave more like schizophrenia patients when they take it and that’s something they should bear in mind.
‘Previous studies have shown a link but we didn’t have this level of detail.
‘What we have shown is that the brain waves which process information and share it with other regions of the brain become de-synchronised like parts of an orchestra playing out of synch.
‘Cannabis has a docile reputation in the drug world. Most people would accept that cannabis abusers are not at their sharpest and might have subtle impairments in memory or decision making but sometimes small doses of the ingredient can cause psychiatric episodes similar to schizophrenia.’
Tests were carried out on rats – and scientists discovered that the creatures were affected for up to two hours after being exposed to cannabis
In experiments, the rats who were given cannabis all became unable to make accurate decisions when navigating around a maze, compared with those who had not been given any.
Two parts of their brain were shown to be affected – the hippocampus which is essential for forming new memories and prefrontal cortex which integrates those memories and uses them for future behaviour and decision-making.
Disruption of the brain waves which allow these two areas to communicate is what happens in schizophrenia, a mental disorder.
It is associated with muddled thought which causes problems in social interaction, bizarre and paranoid delusions and changes in behaviour.
Dr Jones added: ‘You might feel fine – the rats overt behaviour did not look impaired – but when asked to make rapid and accurate decisions following a joint of cannabis, the cross-talk between these parts of the brain was not normal.
‘Taking cannabis while sitting on the couch watching DVDs is one thing, but if you decide to drive to the shops, that’s when the cognitive impairments come out.’
He said super-strong versions of cannabis – known as ‘skunk’ – contain a higher proportion of the active ingredient THC and would most likely have an even more pronounced effect.
The researchers, whose study is published today in the Journal of Neuroscience, hope further research will help them develop treatments for these effects which could help people with mental illnesses.
Schizophrenia is linked to a number of genes, and previous studies have shown cannabis use can accelerate the risk of developing the disease in people who are already pre-disposed to get it.
An analysis of 83 studies earlier this year involving 22,000 young people, concluded that smoking cannabis can accelerate the onset of psychotic illnesses by several years making them harder to treat successfully.
Recently scientists in Germany and the Institute of Psychiatry in London found people who use cannabis are doubling their risk of developing psychotic problems – including schizophrenia as well as paranoid ideas, hallucination and hearing voices.
They looked at 1,900 young people aged 14 to 24 and found a link at a very early stage of use among youngsters who had never experienced such symptoms before.
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