6 ms·

By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the br

by themgt 10y ago

By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the brain. I would imagine a doctor who e.g. understands how many anti-depressants work by targeting the serotonin system would find it interesting the way many psychedelics also are serotonergic - people are basically just dumping analogues of their own neurotransmitters into their brain. Similarly, look at the relationships chemically between sumatriptan (used to treat cluster headaches), psilocybin and DMT. Or the opioids, stimulants ... substances like coca and kratom that have been used for hundreds or thousands of years and analogues of which are used in medical settings all the time. The argument that these are crazy, dangerous substances with zero legitimate medical value pretty instantly falls apart to anyone who understands how closely related nearly all of these substances are to pharma drugs widely understood to have legitimate medical value. I'd in fact be interested to hear which "drugs" have the least relation to any recognized western medicine. Salvia divinorum?

kem 10y ago
I sympathize with the OP, although my concerns are slightly different. I worry that physician groups are trying to shape this narrative in a way that just shifts government-sanctioned power from one group to another. Physicians are not disinterested parties in this, because they have huge financial benefits to gain from official policy being that drugs are a "medical" issue. Once this happens, if nothing changes about the way that the medical system is organized, you'll just have a different group sucking up money and controlling individuals wholesale without sufficient justification. I agree with you up until a very critical point. Doctors are better equipped to understand the neurochemical reactions being caused by drugs than criminal justice professionals. However, they are not necessarily better equipped to understand the neurochemical reactions than other scientific professionals, nor are they better equipped to understand the economic, social, or legal consequences than criminal justice and other professionals. This is what is happening with the medical rhetoric: you have a group of experts in area X, who are currently legally designated as either the only people truly qualified, or in control of those qualified, arguing "drugs are an issue of X." In doing so, they put themselves in control of decision-making in this area, with all the financial benefits that accrue to them, and, more dangerously, simultaneously take control of discourse away from others, because then they become the ones who are only, or who are most qualified to make decisions about whether or not it is an issue of X. Once society deems drug use a "medical disease," then physicians become the people who are only truly legally qualified to make decisions about drug use, and also the only people truly qualified to make decisions about drug use policy. It's an entirely self-serving vicious circle. This line of reasoning is also dangerous, because there is no end to its logic. Given that humans are fundamentally biological beings, any state of human suffering can ultimately be seen as "medical" in nature. Reading this sounds conspiratorial, and I don't mean it to be, but it's frustrating to me that society doesn't recognize the ethical conflict of interest created by current medical certification and licensing systems. Don't get me wrong: the current system for handling drugs is woefully broken. But I worry that labeling drug use as a "disease" will only shift the problems from one area to another, unless that system is also reformed to foster a more competitive, less hierarchical health care community. Drug use problems are a complex, social, biological, psychological, legal, economic problem set that is outside the purview of any particular professional community. The best approach is to just deregulate it, and treat it as a form of human suffering that requires a multifactorial approach. I'm deeply skeptical this will happen, though, given our recurrent need to oversimplify everything.
skissane 10y ago
> By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the brain. I'm not sure how true that is. The amount of knowledge of (bio)chemistry required by most doctors in their day-to-day work is actually quite limited. A few years out of medical school, and many of them have already forgotten most of what they were taught in medical school, and the medical school curriculum really only gives a high-level overview of the topic. I'm not a doctor, but my mother and brother are. My mother despite being a doctor will admit her chemistry knowledge is quite limited, but to be fair to her she doesn't need to know much chemistry at all to do her job–you don't need any detailed knowledge of biochemistry to prescribe an antidepressant or perform a caesarian section. My brother by contrast knows a lot about chemistry, but that's not due to medical school, that's due to majoring in chemistry as an undergrad.
tudorw 10y ago
look at which companies make large acquisitions in pharma nutrition
dfraser992 10y ago
