Thursday, July 4, 2013

8 Facts You Might Not Know About Medical Marijuana

Marijuana as medicine is nothing new, despite the current groundswell of laws making pot legal for medical uses. Here's a quick fact file on cannabis and its medical history, makeup, and legality.
  1. "Marijuana" is a Mexican term that originally was applied to low-quality tobacco.

  2. The plant was cultivated in China for therapy (and recreation) over 4,700 years ago.

  3. More than 20 prescription medicines containing marijuana were sold in U.S. pharmacies at the turn of the 20th century. Pot-based medications were commonly available until 1942, when cannabis was stricken from the U.S. Pharmacopeia, the official compendium of drugs considered effective. From 1937 to 1942 the federal government collected a tax of $1 per ounce for such drugs.

  4. More than 20,000 studies on marijuana and its components have been published, according to the National Organization for the Reform of Marijuana Laws, an advocacy group. Of these, around 100 have looked into therapeutic value on human subjects.

  5. The federal government is in the pot-growing business. Under a federal contract, the University of Mississippi in Oxford cultivates marijuana for use by researchers, who have to be cleared by the National Institute on Drug Abuse.

  6. The plant has nearly 500 chemical compounds, more than 60 of which are called cannabinoids.

  7. Fourteen states and the District of Columbia have legalized medical marijuana: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. But patients in these states face federal prosecution for using it—or for growing or possessing pot for medical purposes.

  8. Federal law prohibits physicians from prescribing or otherwise actively supplying patients with the drug. But in 2002 the U.S. Supreme Court backed an appellate court ruling that physicians who discuss it with patients, or provide oral or written recommendations, are protected.
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Teen Marijuana Use Might Have Lasting Effects on Mood, Anxiety

Marijuana use among teens may trigger neurological changes in the developing brain that lead to increased anxiety and stress levels that could persist into adulthood, new animal research suggests.
Although the finding stems solely from work conducted with adolescent and adult lab rats—not yet replicated among humans—the work suggests that certain troublesome changes in levels of the key brain chemicals serotonin and norepinephrine may linger long after marijuana use ceases.
"Here, the goal was simply to understand the neurological mechanism that could be underlying the specific phenomenon of depression and anxiety observed in previous studies among adolescents chronically exposed to cannabis," explained study author Dr. Gabriella Gobbi, a psychiatric researcher at the Research Institute of the McGill University Health Centre in Montreal.
"And what we found with the animals we worked with is that when those that were exposed to cannabis as adolescents became adults they had low serotonin activity, which is related to depressive behavior, and high norepinephrine levels, which is related to an increase in anxiety and stress," Gobbi continued.
"This means," she cautioned, "that cannabis exposure when young seems to cause changes in the adult brain. And these changes could perhaps be irreversible, even if you stop consuming cannabis."
The study findings were released online Dec. 5 in advance of publication in an upcoming print issue of Neurobiology of Disease.
The authors note that the main ingredient in marijuana—delta-9-tetrahydrocannabinol (THC)—has previously been identified as having an impact on receptors in the brain that regulate cognition and emotion.
In addition, they point out that the adolescent brain is perhaps particularly sensitive to both drug use and related stress, given that this is the pre-adult period during which the brain and its neurochemical composition undergoes extensive reshaping and reorganizing.
To assess the role cannabis may play on adolescent brain development, for 20 days—a period characterized as "prolonged exposure"—adolescent rats were given daily injections of either a low-dose (0.2 milligrams/kilograms) or high-dose (1.0 milligrams/kilograms) of cannabis. For comparison, a group of adult rats underwent a similar regimen.
Following cannabis exposure, both the adolescent and adult groups went 20 days drug-free to allow the effects of drug withdrawal to dissipate, as well as to allow for a wide range of cognitive testing to gauge the long-term effects of cannabis exposure on task execution and mood.
The authors noted that by the conclusion of the 20-day waiting period, the previously adolescent rats were effectively adults.
The team found that chronic exposure to cannabis during adolescence does appear to provoke abnormal emotional activity into adulthood, typified by the onset of depression, poorer social interaction, heightened anxiety and increased stress.
What's more, Gobbi and her colleagues also found a drop in serotonin levels in the adult brain following either low- or high-dose adolescent ingestion and an increase in norepinephrine levels following high-dose exposure.
Rats who had already reached adulthood when chronically exposed to cannabis, however, appeared to experience far less of the detrimental emotional reactions found among adolescent rats. Indeed, adult rats, they observed, seemed to be able to readily cope with, and even overcome, most of the neurological impairments that arose as a result of cannabis exposure.
"We were a little bit surprised by our findings because we didn't expect to see such a strong effect on the adult brain from adolescent usage. It was a very significant effect," said Gobbi.
"So, in general, I think that what people should take away from this work," she advised, "is that just because it's a plant it doesn't mean that marijuana is harmless. It's a pharmacologically active drug, and it must be used with awareness."
For his part, however, Dr. Adam Bisaga, an addiction psychiatrist at New York State Psychiatric Institute, minimized the relevance of the findings.

"I think the translational value of this research is very limited insofar as what the clinical relevance to humans might be," Bisaga cautioned. "It's always very difficult to translate from animal models to humans. Yes, there is some indication that this may be of importance to humans. But most of the data with patients that I am familiar with suggests that most of these cannabis-exposure deficits are reversible. So, for the time being I'm not that impressed, although it's certainly something to further study in humans," he added.
"This is not new," he noted. "Clinicians know well that exposure to large amounts of cannabis in adolescence may produce enduring changes in emotional functioning and reactivity in vulnerable individuals, such as difficult-to-treat anxiety and depressive symptoms. What this paper does is to try to characterize more precisely the components of this syndrome using animal models of emotional reactivity."
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Kids Poisoned by Medical Marijuana, Study Finds

Legalizing marijuana may have unintended consequences. Since medical marijuana was legalized in Colorado, more than a dozen young children have been unintentionally poisoned with the drug, researchers report.
About half the cases resulted from kids eating marijuana-laced cookies, brownies, sodas or candy. In many cases, the marijuana came from their grandparents' stash, the investigators said.

