Tag Archives: SCIENCE & TECH./HEALTH

Attention Deficit Hyperactivity Disorder in Adults Recognition and Management

Posted on by
2

Attention Deficit Hyperactivity Disorder in Adults Recognition and Management

J. Allen Scoggin, Pharm.D., MPA
Associate Professor of Pharmacy Practice and Pharmacoeconomics, University of Tennessee, College of Pharmacy, Memphis, TN

Attention-deficit hyperactivity disorder (ADHD) is considered the most common psychiatric disorder experienced during childhood.(1) Some references indicate an incidence as high as 10% of American school-age children. Most references, however, place the incidence in this age group at around 2%–5%.(2-4) Approximately 80% of children with ADHD continue to have symptoms of the condition as adolescents, and more than 60% of children experience symptoms as adults.(5) If these estimates are correct, between 2 and 5 million adults who had ADHD as a child continue to be affected by the condition. Many adults with ADHD have not been diagnosed as such.(6)

Table 1

Potential Etiological Factors for ADHD

Neurological Factors

Small brain size and/or delayed
maturation of the brain(10)
Neurotransmitter deficiencies such as dopamine(3,10,11)
Reduced blood flow and electrical activity to the promotor cortex and prefrontal cortex of the brain—
areas involved in motor activity and attention(3,10,11)
Seizure disorders(3)     

Genetic Factor

Being a twin of a person with ADHD(11)
Rare thyroid disorder(11)

Environmental and Psychological Factors

Delivery of children by young mothers(3)
Delivery of low birth-weight children(3,11)
Maternal smoking(10)
Maternal alcohol consumption(10)
Disruptive household(10)
Environmental toxins such as lead(10)
Drug-induced factors—seizure medications such as phenytoin(10)

Despite these findings, some physicians are reluctant to diagnose ADHD in adults, believing that the disorder is limited to childhood and probably vanishes with puberty, or at least subsides by the end of adolescence.(7,8) Many adults with ADHD may have been treated previously for depression, antisocial personality, or character disorders.(6) ADHD is often overlooked, particularly if the disorder was not identified when the person was a child.(5,8) Some adults may have avoided early detection due to the presence of a high I.Q., compliant behavior, or interpersonal charm.(8)

Etiology

The exact cause of ADHD is still unknown.(3) It is unlikely that one single factor is responsible for all cases of ADHD.10,11 Barkley and other

researchers provide etiological possibilities that can be grouped into three major categories (TABLE 1). Barkley emphasizes hereditary, or genetic,

factors as playing the largest causative role in ADHD. He suggests that the tendency toward depletion of dopamine in the prefrontal, striatal, and

limbic regions of the brain, and the interconnections located in these areas may be transmitted genetically to a child who develops ADHD.(10)

Table 2

Outcomes Associated with ADHD in Adolescents and Adults Personal Problems
Poor concentration. Many lose things easily (e.g., car keys, tools)(1)
Poor academic achievement. Many do not graduate from high school(4,5,9)
Low occupational achievement(9)
Marital instability(3,8)

Job-Related Problems

Low paying jobs. Research has shown that adults with ADHD are not highly unemployed. However, they do tend to hold lower positions on the occupational ladder.(9)
Restlessness and difficulty with sedentary-type work (e.g., desk jobs)(2)
Failure to listen to or understand instructions(6)
Oppositional behavior toward persons in authority(1,2)
Loss of jobs due to poor performance or attentional and organizational problems. Some quit jobs because of boredom(6)

Psychiatric Problems

Anxiety and mood swings(6)

High rate of substance abuse, especially alcohol and cocaine(1,4,5)
Antisocial behavior and problems with the criminal justice system(9)

Symptoms

Symptoms associated with adult ADHD include many of the same symptoms observed during childhood, except adults tend to have less problems with motor hyperactivity.8 Problems associated with adult ADHD can be grouped into personal, job-related, and psychiatric areas (TABLE 2). Many adults with ADHD feel demoralized and overwhelmed.(8)

Currently, ADHD is classified by the American Psychiatric Association into two categories based on symptoms that produce three distinct diagnostic types (TABLE 3). The three recognized ADHD types include a type in which inattentiveness predominates, a type in which hyperactivity or impulsivity predominates, and a combined type. Symptoms associated with each of these types must have been present prior to the age of seven and produce clear evidence of impairment in social, academic, or occupational functioning.(2)

Comorbidities and Diagnosis

Comorbidities commonly seen in children with ADHD include Tourette’s syndrome, learning disabilities, speech problems, depression, agitation, obsessive

compulsive disorder, and conduct disorders.(5,11) Comorbidities seen in adolescents and adults include agitated depression, hypomania, substance abuse, and antisocial personality disorder.(5)

Diagnosis of ADHD in adults is based on the same diagnostic criteria used for children. The adult must have experienced symptoms of the condition before age seven,2 and those symptoms must have occurred for at least six months and resulted in significant impairment in social and/or academic functioning.

Table 3

Diagnostic Criteria for ADHD

I. Either (A) or (B):

(A) Six (or more) of the following symptoms of Inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with

developmental level

Inattention

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
7. Often loses things necessary for tasks or activities (e.g., toys, pencils, books, or tools).
8. Often is easily distracted by extraneous stimuli.
9. Often is forgetful in daily activities.

(B) Six (or more) of the following symptoms of Hyperactivity-Impulsivity have persisted for at least 6 months to a degree that is maladaptive and

inconsistent with developmental level:

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat.
2. Often leaves seat in classroom or in other situations in which remaining seated is expected.
3. Often runs about or climbs about excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective

feelings of restlessness).
4. Often has difficulty playing or engaging in leisure activities quietly.
5. Often is “on the go” or often acts as if “driven by a motor.”
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been completed.
2. Often has difficulty awaiting turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms of (A) or (B) that caused impairment were present before age seven.

