Lessons from COVID-19 to increase opioid vaccine acceptance.

COVID-19 has put vaccine efficacy under a spotlight. However, the reluctance of people to be vaccinated has postponed the end of the COVID-19 pandemic. Currently, opioid vaccines are being developed, which could help prevent opioid addiction, overdoses, or relapse in combination with medication-assisted therapy. The fear is that the uptake of opioid vaccines could be met by the same reluctance as seen with COVID-19 vaccines.

"Life Is So Good": Centenarians' Autobiographies Between the Promise of Immortality and the Specter of Death.

When we are trying to come to terms with death and dying, or the loss of a loved one, cultural practices can fulfill important functions. Literature, music, and the arts can help us cope with loss by expressing our emotions in a way which seems to be universal. This paper investigates the role of co-written centenarians' autobiographies in this context. It focuses specifically on autobiographies by African American centenarians and white co-authors. The article investigates the dialogue between the centenarian and the co-author as a ritual for coming to terms with the co-author's fear of mortality. It argues that for a white readership that defines itself as secular, the black centenarian - deeply religious himself - can serve as a surrogate and a role model. Just as he assures his middle-aged, white co-author that death is not to be feared, his autobiography may offer a secular readership a model for dying.

Can eastern wisdom resolve western epidemics? Traditional Chinese medicine therapies and the opioid crisis.

The widespread use of opioids to treat chronic pain led to a nation-wide crisis in the United States. Tens of thousands of deaths annually occur mainly due to respiratory depression, the most dangerous side effect of opioids. Non-opioid drugs and non-pharmacological treatments without addictive potential are urgently required. Traditional Chinese medicine (TCM) is based on a completely different medical theory than academic Western medicine. The scientific basis of acupuncture and herbal treatments as main TCM practices has been considerably improved during the past two decades, and large meta-analyses with thousands of patients provide evidence for their efficacy. Furthermore, opinion leaders in the United States favor non-pharmacological techniques including TCM for pain management to fight the opioid crisis. We advocate TCM as therapeutic option without addictive potential and without life-threatening side effects (e.g., respiratory depression) to treat chronic pain patients suffering from opioid misuse. The evidence suggests that: (1) opioid misuse cannot be satisfactorily managed with standard medication; (2) opinion leaders in the United States favor to consider non-opioid and non-pharmacological treatment strategies including those from TCM to treat acute and chronic pain conditions; (3) large meta-analyses provide scientific evidence for the clinical activity of acupuncture and herbal TCM remedies in the treatment of chronic pain. Future clinical trials should demonstrate the safety of TCM treatments if combined with Western medical practices to exclude negative interactions between both modalities.

Health(care) in the Crisis: Reflections in Science and Society on Opioid Addiction.

Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people's lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse.

How We Forgot Who Discovered DNA: Why It Matters How You Communicate Your Results.

One hundred and fifty years ago, a hopeful young researcher reported a recent discovery he had made. Working in the bowels of a medieval castle in the German city of Tübingen, he had isolated a then entirely new type of molecule. This was the birth of a field that would fundamentally change the course of biology, medicine, and beyond. His discovery: DNA. His name: Friedrich Miescher. In this article, the authors try to find answers to the question why-despite the fact that virtually everyone nowadays knows DNA-hardly anyone remembers the man who discovered it. In the history of science, the discovery of DNA was a seminal moment. Why then did it not enter into public memory? Ground-breaking discoveries can occur in a historical context that is not ready to appreciate them. But that's not all that decides who is remembered and who is forgotten. Scientific pioneers sometimes fail to publicize their findings in a way that ensures that they receive the attention they merit. As discussed here, their personalities and habits may cause discoveries to be "overwritten" by more recent researchers, resulting in distorted cultural memories no longer reflecting the initial event.

Biopiracy in India: Seed diversity and the scramble for knowledge.

