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A youth mesmerised by iPhone.
Brushpen with watercolour 14cm x 9cm. Click to enlarge.

By Kirsty McHugh, OUP UK

Last week it was announced by the British Home Secretary, Alan Johnson, that Professor Les Iversen had been appointed as the new chairman of the Advisory Council on the Misuse of Drugs (ACMD). This is the board that advises the UK government on drug issues. Professor Iversen was, until his retirement, at the Pharmacology Department at the University of Oxford. He is also the author of several books on drugs, including Drugs: A Very Short Introduction (2001). In the short excerpt from that book, below, Professor Iversen talks about the oldest of all recreational drugs: alcohol.

Alcohol is the oldest of all recreational drugs, and it is widely consumed in the Western world. The production of wines, beers, and distilled spirits is a very large industry, with worldwide sales of more than $300 billion. In most Western countries more than 80 per cent of the adult population will admit to having tried alcohol, and about 50 per cent are regular users. The consumption of alcohol continues to increase, and the range of alcoholic drinks is constantly widening – with, for example, sweet ‘alcopop’ drinks to attract the younger consumer – and in many countries alcoholic products are available twenty-four hours a day in supermarkets. The alcohol industry spends large amounts of money on advertising to encourage the sales of its products. The consumption of alcoholic drinks is deeply embedded in the culture of many countries: the special atmosphere of the traditional English pub or the German beer garden; the custom of drinking wine with the meal in France and Italy; the ice-cold aquavit of the Scandinavian cold table; and the universal champagne at the wedding reception.

Exactly how alcohol acts in the brain to produce initially a state of excitement and intoxication and later sedation is not precisely understood. Scientists believe that the key actions of alcohol target the two principal chemical messenger systems in the neural circuits of the brain. Alcohol enhances the actions of the main off signal, GABA, and partially blocks the main on signal, L-glutamate. But there is more to it than that: the pleasurable intoxicant actions of alcohol seem to be due in part to its ability to stimulate opiate mechanisms in the brain – the same ones that are stimulated more directly and more aggressively by heroin. The drug naltrexone acts as an antagonist of the opiate receptors in the brain. It has been used successfully in treating heroin addicts, and more recently it has been shown to be effective in treating alcoholics. The drug removes the pleasurable effects of both heroin and alcohol, making it easier for the dependent user to quit.

The majority of drinkers are able to indulge in alcohol without damaging themselves or others, and indeed a number of studies have shown that the consumption of moderate amounts of alcohol can reduce the risk of heart disease and stroke. But alcohol consumption also has a considerable down side. The acute stage of alcohol intoxication releases normal inhibitions and tends to promote reckless and often violent behaviour. Fights with broken bottles and beer glasses as weapons can interrupt the friendly atmosphere of the Engl

I draw better when I pretend to be drunk.
Woodcut with digital colour. 33mm x 45mm. Click to enlarge.

I came across this tiny wood engraving of a man in an eyeball while rummaging through some old papers. I cut it for the Pink Floyd Songbook many years ago.
Wood engraving 40mm x 25mm.Click to enlarge.

I sense that everyone's lying to me.
Top: Pen and ink with brushpen 9cm x 6cm.
Lower: Acrylic on paper 18cm x 25cm. Click to enlarge.

It never ends.
Pen and ink with digital colour. 8cm x 11cm. Click to enlarge.

Bumped into Richard Wentworth today...I haven't seen him since 1975-ish. When I got home I dug out this tiny sketchbook page from 1974. Verso is a dream I painstakingly recorded (on hand ruled lines and red margin). Recto relates to I know not what.
Pen and coloured pencil. 13cm x 9cm. Click to enlarge.