III. Some impairment from symptoms is present in two
or more settings (e.g., at school or work and at home).

IV. Clear evidence must be seen of clinically significant impairment in social, academic, or occupational functioning.

V. Symptoms do not occur exclusively during the course of a pervasive development disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

VI. The diagnosis can consist of three ADHD types:
1. Combined type: Criteria for both (A) and (B) have been met for the past six months.
2. Inattentive type: Criteria for (A) have been met but (B) has been met for the past six months
3. Hyperactive-Impulsive type: Criteria for (B) have been met but (A) has been met for the past six months

Source: adapted from reference (2)

Before the DSM-IV criteria were published, Fargason and associates provided characteristics of adult ADHD that may be useful to practitioners in making a diagnosis (TABLE 4).(4) Because there is no definitive test for ADHD, diagnosis must be made based on a clinical picture of the adult as a child; how that clinical picture has persisted over time, across different settings; and the degree of functional impairment present.(11)

Management

Successful treatment of ADHD in children usually involves drug and nondrug therapies. Nondrug interventions for children include educational and psychosocial activities. A national organization called CHADD (Children and Adults with Attention Deficit Disorder) provides resources to parents and teachers.(6)

Table 4

Adult Characteristics That May Indicate ADHD
Motor Hyperactivity: Restlessness, restless sleep

Attention Deficits: Inability to focus on written material,
day-dreaming

Hot Temper: Outbursts, loss of control

Impulsive: Speaking without reflecting, lack of self-control

Stress Intolerance: Feeling overwhelmed

Nondrug programs for adults with ADHD are less developed. However, because poor self-esteem is common, individual counseling sessions that focus on changing maladaptive behavior, improving social and organizational skills, and handling anger in an appropriate manner are recommended. Vocational counseling, special tutoring, and deficit retraining for adults with learning disabilities may be beneficial.(4)

As with children, the mainstay of treatment for adults with ADHD is medication. Generally, the same medications that are used for children are effective in adults. However, adults seem to have more variability than children in their response to medications.5 There is some evidence that children who were treated with stimulants experience better outcomes as adults.(1)

Stimulants: Stimulants are considered the most effective medications available for adults, particularly when symptoms of ADHD related to cognition are present.(4) Adults tend to be more sensitive to both the therapeutic actions and side effects of stimulant drugs.(8) Dextroamphetamine and methylphenidate are considered by many to be the stimulants of choice, due to hepatotoxicity reported with pemoline.(12) In addition, pemoline has been reported to have a lower response rate in adults than the other two stimulants, except in the most strictly selected patients.4 However, pemoline offers one advantage: it has less potential for abuse and is not subject to the regulations that affect schedule II drugs such
as methylphenidate and dextroamphetamine.(13)

Methylphenidate is the most commonly prescribed of the stimulants, probably because of its balance of quick onset of activity, high efficacy, and minimal side effects.(4) Methylphenidate and dextroamphetamine share a similar pharmacology (both increase the release of norepinephrine and dopamine at nerve terminals) and efficacy.(12,13) Controlled studies indicate that up to 78% of adults respond favorably to stimulants, with similar responses reported for methylphenidate and pemoline.(7) Some researchers suggest that the dose of methylphenidate used in some studies (less than 0.6 mg/kg per day) may not have been high enough to evoke a desired response in adults.(7) With children, doses in the range of up to 150 mg/day for dextroamphetamine and 300 mg/day for methylphenidate have provided a higher level of symptom control than doses recommended in the Physicians’ Desk Reference and other publications.(14) However, since adults are more sensitive to stimulants than are children, the common dose range for methylphenidate in adults is 20–80 mg/day. Some adults respond adequately to only 2 mg/day.(8) The immediate acting form is often preferred because some adults cannot tolerate the excessive side effects from the sustained-release form, whose longer duration of effect may cause insomnia.(8)

Side effects of stimulants in adults are reported to be mild; they include insomnia, edginess, diminished appetite, weight loss, dysphoria, and headaches.(4) Cardiovascular side effects have been clinically insignificant, and there are no reports of abuse in adults from the use of stimulants for ADHD.(7)[underline added]

Nonstimulant Medications: Alternatives to stimulants are needed by many adults with ADHD for several reasons. Stimulants are not effective or well tolerated in about a third of adults, and they carry abuse potential. Their lack of 24-hour dosing creates the possibility for noncompliance. There may be a “rebound of ADHD symptoms,” especially with the short-acting stimulants. In addition, the rebound may be worse than baseline behavior.11 Lastly,

stimulants may produce variable patient response.4 Nonstimulants used for the management of ADHD symptoms in adults include antidepressants, beta-adrenergic blocking agents, and centrally acting antihypertensive agents.

Antidepressants: The tricyclic antidepressants (e.g., imipramine and desipramine) [underline added]offer several advantages over the stimulants, namely longer half-lives to allow for once-a-day dosing, no abuse potential, and the option of plasma level monitoring, if desired.(4,13) Imipramine has produced a high level of response in adults with ADHD, with some experiencing dramatic improvement. However, tolerance to this agent has been reported in some instances after two to three months of therapy.4 Open trials with imipramine in adults indicate that the tricyclic antidepressants may be preferred in patients with comorbidities such as anxiety and addictive tendencies.(13) However, serious cardiac side effects reported in a small number of children taking desipramine may necessitate monitoring (e.g., vital signs and EKG) when using tricyclic antidepressants in adults with a history of heart problems.(5)

Literature describing the use of selective serotonin reuptake inhibitors (SSRIs) in ADHD is limited. However, anecdotal reports indicate the SSRIs are not effective in reducing the core symptoms of ADHD.(5,8) The MAOI-type antidepressants are generally not used in ADHD due to orthostatic hypotension,

interactions with other drugs and certain foods, and the fact that the desired response may not be sustained with these agents.(8) Venlafaxine is an antidepressant that has shown promise in open trials in ADHD, but the incidence of side effects in one series of studies was considered too high.(8)

