[HN Gopher] FDA approves a novel drug for schizophrenia
___________________________________________________________________
FDA approves a novel drug for schizophrenia
Author : tintinnabula
Score : 220 points
Date : 2024-09-29 18:02 UTC (1 days ago)
(HTM) web link (www.washingtonpost.com)
(TXT) w3m dump (www.washingtonpost.com)
| RobotToaster wrote:
| It's this
| https://en.wikipedia.org/wiki/Xanomeline/trospium_chloride
| kstrauser wrote:
| > M4 and M1 receptor stimulation indirectly rebalances
| dopaminergic and glutamatergic circuits involved in the
| symptoms associated with neurological and neuropsychiatric
| diseases such as schizophrenia and Alzheimer's disease.
|
| Whoa. Wonder if that's being evaluated?
| jmcgough wrote:
| Yes, it's being tested for autism as well.
| LoganDark wrote:
| I wonder what their hopes are for autism. I think the
| detail-oriented (or at least logic-oriented) thinking at
| least is an intrinsic part of brain development in
| autistics, but I wonder if it'll ever be possible to
| control certain other symptoms of autism through
| medication.
| consteval wrote:
| It could very well become a cost/reward analysis thing
| since Autism is a spectrum disorder. People who are high-
| functioning will probably be fine without the drug, but
| people who are, for example, non-verbal may be more
| willing to take it.
|
| I'm assuming such a drug would have drastic drawbacks in
| terms of how Autistic people think. Similar to other
| drugs that address mental state, they might not feel like
| themselves.
| LoganDark wrote:
| > I'm assuming such a drug would have drastic drawbacks
| in terms of how Autistic people think. Similar to other
| drugs that address mental state, they might not feel like
| themselves.
|
| Knowing how I think, and how I use knowledge, I'm not
| sure that I'd be better at anything if a drug altered my
| ability to think in detail. Even if something made me
| non-autistic like magic, I have a lifetime of autistic
| knowledge that is structured differently than what a non-
| autistic brain would need. I could have to learn
| everything all over again if I were to become unable to
| comprehend/assemble the logical building blocks that I
| normally use to do everything.
|
| So I have to assume the drug doesn't actually attempt to
| treat the core defining trait of autism and only attempts
| to treat some of the side effects.
|
| As far as I'm aware, even though autism is a spectrum,
| every brain that is autistic has a particularly
| distinctive redistribution of connections, which is what
| results in basically everything. This redistribution is
| likely what results in the overly logical/analytical
| thinking (whether it's bottom-up or top-down), although I
| don't think anyone's been able to prove or disprove that,
| it's just a correlation.
| consteval wrote:
| Right, but we need to consider outcomes. If such a drug
| could help those who can't take care of themselves, take
| care of themselves, that's a very good outcome. An
| outcome for someone like you wouldn't be very good so it
| doesn't matter much. But for some, this could be the
| difference between being institutionalized forever versus
| living a somewhat independent life.
| therein wrote:
| Co-administration of an agonist and an antagonist for the same
| pharmacophore seems like an interesting approach.
| nwienert wrote:
| Looks like the antagonist is only outside the brain, so it
| works to counteract the side-effects, pretty cool.
|
| I wanted sort of the opposite of this for opioids - work in
| the body, not the brain. There's been a few attempts but non
| that passed trials.
| swores wrote:
| Would the opposite (work in the brain but not the body)
| also be a healthier alternative for people addicted to
| getting high on opiates?
| johnisgood wrote:
| Yeah, because it is the high they are after, but not
| working in the brain would make opioids completely
| useless for depression and anxiety (for which it really
| does wonders).
| nwienert wrote:
| My want is for relieving pain in the body without making
| me feel high, I actually assumed you want it in the body
| not brain, as the brain effects are the feel-good
| effects, but really not sure or familiar with how they
| work.
| nullindividual wrote:
| Ibuprofen and acetaminophen may already be that option.
|
| https://www.aafp.org/pubs/afp/issues/2018/0301/p348.html
|
| I believe there are other studies besides this that
| points to these two OTC pain relievers as being 'just as
| good' as opiates.
| nwienert wrote:
| Maybe they work on some small subset of pain similarly,
| but they really are incomparable.
|
| Opiates could near make you not feel your arm being
| chopped off, ibuprofen couldn't prevent a light pinch
| from hurting.
| spondylosaurus wrote:
| There are prescription-grade NSAIDs that make Advil look
| like candy, but they're admittedly still not as heavy-
| hitting as bona fide painkillers. Great for inflammatory
| pain though.
| girvo wrote:
| They're also typically pretty rough on your GI systems.
| Though it's worth the trade-off, usually
| spondylosaurus wrote:
| Ha, also yes. Unfortunately I know this too well, but my
| GI systems are worse than the average person's :P
| raverbashing wrote:
| And there's even topical ibuprofen (or related nsaids)
| gosub100 wrote:
| A controversial and hypothetical drug which might help
| addicts would be a companion drug that somehow prevented
| the development of tolerance. I know nothing about the
| brain so that's probably laughably impossible, but if it
| existed it could cheapen the cost of a habit and lead to
| fewer ODs because they would have no need to chase their
| tolerance to feel the same effects. It would certainly
| have other side effects because someone could essentially
| just remain high 24/7 (in the extreme case).
| Scoundreller wrote:
| > I wanted sort of the opposite of this for opioids - work
| in the body, not the brain
|
| That's already how some anti-diarrheals work like
| loperamide. And some anticonstipation drugs like oral
| naloxone and methylnaltrexone that work as peripheral or
| locally-acting antagonists
| nwienert wrote:
| Yes but loperamide doesn't alleviate pain, which maybe
| just that opioids only alleviate pain if they do reach
| the brain, but I did see trials for non-bbb crossing ones
| that were for pain so not sure what's going on there.
| IAmGraydon wrote:
| It's possible that the analgesic and euphoric effects of
| opioids are one and the same. In other words, it's
| centrally dampening the experience of pain, both physical
| and mental. One is experienced as analgesia and the other
| as pleasure, but both may share the same mechanism,
| making one impossible without the other.
| boingo wrote:
| https://archive.is/BYzWs
| KomoD wrote:
| > Cobenfy, set to launch in October, will have a list price that
| would cost about $22,500 a year. The influential Institute for
| Clinical and Economic Review this year estimated that a price in
| line with expected clinical benefits to patients should be in the
| range of $16,000 to $20,000 a year. Bristol Myers Squibb
| executives say most eligible patients are covered by Medicare or
| Medicaid and wouldn't pay the list price.
| givemeethekeys wrote:
| Didn't some bro from the pharma industry get mercilessly shat
| upon for charging so much for a life saving drug?
| the_sleaze_ wrote:
| You're being downvoted for using an easily google-able
| factoid incorrectly because you're pattern matching on "high
| drug prices"
|
| What happened was Martin Shekreli purchased patents for
| existing life-saving drugs and raised the price for them from
| $1.50 to $30 to cover the cost of the purchasing the patents
| themselves.
|
| This is an entirely different.
| givemeethekeys wrote:
| How people feel about facts is much more important than the
| facts themselves.
|
| The perception of the drug price increase much more than
| the details, along with other asshole things he did made
| him an easy target for outrage.
|
| What is the cost of mass producing this new drug? How much
| profit should the company be allowed to make? Where's the
| outrage?
| nozzlegear wrote:
| The company paid $14b for the research to bring this drug
| to market. Like all Americans -- and all citizens of the
| world, apparently -- I agree that drug prices in the US
| are too high, but shouldn't they be allowed to at least
| recoup that investment?
|
| How can we expect companies like this to continue
| researching such drugs if not? Especially when, more
| often than not, the research leads to a dead end or
| failed trials, and they can't even bring the drug to
| market?
| desumeku wrote:
| Legends say that Shkreli was actually trying to rip off
| insurance companies and left individuals alone, even going as
| far as to give it away for $1 to people without insurance,
| but I'm not sure.
| photochemsyn wrote:
| The FDA is under regulatory capture by the pharmaceutical
| industry, and their approval or lack thereof is one of the most
| unreliable measures of the safety and efficacy of psychiatric
| drugs in particular. Schizophrenia diagnoses are almost entirely
| subjective in nature (there's no reliable biochemical or
| biomolecular or biophysical test for the presence or absence of
| the condition) - really the whole field of psychiatric care for
| mental health issues is about as useful as tuberculosis experts
| were in the 1850s, before Koch's demonstration of the infectious
| microbial nature of the disease.
| olliej wrote:
| No it's under pressure from people who go to the press saying
| "the FDA won't let me use this drug to help me/my family" who
| ignore "because there's no evidence it works" as the reason.
|
| The pharmaceutical just has to tell those people that it does
| work in their particular case and just ignore the studies that
| say it doesn't, and the media and politicians uncritically
| report that as "the FDA is mean, let pharmaceutical companies
| sell new and expensive snake oil and re-victimise these
| people", then in a few years later the same reporters and
| politicians berate the "ineffectual" FDA for allowing snake
| oil.
| dmix wrote:
| Regulatory capture doesn't mean the entire of idea of FDA as
| a safety mechanism is bad... nor does a legitimate reason for
| their existence mean that capture doesn't exist
|
| It is good to hold federal agencies with large power to a
| very high standard. But that's often not the case as any
| critiques get dismissed with the "well they have good
| intentions and can you imagine if they didn't exist?" hand
| wave tactic.
| 77pt77 wrote:
| > Game changer in treatment of disease we can't even define
|
| Doesn't quite have the same ring to it, now does it?
| fnordpiglet wrote:
| I'm sort of surprised to see someone claiming schizophrenia is
| subjective. Schizophrenia has extraordinarily pronounced
| symptoms. It's like claiming lupus doesn't exist because
| there's no single reliable diagnostic test for it.
| Schizophrenia has very specific and easily observed symptoms
| and is specifically affected by medications such as Zyprexa
| that doesn't cause similar changes in behavior for people
| without schizophrenia or psychosis. However that and related
| medications have horrible side effects leading most patients to
| avoid taking it. For people who are or have family members
| ravaged by schizophrenia this is some of the best news you can
| imagine - a medication with similar beneficial effects on their
| loved ones but without turning them into zombies. It feels
| callous to an extraordinary degree to deny the existence of
| schizophrenia and to not recognize the benefit to a minimal
| side effect mediation that can give the schizophrenics life
| back.
| niemal_dev wrote:
| This is actually a ridiculous answer. So you claim if you get
| get cold turkey'ed on Zyprexa you won't hallucinate or have
| mania? You claim, there are people out there, who take a
| dopamine antagonist without getting diabetes, organ issues,
| loss of self (fundamentally this is what these drugs do,
| deprive of brain function) and ultimately sudden death?
| fnordpiglet wrote:
| I made no statements remotely like this.
| niemal_dev wrote:
| > Schizophrenia has very specific and easily observed
| symptoms and is specifically affected by medications such
| as Zyprexa that doesn't cause similar changes in behavior
| for people without schizophrenia or psychosis.
|
| By the nature of these drugs, each and every symptom of
| what you pronounce Schizophrenia would be your daily life
| once on the poisonous neuro-toxic agents.
| consteval wrote:
| This doesn't seem science-backed and feels more
| emotional.
| niemal_dev wrote:
| Whatever feels for you emotional or not is irrelevant. It
| is science-backed that each and every "Schizophrenia"
| symptom of a book that resembles the bible and nothing
| else (going by the name of DSM) is a product of
| chemically induced damage and torture with neuro-toxic
| poison.
