A number of stories caught my eye today and I wanted to write about each of them, but did not want to overwhelm the blog list like someone else who shall remain nameless (but happens to play rugby) does on occasion. The first unifying thread I noticed was that all deal with the letter D. So, like Kathy Griffin, the D-list it is.

Drug dispensers: Vending machines in prison - Pepsi, Coke ... Viagra?

Really, what could go wrong in this scenario? Images of the Fonz whacking the jukebox played in my mind, but replace the Fonz with a convict and the jukebox with a vending machine dispensing prescription drugs...

Corrections departments are responsible for so many burdensome tasks that many of their everyday functions, like administering prescription drugs to inmates, are afterthoughts for the public. However, dispensing medication was so laborious and wasteful for the San Bernardino County (Calif.) Sheriff-Coroner Department that officials sought a way to streamline the process. The end product was essentially a vending machine that links to correctional facility databases and dispenses prescription medications.

Jokes aside, there was a lot of wasted time and drugs, according to the Government Technology Magazine report. At one of the locations "it took four nurses - each working four hours every day - to prep medicine for delivery to prisoners. The time-intensive process also generated medical waste because inmates might be moved between facilities or released during the time it took to prepare their medications, which left some prescriptions unused."

I'm all for efficiency and cutting out waste. But I'd like some numbers. The health supervisor estimated that the county delivers 1.5 million pills to inmates annually. But "although the corrections department didn't track the amount of medicine that had to be disposed of, Fillman said it was an enormous
amount." I believe them, and I'm sure it's saving money. But this is vaguely in the same vein of the argument that Cheney kept America safe. He can't tell us how, but he did, so we should give him carte blanche to do whatever he wants.

Anyway, it seems to be working, and it came in $500,000 under budget. Let's see if we can translate the efficiency and cost savings to the public/private sector, eh? (High five to samzenpus at Slashdot for the heads-up.)

Depression: a mental advantage?

Two scientists are making the case that depression may in fact be a mental adaptation that confers real cognitive benefits. The brain "plays crucial roles in promoting survival and reproduction, so the pressures of evolution should have left our brains resistant to such high rates of malfunction," reports Scientific American. (About 30-50% of the U.S. population have met diagnostic criteria for major depressive disorder at some point in their lives.) So, they argue, mental disorders should generally be rare — why isn’t depression?

Maybe it's a function of aging - our body deteriorates, so depression could be a function of our brain deteriorating. But that argument doesn't really hold water, as depression often strikes in adolescence or young adulthood. What about the idea that it's a function of our current environment - like obesity, which wasn't seen in our ancestral environment? Well, researchers don't think that's plausible either because societies that currently exist and live in similar conditions to our ancestral past still have cases of depression.

What if it is "an adaptation, a state of mind which brings real costs, but also brings real benefits?" There are several hints in the scientific milieu that could support this; one being the 5HT1A receptor, which binds to serotonin (a target of most anti-depressives on the market). The functional portion of the receptor is highly conserved (99% similar between humans and rats), so perhaps natural selection has preserved it.

There's no denying that depression can definitely cause problems for someone. But one "advantage," if you will, is that depressed people often think intensely about their problems and are highly analytical. The 5HT1A receptor plays a role here - it supplies "fuel to the fire" so people can continue to process the problem, breaking it down in to manageable chunks, and also prevents the neurons from "breaking down" so to speak, allowing the analytical process to continue without distraction. Other research shows people who get more depressed while they are working on complex problems in an intelligence test tend to score higher on the test; and people in depressed mood states are better at solving social dilemmas.

"Depression seems less like a disorder where the brain is operating in a haphazard way, or malfunctioning. Instead, depression seems more like the vertebrate eye - an intricate, highly organized piece of machinery that performs a specific function." (Thanks to Cmdr Taco at Slashdot for the story idea.)

Death Row organ donors: really, they aren't going to need them for much longer...

Say you're in desperate need of a new kidney. You're notified that there is a match - great! But someone at the hospital lets slip that your new kidney is courtesy of Charles Manson. Hmm. Not so great. I suppose his kidney wasn't responsible for his criminal activity (although you never know), but the idea makes me a little queasy. Well, in China, this is happening for the majority of organ recipients.

The BBC reports that according to the China Daily newspaper, "executed prisoners currently provide two-thirds of all transplant organs."

Human rights groups have often criticized China for its lack of transparency over organ donation, but critics have focused particular concern on the use of body parts from executed prisoners. In a rare admission of the extent to which this takes place, China Daily - citing unnamed experts - said on Wednesday that more than 65% of organ donations come from death row prisoners. The China Daily quoted Vice-Health Minister Huang Jiefu as saying that condemned prisoners were "definitely not a proper source for organ transplants." The new scheme is therefore designed to reduce the reliance on death row inmates, as well as regulating the industry by combating the illegal trafficking of organs.

We have been after China to work on conservation and recycling; maybe they just took us literally. (Thanks again to samzenpus.)

Drug development: Lupus

The official definition of a rare disease is something that affects less than 200,00 people. There is a law in place that provides incentives for companies to develop drugs that will treat these diseases - think Cystic Fibrosis, for example. But there are other diseases that, while they don't meet the definition, are still (relatively) rare and don't get a lot of press. Lupus is one of these.

An estimated 2 million Americans have lupus, and 90% of them are women. It's very difficult to diagnose and treat, and often takes a long time of visiting multiple doctors until a physician figures it out. Lupus is an autoimmune disease, and inflammation and tissue damage occur all over the body. There hasn't been any new treatment approved in over fifty years.

But hope is on the horizon. Wall Street Journal reported that two drugs, UCB/Immunomedics' antibody epratuzumab, and Human Genome Sciences' belimumab, have both met clinical trial endpoints and are looking good.

There are currently at least 15 drugs in various stages of development for systemic lupus erythematosus - 6 in Phase I clinical trials, 5 in Phase II, 1 in Phase II/III (belimumab), 2 in Phase III (including epratuzumab), and one (thalidomide) that already exists for other indications but is in clinical trials for SLE. Given pharmaceutical R&D history, most won't make it to market, but even a few new options would be a blessing.