Bupropion is an antidepressant that works by a different mechanism than SSRIs or tricyclics and appears efficacious in ADHD at 5–6 mg/kg/day doses.11 Bupropion may have weak dopamine reuptake blocking activity, which could be beneficial in correcting the proposed pathophysiology associated with ADHD.(12) Response from the drug appears to be rapid and sustained.7 In one trial, bupropion was effective in adults with ADHD who formerly received stimulants.(13) However, until more studies are conducted, it should be considered a second-line agent for ADHD, especially if mood instability and/or cardiac abnormalities are present.(7)

Beta-adrenergic Blockers: The role of beta-adrenergic blockers in adults with ADHD is unclear. In a small study (13 patients) of adults taking up to 640 mg/day (528 mg/day was the average dose) of propranolol, temper outbursts improved in over 80% of those studied and the drug was well tolerated.(15)

Another report indicated that adding a beta-blocker to stimulant medication was helpful in three adults.(7) Nadolol at a dose of 20–40 mg/day is another beta-blocker that may be useful in managing adults with ADHD who have excessive excitability and overarousal.(4) Propranolol and nadolol have been used safely alone or in combination with stimulants.

Centrally Acting Antihypertensives: The centrally acting antihypertensives clonidine and guanfacine may be effective in ADHD if combined with other agents. When used with stimulants these agents may help control aggressiveness and hyperactivity in some patients.(4,11) Although clonidine has been shown effective in children and adolescents, it has not been evaluated in adults. Side effects (e.g., hypotension and sedation) may limit use of the drug in adults.(7) Currently, clonidine and guanfacine are considered third-line treatments for ADHD.(15)

Mood Stabilizers: Like the SSRIs, mood stabilizers such as lithium, carbamazepine, and valproic acid do not appear to have a positive effect on the core symptoms of ADHD.(11,15)

Unproven Therapies: A number of unproven therapies are reported (in the media and on the Internet) to be effective as memory stimulants and agents that could improve mental alertness and I.Q. Such claims are associated with hypericum, Ginkgo, pycnogenol, DMAE, the amino acid L-glutamine, and several Chinese herbal combinations. Until these and other ingredients have been evaluated in controlled studies to determine their efficacy and role in ADHD, it is premature to suggest an advantage for any of these.

Conclusion

For many, the symptoms of ADHD continue into adulthood. Although far more is known about this disorder in children and adolescents, it is being recognized more frequently in adults. For those adults with ADHD who cannot use stimulants, a variety of other medications are being tried. Experience with different pharmacologic therapies will, hopefully, give us a better understanding of their role in treating adults with ADHD.

References

1. Saklad JJ, Curtis JL. Psychiatric Disorders in Children, Adolescents and People with Developmental Disabilities. In: Young LY, Koda-Kimble MA eds.
Applied Therapeutics: The Clinical Use of Drugs. 6th ed. Vancouver,WA: Applied Therapeutics, Inc.;1995:78-2.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington. DC, American Psychiatric Association 1994;78-85.
3. Schneider SC, Tan G. Attention-deficit hyperactivity disorder: In pursuit of diagnostic accuracy. Postgraduate Medicine. 1997;101(4):231-40.
4. Fargason RE, Ford CV. Attention deficit hyperactivity disorder in adults: diagnosis, treatment, and prognosis. South Med J 1994;87(3):302-9.
5. Dulcan MK, Benson RS. Summary of the practice parameters for the assessment and treatment of children, adolescents, and adults with ADHD. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1311-17.
6. Children and Adults with Attention Deficit Disorders (CHADD) Internet Home Page (http://www.chadd.org) Available from Webmaster@chadd.org. Accessed 1998 March 13.
7. Wilens TE, Biederman J, Spencer TJ, et. al. Pharmacotherapy of adult attention deficit/ hyperactivity disorder: A review. J. Clinical Psychopharmacology. 1995;15(4):270-9.
8. Dulcan M, Dunne JE, Ayers W, et.al. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997, 36(10 Supp):085S-121S.
9. Mannuzza S, Klein RG, Bessler A, et.al. Educational and occupational outcome of hyperactive boys grown up. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1222-7.
10. Barkley RA. Associated problems, subtyping, and etiologies. In: Barkley RA. Attention-deficit Hyperactivity disorder: A handbook for diagnosis and treatment. New York.: The Guilford Press;1990:74-105.
11. Cantell DP. Attention deficit disorder: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1996;35(8):978-87.
12. Levin GM. Attention-deficit/Hyperactivity Disorder: The pharmacist’s role. Amer Pharmacy. 1995;NS35(11):10-20.
13. Holloman LC, Gutierrez MA, Wincor MZ. Treatment of attention deficit/hyperactivity disorder. U.S. Pharm 1997;22(1):32-57.
14. Kessler S. Drug therapy in attention deficit hyperactivity disorder. South Med J 1996;89(1):33-8.
15. Spencer T, Biederman J, Wilens T. Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesce Psychiatry. 1996;35(4):409-32.

http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf301f.htm

Arlington Institute Report on Global Demographic Shifts

Posted on by
Reply





Report on Global Demographic Shifts

Paul Alois, February 2007

In the last two centuries the human population has increased at an exponential rate. Historically,
humans have had high death rates coupled with high birthrates,
resulting in a very low net increase in total population. Between 0 AD and 1800 AD the total number of people on the planet only increased by 325%, from 300 million to 980 million.[1] In
the two hundred years since the total number of people on the planet
has increased by 670%, and today there are over 6.5 billion people on
the Earth. The advent of vaccinations, hygiene,
refrigeration, medical science, and numerous other modern inventions
dramatically increased life expectancy and decreased infant mortality. Furthermore, most projections suggest that by 2050 the global population will be at over 9 billion.