"We are seeing increases in exposure to marijuana in young pediatric patients, and they have more severe symptoms than we typically associate with marijuana," said lead researcher Dr. George Sam Wang, a medical toxicology fellow at the Rocky Mountain Poison and Drug Center in Denver.
But doctors aren't familiar with marijuana poisoning in children, so unless the parents are forthcoming it can take time and tests to diagnose the problem, Wang said. Symptoms of marijuana poisoning in children include sleepiness and balance problems while walking.
"We hadn't seen these exposures before the big boom of the medical marijuana industry," Wang said.
The active chemical in marijuana, tetrahydrocannabinol, is in higher than normal concentrations in medical marijuana, and often is sold in baked goods, soft drinks and candies, the researchers said in the study, which was published online May 27 in the journal JAMA Pediatrics.

"We are seeing more symptoms because some of these products have very high amounts of marijuana in them," Wang said. "You get such a high dose on such a small child, the symptoms are more severe."
As with many similar poisonings, treatment is limited to supportive care and waiting until the marijuana clears the system, he said.
Children recover quickly in most cases, Wang said. "They don't need more than a day or two of hospitalization," he said. "There were no deaths or lasting side effects."
This report stems from one Denver hospital, and Wang said he doesn't know how extensive the problem is elsewhere. Colorado adults are allowed to possess up to 1 ounce of marijuana or six marijuana plants, according to the study. And Denver issued more than 300 sales tax licenses for marijuana dispensaries in 2010.

For the study, Wang's team compared the number of children treated in the emergency room for marijuana poisoning before and after the law was enacted in October 2009.
In all, almost 1,400 children under 12 were evaluated for accidental poisonings in this one hospital -- 790 before Sept. 30, 2009, and 588 after that.
After decriminalization, 14 children -- mostly boys and some as young as 8 months -- were found to have ingested marijuana. Eight had consumed medical marijuana, and seven ate marijuana in foods. Two were admitted to the intensive care unit.
Before Sept. 30, 2009, none of those possible poisonings was attributed to marijuana, the researchers found.

There may be more unreported cases, the study authors said. "Because of a perceived stigma associated with medical marijuana, families may be reluctant to report its use to health care providers," they wrote in the study.

"Similar to many accidental medicinal pediatric exposures, the source of the marijuana in most cases was the grandparents, who may not have been available during data collection," the researchers added.
Eighteen states and Washington, D.C., have legalized medical marijuana. Colorado and Washington also have legalized the recreational use of marijuana.

In late 2009, the U.S. Justice Department instructed federal prosecutors not to arrest medical marijuana users and suppliers if they complied with state laws, the researchers said.
To prevent harm to children, Wang advises treating marijuana like any other drug and keeping it out of their reach, particularly if it's in a tempting form like cookies.

Some poison-control experts also are pushing for marijuana to come in tamper-proof packages as a way of keeping children away from it.

The ongoing debate about legalizing marijuana should include discussion of the potential consequences to children, said the researchers and other medical experts.

"There is a lot of information that may not be entirely accurate about how benign marijuana is," said Dr. Sharon Levy, an assistant professor of pediatrics at Harvard Medical School, who wrote an accompanying journal editorial.
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Sleep Deprivation Protects Runners' Muscles In 200-Mile Race

Runners who complete one of the world's most difficult ultra-marathons experience less neuromuscular fatigue, inflammation, and muscle damage than those who run distances half to one quarter as long.

The finding came from new research published in PLoS One and was conducted by Jonas Saugy and team from the University of Lausanne, Switzerland.

For the purpose of the investigation, experts analyzed twenty-five male athletes before, during, and about 30 minutes after the race.

The race, known as the Tor des Geants, is an over 200-mile mountain ultramarathon with 24,000 meters of positive and negative elevation change.

The researchers explained:

"Mountain ultra-endurance running has experienced considerable growth in recent years. These events consist of running/walking on mountain trails with positive and negative slopes over a distance longer than the traditional marathon. These extreme events are an opportunity to investigate the physiological responses of the human body when pushed to its limits."

The impact of sleep deprivation as well as blood and muscle markers of inflammation in runners were examined.

Participants at Tor des Geants had fewer changes in neuromuscular functions, compared to runners who completed a shorter Alpine ultra-marathon approximately 103 miles in length.

The runners of the longer race also had lower levels of muscle damage and inflammation, despite the fact that they ran almost twice the distance as those in the other marathon.

The scientists concluded:

"Protective pacing strategies employed by these runners in the first half of the race, combined with sleep deprivation effects in the second half may induce a relative muscle preservation process."

A previous study in Medicine & Science in Sports & Exercise showed that regular long-distance running can help prevent metabolic syndrome, a group of diseases that can lead to cardiovascular disease and diabetes.
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Three-Person IVF Gets UK Government Backing

The UK government has backed three-person IVF, i.e. creating babies using DNA from three people. The UK government said the procedure will probably be available in 2015 after draft regulations have been produced.

Current IVF techniques leave some babies open to potentially disabling and sometimes life-threatening mitochondrial diseases, which are inherited from the mother. Opponents question why couples who are concerned about inherited mitochondrial diseases do not use egg donors instead.

Mitochondria are the powerhouses of cells, organelles that act like a digestive system, taking in nutrients, breaking them down, and creating energy for the cell. Mitochondria are passed on through the egg, from mother to child.