| consteval wrote:
| It is not science-backed the schizophrenia is caused by
| schizophrenia medication. That doesn't even account for
| people who have psychosis evident of schizophrenia but
| have never taken medication.
| fnordpiglet wrote:
| I feel like you don't know anyone personally who has
| schizophrenia or you wouldn't dare to say this. People
| tend to develop schizophrenia in young adulthood and it's
| not after taking antipsychotics they take antipsychotics
| after developing schizophrenia. Schizophrenia existed
| before the development of antipsychotic medications,
| that's why they were developed at all.
|
| There's nothing to glorify in schizophrenia- it's in many
| ways worse than losing your loved ones in a tragic
| accident. It's even worse for the schizophrenic who after
| having a normal life descends into paranoid delusion and
| take on an existence of misery.
|
| I know the right answer here is for me to ignore and walk
| on but it's hard to do so and leave statements like these
| unqualified.
| mikhmha wrote:
| I see this take on the internet a lot usually combined with
| some statement of how Schizophrenics are secret geniuses and
| were the prophets of olden times. It just doesn't square off
| with my own observations of schizophrenics in real life. How is
| the condition subjective when you see the same types of
| symptoms across people? I've seen it with men and women
| afflicted by the condition - always the persecutory delusions,
| belief that they are some king or prophet/chosen one,
| disorganized thinking, and word salads. Why is it always the
| same symptoms? You're telling me that's not rooted in any
| common condition?
| niemal_dev wrote:
| > always the persecutory delusions, belief that they are some
| king or prophet/chosen one, disorganized thinking, and word
| salads. Why is it always the same symptoms?
|
| https://en.wikipedia.org/wiki/Martha_Mitchell_effect
|
| Your argument is as good as calling Martha Mitchell crazy and
| dismissing entirely possible organized exploitation on a
| premise of made-up symptoms that are composed of zero
| scientific evidence.
| amanaplanacanal wrote:
| Pain is entirely self reported by the patient. There is no
| objective measure of it. Painkillers must also then be a scam,
| by your logic.
| rozab wrote:
| I can't stand this term 'game changer', I started noticing it
| being used a lot during early covid and then the Ukraine war, all
| for things which did not turn out to be 'game changers'.
|
| You can see its explosive rise on Google Ngrams. Looks like we're
| still not quite at the peak
|
| https://books.google.com/ngrams/graph?content=game+changer&y...
| drdaeman wrote:
| An unfortunate requirement of modern attention/engagement
| economy. Readers hate this one trick, but for the media
| outlets, if you don't crank up hype clickbait engine to 11,
| you're out, or running some very niche business.
| olelele wrote:
| Readers hate this one trick, click to find out why!
| howard941 wrote:
| At $22.5K/yr it'll be more money changer than game changer.
| beautifulfreak wrote:
| "Double down" has a similar chart, another annoying phrase.
| unsupp0rted wrote:
| In the early days just before and just after AGI, all of a
| sudden a lot of games will be changed in a short period of
| time.
| dang wrote:
| Ok, we've unchanged the game in the title above.
| ck2 wrote:
| The audacity of pedaling a drug pricetag of $22,000 to solve
| someone being homeless when government safetynets won't even
| offer a fraction of that.
|
| It will probably be sold for $220 in other countries.
|
| But hopefully the compounding pharmacies and anti-pharma hacking
| collectives will solve the pricetag problem here.
|
| https://www.vice.com/en/article/how-to-make-your-own-medicin...
| johnisgood wrote:
| Wait till Europe gets generics, it will cost less than $5 per
| month. My MS medication would cost me $8k per month in the US,
| costs me $2 here.
| devin wrote:
| What medication?
| rafram wrote:
| It would cost you $2 with insurance in the US too. It's a
| terrible system, it doesn't make sense, but you have to
| understand that approximately no one pays the list price for
| prescription drugs - even people without insurance.
| crooked-v wrote:
| The US will do anything and everything to solve homelessness as
| long as it doesn't actually involve building more homes or
| giving homes to people.
|
| I mean that in a fully genuine way. Just look at how much money
| gets set on fire cycling the same homeless people in and out of
| jails and emergency rooms and you can see that nobody actually
| cares about the amount of money being spent, but only that
| homes themselves aren't easier to get.
| microbug wrote:
| imagine thinking that the "homelessness" crisis is only lack
| of homes.
|
| go talk to a sample and you'll quickly find out it ain't the
| lack of home.
| crooked-v wrote:
| The point of my comment, in response to its parent, is that
| people in the US are willing to support _immense_ amounts
| of money being spent on the homeless as long as it doesn 't
| involve housing anyone.
|
| I think the institutional structure of most US states and
| cities wouldn't blink at spend huge amounts on
| schizophrenia drugs as long as it doesn't involve any kind
| of inpatient treatment (forced or not) that would put a
| roof over anyone's head.
| com2kid wrote:
| For 20-30% of people it is a lack of an affordable home.
|
| If building more homes solves 30% of the problem and this
| drug solves another 10%, that is 40% of homeless taken care
| of.
|
| That would be a huge victory that would save hundreds of
| thousands of lives.
| consteval wrote:
| The core issue with homelessness is one of how our modern
| capitalist socieites are laid out.
|
| In order to have a life, you must have a job. This is the
| underlying assumption that fuels everything. This
| assumption has a critical flaw: not everyone can have a
| job.
|
| For some segments of the population, we just "bolt on"
| fixes to this fundamental problem. 401k's so that workers
| may still get their money when they no longer work. Foster
| care, so that abandoned babies who cannot work can still
| live.
|
| For the severely mentally ill and drug addled, we haven't
| figured it out. The reality is these people cannot work a
| job and most will never be able to work steadily.
| Advancements in drugs may help, but even then there will
| always be some segment of the population who simply cannot
| work.
|
| Previously, we took an "out of sight, out of mind"
| approach. Institutionalize these people. It's cheap,
| particularly if we treat them like dogs. We've evolved and
| realized such an approach is inhuman and evil. Now, though,
| what do we do?
|
| If these people had a basic income available, they could at
| least pay to help themselves. This isn't a silver bullet,
| but I believe it's better than the current problem we have.
|
| The true solution is fixing the fundamental problem modern
| society has: everyone has to work. This is really hard.
| the_optimist wrote:
| What qualifies to you as a home? Is it "nice"? Fully
| finished? Large? In a nice area? In an area with good
| weather? In good repair?
| crooked-v wrote:
| In short, a couple of hundred square feet with decent
| temperatures, a sturdy lock, and basic facilities. I
| believe that the de facto illegalization of SROs in US
| cities is one of the more prominent factors when it comes
| to both invisibly and visibly homeless populations.
| com2kid wrote:
| We tore down all the slums because they were unhealthy
| and dangerous, and then shoved all the former tenants
| onto the streets.
| macintux wrote:
| Same basic story as asylums.
| Something1234 wrote:
| School Resource Officers???
|
| What are SROs?
| crooked-v wrote:
| https://en.wikipedia.org/wiki/Single-room_occupancy
|
| It's a category that's been mostly legislated out of
| existence in the US today.
| s1artibartfast wrote:
| I tend to agree. Unfortunately, such places are illegal
| to build and rent.
| oatmeal1 wrote:
| The US simply needs to undo the zoning laws, parking
| minimums, and setback requirements that make it illegal to
| build affordable housing.
| datavirtue wrote:
| First, you need a politician to say: "your home is not an
| investment, it's an asset."
|
| They would be flayed. Might as well just belt out a "Dean
| scream" at a live event.
| NHQ wrote:
| Healthcare in the US is an elite graft, the system will pay the
| full price. That is actually why prices are so high and
| hospitals try to keep price tags a secret, because the bill
| does get paid, and all those executives and investors and even
| the insurance companies all make off with riches, increasingly
| paid for by the public. The real crime is setting up indigent
| people now using drugs on the street to become a massive market
| for psychiatric medication on the pretense of a pseudo-
| scientific "disorders" like schizophrenia.
| rafram wrote:
| > pseudo-scientific "disorders" like schizophrenia.
|
| Are you saying you don't believe in schizophrenia?
| chiefalchemist wrote:
| If the FDA was truly interested in game changing it would lead.
| As it is, it's a sock puppet for Big Pharma.
|
| https://michaelpollan.com/books/how-to-change-your-mind/
| pjmorris wrote:
| > a price in line with expected clinical benefits to patients
|
| What would a price in line with recouping R&D and production
| costs and, say, a 20% profit margin be?
| thefounder wrote:
| It may not be fair math. The company may bet on 10 different
| things and just one pays off. It needs to pay off for the bad
| bets as well.
| gramie wrote:
| > in line with recouping R&D and production costs
|
| That's the "recouping R&D" part.
| datavirtue wrote:
| It seems like a previous comment pointing out how investors
| actually fund new drug development seems to track with the
| loads of pharma startups working on one thing each.
|
| Run some stock screeners on your brokerage account. You have
| to work to generate a list without a pharma startup on it.
| s1artibartfast wrote:
| A big part of this businesses model is because only large
| Pharma companies are equipped to handle the regulatory
| barriers and large enough to negotiate with the PBMs
| jdietrich wrote:
| In their last 10-K, Bristol Myers Squibb reported an operating
| income of $8.4bn on sales of $43.7bn, giving them a gross
| profit margin of just over 19%.
|
| https://www.sec.gov/ix?doc=/Archives/edgar/data/14272/000001...
| cma wrote:
| You shouldn't look at R&D on one product, since lots fail.
| Would be like saying a record label that funds 100 artists with
| 1 being profitable should have a strict 20% profit cap on the
| profitable one. That wouldn't allow ongoing funding of the
| broader pool of bets.
| givemeethekeys wrote:
| How much of the record label's music production is funded by
| tax dollars?
| throwup238 wrote:
| David Bowie, Mick Jagger and Keith Richards, John Lennon
| and Paul McCartney. The list of musicians who were "on the
| dole" to support their music careers before they made it
| big is huge. It's almost a cliche at this point. And when
| they do make it big, their biggest concerts are usually
| held in stadiums that were heavily subsidized by tax
| payers.
|
| Besides, Bristol Meyers Squibb acquired this drug for $14
| billion which is bigger than the annual budget of the
| entire NSF. For a single drug. Tax payers weren't the ones
| on the hook for that.
| cma wrote:
| That's fine but even considering that, is 20% only on
| successes enough to fund the rest of the portfolio that
| fails? And will it pass the risk free rate of return you
| can get from money markets or treasuries or whatever?
| s1artibartfast wrote:
| In what sense are you proposing pharma production is funded
| by tax dollars?
|
| Selling a product to the taxpayers is not the same as
| funding.
| cma wrote:
| Fundamental research slants towards public institutions,
| advertising and the clinical trials are the main spending
| the drug companies do, though they have research beyond
| trials too. Lots of acquiring university spinouts as
| well.
| wbl wrote:
| The gap between "one chemical that targets this thing"
| and a drug is massive. And basic research might not even
| end up with the first, just the target idea.
| pjmorris wrote:
| 'Bristol Myers Squibb executives say most eligible
| patients are covered by Medicare or Medicaid and wouldn't
| pay the list price.'
| s1artibartfast wrote:
| That's kind of like saying hamburger buyers are funding
| McDonalds.
