Tag Archives: drugs

LSD and Human Frailty

I went to a book reading the other night by Don Lattin, author of The Harvard Psychedelic Club, a new bestseller about the period in the early 1960’s when Timothy Leary and Richard Alpert, professors at Harvard, were conducting free-wheeling experiments using LSD and other psychedelic drugs. It sounds like a great book, and well worth reading.

The book discusses the broad theme of how psychedelic use ushered in the 60’s as we know them, but I want to focus on two of the personality issues that Lattin brought up last night. It turns out that one of the Harvard undergrads who tried to get involved in the experiments was Andrew Weil, who would later become Dr. Andrew Weil, bearded king of holistic medicine. Weil was rebuffed, since Leary and Alpert had promised not to use undergrads in their experiments. He did not take this rebuffery well, and used his position as a reporter for the Harvard Crimson to dig up dirt on Leary and Alpert, lying, cheating and betraying his best friend in the process. So to clarify: Dr. Andrew Weil, who has made millions on “balanced living,” got his start by sliming other people.

After being fired from Harvard, thanks to Weil’s sneaky maneuvers, Richard Alpert traveled to India, found a guru, and came back to the US as Baba Ram Dass, becoming a well-known spiritual teacher who wrote the bestseller Remember, Be Here Now. Since then, Alpert has dedicated himself to living, and helping others live, a spiritual, be in the moment kind of life. Despite that, Lattin described how when he was spending time with Alpert while working on the book, Alpert still got angry at the thought of Andrew Weil, even 40-plus years later. This is not exactly the behavior one expects of a spiritual guru.

My point is not to criticize Weil and Alpert. My point is to note that even the most centered among us is still human, and thus fallible. Actually, Weil may not be centered – he may be an ambitious, money-grubbing jerk – but that is beside the point. Whether centered or not, spiritual or not, LSD-gobbling or not, we are all human, all too human, and with our humanity comes frailty. We would do well to remember that as we observe the behavior of those around us.

Another Data Point on Health Care Reform

Apparently there is an ongoing debate in ophthalmological circles about using Lucentis or Avastin to treat macular degeneration. These are two closely related drugs, both made by Genentech from the same molecule. Avastin has been approved for treating various cancers, but ophthalmologists have evidently been using it off-label for a while to treat macular degeneration. This off-label use is one of the reasons Genentech produced Lucentis, which has been approved for macular degeneration.

Why is this relevant to health care reform? Because Lucentis costs thousands of dollars per dose while Avastin costs less than one hundred dollars. Even worse, as I was told by an ophthalmologist over the weekend, insurance policies keep even those doctors who are worried about costs from using Avastin. Doctors pay $50 for a dose of the drug, but only get reimbursed $7, so they are losing $43 per treatment. If they use Lucentis, they get full reimbursement. One might argue (in fact, I probably would) that the ophthalmologists are making so much charging for the treatment that they should eat the $40 loss, but I doubt many of the doctors will listen.

I know that there are many complexities here: you can’t expect insurance companies to fund the use of unapproved drugs, and you want a drug approval system that errs on the side of safety, and there hasn’t been a head-to-head trial to see if Avastin is fully equivalent to Lucentis. But surely there is a middle ground, where drugs are sufficiently vetted yet we are not incenting doctors to prescribe thousand dollar drugs instead of fifty dollar drugs.