Group psychedelic therapy: empirical estimates of cost-savings and improved access.

Objective: To compare group and individual psychedelic-assisted therapy in terms of clinician time, costs and patient access. Methods: Using 2023 data from two group therapy trial sites, one using 3,4-Methylenedioxymethamphetamine (MDMA) to treat posttraumatic stress disorder (PTSD), and one using psilocybin to treat major depressive disorder (MDD), we compared overall variable costs, clinician costs and clinician time required by therapy protocols utilizing groups versus individual patient therapy. Using published literature, we estimated the prevalence of adults with PTSD and MDD eligible for treatment with psychedelic therapy and projected the savings in time and cost required to treat these prevalent cases. Results: Group therapy saved 50.9% of clinician costs for MDMA-PTSD and 34.7% for psilocybin-MDD, or $3,467 and $981 per patient, respectively. To treat all eligible PTSD and MDD patients in the U.S. in 10 years with group therapy, 6,711 fewer full-time equivalent (FTE) clinicians for MDMA-PTSD and 1,159 fewer for FTE clinicians for psilocybin-MDD would be needed, saving up to $10.3 billion and $2.0 billion respectively, discounted at 3% annually. Conclusion: Adopting group therapy protocols where feasible would significantly reduce the cost of psychedelic-assisted therapies. By enhancing the number of patients served per clinician, group therapy could also ameliorate the anticipated shortage of appropriately trained clinicians, thereby accelerating access to these promising new therapies.

Assessment of Psilocybin Therapy for Patients With Cancer and Major Depression Disorder.

This nonrandomized controlled trial used a 1-to-1 therapist-to-patient ratio to administer psilocybin to groups of patients with cancer who were diagnosed with major depression disorder to create a scalable, rapidly effective depression treatment.

Consequences of Heterogeneous Crowding on an Enzymatic Reaction: A Residence Time Monte Carlo Approach.

Translational diffusion of a free substrate in crowded metabolically active spaces such as cell cytoplasm or mitochondrial matrix is punctuated by collisions and nonspecific interactions with soluble/immobile macromolecules/macrostructures in a variety of shapes/sizes. It is not understood how such disruptions alter enzyme reaction kinetics in such spaces. A novel Monte Carlo (MC) technique, "residence time MC", has been developed to study the kinetics of a simple enzyme-substrate reaction in a crowded milieu using a single immobile enzyme in the midst of diffusing substrates and products. The reaction time lost while the substrate nonspecifically interacts or is transiently trapped with ambient macromolecules is quantified by introducing the residence time "tau". Tau scales with the size of crowding macromolecules but makes the knowledge of their shape redundant. The residence time thus presents a convenient parameter to realistically mimic the sticky surroundings encountered by a diffusing substrate in heterogeneously crowded physiological spaces. Results reveal that for identical substrate concentration and excluded volume, increase in tau significantly diminished enzymatic product yield and reaction rate, slowed down substrate/product diffusion, and prolonged their relaxation times. A smooth transition from the anomalous subdiffusive motion to normal diffusion at long time limits was observed irrespective of the value of tau. The predictions from the model are shown to be in qualitative agreement with in vitro experimental data revealing the rate of alkaline phosphatase-catalyzed hydrolysis of p-nitrophenyl phosphate in the midst of 40/500/2000 kDa dextrans. Our findings from the residence time MC model also attempt to rationalize previously unexplained experimental observations in crowded enzyme kinetics literature. Furthermore, major insights to emerge from this study are the reasons why free diffusion of the substrate in crowded physiological spaces is detrimental to enzyme function. It is argued that organized enzyme clusters such as "metabolon" may perhaps exist to regulate the substrate translocation in such sticky physiological spaces to maintain optimal enzyme function. In summary, this work provides key insights explaining why absence of substrate channeling can dramatically slow down enzyme reaction rate in crowded metabolically active spaces.

Postcranioplasty Quantitative Assessment of Intracranial Fluid Dynamics and Its Impact on Neurocognition Cranioplasty Effect: A Pilot Study.

BACKGROUND: This study was done to evaluate the effects of cranioplasty on cerebrohemodynamics (cerebral blood flow [CBF] and mean transient time [MTT]) and cerebrospinal fluid (CSF) hydrodynamics (flow velocities) by using computed tomography perfusion and cardiac-gated cine phase magnetic resonance imaging (MRI) (phase contrast [PC] MRI), respectively. It also aims to determine the co-relation between changes in CBF, MTT, and CSF flow dynamics with neurocognitive outcome. RESULTS: The mean values of ipsilateral CBF were 27.58 and 41.66 mL/min/100 g in pre- and postcranioplasty patients, respectively (P = 0.04). Contralateral CBF also showed improvement from 38.76 to 60.44 mL/min/100 g (P = 0.03). Mean values of MTT were found to be decreased in the bilateral hemisphere after cranioplasty. On evaluation of CSF flow velocities by PC MRI, the means of the maximum velocity and peak velocity at the aqueduct of Sylvius were increased from pre- to postcranioplasty as 2.36 to 3.84 cm/s (P = 0.048) and 1.21 to 3.50 cm/s (P < 0.001), respectively. Cognitive evaluation showed a significant improvement at 1 (P = 0.035) and 6 months (P = 0.002) postcranioplasty. METHODS: All cases were subjected to precranioplasty cine phase cardiac gated contrast MRI for CSF dynamics and computed tomography perfusion for cerebrovascular hemodynamic parameters. CBF and related indices were calculated at different regions of interest with the help of the manufacturer's software package of computed tomography perfusion in the ipsilateral hemisphere and simultaneously on the contralateral side. Cine cardiac gated phase contrast MRI was also done for CSF flow velocity at the aqueduct of Sylvius and median aperture (foramen of Magendie). Both studies were again performed on postcranioplasty day 5-7. CONCLUSIONS: Cranioplasty can remarkably improve cortical perfusion for both the ipsilateral and contralateral hemispheres. Postoperative increased CSF velocities suggest improved rapid turnover of CSF in a circuit and possibly play a role in good neurologic outcome. Our study shows there is improvement in CSF flow at the aqueduct of Sylvius after cranioplasty. We propose that improvement in CSF circulation along with changes in CBF co-relate well with cognitive outcome (Montreal Cognitive Assessment score).

Patients' views on financial conflicts of interest in cancer research trials.

BACKGROUND: Financial ties between researchers or medical centers and companies whose drugs are being tested have come under increasing scrutiny. METHODS: We conducted in-person interviews with 253 patients in cancer-research trials (a 93% response rate) at five U.S. medical centers to determine their attitudes regarding potential financial conflicts of interest among researchers and medical centers. RESULTS: More than 90% of patients expressed little or no worry about financial ties that researchers or institutions might have with drug companies. Most patients said they would have enrolled in the trial even if the drug company had paid the researcher for speaking (82% of those interviewed) or consulting (75%) or if the researcher had received royalty payments (70%) or owned stock in the company (76%). Similarly, most patients would have enrolled in the trial if their cancer center had owned stock in the drug company (77%) or received royalty payments from the company (79%). Most patients believed it was ethical for researchers to receive speaking fees (81%) or consulting fees (82%) from the company. However, a substantial minority of patients wanted disclosure of the oversight system for researchers (40%) and of researchers' financial interests (31%); 17% thought no disclosure to patients was necessary. CONCLUSIONS: Most patients in cancer-research trials were not worried about financial ties between researchers or medical centers and drug companies and would still have enrolled in the trial if they had known about such financial ties. A substantial minority wanted to be informed about the oversight system to protect against financial conflicts of interest and about researchers' financial interests.