Consumption, etc

I fixed the problem I was unaware of, and you should be able to comment now. You'll have to press the "Comment Anonymously" link, and it'll pop up. You'll have to do a CAPTCHA, unfortunately...

Oh, adrafinil! What a wonderful friend you are. Discovered by French pharmaceutical research company Lafon Laboratories in the late 70s, this psychostimulant is currently an OTC product in several European countries, including France, and is recommended for 'disorders of vigilance and attention, and in the degradation of mental activities' (or so my self-translation of the French insert for Olmifon says... Cognates are wonderful things). Effectiveness has 'not been proven outside of old subjects,' though, and so I'm going to have to try and prove it for them. In America, as far as I have been able to find, adrafinil is unscheduled and unregulated by the FDA. This puts it on the same level as the supplements you buy in your local pharmacy/grocery/GNC, etc., except it isn't cleared to be sold for human consumption. I haven't been able to find any American producers/suppliers of adrafinil, but you can [fairly easily] purchase Olmifon over the internet. It runs about $1/pill (300mg) and comes in packs of 40.¹

So, what the hell am I doing writing about a foreign OTC drug that only has 24 entries on PubMed? Well, Lafon Laboratories discovered another drug very similar to adrafinil that is sold in the USA: modafinil. Since 1998, modafinil has been prescribed under the name Provigil by Cephalon. Provigil is making great strides in America as a 'wakefulness-promoting agent.' If you decided not to read my first excessively long post, the US Air Force gives it to their pilots as a "go-pill" for long flight missions, a status which was previously held only by amphetamine.² Provigil was shown to allow pilots to maintain 'normal function' in flying tests after being sleep deprived for up to 40 hours.^3,4 It allows patients performing with sub-normal cognition (i.e. sleep deprived, ADHD, Alzheimer's, etc.) to maintain focus, perception, and attentiveness well beyond normal human standards without an impact on sleep rhythms or the development of abuse patterns.^10-12 It's normally prescribed for narcoleptic patients, those with sleep apnea, and those with shift-work sleep disorder, though, and is a Schedule IV drug, and not legal to own without a prescription.⁵ Hits on PubMed have been appearing every month for modafinil at a rate that's likely to increase before it decreases, but Cephalon's latest approved drug, armodafinil, may overtake modafinil over the next few years due to a longer effective duration.⁹

And this is where adrafinil comes back in to the picture! Remember adrafinil? Well, it's not illegal to own like modafinil. At least, not clearly so. There is a fair amount of hearsay and conjecture posing as fact about the legality of adrafinil, and without having a legal professional on hand familiar with the matter, it's very hard to find an absolute answer to the question. Well more than half of the sources I found list adrafinil as legal to own in the US, even the DEA's website.^6-8 Everything is not without its caveats, though, and I question whether it is legal to own the modafinil in your system after it has been converted from adrafinil. I'm not too concerned about being blood tested for modafinil, though. So here I am about to tell you that I purchased adrafinil after writing that first excessively long post and becoming intensely intrigued by the product, I did some experimenting on myself. I trust the Olmifon product because it's sold by the same folks who produce the American modafinil, Cephalon. I haven't found the official literature yet for liver damage either, but many people are passing on the idea that frequent adrafinil use may cause increase in liver enzymes ALT, AST, GGT, and hepatic alkaline phosphate, which all indicate liver damage. Modafinil supposedly got rid of this little unpleasant side effect. My adventures in adrafinil will be forthcoming - apologies for the serious draught in posts. I'll do my best to pick up again soon.

 

1. http://www.antiaging-systems.com/iasstore/acatalog/adrafinil.html
2. "Modafinil and Management of Air Crew Fatigue." United States Air Force Memo, Dec 02 2003. 14 Apr 2008. <http://www.hep.afrl.af.mil/HEPF/Policy/modafinil.pdf>.
3. Caldwell, et al. "The Effects of Modafinil on Aviator Performance During 40 Hours of Continuous Wakefulness." USA Aeromedical Res Lab Jun 1999.
4. Caldwell, et al. "The efficacy of Modafinil for sustaining alertness and simulator flight performance in F-117 pilots during 37 hours of continuous wakefulness." US Air Force Research Lab Jan 2004.
5. http://www.rxlist.com/cgi/generic/modafinil.htm
6. http://www.usdoj.gov/dea/pubs/scheduling.html
7. http://en.wikipedia.org/wiki/Controlled_Substances_Act
8. http://www.erowid.org/smarts/modafinil/modafinil.shtml
9. Lankford, D.A. "Armodafinil: a new treatment for excessive sleepiness." Expert Opin Investig Drugs. 2008 Apr;17(4):565-73. Last Accessed 5/27/08. <http://www.ncbi.nlm.nih.gov/pubmed/18363520?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.
10. Huck, N.O., et al. "The effects of modafinil, caffeine, and dextroamphetamine on judgments of simple versus complex emotional expressions following sleep deprivation." Int J Neurosci. 2008 Apr;118(4):487-502. Last Accessed 5/27/08. <http://www.ncbi.nlm.nih.gov/pubmed/18322858?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>
11. Biederman J, Pliszka SR. "Modafinil improves symptoms of attention-deficit/hyperactivity disorder across subtypes in children and adolescents." J Pediatr. 2008 Mar;152(3):394-9. Epub 2007 Oct 24. Last Accessed 5/27/08.  <http://www.ncbi.nlm.nih.gov/pubmed/18280848?ordinalpos=24&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.
12. Minzenberg MJ, Carter CS. "Modafinil: a review of neurochemical actions and effects on cognition." Neuropsychopharmacology. 2008 Jun;33(7):1477-502. Epub 2007 Aug 22. Last Accessed 5/27/08. <http://www.ncbi.nlm.nih.gov/pubmed/17712350?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