Approximately 1 in every 6,500 babies inherits defective mitochondria from the mother. Without properly functioning mitochondria cells may starve, the baby can become blind, develop serious muscle weakness, become tired easily, there is a risk of heart disease, intestinal disorders, and in extreme cases premature death.

According to previous studies, using mitochondria from a donor egg could be one way of preventing mitochondrial diseases. In the UK alone, approximately ten couples each year would benefit from receiving mitochondria from a donor egg.

Baby would have DNA from three "parents"

Mitochondria have their own DNA, so if mitochondria from a donor egg were used, the baby would have DNA from the mother, father and the donor of the egg.

At the UK government's request, in September 2012 the Human Fertilisation and Embryology Authority launched a public consultation on the ethics of using DNA from three "parents" to prevent the passing on of serious mitochondrial diseases.

In the UK, carrying out mitochondrial replacement in the laboratory is legal, but embryos must not be used in treatment.

In March 2013, HFEA (Human Fertilisation and Embryology Authority) reported that there was no evidence that the three-person IVF procedure was unsafe and that there was "general support" for the idea.

On March 28th, HFEA sent the finalized public dialogue and scientific update reports from public consultation - "Medical frontiers: debating mitochondria replacement" - to the UK Government.

HFEA also gave the following advice regarding the ethics and science of new IVF-based techniques aimed at avoiding mitochondrial diseases:
  • Only clinics licensed by HFEA should be allowed to offer mitochondria replacement

  • Each mitochondria replacement proposal should be approved by HFEA. However, "Regulations should provide the flexibility to modify this in the future".

  • IVF clinics must make sure that follow-up research is done on each child born.

  • Mitochondria donors, like tissue donors have the right to anonymity. The resulting child should not have the right to track down the donor "although information exchange and contact could be arranged locally by mutual consent."

  • "A further assessment of the safety and efficacy should be commissioned by the HFEA once a clinic has submitted an application to carry out one of the techniques. This follows advice from an expert scientific panel that there is no evidence to suggest that mitochondria replacement is unsafe, but that further specific experiments should be conducted."
England's Chief Medical Officer, Prof Dame Sally Davies said "Scientists have developed ground-breaking new procedures which could stop these diseases being passed on, bringing hope to many families seeking to prevent their future children inheriting them. It's only right that we look to introduce this life-saving treatment as soon as we can."

Mitchondrial Replacement in IVF Procedures

Scientists have developed mitochondrial replacement techniques that use mitochondria from donated eggs to prevent mothers passing on mitochondrial diseases to their offspring.

These techniques result in healthy embryos without mitochondrial diseases. They have the DNA of three different people - the father, mother and egg donor. 20,000 genes come from the mother and father and 37 mitochondrial genes from the donor.

Mitochondrial replacement in IVF procedures affects the "germ line" - the donor's mitochondrial DNA will be passed on to future generations of the "three-parent" child. This is a fundamental change to human genetic inheritance.

The BBC quotes Dr. David King, director of Human Genetics Alert, who said "These techniques are unnecessary and unsafe and were in fact rejected by the majority of consultation responses. It is a disaster that the decision to cross the line that will eventually lead to a eugenic designer baby market should be taken on the basis of an utterly biased and inadequate consultation."

HFEA responded to some of Professor King's allegations. With regard to King suggesting that the HFEA consultation process was flawed and the analysis of findings misrepresented in public opinion, HFEA wrote "We strongly refute Dr King's suggestions and think it is important to address his comments. The consultation was made up of many strands. One strand of the consultation showed a small majority against mitochondria replacement and those people tended to have broader concerns about IVF.

In all the other public engagement strands a majority of respondents and participants supported the use of mitochondria replacement. We used a range of methods to explore these complex issues. Our consultation was a more nuanced exercise than simply counting up votes for and against the techniques."

The IVF technique to eliminate mitochondrial disease was pioneered at Newcastle University, England, by Professor Doug Turnbull and Professor Mary Herbert at Newcastle University.

Professor Doug Turnbull said: "I am delighted that the Government is moving forward with publishing draft regulations this year and a final version for debate in Parliament next year. This is excellent news for families with mitochondrial disease. This will give women who carry these diseased genes more reproductive choice and the opportunity to have children free of mitochondrial disease. I am very grateful to all those who have supported this work."

Professor Mary Herbert said "Today's announcement is really encouraging news for families affected by mitochondrial DNA disease. The IVF-based techniques currently under development offer the possibility of greatly reducing the risk to children of affected women. We are in the fortunate position of having substantial Wellcome Trust funding to continue to refine the techniques and to optimise their safety and efficacy.

"We have made good progress in optimising the pronuclear transfer technique and will continue to need a supply of healthy eggs to perform further tests on the safety of the technique. Obviously, the timescale will depend on the outcome of those tests."
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Women Lose Weight With Help From Avatar

Could an avatar modeling weight-loss behavior help you fight the flab? Perhaps, according to US researchers whose pilot study suggests a virtual world "alter ego" may help some women lose weight in the real world. If confirmed with further research, the approach may also offer a cost-effective alternative to "live" group or personal weight-loss training.

Estimates indicate some two-thirds of Americans are overweight or obese and many are struggling to get their weight down and keep it down, despite trying a multitude of pills, fads, diets and exercise plans.

Now a new pilot study published online in the July issue of the Journal of Diabetes Science and Technology, finds there is a high level of interest in using a virtual reality "alter ego" or avatar as an aid to weight loss, with initial results showing promise.

First author Melissa Napolitano, associate professor of prevention and community health at The George Washington University (GWU) School of Public Health and Health Services (SPHHS), says in a statement that virtual reality could be a promising new tool for people who want to lose weight and adopt healthier lifestyles:

"This pilot study showed that you don't have to be a gamer to use virtual reality to learn some important skills for weight loss," she explains.

Using virtual reality to model skills or provide reinforcement can be effective.

