user: Molecules, Money, and Ambien Awakenings

The New York Times Magazine had a great piece last week on scattered case reports that doses of Ambien can at least temporarily awaken patients who are in a vegetative state.

Convinced that the son they know and love is still “in there,” Chris’s parents have spent the past three years searching for a way to bring him back out. So far, their best hope has come from an unlikely source: Ambien. A growing body of case reports suggests that the popular sleep aid can have a profound — and paradoxical — effect on patients like Chris. Rather than put them to sleep, both Ambien and its generic twin, zolpidem, appear to awaken at least some of them. The early reports were so pronounced that until recently, doctors had a hard time believing them. Only now, more than a decade after the initial discovery, are they taking a closer look.

The first report of a zolpidem awakening came from South Africa, in 1999. A patient named Louis Viljoen, who, three years before, was declared vegetative after he was hit by a truck, had taken to clawing at his mattress during the night. Thinking he was suffering from insomnia, his family doctor suggested zolpidem to help him sleep. But 20 minutes after his mother ground the tablet up and fed it to him through a straw, Viljoen began to stir. His eyes, which normally wandered the room, vacant and unfocused, flickered with the light of consciousness. And then he began to talk (his first words were “Hello, Mummy”), and move (he could control his limbs and facial muscles). A few hours later he became unresponsive. But the next day, and for many days after that, zolpidem revived him, a few hours at a time.

Here was a case worthy of Hollywood: three years was well past the point at which doctors would expect any sort of spontaneous recovery. Viljoen awoke with the ability to speak in complete sentences. Not only did he recognize his mother, but he also recognized the voices of people who had spoken to him only when he was apparently vegetative. He remembered nothing of the mysterious realm he kept receding back into. When doctors asked him what it was like to slip away, he said he felt no changes at all. But he could recall conversations from the previous day’s awakening, along with bits and pieces of his former life: his favorite rugby team, specific matches he attended, players that he rooted for and against. As time passed, his cognition improved. He could laugh at jokes, and his awakenings stretched from a few hours to entire days. Eventually, he no longer needed zolpidem.

The story is a fascinating read — although it’s hard to know from scattered case reports whether or not this really will become a better treatment option for these patients. One big caveat I’d like to add to that simple medical doubt, though: if generic Ambien can help these patients, who is going to pay to test it? Now that the drug is generic, no company is going to get a return on investment from doing so.

In the U.S., we pay for drugs while there is a patent, and then they get super-cheap. But the value isn’t always so much in the molecule, in zolpidem or atorvastatin (Lipitor) or fluoxetine (Prozac). It’s in the research that proves that medicine is useful. As new ways of looking at biology change medicine, it would be great if we could figure out a payment model that didn’t focus so much on the molecule — and put a little more focus on all forms of research that create medical value.

If this research pans out, will we see big drug giants like Pfizer and Eli Lilly dusting off experimental Ambien-like drugs that didn’t make it to market for a new use? It will be interesting to watch.

Summary: Some thoughts on scattered reports that Ambien can help some patients who are in a vegetative state.


Flavor Flav Ignites Mega-Explosion ... Cops Rush In

Flavor Flav Ignites Mega-Explosion ... Cops Rush In

It looked like a post-apocalyptic WAR ZONE when cops arrived to

's home on the 4th of July ... with smoke, loud explosions, and a charged up mob ... and the whole thing was caught on tape.

Long story short -- Flav and some of his Las Vegas neighbors set off a TON of fireworks in the middle of the street ... and not surprisingly, the noise (and the giant fireworks in the sky) attracted the local police.

When cops arrived ... they sifted their way through the smoke and located Flav, who was still clutching a lighter in his hand.

Flav was totally cooperative -- and forked over his I.D. to the police. The laws regarding fireworks in Vegas are a little loose ... but cops didn't feel like Flav's situation warranted an arrest.

Instead, cops asked the rapper and his neighbors to stop lighting the fireworks and clear out of the street ... and everyone seemed to oblige.

We spoke to Flav about the incident, who told us, "We had a good time watching my fireworks show and everything ended safely. Cops came a few times but didn’t arrest me … thank God (and the police)!!”

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Summary:

assistant: It looked like a post-apocalyptic WAR ZONE when cops arrived to Flavor Flav's home on the 4th of July ... with smoke, loud explosions, and a charged up…