As we peek into the future to see just what life will be like in the UK in 2020, a grim sight lies before us…

Power is now firmly in the hands on the heavily armed, tear-away children, nurtured by the recent Labour government, and statistics show over half the population is now Muslim. Christianity is an underground religion, practiced secretly, for fear of retribution, and the NHS has decided it will ONLY treat foreigners. Council houses are reserved exclusively for gypsies, asylum-seekers and paedophiles. And education (in the areas it’s still available face-to-face) is a guarded operation, with the teacher sitting behind bullet-proof glass and children wearing full body-armour (with an army of translators at the ready). Adults have resorted to leaving their boarded-up homes only in large gangs, or in tanks provided by the army. (The army is now boasting such fine military planners as the two prospective young terrorists recently found not guilty of planning toblow up their school, after hoping to kill hundreds of their innocent schoolmates.) 

Image via Wikipedia

The newly elected Lib-Dem goverrnment - voted inafter the late Conservative leader, David Cameron, was discovered to be nothing but a holographic image, projected by the President of America (as was Tony Blair), in order to control our country from afar – are using the military police to import illegal drugs, bought from the Afghan government, in order to keep the children on the streets as calm as possible. They still believe there’s some way out ofthis mess. 

Image via Wikipedia

Anyone who was able jumped ship years ago. Now only the poorest remain, along with the millions of half-blind elderly people who’ve been imprisoned for failing to pay the fines handed out for recycling offences (such as accidentally disposing of a potato peeling in the box designated for tin cans).

Image via Wikipedia

Aaah, but such is life!

As we peek into the future to see just what life will be like in the UK in 2020, a grim sight lies before us…

Power is now firmly in the hands on the heavily armed, tear-away children, nurtured by the recent Labour government, and statistics show over half the population is now Muslim. Christianity is an underground religion, practiced secretly, for fear of retribution, and the NHS has decided it will ONLY treat foreigners. Council houses are reserved exclusively for gypsies, asylum-seekers and paedophiles; inner-city areas resemble scenes from District 9.

Education (in the areas it’s still available face-to-face) is a guarded operation, with the teacher sitting behind bullet-proof glass and children wearing full body-armour (with an army of translators at the ready). Adults have resorted to leaving their boarded-up homes only in large gangs, or in tanks provided by the army. (The army is now boasting such fine military planners as the two prospective young terrorists recently found not guilty of planning to blow up their school, hoping to kill hundreds of innocent school friends and teachers.) 

Image via Wikipedia

The newly elected Lib-Dem government - voted in after the late Conservative leader, David Cameron, was discovered to be nothing but a holographic image, projected by the President of America (as was Tony Blair), in order to control our country from afar – are using the military police to import illegal drugs, bought from the Afghan government, in order to keep the children on the streets as calm as possible. They still believe there’s some way out of this mess…

Image via Wikipedia

Anyone who was able to jumped ship years ago. Now only the poorest remain, along with millions of half-blind elderly people who were imprisoned for failing to pay the fines handed out for their recycling offences (such as accidentally disposing of a potato peeling in the box designated for tin cans).

Image via Wikipedia

Suicide is now the only option.

Portrait of a very angry young man.
Pencil 20cm x 27cm. Click to enlarge.

Life -So... apparently, someone sneaked an Alice & Wonderland style mushroom in the tart we cooked yesterday, because both Lindsay and I slept horribly and had ODD dreams. Last night it was a real struggle keeping my eyes open... It was very delicious though, and we are already planning variations, hopefully ones sans LSD.After much struggling, cursing and braving of nasty spiders, my mother and

Humour is a deadly business.
Ink and watercolour 10cm x 10.5cm. Click to enlarge.

Spermzilla escapes from the North East England Stem Cell Institute.
Acrylic on paper 31cm x 41cm. Click to enlarge.

Oestrogens tablets are often used to treat prostate cancer. About 30% of all patients treated with oestrogens develop tummy pain, wind and nausea. There are mood changes too and all patients suffer from swelling of the breasts which may be very tender and most unpleasant.
Brushpen 15cm x 11cm. Click to enlarge.