For example, research published in 2012 suggests that when individuals strongly identify with a cyber representation of themselves, known as an "avatar", it can influence their health and appearance.

And researchers at Stanford University found that people who watched avatars resembling themselves running on treadmills were more likely to exercise the next day than if they had watched unfamiliar avatars.

For their study, Napolitano and colleagues wanted to find out if avatars could help overweight women acquire weight-loss behaviors.

Their study was in two phases. The first phase was an online survey of 128 overweight women to get their reactions to the idea of observing an avatar modeling healthy weight-loss habits as a way to help them lose weight.

Although the women who completed the survey had been trying to lose weight in the previous 12 months and most had never used a virtual reality game or program, 88% said they would be willing to try it if it might help them lose weight.

Many of the respondents agreed that an avatar could help them visualize and then practise weight-loss behaviors, such as taking a walk every day or choosing healthy options when shopping for food.

Napolitano says there is evidence that seeing or copying the steps that lead to a desired goal can make it easier for people to change their habits.

The second phase involved developing and testing avatar-based technology modeling weight-loss behaviors such as taking exercise and practising portion control.

The technology was developed at Temple University in Philadelphia, where Napolitano conducted the study before transferring to GWU.

For the second phase, the team recruited eight women to take part in a four-week usability test. The women were asked to set weight-loss goals and keep a food and exercise diary.

For each of the four weeks, the women attended a clinic where they watched a 15-minute video of an avatar demonstrating healthy weight-loss behavior.

For instance, one demonstration showed the avatar taking her place at the dinner table, looking at various dishes, considering portion sizes, rejecting ones that were too large and choosing the right portion size.

Another demonstration shows the avatar walking on a treadmill, and learning the correct, moderate intensity pace to help with her weight-loss goals.

At the end of the four weeks, the women on average lost 3.5 pounds (1.6 kilos).

Most of the women said the avatars were helpful, and they all said they would recommend the program and that it influenced their diet and exercise behavior.

Napolitano says the average weight loss was fairly typical for a four-week program, but they hope that watching the avatars model the healthy weight-loss behaviors will be more likely to help the women maintain their new healthy habits in the longer term and keep the weight off.

The team believes that the more the avatar resembles the user, the more likely they are able to identify with it and model what it demonstrates.

Although the women could not interact with their avatar, they could pick out some basic variables like skin color and shape. Napolitano says this helps the user visualize and learn the new behavior.

Co-author Giuseppe Russo, one of the experts on the technical programming team at Temple's Sbarro Institute for Cancer Research and Molecular Medicine, who helped develop the avatar virtual reality simulation, says:

"This study is a perfect example of how virtual reality can be used in promoting human health."

Napolitano says their study is just a "first step", and more studies are now needed to confirm and consolidate these findings, and also show that men and women would both find avatars a useful aid to losing weight and maintaining weight-loss.

"We are excited by the potential of this technology as a scalable tool to help people learn the skills to be successful at weight loss over the long run," she adds.
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Late Bedtimes Linked To Weight Gain In Healthy People

If you are healthy and go to bed late regularly and you do not sleep enough, your risk of gaining weight is significantly greater than if you go to bed earlier and have a good night's sleep every night, says a new study published in the journal Sleep.

If you also eat late at night, you will probably put on even more weight, researchers from the University of Pennsylvania added. In fact, they say it is the extra eating among sleep-deprived individuals that appears to be the main reason for the weight gain.

The authors say that theirs is the largest study so far of healthy people, under controlled laboratory conditions, that demonstrates a clear association between very late night sleeping combined with sleep restriction and weight gain.

Andrea Spaeth and team had one group of participants sleeping just from 4 a.m. to 8 a.m. each night for five nights running, and compared them to a control group who were in bed from 10 p.m. to 8 a.m.

The investigators also found that those who slept much less consumed more food, and therefore calories, compared to the normal-hours sleepers. Meals eaten during the late-night hours had a higher overall fat content than the other meals.

Lead author, Andrea Spaeth, a doctoral candidate in the psychology department at the University of Pennsylvania, said:

"Although previous epidemiological studies have suggested an association between short sleep duration and weight gain/obesity, we were surprised to observe significant weight gain during an in-laboratory study."

The experiment was conducted at the Sleep and Chronobiology Laboratory at the Hospital of the University of Pennsylvania. It involved 225 people aged between 22 and 50 years, all of them healthy and non-obese. They were randomly selected either into the sleep restriction group or control group, and stayed in the lab for up to 18 days.

The participants were all served set meals at the same time each day. They also had free, 24-hour access to a well-stocked kitchen. They were allowed to move around, but not to exercise. They could play video games, watch TV, read and do other sedentary activities.

The study also showed that when sleep-deprived for several consecutive days:
  • Men put on more weight than women
  • African-Americans piled on the pounds more rapidly than Caucasians
Spaeth said:

"Among sleep-restricted subjects, there were also significant gender and race differences in weight gain. African Americans, who are at greater risk for obesity and more likely to be habitual short sleepers, may be more susceptible to weight gain in response to sleep restriction. Future studies should focus on identifying the behavioral and physiological mechanisms underlying this increased vulnerability."

Weight Loss Programs Should Include Proper Sleep

Researchers from the University of Colorado Bolder explained in the March 2013 issue of PNAS (Proceedings of the National Academy of Sciences) that even though sleep-deprived people burn more calories because they are moving around when they would otherwise be sleeping, these people end up consuming many more calories and gain weight. Their extra calorie-consumption is greater than the additional calories burned while being awake longer.

Kenneth Wright, director of the Sleep and Chronobiology Laboratory explained that it is not just the less sleep that causes weight gain. When people sleep less they eat more.

