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Today is the fifth and final instalment in our key tech trends to watch out for in 2019. Today, we’re taking a look at medicine.
A strange thing happened in medicine over the course of the 20th century. Although it progressed massively in many areas, in many more it was held hostage by political beliefs.
You may think that science is the driving force of medicine. But that is simply not the case. Politics comes above science when it comes to medicine. When it comes to most things, in fact.
The 20th century’s “war on drugs” meant many promising compounds were kept out of the reach of medical researchers.
The Controlled Substances Act (CSA) was drawn up in 1970. It divides drugs into four categories.
On this scale, schedule one drugs are the worst you can get. They are defied as having “no currently accepted medical use and a high potential for abuse.”
And this is where the trouble starts.
In this category there is:
- Diamorphine (heroin)
- MDMA (ecstasy)
- Psilocybin (magic mushrooms).
If a drug is in this category, it is incredibly hard to conduct medical trials with.
Remember, officially, all schedule one drugs have no medical use. If one did, it would no longer be schedule one. It would have to be re-classified.
At least that’s what would happen if politics followed logic. Unfortunately, it does not. Politics is based on ideologies, not science or logic. And so the CSA is also based on ideologies and not science or logic.
For example, diamorphine is regularly prescribed for pain relief and cancer care in the UK. It clearly has medical uses.
A lot is already known about diamorphine because it is an opioid. Most prescription painkillers are. And as such, they all work in a similar way. Other than diamorphine, the most well-known opioids are probably morphine and codeine.
Yes, that’s right. Codeine is an opioid. That’s why you can only buy it over the counter when it’s missed with paracetamol and called co-codamol. They mix it with paracetamol to stop people abusing it recreationally.
You might remember that the US is currently in the grip of an “opioid crisis”. Prescription painkillers – both opioid and synthetic opioid – have become such a problem that they have actually reduced the average life expectancy in the US.
According to the CDC, 2017 was the third year in a row in which US life expectancy fell. That hasn’t happened since the dual decimation of the First World War and Spanish flu in 1915-1918.
The cause this time, is opioids and suicides.
The opioid epidemic began in the 1990s, when pharmaceutical marketing and lobbying led doctors to prescribe far more opioid painkillers — leading to a first wave of overdose deaths as more people, including both patients and people who stole or bought painkillers from patients, misused the drugs and got addicted.
A second wave of drug overdoses took off in the 2000s when heroin flooded the illicit market, as drug dealers took advantage of a new population of people who used opioids but either lost access to painkillers or simply sought a better, cheaper high. And now the US is in the middle of a third wave, as fentanyls offer an even more potent, cheaper — and deadlier — alternative to heroin.
Policymakers are starting to realise it may be time to stop pushing opioids and look towards other compounds.
Like I said, diamorphine – even though it is schedule one, and arguably the most dangerous of all the schedule one drugs – is regularly prescribed to patients in the UK.
Fentanyl, which is essentially the most dangerous drug on the streets in the US, is a synthetic opioid prescription painkiller.
But it goes even further than this. As the Washington Post points out, it is not just opioid overdoses that are the problem. It is suicides, too:
Life expectancy in the United States declined again in 2017, the government said Thursday in a bleak series of reports that showed a nation still in the grip of escalating drug and suicide crises.
The data continued the longest sustained decline in expected life span at birth in a century.
Not only are our current painkillers flawed – in that they are killing vast swaths of the population – but current antidepressants only work in around 60% of cases.
If only scientists were free to use all the tools at their disposal to tackle the problem. Perhaps they would come up with some new “innovative” treatments instead of pushing out stronger and stronger opioid variations, and lacklustre antidepressants.
Well, it seems that enough people have been dying for policymakers to start thinking more rationally about the problem.
Over the last few years, we’ve seen a number of studies come out that showed the vast potential of many schedule one substances (which you’ll remember, have “no currently recognised medical uses”).
The interesting thing about these findings is that these illegal drugs are proving to be viable treatments for conditions that traditional treatments are failing at.
The key ones are depression, anxiety, post-traumatic stress disorder (PTSD) and end of life care.
Ketamine can reduce depression “within hours”
Most anti-depressants work on regulation of serotonin. Serotonin plays a key role in our mood. These anti-depressants stop the “re-uptake” of serotonin and leave more of it floating around in our bodies.
The problem is, in many cases this method doesn’t work too well.