With astronomical numbers
like these being widely cited in the media, the emergence of a new
demographic trend has largely been ignored. Today,
worldwide fertility rates are at an all time low, and in the decades
following 2050 the global population is actually expected to stabilize
and possibly decrease. The two factors driving this new
pattern are the emergence of women’s rights on a global scale and the
expectation among parents that all their children will survive to
maturity.

Fertility rates, the best indicators of long term population changes, refer to the average number of children a woman will have. In order for a given population to replace itself, its fertility rate must be at 2.1 or higher. Graph 1[2]
illustrates the decline of fertility rates that has occurred in the
last fifty years, and shows projections for the next fifty years.

FertilityRates

Furthermore, between 2005 and 2050 the median age of the global population is expected to increase from 28 to 39. Graph 2[3] shows projected changes in median age by region.

RegionMedianAge

 
Graph 3 shows 2006 fertility rates by region,
cross-referenced with the percentage of the global population in that
region in order to illustrate the textured nature of demographic
changes.

  • Asia has the most bipolar fertility rates of all the world’s regions. The
    developing countries in Asia, lead by India, will maintain relatively
    high fertility rates into the next several decades. The developed countries in Asia, however, have the lowest fertility rates in the world.
  • Although China is a developing country, its
    policy of limiting family size has given it very low fertility rates
    for several decades. China is already seeing an increasing number of retirees even as the number of available workers declines.[4] Due to its poorly developed economy, China is far less able to manage these changes than developed countries.
  • Africa currently has the highest fertility rates in the world. Sub-Saharan
    Africa also faces staggeringly high rates of HIV-AIDS, TB, and malaria.
    In areas with high mortality rates women are inclined to have as many
    children as possible, as it ensures that enough children will survive
    to maturity. The North African nations, populated by
    ethnic Arabs, have much lower fertility rates that more closely mirror
    trends in the Middle East.
  • Europe as a whole has the lowest fertility rates in the world. Even with immigration Europe’s population is expected to decrease in the coming decades. Eastern
    Europe and Russia have the lowest fertility rates in the region, even
    as lose their adult population via emigration to Western and Northern
    Europe.
  • Latin America and the Caribbean are barely maintaining replacement levels. By 2050, Mexico will have an older median age than the United States.
  • In North America, Canada has a fertility rate of 1.5. The
    United States is the only developed country in the world where
    fertility rates will remain stable over the next fifty years, and the
    population will actually increase as a result of relatively high
    immigration. However, among native born women
    fertility rates are slightly below replacement levels, so the ethnic
    makeup of the United States will change substantially.
  • In Oceania, Australia and New Zealand have fertility rates of 1.75 and 2.0 respectively.

PopulationStats

As the world continues to have fewer children, and
median ages continue to rise, enormous adjustments will have to take
place on a society wide basis.

  • Most social security systems in the developed world were created when the ratio of workers to retirees was 5:1 or higher. In many places today that ratio has decreased to 3:1, straining these systems. Coming
    demographic shifts will further exacerbate this trend, and in the near
    future these social security programs will likely become untenable.
  • Economic growth will be jeopardized by a dearth of new workers. According
    to Harvard economist Alvin Hansen three things drive economic growth:
    population increases, new resource exploitation, and technological
    innovation. With population decline a foregone conclusion
    in the developed world and resource depletion becoming a serious
    problem, technological innovation alone will have to drive the global
    economy. If it is unable to do so, an economic model predicated on perpetual growth may be unsustainable.
  • The developed countries in Europe, North America, and Asia will likely begin seeing more racial and ethnic tension. Not
    only do these countries have high immigration, but immigrant
    communities in these countries have far more children than native
    communities. As evidenced by recent rioting in France,
    the children of immigrants often grow up feeling isolated from their
    parent’s culture as well as the culture they find themselves living in. Furthermore,
    these non-native children will likely be subjected to extremely high
    taxes to support retirees that are mainly of the native ethnicity,
    creating tension along generational lines as well.
  • An aging population will further stress the world’s medical systems. In
    the United States, the government program covering retirees already
    pays out an average of $9,000 per person every year.[5] In the socialized systems of Europe and the UK, waiting lines for major operations can be months or even years long. The
    historical medical paradigm has emphasized attacking disease rather
    than promoting health, so many retirees today are suffering from
    decades of poor information regarding diet, exercise, and other habits. In
    the coming years more energy may be put into researching new ways to
    maintain good health, and governments may begin taxing or restricting
    goods that damage health.

In the coming century one of the greatest problems
facing human beings is the question of how to redesign social,
economic, and political institutions to adapt to this new world. The
systems currently in place were designed in a world where perpetual
population growth was considered to be inevitable, and as the global
population begins to decline these systems will literally fall apart. While
a decreasing population has the potential to be an enormously positive
development, the challenge is creating a world where it can be.

This article may be reprinted or copied for non-commercial purposes as long as proper citation standards are observed.

[2] Adapted from United Nations Population Division, World Population Prospects, http://esa.un.org/unpp

[3] Adapted from United Nations Population Division, World Population Prospects, http://esa.un.org/unpp

[5]http://www.cms.hhs.gov/CFOReport/Downloads/2006_CMS_Financial_Report.pdf

World food stocks dwindling rapidly, UN warns

Posted on by
Reply



The
world food supply is dwindling rapidly and food prices are soaring to
historic levels, the top food and agriculture official of the United
Nations warned Monday. (Mohammed Ameen/Reuters)


World food stocks dwindling rapidly, UN warns


Published: December 17, 2007


P

ROME:
In an “unforeseen and unprecedented” shift, the world food supply is
dwindling rapidly and food prices are soaring to historic levels, the
top food and agriculture official of the United Nations warned Monday.

The changes created “a very serious risk that fewer people will be
able to get food,” particularly in the developing world, said Jacques
Diouf, head of the UN Food and Agriculture Organization.