               Sorry for the dearth lately, I am in the middle of finals and such right now. Posting will pick up over the summer when I can focus my energies into something vaguely productive.

So, money! Who doesn't love making money? Well, it should be said, this is all silly, because I know nothing about stocks and am deathly afraid of losing money meaninglessly, so you will never catch me putting my money on the market. Any advice I give is from my own shortsighted view which totally neglects anything related to 'the market' and focuses solely on companies that seem to make 'good decisions.' If the rest of the real world is any indicator, these companies which make 'good decisions' are bound to fail spectacularly, crushed underfoot by those marching onward with 'more of the same.'

To skip to the last sentence of this post, the main point is perhaps you should invest in Swiss drug maker Roche Holdings (RHHBY). They produce a product called Mircera (Methoxy polyethylene glycol-epoetin beta). The CERA in Mircera stands for Continuous-Erythropoietin-Receptor-Activator. The devil, I say! Those silly drug names actually mean something. But what is this erythropoietin whose receptor is getting continuously activated?

Erythropoietin (also called epoetin, hematopoietin, and EPO) is a hormone naturally produced by me (and you, and hopefully all of your friends) in your kidneys when your blood is carrying too little oxygen (hypoxia). EPO travels via the bloodstream to the bone marrow, where it stimulates the production of more red blood cells (erythrocytes), which in turn will cause more oxygen to be present in the blood. Pretty simple. This is just one of the many natural processes that keeps me (and you, and your friends) alive every day. Some people, though, need more EPO than their body produces. Major surgeries are typically followed with blood transfusions to aid the healing process and prevent... death. Some medications cause low oxygen levels in the blood (anemia), also. Specifically, chemotherapy medications are well known for producing anemia, among a number of other nasty side effects. People with chronic renal failure who suffer from anemia are also ideal patients for EPO treatment. In all of these cases, low erythrocyte counts threaten lives.

Thankfully, in 1989, the first synthetic EPO drug product was approved for use in the USA by the FDA. Epoetin alfa was released under the names Epogen and Procrit, and eventually, the products were approved for all of the above indications mentioned. The downside to the drugs was that they must be injected three times a week, which, as you can imagine, is not the most convenient regimen in the wide world of pharmaceutics. In 2001, however, a new EPO drug was approved by the FDA. Darbepoetin alfa (Aranesp) was very similar to the previous drugs, but the hormone was modified slightly so that it lasted roughly four times longer in the blood. What this meant, simply, was that you went from taking three injections a week to one. Now that's a much more manageable regimen! In four short years, Aranesp went from being a product new to the market to the #1 EPO prescription.

This is about where Mircera comes in to the picture, in the good ol' year of 2007. For starters, it uses epoetin beta as its foundation, not epoetin alfa. Both forms are present in your body, and both get the job done. Clinically, the beta form was shown to last a bit longer than the alfa form, but not significantly so. But it's a good start. They took this sturdy foundation and then they went ahead and PEGylated it. PEG is polyethylene glycol, a brilliant pharmacokinetic solution to a wide variety of problems. Attaching polyethylene glycol (PEG) to a drug molecule has been shown to increase its solubility, reduce kidney filtration of the substance, and protect it from degradation by proteolytic enzymes in the blood. So, they PEGylated epoetin beta, which I already said was a pretty good foundation. What was the outcome?

Aranesp, if you remember, has four times the longevity of epoetin alfa. Mircera has 27 times the longevity of epoetin alfa.

Let's hit the high notes again: Aranesp sweeps the EPO market in four years by lasting four times as long as the previous product (no correlation between four and four... I hope). Mircera hits the market and is 27 times more likely to hang around in your blood than the first product, roughly 6.5 times Aranesp's half life. Let me display this graphically for you:

 

Wonderful, right? We went from three injections a week to one injection every two weeks, with less drug necessary. I think you understand what I expect to happen to the EPO market now. The only problem is that Mircera is currently only approved for chronic renal failure, whereas epoetin alfa is indicated for that, anemia in cancer patients, anemia in HIV patients, and for the reduction of blood transfusions in surgery patients. Aranesp, for reference, is indicated for renal failure and chemotherapy. It will likely just be a matter of time (yes, years) before Mircera is approved for more uses, though, so you should get on that investment train while the getting is good.

