Placebos as medicine

Did you know that your doctor may be giving you a placebo for your niggle? Well they very well may be. Antibiotics for flu? There you have one example already.

A recent survey was done by Kermen and co-workers¹ to determine how frequently American physicians prescribe placebos.Fifty-six percent (56%) of surveyed physicians reported prescribing or administering placebos in their practices, with younger physicians being a lot more likely to prescribe placebos than older physicians. The most frequently-used placebo was antibiotics (for non-bacterial diagnoses, 40%). The second most frequently prescribed placebo was vitamines (23%), followed by herbal supplements (12%). The most common reasons for prescribing placebos were “unjustified demand for medication” (32%) and “to calm patients” (21%). Most physicians (31%) told their patients that their presription consisted of a substance that will help and not hurt, and a very honest 2% told their patients that what they were given was an actual placebo. Most physicians believe that the placebo effect is beneficial and can have real, positive results.

So, while most physicians "believe" in the placebo effect, only about half would prescribe a substance that they knew had no direct therapeutic ingredient. Of course this was a very small study, but it makes one wonder what's happening in one's own surgery. It also reiterates the strong effect that thoughts can have on health.

¹ Kermen R, Hickner J, Brody H, Hasham I. Family physicians believe the placebo effect is therapeutic but often use real drugs as placebos. Fam Med. 42:636-42 (2010)
Source

Christmas special: the weird and the wonderful

In the process of looking for hot new research topics (or just in the course of my daily working day) I find a fair amount of curious papers. So, as a final entry for the year I thought I'd post a special edition, listing a few of my favourites.

From the department of Advanced Medical Science (literally)¹:

"Obesity significantly increases the difficulty of patient management in the emergency department."

With the objective to "... determine which aspects of ED management are adversely affected by patient obesity, to determine the level of obesity above which management is made more difficult and to make recommendations on how these effects might be mitigated...", this study showed that patient obesity makes it difficult to manage an emergency department. And offered no solutions.


Ever wondered if watching TV or working on your computer late at night affects your sleep? So did a couple of researchers in Brazil who investigated the "Quality of sleep among university students: effects of nighttime computer and television use."²

The internet lost out in this study as it seems to affect sleep a lot more than television. Interestingly, if you manage to use the internet untill 3am, you sleep a bit better. This blogger wonders how much of the "affected sleep" is due to online arguing...



The title of this paper says it all, really: PMS: premenstrual storm? An unusual cause of electrical storm in a young woman with vasospastic angina. ³
Never underestimate how hard it is to be a girl...



Apparently "Hearing loss in stranded odontocete dolphins and whales" ⁴ is a big problem. Researchers speculate that this may have somethig to do with the actual stranding. How do you measure hearing in a dolphin? Well, with great difficulty, but apparently "in all cases, a jawphone consisting of an ITC-1042 piezoceramic transducer embedded in a RTV silicone suction cup was placed on the lower jaw fat pad to deliver sound stimuli." If a response could be detected from the dolphin or whale, then that was marked as the level at which the animal could "hear". There was a strong correlation between stranding and hearing loss in some of the species. (Picture below: a hydrophone)




The brushtail possum is a major pest species of New Zealand. Some researchers are investigating a nanoparticle system containing a chemical sterilitant which could be used orally to control their numbers.⁵ Poor little possums.




Our last two entries are shamelessly of a scatological nature:

A woman with a history of depression presents with abdominal bloating. Her doctor sends her for a colonoscopy. It turns out she's fine, but they do find something odd. A cockroach. ⁶


And finally... Apparently "robotic assisted laparoscopic radical prostatectomy" is a fairly uncomfortable procedure used in prostate cancer. So a few researchers in Seattle wondered whether a suppository containing belladonna (that's deadly nightshade to me and you) and opium would help.⁷ And indeed it did! With no adverse events noted either!