BACKGROUND: Biopiracy has usually been discussed mostly in the context of the life sciences, sometimes in dialogue with legal debates or political implications. This paper provides a humanities perspective on contemporary discussions of biopiracy and biopatenting. HYPOTHESIS: It proceeds from the hypothesis that contemporary debates and practices of biopiracy can be understood as harking back to colonial legacies, which systematically disregard "native" knowledge or seek to appropriate it for their own purposes. RESULTS: Drawing on the work of Vandana Shiva, the present article seeks to redefine the notion of ownership of knowledge from a cultural studies perspective. Exploring the 2016 documentary film Seed: The Untold Story, it analyses counter-discourses to practices of biopiracy. CONCLUSION: The paper concludes that given the roots of biopiracy in colonial legacies, forms of resistance may need to appropriate colonialist epistemologies. One example of such appropriation is Vandana Shiva's own campaign, which casts seed ownership in the imagery and rhetoric of Mahatma Gandhi's fight against British colonialism in India. Finally, the article ends by suggesting that issues of biopiracy need to be seen in larger context. Drawing on the work of cultural philosopher Hans-Ulrich Gumbrecht, it argues that the problem of the twenty-first century may be a scramble for natural resources such as the right for clean water. Biopiracy is hence far from a debate linked only to specific cases in particular locales, but is part of a global epistemological and political framework, which has systematically disenfranchised communities of color and countries of the global South.

Biopiracy versus One-World Medicine-From colonial relicts to global collaborative concepts.

BACKGROUND: Practices of biopiracy to use genetic resources and indigenous knowledge by Western companies without benefit-sharing of those, who generated the traditional knowledge, can be understood as form of neocolonialism. HYPOTHESIS: The One-World Medicine concept attempts to merge the best of traditional medicine from developing countries and conventional Western medicine for the sake of patients around the globe. STUDY DESIGN: Based on literature searches in several databases, a concept paper has been written. Legislative initiatives of the United Nations culminated in the Nagoya protocol aim to protect traditional knowledge and regulate benefit-sharing with indigenous communities. The European community adopted the Nagoya protocol, and the corresponding regulations will be implemented into national legislation among the member states. Despite pleasing progress, infrastructural problems of the health care systems in developing countries still remain. Current approaches to secure primary health care offer only fragmentary solutions at best. Conventional medicine from industrialized countries cannot be afforded by the impoverished population in the Third World. Confronted with exploding costs, even health systems in Western countries are endangered to burst. Complementary and alternative medicine (CAM) is popular among the general public in industrialized countries, although the efficacy is not sufficiently proven according to the standards of evidence-based medicine. CAM is often available without prescription as over-the-counter products with non-calculated risks concerning erroneous self-medication and safety/toxicity issues. The concept of integrative medicine attempts to combine holistic CAM approaches with evidence-based principles of conventional medicine. CONCLUSION: To realize the concept of One-World Medicine, a number of standards have to be set to assure safety, efficacy and applicability of traditional medicine, e.g. sustainable production and quality control of herbal products, performance of placebo-controlled, double-blind, randomized clinical trials, phytovigilance, as well as education of health professionals and patients.

Psychodynamic Online Treatment Following Supportive Expressive Therapy (SET):Therapeutic Rationale, Interventions and Treatment Process.

OBJECTIVES: The feasibility of psychodynamic online treatments has remained an issue of debate. The paper presents rationale and technique of a psychodynamic online intervention discussing therapeutic process and alliance based on two case examples from an RCT. METHODS: A weekly writing task is followed by individual feedback from the online therapist. Treatment focuses on a 'Core Conflict Relationship Theme' based on relationship episodes according to the wish of the patient, reactions of the others and reactions of the self. Maladaptive interpersonal interactions are worked through by supportive and expressive therapeutic interventions. RESULTS: Case reports from our study illustrate a productive therapeutic process without immediate personal contact or nonverbal communication. CONCLUSIONS: Emotional reactions and felt concern of the online therapist promote engagement in patients. Online therapists need to detect alliance ruptures based on text messages and remedy them. We discuss psychodynamic online treatments as adjuncts to face to face psychotherapy.

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults.

INTRODUCTION: We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. METHODS: The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants' narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ). RESULTS: While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores. DISCUSSION: Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.

Living autobiographically: Concepts of aging and artistic expression in painting and modern dance.

