The 3rd Annual Alexander Awards: Best Tox Reading of 2012

January 2, 2013, 1:19 pm

Alexander Gettler

The Poison Review is proud to announce the Alexander awards for the best writing concerning toxicology on the web during the year 2012. The awards are named in honor of Alexander Gettler (1883-1968). the chief toxicologist with the Office of the Chief Medical Examiner of the City of New York during the first half of the 20th century. Gettler’s work was crucial in the development of modern forensic toxicology.

To be eligible, an article or paper must be freely accessible on the web, and not locked up behind some firewall or restrictions. By definition, this eliminates from consideration almost all publications in major medical journals.

A June cover story in the New York Times magazine by Patrick Radden Keefe outlined in stunning detail the business model and organizational structure of the Mexican drug cartels. By making the operational methods of the cartels rational and understandable, Keefe illustrates just how difficult it will be to defeat the illicit drug trade. This is riveting reporting, and a must-read.

Former Golden Alexander winner Deborah Blum (@deborahblum) comes in with two entries. Her piece about “Fly Paper: An Arsenic Story Told in Four Acts” on Wired Science Blogs gives specific examples illustrating just how readily available lethal doses of arsenic were in the 19th and early 20th centuries, and how this situation was reflected in contemporary mystery fiction. Also essential is her essay on radioactivity found in cigarettes and how this might affect the investigation into the death of the Palestinian leader Yasser Arafat.

The New Yorker magazine had two blockbuster stories of special interest to toxicologists and pharmacologists during 2012. In Oliver Sack’s “Altered States“, an excerpt from his book Hallucinations, the author and neurologist describes his truly prodigious use of psychotropic drugs while he was a resident at UCLA and a young attending physician i New York City. During these early years, Sacks consumed massive amounts of the anticholinergic drug Artane, morning glory seeds, LSD, amphetamines, hashish, morphine, and chloral hydrate. This is a stunning piece, though bordering on the unbelievable in parts. To read my original post about “Altered States”, click here.

Also from the New Yorker is “Operation Delirium“, Raffi Khatchadourian’s long history of the “volunteer” experiments carried out by the U.S. Military during the cold war, exposing often unsuspecting soldiers to chemical weapons such as the nerve agents sarin and VX, vesicants such as sulfur mustard, and incapacitating agents such as BZ, PCP, and LSD. The read my original post about “Operation Delirium”, click here. In association with the story, Khatchadourian has also posted some primary sources for his reporting. Many of these were obtained via the Freedom of Information Act, and include military orders, medical records, and subjects’ own descriptions of their experience when exposed to LSD and other psychotropics. Both “Operation Delirium” and the supplementary primary sources are absolute must-reads.

The Los Angeles Times ran a multi-part series in 2012 outlining how unscrupulous physicians and rogue pharmacists have combined to provide easy access to opiate analgesics, a situation associated with an epidemic of overdose fatalities.   Part I showed that a relatively small number of physicians wrote scripts associated with a disproportionally large number of these fatalities. Parti II described alleged reckless prescribing by individual California physicians who wrote for enormous amounts of these drugs. (Given the risk of withdrawal, this piece could be turned into a TV cable series called Califormication.)  Part III concentrates on rogue pharmacists who fill these prescriptions, often with no questions asked.

We come now down to the two finalists for the prestigious Golden Alexander, awarded to the most important  piece of writing about toxicology and poisoning to be found on the web in 2012. The runner-up is Peter Whoriskey of the Washington Post for his investigative piece “Rising painkiller addiction shows damage from drug makers’ role in shaping medical opinion“. Whoriskey reports that prescriptions for opioid analgesics have tripled in the past 20 years, a period coinciding with “a massive effort by pharmaceutical companies to shape medical opinion and practice.” Whoriskey suggests that drug companies systematically exaggerated benefits and minimized risks in studies they published on opioid analgesia. The ultimate effects on some communities — addiction, death — are described by one public health nurse as “pharmageddon”.

And finally . . .the winners of the Golden Alexander are Thomas Catan and Evan Perez for their revelatory Wall Street Journal story “A Pain-Drug Champion Has Second Thoughts.” This piece focuses on Dr. Russell Portenoy, a New York pain specialist who was a prime mover in the effort to treat chronic pain aggressively with strong opioids.

The Journal notes that as a result of this, today prescription opioids are responsible for “the country’s deadliest drug epidemic”, with over 16,500 deaths annually.

Dr. Portenoy and others worked with drug companies to spearhead the effort to make pain a “fifth vital sign”.

Today, Dr. Portenoy expresses regret that his efforts may have contributed to rising rates of addiction and overdose fatalities, and admits that “I gave innumerable lectures in the late 1980s and ’90s about addiction that weren’t true”.

This article should be read by all physicians who prescribe analgesics of any time. To read my original post about it, click here.

In all, this was a very good year for posting on the web related to toxicology. Here’s hoping that 2013 will bring many worthy contenders for the Golden Alexander. TPR wishes a Happy New Year to everyone!



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