An evening 'round at the Brixton Fauves' gaff.
Ink and gouache 17cm x 12cm.

There were only two survivors at the Sylvian Fissure....the Chaplain General and his adjutant.
Pen and ink with watercolour. 30cm x 42cm. Click to enlarge.

Today we bring you more research-y goodness from folks over at MTV Sticky (i.e. Viacom Brand Solutions International) and their very cool Teen Age Clicks: Understanding Global Youth Culture report. It's a collection of eye-opening stats around teen... Read the rest of this post

At the field hospital, (part of the War series).
Pen and ink with watercolour 12.5cm x 17.5cm. Click to enlarge.

I need to unblock my Qi. Drawn while listening to Woodbine.
Indian ink and watercolour 12.5cm x 17.5cm

Edward Shorter is the Hannah Chair in History of Medicine and Professor of Psychiatry at the University of Toronto.  His new book, Before Prozac: The Troubled History of Mood Disorders in Psychiatry is an unsettling look at how greed, lax regulations, and academic infighting have set the field back fifty years.  In the excerpt below, Shorter looks at how the psychiatrists in “the trenches” are making drugs work for their patients.

On a psychopharmacology listserv, one participant, himself a psychiatrist, posted a message seeking help for his ailing wife.  He thought, with a touch of professional rivalry, that her current psychiatrist was not serving her well, having prescribed two SSRIs.

“Does this make sense to anyone?” he asked the list.  “Is there anything in the literature, or from people’s experience, that supports the co-administration of two SSRIs?”

One member of the list responded,

Who really knows what causes depression? And for that matter who really knows what neurotransmitters or pathways are involved? New agents in research do not even touch the serotonergic pathways. I take the path of “whatever works.” Evidence-based medicine will never look at combinations and the like [which members of the list prescribe all the time] as it would not benefit the industry’s bottom line. As clinicians we have to tinker with the tools we have and see what happens. Or have I missed something over these years? Our evidence usually is sitting in front of us and is known as the patient.

These are words of wisdom: The evidence is in front of us and is how the patients respond to treatment.

We can find out all kinds of things by looking at the patients.  An example: trazodone was a mildly effective antidepressant developed in Italy in the 1960s and marketed in the United States by Mead Johnson in 1982 as Desyrel; it had indifferent success.  Today, trazodone is experiencing a big comeback, not as an antidepressant but as a hypnotic.  In the world of everyday psychiatry, trazodone is loved for its gentle qualities and its affordable price, in contrast to the patent-protected sleep aids that cost the moon.  Yet you will never see an ad in a medical journal for trazodone, nor will drug reps ever stop by your office with free samples in the hopes that your patients might start on it and stay with it.

Once you get away from the glossy ads in the journals, in psychiatry today it’s the Wild West out there. Clinicians are experimenting constantly with different combinations of treatments, many of them from psychiatry’s past, that promise new therapeutic effectiveness. They communicate their day-to-day experiences almost furtively on listservs such as this one, aware that they are pioneering the future of therapeutics in a way that industry will not countenance, because most of the older drugs are not patent protected; government agencies will not support this kind of clinical experimentation because the whole enterprise seems much too empirical for “science” and does not involve research in molecular genetics.

Academic psychiatry offers the image of a prescribing desert with just two tall cactuses, the SSRIs and the atypical antipsychotics.  But in the real world it’s a different story. Among community psychiatrists with a good knowledge of psychopharm, there’s a thoughtful pioneering of combos of the most diverse and imaginative variety.  This is not polypharmacy, the harmful proliferations of medications.  It’s combopharmacy of the kind that the Food and Drug administration rejected…the realization that the brain offers multiple pathways to the remediation of illness.