This article discusses the ways in which artists have incorporated or failed to incorporate the aging process of their bodies into their art. Using Russian ballet dancer Mikhail Baryshnikov and the French painter Claude Monet as cases in point, we explore situations in which physical changes brought about by aging compromises artists' ability to engage with their artistic medium. Connecting Monet's oeuvre and Baryshnikov's dance performances to life writing accounts, we draw on John Paul Eakin's concept of "living autobiographically": In this vein, life writing research does not only have to take into account concepts of identity as they emerge from life writing narratives, but it also needs to explore the somatic, corporeal and material dimensions of these narratives.

Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact.

The cardiac impact of psychological stress historically and socially understood as boundary experiences of human life has long since become an icon. From the aching heart to the sudden death provoked by awe, horror, grief, anger, and humiliation on one side and extreme enchantment, enthusiasm, and excitement on the other, the broken heart has become a globally recognized and powerful metaphor present from folklore to popular culture to high literature and back to everyday communication. In medicine, the "broken heart syndrome" is described as a relatively new nosological entity that has been used synonymously with the term tako-tsubo or stress cardiomyopathy. Among those three terms, however, the broken heart most vividly draws the connection between conditions under which lived experience triggers cardiac damage and conversely, cardiovascular death occurs. According to Hassan and Yamasaki (2013) [1] and quite apart from the general perception medical notions of the broken heart indeed go back to at least 1967, when Rees and Lutkins studied the death rate among 903 relatives of patients who died in Wales. They found that 4.8% of bereaved close relatives died within a year of bereavement compared with 0.68% of a non-bereaved control group. Among widows and widowers, the mortality rate was even 10 times greater than that of the matched controls. After the first year of bereavement, however, mortality rates of relatives of a deceased person did not differ significantly from the control group Rees and Lutkins (1967) [2]. Similar findings were published by Parkes et al. (1969) [3] following up on 4486 widowers at the age of 55 for 9years following the death of their wives in 1957. During the first six months after the spouse had died, the mortality rate of the widowers was 40% above the rate of married men of the same age. While it seems plausible to accept the etiological role and pathogenic impact of personal loss, the pathogenic processes causing death remained relatively blurred. We will explain, why inaccurately stressing the fact that the broken heart and/or tako-tsubo syndrome would be a relatively new way of looking at stress-related cardiomyopathy as outlined by Yoshikawa (2015) [4] and why attaching stress-related cardiomyopathy to culturally powerful yet value-laden metaphors, might obstruct pathways to a better understanding, prevention and clinical management of the disease. By looking at narrative understandings and clinical representations of the broken heart, we aim to highlight the need for a more contextualised view of the broken heart syndrome in order to facilitate multi- and transdisciplinary approaches aiming at its prediction, prevention, and treatment.

Pharmaceutical care as narrative practice? Rethinking patient-centered care through a pharmacist's perspective.

Illness is a disruptive experience that requires high-quality care. The best evidence-based medical treatment risks losing some of its efficacy, however, when patients feel misunderstood when faced with the complexity of their experiences. They might stop treatment, refuse to disclose relevant information or seek unsound alternatives. A narrative-based approach to health care understands the patient's case history as a narrative that can be read or analyzed like a story. In other words, this approach honors individual illness experiences through the stories that patients tell. While programs that train 'narrative competence' have been successfully implemented in medical education, an application to pharmaceutical training is missing so far. We argue for the necessity to complement evidence-based pharmaceutical practice with narrative-based approaches to ensure high-quality care. Using the perspective of a pharmacist in a case scenario, we exemplify the centrality of "narrative pharmacy" for improving the quality and safety of pharmaceutical health care.

Depression, anxiety and suicidal ideation among 1(st) and 2(nd) generation migrants - results from the Gutenberg health study.