|
| Buyer typically do not have a direct say in how
| businesses are run. They exert influence by either buying
| a product or not.
| pjmorris wrote:
| > That's kind of like saying hamburger buyers are funding
| McDonalds.
|
| If Medicare and Medicaid cover hamburgers.
|
| I could be wrong, but it looks to me like the fact that
| there's a built-in government-funded ('tax dollars')
| market is an aspect of pharma calculations.
| throwup238 wrote:
| Bristol Myers Squibb acquired Karuna Therapeutics, the company
| behind Cobenfy (formerly KarXT), for $14 billion earlier this
| year so that's their break even for the drug and presumably
| what their investors thought was fair. I don't think Karuna had
| anything else interesting in trials so they have to recoup all
| of that from Cobenfy before they're in the black on the
| acquisition.
|
| Pharmaceutical companies offload most of the risk onto
| institutional investors and the public (most biotechs IPO _pre-
| revenue_ to fund clinical trials) but the flipside is that they
| have to pay eye-watering sums to acquire promising drugs.
| tomrod wrote:
| Per wikipedia, wholesale for the drug is $1,850/month.
|
| I think I echo my prior comments on the US health and pharma
| system: why?
|
| [0] https://en.wikipedia.org/wiki/Xanomeline/trospium_chloride
| relativ575 wrote:
| Why not?
|
| Software engineer in the US makes 100K or higher. Why?
|
| If you have reasons to believe the price is too high, present
| them?
| slibhb wrote:
| 1. If prices weren't this high then there wouldn't be incentive
| to develop these drugs in the first place. There's a reason
| most novel drugs come from the US!
|
| 2. The vast majority of drugs do not pan out and most fledging
| companies formed to study them fail
|
| 3. In the US, insurance mostly covers the cost of drugs
|
| 4. In 14-20 years, the drug will be turned into a generic and
| the prices will plummet
| guerrilla wrote:
| > then there wouldn't be incentive to develop these drugs in
| the first place.
|
| This isn't true. The incentive is to help people. There are
| many people who are calable of doing that but can't do it
| afford to. We can just pay for their cost of living and
| research directly, cutting out the profit entirely.
| s1artibartfast wrote:
| Most doctors, nurses, and even scientists dont work for
| free.
|
| The incentive to help people is insufficient alone.
| guerrilla wrote:
| I acknowledged that in my comment, but you missed my
| point. They don't work for free because they can't in our
| current system. We can change that.
| s1artibartfast wrote:
| I dont think they would want to, not to the same degree.
| consteval wrote:
| Rockefeller famously opened up about 1500 libraries
| nationwide. Free to use public libraries, but the
| librarians and such were paid.
|
| Meaning, such philanthropy does not require every single
| soldier ant to be a philanthropist. But it does require
| them to not seek a "get rich" mentality. Such a mentality
| is inherently incompatible.
|
| And, for the rich philanthropist, he must be ready to
| lose money. You and I are but lowly ants, and to us
| losing money is bad. But consider for someone like
| Rockefeller, there was 0 quality of life decrease after
| opening those libraries. Of course, if I open even one
| library, I'm broke.
| s1artibartfast wrote:
| Surely healthcare requires many ants who want to be
| compensated.
|
| For this reason I think the idea that healthcare should
| not be contingent on profit seeking individuals to be a
| pretty hollow statement.
|
| It also seems that we have a shortage of Rockefellers to
| bankroll the US healthcare system as active charity with
| no profit motive.
|
| That seems inconsistent to claim that people will do the
| work and donate money without returns in the face of
| reality where very few people do that.
|
| The response seems to be that people in our current
| system are forced to seek compensation to survive. This
| seems easily testable. Cut back doctor and healthcare
| workers salaries to a subsistence income or even the
| median and you will quickly see if people flock to the
| profession or leave it
| consteval wrote:
| This doesn't align with reality, in which almost all
| developed nation-states have public healthcare systems.
|
| It is for the benefit of society as a whole that people
| be healthy. Therefore, it is in the interest of each and
| every person our healthcare be funded. Therefore, they
| should all fund it.
|
| It's not like other goods where some people want a toy,
| and some people don't. It's more in line with education.
| Everyone needs it, and if everyone has it then things
| improve for everyone - even those who can't get it, for
| one reason or another.
|
| In my eyes, healthcare as a field almost perfectly fits
| the description of what should be a nationalized service.
| We've taken the jump with other low-hanging fruit, like
| education. And society as a whole has benefited greatly
| from no longer having the majority of the population be
| illiterate.
| slibhb wrote:
| Developed nation states with public healthcare systems
| rely on the US pharma industry for an outsize part of
| drug discovery. It may be better for the whole world that
| there's one rich country taking the private approach.
|
| Also, the idea that if "something is in everyone's
| interest, it should be nationalized" doesn't address the
| fact that free markets are better at matching supply to
| demand. For example, the UK and Canada have significant
| healthcare supply shortages that only seem to be getting
| worse.
|
| To put the previous paragraph another way: having "a
| right to healthcare" in the abstract is nice but if you
| need to see an oncologist, waiting weeks/months/years is
| going to get you killed. In the US this is much less of
| an issue. Yes it's expensive but when the alternative is
| "dying of cancer," people are okay going into debt!
| selimthegrim wrote:
| Carnegie?
| imperio59 wrote:
| Let's remember it was recently proven that there is little to no
| evidence that serotonin levels are linked to depression:
| https://www.nature.com/articles/s41380-022-01661-0
|
| It's pretty much likely to be the same deal here.
|
| Since there is no chemical or biological test one can do to
| confirm a schizophrenia diagnosis, it's a subjective diagnosis by
| practitioners, treating such subjective diagnosis with powerful
| brain-chemistry altering drugs. Worse, we do not yet know whether
| these new drugs will be easy to get off of. Some of the other
| anti-psychotic type medication is VERY hard to get off of, such
| as abilify, where most drug treatment centers will not deal with
| Abilify withdrawals or take on those patients because those are
| so severe (extreme violence, self harm, etc during withdrawal).
|
| Until Psychiatry can reform itself to become a real science,
| using the scientific method (repeatable, provable results and not
| just a "theory of how brain chemistry maybe works sorta but we're
| not sure"), it will continue to just be a big cash cow for Big
| Pharma while hooking many patients who do not need these drugs
| onto them for life, while failing to effect ANY cure on the
| things they are treating (Have you heard of someone getting
| "better" after taking anti-depressants and being able to come off
| them? No. They have to take them for life. That's not a cure.)
| throw18376 wrote:
| i'm curious what is the longest conversation you've ever had
| with an untreated schizophrenic person?
|
| it's so obviously a "real disease" even if we don't fully
| understand the biological basis. it's subjective but honestly,
| there are just a ton of completely obvious cases.
|
| abuses of the psychiatric system are very bad, but
| schizophrenia is so so clearly real.
| crooked-v wrote:
| > Have you heard of someone getting "better" after taking anti-
| depressants and being able to come off them? No. They have to
| take them for life. That's not a cure.
|
| There is no medicine in the world that you can take for a
| limited time to fix problems forever. That's not how medicine
| works. That's not how the _world_ works.
| catlikesshrimp wrote:
| Antibiotics (Most of the time) Everything surgery, I would
| include gene replacement therapy and auto transplants in its
| viccinity.
| ClassyJacket wrote:
| Yes there are? Antibiotics for one.
| copperx wrote:
| And those that change gene expression, like Accutane for
| acne.
| Etheryte wrote:
| This is so misguided that it's hard to even know where to
| begin. People who develop high blood pressure without a known
| underlying cause take a pill for it every day for the rest of
| their life. You could say the same thing, they're not cured,
| but what actually matters is that they get to live a full life,
| unconstrained by the disease even if we don't know the
| underlying cause. Of course it would be better if we were more
| advanced of a civilization and figured it out, but the
| important thing is that these people get their lives back.
| toast0 wrote:
| > Have you heard of someone getting "better" after taking anti-
| depressants and being able to come off them? No. They have to
| take them for life. That's not a cure.
|
| Some people with acute depression can take the meds, work on
| the underlying issues and taper off, yes.
|
| People with chronic depression likely need to take the meds for
| life.
|
| People with type I diabetes can't get insulin one time either.
| People with allergies often take the allergy meds when exposed
| to allergens, which is always for some.
|
| That's not big pharma being greedy, that's a chronic condition
| requires chronic treatment.
| smeej wrote:
| I'll raise my hand here. Took antidepressants for a year.
| Successfully weaned off of them. Have not had recurrence of
| symptoms.
|
| I needed the boost to be able to get out of bed often enough
| to do the work in therapy. That led to being able to take
| other actions that helped my brain chemistry too, like eating
| better food, which reduced inflammation, and getting outside
| more often.
|
| My doc said her experience was about half and half. Half of
| people were able to wean off successfully. Half ended up
| deciding it was better to stay on.
|
| Recovery _does_ happen. For lots of us.
| girvo wrote:
| My experience was the same; they were like a bandage we put
| on to allow us to heal without infection, for me SSRIs were
| a mental bandage so I could heal enough to get to a
| psychologist. I came off them, and was fine. My situation
| is confounded by my buprenorphine script though, as it's
| known to be a reasonbly effective anti-depressant in it's
| own right, albeit via a completely different mechanism
| (it's an opioid-receptor agonist, partial agonist _and_
| antagonist. Weird drug)
| toastau wrote:
| We don't have cures for diabetes, HIV/AIDS, allergies, plenty
| of ailments. Having treatments is totally valid even if they
| are taken forever.
|
| People with the guidance of their doctor stop taking
| antidepressants all the time. External factors aren't static
| and often these can change. (separately or because of the
| treatment) You do not need to stop treatment unless you and
| your doctor have decided it is going to be better for you.
|
| Another point I'd make is that we don't have exact mechanisms
| for action in other treatments like paracetamol. That doesn't
| make it invalid treatment.
| catlikesshrimp wrote:
| What is your doubt about paracetamol? This drug's
| pharmacology is rather well understood.
|
| About the analgesic activity
| https://pubmed.ncbi.nlm.nih.gov/31734950/
|
| About the antipyretic activity
| https://pubmed.ncbi.nlm.nih.gov/29738273/
| nullindividual wrote:
| An enlarged salience network may be responsible for depression
| in some patients[0]. Some individuals are pre-disposed to being
| depressed and it may be a chronic condition, like any other
| chronic condition. For others, it could "simply" be a chemical
| imbalance that taking medication for a set period of time
| resolves (lucky them).
|
| [0]https://www.nih.gov/news-events/nih-research-
| matters/mapping...
| jmcgough wrote:
| I work as an EM scribe and routinely see patients experiencing
| psychotic episodes. My background is in neuroscience and I'm
| interviewing for med school right now.
|
| > it was recently proven that there is little to no evidence
| that serotonin levels are linked to depression
|
| This has been the consensus of the psychiatric community for
| the last 20+ years. The serotonin hypothesis was heavily pushed
| in marketing as a way to medicalize depression and convince
| people to seek treatment for it. Probably a net positive when
| it comes to reducing stigma, but few people have been seriously
| arguing the serotonin hypothesis. As it takes about a month for
| effects to kick in, most people believe that it's compensatory
| changes to the brain that happen in response to upregulation of
| serotonin, such as downregulation of 5ht2a which has an
| overdensity in people with depression.