The agency's food price index rose by more than 40 percent this
year, compared with 9 percent the year before – a rate that was already
unacceptable, he said. New figures show that the total cost of
foodstuffs imported by the neediest countries rose 25 percent, to $107
million, in the last year.

At the same time, reserves of cereals are severely depleted, FAO
records show. World wheat stores declined 11 percent this year, to the
lowest level since 1980. That corresponds to 12 weeks of the world's
total consumption – much less than the average of 18 weeks consumption
in storage during the period 2000-2005. There are only 8 weeks of corn
left, down from 11 weeks in the earlier period.

Prices of wheat and oilseeds are at record highs, Diouf said Monday.
Wheat prices have risen by $130 per ton, or 52 percent, since a year
ago. U.S. wheat futures broke $10 a bushel for the first time Monday,
the agricultural equivalent of $100 a barrel oil.

Diouf blamed a confluence of recent supply and demand factors for
the crisis, and he predicted that those factors were here to stay. On
the supply side, these include the early effects of global warming,
which has decreased crop yields in some crucial places, and a shift
away from farming for human consumption toward crops for biofuels and
cattle feed. Demand for grain is increasing with the world population,
and more is diverted to feed cattle as the population of upwardly
mobile meat-eaters grows.

“We're concerned that we are facing the perfect storm for the
world's hungry,” said Josette Sheeran, executive director of the World
Food Program, in a telephone interview. She said that her agency's food
procurement costs had gone up 50 percent in the past 5 years and that
some poor people are being “priced out of the food market.”

To make matters worse, high oil prices have doubled shipping costs
in the past year, putting enormous stress on poor nations that need to
import food as well as the humanitarian agencies that provide it.

“You can debate why this is all happening, but what's most important
to us is that it's a long-term trend, reversing decades of decreasing
food prices,” Sheeran said.

Climate specialists say that the vulnerability will only increase as
further effects of climate change are felt. “If there's a significant
change in climate in one of our high production areas, if there is a
disease that effects a major crop, we are in a very risky situation,”
said Mark Howden of the Commonwealth Scientific and Industrial Research
Organization in Canberra.

Already “unusual weather events,” linked to climate change – such as
droughts, floods and storms – have decreased production in important
exporting countries like Australia and Ukraine, Diouf said.

In Southern Australia, a significant reduction in rainfall in the
past few years led some farmers to sell their land and move to
Tasmania, where water is more reliable, said Howden, one of the authors
of a recent series of papers in the Procedings of the National Academy
of Sciences on climate change and the world food supply.

“In the U.S., Australia, and Europe, there's a very substantial
capacity to adapt to the effects on food – with money, technology,
research and development,” Howden said. “In the developing world, there
isn't.”

Sheeran said, that on a recent trip to Mali, she was told that food
stocks were at an all time low. The World Food Program feeds millions
of children in schools and people with HIV/AIDS. Poor nutrition in
these groups increased the risk serious disease and death.

Diouf suggested that all countries and international agencies would
have to “revisit” agricultural and aid policies they had adopted “in a
different economic environment.” For example, with food and oil prices
approaching record, it may not make sense to send food aid to poorer
countries, but instead to focus on helping farmers grow food locally.

FAO plans to start a new initiative that will offer farmers in poor
countries vouchers that can be redeemed for seeds and fertilizer, and
will try to help them adapt to climate change.

"The Devil's Doctor: Paracelsus & the World of Renaissance Magic and Science," a review by Erik Davis

Posted on by
Reply

The Devil's Doctor: Paracelsus & the World of Renaissance Magic and Science

a review by Erik Davis

It's
a rare treat to be able to trace an abiding intellectual obsession to a
single moment in time. But so it is when I ponder my ongoing
fascination with the occult fringes of science, and, more generally,
with the anthropology of knowledge. It was senior year in high school,
and for once I was paying attention to Mr. Grey, a physics teacher
whose name I don't actually remember but whose entire being radiated
the sort of officious banality my typically romantic and alienated teen
self loathed. A retired Navy guy (this was San Diego) with a gravely
voice and a grey buzzcut, Mr. Grey was a droning, pedantic bore, and it
is no wonder that I spent most of the classes in the back row, cracking
jokes with Chuckles and playing hot'n'heavy footsie with the impish
Jenny Cole. I liked physics, but I ignored the class.

This was
not the case, however, on the day we dug into Kepler's three laws of
planetary motion. Reading about Kepler's discovery of elliptical orbits
in the textbook had fascinated me, not so much because I love astronomy
(which I do), but because the textbook had had the rare generosity of
mentioning that, while Kepler thought that the three laws were pretty
nifty, what really rocked his boat was his discovery that the
relationship between the planetary orbits could be neatly mapped onto a
nested organization of the five Platonic solids, wherein the vertices
of one solid touched the faces of the next largest solid in the series.
In other words, Kepler thought that what we now consider his immortal
astronomical discoveries were less significant than his
metaphysical—and essentially occult—speculations about the
geometrically perfect harmony of the spheres.

This visionary
dimension seemed deeply important, so I asked Mr. Grey whether Kepler's
wacky Platonic Russian doll should have any bearing on our
understanding of Kepler's achievement. He didn't even understand the
question, and we blubbered back and forth for a bit until I gave up and
resumed the footsie action. To Mr. Grey, all that mattered was the
usefulness of the laws; all the rest was trash.

To me, the
speculative context made all the difference, because it showed the
vital and organic correspondences between what we think of as science
and what we think of as occult or theologically-informed cosmology.
More to the point, it told us something vital about Kepler himself.
Years later, when I read Arthur Koestler's great book The Watershed, I
felt confirmed in my view that this historical conjunction is not just
of historical interest, but strikes at the heart of the meaning and
function of cosmology, certainly in the Renaissance, and
possibly–probably–today. More deeply, it points to the role that the
poetic imagination–the fancy that weaves analogies and
correspondences–plays in the construction of our “real world.”