Wright said "I don't think extra sleep by itself is going to lead to weight loss. But I think it could help. If we can incorporate healthy sleep into weight-loss and weight-maintenance programs, our findings suggest that it may assist people to obtain a healthier weight."
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State Battles Federal Government for Independence in Medical Marijuana Case

Magistrate Maria-Elena James ruled that a cannabis dispensary in Oakland, CA, is free to stay open while local authorities fight federal prosecution to shut it down, reports Reuters.
The ruling came in on July 3rd, just under the wire for local supporters of the Harborside Health Center to celebrate their temporary medical marijuana freedom on the Fourth of July.
This long-standing court case between California and the US government is currently in an appeals stage, whereby the local government is contesting Magistrate James's February decision that the city has no right to interfere in a federal prosecutor's action to shut down or seize the property of the Oakland-based pot store.
Currently in the US, marijuana is not an approved drug according to the Federal Drug Administration (FDA), but rather an illegal narcotic. Still, the District of Columbia and 16 states have deemed cannabis to be legal if sold as a medicine prescribed by a doctor.

The medical world weighs in on marijuana

Outside of politics, the medical community has waged its own debate over the last decade about the health merits of marijuana. The Center for Medicinal Cannabis Research (CMCR), which is run by the University of California, has been conducting scientific studies for several years.
In one study involving effects of cannabis on pain from HIV-related peripheral neuropathy, the CMCR concluded that 52% of patients who smoked marijuana had over a 30% reduction in pain, compared to 24% in the placebo group.
And in another study conducted by the CMCR and published by the Canadian Medical Association Journal (CMAJ), researchers found that smoked cannabis significantly reduced symptoms and pain associated with multiple sclerosis spasticity.

Cannabis for medical use is a polarizing issue

Still, the medical community is divided, with some professionals calling for more in-depth studies and research before medical marijuana is prescribed to patients.
A paper published by the National Center for Biotechnology Information (NCBI) suggests that:
"over the longer term cannabis may have unwanted systemic and psychoactive adverse effects that must be taken into consideration in chronic pain populations, who have high rates of co-occurring medical illness and co-morbid psychiatric and substance use disorders."
Whether a medical or political issue, medical marijuana has strong supporters who are either for or against it.
In an act of solidarity with the state's physicians, the Medical Board of California published standards for physicians who prescribe medical marijuana to patients.
According to a statement from the Board, physicians who prescribe cannabis will not receive any ill effects toward their physician's license, so long as they follow good medical practice during patient consultation, including:
  • History and good faith examination of the patient
  • Development of a treatment plan with objectives
  • Provision of informed consent including discussion of side effects
  • Periodic review of the treatment's efficacy
  • Consultation, as necessary
  • Proper record keeping that supports the decision to recommend the use of medical marijuana.
Though the case involving the fate of Oakland's medical marijuana dispensary has yet to be resolved, Cedric Chao, the attorney representing the city in the case, remains positive, saying:
"The court has recognized that Oakland has legitimate interests in protecting its residents' health, in promoting public safety, and in protecting the integrity of its legislative framework for the regulation of medical cannabis. Today's order, coming right before the July Fourth holiday, reminds us all that one of the strengths of our country is its independent judiciary."
The state of California and supporters of the Harborside Health Center may be on the verge of a metaphorical Boston Tea Party scenario with the federal government, but for this Independence Day, they can hold onto their tea.
Or even smoke it.
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Exercise Helps Brain Become More Resilient To Stress

Physical exercise reorganizes the human brain so that it responds better to stress and normal brain function is less likely to be affected by anxiety, researchers from Princeton University wrote in the Journal of Neuroscience.

In an animal experiment, the authors found that when very physically active mice were exposed to a stressor - cold water - neurons in their brains that shut off excitement in the ventral hippocampus became much more active. The ventral hippocampus is a region in the brain that regulates anxiety.

This study may also resolve an inconsistency in research regarding the effect exercise has on the brain - namely that physical activity lowers anxiety while at the same time encouraging the growth of new neurons in the ventral hippocampus.

Exercise should, in theory, lead to more anxiety, not less, because these young neurons are typically more excitable than their older equivalents. However, this study found that physical activity also enhances the mechanisms that stop these neurons from firing.

Senior author, Elizabeth Gould, Princeton's Dorman T. Warren Professor of Psychology, explained that the effect physical exercise might have on the ventral hippocampus specifically has not been explored deeply. In this study, the team was able to isolate brain cells and regions that play key roles in the regulation of anxiety. They believe their findings may help researchers better understand and treat anxiety disorders.

From an evolutionary perspective, the study also showed how the brain can be surprisingly adaptive, tailoring its own processes to an organism's surroundings and lifestyle. Less physically fit creatures, for example, may benefit from a higher likelihood of anxious behavior. Gould said "Anxiety often manifests itself in avoidant behavior and avoiding potentially dangerous situations would increase the likelihood of survival, particularly for those less capable of responding with a 'fight or flight' reaction."

Professor Gould said:

"Understanding how the brain regulates anxious behavior gives us potential clues about helping people with anxiety disorders. It also tells us something about how the brain modifies itself to respond optimally to its own environment."

In this study, the mice were divided into two groups:
  • The active group - all the mice had free access to a running wheel
  • The sedentary group - there was no running wheel
Mice love running - give them a wheel and they will run about 2.5 miles (4 kilometers) every night. Six weeks later, the mice were exposed to brief periods of cold water.

Nearly as soon as they were exposed to the cold water (the stressor) the brains of the sedentary and active mice behaved differently:
  • In the sedentary group, the cold water triggered an increase in "immediate early genes" - short-lived genes that are turned on rapidly when a neuron fires.
  • In the active group these genes were not present, suggesting that their neurons did not immediately become super excited in response to the stressor.
The brain of an active mouse "showed every sign of controlling its reaction to an extent not observed in the brain of a sedentary mouse". Inhibitory neurons, which are known to keep excitable neurons in check, became much more active. Also, the neurons in the active mice's brains released more GABA (gamma-aminobutyric acid), a neurotransmitter that calms down neural excitement. There were higher levels of the protein that packages GABA into vesicles for release into the synapse in the active mice.