As a side note, there is an underground market for EPO as well. High-performance athletes use EPO to increase their performance in competition through the increase in available oxygen. In the 2002 Winter Olympics, cross country skiers had gold medals stripped for testing positive for Aranesp. The Tour de France has a long and storied history of EPO abuse as well. So much so that I conjecture that without the scandals in cycling's past, the Olympic event would still be on the level of "That's a sport?" to most Americans. They do this despite the wonderful black box warning on all four FDA approved EPO products threatening  "INCREASED MORTALITY, SERIOUS CARDIOVASCULAR AND THROMBOEMBOLIC EVENTS, and TUMOR PROGRESSION." Oh well.

If you remember how we began, we may now close by saying the main point is perhaps you should invest in Swiss drug maker Roche Holdings (RHHBY).

 
References:

McCance, Kathryn and Huether, Sue. Pathophysiology: The Biologic Basis for Disease in Adults and Children 5^th Ed

Epogen." RXList: The Internet Drug Index. <http://www.rxlist.com/cgi/generic/epogen.htm>.

"Procrit." RXList: The Internet Drug Index.  <http://www.rxlist.com/cgi/generic/procrit.htm>.

"Aranesp." RXList: The Internet Drug Index.  <http://www.rxlist.com/cgi/generic/aranesp.htm>.

"Mircera." RXList: The Internet Drug Index.  <http://www.rxlist.com/cgi/generic/mircera.htm>.

Rimoldi, John. "Cells of the Immune System." MEDC 317. TCRC, University, MS. Spring 2008.

            Most people, despite all I have to say on the subject, just refuse to believe me when I tell them that Google is evil. They can't see the signs even though they're all there, staring the public in the face. I suppose it's because they don't follow the news - they just use the front page search. Sure, the search is good enough. It works well and it works fast. There's nothing wrong with that, as far as I'm concerned. And if they could maintain as just a search engine without getting their fingers into every other facet of life, I'm sure I wouldn't have any particular problems with them.

            But that's not the case.

            Where shall we start? How about their newest hit privacy invader: Street View. What is Street View? In short, Google put cameras on cars, and then drove them around major metropolitan areas. What an odd thing to do! But why's this a problem? In my opinion, the first question you should ask is "Why the hell?" I can't tell you that with the advent of internet maps and printers, personal and in-car GPS units, and pervasive cell phone coverage, I still need pictures to figure out where I'm going. Is the average American really perceived to be that incompetent? Is Street View really an effective use of your time and resources? Take hold of your sensibilities and do a little detective work on your own - man's been doing it for thousands of years. It's not that hard to get where you're going.

            Anyway, what's the particular problem with Street View? Think about it. A robot is taking pictures of everything it sees - there is no privacy, and there is no discretion. Well, that may not be entirely true. A billboard of competitor Microsoft's Virtual Earth was found... mostly obscured, mysteriously. This may or may not be consistent with seemingly random black holes, but there's no telling without a word from the horse's mouth. Some of the pictures that you would want obscured - if they were you, at least - aren't. Sneaking around? Going somewhere you'd like to keep private (click the little yellow man if it gives you trouble)? Doing something you didn't expect to be caught on the internet (click the man and zoom out and explore... you'll see)? How about just walking around? With your children (zoom out) or family. Oh, and your license plate isn't safe either. Candid camera from boingboing. Seen enough yet? It's a bit disconcerting to think anything I could do at any point in time might be made freely available to the great masses via the internet. I'd prefer to pick and choose my moments (see: this blog).

What about your children, though? There isn't anything keeping them from seeing things you probably don't want them to. To think your kids will never find these random pictures on Street View may be a foolish mindset - someone else will find them for your children. Wired ran a contest to find the most interesting images on Street View, and many other sites (see links at the end) accumulate pictures such as those above for humor and interest purposes.^1-4 I think the pictures can speak for themselves on the subject. And good luck getting something removed.

Google maintains that anyone can ask to have pictures removed, but apparently the process is not without its flaws. At least two instances turned up in a cursory search for where Google's method for removal apparently was not cutting it. One woman found pictures of her cat, inside her house, through an open window, and the story made it as far as the New York Times.⁵ Why? Because she was denied removal of the images by Google.⁷ Another couple found their home - located on a private road - available for view on Street View, and are now attempting to sue Google.⁶ They said that a significant factor behind the purchase of their home was the privacy it afforded, and Google has severely depreciated that value. The problem behind this suit is that Google says "Street View features imagery taken on public property."⁵ The nature of living on a private road, however, is that the upkeep is maintained by a housing co-op or homeowners association - not the government. Unauthorized presence on the road can be construed as trespassing. Google has removed the offending images, but it reveals the problem underlying the whole situation.

Street View is operating on an 'opt out' policy, not an 'opt in' policy. Google has not asked the citizens of these cities if they may randomly photograph them without warning throughout the course of the day. Residents have not given consent to have their homes (and whatever may be visible through open windows), families, cars, or private lives photographed and placed on the internet. If you don't like something Street View has portrayed of you, you first must find yourself on Street View to know the material is there. Since Google doesn't have loudspeakers on their vans announcing "WE MIGHT BE PHOTOGRAPHING YOU RIGHT NOW. TRY AND FIND YOURSELF ON STREET VIEW," and most private citizens do not operate in a state of hyper-vigilance, I expect most people on Street View have no idea they are visible on one of the most visited internet sites in the world. Many of them likely have not even heard of Street View, and some of them may go the rest of their lives without knowing they, their friends, and their property are free to view online.  