|
| > Since there is no chemical or biological test one can do to
| confirm a schizophrenia diagnosis, it's a subjective diagnosis
| by practitioners
|
| This is true to some degree - we don't have a blood test or an
| fmri scan that will definitively point to schizophrenia, the
| diagnosis is (for now) based on DSM criteria and by thoroughly
| ruling out other causes of schizophrenia. We do have tests for
| a number of other causes of psychosis, like lumbar punctures
| for NMDA-receptor encephalitis.
|
| I'd like to emphasize that there are MANY diseases and
| conditions that we treat empirically for based on subjective
| symptoms which are just as real as schizophrenia. There are no
| tests we can perform for concussions or migraines. The brain is
| very challenging to perform tests on because of the blood-brain
| barrier and the skull.
|
| > Worse, we do not yet know whether these new drugs will be
| easy to get off of.
|
| Cholinergic drugs are VERY well understood and used in the
| treatment of a number of diseases. This "new" drug is a drug
| that was discovered 20+ years ago and is being used in a
| creative way to mitigate its GI side effects. Everything so far
| points to this being more effective at treating the negative
| symptoms of schizophrenia (loss of motivation, cognitive
| impairment), with milder side effects (some mild GI issues
| which typically resolve after a few days), which is a huge deal
| considering how many people with schizophrenia quit
| dopaminergic drugs due to the side effects.
|
| One of the biggest problems with our for-profit system is that
| schizophrenia is comparatively rare and largely affects those
| with a lower socioeconomic status, so there isn't a huge
| financial incentive to work on schizophrenia drugs. This one
| was being developed for another purpose entirely.
|
| > Until Psychiatry can reform itself to become a real science,
| using the scientific method (repeatable, provable results and
| not just a "theory of how brain chemistry maybe works sorta but
| we're not sure"), it will continue to just be a big cash cow
| for Big Pharma while hooking many patients who do not need
| these drugs onto them for life, while failing to effect ANY
| cure on the things they are treating
|
| It sounds like you have an ax to grind against the profession,
| but I can assure you that there is a huge need for it and that
| people largely see benefits from medication. For me, SSRIs got
| me stable and functional so I could better address the root
| causes of my depression. Psychiatric drugs aren't perfect, but
| for many people they're truly life-saving. There is evidence to
| support kindling in some diseases such as bipolar as well -
| that if you remain unmedicated, manic episodes become
| progressively worse as the brain becomes more damaged.
|
| Additionally, psychiatrists treat more than just depression.
| Some specialize in sleep medicine, addiction medicine,
| toxicology. They are trained to tease apart primary depression
| from other non-psychiatric diseases masquerading as a
| psychiatric disease. I saw a patient once who had been treated
| with a number of antipsychotics by his PCP and mid-level
| providers for persistent visual hallucinations. He met with a
| psychiatrist who tried increasing his anti-seizure meds, which
| resolved what was likely a recurrent partial seizure.
|
| Every drug (sans some off-label use) goes through an FDA
| approval process and is, over the course of several years and
| millions of dollars, shown to be effective and relatively safe.
| I can assure you that psychiatry is as scientific as any other
| field of medicine. It's still in its infancy compared to some
| other specialties - the brain is a very complex organ and
| difficult to study - but we have as good of an understanding of
| most psychiatric illnesses as we do neurodegenerative diseases
| such as Alzheimer's, which have been equally as difficult to
| study and treat.
|
| Psychiatry is not even close to the most profitable area of
| American healthcare. Psychiatrists are one of the lower-earning
| specialties, and most people with mental illness never obtain
| treatment for it. Compare that to the 10% of all seniors who
| are on Eliquis to prevent blood clots, which costs a thousand
| dollars a month without insurance.
|
| Trust me, if there was a way to permanently cure a psychiatric
| disease with one procedure or pill, we would all be in favor of
| it. Just because a diabetic needs to take insulin for life
| doesn't make endocrinology a scam.
| FollowingTheDao wrote:
| > by thoroughly ruling out other causes of schizophrenia.
|
| This never happens. "thoroughly" never happens. There are
| many examples of this. Recently a woman who was in
| psychiatric care fro over 20 years was finally diagnosed with
| Lupus (NPSLE) and cured.
|
| They did not thoroughly do anything for me. I had to figure
| it out for myself.
|
| > people largely see benefits from medication
|
| I have a friend with depression and they had her on two
| adrenal receptor inhibitors (trazadone and risperidone) and
| she only got worse. They they went to ECT. She had severely
| constipation (treated with yet another drug, Linzess) and
| hypotension as well. They they started her on ECT, which did
| not work and she lost some memory.
|
| The doctors failed to see that adrenal blockers could be
| causing her depression. I showed her the science, she asked
| her doc to stop those meds. She she no longer depressed nor
| has hypotension or consipation. And now she is angry.
|
| They diagnosed her with schizophernia after they started her
| on antidepressants 25 years ago.
|
| I am not saying medication are not sometimes useful, but I
| cannot count the times I have seen patients get worse on
| psych meds.
|
| > He met with a psychiatrist who tried increasing his anti-
| seizure meds, which resolved what was likely a recurrent
| partial seizure.
|
| You are still in med school so I hope you learn more. Anti
| Seizure meds have been the go to for these disorders fro
| years. They put me on depakote for my modo disorder 20 years
| ago.
|
| > Psychiatry is not even close to the most profitable area of
| American healthcare.
|
| Psych pharm businesses are very profitable though, and that
| is what we are talking about here.
|
| > Trust me, if there was a way to permanently cure a
| psychiatric disease with one procedure or pill, we would all
| be in favor of it.
|
| There is not pill, but there is a method. It is called
| Personalized Medicine.
|
| And by the way KaRXT is not going to work. You should learn
| about receptor density changes when people take these
| receptor modulating drugs. This is why they always fail.
| There are better ways to manage the glutamate/GABA balance if
| that is the persons issue which it many cases it may not be,
| or may not be the fundamental problem. And if the
| acetylcholine is the problem in schizophrenia, why does M1
| and M4 receptor in the body have bad side effects but whil in
| the brain it is good?
|
| I will tell you why, they are using this drug to sedate the
| patient, not treat the patient.
| idunnoman1222 wrote:
| After one meeting with her doctor, they gave my daughter
| antidepressants a the class of drug that's meant to be taken
| for life. She was just an angsty teenager during covid.
|
| She didn't take them, shes fine, but yall are the devil frfr
|
| Admit this: if you go to a doctor and say anything about the
| inside of your head that makes them uncomfortable you're
| getting a chemical lobotomy immediately
| consteval wrote:
| It's significantly better now, because your daughter didn't
| get a real lobotomy. Which was the expected treatment for a
| young woman who misbehaves.
|
| It's not typical to get antidepressants after a single
| meeting with a general practitioner. In fact, I don't even
| know if that can happen.
|
| That being said, depression is real, and it does take
| lives. I've known many people who have successfully
| survived depression via SSRI's and no longer take them.
| That's the flip side you're not seeing. I've also seen
| unmedicated people take their lives.
| idunnoman1222 wrote:
| -Appeal to worse problems
|
| -Gaslight and hand wave
|
| -Slippery slope
|
| I do agree that women are disproportionately affected by
| the over prescription
| consteval wrote:
| I would argue that you're doing the same thing. You're
| hand waving and gaslighting people who were/are helped by
| SSRIs. You're appealing to a worst-case scenario, where
| someone who does not have depression is immediately
| prescribed medication (incredibly rare, in fact not sure
| if this can happen). And you're claiming a slippery slope
| by extrapolating this to other mental health issues and
| psychiatry as a whole.
| throw18376 wrote:
| look, if someone has actually have a new drug that works like
| antipsychotics but doesn't have the nightmare side effects, i am
| very happy for that person to get filthy rich.
|
| if this pans out the way they hope, by all means give the lead
| guy a couple yachts or whatever he wants. space tourism, gold
| statue of himself, whatever. big bonuses all the way down the org
| chart.
|
| there's the potential to reduce an absolutely staggering amount
| of human misery here. frankly (again if this pans out) our
| homelessness crisis would look very different if this drug had
| existed 20 years ago, when the mechanism of action was
| discovered.
|
| the people who cared enough and took a huge concentrated risk to
| do this should just get rich, if in fact it pans out.
| throwup238 wrote:
| _> the people who cared enough and took a huge concentrated
| risk to do this should just get rich, if in fact it pans out._
|
| They already did. Bristol Myer Squibb acquired the company
| behind this drug for $14 billion earlier this year.
| lukan wrote:
| "frankly (again if this pans out) our homelessness crisis would
| look very different if this drug had existed 20 years ago"
|
| Are there numbers, for how many homeless people, are suffering
| from schizophrenia?
|
| I would assume only a very small number of homeless people has
| the clinical condition, but those who have it, are just very
| visible. Most homeless people are hidden usually and avoid
| attention.
| dgacmu wrote:
| It's actually quite high. 10%+ in this meta-analysis, and 21%
| with some form of psychosis.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880407/
|
| If I were to guess, I would say that while many people may
| experience bouts of homelessness, the ones with schizophrenia
| are more likely to be persistently homeless.
| throw18376 wrote:
| this is completely true, but they take up a very
| disproportionate amount of time and energy from social
| service providers, people who work in shelters, etc, and make
| all spaces for homeless people much more chaotic.
|
| the crisis would look very different if it was just a mix of
| people dealing with drug addiction (but basically lucid and
| rational) and with poverty.
| lukan wrote:
| "drug addiction (but basically lucid and rational) "
|
| Serious drug addicts are seldom lucid and rational.
|
| But I very much do get the point, that solving the
| schizophrenic problem, would help a lot with everything
| else. (I am just way more sceptical, that this drug can
| deliver that)
| 11235813213455 wrote:
| Even those who are not, will probably develop some sort of
| schizophrenia due to their marginal lifestyle, but I wonder
| if it's really a "disease", I feel like it's an adaptation to
| their environment for people who are more sensitive than
| others. I feel like the pain is more due to the lack of
| solutions, especially in a city centre, where it's a constant
| hell for these guys (and for most any other animal actually,
| except a few who adapted to that: pigeons, rats, some insects
| but not the most beautiful ones), just my thought
| rs999gti wrote:
| > but I wonder if it's really a "disease"
|
| Not a disease but a real illness, with no cure but
| treatment like cancer.
|
| Even with effective treatment, sometimes the psychosis
| wins, and the patient can backslide into full blown
| illness.
| codedokode wrote:
| Homeless people are unlikely to pay $20 000 per year which is
| the price of the drug though.
| toxicdevil wrote:
| > Homeless people are unlikely to pay $20 000 per year which
| is the price of the drug though.
|
| True, but think about all the people who are fully
| functioning and productive members of society and got
| afflicted with this disease. This med will increase the
| likelihood that they continue to be highly functioning and
| compliant with the treatment. This will allow them to keep
| their jobs and cognitive abilities.
|
| Every person I know with this disease has trouble sticking to
| meds due to side effects, and not sticking to the meds and
| relapsing multiple times is probably one of the most
| important reasons that their condition regresses.
| lotusZZZ wrote:
| It's not just the side effects that cause people with
| schizophrenia to be non-compliant with meds. Many people
| with schizophrenia stop taking meds because they do not
| think they are sick - anosognosia. It's why a longer
| lasting injectable is often recommended over daily oral
| meds.