¹ Kam J, Taylor DM. Emerg Med Australas. 2010 Aug;22(4):316-23. Source

² Mesquita G, Reimão R. Arq Neuropsiquiatr. 2010 Oct;68(5):720-5. Source

³ Li J, Zitron E, Katus HA, Becker R. Clin Res Cardiol. 2010 Nov 30. [Epub ahead of print] Source

⁴ Mann D, Hill-Cook M, Manire C, Greenhow D, Montie E, Powell J, Wells R, Bauer G, Cunningham-Smith P, Lingenfelser R, DiGiovanni R Jr, Stone A, Brodsky M, Stevens R, Kieffer G, Hoetjes P. PLoS One. 2010 Nov 3;5(11):e13824. Source

⁵ Kafka AP, McLeod BJ, Rades T, McDowell A. J Control Release. 2010 Oct 31. [Epub ahead of print] Source

⁶ Kumar AR, Perez JA, Miick R, Govil YK Endoscopy. 2010;42 Suppl 2:E209-10. Epub 2010 Sep 15. Source - INCLUDES FULL ARTICLE PLUS PHOTO!

⁷ Lukasewycz S, Holman M, Kozlowski P, Porter CR, Odom E, Bernards C, Neil N, Corman JM. Can J Urol. 2010 Oct;17(5):5377-82. Source

New skins for old wine

Curcumin is the metabolite that's responsible for the yellow colour of the spice, tumeric. It can be used for food colouring (it's E number is E100), to quantify boron ¹, and to treat a number of ailments.

The first research on curcumin looked at its antibacterial properties ², and since then researchers have looked at its antioxidant properties ³, its use as an antirheumatic ⁴, a potential cholesterol-lowering role for it ⁵ and many other medicinal applications.

Recently a group in Canada investigated the effect of tumeric on cancer treatment.⁶ Previous research showed that curcumin also has an anti-cancer effect, but these researchers wanted to know if curcumin given in addition to standard chemotherapy could improve the efficacy of the treatment while keeping side-effects to a minimum. The researchers found that the combined treatment worked at lower doses than monotherapy; that non-cancerous cells remained unaffected; and that cancer cells still responded to the treatment even after the drugs were removed.

Many people scoff at the idea of "natural therapies", but it is important to remember that aspirin was originally made from willow bark. Tumeric might be the next aspirin!


¹Roth HJ, Miller B. On the color reaction between boric acid and curcumin. I. Boric acid-curcumin complexes. Arch Pharm (Weinheim)297:617-23 (1964)

²SCHRAUFSTATTER E, BERNT H. Antibacterial action of curcumin and related compounds. Nature. 164(4167):456 (1949)

³ Sharma OP. Antioxidant activity of curcumin and related compounds. Biochem Pharmacol. 25:1811-2 (1976)

⁴Deodhar SD, Sethi R, Srimal RC. Preliminary study on antirheumatic activity of curcumin (diferuloyl methane). Indian J Med Res. 71:632-4 (1980)

⁵Soudamini KK, Unnikrishnan MC, Soni KB, Kuttan R. Inhibition of lipid peroxidation and cholesterol levels in mice by curcumin. Indian J Physiol Pharmacol. 36:239-43 (1992)

⁶
Chatterjee SJ, Pandey S. Chemo-resistant melanoma sensitized by tamoxifen to low dose curcumin treatment through induction of apoptosis and autophagy. Cancer Biol Ther. 2011 Jan 29;11(2). [Epub ahead of print]

Nanobots!

In Star Trek: The Next Generation episode Evolution (1989), Wesley Crusher creates Nanobots called “nanites” which unexpectedly evolve to the point of sentience.

According to the Futurama Wiki "The Nanobots were a model of Robots created by Professor Hubert J. Farnsworth that inhabited the Robo-Planetoid during August of 3010."

Recently, Prof Joseph Wang and his team at UCSD published a paper on fuel free nanomotors¹. These nanomotors or nanoshuttles are designed to pick up, transport, and deliver drugs to their target more efficiently than current nanotherapy strategies.

Each nanoshuttle has a polypyrrole-cadmium nanowire containing a diode, which allows an electric current to flow in only one direction.² In order to get the nanoshuttles to move, an alternating current electric field is applied to the nanowires - this propels the shuttle by converting electrical energy into movement. The nanoshuttles are propelled a distance equivalent to seven times their body length in one second.


¹ Kagan D et al. Small Oct 27 (2010) E-pub
² Burch H. Nanomotors go fuel-free. Chemical Science 09 February 2010. (Source) This article includes a video.