But this applies to everyone, right? Equal privacy intrusion for all?

Wrong. Google crumbled to the whims of the Department of Defense in less than 24 hours upon the request that pictures of government buildings be removed.^7,8 Even more interesting, at least two takes on this news story have gone missing, one of which was hosted by Google itself.^9,10 So we can see the government has a defensible right to privacy and secrecy, in the name of national defense. This is all pretty understandable. I don't think, as an American citizen, that I want pictures of our military bases online. But why can't the private sector get the same respect that the government does? That woman (and her cat) are in the spotlight now, plastered all over the internet and news media (thank you Streisand effect). Pranksters, thieves, perverts, stalkers, and neighbors now know where she lives, what the place looks like, and that she has a cat. I'm glad Street View may never make it to the small college town I live in now, because that's a safety and security issue I never want to have to deal with. The failure of Google to remove pictures of the previously mentioned woman's cat is a blatant disregard by Google for the rights of the individual, in the name of... well, what's it in the name of? Freedom of information? Is this information we really need, or want, to be free?

I got a little carried away with Street View, so we'll discuss that next time around...

 

P.S. Picture of the Street View camera.

 

References:

1. Top 15 Google Street View Sightings
2. Google Street View: would it be more or less evil if it was CIA or NSA?
3. Watch out for the Google van!
4. Request for Urban Street Sightings
5. Google Zooms In Too Close for Some
6. Google sued over Street View
7. Google pulls some map images at Pentagon's request
8. Google Pulls Army Base Maps, Says Photographer Violated Policy
9. http://ukpress.google.com/article/ALeqM5jPkfWnWyff0UDNOUnveImUkfFs4A
10. http://news.yahoo.com/s/nm/20080306/wr_nm/usa_military_google_dc
11. The Google Maps Street View Camera

    I was recently posed with the question: Which is worse for you, high fructose corn syrup, or sucrose (table sugar)? My gut reaction was: well, high fructose corn syrup of course! The media said so! It must be true. So I set out on Google to get my bearings, before heading to NCBI to get my back-up. What kind of reports did Google produce?

The Murky World of High-Fructose Corn Syrup
"So they repeated their studies with two groups of rats, one given high amounts of glucose and one given high amounts of fructose. The glucose group was unaffected but the fructose group had disastrous results. The male rats did not reach adulthood. They had anemia, high cholesterol and heart hypertrophy--that means that their hearts enlarged until they exploded. They also had delayed testicular development."

    Brilliant! Any God-fearing American doesn't want their children's testicles to develop late, or, secondarily, to have their hearts explode. Well, they're not exactly spot on. "Hypertrophy" only means "enlarged cells" - and yes, cardiohypertrophy is bad news, indeed. But an exploding heart? Not at the snap of a finger. Anyway, let's move on. P.S., Sources cited? No.
 
Sugar Coated / We're drowning in high fructose corn syrup. Do the risks go beyond our waistline?
"The end result is that our bodies are essentially tricked into wanting to eat more"
"The USDA suggests most of us limit our intake of added sugar [...] to about 10 to 12 teaspoons a day. [...] In 2000, we ate an average of 31 teaspoons a day,"
"in 1980, just after high fructose corn syrup was introduced in mass quantities, relatively stable obesity rates began to climb."

    So, HFCS tricks us in to eating more. Unrelated, the USDA says we should eat about 1/3 the sugar we do. Lastly, the author insinuates that the introduction of HFCS has caused the increase in obesity. Well, we'll get to the first and third points at the end. The second point is pretty spot on - we eat too much sugar. Sources cited? Nope.

    Around this point, I found What is high fructose corn syrup?, At a glance, this appears to be a complete BS site run by the HFCS producers of America. I mean, look at the URL alone. HFCS Facts? Yeah right, the only people who have to say their words are "facts" on the internet are "liars." This is a well supported fact, as evidenced on the rest of the internet. They cited research and articles spouting such nonsense as "Experts Conclude Evidence Lacking to Implicate High Fructose Corn Syrup as a Unique Cause of Obesity" and "Weak Association between Sweeteners or Sweetened Beverages and Diabetes." What a load, right? I closed this tab pretty quickly and continued on in my search. I don't need the manufacturers shoving their PR down my throat. Sources Cited? I don't know if LIES count as sources, but yes, perhaps. Let's just get back to the facts, here.

A Sweetener With a Bad Rap
"There's no substantial evidence to support the idea that high-fructose corn syrup is somehow responsible for obesity,"

Wait, what?

"It was a theory meant to spur science, but it's quite possible that it may be found out not to be true,"

Woah woah woah. Let's back the truck up.

"I don't think it is likely that things would be very different if people consumed increased amounts of either sucrose or high-fructose corn syrup,"

All of these quotes came from scientists, doctors. I don't know about all this. Let's push forward. Sources Cited? Nope.

High Fructose Corn Syrup
"there is also some preliminary evidence that HFCS is carcinogenic."

