Archive for December 2012

Must-read: Cold War experiments into BZ, sarin and other chemical weapons

December 23, 2012, 11:30 pm

Raffi Khatchadourian’s recent New Yorker article “Operation Delirium” is an amazing piece that details the U.S. military’s “volunteer” human experiments — mostly carried out at the Edgewood Arsenal in Maryland — concerning incapacitating agents such as LSD, PCP and BZ.

In this context, subjects were also exposed to sublethal doses of the nerve agents sarin and VX

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L.A. Times series on prescription drug abuse — Parts II and III

December 22, 2012, 6:41 pm

Last month, TPR post about Part I of the Los Angeles Times’ investigative series on deaths from prescription drug abuse. Over the last several weeks additional installments have been published. Part II describes “reckless prescribing” by individual California physicians who write for enormous amounts of OxyContin, Xanax, and Soma — among other controlled substances — for patients who travel 350 …

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Brussel-sprout-induced inhibition of warfarin anticoagulation

December 20, 2012, 8:13 pm


The hazards of brussels sprouts consumption at Christmas. Pettit SJ et al. Med J Aust 2012 Dec 10;197(11):661-2.

No abstract available

This interesting short case report describes a man with an implanted left ventricular assist device who was on warfarin but had persistently subtherapeutic INR measurements. Dietary history revealed that during Christmas festivities he had been consuming 15-20 Brussels sprouts …

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Surprise quiz: metformin overdose

December 18, 2012, 11:53 pm


Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship. Kopec KT, Kowalski MJ. J Med Toxicol 2012 Dec 12 {Epub ahead of print]

No abstract available

This case-based review of metformin-associated metabolic acidosis (MALA) is concise and worth reading. The following is a surprise quiz based on some of the points made in the article. …

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The money and influence behind “Pain as the Fifth Vital Sign”

December 16, 2012, 11:46 pm


A must-read article in the Wall Street Journal this weekend focuses on Dr. Russell Portenoy, a New York City pain specialist who two decades ago was instrumental in the drive to expand use of opioid analgesics to treat chronic pain. (Unfortunately, the article is behind the WSJ firewall and requires subscription.)

The Journal notes that today, prescription opioids …

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CPC: alcohol withdrawal with delirium tremens and a significant missed diagnosis

December 15, 2012, 6:25 pm


A 55-Year-old Man with Alcoholism, Recurrent Seizures, and Agitation. Nejad SH et al. N Engl J Med 2012 Dec 20;367:2428-2434.

No abstract available

No spoiler alert needed. The diagnosis in this episode of “Case Records of the Massachusetts General Hospital” is exactly what is suggested by the title — alcohol withdrawal with seizures and delirium tremens. Certainly a worthy …

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Case report: cocaine cardiotoxicity treated with intravenous lipid infusion

December 10, 2012, 11:59 pm


Usefulness of Intravenous Lipid Emulsion for Cardiac Toxicity from Cocaine Overdose.  Arora NP et al. Am J Cardiol 2012 Nov 24. [Epub ahead of print]


This case report describes a 26-year-old man who developed status epilepticus, tachycardia, and hypotension after smoking a “large amount” of crack cocaine. EKG showed a wide-complex tachycardia (QRS = 148 msec) with a prolonged …

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Tox Tunes #67: Pipe Dream Blues (Hazel Meyers 1924)

December 9, 2012, 8:03 pm

Little is known about the American blues singer Hazel Meyers, not even the year of her birth or death. According to Wikipedia, Meyers spent much of her career in black vaudeville, and recorded extensively in the single year form September 1923 to August 1924. Artists she recorded with include Fletcher Henderson, Don Redman, and Fats Waller.…

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Drug reps can now promote their products for off-label indications. Or can they?

December 8, 2012, 6:52 pm

In 2005, Alred Caronia, a drug rep for Orphan Medical Inc., was charged with promoting the company’s new drug Xyrem — which had recently been approved for the treatment of narcolepsy — for use in treating chronic pain and fatigue. In 2008, he was convicted of introducing a misbranded drug into interstate commerce. In a split decision published this week, …

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