Legal doesn't mean safe

Salvia divinorum, also known as ska Maria Pastora or diviner's sage, is a hallucinogen from the sage family. It is the most potent natural hallucinogen. It has been used for centuries by the Mazatec Indians of Oaxaca, Mexico to experience a mystical or spiritual encounter as well as for medicinal purposes.

Recently, it's become a concern in the United States (as well as other Western countries) because of its recreational use. S. divinorum is legal in (most of) the United States and can be bought in tobacco shops and online but it's safety is questionable. The DEA added it to the list of drugs of concern in 2003 because of its use among young adults in search of the hallucinations it causes.

Brett Chidester, a 17-year old honor student from Delaware, was found dead in his garage of carbon monoxide poisoning after using Salvia. His parents found his suicide note shortly after his death in which he claimed that he had discovered the meaning of life:

"How can I go on living after I learned the secrets of life," he wrote. "It took me 17 years, but I finally figured it out. I can't tell you that here because that kind of information can cause chaos."

Salvia is known for its ability to encourage "epiphanies" in its users.

"Scientists identified Salvinorum A as the active chemical that causes the hallucinogens. But neurologist Ethan Russo (MT, USA) warns that ‘we don't know how [Salvia] works. It doesn'’t work on serotonin, dopamine or any of the known neurotransmitters.’ Users claim the drug is non-addictive, but its long-term effects are not known." doi:10.1016/S1360-1385(01)02118-5

Salvia seems to be especially dangerous because of it's legality. Users are fooled into believing that since you can buy it in a smoke shop (and without any age restrictions), it is safe. So far, only Missouri and Louisiana have passed legislation criminalizing the distribution possessionsion of the herb.

Some scientists believe that a derivative of salvia, salvinorin A, may have use as a medication. It targets a receptor involved in

"consciousness and our perception of reality," and it is located in neurons that have a role in depression, drug abuse and schizophrenia. "Many teams of chemists around the world are making salvinorin A for research," Roth says. "Criminalizing salvia and its derivatives would make it "almost impossible" to get salvia-related compounds approved for human use. -Bryan Roth, director of the Psychoactive Drug Screening Program for the National Institute of Mental Health

The long-term effects of the drug remain to be seen.

Do the possible medicinal benefits of salvinorin A outweigh the dangers of a powerful legal hallucinogen?

Other Sources: doi:10.1016/j.lfs.2005.09.008

"Closed-Heart" Valve Replacement

New surgical methods are allowing cardiac surgeons to replace heart valves without cracking open patients' chests. One patient received an artificial valve through a two inch incision in the chest and another received one through a leg artery ("percutaneous valve replacement.") Traditional valve replacement surgery requires that the breastbone be sawed open, the heart stopped, the old valve cut out and the new one sewed in. The period of recovery for this surgery is at least two months and many patients in need of valve replacement are not strong enough to undergo traditional valve replacement. This new less-invasive method may prove to be a viable option for these patients.

Valves are delicate flaps that regulate blood flow in the heart and prevent backflow. When disease sets in, calcium deposits harden the valves and prevent them from working properly. The new method of valve replacement allows doctors to avoid the cutting out and sewing in of traditional heart surgery and instead simply prop open the diseased valve and wedge the artificial valves into the space.

So far some of the surgeries have proven problematic. When doctors used a leg vein (rather than an artery) to coax the new valve into place, they sometimes damaged another valve. Four of the first seven American patients died after receiving the surgery using the leg vein. Only one patient has died out of the twelve that received the valve through the leg artery.

This new surgery is not available to patients yet and its use in patients healthy enough for open heart surgery is still being debated. So far the first patients in the studies have survived with the new valves for two years but long-term success is still unknown.

Source:
Yahoo! News. Neergaard, Lauran. "Closed-Heart a Less-Invasive Alternative." 1 April 2006

Unnecessary Episiotomies? Often do more harm than good.

Episiotomies, the common obstetric surgery used to widen the vaginal opening for women in labor, have not been found to improve labor, delivery and recovery, according to the American College of Obstetricians and Gynecologists. Additionally, risks of a greater tear, anal sphincter dysfunction and painful sex increase after an episiotomy.

Unless there is a risk of severe tearing or there is fetal distress, episiotomies should be avoided.

In related news, the March issue of the Journal of the American Medical Association advocated perineal massage as a method to avoid episiotomies. The method (which can be seen at this Univ. of Michigan, Nursing page ) can be used beginning at week 34 and has been shown to be especially beneficial for women having a vaginal birth for the first time. Doctors should also explain the procedures to their patients.

Source:
Yahoo! News. Beasley, Deena. "Doctors urged to restrict episiotomies" 31 March 2006
JAMA. 2006; 295:1361-1362.

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