When the scientists blocked the GABA receptor that tamps down neural activity in the ventral hippocampus, the anxiety-reducing effect of physical exercise was canceled out.

In an Abstract in the journal, the researchers concluded:

"Together, these results suggest that running improves anxiety regulation by engaging local inhibitory mechanisms in the ventral hippocampus."

Exercise, even when forced, reduces anxiety and depressive symptoms

Even forced exercise reduces anxiety - physical activity helps relieve the symptoms of anxiety and depression whether you exercised because you wanted to or were forced to, researchers from the University of Colorado, Boulder, wrote in the European Journal of Neurosciences (February 2013 issue).

The authors explained that previous studies had demonstrated how exercise can help protect against stress-related disorders. However, nobody had looked into the effect forced exercise might have on anxiety. Examples of forced exercise may be seen among high school students, college and professional sportsmen and women, and military personnel.

Greenwood wondered "If exercise is forced, will it still produce mental health benefits? It's obvious that forced exercise will still produce peripheral physiological benefits. But will it produce benefits to anxiety and depression?"

The researchers designed an animal experiment using rats. They were divided into two groups, active and sedentary. The active group was further split into two, with one running whenever it wanted, and the other having to run on mechanized wheels that turned on at different speeds and for varying periods so that both active groups ended up doing the same amount of exercise.

Six weeks later the rats were exposed to a stressor and their anxiety levels were tested the following day.

They found that regardless of whether the rats were forced to run or chose to, the physically active rats were protected against stress and anxiety equally, compared to the sedentary rats.

Greenwood said "The implications are that humans who perceive exercise as being forced - perhaps including those who feel like they have to exercise for health reasons - are maybe still going to get the benefits in terms of reducing anxiety and depression.

A British study showed that regular intense physical exercise protects men from anxiety and depression for many years after they stop.
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What Are Benzodiazepines? What Are The Risks Of Benzodiazepines?

Benzodiazepines are a class of psychoactive drugs used to treat anxiety, insomnia, and a range of other conditions. They are one of the most widely prescribed medications in the U.S., particularly among elderly patients.

Benzodiazepines possess sedative, hypnotic, anti-anxiety, anticonvulsant, and muscle relaxant properties.

Benzodiazepines work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) - which is responsible for reducing the activity of neurons that cause stress and anxiety.

Short term use of these mediations are generally safe and effective. However, the long term use of benzodiazepines is very controversial, because of the potential of tolerance, dependance, and other adverse effects.

The first benzodiazepine - chlordiazepan - was accidentally developed in 1955 by Leo Sternbach.

Medical uses of benzodiazepines

  • Generalized anxiety disorder (GAD) - Benzodiazepines are often used in the treatment of GAD. The National Institute of Health and Clinical Excellence (NICE) recommends the use of benzodiazepines for short term GAD treatment for no longer than one month. SSRIs are considered to be more effective at treating long-term GAD.

  • Insomnia - As Benzodiazepines can lead to dependence, they are normally only used as a short-term treatment for severe insomnia or on a "irregular/as-needed" basis.

  • Seizures - Benzodiazepines are powerful anticonvulsants and are very effective at preventing prolonged convulsive epileptic seizures. The first-line hospital choices for treating seizures are either clonazepam, diazepam, or lorazepam.

  • Alcohol withdrawal - The most common benzodiazepine prescribed for alcohol withdrawal is chlodiazepoxide, followed by diazepam. The drugs help alcoholics with detoxification and reduce their risk of severe alcohol withdrawal effects. A study conducted at the University of Ioannina School of Medicine in Greece found that people given benzodiazepines were 84 percent less likely to have alcohol withdrawal-related seizures compared to those given placebos

  • Panic attacks - Because of their rapid anti-anxiety effects, benzodiazepines are very effective at treating anxiety associated with panic disorder. The American Psychiatric Association says that their use for initial treatment is strongly supported by many different study trials. However, UK based NICE says that long-term use of benzodiazepines for the treatment of panic disorder is not recommended.

Mechanism of benzodiazepines

The human brain contains many different neurotransmitters which are responsible for sending messages between brain cells, these messages have either "tranquilizing" or "excitatory" effects.

When someone feels overly anxious the brain becomes "excited" and over-active, tranquilizing transmitters need to quickly send messages to brain cells to slow down activity in the brain and reduce the symptoms of anxiety.

GABA is the brain's tranquilizing neurotransmitter, and billions of brain cells respond to its signals.

Benzodiazepines work by enhancing the effect of the neurotransmitter GABA. The drugs contain chemicals which add to the calming effect already produced by the human body and essentially keep the brain in a more "tranquilized" state.

What are the different types of benzodiazepines?

There are many different benzodiazepines and they all have differences in potency, speed at which they are metabolized, and "half-life" (time required for the quantity of the drug in the bloodstream to decrease to half its value), and therapeutic use.

List of Benzodiazepines:
  • Alprazolam (Xanax) - FDA approved for the treatment of panic and anxiety disorders. Alprazolam is the most prescribed benzodiazepine in the U.S.

  • Bromazepam (Lectopam) - Used as a short-term treatment for anxiety and to alleviate anxiety before surgery.

  • Brotizolam (Lendormin) - A very potent anxiolytic, hypnotic, and anticonvulsant drug with fast onset of action. It is used to treat severe insomnia. The drug is not approved in Canada, Britain and the U.S.

  • Chlordiazepoxide (Librium) - Used for the management of alcohol withdrawal syndrome.