So there’s a big disconnect between what is happening the trenches and in the world of official medicine. The young community psychiatrists combining remedies from the shelf like kitchen spices rarely publish, although communication among themselves in listservs is lively.  Academica with honoraria from drug companies dominate the meetings with papers on patent-protected compounds for FDA-approved indications.  But this kind of disconnect is not good for a field.  It recalls the days when the bewigged courtiers of Louis XVI confronted the angry citizens of Paris over the barricades.  Perhaps the conflict between the arid desert of academic psychiatry and the vitality of community practice will have a similar outcome.

I was trying to convey the feeling of sleep paralysis.
Acrylic, pen and ink. 25cm x 17cm. Click to enlarge.

Eric Chivian, MD, is the founder and Director of the Center for Health and the Global Environment at Harvard Medical School. In 1980, he co-founded, with three other Harvard faculty members, International Physicians for the Prevention of Nuclear War, which won the 1985 Nobel Peace Prize. Aaron Bernstein, MD has been affiliated with the Center for Health and the Global Environment since 2001 and is currently a resident in the Boston Combined Residency in Pediatrics. Together they wrote Sustaining Life: How Human Health Depends on Biodiversity which presents a comprehensive review of how human medicines, biomedical research, the emergence and spread of infectious diseases, and the production of food all depend on biodiversity. In the excerpt below the authors look at how traditional medicine has led to some of our most important modern drugs.

Ethnobotany, that is, the scientific study of the use of plants by native cultures, including their use as medicines, can be said to have begun with Carl Linnaeus, who in the 1730s published Flora Lapponica, his detailed account of plant use by the Lappish, or Sami, people, living north of the Arctic Circle. These observations, like many made since then that draw on knowledge of the natural world gathered over many generations by indigenous peoples, have contributed significantly to the practice of medicine today.

The history of two modern pharmaceuticals—quinine and artemisinin serve to illustrate our enormous debt to traditional medical healers.

Quinine
The isolation of the antimalarial drug quinine from the bark of cinchona trees (e.g., Cinchona officialinis) was accomplished by the French chemists Pierre- Joseph Pelletier and Joseph-Bienaimé Caventou in 1820. The bark had long been used by indigenous peoples in the Amazon region for the treatment of fevers. Spanish Jesuit missionaries, after the conquest of the Inca Empire in Peru in the late sixteenth and early seventeenth century, learned of this use from the natives and found that the bark was effective in preventing and treating malaria. They brought this knowledge, along with the bark, back to Europe, where it became widely used and was often referred to as “Peruvian bark.” With quinine as the model, chemists subsequently synthesized the antimalarial drugs chloroquine and mefloquine, and they have continued to modify the basic structure of quinine to produce even more effective agents, such as the new antimalarial bulaquine.

Artemisinin
The Sweet Wormwood plant (Artemesia annua) was also used as a treatment for fevers in China for more than 2,000 years (it is called qing hao in Chinese), but it was not until 1972 that the active compound artemisinin (qing hao su, which means the active principle of qing hao) was extracted and later identified as a potent antimalarial drug by Chinese scientists. This effort was part of a systematic examination at that time of indigenous plants in China as sources of new medicines. More soluble derivatives, artemether, artether, and artemotil, have been developed in recent years. These medicines, in combination with other antimalarials such as mefloquine, have proved highly effective in treating malaria, particularly the most deadly form caused by Plasmodium falciparum (see chapter 7 for a further discussion of malaria), which has become increasingly resistant to the first-line treatments chloroquine and sulfadoxine-pyrimethamine—in Asia, South and Central America, and Africa. Given that malaria, despite intensive efforts by the world community, continues to kill between one and three million people each year, approximately three-fourths of whom are African children, and to cripple economies around the world, the importance of artemisinin and other effective antimalarials cannot be overstated.

Another possible use of artemisinin is in the treatment of cancer. Its antimalarial activity is thought to be due to its interaction with iron, present in very high concentrations in the malarial parasite. Since some cancer cells, particularly leukemia cells, also have high iron concentrations, they may also be killed by artemisinin, as has been demonstrated in some initial studies with cancer cells in tissue culture. The potential of artemisinin and its derivatives as cancer chemotherapeutic agents is being actively investigated in a variety of anticancer screens.