As Michael Pollan, the guest and author on Tim Ferriss’ podcast, notes:
“It’s important to understand how few tools psychiatry has to deal with mental health problems in general. The last major innovation was the introduction of Prozac in the late ’80s, and those anti-depressants aren’t working very well anymore. They’re fading in their effects, they only do a little bit better than placebos in trials, and people hate the side effects – they’re very hard to get off of.”
And that’s where ketamine comes in. As a 2012 study found:
A notable recent discovery shows that ketamine, a N-methyl-D-aspartate receptor antagonist, produces rapid (within hours) antidepressant responses in patients who are resistant to typical antidepressants. Basic studies show that ketamine rapidly induces synaptogenesis and reverses the synaptic deficits caused by chronic stress. These findings highlight the central importance of homeostatic control of mood circuit connections and form the basis of a synaptogenic hypothesis of depression and treatment response.
Ketamine works in a different way to current anti-depressants and as you can see, it has proven to be a very promising treatment in depression and anxiety.
The authors of that study ketamine: “the most important discovery in half a century.”
And a more recent study this year concluded:
Ketamine demonstrated a greater reduction in clinically significant suicidal ideation in depressed patients within 24 hours compared with midazolam, partially independently of antidepressant effect.
MDMA is an effective treatment for PTSD
MDMA – better known as ecstasy – the chosen drug of 90s ravers, has proven to be an effective treatment for PTSD.
When combined with talking therapy, it was found to be a very effective treatment. So much so that the FDA has granted it a “breakthrough therapy” designation.
And as reported in Business Insider:
Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies — a leading nonprofit behind psychedelic research — believes ecstasy is the “most likely” psychedelic to get adopted first by mental health professionals.
The results and the fact that MDMA received an FDA “breakthrough therapy” designation — a label designed to hasten the research and approval process — convinced some experts that the drug will be approved as early as 2021. The next phase of research is set to begin this summer and will involve roughly 250 people.
You can read about the success of the trial here in The Lancet. The study looked at:
(MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers.
But perhaps the most promising treatment of all is cannabis
It has been proven to help with:
- Multiple sclerosis (MS)
- Crohn’s disease and inflammatory bowel disease
- Chronic pain.
As you can see in my article here.
Now that cannabis has been legalised in Canada and much of the US, scientists are free to start using it as the basis of new treatments.
MDMA, while still “schedule one”, has been branded as a “breakthrough therapy” by the FDA.
And psychedelics, like LSD and magic mushrooms, are province to be effective in treating many mental health conditions – without the dangerous side effects of current treatments.
In September 2018, Johns Hopkins researchers urged policymakers to reclassify magic mushrooms as schedule four.
From Science Daily:
Although preliminary research studies suggest that psilocybin may be effective for smoking cessation and for disorders such as cancer-specific depression and anxiety, it must clear phase III clinical trials before the Food and Drug Administration can be petitioned to reclassify it.
Studies in animals and humans both show low potential for abuse, the researchers say. When rats push a lever to receive psilocybin, they don’t keep pushing the lever like they do for drugs such as cocaine, alcohol or heroin. When it comes to human studies, people who have used psilocybin typically report using it a few times across their lifetime.
As for safety, studies show it frequently falls at the end of the scales with the least harm to users and society, say the researchers. Psilocybin also is lowest in the potential for lethal overdose as there is no known overdose level.
“We should be clear that psilocybin is not without risks of harm, which are greater in recreational than medical settings, but relatively speaking, looking at other drugs both legal and illegal, it comes off as being the least harmful in different surveys and across different countries,” says Matthew Johnson, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
As you can see, there is clearly a movement towards giving scientists the tools they need to create effective treatments.
It’s hard to pinpoint exactly when or what changed, but something certainly did.
So in 2019, I expect one of the main trends in medicine will be in treatments derived from “recreational” drugs.
And where these drugs seem to be most effective is in the treatment of mental health and physical pain.
Given that suicide and current pain treatments are the leading factors in US life expectancy declining, effective treatments in these areas are clearly needed.
Hopefully, 2019 will bring us some breakthroughs in these areas, and an end to “the war on drugs”.
However, what I’ve covered today is just one small part of what we can expect to see from the medical world in the coming year.
There are big developments going on in gene editing, biohacking and AI-enhanced treatments. My publisher Nick O’Connor explores these areas in-depth in his book: The Exponentialist.
If you want to see what the future of medicine will look like, I highly recommend you take a look at this book. You can get your hands on your own copy here.
Until next time,
Editor, Exponential Investor