  • Clonazepam (Klonopin) - A high potency sedative, anxiolytic, hypnotic, and anti-convulsant drug. Clonazepam is a long acting benzodiazepine with a half life between 20 to 50 hours. The FDA has approved the drug for treatment of epilepsy and panic disorder.

  • Clorazepate (Tranxene) - A hypnotic, sedative, anxiolytic drug used to treat severe insomnia and anxiety disorders.

  • Clotiazepam (Clozan) - Used for short term anxiety treatment.

  • Cloxazolam (Sepazon) - Prescribed to treat anxiety.

  • Diazepam (Valium) - An anxiolytic, hypnotic, sedative, and anticonvulsant drug with rapid onset. It is used to treat panic attacks, insomnia, seizures, restless leg syndrome, and alcohol withdrawal. Diazepam is also used for the treatment of benzodiazepine dependence because of its low potency.

  • Estazolam (ProSom) - A sedative, anxiolytic drug prescribed for short term treatment of insomnia

  • Etizolam (Etilaam) - Used to treat insomnia

  • Flunitrazepam (Rohypnol) - Usually prescribed for short term treatment of chronicly severe insomnia. The drug is sometimes misused as a date rape drug because of its ability to cause amnesia.

  • Flurazepam (Dalmane) - A sedative, anxiolytic drug used to treat mild to moderate insomnia.

  • Loprazolam (Somnovit) - A sedative, anxiolytic drug used to teat moderately severe insomnia.

  • Lorazepam (Ativan) - A very high-potent drug with sedative, anxiolytic, and muscle relaxation properties. It is prescribed for the short-term management of severe anxiety.

  • Midazolam (Dormicum) - A high potent drug with anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. It is used to treat acute seizures and severe insomnia, as well as inducing sedation before surgical procedures.

  • Nitrazepam (Alodorm) - A hypnotic drug used to treat severe insomnia.

  • Nordazepam (Nordaz) - An anticonvulsant, anxiolytic, muscle relaxant and sedative drug used to treat anxiety.

  • Oxazepam (Seresta) - Used to treat anxiety and insomnia and control the symptoms of alcohol withdrawal.

  • Temazepam (Restoril) - Approved for the short-term treatment of insomnia.

Side effects and risks associated with benzodiazepines

Side effects of benzodiazepine usage may include:
  • Drowsiness
  • Confusion
  • Dizziness
  • Trembling
  • Impaired coordination
  • Vision problems
  • Grogginess
  • Feelings of depression
  • Headache
A study, published in the BMJ (British Medical Journal), identified an association between prolonged use of benzodiazepines among seniors (over 65s) and an increased risk of dementia. Long-term use of benzodiazepines can also result in physical dependence.

The withdrawal symptoms of benzodiazepines include trouble sleeping, feelings of depression and sweating.

If someone has become dependent on a benzodiazepine it is crucial that they do not suddenly stop therapy cold turkey. Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help.

Drug interactions

Before beginning treatment with a benzodiazepine it is important to tell your doctor about every medication you are on.

Some drugs, including antidepressants and oral contraceptives can cause excessive drug accumulation and increased side-effects of benzodiazepines.

In contrast, St John's wort, the antibiotic rifampicin, and the anticonvulsants carbamazepine and phenytoin decrease the effectiveness of benzodiazepines.

Most importantly, patients should never mix benzodiazepines with alcohol or opioids, the interaction can be life threatening.

Misuse of benzodiazepines

Abuse of Benzodiazepines is becoming a serious public health issue. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hospital admissions among people over the age of 12 related to the abuse of benzodiazepine drugs rose from 22,400 in 1998 to approximately 60,200 in 2008.

SAMHSA Administrator Pamela S. Hyde, J.D., said that "the misuse of benzodiazepines along with other prescription drugs is fueling the rise of treatment admissions. Prescription drug misuse is dangerous and can even be deadly.

Everyone has a role to play in helping to prevent prescription drug misuse. Simple steps such as locking up medications and proper disposal of unused medications are easy ways people can contribute to reducing the problem."
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Two Men HIV-Free After Bone Marrow Transplants

Two HIV-positive men no longer have detectable virus in their blood after receiving bone-marrow transplants to treat Hodgkin's lymphoma. Timothy Henrich and Daniel Kuritzkes , from Brigham and Women's Hospital, Boston, USA, explained at the International AIDS Society Conference, Kuala Lumpur, Malaysia, that one patient has been off HIV medications for over fifteen weeks and the other seven weeks, and there are still no signs of the virus rebounding.

Completely ridding a patient of HIV is extremely difficult. The virus hides within human DNA in such a way as to become "untouchable". ART (anti-retroviral therapy) helps control the virus in the bloodstream. However, as soon as ART stops, HIV usually replicates rapidly.

The two patients had been HIV-positive for over thirty years. They had both developed Hodgkin's lymphoma, a blood cancer that requires a bone marrow transplant if chemotherapy and other treatments failed. Blood cells are made in the bone marrow - experts believe the bone marrow is a major HIV reservoir.

After undergoing the bone marrow transplants, one man has had no detectable HIV in his blood for four years, and the other for two years.

Lead researcher, Dr. Timothy Henrich warned against using the C-word (cure), saying it is still early days.

In an interview with the BBC, Henrich said:

"We have not demonstrated cure, we're going to need longer follow-up. What we can say is if the virus does stay away for a year or even two years after we stopped the treatment, that the chances of the virus rebounding are going to be extremely low."

Last year, Kuritzkes and Henrich announced that HIV was easily detected in the blood lymphocytes of the two patients before their transplants, but within eight months post- transplant the virus had become undetectable. At the time the patients were still on ART.

The two patients came off ART earlier this year. They are regularly monitored and have no detectable HIV virus. Henrich said "We demonstrated at least a 1,000 to 10,000 fold reduction in the size of the HIV reservoir in the peripheral blood of these two patients. But the virus could still be present in other tissues such as the brain or gastrointestinal track."