The combination of a high demand for artemisinin-based antimalarials and limited commercial-scale production of Artemesia annua (in only a few locales in China and Vietnam) has left artemisinin-based therapies in short supply. The World Health Organization has stepped in to develop a plan to bolster production.

One possible solution to the supply problem may come from biotechnology. Scientists in California have recently produced the base structure of the chemical artemisinin in the bacterium Escherichia coli, and in yeast (Saccharomyces cerevisiae), by transferring the necessary genes from Artemisia annua into these microbes. For E. coli or yeast to become a viable source for artemisinin, the base structure would need to be modified, and the entire process would have to be scaled up to achieve commercial production levels.

Traditional medicine, as practiced by indigenous people today, relies on its own version of “clinical trials,” where natural products continue to be used only if they have been shown to be effective. These trials may take place over very long periods of time, sometimes over hundreds of years by generations of healers, and they lead to a vast and detailed knowledge of the medicinal properties of many natural substances. That is why many believe there is such enormous potential for finding new medicines among those used by traditional healers.

But there are also problems in using these leads for drug discovery. For one, there is the problem of diagnosis. In the absence of diagnostic tools such as blood tests, X-rays, MRIs, and invasive techniques such as surgery, traditional healers must rely largely on a patient’s history, on the physical exam, and on the external manifestations of disease, all of which can be unreliable. Superstition may also prevent accurate diagnosis and, along with the placebo effect, cloud objective evaluation of the success of treatment. Furthermore, some diseases, for example, those involving the elderly, such as Alzheimer’s and most cancers, may be rare in some indigenous populations where life expectancy is short. Finally, knowledge may or may not have been faithfully transcribed from one generation to the next. Traditional medical practices in several parts of Asia, including China, Japan, Korea, and India, have been recorded in great detail over the centuries in written texts, in contrast to those in some other parts of the world, such as among South American Indians, where the passage of knowledge has been primarily by oral means. While these oral traditions may reflect very careful trials and observations, they are prone to errors as a result of unreliable transmission and anecdotal reports.

Nevertheless, indigenous healers have been critically important in the discovery of many new drugs. One study demonstrated that of 119 drugs (derived from some ninety plant species) currently in use in one or more countries, almost three-quarters were discovered by extracting the active chemicals from plants used in traditional medicines.

Tragically, traditional healers now face a double threat—both from the loss of biodiversity that depletes the natural sources that make up their pharmacopoeia, and from encroachment by the outside world that may wipe out their cultures. In the first three-quarters of the twentieth century, more than ninety tribes have become “extinct” in Brazil alone. Scientists are racing to record the secrets these native healers hold before they and the plants and other species they use are gone.

Dissection of an artist.
Ink and watercolour, with digital adjustment. 22cm x 17cm. Click to enlarge.

Hearn, Julie. Ivy. 2008.

This story takes place in London in the early 1800s. Ivy's family is poor and makes it's living in dishonest ways. When she is little, she is taken away from her family by Carroty Kate, a woman who comes from a gang of criminals worse than her own family. They use her to help them rob people, particularly other children. When Kate dies, Ivy ends up back with her family again. Ivy ends up as an artists model for a rich artist but his mother hates her immediately and does everything she can to be rid if her. Ivy has a problem with laudanum, which is a liquid that was put into water and would put a person to sleep. It's a drug that could easily kill a person if taken improperly.

There were aspects of the story that didn't make sense to me, which I won't write about here because I don't want to give away anything about the plot or characters. Certain things that were in the book didn't add to the story at all and left me wondering why they were in there at all. This book won't disappoint fans of historical fiction, but other readers might not find much to like about it.

Some character studies for a modern Bosch epic.
Mixed media on paper 33cm x 23cm. Click to enlarge.