From a scientific standpoint, salvia should be researched as it operates on the k-opiod receptor and ought to be useful in gaining more insight into consciousness (as anyone who has taken it would attest) [1] There are other opiods mentioned in the Wikipedia article in the same class that are used as pain medication. From a medical standpoint, I believe there has been some research into salvia's potential use as a anti-depressant, but that might just be anecdotal, I can't recall right now.. [1] points to some clues how this might be the case. Now I remember some research into depression and how it is related to the pain centres in the brain in some fashion - "Tylenol appears to reduce activity in a region of the brain called the “dorsal anterior cingulate cortex,” which research has tied to physical pain and social rejection and ostracism, Randles explains. It’s likely that dampening activity in this brain region accounts for the study participants’ weakened sense of anxiety, though Randles says it’s too early to prescribe Tylenol as a cure for existential distress." From a psycho-spiritual viewpoint, oh boy. I could go on forever about that and the need to really start getting a handle on this topic (re: transpersonal psychology). But my own experiences (i.e. kundalini, reliably) and what that is like... what is going on, from a scientific standpoint, even if it's all in my head, is very interesting. The brain/mind connection is a lot more complex than we can even think of... I haven't read the article yet, so I don't know if it promotes the medicalization of psychoactive substances, which is a concern of mine. Lumping everything under "drugs" (but leaving out alcohol) is really idiotic. There are all these facets, along with sociological aspects, that each substance needs to be considered individually when figuring out a rational way to deal with the problems while utilizing them in some fashion to improve society. So, no, salvia does have some relation to western medicine. [1] https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor#Consciousness https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor#Conscio...
threatofrain 10y ago
This sounds like you at least want to have policy experts or domain statisticians involved. Doctors aren't really in a place to understand whether a policy has failed, but they are in a place to lend credibility as a community that has fostered the currency of credibility. I think you'd be surprised how many doctors don't understand the empirical aspects of medical literature, or any empirical literature.
kolinko 10y ago
Well, a doctor who studied serotonin extensively, but never took MDMA is like a virgin read all the online tutorials about sex. He may have the knowledge, but I'd question his understanding.
anexprogrammer 10y ago
The full editorial itself is reasonably neutral and well stated. They may be overstating their ability to "build pragmatic and rational policy". For your assertion however, I can only yell "NO". I can't emphasise that strongly enough. Just gives supremely high chance of poor opinions heavily biased by the over confidence effect. This is probably controversial, so bear with me, while I try and explain as it'll probably take some space. I'll apologise for length and poor explanation before I even start! Let's look at a different neurotransmitter a moment - dopamine. Amphetamines markedly affect dopamine receptors. If most people take recreational doses they'll be stimulated, motivated, and sociable. If I take it I get no effect on motivation, and chill out. I'll probably sit and binge watch TV, work or read a book for eight hours straight. I won't be bothered to be sociable as I'd be delighting in the chilled calm. You may not be surprised to learn I have ADHD. I fought for years with doctors "knowing" drugs and how they act on the brain in trying to get diagnosed with ADHD. Took years to not be dismissed out of hand. I don't find most doctors any more aware than the general public much of the time. That's not a function of where I live - time hanging around the assorted ADHD forums that have come and gone show all countries have had similar issues and hundreds of people struggling to get a diagnosis or referral because of horribly poor doctor, psychiatric or specialist awareness. Often those doctors are responding as though the patient is a normal brain merely seeking recreational drugs (which of course happens too), but it's entirely opinion. It's not uncommon to get misdiagnosed something else, perhaps with lasting and damaging consequences. (You don't typically ever get "undiagnosed" of mental disorders). For many only when learning the field extensively themselves is real progress made. It's quite sobering to realise just how many have had to start studying and reading research themselves prior to being able to get diagnosis. Minds are more difficult as we tend not to be able to diagnose anything like as easily as a broken bone, germ or viral illness. There's a need to rely solely on self reporting as we can't, yet, throw someone in a scanner and identify them as having depression, ADHD, Asperger's or LSD addiction. In the case of recreational drugs and use there's going to be little in the way of studies of their effects on healthy minds. I seem to remember quite recently LSD had the first study in 50 years. Anti depressants often seem to have suicide and suicidal ideation as side effects - the same medicine can have dramatically different mental effects in ways not often seen with say paracetamol. The main difference then is a doctor is more likely to be believed and have opinions acted upon without any real understanding. They may have better understanding, if and only if the correct studies are there. For the most part they won't be. Yet. Doctors are well placed to advise on studies and contraints as health impacts arise from legalisation however.
nradov 10y ago
Except that no one really understands why SSRIs have an antidepressant effect in some patients. We have some hypotheses but the underlying neurochemical mechanism is still somewhat mysterious and unproven.