Ah HA!

"Watching the food channel, I recently heard that the most delicious pork comes from Spain, where the swine are fattened up on an all-corn diet. This little tidbit reminded me of we Americans. Surely Americans are often enough referred to as pigs, but who knew we held so much in common with this lowly animal? It seems we and they are being fattened up for some strange slaughter yet to come."

    Oh, now that's what I'm talking about. Pull my conservative heart strings, tug on my sensibilities. I don't want to be compared to a pig by foreigners! I'd best stop eating HFCS. Hell, it might give me cancer. I'll just stick to Butter Yellow and Nitrosamines, thanks. Sources cited? Nope.

    Well, these results seem pretty clear, except for a few non-believers. HFCS is bad. Let's move to NCBI, a free, government run repository for scholarly research articles. If you need an article, you go here. So, the results? Well, let's cut to the chase. What began with a lot of confusion and expectations ended brilliantly in one article that cited almost every article I was going to consider my "body of research," plus several more. Better yet, it cites Shakespeare's "Much Ado About Nothing." Let's see what we get. The good stuff is marked.

Much ado about high-fructose corn syrup in beverages: the meat of the matter

    Over the past 35 y the prevalence of obesity has risen concurrently with an increased availability of added sugars in the food supply. Food disappearance data, used as an indicator of trends in food consumption, have shown a 20% increase in the availability of caloric sweeteners (sugars) in the United States from 1970-1974 to 2000 (2). Obesity has been blamed on sugars and sugar-sweetened beverages, but the debate has raged for many years with little resolution (3). More recently, the intensity of the debate was fueled by the hypothesis that introduction in the 1970s of high-fructose corn syrup (HFCS) as a caloric sweetener in beverages was specifically at fault (4). HFCS was proposed to lead to obesity because fructose bypasses food intake regulatory systems and favors lipogenesis.

    However, although the availability of sugars has increased in the US food supply over the past 4 decades, it has not increased disproportionately as a contributor to the increase in total energy availability. From 1970-74 to 2000 the increase in per capita availability of total energy, sugars, carbohydrates, and fats was 25%, 22%, 26%, and 48%, respectively (2).

    Furthermore, in the United States, HFCS has primarily been used to substitute for sucrose as a caloric sweetener rather than to be used in addition to sucrose. Sucrose use has declined from 80% of total caloric sweetener availability in 1970 to 40% of caloric sweetener availability in 1997. This reduction in sucrose consumption was simply made up for by HFCS, which has increased from nearly 0% in 1970 to 40% of total caloric sweeteners in 1997. The availability of HFCS in the US food supply did not change from 1997 [60.4 pounds (27.4 kg) per capita annually] to 2004 [59.2 pounds (26.9 kg) per capita annually] (2), during a time of continued weight gain.

    There is no evidence that the ratio of fructose and glucose consumed from sugars has changed over the past 4 decades as a result of HFCS replacing sucrose in many applications. The term "high fructose corn syrup " is not a good descriptor of its composition, but the term was mandated to distinguish the newly developed fructose-containing corn syrup from the traditional all-glucose corn syrup. HFCS is predominantly sold as HFCS-55 (55% fructose, 41% glucose, and 4% glucose polymers) or HFCS-42 (42% fructose, 53% glucose, and 5% glucose polymers) (5). In North America, the former is used in beverages and the latter in solid foods.

    The significance of replacing sucrose with HFCS in soft drinks and other beverages is addressed in this issue of the Journal by Soenen and Westerterp-Plantenga (6) and merits emphasis because it challenges the argument of biologic plausibility that was proposed to support the hypothesis. When compared with a diet drink, subjective appetite and food intake were decreased by the consumption of solutions of sugars (86 g/800 mL water). The drink mixtures contained primarily HFCS or sucrose and were prepared by using syrups added to beverages consumed in Europe. They contained either sucrose or HFCS to which was added glucose syrup (90% glucose and 9% fructose). The final composition of the sucrose beverage was 64% glucose and 36% fructose, whereas the HFCS beverage contained 41% glucose and 59% fructose. Thus, the difference in fructose content of the test beverages was exaggerated relative to the differences in beverages containing only sucrose or HFCS. Yet, no difference in food intake was found at a meal consumed 50 min later or in postprandial blood concentrations of glucose, insulin, glucagon-like peptide 1, or ghrelin--all components of food intake regulatory mechanisms.

    Implicit in the argument that HFCS in soft drinks is different from sucrose is the notion that sucrose, as the disaccharide, may in some way stimulate metabolic satiety signals or increase fatty acid synthesis more than the monosaccharide mixtures. However, these possibilities were recently explored also (7). HFCS and sucrose, compared with solutions containing equal proportions of glucose and fructose, resulted in no differences in food intake 80 min after consumption. Sucrose and solutions of its monosaccharide equivalents resulted in no differences in postprandial blood glucose, insulin, and ghrelin concentrations. Thus, there is no evidence that sucrose--when consumed in its intact form--would confer any benefits over HFCS, which contains the 2 unbound monosaccharides. Furthermore, when added to the acidic environment of soft drinks, sucrose is most likely consumed as the monosaccharide because of hydrolysis.

