VENTURE 17             - Private Education for the Medical Arts and Sciences
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This article is Part II of my recent syndicated article on the use of Heroin in hospice patients. I think you will find it informative and historically interesting. If you haven’t read the first article, it is entitled “Heroin, Why It’s Here, And Where It Stands”. Read on.
In as far as the treatment of hospice patients, certainly, an argument could be made for fentanyl, the most potent opiate pain killer ever synthesized by man, and available in the United States. Also known as Duragesic®, and Sublimaze®, the drug’s ability as a pain palliator is legend, but much like morphine, it is more specifically designed for pain and questionable in delivering the euphoric side effect available from Heroin.
Keep in mind that fentanyl is a highly selective opiate mµ receptor agonist. Binding the receptor tightly, fentanyl is built perfectly for pain control. As the synthesis of opiate compounds has evolved, the reach for better pain control with fewer side effects has been the goal in pharmaceutical science.
The “dirtier” or less refined the opioid, the more of accompanying side effects, including euphoria, tend to be present. For instance, opium, codeine, and hydrocodone are considered “more dirty” by practicing physicians. As a drug is refined and we move toward better pain control, one finds drugs like oxycodone, hydromorphone, meperidine, and morphine, ultimately reaching the pristine fentanyl. Interestingly, the dirtier the opioid, the lower on the controlled substance list we find the drug. Go figure.
Fentanyl is what we in Medicine call a “designer drug”. Born in the streets of California, it found its way into the U.S. Pharmacopeia in a circuitous fashion. In 1973, when the Bureau of Narcotics and Dangerous Drugs (BNDD) was disbanded and the Department of Justice reformed it as the Drug Enforcement Administration (DEA), the well known list of controlled substances and the scheduling system for control types was published and made into law.
This list included all known opiate compounds at the time. What resulted from this was a group of black market chemists beginning a campaign to outwit the DEA by modifying opiate drugs, bending their molecular structure so as not to appear on the DEA’s list. A modification would occur and appear on the streets, illegal profits would be made, and with time the DEA would catch up. The DEA would then add the new street drug to their list, but the chemists would move on to a different modification not on the list. This went on for years.
The products of this “make and chase” routine, were “designer drugs”, made by black market chemists to escape the controlled substance list and prosecution by the federal government.
One of these designer drugs ended up on the street as a “new Heroin”, dubbed “China White”. When it first showed up, many Heroin addicts who first tried it at doses to which they were accustomed, died from overdoses. The drug was extremely potent and much lower dosages were required. The Ld50, what we refer to as the lethal dose which will kill at least 50% of those who consume the drug, was tiny when compared to Heroin’s Ld50. Although China White has been the center of much fiction in literature and film lore, the real China White was a designer drug from the black market now known as fentanyl. That’s right!
A pharmaceutical firm eagerly observing and following this war between the DEA and criminal street chemists, isolated the compound, patented it, got FDA approval in the U.S., and reintroduced it as a legal controlled intravenous pain killer under the name Sublimaze®, and later, the transdermal form, Duragesic®.
To this day, Janssen Pharmaceuticals plays this down; vehemently assuring the medical world that Dr. Paul Janssen synthesized the drug in 1960. However, those of us in the medical profession know that they garnished the drug from the streets of Los Angeles and didn’t invent it on their own. Not surprisingly, the profits made from this “legal form” of the drug were in the billions of dollars.
So yes, we have excellent pain nullifying drugs available, they even have a colorful history, but what Medicine seeks is a comfortable place for our patients who are dying with malignant pain. Many in the profession would say, “All we seek for our patients is a peaceful and comfortable calling back to Elysium”.
We have come full circle, and here we are, back at Heroin. We can only wait to see what the future of opiate and even cannabinoid “receptor binding” research brings. Hopefully a drug that is safe, a drug which is perfect for our hospice patients, and with no stigma attached to it.
Dr. Counce

Stem Cell Research Stopped?

This is a re-post from last year when a small group of very naive Christian attorneys nearly cost the tax payers $500,000,000, and a total loss of 25 years of research to cure Paraplegia, Quadriplegia, Alzheimers Disease, Parkinson's Disease, Coronary Artery Disease, and Diabetes to name only a few.
Are we going to continue the same type of censorship we had under the Spanish Inquisition, which allowed the Christian lead world to delay the age of enlightenment by 800 years? We might as well be in Stalinist Russia. It’s called separation of church and state. WAKE UP, PEOPLE. This is a reminder that the earth is not flat. It’s round. The Black Plague was not a purging of mortal sins. It was a  tiny organism we now know how to control. Step aside and let us get our work done so we can continue our craft, which is to save lives and heal the crippled. GET A CLUE and either help or shut up!
Before you get a half informed attitude, read the whole article. Stay informed. Read about what we scientists are doing for you. Learn! Then you can talk. If you have something to say, make a comment below.
Here is the original article. Read it.

Stem Cell Ruling to Be Appealed; Some Work to Stop
WASHINGTON (Aug. 24, 2010) -- The government will quickly appeal a court ruling that undercut federally funded embryonic stem cell research, the Obama administration declared Tuesday, but dozens of experiments aimed at fighting spinal cord injuries, Parkinson's disease and other ailments probably will stop in the meantime.