Nanotherapy for targeted cancer treatment

Many researchers are currently investigating more effective, targeted ways of delivering cancer drugs and therapies to patients.

Two such innovative studies have looked at the use of wheat germ agglutinin and folic acid, respectively, as a conjugate to target tumors.

A team in Singapore have modified the nano-encapsulated drug, paclitaxel, with wheat germ agglutinin (WGA) to target colon cancer cells.¹ These cells express a greater amount of WGA-binding glycoproteins. Nanoparticles modified with WGA showed greater uptake into cancer cells when compared to unmodified particles. The WGA-modified particles also showed an enhanced anti-proliferative activit.

In India, a research team have modified nanoparticles loaded with grape seed extract(active as a neutraceutical), in order to target them to folate receptor over-expressing cancers.² The nanoparticles were conjugated with folic acid in order to target them to these cells. Folate receptor positive cancer cells readily took up the nanoparticles, showing enhanced bioavailability to tumor cells, sparing the normal ones.

Both these reports underline the application of modifications to target cancer therapies - strategies that may greatly improve the side-effects of chemotherapy.

¹ Wang C, Ho PC, Lim LY. Wheat germ agglutinin-conjugated PLGA nanoparticles for enhanced intracellular delivery of paclitaxel to colon cancer cells. Int J Pharm 400:201-10 (2010).

² Narayanan S, Binulal NS, Mony U, Manzoor K, Nair S, Menon D. Folate targeted polymeric 'green' nanotherapy for cancer. Nanotechnology 21:285107 (2010).

Neurorehabilitation - gaming systems

In a marriage of medicine and gaming culture, virtual reality games have been investigated in the rehabilitation of stroke patients.¹

Researchers in Barcelona have investigated novel technology-based neurorehabilitation techniques in the treatment of strokes. A special aspect of this technique was the fact that the game could be adjusted and personalized for each patient.

While a stroke causes massive damage, brain cells can reorganize themselves. Therefore the aim of rehabilitation is to maximize the effect of this plasticity. The Spanish research team developed the Rehabilitation Gaming System (RGS), a virtual reality-based neurorehabilitation program .

The RGS tracks arm and finger movements and maps them onto a virtual environment. The user controls the movement of two virtual limbs that are viewed on a screen. The RGS "game" that the researchers used was called Spheroids (see figure below). In this game the user has to catch and place spheres that move towards them. The idea behind this is that, when the patients use their limbs and observe the virtual limbs move in a way that is controlled by them, conditions are created that stimulate the reorganization of neurons involved in motor functions.


The researchers also tried to make the tasks just challenging enough to remain engaging for the patients. The RGS automatically adjusts the difficulty of the task with respect to the measured performance of a subject in order to keep them encouraged and to maximize effect.

The researchers concluded that the RGS is a promising neurorehabilitation tool that can be used to alleviate the deficits brought on by lesions to the central nervous system as the ones caused by stroke.

¹ Cameirão MS, Bermúdez i Badia S, Oller ED, Verschure1 PFMJ. Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation. Journal of NeuroEngineering and Rehabilitation 7:48 (2010).
Source

Stem cell therapy for cardiovascular disease

Stem cell therapy is controversial, mostly for the application of foetal stem cells in a large proportion of research.

A new type of stem cell has been developed by researchers in Japan, called induced pluropotent stem (iPS) cells. These cells derive from somatic (body) cells, and therefore are a lot less morally questionable than foetal cells.

A recent study has investigated the usage of iPS cells in the treatment of ischemia ¹ - the restriction of blood supply to a specific body part that can lead to tissue damage. Hind limb ischemia in mice was treated with iPS cells specifically treated to produce a protein called fetal liver kinase-1 (Flk-1). This protein plays an important role in the formation of blood vessels.

Transplantation of stem cells producing Flk-1 into the damaged limbs of mice accelerated the formation of new blood vessels, showing that this therapy could potentially rescue tissues that have suffered restricted blood flow. This could potentially be applied after events such as heart attacks.

¹ Suzuki et al. Therapeutic angiogenesis by transplantation of induced pluripotent stem cell-derived Flk-1 positive cells. BMC Cell Biology 11:72 (2010)