    The article by Soenen and Westerterp-Platenga (6) also suggests that all beverages may be created equal. The results support the view that compensation for calories in beverages is incomplete. . Neither food intake nor caloric compensation was different after subjects consumed HFCS, sucrose, or milk drinks (1.5 mol). However, caloric compensation, the reduction of intake at the test meal as a percentage of calories in the preload, averaged <40% for women and 60% for men. Whether compensation would be higher for a solid food of similar composition remains to be determined (8).

    There are multidimensional determinants of obesity. It was previously noted that neither sugar nor carbohydrate consumption has been clearly delineated as a direct cause of obesity (9). However, it is clear that energy imbalance for most individuals is accounted for by energy intake exceeding expenditure. The lifestyle factors that lead to this problem are too little exercise and too much food, but the determinants of such vary greatly between individuals. A food solution to obesity remains elusive, but a reductionist approach that focuses on one food or one component of the food supply, in the presence of too much (9), is unlikely to succeed.

    Unfortunately the recent focus on HFCS has done little to resolve the role of sugars in contributing to energy imbalance. The hypothesis that the replacement of sucrose with HFCS in beverages plays a causative role in obesity is not supported on the basis of its composition, biologic actions, or short-term effects on food intake. Had the hypothesis been phrased in the converse, namely that replacing HFCS with sucrose in beverages would be a solution for the obesity epidemic, its merit would have been seen more clearly. Put simply, a proposal that a return to sucrose-containing beverages would be a credible solution to the obesity epidemic would have been met with outright dismissal. In many countries where trade barriers have prevented the replacement of sucrose with HFCS, the prevalence of obesity is high. Therefore, what role HFCS in beverages plays in the etiology of obesity, as in Much Ado about Nothing (1), may simply be a play on words.

    So. Interesting. There's not a whole lot more I can say about the topic. All the world's a stage, it seems, and HFCS is but one of the players in the great theater of lies and deviltry. Sugar is sugar, and that's what you need to know. You eat too much, and you get fat. Did anyone's heart explode? Doesn't seem so. Did anyone get sugar cancer? Not yet. Heck, do we even eat more because of it? A thousand times no! Beware the lies of the media. They have found their target, and it is high fructose corn syrup. Some day, the truth may hit the headlines, but it will likely be the day it can be pushed to the third page when the story about The Simpsons being canceled hits AP wire.

    Pharmacological means have rapidly become the most looked-to solution for health troubles in modern America. Many take for granted the enormous progress made over the past century, where rapid advances in medicinal chemistry as well as improvements in safety regulations have changed the face of pharmacotherapy for the better. Dating back thousands of years, what was once the vague administration of impure compounds whose properties were largely unknown has become a precision art able to combat an ever-increasing portion of all known symptoms and illnesses both safely and effectively. As the range of classes and applications of pharmaceutical therapies broadened, so did the scope of their effects. While pharmacotherapy was once reserved for the sick and deteriorating, it has now become a means of image and lifestyle modification available to the young and healthy looking for exaggerated change. Anabolic steroids, while often viewed as a popular pharmacotherapy for improving personal traits, are taking a back seat to less obvious forms of enhancement. Those substances capable of sharpening the 'mental muscle' for competitors are giving them the edge in fields where physical prowess may not be the deciding factor. Outside of sporting events, use and misuse of these modern pharmaceutical therapies is changing the playing field in a wide array of challenges not considered to be 'classic' competitions. Cognitive enhancement through pharmaceutical methods is shaping the future of the military as well as academics.

            To understand the present situation of American consumption of ergogenics (compounds enhancing physical or mental performance), one must of course begin in the past. Man has been recorded as consuming mental supplements for thousands of years. Drugs characterized as methylxanthines, which includes caffeine, may potentially be the oldest substances known to be consumed by humans for cognitive enhancement. The ingestion of plants containing these alkaloids dates back many thousands of years.¹² The Mayans of Central America were well known for their habit of chewing cacao leaves to keep awake and alert while performing their daily tasks. The use of stimulating plants was only noted in the regions where the plants grew, however, and was characteristic of few cultures. Beginning in 2737 B.C.E., the Chinese revolutionized the concept after discovering how to harness caffeine and other alkaloids by steeping their parent leaves in boiling water, thus creating a convenient drink called 'tea.' ³ This conversion of caffeine's route of administration to a drink marked a change in the spread of its use as an ergogenic. Tea leaves had now become a commodity able to be transported to lands which had inappropriate climates for the growth of this flora. The transport of tea leaves allowed caffeine to become the first accessible cognitive enhancer whose effects were known to all cultures across the globe. Because of its ability to increase reaction time, spatial relationships, and memory while having minimal toxic effects, caffeine may also be viewed as a golden standard ergogenic.⁴ As evidence to this, more than 80% of Americans consume caffeine every day.⁵ Caffeine acts as a central nervous system stimulant (CNS), producing the effect of alertness and reducing fatigue.