| rs999gti wrote:
| > longer lasting injectable is often recommended over
| daily oral meds
|
| Both are recommended. Why? Daily meds are not only
| effective, but remind the patient that they have an
| illness that needs daily maintenance, it makes them
| involved in the treatment. Long acting injectables are
| added monthly to prevent backslides in case the patient
| forgets or does not want to take their medicine.
| hackernewds wrote:
| It would be nice if every one could afford it. And people
| were still filthy rich, but not necessarily exorbitantly
| rich? It cost the company discovering the drug around $11M
| asveikau wrote:
| I agree that price feels shockingly high. However, the
| government can subsidize treatment. As can private insurance
| policies, before the sufferer becomes homeless, or if they
| qualify for a family member's plan.
|
| The population suffering these illnesses are already costing
| the public a lot of money in various forms, it could be worth
| the investment.
| BurningFrog wrote:
| If they're homeless because of schizophrenia, and the drug
| cures that, $20k/year is easily a profitable investment!
| sqeaky wrote:
| How completely inhumane. From a strictly numerical
| perspective you are correct, but it is disgusting and vile.
|
| I know plenty of people without mental health issues who
| can't get jobs that make 20k and I know a few with degrees
| who can't.
|
| Making healthcare a for-profit venture guarantees that poor
| people suffer disproportionately. Making chemicals is cheap
| and most of the innovation happens on government grants and
| funding. A government run healthcare system is obvious a
| cheaper solution with less suffering.
| oatmeal1 wrote:
| > Making healthcare a for-profit venture guarantees that
| poor people suffer disproportionately.
|
| This is true of literally every industry; the poor always
| get less than the rich. Why not nationalize everything so
| that the poor always get the same as the rich? Surely if
| the government can run healthcare it can run toy shops
| and grocery stores.
| sqeaky wrote:
| We have seen more than 100 other countries nationalize
| healthcare and seen it work well. Arguing against it is
| silly, bordering on irrational.
|
| Capitalism simply doesn't work in an environment where
| one side has infinite leverage.
| s1artibartfast wrote:
| Even those countries, it is still a for profit verture.
| Companies are paid for products, Doctors and healthcare
| professionals are paid to go to work.
|
| These other countries didn't nationalize their
| industries. They simply use spending controls. The
| government says we "will pay $X and you can take it or
| leave it". The US is rather rare in that we say "We will
| take it no matter the cost".
|
| Companies are more or less greedy in different countries.
| They are the same companies!
| sqeaky wrote:
| By this logic anything that involves money ever is a for-
| profit venture, that clearly isn't the case.
| s1artibartfast wrote:
| Most human labor IS motivated by profit.
|
| There can be specific individuals or organizations that
| seek no profit, but they are almost always working with
| and through other for profit entities.
|
| To say something like an entire industry should be
| nonprofit is pie in the sky, which is what I am trying to
| highlight.
|
| Overly broad moral sentiments like people should not seek
| profit when it comes to healthcare quickly break down
| when examined in any detail.
|
| I think What people usually mean is simply that they
| think health insurance should be funded by taxes and
| accessible to all. Instead of simply saying this, they
| end up justifying it with overly broad and poorly thought
| out moral laws.
| consteval wrote:
| Correct, this does happen in every industry. But
| industries are not created equal. Some are really
| important, and some are just kind of there.
|
| A kid not getting a toy is sad, but it's not the end of
| the world. However, healthcare is literally life or
| death. It makes complete sense to single out healthcare.
| bawolff wrote:
| Fact is, government run public health does look at
| numbers at the end of the day. A medicine that increases
| "value" (however you define that) more than it costs is
| more likely to get gov funding.
|
| Turning away from the elephant in the room because it is
| "vile" doesn't help anyone and just entrenches the status
| quo.
| sqeaky wrote:
| You're looking at this in a very American Centric way, a
| lot of other countries figure out how medicines for very
| low costs. When that happens the numbers change a lot.
| bawolff wrote:
| I'm from one of those other countries. Yes, its not as
| insane as america, but budgets and cost vs value
| tradeoffs are still a thing.
| tptacek wrote:
| Making a public policy argument for subsidizing a helpful
| medical intervention isn't "disgusting and vile".
| chpatrick wrote:
| Drugs cost money to develop whether you like it or not,
| the only question is how exactly the money flows.
|
| If it was taxpayer funded research it would still cost
| this much.
| shiroiushi wrote:
| The idea is for the _government_ to spend that $20k /year
| somehow (and hopefully get a big discount by buying in
| bulk). Spending that much on countless homeless people,
| and turning a large fraction of them into productive
| citizens, isn't "vile" at all: it would make the homeless
| people much happier for one thing, but would also save
| the rest of society a lot of money by not having to deal
| with the negative effects of their homelessness, plus
| increase the GDP and thus the tax base, easily paying for
| itself.
| sqeaky wrote:
| I don't think that's what they were advocating, the way I
| read it they were saying that people should spend that
| money on themselves and neglected the idea of people who
| couldn't afford it. But yeah if the idea is for the
| government to lift people out of poverty that's great we
| just haven't seen much of that in this country, or at
| least not as much as I think we could practically afford.
| BurningFrog wrote:
| I wasn't really advocating anything, just pointing out
| that the math works.
|
| Who might pay the $20k of course varies a lot, depending
| on the health care system.
|
| One thing I've learned over the years is to not try
| "reading between the lines" to suss out what people are
| "really saying". It's just too error prone, and you
| rarely end up communicating.
| rs999gti wrote:
| No
| ninetyninenine wrote:
| a necessary evil in a capitalist system. Is capitalism
| perfect? No. Do we know of a better system yet? Maybe. But as
| of right now better to have a possible cure for 20k rather
| then nothing.
| rs999gti wrote:
| Drugs become generic eventually and costs come down.
|
| Zyprexa, which was mentioned in the article, is almost always
| prescribed as generic Olanzapine. Cost as of 2024 for generic
| - 9 USD, brand name 476 USD.
| throwaway0665 wrote:
| > What are "Novel" Drugs?
|
| > "Novel" drugs are new drugs never before approved or marketed
| in the U.S.
| rendx wrote:
| The Role of Childhood Trauma in Psychosis and Schizophrenia: A
| Systematic Review
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858420/
|
| "Childhood Trauma is probably the most important environmental
| factor associated with Schizophrenia. There is evidence of
| multiple paths between traumatic experiences and psychosis.
| Mental disorders are systems of interacting symptoms through a
| framework of networks. Psychotic symptoms in patients with a
| history of child abuse are more severe, persistent, and
| refractory to treatment. In developmental years, exposure to
| neglect and abuse reveals severe adverse effects on the average
| neurobiological growth, leading to vulnerable neurobiology
| preceding disadvantageous psychiatric outcomes."
|
| https://www.theguesthouseocala.com/understanding-the-connect...
|
| "The guiding principles of trauma-specific care can give you the
| space to uncover the root of your schizophrenia and trauma. Thus,
| understanding how your early traumas have impacted you opens the
| door to dismantling maladaptive coping mechanisms. As you deepen
| your self-understanding, it encourages you to lean into adaptive
| coping strategies to process your experiences and life stressors.
| Furthermore, with support, you can find a path to recovery from
| schizophrenia and trauma that considers you and your specific
| experiences."
| throw18376 wrote:
| i'm getting very argumentative on the internet today (under a
| pseudonymous account because as you might guess from my
| incessant posting, this issue is personal for me)
|
| trauma (at any time), drug use, other experiences -- all can
| make schizophrenia more likely in those susceptible. absolutely
| true.
|
| but it is a biological disease, and healing trauma won't stop
| its progression. as your source notes, the trauma causes
| differences in brain development, and once that's done its
| done.
|
| i don't think coming up with a new drug, the main advantage of
| which is it _doesn 't_ numb you the horrible way existing
| antipychotics do, is a bad thing.
|
| this is basically a drug that was only created to improve the
| QoL of people with schizophrenia. if society just wanted to
| numb them, we already have drugs for that and could just be
| much more aggressive in violently coercing treatment.
|
| investing in these drugs isn't "looking away", it's putting in
| a huge investment of many billions of dollars to _help_ the
| victims live better lives.
| rendx wrote:
| > once that's done its done
|
| "As such, the hippocampus and hippocampal neuroplasticity may
| also play a key role in resilience and recovery from stress.
| This is supported by the current finding that hippocampal
| volume increased following psychological therapy."
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943737/
|
| "we found a significant [hippocampal] volume expansion during
| a 12-week treatment period, which correlated with clinical
| improvement"
|
| https://www.biologicalpsychiatryjournal.com/article/S0006-32.
| ..
|
| Increased hippocampal volume and gene expression following
| cognitive behavioral therapy in PTSD
|
| https://www.frontiersin.org/journals/human-
| neuroscience/arti...
| sterlind wrote:
| All those articles are for PTSD. PTSD is not the same as
| schizophrenia. Just because psychotherapy helps with PTSD
| doesn't mean it'll help with schizophrenia. Mental
| illnesses, and their treatments, are not fungible!
| asveikau wrote:
| Psychotherapy does in fact help with schizophrenia. It's
| been a while since I was steeped in reading sources that
| backs this up, but one thing I came across was the notion
| that therapy alone is actually more effective than
| antipsychotics alone for certain symptoms. (If memory
| serves, therapy is better than drugs for persistent
| delusions.)
|
| However, I think the best treatment involves both.
| rendx wrote:
| 1. See my other reply in this thread about the potential
| link between and high comorbidity of PTSD and
| schizophrenia.
|
| 2. The argument brought up was that brain 'damage' "just
| is", and cannot be reversed; which is where _any_
| neuroplasticity research can be used to show that it is
| not that simple, and that even brain structures can and
| do continue to change over the course of a lifetime, not
| only on the level of transmitters.
|
| 3. The positive effects of psychotherapy for
| schizophrenia are well researched.
| none4methx wrote:
| I'd like to call you both right on the basis that a working
| brain at age 40 retired with less than a working brain from
| age 27 or whenever schizophrenia tends to present.
|
| Outcomes are what we're hoping to improve. Your data looks
| like we get brain recovery, which is an improvement to
| outcomes. Necessary, maybe not sufficient.
| creatonez wrote:
| No one mentioned PTSD?
| rendx wrote:
| I did!
|
| When you look at the studies I posted initially, one
| theory is that schizophrenia is a _result_ of
| posttraumatic stress caused by childhood trauma, and a
| _coping strategy_ (flashbacks, intrusions, dissociation).
| It may not be in all cases, but in the cases where that
| is, PTSD treatment seems to work to fundamentally heal
| schizophrenia.
|
| Remission of schizophrenia after an EMDR session
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820797/
|
| Applications of Trauma Treatment for Schizophrenia https:
| //www.tandfonline.com/doi/full/10.1080/109267710037051...
|
| Making meaning of trauma in psychosis https://www.frontie
| rsin.org/journals/psychiatry/articles/10....
|
| Even if you believe schizophrenia to be first and then
| _lead to_ traumatic experiences (which it certainly
| will), it makes total sense to do a trauma assessment and
| heal the maladaptive strategies and broken beliefs
| related to these traumatic experiences, which is where
| again PTSD treatment comes in.
