Tylenol and the War on Drugs

By Kurt Harris, M.D.


Many years ago after a surgical procedure I was given a prescription for Vicodin, which is the brand name combination of hydrocodone and acetaminophen. Hydrocodone is an opioid analgesic – related to morphine and heroin – and acetaminophen is the generic name for tylenol. There was not (and still is not) a version of hydrocodone all by itself – you can only get the two in combination.

The toxicity of acetaminophen to your liver is well known. Currently some 38% of cases of acute liver failure are due to acetaminophen ingestion. You can get liver failure from taking 15 extra strength tylenol (containing 500 milligrams of acetaminophen) a day or from as few as 4 if you have liver damage from alcohol. This liver failure is insidious. Once it starts, it can quickly progress to the point where you feel fine but will be dead in a matter of days unless you have a liver transplant. By the time you feel desperately ill, it may be too late. If you have overdosed on tylenol and have abdominal pain, you need to get yourself to an emergency room quickly.

I remember being annoyed that in order to get effective pain relief I was being forced to take a liver toxin that added little to the pain relieving efficacy of the opiate. I speculated to my wife that there was probably more injury and death occurring from the acetaminophen than the “dangerous narcotic” in the Vicodin.

Now it looks like the FDA has recognized the same thing that was casually obvious to a radiologist more than 10 years ago. As recreational drug users and addicts seek Vicodin for it’s narcotic benefits, and regular folks have acute pain, they are increasingly suffering inadvertent liver toxicity from acetaminophen, contributing to the 40,000 Emergency room visits per year related to acute liver injury.

From this article in the Wall Street Journal January 13, 2011:

Federal health regulators are restricting the amount of acetaminophen in prescription painkillers such as Vicodin and Percocet because of concerns that acetaminophen overdoses are linked to thousands of cases of liver damage in recent years.

The Food and Drug Administration said Thursday it will ask manufacturers to limit acetaminophen used in combination prescription drugs to 325 milligrams. The agency is also asking drug makers to add the strongest warning-a black box-to their labels about the possibility of severe liver damage.

What has all this to do with the war on drugs?

In the early days of the misguided, counterproductive and massively expensive “war on drugs”, Richard Nixon signed the Drug Control Act that established “schedules” that doctors and patients must deal with today. The schedules range from IV to I, in order of their “abuse potential”.

Just don’t get confused and think that this had something to do with safety. Toxic chemotherapy agents, the blood thinner warfarin and many other very dangerous drugs are not on the schedule at all, but pretty much any drug someone might take at a party is.

It was decided that drugs should be made more difficult to obtain based on their potential for “abuse”. In keeping with the moralistic and authoritarian origins of all this, “abuse” means “getting high” and has little to do with how dangerous the given drug is to your health. Some drugs, like cannabis, are schedule I and legally unavailable to anyone in most states. Does anyone really think cannabis is deadlier than Jim Beam?

This is how you end up with an unnecessary liver toxin in your narcotic. The government figures it has a lower potential for abuse because you will be dissuaded from taking enough of it to “get high’ by the potential for hepatotoxicity due to the added acetaminophen! The manufacturer quite naturally responds to the perverse incentives of the Drug Control Act by adding the acetaminophen to get a schedule III classification. This makes it less onerous for the prescribing physician, and easier for the patient, resulting in greater sales for the drug company.

Make the potential party drug more toxic so it is less likely to be “abused”.

In case you think my reasoning on this is overly cynical, have you ever purchased denatured alcohol at the hardware store? This is ethanol – the same kind found in your gin and tonic – which has been purposefully engineered to kill you if you drink it. “Denatured” implies there has been some chemical alteration of the alcohol, but in fact it is just intentionally contaminated with toxic industrial solvents like methanol or acetone.

The manufacturer goes to extra effort and expense to add poison for the sole purpose of escaping burdensome government regulation and taxation. And the government dissuades you from getting high with a legal drug by threatening you with death.

Still doubt that your government might be willing to burn the village in order to save it?

Read an article by Deborah Blum of Slate called The Chemist’s War.

Here are some excerpts:

It was Christmas Eve 1926, the streets aglitter with snow and lights, when the man afraid of Santa Claus stumbled into the emergency room at New York City’s Bellevue Hospital…

Before hospital staff realized how sick he was-the alcohol-induced hallucination was just a symptom-the man died. So did another holiday partygoer. And another. As dusk fell on Christmas, the hospital staff tallied up more than 60 people made desperately ill by alcohol and eight dead from it. Within the next two days, yet another 23 people died in the city from celebrating the season…..

Frustrated that people continued to consume so much alcohol even after it was banned, federal officials had decided to try a different kind of enforcement. They ordered the poisoning of industrial alcohols manufactured in the United States, products regularly stolen by bootleggers and resold as drinkable spirits. The idea was to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the federal poisoning program, by some estimates, had killed at least 10,000 people….

So I am glad the FDA is finally realizing what is going on, but it’s too bad they don’t address the true source of the problem, which is Prohibition II – the absurd war on drugs, the “schedule” and the perverse incentives such attempts at control always create.

Your government is determined to protect you from too much fun, even if it kills you.