This ancient ergogenic satisfied the needs of ancient man, but as time progressed, more powerful ergogenics were developed. Unfortunately, greater risks associated with use came paired with greater clinical outcomes. Amphetamine, a powerful CNS stimulant, was first put on to the market in 1932 as an over-the-counter inhaler product indicated for congestion under the name Benzedrine, and 1937 sees the advent of tablet-form amphetamine for use as an anti-narcoleptic.⁶ The military was quick to observe the wakefulness-inducing properties of the drug, and World War II saw methylated amphetamine (methamphetamine) given to soldiers on both sides in order to maintain alertness and vigilance. The drug was propagandized to American soldiers "For men in combat when the going gets tough."⁷ Returning home to America victorious, these soldiers found they brought back with them an addiction to the drugs the government had instructed them to take. Benzedrine became the de facto substance in American culture for those looking simply to get some 'pep in their step' or to binge and indulge for days without sleep. Usage crossed boundaries from hardcore abusers such as the Hell's Angels motorcycle club to housewives looking to stay fit and awake during the day.^7,8 The drug infiltrated the artists and authors of the time as well, appearing in and affecting the lives and works of Jean-Paul Sartre, Hunter S. Thompson, and William Burroughs, to name a few.⁹ The dangers of amphetamine use were recognized in due course and resulted in the substance becoming a Schedule II drug in 1971. Despite the fact that the FDA had not approved amphetamine for the management of fatigue, however, the U.S. Air Force has sanctioned amphetamine and dextroamphetamine (Dexedrine) for in-flight use since 1960 and continued to do so until the end of the Gulf War in 1991, when it banned Benzedrine.¹⁰

There can be no doubt about it - numerous studies have shown time and again that amphetamine increases focus, alertness, wakefulness, sharpens mental acuity, and increases physical output in humans.^11,12 No pilots were shown to be using amphetamine during the Gulf War when a "Class A" mishap occurred, and this fact speaks volumes when combined with the statistic that at least 57% of American pilots used the drug at least once during the air war. ¹⁰ Despite the banning of Benzedrine in 1991, the military continued their attempts to pharmacologically improve their troops. Dexedrine use sustained, and reports arose of undesirable outcomes. In April of 2002, two American pilots killed four Canadian soldiers in Afghanistan after mistaking them for the enemy.¹³ Dexedrine use was indicted in the case, as both pilots had been using Dexedrine to fly long missions repeatedly for several weeks prior to the incident. Further yet, the claims arose that the pilots would be found unfit for duty if they did not take Dexedrine.¹⁴ Spurious claims of safety should warrant more concern than is given for cases such as this. Amphetamine has been shown to cause paranoia, mood swings, and panic attacks, and yet is still being forced upon soldiers under the threat of being discharged.^14-17 The answer to the dangers of amphetamine may have been delivered to the military in 1998, however, with the approval of the drug modafinil (Provigil) by the FDA.

Modafinil is an ergogenic indicated as an anti-narcoleptic that doesn't interfere with normal circadian rhythm. The effects of modafinil sought after by the military include not only a mild increase in executive function, but more importantly the attenuation of 'physiologic sleepiness' and 'neurobehavioral deficits' associated with being tired.¹⁸ In 2003, the United States Air Force approved modafinil for the 'management of air crew fatigue.'¹⁹ The drug has been cited as creating amazing performance capabilities in citizens and soldiers alike, with pilots easing the consequences of up to 40 hours of wakefulness to performance levels near baseline, which were measured after a night's rest.^20,21 Modafinil allows for a combat zone environment composed of 24/7 soldiers who need, instead of a standard sleeping regimen, only to ingest a pill to stay focused, alert, and on the move for a day longer than his non-pharmacologically enhanced opponents. Without the debilitating effects of sleep deprivation or the overwhelming 'rush' of amphetamine, soldiers have become finely honed tools for time spans twice as long as previously achievable on the battlefield. The military believes the therapeutic outcomes derived from these substances are a "21^st century revolution in military affairs" that "will fundamentally change current military concepts of 'operational tempo' and contemporary orders of battle for the military services."²²These highly desirable effects of amphetamine, modafinil, and other drugs have not gone unnoticed outside of the theatre of war.

With the already stated rapport among the military, one must ask how the private sector has reacted to the availability of ergogenics. It seems almost needless to say that performance enhancing drugs are infiltrating every facet of life in contemporary America. Of special note is academia which displays unexpectedly large infiltration. 10% of American high school students were reported as legally being on the Schedule II drug methylphenidate (Ritalin), which is indicated for ADHD and narcolepsy.²³ Like amphetamine, methylphenidate is a CNS stimulant that creates the desired effects of wakefulness and focus, potentially for several days straight if misused.²⁴ The advantageous therapeutic outcome of this drug in academia was well observed by the peers of those on the drug, though. Studies have shown that an even higher percentage of students have abused methylphenidate or taken it illegally. Some university surveys reported numbers as high as 20% of students having taken methylphenidate illegally or recreationally at least once.^25,26 With rates as staggering as these, it's a wonder that greater societal impact has not been exclaimed by the media. Do these statistics merit a cause for alarm among anti-drug forces? Adderall (a combination of amphetamines and dextroamphetamines) and methylphenidate cause fewer and safer side effects than the CNS stimulating street drugs cocaine and methamphetamine. Even still, while these street drugs are seen as 'party' drugs, methylphenidate and Adderall are widely viewed as 'cramming' or 'study' drugs.²⁷ The study drugs often carry a completely different stigma than the more common drugs of abuse, and not just to students.