|
| "In the last 2 decades, it has become obvious that child
| abuse, urbanization, migration, and adverse life events
| contribute to the etiology of schizophrenia and other
| psychoses. [...] I expect to see the end of the concept
| of schizophrenia soon." (Murray, R. M. (2016). Mistakes I
| Have Made in My Research Career. Schizophrenia Bulletin,
| sbw165. doi:10.1093/schbul/sbw165)
| froh wrote:
| yes, there are indications for this to be true, however,
| it's _extremely_ hard to find clinicians willing to and
| courageous enough to work with patients with psychotic
| experiences on trauma.
|
| basically admitting psychotic episodes kicks you out of
| most programs before you can even start, because the
| anticipated overreaction to slight triggers can only be
| handled by the most experienced counselors, or so they
| believe.
|
| In that sense I appreciate you sharing these papers while
| pointing out that it's still a looong way to have this
| currently "esoteric" knowledge mainstream.
| 47282847 wrote:
| Trauma therapy has three components: safety from
| continued abuse, stabilization/resource
| building/(co)regulation, and confrontation. It would be
| ill-advised indeed to start confrontation when the other
| two are not in place, however it is perfectly possible to
| use trauma therapeutic methods for stabilizing, also for
| patients with psychoses.
|
| Build a stable base camp. No need to go in deeper yet.
| But if you are preparing to go in and face the truth, you
| cannot do it with meds that blind you.
| maybelsyrup wrote:
| > but it is a biological disease
|
| I want to be charitable because I think I know the point
| you're trying to make in your comment, and what I want to say
| is mostly to the side of that. But I think that this
| statement at best glosses over what's been a long, expensive,
| and heated (though sincere) scientific conversation about
| schizophrenia over the past century and change. It's one that
| not only includes a substantively fruitless search for any
| underlying pathophysiology, but a spirited conversation about
| the validity, reliability, and plain-English usefulness of
| the concept itself! Further, this conversation is far from
| the stomping grounds of cranks and scammers; it has taken
| place inside what you might call the most orthodox
| psychiatric and psychological institutions: the APA, the
| major high-impact journals, fancy universities etc etc.
|
| So when an eminence like Robin Murray, knighthood and all,
| can go into Schizophrenia Bulletin (2017) and write something
| like ...
|
| "I expect to see the end of the concept of schizophrenia
| soon. Already the evidence that it is a discrete entity
| rather than just the severe end of psychosis has been fatally
| undermined. Furthermore, the syndrome is already beginning to
| breakdown, for example, into those cases caused by copy
| number variations, drug abuse, social adversity, etc.
| Presumably this process will accelerate, and the term
| schizophrenia will be confined to history, like 'dropsy.'"
| [1]
|
| ... saying that we know it's a biological disease as part of
| broader claims about treatment effectiveness doesn't tell the
| whole story. (I encourage everyone to read Murray's
| reflections in the linked article, as it's a fascinating
| retrospective on an illustrious career in psychosis research
| and psychiatry.)
|
| [1] https://academic.oup.com/schizophreniabulletin/article-
| abstr...
| sudoshred wrote:
| Excellent comment. A "symptom" of schizophrenia is thinking
| that one does not have schizophrenia. A "heads I win tails
| you lose" situation where the single doctor is solely and
| individually responsible for diagnostics and treatment, but
| not liable. Criminals are given more rights and protection
| from abuse, and the legal systems has known and documented
| failures. For those who are labeled mentally ill there have
| not been established effective safeguards to protect and
| support those who might speak out, and by definition of
| competency their perspectives are not valid. Those who are
| economically incentivized to argue in favor of a biological
| explanation can be expected to do so, despite no personal
| expertise in the matter, and regardless of reproducible
| evidence.
| slibhb wrote:
| As I read it, the parent comment is making a point about
| the classification of schizophrenia. It is not disputing
| that the condition (psychosis) is real, or claiming that
| people are frequently misdiagnosed with some form of
| psychosis.
| throw18376 wrote:
| i think we would agree a lot about the brutality and
| incompetence of the current system of psychiatric
| institutions.
|
| however, the reality is, psychosis frequently prevents
| people from recognizing their own impairment. it's just
| true that this is very common, and maybe shouldn't be so
| surprising, since in many other cases (alcohol, drugs,
| dementia, brain injury) people also are prone to
| underestimate how impaired they are.
| throw18376 wrote:
| well, okay, then we can say that a lot of people diagnosed
| with schizophrenia now, even if the concept of
| schizophrenia is not viable, do have biological disease(s)
| that cause psychosis alongside what we now call the
| negative symptoms of schizophrenia. I'm fine with that
| claim.
|
| it's very different than the common anti-psychiatry claim
| that the schizophrenia diagnosis is a social construction
| that gets applied to healthy people who violate social
| norms.
| throw23478 wrote:
| Are there any consistent biomarkers for people with
| schizophrenia?
| gosub100 wrote:
| > with support, you can find a path to recovery from
| schizophrenia
|
| They misspelled "medication". There are narrow situations where
| very skilled psychiatrists have successfully treated
| schizophrenics using non-pharma (read: traditional)
| psychotherapy, but they are truly exceptional cases.
|
| Being schizophrenic is not a lack of "deepening your self-
| understanding" that blocks them from "uncovering the root of "
| their illness! That is absolutely horse shit and belongs in a
| new age Homeopathy boutique.
|
| Schizophrenics firmly believe their delusions and paranoia. In
| fact, one of the worst things you can say to them is "it's all
| in your head! The voices aren't real!". Commonly, they split
| the world into allies and suspects, so the moment you try to
| invalidate them, they add you to the list of
| agents/spirits/whatever is after them.
|
| This disease requires a psychiatrist and medication, full stop,
| and is fully orthogonal to child abuse.
| hn72774 wrote:
| I lost a good friend to this. Hope it helps other people.
|
| The meds helped him but he didn't like the side effects so he
| stopped taking them. Went in and out of homelessness. In the end
| he thought he had superpowers and could fly. He could fly, but he
| could not land. It eventually took him.
| hilux wrote:
| Same story here, more or less. Freshman roommate.
|
| It's probably a common story.
| 11235813213455 wrote:
| Oh man, I'm probably half schizophrenic, tried some
| antipsychotics at some point and had same reaction, and
| recently started to spend most my time outside (sleeping too),
| I found a nice spot. Fortunately I still have my remote
| developer job, and try to remain stable but I'm over sensitive
| and in the long run I can't sleep in my apartment (noise,
| smells - cigarette, here in France, it's horrible, maybe WIFI
| waves too). But isolation tends to makes me a bit more tolerant
| to people, I love birds and any really natural living being
| though
| iaaan wrote:
| Just out of curiosity (no obligation to respond): how long
| have you been experiencing these difficulties? Have you
| always been sensitive to these things?
| 11235813213455 wrote:
| I'm 39 now, since 22-24 so 15+ years, it started at the end
| of studies, I started to stop spending money (except appt.
| rent), OCD things appeared, I manage to keep stable jobs
| and after years I started eating better, fueling better the
| brain, most OCD troubles disappeared, but I feel like I
| changed myself to someone more sensitive, more wild in some
| way. in the long run I can't handle a "normal life", sit
| down in a closed air-conditioned place, eat industrial
| food, tolerate cigarette smokers around, noisy motorbikes,
| and all forms of pollutions. I started to also try to avoid
| polluting as much as possible, by respect for nature, which
| is my real efficient treatment I think
| madmask wrote:
| I would move outside of the city/town, on a very small
| but independent house far from others. A quiet and
| beautiful natural place. Now internet is everywhere and
| it's possible to work from nice places.
| Loughla wrote:
| The problem is if you need medical care, there aren't
| great options in rural areas.
|
| Source: the closest hospital to me is 30 minutes and it
| sucks out loud for anything but basic injuries.
| madmask wrote:
| May be true, but if there are no other pathologies that
| require frequent visit to the hospital, and the quiet
| living might help the mental side of things, why not?
| Maybe giving it a go for a while at first.
|
| Maybe it's just me, I only once in almost 40 years
| required urgent medical attention and would have survived
| without.. so I don't understand the worry about not
| having an hospital close to home.
| 11235813213455 wrote:
| Thanks yes that's my plan and hope. I don't need much
| healthcare, except maybe teeth (that got a bit damaged
| when I was too underweight), not something frequent
| stndef wrote:
| I'm not a professional, and I'm not diagnosing, but I am
| diagnosed autistic and I share some of what you're talking
| about here.
|
| I'm sensitive to noise, smells, lights and vibrations (living
| next to a very busy road, I can feel almost every large non-
| electric vehicle go by -- makes working from home hard at
| points).
|
| Worth reading into if you have the energy. I do know folks
| who are diagnosed with schizophrenia and they seem to have an
| underlying component of some neurodivergence (arguably
| schizophrenia should also be considered neurodivergence) and
| went through an extreme burnout/traumatic event.
|
| Hope you're able to get some peace!
| retrac wrote:
| I moved twice in the last few years. Immediately after
| moving I was completely unable to sleep. Too bright. Too
| loud. What are these noises? What is that vibration? For
| me, it fades after a few weeks. The train can be rumbling
| by with the horn going and I'll sleep right through it now.
| I think maybe for some, that filter never builds up. Not
| sure how to articulate it but it does seem a significant
| component of both autism and schizophrenia (which in some
| ways seem to be almost opposites) is a difficulty in
| developing that sort of filtering-out of the constant
| sensory bombardment we're all under.
| stndef wrote:
| Acclimitisation can be hard. In some cases I can put
| things to the back of my mine, but often it's just hard
| or not possible.
|
| Certainly in my experience and from talking to others who
| identify or have been diagnosed similarly, in the
| majority of cases you don't get used to certain things.
| You can't acclimitise and that's why a load of people who
| are autistic aren't employed.
|
| I might seem okay in the office, but what isn't seen is
| my complete inability to function at home if there have
| been too many inputs and distractions. Lucky I can work
| from home a couple of times a week and my hours are
| flexible in that I can start earlier so not to travel
| into the city when it's busy -- busses are quiet at
| 05:00/06:00 thankfully!
|
| Having a small office I share with a few people helps. My
| last place went all in on the open-planned office and it
| was hell. I can't see how anyone is getting much work
| done in environments like that, haha.
| LoganDark wrote:
| Schizophrenia is certainly neurodivergence, as far as I
| know. I've often seen it depicted that autism and
| schizophrenia are roughly on opposite sides of
| neurotypical:
|
| - Autism can make one prone to detail-oriented thinking,
| focusing on small details, requiring logical connections to
| understand and apply ideas. Constraints are well understood
| and considered. This can result in stuff like OCD.
|
| - Schizophrenia can make one prone to disconnected
| thinking, focusing on big pictures, fitting together ideas
| that may seem entirely unrelated. Even constraints that
| seem obvious may be completely ignored. This can result in
| stuff like conspiracy theories and convoluted delusions.
| Delusions happen because beliefs may not be constrained by
| what's actually realistic, the big picture could be more
| prominent.
|
| I don't know how true this analogy is, but it certainly
| seems interesting to consider.
| 11235813213455 wrote:
| Very insteresting, my father thinks I'm autistic, while
| some psychiatrist concluded for "Hebephrenic
| schizophrenia". In my developer work I tend to rush
| things a bit, maybe because I don't know how long I'll
| feel in peace, but if I can really find peace, then I
| deeply focus like an autist. Also I'm not associal
| (except the fact I don't like cigarette, so I'll avoid
| crowd due to that unfortunatly) I usually engage
| conversations with anyone, helps breaking my loneliness,
| and that's not really a trait of autists I believe (who
| are more shy/introvert/associal no?)