BACKGROUND: Even though migrants constitute a large proportion of the German population, there is a lack of representative studies on their mental health. Hence, the present study explored mental health characteristics and suicidal ideation comparing 1(st) and 2(nd) generation migrants to non-migrants and subgroups within 1(st) generation migrants. METHODS: We investigated cross-sectional data of 14,943 participants of the Gutenberg Health Study (GHS), a population-based, prospective, single-center cohort study in Mid-Germany (age 35 to 74 years). Migration status was assessed according to the German microcensus criteria. Depression and anxiety were measured by the PHQ (PHQ-8, GAD-2, Panic module), social anxiety by the Mini SPIN and Distressed Personality (Type D) by the DS-14. Suicidal ideation was assessed by the single item of the PHQ-9. RESULTS: A total of n = 3,525 participants had a migration background; the proportion of 1(st) generation (immigrated after 1949) migrants was 10.6 % (2(nd) generation 13 %). Among the 1(st) generation migrants those with Polish (N = 295) and Turkish (N = 141) origins were the largest groups from single countries. Controlling for sex, age and socioeconomic status, 1(st) generation migrants reported significantly more depression (OR 1.24; CI 1.01-1.52), generalized anxiety (OR 1.38; CI 1.13-1.68), panic attacks in the past 4 weeks (OR 1.43; CI 1.16-1.77); Type D (OR 1.28; CI 1.13-1.45) and suicidal ideation (1.44; CI 1.19-1.74) compared to non-migrants. The mental health of 2(nd) generation migrants did not differ from native Germans; they had the highest socioeconomic status of the three groups. Compared to native Germans, Turkish migrants of both sexes reported more depression and panic, particularly a strongly increased suicidal ideation (OR 3.02; CI 1.80-5.04) after taking sex, age, and socioeconomic status into account. Polish migrants only reported an increased rate of suicidal ideation and Type D. Turkish migrants exceeded Polish migrants regarding depression (OR = 2.61; 95 % CI 1.21-5.67), and panic attacks (OR=3.38; 95 % CI 1.45-7.85). In the subgroup analyses years lived in Germany was not significant. CONCLUSIONS: One of few representative community studies shows that compared to native Germans depression, anxiety and suicidal ideation were more frequently reported by 1(st) generation migrants, particularly of Turkish origin. Overall, 2(nd) generation migrants appear to have adjusted successfully. Limitations refer to a lack of data for persons without German language skills and missing mental health data in the Turkish sample. Further analyses need to address causes of mental strains and health care needs and provision.

Biopiracy of natural products and good bioprospecting practice.

BACKGROUND: Biopiracy mainly focuses on the use of biological resources and/or knowledge of indigenous tribes or communities without allowing them to share the revenues generated out of economic exploitation or other non-monetary incentives associated with the resource/knowledge. METHODS: Based on collaborations of scientists from five continents, we have created a communication platform to discuss not only scientific topics, but also more general issues with social relevance. This platform was termed 'PhytCancer -Phytotherapy to Fight Cancer' (www.phyt-cancer.uni-mainz.de). As a starting point, we have chosen the topic "biopiracy", since we feel this is of pragmatic significance for scientists working with medicinal plants. RESULTS: It was argued that the patenting of herbs or natural products by pharmaceutical corporations disregarded the ownership of the knowledge possessed by the indigenous communities on how these substances worked. Despite numerous court decisions in U.S.A. and Europe, several international treaties, (e.g. from United Nations, World Health Organization, World Trade Organization, the African Unity and others), sharing of a rational set of benefits amongst producers (mainly pharmaceutical companies) and indigenous communities is yet a distant reality. In this paper, we present an overview of the legal frameworks, discuss some exemplary cases of biopiracy and bioprospecting as excellent forms of utilization of natural resources. CONCLUSIONS: We suggest certain perspectives, by which we as scientists, may contribute towards prevention of biopiracy and also to foster the fair utilization of natural resources. We discuss ways, in which the interests of indigenous people especially from developing countries can be secured.

Captious certainties: makings, meanings and misreadings of consumer-oriented genetic testing.

Members of the scientific and medical communities concerned with genetic testing might wonder, why cultural and ethical analyses of genetic testing are increasing again, especially since legal frameworks have, by now, come to provide more solid grounds for the routine application of genetic testing on both levels of application, diagnostics, and prediction. This contribution aims to shed light on the changing concept of genetic testing as it is raised by novel cultural practices and perceptions mainly triggered by direct-to-consumer predictive testing, including the phenomenon of a new genetic exceptionalism "from below". We are seeking to determine what is at stake in this practice and what consequences arise from it for the medical and scientific community. What exactly happens as we move from diagnostic to prognostic medicine? Above all, this article pivots on the notion of captious certainties, a concept, which we will elaborate on as our argument progresses.