All
this was brought back to me recently when I was in London. I was
scanning the ever-excellent and ever-expanding book collection of my
pal the Pilkdown Man. Topping one of the towers of text was The Devil's Doctor, a book about Paracelsus and “the World of Renaissance Magic and Science” by the British science writer Philip Ball.
It was a fortuitous discovery, because, as part of an ongoing but
essentially lazy quest to wrap my psyche around alchemy, I had recently
been drawn towards Paracelsus: the wonder-working itinerant
sixteenth-century healer who is sometimes cast as the Copernicus of
medicine. Rejecting the leech-loving, bass-ackwards, and literally
by-the-book healing practices of most medieval doctors, Paracelsus
instead made room for a medicine based on plants, material causality,
and self-healing powers of the body.

Having already brushed up
against Paracelsus' own rich but impenetrable prose, I was immensely
relieved that Ball had appeared to lead me through the Renaissance
thickets by the secondary hand. (I told you I was lazy.) Given the
noodle-limp dollar, The Devil's Doctor was about the only thing I
purchased in the UK. I read almost the whole thing on the plane ride
home, in between marveling at the glittering, melting majesty of
Iceland and Greenland as they unrolled below me and marveling at the
complete absorption of all but one of my fellow travelers in the movies
flickering across their cramped little screens.

Ball's book is a
marvel of the middle of the road—clear and readable, entertaining and
informative, and quietly significant. With sympathy and a tart wit,
Ball tells Paracelsus' fascinating story, which is rich enough for a
crusty biopic starring Harvey Keitel. Ball also puts this very strange
man in context by painting a number of relevant historical backdrops:
medieval medicine, the proto-sciences of mining and metallurgy,
Renaissance astrology, the early Reformation, the legend of Faust.

These
micro-histories alone are worth the price of admission, but what truly
delights is Ball's portrait of Philip Theophrastus Bombast von
Hohenheim, aka Paracelsus, a cranky, brilliant and, yes, bombastic
vagabond healer. Paracelsus was seemingly in love with skewering sacred
cows and pissing off the local muckety-mucks—especially those doctors
who siphoned their high-status positions from the muck of ignorance and
credulity. Medieval doctors didn't even carry out the gruesome
surgeries of the day, which were left to lower-class barbers while the
“scholars” flipped through Galen and plucked out recommendations.
Paracelsus hated these guys.

So he had to keep on trucking. At a
time when few folks traveled far from their birthplaces, Paracelsus
wandered everywhere—the Holy Land, Egypt, western Europe, England,
Sweden, Russia, Turkey. He picked up tips from Tartar shamans, drank
and ranted in bars, mocked those in power, and healed a lot of people.
My favorite tale took place in Basle, during one of Paracelsus'
controversial and, as usual, short-lived teaching gigs. In a lecture
hall filled with doctors, Paracelsus claimed he was about to reveal the
greatest secret of medicine—and then unveiled a steaming plate of human
shit.

The crap was more than a prank. As Ball explains, it also
derived from Paracelsus' alchemical belief in the potential fecundity
of waste and decay. Indeed, one of Paracelsus' many remarkable (and
often kooky) innovations was to apply the basic dynamics of alchemical
transmutation to the intertwined world of plant medicines and the human
body. Ball calls it “alchemical materialism,” a sort of enchanted
bio-chemistry. Even the concept of metabolism arose from Paracelsus'
dynamic and, in many ways, highly corporeal understanding of bodily
being—a corporeal understanding that looked to herbs and minerals but
was by no means adverse to the invocation of astrological forces or the
healing power of mumia—aka, powdered mummy.

It's to Ball's
enormous credit that, while remaining firmly rooted in western science,
he understands and appreciates the premodern, theological (and magical)
aspects of Paracelsus' worldview. The Renaissance is almost defined by
this extraordinary conflict between the premodern imagination and a
budding skeptical modernity—in fact, it is precisely Paracelsian-style
“natural magic,” with its pragmatic, operative character, that bridges
the gap between dusty Aristotelian book lore and empirical science.
Ball defines Paracelsus himself as a “skeptical mystic”—deeply beholden
to alchemical cosmology, but also critical of the existing social order
and its medical shibboleths. It is because of this perspective—in
betwixt and in-between—that Paracelsus was able alter and reimagine the
west's fundamental culture of healing.

And of poisoning. One of
Paracelsus' great insights, which sometimes earns him accolades (or
blame) as the grandfather of homeopathy, was that “poison” is a
relative term, if not a hidden balm. Mercury, for example, whose
toxicity was known, could cure syphilis, but only in moderation. “Is
not a mystery of nature concealed in every poison? What has God created
that He did not bless with some great gift for the benefit of man? Why
then should poison be rejected and despised, if we consider not the
poison but its curative virtue?”

There is something searching and
empirical about this insight. At the same time, it also reflects the
deeply dialectical nature of alchemy, which finds in antinomies echoes
of the fundamental dynamics of the soul. In the end, Ball is enchanted
by these dynamics while recognizing that they are, from a scientific
view, wrong-headed. I remain tremendously enamored of what Ball calls
“chemical theology”, but I also understand why Ball insists on the
errors of the approach. When I caught pneumonia last spring, I was
gobbling down penicillin, not wielding a dowsing rod or measuring the
heavens.

Ball praises Paracelsus for rejecting the hide-bound
medicine of the medieval docs, but you can tell that the biographer
also recognizes what we moderns lose when we leave the magical
correspondences of the religious imagination behind. In the end, this
loss of “soul” just might wind up sickening our bodies as well—to say
nothing of the planet. “In all things there is a poison,” wrote
Paracelsus. “It depends only upon the dose whether a poison is a poison
or not.”

