Think Different

Feb 22, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

It was about 11:30 am on a Wednesday when my cell phone went off at work. I was charging my phone in the lab while I was in the dispensary, so I missed the call. When I picked up my phone, it said I'd missed a call from Barker School. Eric goes there. I called back and got the principal, Kim MacMillan. She wasn't standing over Eric's crippled body, so I took that as a good sign. She said she thought Eric had just called my cell, but wasn't sure where he was. She said she'd find him. Eric eventually called back. He asked me to bring him a lunch. I said I saw him pack his own lunch that morning. He agreed that he hadn't forgotten his lunch, but his lunch was now moldy. Could I bring him a new one? How different does someone have to think to pack themselves a moldy lunch?

There was a famous 1997 Apple commercial called "The Crazy Ones". It showed clips of famous mavericks from John Lennon to Amelia Earhart to Mohammad Ali to Mahatma Gandhi who changed the world by thinking differently. There are lots of problems in health care that need some different thinking. Here are some crazy ones that might make a difference.

There is an Alzheimer's study called SNIFF or "The Study of Nasal Insulin in the Fight Against Forgetfulness". The study directors are Suzanne Craft from Wake Forest University Health Sciences and Paul Aisen from USC Alzheimer's Therapeutic Research Institute. The SNIFF study is supposed to be wrapping up this month. The researchers are giving 240 participants either inhaled Humulin R insulin or a placebo twice a daily before breakfast and supper for 12 months. Then all 240 participants will get insulin nasally for 6 months. The study participants will be given a standard memory tests at 3, 6, 9, 12 and 15 months. They will also get an MRI brain scan. The researchers are hoping the people on inhaled insulin will have better memories than those who aren't.

We don't know if this insulin trial will be the magic bullet for Alzheimer's disease. But it is fantastic that interesting new research is being done. Our current drugs like donepezil or Aricept are moderately effective at best. They can slow down the progression of Alzheimer's. They can't stop it or make Alzheimer's better.

How about fighting infection with bugs? Antibiotic resistance is a big problem and becoming bigger. How are we going to do surgery, cancer treatment or help people with pneumonia when our antibiotics don't work anymore? Well, what if we convince some predatory bacteria to eat what is causing the infection?

In the November 2016 issue of Current Biology, researchers published an interesting trial. They infected some zebrafish larvae with antibiotic resistant Shigella bacteria. Shigella are Gram-negative bacteria that can cause intestinal disease in humans and are often associated with "traveller's diarrhea". After the zebrafish larvae were infected with the antibiotic resistant Shigella, the researchers released the predatory bacterium called Bdellovibrio, which is able to kill Gram-negative bacteria. The research team found that the Bdellovibrio injection resulted in more of the Shigella being killed. It also reduced the number of zebrafish larvae that died by 50%. This resulted from the direct killing action by the predatory bacterium and that helped the immune system of the host defeat the Shigella as well. Will we be injecting bacteria in us to defeat other bacterial infections tomorrow? Probably not, but it is nice to see some novel approaches to the antibiotic resistance problem.

Marijuana. Whether you think it is wonderful or terrible it is here and there is going to be more of it used legally. Right now, with the right paperwork from the doctor, patients can get medicinal marijuana legally in Canada. It sounds like within the next 12 months there will be a way for adults to get marijuana legally for recreational use in Canada.

Medically, what is marijuana good for? There are hundreds of claims, but the US National Academy of Sciences says there is only good evidence to support three of those claims. The team of authors, consultants and reviewers, led by Dr. Marie McCormick, a professor of pediatrics at Harvard Medical School, found there is "conclusive or substantial" evidence that cannabis is effective for the treatment of chronic pain in adults, reducing nausea and vomiting during cancer chemotherapy, and for improving patient-reported multiple sclerosis spasticity symptoms.

The report also found "moderate" evidence that some cannabinoids, primarily nabiximols, are effective for improving short-term sleep outcomes in patients with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain and multiple sclerosis.

I was surprised to hear that there is moderate evidence that cannabis is not associated with increased risk for lung, head or neck cancer.

The report found a number of downsides to marijuana use, including:

  • More breathing problems and more frequent chronic bronchitis episodes with long-term cannabis smoking;
  • increased risk of motor vehicle crashes;
  • increased risk of overdose injuries, including respiratory distress, among pediatric populations in U.S. states where cannabis is legal;
  • an association between maternal cannabis smoking and lower birth weight of the offspring;
  • impairment in learning, memory and attention with acute cannabis use; and
  • development of schizophrenia or other psychoses, with the highest risk among the most frequent users.

As unthinkable as it was even 10 years ago, medicinal marijuana is becoming a part of main stream medical treatment.

Eric thinks differently than I do. I'm sure one day he will change the world or at least discover a new form of food poisoning. I'm still not certain how he packed himself a moldy lunch, but here is my theory. Eric packed a lunch on Monday. Didn't eat all of it. He didn't need a lunch on Tuesday, so Monday's lunch stayed in his back pack. On Wednesday, he found it incredibly unfair when I told him to pack a lunch for school. Thus logically, he took his left-over lunch from Monday, from wherever it was hiding, and put it in his back pack. Wednesday as lunch draws near, he opens lunch kit. Viola! Moldy lunch. Probably, in his mind blames his sister for this lunch disaster. Calls Dad to bring him a new lunch. The crazy ones do think different.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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SNIFF study -

Predatory bacterium could fight drug-resistant superbugs -

The Health Effects of Cannabis and Cannabinoids -

Apple Think Different "The Crazy Ones" Commercial -


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