If the virus were to rebound, it would mean that the brain, GI tract, lymph nodes or some other sites are important reservoirs of infectious virus "(and) new approaches to measuring the reservoir at relevant sites will be needed".

Bone marrow transplant not the answer to HIV infection

Bone-marrow transplant as a way of curing people infected with HIV is unlikely to ever become standard clinical practice.

In this case, the two patients had blood cancer; the transplants were performed to treat the cancer, not the HIV infection.

Most HIV-positive people do not have blood cancer. Bone marrow transplants are costly and risky - patients face a 20% risk of death. Before undergoing a transplant, the patient's immune system needs to be weakened to minimize the risk of rejection.

A third patient, who also had lymphoma and was HIV-positive and had received the same transplant as the two Boston subjects, died from cancer.

With ART, a person with HIV can enjoy the same life expectancy as other people.

Doctors "cured" baby born with HIV infection

In March this year, doctors from Johns Hopkins Children's Center, the University of Mississippi Medical Center and the University of Massachusetts Medical School announced that an HIV-positive baby who was administered ART within 30 hours of being born had been "cured".

Deborah Persaud, M.D., explained that it is very uncommon to treat a baby for HIV-infection so soon after birth. She added that this was the first case of a functional cure in an HIV-positive infant. The medical team believes that the prompt administration of antiretroviral therapy led to the newborn's cure.

Dr. Persaud said "Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place."

First apparent HIV-infection cure probably occurred in Germany, 2010

In December 2010, researchers from Charite - University Medicine Berlin, Germany, wrote in the journal Blood than an acute myeloid leukemia patient, Timothy Brown, who was also HIV-positive had been cured of HIV infection after receiving a bone marrow transplant.

The scientists wrote "Our results strongly suggest that cure of HIV has been achieved in this patient."

In 2007 Timothy Brown stopped receiving ART, had his own immune system effectively wiped out with high-dose chemotherapy and radiation therapy, and received a bone marrow transplant.

In this case, the donor had a very rare gene mutation - CCR5-delta32 - which protected him from HIV infection, meaning that Brown acquired that protection. In July 2012, scientists in California found traces of HIV in his tissue. However, Brown says that any virus that remains in his body is completely inactive ("dead") and cannot replicate.
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Super-Quick Test for Bacteria Thanks to Nano-Sized "Tuning Forks"

Some bacterial infections are so severe that if the right antibiotic is not given straight away, there is a high chance the patient will die. But unfortunately with current methods it can take days if not weeks to test a bacterium's response to treatment. Now researchers in Switzerland have developed a test based on nano-sized "tuning forks" that could cut this timescale to minutes and thereby save lives.
At present, to find out if a bacterium is responding to antibiotic treatment, clinicians have to wait and see what happens when they try to grow it in a culture. For some types of bacteria, such as the one that causes tuberculosis (TB), this can take up to a month.
The nano-sized "tuning forks" that the researchers in this new study have developed are tiny and extremely sensitive cantilevers, thinner than human hair, that can pick up almost imperceptible atomic-level vibrations emitted by live bacteria.
Researchers from Ecole Polytechnique Fédérale de Lausanne (EPFL) report how they developed and demonstrated the technology in a study published online in Nature Nanotechnology on 30 June.
"Here we show that the fluctuations of highly sensitive atomic force microscope cantilevers can be used to detect low concentrations of bacteria, characterize their metabolism and quantitatively screen (within minutes) their response to antibiotics," they write.

Tuning Forks Pick Up Bacterial Vibrations

Live bacteria are busy with metabolic activity, the set of life-sustaining chemical reactions that goes on in living cells. The researchers propose that it is this metabolic activity that sends out the tiny vibrations that their technology detects.
Placing the bacteria on or near the nano-sized tuning forks or cantilevers causes them to oscillate in response to the bacterial vibrations. The oscillations are very small, of the order of one millionth of a millimeter.
Measuring device
The measuring device © EPFL / Alain Herzog
By projecting a laser beam onto the cantilever and picking up how the light is reflected back, the researchers convert the oscillations into electrical signals that can be read easily.

Fast and Accurate Way to Find Out If Antibiotic Is Working

When the electrical signal is a flat line, it means there are no live bacteria. An effective way to find out very quickly whether treatment with an antibiotic has had the desired effect. This is especially useful for testing resistant strains.
Study author Giovanni Dietler, a physicist who investigates properties of living materials, says in a statement:
"This method is fast and accurate. And it can be a precious tool for both doctors looking for the right dosage of antibiotics and for researchers to determine which treatments are the most effective."
"We applied this methodology to Escherichia coli and Staphylococcus aureus, showing that live bacteria produced larger cantilever fluctuations than bacteria exposed to antibiotics," write the authors.

Technology Fits In a Matchbox

The researchers have miniaturized their technology so it fits in a device the size of matchbox, making it easily portable for clinical use.
Dietler says they could make it even smaller:
"By joining our tool with a piezoelectric device instead of a laser, we could further reduce its size to the size of a microchip," he explains.
And he also sees it may be possible to develop a version that can test a series of antibiotics on one strain in only a few minutes.

Nano-Sized Tuning Forks May Have Use In Cancer Treatment

The researchers suggest their nano-sized tuning forks could also be useful for testing response to chemotherapy treatment.
They are currently looking at a way to use their nano-sized tuning forks to measure the metabolism of tumor cells that have been exposed to chemotherapy.
Again, as with bacterial infections, the huge advantage would be to see within minutes instead of weeks, whether the cancer was responding to treatment.
Another way scientists are using nanotechnology in medicine is to target therapy at the cellular level. For example, one group at MIT in the US has developed an approach that could be used to create "nano-factories" that make protein-based drugs at tumor sites to fight cancer.
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