This particular phenomenon in ergogenics has been shown to reach beyond just our schools. A recent survey showed one in five readers of Nature, predominantly persons of science, admitted to 'boosting their brain' with methylphenidate, modafinil, or other ergogenic drugs. More surprising, these results did not vary by age group, and 69% of those polled that they would risk normal side effects to take the drugs.²⁸ Is it responsible to judge children guilty of using ergogenic drugs illicitly when the leaders of academia not only are shown to be more likely to partake, but deem drug use ethical in matters of improving focus and concentration? These same academic leaders believe so, as 86% percent of them also stated that children under 16 should not be allowed to take the drugs.²⁸ Some consider taking the aforementioned stimulants to have 'no intrinsic ethical difference' from the consumption of caffeine or energy drinks.²⁹ This double standard in the private sector must warrant concern that goes beyond the parties involved. Parents want their children to succeed in school to achieve an outcome, just as the military wants their soldiers to succeed in battle to achieve their desired outcome. The pharmacological solution seems both effective and appropriate - at a glance. Methylphenidate and Adderall, as Schedule II drugs in the USA, have been shown to have a high likelihood of abuse and able to create addiction patterns. ^30-33 While these effects are diminished compared to street drugs, the problem is not one that can simply be overlooked. If the drugs were truly considered to be safe across a broad range of uses and doses, it should follow that this significant portion of academicians which allows for and perpetrates their usage would not keep their children from excelling in school and work through the use of the same drugs they themselves are taking. More work is being completed every day, though, to create more ideal compounds with high therapeutic tolerance, no chance of physical addiction, and no toxicity effects.

What does the future of ergogenic drug use hold? One particular class of compounds of interest to ergogenic enthusiasts is the racetams, such as piracetam, aniracetam, oxiracetam, and pramiracetam. This emerging class of drugs maintains toxicity levels next to nonexistent and yet has been shown to cause CNS changes that attenuate the neurophysiologic signs of aging as well as improving learning and memory.^34-36 Unlike all of the drugs discussed so far, the racetams are all currently unscheduled by the FDA and are legal to purchase and own without a prescription in America. The therapeutic dose-response of these drugs is nowhere near as potent as that of amphetamine or methylphenidate, but the high safety threshold may outweigh the burden of taking more or larger pills. The 'eugeroic' (literally "good arousal") effect of these drugs may not be as great as modafinil, but the decrease in cost of up to a factor of five may overcompensate for this fact. The safety and legal benefits of racetams currently surpass all aforementioned stimulants, and while their use is restricted predominantly to those 'in the know,' the potential for future prevalence is great as more data on their beneficence emerges. Before one introduces the subject of competition, taking racetams as 'mental supplements' to increase focus, alertness, and mental clarity is simply a positive adjustment of one's own characteristics. Under the context of war or academia, however, the topic suddenly becomes highly suspect.

There are no standards for the use of cognition enhancing drugs because these substances are years beyond the cacao leaves our ancestors chewed. Over the past 120 years, America has dealt with cocaine and methamphetamine usage, but these stimulants are widely considered dangerous and unpredictable. Stimulants have never been as safe and effective as the compounds produced in the last quarter century. The current generation is the generation that will suffer the casualties and make the mistakes requisite in the development of a code of ethics. Most, if not all, professional sports regulate the chemical intake of the participants in the effort to create a fair playing field. Academia has no mandatory drug tests, however, and it is shown that among adult scientists, safe ergogenic use is a welcome facet. If American culture as a whole cannot determine a system of beliefs and regulations on ergogenic use, the results may be disastrous. The concept of being 'competitive' may become forever entangled with the consumption of ergogenic compounds without undergoing all applicable non-pharmacological methods beforehand. It has been suggested that employers could require their employees to ingest ergogenics to increase work output, but the cost of widespread ergogenic consumption could be prohibitive, and long term use of many ergogenics has been studied sparingly if at all.³⁷ These concerns of safety, cost, and ethics all lay on the forefront of the future. Questions that never before needed to be asked are now challenging our cultural beliefs of what is right and what is just. America is on the cusp of the ergogenic revolution and, in the coming years, these decisions must be made for the safety and beneficence of its citizens.

 

 

References

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I have caved and started a blog. This may mean I have officially stepped in to the 20th century. I will likely soon catch up to the 21st. The one good thing about this blog is that it may help me complete more work of personal interest, simply for the sake of publishing rather than just letting it sit in my archives. Things to expect: art, literature research, information, news, commentary... Potentially more things as well.

Firstly, a paper I just finished writing. I feel like it's not awful. Can you believe I haven't turned in a graded piece of original prose since Spring of 2006? I think the last paper I wrote was a research paper then, too... A lovely BS piece on advertising in videogames. Teacher was quite in to it, at least. Hopefully my teacher now will be in to this piece of synergistic research I produced.