The White House and scientists said Monday's court ruling was broader than first thought because it would prohibit even the more restricted stem cell research allowed for the past decade under President George W. Bush's rules.

The Justice Department said an appeal is expected this week of the federal judge's preliminary injunction that disrupted an entire field of science.

The Justice Department is set to appeal a court ruling that undercut federally funded embryonic stem cell research.

That initial ruling won't stop all the work that scientists call critical to finding new therapies for devastating diseases. The National Institutes of Health told anxious researchers late Tuesday that if they've already received money this year - $131 million in total - they can keep doing their stem cell experiments.

But 22 projects that were due to get yearly checks in September, $54 million worth, "will be stopped in their tracks," said NIH Director Francis Collins - meaning a waste of the millions those scientists already have spent unless they can find private dollars to keep the stem cells alive. Dozens more proposals won't get a hearing pending the court case's conclusion.

"This decision has just poured sand into the engine of discovery," Collins said.

However, the ruling drew praise from the Alliance Defense Fund, a group of Christian attorneys who helped with the lawsuit filed by two researchers against the administration rules.

"The American people should not be forced to pay for experiments - prohibited by federal law - that destroy human life. The court is simply enforcing an existing law passed by Congress that prevents Americans from paying another penny for needless research on human embryos," said Steven H. Aden, the group's senior legal counsel.

President Barack Obama, who last year ordered an expansion of stem cell research, "put forward stringent ethical guidelines, and he thinks that his policy's the right one," Deputy Press Secretary Bill Burton told reporters Tuesday.

Asked if it might take new legislation from Congress to counter the ruling from U.S. District Judge Royce Lamberth, Burton said the administration was exploring all avenues "to make sure that we can continue to do this critical lifesaving research."

How quickly any appeal could go through may determine how much is permanently lost.

"These cells are notoriously finicky, and you have to take care of them every day. You can't just lock up a lab and walk away for two weeks and come back and everything's fine," said Dr. Jonathan Moreno, a medical ethicist at the University of Pennsylvania, where scientists were scrambling to tell which projects had to halt and which didn't.

If it takes "months to settle the legal wrangling, then we will just end our work," said Dr. Sean Morrison, director of the University of Michigan Center for Stem Cell Biology, whose lab is studying embryonic stem cells in hopes of reversing a serious intestinal birth defect.

Already, one leading stem cell researcher had shifted gears: At Children's Hospital Boston, Harvard researcher Dr. George Daley told his team to assume they couldn't use any of millions of dollars in government grant money to nurture the embryonic stem cells growing in his lab but must keep those cells alive by using equipment bought with private funds.

Lamberth on Monday temporarily blocked government funding of embryonic stem cell research, ruling that the pending lawsuit against the Obama policy was likely to succeed in its argument that such research violates the intent of a law prohibiting use of taxpayer dollars in work that destroys an embryo.

That law, called the Dickey-Wicker amendment, was written several years before scientists began growing batches, or lines, of stem cells culled from embryos, and Obama and two previous administrations - Bush and Clinton - had made a distinction between it and stem cell research.

Here's how: Culling embryonic stem cells - master cells that can turn into any tissue of the body - does kill a days-old embryo, so doing that must be funded with private money. But once the cells are culled, they can reproduce in lab dishes indefinitely. Hence government policies that said using taxpayer dollars to work with the already-created batches of cells were OK, and Congress not only never overturned those policies, it twice passed legislation specifically calling for tax-funded stem cell research, legislation that Bush vetoed.

Some Democrats said Tuesday they would try the legislation again, and Sen. Tom Harkin, D-Iowa, pledged a hearing on the court ruling as soon as Congress returns next month.

Bush had allowed taxpayer-funded research on 21 stem cell lines. Obama expanded - up to 75 so far - the number that could be used but with additional caveats: that the original embryo was left over from fertility treatment and the woman or couple who donated it did so voluntarily and was told of other options, such as donating the embryo to another infertile woman.

The lawsuit was filed by two scientists who argued that Obama's expansion jeopardized their ability to win government funding for research using adult stem cells - ones that have already matured to create specific types of tissues - because it would mean extra competition.

But learning how embryonic stem cells can be so flexible is crucial to scientists' ultimate objective, said Dr. Elaine Fuchs of Rockefeller University, who works with adult stem cells: Taking ordinary skin cells and slipping genes inside to make them embryo-like so they can grow other tissues.

"The progress of adult stem cell research, in my view, has been really set backward" by the ruling, too, she said.

And other researchers who work with all types said the competition argument sets a dangerous precedent. They said the NIH has spent triple the amount on adult stem cells as embryonic - and that science in this country has always been funded according to its merit.

Do not forget what we in Medicine do for you. We can give you a new heart or a liver or a kidney. We wiped Diphtheria, and Small Pox off the face of the Earth. We gave you the x-ray and antibiotics. We can cure cancer with radiation and plants from the rain forest. There is so much more to come.
Dr. Counce