Source Psychology Today

Effects Of Stress And Pollution Passed To Future Generations Through Epigenetic DNA Changes


When the Human Genome Project ended a decade ago, scientists thought that they had closed the lid on all that is to be known about our genes. But what they really did was open a Pandora’s Box, says theoretical evolutionary biologist Prof. Eva Jablonka of Tel Aviv University’s Cohn Institute for the History and Philosophy of Science and Ideas.

After sifting through hundreds of scientific studies concerned with epigenetics, Prof. Jablonka concludes that some of the effects of stress, cancer, and other chronic diseases we suffer from may be passed on to our offspring through deep and complicated underlying cellular mechanisms that we are just now beginning to understand.

Prof. Jablonka will discuss her findings at an epigenetics conference in North Carolina later this month.

The invisible threat
Epigenetic research suggests that the effects of stress and environmental pollution can be passed on to future generations without any obvious change or mutation in our DNA. The problem, Prof. Jablonka points out, is that we have no idea of the extent these effects will have on the human genome of the future.

“I am a story teller. I read a lot of information and develop theories about evolution. For the last 25 years, before it became a fad, I was interested in the transmission of information not dependent on DNA variations,” Dr. Jablonka says. “Epigenetic inheritance is information about us that is not explicitly encoded in our genes. Two individuals may have identical genes, but the genes present very different characteristics. They can be genetically identical but different epigenetically.”

In a 2009 paper for the Quarterly Review of Biology, Prof. Jablonka wrote about cellular epigenetic inheritance and explored some of the consequences of such inheritance for the study of evolution, also pointing to the importance of recognizing and understanding epigenetic inheritance for practical and theoretical issues in biology. She has since concluded that individuals can influence their heredity.

After reviewing the literature, she has found more than 100 examples of living organisms, from bacteria to human beings, demonstrating how our genes’ expression can be altered and inherited.

“Stress is enormously important,” Prof. Jablonka says. “It can affect the development of cancer and other chronic diseases, and may also have long term impacts on ecology.” At the conclusion of the Human Genome Project, researchers hoped that the findings would provide relief from several diseases. “What they weren’t prepared for,” she continues, “is that genes really do so many things, and that gene expression patterns can be heritable. We can learn some things about diseases from our DNA, but it doesn’t tell the whole story.”

Is environmental pollution irreversible?
Stress can create near invisible effects on gene expression, effects that can be passed from mother or father to child. Some of this operates through microRNA, tiny RNA discovered about a decade ago, which work as cellular “micro-managers.” In addition, a process called DNA methylation alters gene function. Various processes “hidden” in chromosomes within the cells appear to be influenced by lifestyle and disease.

As a result, Prof. Jablonka advises that it might be prudent to reconsider all the environmental pollutants being introduced into the planet’s ecosystems. Some pesticides and fungicides are androgen suppressors and have many effects on gene expression — and these effects can be inherited. Whether and how future generations can endure with these altered gene functions are still open questions, she says.

Source The Behavioral Medicine Report

Similarities Found in Brain Activity for Both Habits and Goals

ScienceDaily


A team of researchers has found that pursuing carefully planned goals and engaging in more automatic habits shows overlapping neurological mechanisms. Because the findings, which appear in the latest issue of the journal Neuron, show a neurological linkage between goal-directed and habitual, and perhaps damaging, behaviors, they may offer a pathway for beginning to address addiction and similar maladies.

The study was conducted by researchers at New York University’s Center for Neural Science and Department of Psychology, Princeton University’s Department of Psychology and Neuroscience Institute, and University College London’s Wellcome Trust Centre for Neuroimaging and Gatsby Computational Neuroscience Unit, University College London.

The brain is believed to engage in two types of decision-making processes — deliberative, in which the future consequences of potential actions are weighed in order to achieve a particular goal, and automatic or habitual, in which previously successful actions are repeated without further contemplation. While the mechanisms behind these behaviors are distinct — with goal-directed actions the result of planning and habitual ones, associated with addiction, produced more thoughtlessly — researchers have had difficulty separating them behaviorally as they both typically pursue common ends.

The researchers on the Neuron study sought to differentiate both types of decision making by studying how humans’ decisions and brain activity, measured using functional magnetic resonance imaging (fMRI), were influenced by previously received vs. potential future rewards in a gambling game.

In the experiments, subjects were asked to make two sets of choices, with a monetary reward given if they made certain selections. In the first set of choices, subjects were asked to make selections between different slot machines, represented by colored boxes. These choices led to the opportunity to choose between additional slot machines. If the subjects made certain choices in this second stage, they received a monetary reward. Each subject repeated this process 200 times, with the chance of winning a monetary reward varying in each round — in some rounds, certain selections were associated with a high chance of winning money; in other rounds, these same choices were much less likely to yield a monetary benefit.

By analyzing how subjects adjusted their choices based on winning, or failing to win, money, the researchers were able to distinguish goal-directed from habitual decisions. Since the chances of winning money for different choices were constantly changing, a habitual decision, which is based on repeating a previously rewarded choice, was distinct from a goal directed one, which is based on contemplating the future outcome expected for the action.