by themgt 10y ago

kem 10y ago

I sympathize with the OP, although my concerns are slightly different. I worry that physician groups are trying to shape this narrative in a way that just shifts government-sanctioned power from one group to another. Physicians are not disinterested parties in this, because they have huge financial benefits to gain from official policy being that drugs are a "medical" issue. Once this happens, if nothing changes about the way that the medical system is organized, you'll just have a different group sucking up money and controlling individuals wholesale without sufficient justification. I agree with you up until a very critical point. Doctors are better equipped to understand the neurochemical reactions being caused by drugs than criminal justice professionals. However, they are not necessarily better equipped to understand the neurochemical reactions than other scientific professionals, nor are they better equipped to understand the economic, social, or legal consequences than criminal justice and other professionals. This is what is happening with the medical rhetoric: you have a group of experts in area X, who are currently legally designated as either the only people truly qualified, or in control of those qualified, arguing "drugs are an issue of X." In doing so, they put themselves in control of decision-making in this area, with all the financial benefits that accrue to them, and, more dangerously, simultaneously take control of discourse away from others, because then they become the ones who are only, or who are most qualified to make decisions about whether or not it is an issue of X. Once society deems drug use a "medical disease," then physicians become the people who are only truly legally qualified to make decisions about drug use, and also the only people truly qualified to make decisions about drug use policy. It's an entirely self-serving vicious circle. This line of reasoning is also dangerous, because there is no end to its logic. Given that humans are fundamentally biological beings, any state of human suffering can ultimately be seen as "medical" in nature. Reading this sounds conspiratorial, and I don't mean it to be, but it's frustrating to me that society doesn't recognize the ethical conflict of interest created by current medical certification and licensing systems. Don't get me wrong: the current system for handling drugs is woefully broken. But I worry that labeling drug use as a "disease" will only shift the problems from one area to another, unless that system is also reformed to foster a more competitive, less hierarchical health care community. Drug use problems are a complex, social, biological, psychological, legal, economic problem set that is outside the purview of any particular professional community. The best approach is to just deregulate it, and treat it as a form of human suffering that requires a multifactorial approach. I'm deeply skeptical this will happen, though, given our recurrent need to oversimplify everything.

skissane 10y ago

> By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the brain. I'm not sure how true that is. The amount of knowledge of (bio)chemistry required by most doctors in their day-to-day work is actually quite limited. A few years out of medical school, and many of them have already forgotten most of what they were taught in medical school, and the medical school curriculum really only gives a high-level overview of the topic. I'm not a doctor, but my mother and brother are. My mother despite being a doctor will admit her chemistry knowledge is quite limited, but to be fair to her she doesn't need to know much chemistry at all to do her job–you don't need any detailed knowledge of biochemistry to prescribe an antidepressant or perform a caesarian section. My brother by contrast knows a lot about chemistry, but that's not due to medical school, that's due to majoring in chemistry as an undergrad.