| tough wrote:
| It's a spectrum https://neuroclastic.com/its-a-spectrum-
| doesnt-mean-what-you...
| LoganDark wrote:
| > I usually engage conversations with anyone, helps
| breaking my loneliness, and that's not really a trait of
| autists I believe (who are more shy/introvert/associal
| no?)
|
| I think 'autistics' is a better term here; 'autists' can
| make... not the best impression.
|
| Anyway: no, autistics aren't necessarily more
| shy/introverted/asocial. I'm autistic and I'm definitely
| not that way; I usually try to connect to as many people
| as I can and I have to speak to people essentially every
| day or else I get extremely lonely/depressed. Part of
| this is probably due to ADHD and possibly also
| B(orderline)PD, but it's also because that's just the way
| I am.
| maleldil wrote:
| > arguably schizophrenia should also be considered
| neurodivergence
|
| Isn't it? My understanding of the word is "anyone who
| experiences the world differently from the social
| 'normal'", which would certainly include schizophrenia and
| other kinds of mental disorders.
| Loughla wrote:
| I'm with you, I thought neurodivergent included any folks
| whose brain chemistry was different than the 'regular'
| baseline. Bipolar, schizophrenic, etc.
| heraldgeezer wrote:
| In the genderified xitter space "neurodivergence" has
| been hijacked to mean adhd and autism only.
|
| I cant wait for the TikTokers to find out about
| Schicofrenia where they can actually think they are god!!
| rs999gti wrote:
| > arguably schizophrenia should also be considered
| neurodivergence
|
| Nope never!
|
| I have experience with schizophrenia and it can never be
| confused with anything else. The person with it is devoid
| of reality and does not know they are sick. They resist
| treatment and sometimes would rather go homeless, stop
| eating or taking care of themselves, in order to avoid
| treatment. They pull down everyone in their lives trying to
| help them, and it really takes a toll on family and
| relationships.
| johndunne wrote:
| I couldn't agree more with you. I've got a brother who's
| been diagnosed with schizophrenia. He's in denial and
| it's a constant worry that he will stop taking his meds
| again. It's a brutal, life-destroying illness if it's not
| managed. His lows are truly soul-destroying to witness.
| heraldgeezer wrote:
| >maybe WIFI waves too
|
| Certified nutcase comment lmao, WIFI waves do not do anything
| are you gonna buy some shugnite rocks too like the two timer,
| also smoke smell, move then or move out of city. Im mentally
| ill too but its mild autism, adhd (takes me all day to watch
| a 2h movie I pause adn pause and pauise and pause and pause
| and pause) and depression (I recently cleaned my fridge from
| 4 year old rotting food) but astleast I sleep inside.
| foobiekr wrote:
| Being downvoted for tone, I guess, but the "remote
| influencing via waves" is _the_ classic delusion common to
| a lot of psychotic disorders.
|
| The poster needs to seek actual help.
| 11235813213455 wrote:
| I don't know for WIFI, but I really receive 4 with 5/5
| connectivity, and more than 30 in total from my apartment,
| it's crowded, and that's a bit silly that everyone installs
| their own box. I don't know exactly where it comes from,
| but even when it's calm and breathable, I don't feel
| especially good in my apartment, the difference with
| outside is incredible, so I'm trying to sleep, eat & work
| outside. I go back at my appt so recharge batteries, water
| bottles and food
| heraldgeezer wrote:
| It's not the Wi-Fi.
|
| >I don't feel especially good in my apartment, the
| difference with outside is incredible
|
| You have a mold issue in your apartment or some other
| problem like that then.
| FollowingTheDao wrote:
| > The meds helped him but he didn't like the side effects so he
| stopped taking them.
|
| This is frustrating to me as a long time psych med user. If the
| meds have intolerable side effects then the meds do not help.
| Period. I do better off my meds than anything they ever tried
| to give me.
|
| The system failed your friend. Not his ability to tolerate
| these horrible side effects.
|
| IF we actually cared about human life we would have done much
| more to help your friend, but we did not. We care about human
| life up to the point it starts diminishing our comfort, and I
| am afraid we are valuing our comfort more and more than we care
| about others who are suffering in the last thirty years.
| shermantanktop wrote:
| It appears there is more suffering and misery out there than
| any single concerted effort could solve.
|
| I'm in NYC and just yesterday saw a homeless guy pick up a
| used needle from the street and check to see if it had any
| drugs left in it. The story that led him that state, and
| where that story goes from here, multiplied by thousands of
| people in a big city alone...it's hard to imagine solving
| that.
| rs999gti wrote:
| > The meds helped him but he didn't like the side effects so
| he stopped taking them.
|
| They, their family, or guardian should have consulted their
| psychiatrist to tune the meds for less side effects or to
| switch them. That is what psychiatrists are there for.
|
| Especially for schizophrenics, they should never have the
| option to get off meds, in fact there should be a long acting
| backup med to go with the normal treatment in case the
| patient were to skip a dose.
|
| Those with experience with schizophrenia know this is the
| hardest part of dealing with this mental illness - getting
| the patient into treatment and onto meds. Sure it is easy to
| maintain meds, but on boarding is the biggest challenge -
| that once it is setup, working, and bringing the patient back
| to reality it needs to be maintained, otherwise the patient
| and family have another long, uphill battle getting the
| patient back under treatment.
| FollowingTheDao wrote:
| > they should never have the option to get off meds
|
| (I have Schizoaffective Disorder)
|
| The meds do not work and they have horrible and even deadly
| side effects. To say I should never be allowed to stop them
| denies me of my agency and would force me to endure a life
| of misery. I am no longer on medications and better than I
| have ever been. I am rare. Even psychiatrists do not like
| this idea.
|
| We could open up psychiatric institutions again like they
| were when my mother was in one. It was great for her. Now
| we have these prisons they call psychiatric hospitals run
| by fro profit companies. (Just google Holly Hill Hospital
| in Raleigh, NC for an example.)
|
| What we need is better research that is not dominated by
| funding from Corporations. All funding should come from the
| Government.
| hn72774 wrote:
| > they.. should have
|
| Believe me, "they" tried. Just finding him was hard and he
| moved to a remote location. Gave away all of his
| possessions, including cell phone. Lived in a temperate
| climate where it was easy to get "lost" in the vegetation
| and live off the land.
| t0lo wrote:
| Does anyone else feel like this is just some sort of population
| control measure?
| jacobjjacob wrote:
| No, what's your rationale?
| nucleardog wrote:
| The schizophrenics certainly do!
|
| https://my.clevelandclinic.org/health/diseases/23348-paranoi...
| hindsightbias wrote:
| They already have Chemtrails and TV for that.
| sqeaky wrote:
| "Netflix and chill" is surely a different take on "population
| control".
| ndynan wrote:
| https://www.sciencedirect.com/science/article/pii/S014067362...
|
| Here is the drug trial results for EMERGENT-2 which was one of
| the two phase-3 trials that lead to the approval.
|
| I think its striking that the trial is only 5-weeks long and this
| medication gets approval.
| throwup238 wrote:
| From your linked paper:
|
| _> Results from additional trials, including the identical
| EMERGENT-3 trial and the 52-week, open-label EMERGENT-4 and
| EMERGENT-5 trials, will provide additional information on the
| efficacy and safety of KarXT in people with schizophrenia._
|
| EMERGENT-4 and EMERGENT-5 concluded last year [1], which was
| the reason for the approval. EMERGENT-2 was mostly a milestone
| Karuna Therapeutics used to get enough funding for the rest of
| the trials and inform their design.
|
| [1] https://news.bms.com/news/details/2024/Bristol-Myers-
| Squibb-...
| ndynan wrote:
| Thanks for the info - curious to look at these trials and see
| if there are sustained long term positive outcomes on the
| PANSS or these are just safety /tolerability studies.
| bombi wrote:
| Schizophrenia can be cured with niacin (vitamin B3). Search for
| Adam Hoffer's achievements
| the_gorilla wrote:
| Every single time someone has told me a disease could be cured
| with vitamins, it was scurvy or bullshit.
| FollowingTheDao wrote:
| Enzymatic cofactors (vitamins) many not a be cure, but maybe
| a better, cheaper, less harmful, treatment. Take pyridoxine
| (B6) as an example.
|
| Also, did you know vitamin C deficiency not only casues
| scurvy but mood disorders as well? The neuropsychiatric
| effects of vitamin C deficiency: a systematic review
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302360/
|
| on Pyridoxine:
|
| Pyridoxamine: A novel treatment for schizophrenia with
| enhanced carbonyl stress
| https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12613
|
| Vitamin B6 deficiency hyperactivates the noradrenergic
| system, leading to social deficits and cognitive impairment
| https://www.nature.com/articles/s41398-021-01381-z
|
| Vitamin B6 as add-on treatment in chronic schizophrenic and
| schizoaffective patients: a double-blind, placebo-controlled
| study https://pubmed.ncbi.nlm.nih.gov/11838627/
|
| Decreased serum pyridoxal levels in schizophrenia: meta-
| analysis and Mendelian randomization analysis
| https://www.jpn.ca/content/43/3/194.abstract
|
| Treatment of Pyroluric Schizophrenia(Malvaria) With Large
| Doses of Pyridoxineand a Dietary Supplement of Zinc
| https://isom.ca/wp-
| content/uploads/2020/01/JOM_1974_03_4_11_...
| smolder wrote:
| It's weird that you would state that so confidently when, as
| wikipedia says, "Hoffer's ideas about megavitamin therapy to
| treat mental illness are not accepted by the medical
| community." It didn't pan out.
| niemal_dev wrote:
| Didn't pan out because it's not the plan to pan out. The plan
| is to make people think there's something wrong with them and
| recycle them with insurance.
| dailykoder wrote:
| RIP in peace Terry Davis. If you only had that :(
| heraldgeezer wrote:
| May he run over many CIA glowies in heaven <3
| pcrh wrote:
| Nice to see!
|
| This was developed in the UK for PS11million and sold to Bristol
| Myers Squib for USD 14billion...
|
| https://wellcome.org/news/new-treatment-for-schizophrenia-Co...
| hackernewds wrote:
| That's quite a handsome return. Which BMS feels empowered to do
| to since they can charge exorbitant amounts for it
|
| I often am against the narrative that every pill should be
| priced at the cost of manufacturing + healthy margin, since by
| that logic the first pill should cost billions to cover for the
| R&D. In this case, it doesn't quite translate.
| greenish_shore1 wrote:
| Want to buy it cheaper? ALWAYS look for the molecule's CAS number
| in your search engine of choice.
|
| https://www.google.com/search?q=131986-45-3 (Xanomeline)
| https://www.google.com/search?q=10405-02-4 (Trospium chloride)
|
| Now you see, they're selling it with a huuuuge markup, just for
| that FDA's "stamp" on the box. But inside the packaging, it's
| just... this. But to everyone their own, I guess.
| notQuiteEither wrote:
| You're suggesting to people that they should buy research use
| only chemicals and attempt to compound them at home? That is
| incredibly irresponsible and dangerous.
| greenish_shore1 wrote:
| If you don't trust people to compound a drug for their own
| use, why would you trust them to not jump off a bridge, to
| not kill or injure a passerby, or not to perform other
| serious antisocial actions? Of course this is a way deeper
| issue, but I tend to approach it this way. In the Western
| values, we tend to value freedom, also as freedom of people
| to self-define, very high, despite the risks it takes. And
| this, this is a modern part of exactly the same dilemma.