Having dissociated the two types of decisions, the researchers examined brain activity related to decision processes. Despite the distinctions between goal-directed and habitual behaviors, the subjects’ brain activity was similar for both types of action. Indeed, signals related to goal-directed plans were observed in an area of the brain known as the ventral striatum, which is normally associated with habits and drug abuse.

“This surprising result shows that the brain’s systems for different behaviors are more intertwined than previously thought,” explained Nathaniel Daw, an assistant professor in NYU’s Center for Neural Science and Department of Psychology, one of the study’s co-authors.

The authors added that the finding paves the way for seeking to understand how the brain regulates between goal-directed and habitual behaviors. By comprehending the mechanisms by which the brain controls these behaviors, subsequent research can begin to address how to curb habitual behaviors such as drug addiction or alcoholism. More specifically, because these decisions have a common neural target, there is a possibility that therapeutic methods could be designed and tested, targeting this locus, to enhance goal-directed behaviors while diminishing habitual ones.

The study was funded, in part, by a grant from the National Institute of Mental Health.

Source ScienceDaily

How to feel good – or at least stop feeling bad

By Dr. Leslie Becker-Phelps


If only we could wish away bad habits and unwanted traits. We would all be like the population of Garrison Keillor’s Lake Wobegon – “where all the women are strong, all the men are good looking, and all the children are above average.” Instead, we are stuck with our imperfect selves. While we enjoy shining moments of accomplishment and virtue, we also struggle with the less stellar aspects of ourselves; such as unhealthy eating, low self-esteem, depression, or untold anxieties.

Part of being human is the experience of always being a work in progress – never that final, perfect person. This can make life an exciting adventure; as long as you continue to move in the direction of growth.

Two important steps in encouraging growth are really being ‘in’ your life experiences – not always thinking about other things – and accepting those experiences. When you acknowledge, experience, and fully accept your feelings, you are essentially accepting all aspects of yourself and gaining a sense of being ‘at home’ in you. Even when you don’t like your emotions or are unhappy, they can still feel right. A perfect example of this is when you grieve the loss of someone important in your life; you don’t like the experience, but you have a sense that it is a genuine expression of your feelings, and so it feels right.

You might be thinking; This all sound great, but how can I find such inner peace? There is one very good way to do this that I am hesitant to mention because so many people misunderstand it… meditation. Although increasingly more people are learning the benefits of it for themselves, there are also many others who immediately ‘know’ it is not for them. They might be right, but they dismiss it before they really even understand it.

People often think of meditation as achieving a state of bliss, or at least a deep calm. Although it’s true that meditation can be relaxing, that’s not its main purpose. It is a practice of being aware of, and directing, your attention to your moment-by-moment experience. And it does this by teaching people to see when they become distracted or carried away with thoughts or feelings; and to return their attention to the moment (often focusing on their breath).

This process can be applied to people’s lives outside of meditation, helping them to change things about themselves. So, for example, the emotional overeater can note her urges to eat; learn to tolerate them – along with any accompanying unpleasant emotions – without reaching for food; and return her attention the tasks at hand in her daily routine. Importantly, she is neither denying her urges, which might send them underground to sabotage her later; nor chastising herself for having them, which would undermine her motivation to treat herself well and make healthier food choices.

Stated succinctly, meditation helps people change by teaching them to be inside their experience and simultaneously outside, watching it with perspective. By being in the moment without feeling overcome by emotion, people can become adept at seeing themselves repeat patterns. Then, while acknowledging and experiencing an old pattern, they can choose to respond differently. It’s in this way that meditation frees people to make the personal changes they so desire.

Source Psychology Today

Stress Affects The Balance Of Bacteria In The Gut And Immune Response

By Christopher Fisher, PhD


Stress can change the balance of bacteria that naturally live in the gut, according to research published this month in the journal Brain, Behavior, and Immunity. Exposure to stress led to changes in composition, diversity and number of gut microorganisms, according to scientists from The Ohio State University. The bacterial communities in the intestine became less diverse, and had greater numbers of potentially harmful bacteria, such as Clostridium.

“These bacteria affect immune function, and may help explain why stress dysregulates the immune response,” said lead researcher Michael Bailey.

“These changes can have profound implications for physiological function,” explained Dr Bailey. “When we reduced the number of bacteria in the intestines using antibiotics, we found that some of the effects of stress on the immune system were prevented”, he added. “This suggests that not only does stress change the bacteria levels in the gut, but that these alterations can, in turn, impact our immunity.”

“This is the first evidence that the gut microorganisms may play a role in innate immunological stress responses,” said Monika Fleshner, Professor of Integrative Physiology at the University of Colorado, Boulder. “The study reveals the dynamic interactions between multiple physiological systems including the intestinal microbiota and the immune system.”

Because gut bacteria have been linked to diseases like inflammatory bowel disease, and even to asthma, a future goal of the study is to determine whether alterations of gut bacteria is the reason why these diseases tend to be worse during periods of pressure.

The research was conducted with colleagues from the Texas Tech University Health Sciences Center and the Research and Testing Laboratories, and was funded by the National Institute of Health.

Source The Behavioral Medicine Report