tudorw 10y ago

look at which companies make large acquisitions in pharma nutrition

dfraser992 10y ago

From a scientific standpoint, salvia should be researched as it operates on the k-opiod receptor and ought to be useful in gaining more insight into consciousness (as anyone who has taken it would attest) [1] There are other opiods mentioned in the Wikipedia article in the same class that are used as pain medication. From a medical standpoint, I believe there has been some research into salvia's potential use as a anti-depressant, but that might just be anecdotal, I can't recall right now.. [1] points to some clues how this might be the case. Now I remember some research into depression and how it is related to the pain centres in the brain in some fashion - "Tylenol appears to reduce activity in a region of the brain called the “dorsal anterior cingulate cortex,” which research has tied to physical pain and social rejection and ostracism, Randles explains. It’s likely that dampening activity in this brain region accounts for the study participants’ weakened sense of anxiety, though Randles says it’s too early to prescribe Tylenol as a cure for existential distress." From a psycho-spiritual viewpoint, oh boy. I could go on forever about that and the need to really start getting a handle on this topic (re: transpersonal psychology). But my own experiences (i.e. kundalini, reliably) and what that is like... what is going on, from a scientific standpoint, even if it's all in my head, is very interesting. The brain/mind connection is a lot more complex than we can even think of... I haven't read the article yet, so I don't know if it promotes the medicalization of psychoactive substances, which is a concern of mine. Lumping everything under "drugs" (but leaving out alcohol) is really idiotic. There are all these facets, along with sociological aspects, that each substance needs to be considered individually when figuring out a rational way to deal with the problems while utilizing them in some fashion to improve society. So, no, salvia does have some relation to western medicine. [1] https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor#Consciousness https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor#Conscio...

threatofrain 10y ago

This sounds like you at least want to have policy experts or domain statisticians involved. Doctors aren't really in a place to understand whether a policy has failed, but they are in a place to lend credibility as a community that has fostered the currency of credibility. I think you'd be surprised how many doctors don't understand the empirical aspects of medical literature, or any empirical literature.

kolinko 10y ago

Well, a doctor who studied serotonin extensively, but never took MDMA is like a virgin read all the online tutorials about sex. He may have the knowledge, but I'd question his understanding.

anexprogrammer 10y ago

The full editorial itself is reasonably neutral and well stated. They may be overstating their ability to "build pragmatic and rational policy". For your assertion however, I can only yell "NO". I can't emphasise that strongly enough. Just gives supremely high chance of poor opinions heavily biased by the over confidence effect. This is probably controversial, so bear with me, while I try and explain as it'll probably take some space. I'll apologise for length and poor explanation before I even start! Let's look at a different neurotransmitter a moment - dopamine. Amphetamines markedly affect dopamine receptors. If most people take recreational doses they'll be stimulated, motivated, and sociable. If I take it I get no effect on motivation, and chill out. I'll probably sit and binge watch TV, work or read a book for eight hours straight. I won't be bothered to be sociable as I'd be delighting in the chilled calm. You may not be surprised to learn I have ADHD. I fought for years with doctors "knowing" drugs and how they act on the brain in trying to get diagnosed with ADHD. Took years to not be dismissed out of hand. I don't find most doctors any more aware than the general public much of the time. That's not a function of where I live - time hanging around the assorted ADHD forums that have come and gone show all countries have had similar issues and hundreds of people struggling to get a diagnosis or referral because of horribly poor doctor, psychiatric or specialist awareness. Often those doctors are responding as though the patient is a normal brain merely seeking recreational drugs (which of course happens too), but it's entirely opinion. It's not uncommon to get misdiagnosed something else, perhaps with lasting and damaging consequences. (You don't typically ever get "undiagnosed" of mental disorders). For many only when learning the field extensively themselves is real progress made. It's quite sobering to realise just how many have had to start studying and reading research themselves prior to being able to get diagnosis. Minds are more difficult as we tend not to be able to diagnose anything like as easily as a broken bone, germ or viral illness. There's a need to rely solely on self reporting as we can't, yet, throw someone in a scanner and identify them as having depression, ADHD, Asperger's or LSD addiction. In the case of recreational drugs and use there's going to be little in the way of studies of their effects on healthy minds. I seem to remember quite recently LSD had the first study in 50 years. Anti depressants often seem to have suicide and suicidal ideation as side effects - the same medicine can have dramatically different mental effects in ways not often seen with say paracetamol. The main difference then is a doctor is more likely to be believed and have opinions acted upon without any real understanding. They may have better understanding, if and only if the correct studies are there. For the most part they won't be. Yet. Doctors are well placed to advise on studies and contraints as health impacts arise from legalisation however.

nradov 10y ago

Except that no one really understands why SSRIs have an antidepressant effect in some patients. We have some hypotheses but the underlying neurochemical mechanism is still somewhat mysterious and unproven.