The superstitious and sometimes harmful credulity of
religious tradition can certainly be considered a poison. But for many
of us moderns, hurtling towards a chilly posthumanism, a draught of the
poetic and cosmic imagination that feeds religious credulity can wipe
away the pain. And even, potentially, heal it. For though skepticism
and empirical reason have cleared away many cobwebs of theological
error, we are all swimming in the toxic sludge these cultural solvents
have left in their wake. The alchemist can envision the gold growing in
the sludge; the realist only marvels at the mess we've made, and turns
up the collar of his coat.

Hitching a Ride on the Infinite Subway (Dr. Stan Grof's 'holotropic' research)

Posted on by
Reply

Here's another excerpt from Michael Talbot's fascinating book The Holographic Universe. I continue to recommend this book.

Hitching a Ride on the Infinite Subway
(pp. 66-72)

The idea that we are able to access images from the collective unconscious, or even visit parallel dream universes, pales beside the conclusions of another prominent researcher who has been influenced by the holographic model. He is Stanislav Grof, chief of psychiatric research at the Maryland Psychiatric Research Center and an assistant professor of psychiatry at the John Hopkins University School of Medicine.

After more than thirty years of studying nonordinary states of consciousness, Grof has concluded that the avenues of exploration available to our psyches via holographic interconnectedness are more than vast. They are virtually endless.

Grof first became interested in nonordinary states of consciousness in the 1950s while investigating the clinical uses of the hallucinogen LSD at the Psychiatric Research Institute in his native Prague, Czechoslovakia. The purpose of his research was to determine whether LSD had any therapeutic applications. When Grof began his research, most scientists viewed the LSD experience as little more than a stress reaction, the brain's way of responding to a noxious chemical. But when Grof studied the records of his patient's experiences he did not find evidence of any recurring stress reaction. Instead, there was a definite continuity running through each of the patient's sessions.

“Rather than being unrelated and random, the experiential content seemed to represent a successive unfolding of deeper and deeper levels of the unconscious,” says Grof. This suggested that repeated LSD sessions had important ramifications for the practice and theory of psychotherapy, and provided Grof and his colleagues with the impetus they needed to continue the research. The results were striking. It quickly became clear that serial LSD sessions were able to expedite the psychotherapeutic process and shorten the time necessary for the treatment of many disorders. Traumatic memories that had haunted individuals for years were unearthed and dealt with, and sometimes even serious conditions, such as schizophrenia, were cured. But what was even more startling was that many of the patients rapidly moved beyond issues involving their illnesses and into areas that were uncharted by Western psychology.

One common experience was the reliving of what it was like to be in the womb. At first Grof thought these were just imagined experiences, but as the evidence continued to amass he realized that the knowledge of embryology inherent in the descriptions was often far superior to the patients' previous education in the area. Patients accurately described certain characteristics of the heart sounds of their mother, the nature of acoustic phenomena in the peritoneal cavity, specific details concerning blood circulation in the placenta, and even details about the various cellular and biochemical processes taking place. They also described important thought and feelings their mother had had during pregnancy and events such as physical traumas she had experienced.

Whenever possible Grof investigated these assertions, and on several occasions was able to verify them by questioning the mother and other individuals involved. Psychiatrists, psychologists, and biologists who experienced prebirth memories during their training for the program (all of the therapists who participated in the study also had to undergo several sessions of LSD psychotherapy) expressed similar astonishment at the apparent authenticity of the experiences.

Most disconcerting of all were those experiences in which the patient's consciousness appeared to expand beyond the usual boundaries of the ego and explore what it was like to be other living things and even other objects. For example, Grof had one female patient who suddenly became convinced she had assumed the identity of a female prehistoric reptile. She not only gave a richly detailed description of what it felt like to be encapsuled in such a form, but noted that the portion of the male of the species' anatomy she found most sexually arousing was a patch of colored scales on the side of its head. Although the woman had no prior knowledge of such things, a conversation Grof had with a zoologist later confirmed that in certain species of reptiles, colored areas on the head do indeed play an important role as triggers of sexual arousal.

Patients were also able to tap into the consciousness of their relatives and ancestors. One woman experienced what it was like to be her mother at the age of three and accurately described a frightening event that had befallen her mother at the time. The woman also gave a precise description of the house her mother had lived in as well as the white pinafore she had been wearing––all details her mother later confirmed and admitted she had never talked about before. Other patients gave equally accurate descriptions of events that had befallen ancestors who had lived decades and even centuries before.

Other experiences included the accessing of racial and collective memories. Individuals of Slavic origin experienced what it was like to participate in the conquests of Genghis Khan's Mongolian hordes, to dance in trance with the Kalahari bushmen, to undergo the initiation rites of the Australian aborigines, and to die as sacrificial victims of the Aztecs. And again the descriptions frequently contained obscure historical facts and a degree of knowledge that was often completely at odds with the patient's education, race, and previous exposure to the subject. For instance, one uneducated patient gave a richly detailed account of the techniques involved in the Egyptian practice of embalming and mummification, including the form and meaning of various amulets and sepulchral boxes, a list of the materials used in the fixing of the mummy cloth, the size and shape of the mummy bandages, and other esoteric facets of Egyptian funeral services. Other individuals tuned into the cultures of the Far East and not only gave impressive descriptions of what it was like to have a Japanese, Chinese, or Tibetan psyche, but also related various Taoist or Buddhist teachings.

In fact, there did not seem to be any limit to what Grof's LSD subjects could tap into. They seemed capable of knowing what it was like to be every animal, and even plant, on the tree of evolution. They could experience what it was like to be a blood cell, an atom, a thermonuclear process inside the sun, the consciousness of the entire planet, and even the consciousness of the entire cosmos. More than that, they displayed the ability to transcend space and time, and occasionally they related uncannily accurate precognitive information. In an even stranger vein they sometimes encountered nonhuman intelligences during their cerebral travels, discarnate beings, spirit guides from “higher planes of consciousness,” and other suprahuman entities.

