Factual Dispatch #24: Esketamine Nightmares

The VA weighs an inferior drug, Anti-vaxx funders unmasked, and the ascendance of smartphone internet.

June 21, 2019

Ketamine’s potential as a treatment for refractory depression and suicidal ideation became too difficult to ignore this spring. But, because it’s off patent, it would have been extremely expensive/unprofitable for any pharmaceutical company to do clinical trials and get the substance FDA approved. The solution to this was Spravato, the brand name referring to a Ketamine isomer named Esketamine. Having a cadillac drug that the VA could use to treat suicidal feelings and PTSD, electrified Trump, who has been reported to have wanted the VA to order “truckloads” of the substance.

This has led to the substance getting its FDA approval fast-tracked, and the VA is in the process of evaluating adding it to its formulary, which puts the drug within immediate reach of millions of veterans. There’s just one tiny problem, the drug might actually not work. To put this in somewhat bleak terms, I’ll just summarize the Center for Public Integrity’s exceptional findings on this:

  • The FDA put aside its usual process for anti-depressants, requiring 2 successful trials, accepting a single successful trial out of three.

  • There is currently no evidence that the drug is effective on people over 65, and little evidence the drug is effective on males at all. 90% of veterans seeking VA care are male and 52% are over 65.

  • Three people committed suicide on the drug during the trials, compared to zero people committing suicide when they were taking the placebo.

All of this is fitting together to give some people in the industry a chance for pause. A piece on VICE was the first to detail the issues with using the effectiveness of Ketamine infusions to fast-track Esketamine. Since then, mainstream health publications have started to report on the very valid concerns that anesthesiologists, harm reduction advocates, and psychiatrists have about this process. My biggest fear is that we’re swapping an effective, cheap drug, for an ineffective, expensive one, in the name of profit and bragging rights, and possibly losing our one chance to open up avenues of research on world-changing drugs, like (2R,6R)-HNK, the metabolite that is purported to be the workhorse of Ketamine’s anti-depressant effects. 

Love (& Divorce) In The Time of CholeraThe Washington Post & Daily Beast did some amazing work this week, unearthing the source of millions of dollars in anti-vaxx propaganda funding. Bernard Selz and his (ex)wife have donated over $3 million to various anti-vaxx groups like the Informed Action Consent Network, starting with a $200,000 donation to the now rightly-discredited Dr. Wakefield himself. Albert Dwoskin, a Democratic Party mega-donor, admitted funding the Children’s Medical Safety Research Institute (another anti-vaxx messaging bilge factory) until December 2018, while also throwing his ex-wife under the bus. These two rich people are foundational reasons you can’t talk to some of your relatives on Facebook anymore.

Independent of the people with more money than sense, opposition to vaccinations has a long, dumb history in this country. From 1991 in Philadelphia:

The court order had taken a few weeks. By the time the vaccines were administered, the measles outbreak was subsiding in Philadelphia. Only nine children from the church were ultimately vaccinated, and Ross says the intervention probably didn't affect the spread of the disease.

In the end, nine kids across Philadelphia died, including six from Faith Tabernacle. The church is still operating the school today but declined to comment.

The new rub on vaccine opposition is that it’s being pushed by Russian disinformation trolls. That’s right, a bunch of the anti-vaxx moms yelling on Twitter are actually GRU foreign cyber assets wedging our discourse. And it’s not just happening in the USA. Anti-vaxx conspiracies & epidemics related to measles alone have infected France, Madagascar, the Philippines, Romania, the Czech Republic, Ukraine, and Italy. Even Russia’s chief physician has started calling for required/expanding vaccination, as they saw their reported cases of measles jump 13-fold between 2017 and 2018.

