The Corpus Callosum

Sparkgrass Community, a bunch of med student bloggers, along with a few other intellectual types, wrote about it here.  There's a little more discussion at Science Banter, a blog by a science writer.  The Neurophilosopher's Weblog reviews the article, adds a few links, and has a nice illustration, to boot. There is a bit of historical perspective at Further: Strange Attractor and beyond.  Scienceblog (not to be confused with THE ScienceBlogs) picked up on the story here.  Interestingly, there is a blog called Addiction and Recovery News, written by a worker at Dawn Farm, that made note of the article.  Dawn Farm is a long-term substance abuse recovery facility near Ann Arbor.  The Szasz Blog picked it up, too.  I've never been a fan of Thomas Szasz, but I was interested to note that his followers maintain a web presence.  Another site to note the article was Sushi Tuesday, which appears to be a site devoted mainly to medical and science news, but has a lot of other stuff.  Hassenpfeffer, a blog written by a resident of Saskatchewan, noticed it and wrote about it, primarily because the author grew up in the town where the experiments were performed.  Perhaps most strangely, it was also noted on the Repbulican National Convention Blog, and Old Right, "the voice of the right."

There were numerous other mentions on various Livejournal sites, among others.  In fact, I was surprised at the number of bloggers who expressed an interest in the topic.  Apparently, a wide variety of people have an interest, for a variety of reasons.  

I am interested in this for the same reason I was interested when there was a news article about the use of ibogaine for alcoholism.  But the article about LSD was more interesting.  For one, it was published in the journal, Social History of Medicine.  Two, the journal article provides a fascinating perspective on the medical history that puts the study in context.  Third, the article got me to thinking a lot.  Which is why I read those kinds of things.  

Unfortunately, much of the interesting material requires a subscription, or academic access of some sort.  The abstract is openly available here; the full text is here (if you have access.)

The crux of the story is here:

In 1962, psychiatrist Sven Jensen, working in Weyburn, Saskatchewan, accepted this challenge and published the first controlled trial on LSD treatment for alcoholism.

Jensen relied on three pools of subjects for treatment: one group of alcoholics took LSD at the end of a hospital stay (usually lasting a few weeks); the second received group therapy; and Jensen’s colleagues at Weyburn treated the third group with their own standard approaches, excluding psychedelic therapy. In his two-year study, involving follow-up periods of 6 to 18 months, The results of the study demonstrated that 38 of the 58 patients given LSD remained abstinent throughout the follow-up period. These numbers conveyed greater significance when compared with the second group. Among those patients receiving nothing other than group therapy, only 7 of the 38 involved in the trial remained abstinent. Even those figures, however, showed greater promise than the results from the group treated by Jensen’s colleagues by other means; in this group only 4 out of 35 patients stopped drinking.

The ARF countered with its own trials. Researchers Reginald Smart, Thomas Storm, William Baker and Lionel Solursh designed an experimental environment that isolated the effects of the drug before analysing its efficacy. They administered LSD to subjects and subsequently blindfolded them and/or employed physical restraints to restrict movement.

They instructed observers not to interact with the subject, creating a research design aimed to minimise the influence of all factors except the drug itself. This approach sought more adequately to ascertain whether the drug offered genuine benefits, or whether the perceived advantages merely inspired clinical enthusiasm that corrupted the real outcome. Subjects used in the ARF study showed some improvement, but, overall, the results from this study demonstrated that LSD did not produce results analogous to those claimed by the Saskatchewan group. Conclusions from the ARF trial indicated the ineffectiveness of LSD when measured under controlled circumstances. Given the authority vested in this form of methodology, the ARF study represented damaging criticism.

The problem was that the more conservative, mainstream medical group insisted on a particular kind of controlled study.  That is, they wanted to get rid of the effect of the relationship between the doctors and the patients.  

Hmmm.

I generally support the notion of strict controls.  But I also support the notion of doing studies under conditions that mimic actual clinical practice.  If a drug works in the lab, but not in the office, what good is it?  Likewise, if something is marginally effective in the lab, but is remarkably effective in the hands of a skilled practitioner, who care about the results in the lab?  Does it really make sense to deny patients an effective treatment, just because of a technicality?  

In point of fact, every decent psychiatrist on the planet will tell you that the relationship with the patient plays a very important role in the effectiveness of the treatment.  So, it is interesting to see what happens when the relationship is factored out, but it does not tell you anything that is directly useful.  

Note that I am not advocating this treatment.  The studies never went far enough to come close to satisfying modern requirements for FDA approval.  Plus, it obviously is counterintuitive to think that you could treat an addiction by introducing the patient to an abusable drug.  Probably most AA adherents would find the idea repulsive.

One of the core ideas in substance abuse treatment is that the person in recovery needs to swear off all methods of getting high.  Absolutely.  

Now, I don't consider this post finished, but it is getting a little too long for my tastes...