On occasion subjects also traveled to what appeared to be other universes and other levels of reality. In one particularly unnerving session a young man suffering from depression found himself in what seemed to be another dimension. It had an eerie luminescence, and although he could not see anyone he sensed that it was crowded with discarnate beings. Suddenly he sensed a presence very close to him, and to his surprise it began to communicate with him telepathically. It asked him to please contact a couple who lived in the Moravian city of Kromeriz and let them know that their son Ladislav was well taken care of and doing all right. It then gave him the couple's name, street address, and telephone number.

The information meant nothing to either Grof or the young man and seemed totally unrelated to the young man's problems and treatment. Still, Grof could not put it out of his mind. “After some hesitation and with mixed feelings, I finally decided to do what certainly would have made me the target of my colleagues' jokes, had they found out,” says Grof. “I went to the telephone, dialed he number in Kromeriz, and asked if I could speak with Ladislav. To my astonishment, the woman on the other side of the line started to cry. When she calmed down, she told me with a broken voice: 'Our son is not with us any more; he passed away, we lost him three weeks ago.' “

In the 1960s Grof was offered a position at the Maryland Psychiatric Research Center and moved to the United States. The center was also doing controlled studies of the psychotherapeutic applications of LSD, and this allowed Grof to continue his research. In addition to examining the effects of repeated LSD session on individuals with various mental disorders, the center also studied its effects on “normal” volunteers—doctors, nurses, painters, musicians, philosophers, scientists, priests, and theologians. Again Grof found the same kind of phenomena occurring again and again. It was almost as if LSD provided the human consciousness with access to a kind of infinite subway system, a labyrinth of tunnels and byways  that existed in the subterranean reaches of the unconscious, and one that literally connected everything in the universe with everything else.

After personally guiding over three thousand LSD sessions (each lasting at least five hours) and studying the records of more than two thousand sessions conducted by colleagues, Grof became unalterably convinced that something extraordinary was going on. “After years of conceptual struggle and confusion, I have concluded that the data from LSD research indicate an urgent need for a drastic revision of the existing paradigms for psychology, psychiatry, medicine, and possibly science in general,” he states. “There is at present little doubt in my mind that our current understanding of the universe, of the nature of reality, and particularly of human beings, is superficial, incorrect, and incomplete.”

Grof coined the term transpersonal to describe such phenomena, experiences in which the consciousness transcends the customary boundaries of the personality, and in the late 1960s he joined with several other like-minded professionals, including the psychologist and educator Abraham Maslow, to found a new branch of psychology called transpersonal psychology.

If our current way of looking at reality cannot account for transpersonal events, what new understanding might take its place? Grof believes it is the holographic model. As he points out, the essential characteristics of transpersonal experiences—the feeling that all boundaries are illusory, the lack of distinction between part and whole, and the interconnectedness of all things—are all qualities one would expect to find in a holographic universe. In addition, he feels the enfolded nature of space and time in the holographic domain explains why transpersonal experiences are not bound by the usual spatial or temporal limitations.

Grof thinks that the almost endless capacity holograms have for information storage and retrieval also accounts for the fact that visions, fantasies, and other “psychological gestalts,” all contain an enormous amount of information about an individual's personality. A single image experienced during an LSD session might contain information about a person's attitude toward life in general, a trauma he experienced during childhood, how much self-esteem he has, how he feels about his parents, and how he feels about his marriage—all embodied in the overall metaphor of the scene. Such experiences are holographic in another way, in that each small part of the scene can also contain an entire constellation of information. Thus, free association and other analytical techniques performed on the scene's minuscule details can all forth an additional flood of data about the individual involved.

The composite nature of archetypal images can be modeled by the holographic idea. As Grof observes, holography makes it possible to build up a sequence of exposures, such as pictures of every member of a large family, on the same piece of film. When this is done the developed piece of film will contain the image of an individual that represents not one member of the family, but all of them at the same time. “These genuinely composite images represent an exquisite model of a certain type of transpersonal experience, such as the archetypal images of the Cosmic Man, Woman, Mother, Father, Lover, Trickster, Fool, or Martyr,” says Grof.

If each exposure is taken at a slightly different angle, instead of resulting in a composite picture, the piece of film can be used to create a series of holographic images that appear to flow into one another. Grof believes this illustrates another aspect of the visionary experience, namely, the tendency of countless images to unfold in rapid sequence, each one appearing and then dissolving into the next as if by magic. He thinks holography's success at modeling so many different aspects of the archetypal experience suggests that there is a deep link between holographic processes and the way archetypes are produced.

Indeed, Grof feels that evidence of a hidden, holographic order surfaces virtually every time one experiences a nonordinary state of consciousness:

Bohm's concept of the unfolded and enfolded orders and the idea that certain important aspects of reality are not accessible to experience and study under ordinary circumstances are of direct relevance for the understanding of unusual states of consciousness. Individuals who have experienced various nonordinary states of consciousness, including well-educated and sophisticated scientists from various disciplines, frequently report that they entered hidden domains of reality that seemed to be authentic and in some sense implicit in, and supraordinated to, everyday reality.

Holotropic Therapy

Perhaps Grof's most remarkable discovery is that the same phenomena reported by individuals who have taken LSD can also be experienced without resorting to drugs of any kind. To this end, Grof and his wife, Christina, have developed a simple, nondrug technique for inducing these holotropic, or nonordinary, states of consciousness. They define a holotropic state of consciousness as one in which it is possible to access the holographic labyrinth that connects all aspects of existence. These include one's biological, psychological, racial, and spiritual history, the past, present, and future of the world, other levels of reality, and all the other experiences already discussed in the context of the LSD experience.

The Grofs call their technique holotropic therapy and use only rapid and controlled breathing, evocative music, and massage and body work, to induce altered states of consciousness. To date, thousands of individuals have attended their workshops and report experiences that are every bit as spectacular and emotionally profound as those described by subjects of Grof's previous work on LSD. Grof describes his current work and gives a detailed account of his methods in his book The Adventure of Self-Discovery. …