Computer Cable CuttingI wanted to highlight this startling finding Pew reported this week: Not only do 37% polled say they only access the Internet on their smartphone, 17% have a smartphone and no home broadband connections at all. The moves are attributed to the usual suspects of cost, rural access barriers, and the changing demographics of the country, but there’s a bigger story here. As cable cutting accelerates, streaming services fight for turf, and the economic malaise continues, more people will use their phone for everything they used a tablet for 5 years ago, a laptop 10 years ago, a desktop computer 15 years ago, and a TV 20 years ago. As the “device mix” changes over time, the way to make money from media on those devices changes with it.

The Philly Inquirer documented how this is happening reasonably well this week, and also explained how advanced ad technology that you’d expect on your phone, is pushing back into legacy platforms:

Advanced advertising on TV was one of the insights that the Philadelphia ad agency Harmelin Media shared with clients at a Wednesday event…For example, cable and satellite providers such as Comcast and DISH network now show highly customized TV ads to one household that owns a cat, while a different ad broadcasts at the same time to a household next door owning a dog, based on credit card data, GPS phone location data, and other tracking data, he said.

This continued shift in not only where our eyeballs are, but how the ads those eyeballs see are constructed, has already upended journalism, but it may be in the process of upending electronics.

 Eye-Watering Data Visualization of the Week: The Pareto Principle states 80% of an event’s effects (sales, views, etc) are usually driven by 20% of the actors or inputs. On YouTube, only 0.64% of videos have more than 100,000 views.

Vaguely Dystopian Read of the Week: Facebook lawyers declared that the simple act of using Facebook the way it’s meant to be used, voids any expectation of privacy. Also Serbia is deploying China’s facial recognition technology, which might signal a new type of Digital Panopticon Belt & Road.

“Huh, Interesting” Read of the Week: The World Economic Forum published a great look at how work has changed over the last century.

Annoying-But-Correct Take of the Week: Chinese AI, while presenting as formidable, is just not that good comparatively, as detailed on June 7th in testimony before the U.S.-China Economic and Security Review Commission by Jeffrey Ding.

Royal Sampler

A salvo of military tech news this week, on everything from Hypersonic missiles (NYTimes) and next generation air superiority (Defense One) to mini drones and robotic mules (Breaking Defense)

The New Yorker takes a leisurely stroll around the idea that socialism has possibly worn out its dirty word status and how it’s perfused through our new political discourse.

Of course payday lenders spent big at Trump’s Doral Hotel and were rewarded handsomely for it. (ProPublica)

With active management being beaten back by the tide of FinTech robots every year, a piece of harrowing fiction about someone who made all the right moves. (The Reformed Broker)

A non-fiction story, begging you, by way of a depressed life, a pet, and a friend, to stay in the game. (Albert Bridge Capital)

The Paradox of Choice is why you get paralyzed by decision-making anxiety before the fact, and wracked with guilt afterwards. JD Roth can help with that. (Get Rich Slowly)

Dunk of the Week: First time I’ve chosen a pull quote and not a retort as a dunk, because I think it speaks for itself. By Adam Serwer for The Atlantic:

Black Americans did not abandon liberal democracy because of slavery, Jim Crow, and the systematic destruction of whatever wealth they managed to accumulate; instead they took up arms in two world wars to defend it. Japanese Americans did not reject liberal democracy because of internment or the racist humiliation of Asian exclusion; they risked life and limb to preserve it. Latinos did not abandon liberal democracy because of “Operation Wetback,” or Proposition 187, or because of a man who won a presidential election on the strength of his hostility toward Latino immigrants. Gay, lesbian, and trans Americans did not abandon liberal democracy over decades of discrimination and abandonment in the face of an epidemic. This is, in part, because doing so would be tantamount to giving the state permission to destroy them, a thought so foreign to these defenders of the supposedly endangered religious right that the possibility has not even occurred to them. But it is also because of a peculiar irony of American history: The American creed has no more devoted adherents than those who have been historically denied its promises, and no more fair-weather friends than those who have taken them for granted.

But, for everyone who still wants a Dunk, here’s a self murder of truly world-breaking proportions:

Longest Day of the Year! Get some sun on your face if you can, stay dry if you can’t.

T