|
| People already do exactly that, and with some basic knowledge
| (which should and probably will be in 20-30 years a common
| knowledge) it's much safer than one could expect.
|
| Of course, it'd be ideal if they wouldn't need to worry about
| it and could leave this to a person who is guaranteed to be
| more knowledgeable in doing that, but with all the over-
| regulation burden, drug patents, drug schedules, it's not
| happening. Example of that is, precisely, the price of this.
| It could literally be 2000x smaller if we only get rid of
| that burden, which was created to give some people profit.
| And if we subside that with taxes, these taxes go to the
| pocket of a gatekept and protected-by-the-state manufacturer.
| That's not how taxes should even work, they should benefit
| the society instead.
|
| TL;DR: This is a _much_ wider issue.
| glial wrote:
| I mean, I wouldn't compound drugs for myself for the same
| reason I don't do maintenance on my car's transmission
| myself: I don't really know what I'm doing and would
| probably get myself killed.
|
| From what I understand - may be wrong - the 2000x has more
| to do with IP protections than production safety.
| greenish_shore1 wrote:
| Basically, I agree. Would be great if people wouldn't
| have to bother. But that's a perfect world which,
| apparently, isn't very real. Hence, let's try to think
| about a solution which, even though not ideal, could
| possibly be better than the existing state... Because
| always, there is, among others, the greed of some, and so
| on.
|
| By the way, I'm not even sure does IP protections itself
| apply here. Both parts of this fixed combination drug
| were known for quite some time (particularly trospium
| chloride is very old, also often used in research
| settings). But if they would apply (if the molecule
| itself was patentable as someone's intellectual
| property), they would be additional HUGE problem. But
| what constitutes (or creates) that "2000x" problem here
| isn't even that, this is most likely the FDA regulations
| regarding drug approvals and so on, exclusively.
|
| It could be a good idea to wonder about, what if FDA as a
| governmental agency limited itself to "trusted"
| information campaigns to the public on efficiency of all
| medicines, but not doing anything which touches, notably,
| revenue matters of pharmaceutical companies (as that's
| why, in my opinion, corporations actually lobby for big
| FDA influence, they can make more profit off that).
|
| Also, definitely FDA in that model wouldn't be setting
| themselves as an "authority" for "approvals" of drugs and
| so on, which for my taste is completely contrary with
| both the whole putative role of (federal) government, and
| further, with the Western values (as I outlined in my
| previous comment) themselves.
|
| That new role and "definition" of FDA would be exactly
| akin to what NIH is doing even now in the area of
| nutrition. If you don't know what they do, look at the
| USDA FoodData Central or all the micronutrient factsheet
| they publish - it's my go-to resource when I wonder
| anything about food.
|
| But the FDA role would then be like that, but in regard
| to man-made substances of medicinal use, as opposed to
| these occurring in abundance in nature (which, in a great
| simplification, when they're essential to a human body,
| we consider "food"). And DEA's complementary role here
| would be to go after manufacturers who do not label their
| products according to the truth.
| lossolo wrote:
| The FDA exists to prevent us from repeating history[1]
| and to minimize the risk of people being killed,
| developing tumors, or buying placebos instead of real
| cures.
|
| 1. https://en.wikipedia.org/wiki/Snake_oil
| greenish_shore1 wrote:
| That's why I said about them releasing science and
| evidence-based trusted information campaigns. Not about
| getting rid of the FDA entirely.
|
| In the present information age, you don't need to give
| them such wide powers to avoid precisely what you're
| afraid about avoiding.
| lossolo wrote:
| That's a very naive view of the world. There are
| predators waiting for deregulation to flood the market
| with snake oil and profit from everyone. By the time the
| FDA can launch any campaign, people will already have
| been scammed or even killed. Moreover, the information
| age doesn't help or prevent these issues--just look at
| obesity rates, despite the wealth of information and
| science about junk food. What you're proposing might work
| for a small percentage of the most informed and
| intellectually capable individuals, but it creates risks
| for everyone else.
| greenish_shore1 wrote:
| I don't agree and I think some of what you're pointing
| out is because we're still in a transitional period into
| a full information society (which we don't even fully
| know what it would be, even now, 30 years deep into that
| transitional period, but it's inevitable and I'm
| personally sure that it would be infinitely better that
| what we have now). I think of it as a duality, that
| usually, when we do something good, it usually creates
| some harm (for example, to a group we haven't even
| realized it existed!).
|
| However, your point made me realize that, in fact,
| probably what you generally described as the most capable
| individuals, are probably even now mostly immune to the
| harm which FDA creates as "side effects" of what they
| consider good. So, if we assume that FDA's action don't
| "touch" them in most ways, should these most capable
| individuals be trying to reform it? But I don't think
| that the FDA's action don't affect the most capable
| individuals much. We're all one society and even if it
| doesn't influence them much directly, it still very much
| does so in more indirect ways.
|
| Also think, why do you think that "predators" even exist?
| It could be either evil nature of the humankind itself,
| if we assume there is such, or something else creating a
| place for them. If it's the first one, we're fucked
| regardless. But maybe it's not?
| xutopia wrote:
| 1850$ a month at wholesale cost. That's prohibitively
| expensive and it could save lives.
| munificent wrote:
| Or end them.
| ThinkBeat wrote:
| This reads like a happy clappy advertisement.
|
| It is often not the common side effects: "gain weight, fall
| asleep and experience involuntary muscle jerking" that cause
| people to stop taking meds. It is that their brain feels
| different, not like how it should be.
|
| Now involuntary muscle jerking has a high stigma. It can, in the
| worst cases be highly visible. The new drugs seem to stop this
| drawback and instead introduces vomiting. That would be even
| worse.
|
| The worst part of the article though is the frequent reference to
| homeless people. and that seems to be written by someone who has
| no idea of the realities.
|
| A majority of homeless people do not have access to even basic
| healthcare. There are different reasons for this, but it is true
| of the majority. You dont have a look that closely to see open
| wounds, some infected, esp on feet and legs. These are basic
| healthcare concerns. Probably they have several other conditions
| that require treatment, and deficiencies due to a lack of food
| period, and certain lack of food that is nutritious and healthy.
|
| Are the doctors just going to walk up and down the lines of
| homeless giving out bottles of pills and hope the world will
| change?
|
| These types of drugs should always be closely monitored by a
| psychiatrist. Which is made nearly impossible with homeless
| people. (not to mention the cost. It could have high co-pays but
| I hope there are programs that can mitigate this.
|
| The only way to do this is to give the person a place to live.
| Ensure the person has healthy and decent food. This will require
| time and treatment so build up a new sense of safety.
|
| Once achieved treatment for schizophrenia could start with the
| drug and be closely monitored by professionals.
|
| None of the drugs to treat mental health issues will work on all,
| And some people will have strong side effects.
| smugma wrote:
| My read on the one reference to homelessness in the article was
| that a life-changing medication that can help with a disease
| like schizophrenia can prevent homelessness in the first place.
|
| I have a close family member that had a psychotic episode
| during the pandemic. They were hospitalized but were eventually
| able to get effective treatment and medication and now live a
| mostly normal life.
|
| Had they not had the support to get proper medication, I have a
| hard time seeing how they wouldn't end up homeless.
| 2close4comfort wrote:
| After seeing how much they are going to charge for it, I am
| not sure if it will not cause more homelessness.
| InSteady wrote:
| $20k per year for a brand new drug that went through 15
| years of development is peanuts. Welcome to healthcare in
| the country that leads the world in pharma research, for
| good and for ill.
| rs999gti wrote:
| > $20k per year for a brand new drug
|
| The thing is you don't even need this new drug, from the
| article "Risperdal and Zyprexa" are very effective
| antipsychotics. Even more effective when combined with a
| long acting to prevent backslide from missed does.
|
| Who cares about the TD, tremors, etc. when that patient
| can rejoin society? Really what needs to change is reopen
| US mental hospitals to get these patients treatment and
| end the stigma around mentally illness.
| elil17 wrote:
| Napkin mathing here since available data isn't great, but
| the US definitely doesn't lead the world in healthcare
| R&D spending relative to our size. We're spending
| something like 0.22% of GDP on healthcare R&D, putting us
| at about #7 globally. In comparison, Denmark spends 0.93%
| of GDP on healthcare R&D. And that list is missing data
| from other countries that probably rank above us, like
| Cuba.
|
| Sources: https://www.oecd-
| ilibrary.org/docserver/sti_scoreboard-2009-...
| https://www.who.int/observatories/global-observatory-on-
| heal...
| sudosysgen wrote:
| Not saying it is or isn't overpriced, but 20k/year is
| actually a good price for something that can avoid
| homelessness. Just the cost of extra medical care and/or
| jail, let alone social services and lost productivity, is
| worth it.
| omegaworks wrote:
| > A majority of homeless people do not have access to even
| basic healthcare.
|
| > The only way to do this is to give the person a place to
| live. Ensure the person has healthy and decent food.
|
| > This will require time and treatment so build up a new sense
| of safety.
|
| In many ways, just meeting people's basic needs would go
| farther to address mental health than any miracle drug.
| rs999gti wrote:
| > The only way to do this is to give the person a place to
| live. Ensure the person has healthy and decent food. This will
| require time and treatment so build up a new sense of safety.
|
| > Once achieved treatment for schizophrenia could start with
| the drug and be closely monitored by professionals.
|
| At least for mental illness, the US state run mental hospitals
| should be reopened to put the mentally ill under care,
| monitoring, and to get them back on medicine.
|
| Modern psychiatric medicine could reverse the issues that used
| to stigmatize the mentally ill.
| lazide wrote:
| Improperly supervised psychiatric patients are a nightmare, if
| for no other reason than they often don't take the drugs that
| make them not a nightmare.
|
| That means stand-alone housing just won't work properly.
| debacle wrote:
| "The only way to do this is to give the person a place to
| live."
|
| The people who are homeless are homeless because they, due to
| drugs, alcohol, or mental illness aren't safe to have around
| others of extreme poverty.
|
| My friend operate several halfway houses. Almost weekly he has
| to kick someone out because they are a danger to staff or other
| clients. Generally this is at 2am, and the police are involved.
|
| Our society has decided that institutionalizing people is
| inhumane. Well, if someone isn't safe enough to be in a halfway
| house and institutions are inhumane, the only place for them to
| go is the street, and, eventually, if they are lucky, prison.
| mik0n wrote:
| New drugs are sorely needed
|
| The current crop can best be described as chemical lobotomy.
| Impossible to focus on anything for more than 30 seconds. And
| it's not even a pleasant stupidity.
|
| There's Abilify, but unfortunately doctors don't like it (due to
| it being perceived as less effective).
| rs999gti wrote:
| Remove the stigma of mental illness and new drugs are not
| really needs. The current class of drugs are excellent at
| controlling psychosis.
|
| Sure there are side effects, but in this case the side effects
| are better than the psychotic behavior and breakdown of the
| patients.
| mik0n wrote:
| Wouldn't it be better to have a drug with NO severe side
| effects, so we can actually get people to eat them? Which is
| exactly what they are trying to do. So many quit their meds,
| then wham another psychosis.
|
| I just don't understand the negativity in this thread. They
| are doing gods work as far as I'm concerned.
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