- Email: [email protected]
Mild cognitive impairment
Correspondence
In their Seminar on mild cognitive impairment,1 Serge Gauthier and colleagues list useful tools for the prevention of cognitive decline. Identification of mutable factors in the early stages of cognitive decline can be critical to effective prevention. In this setting, increasing evidence suggests that insulin concentrations could have a direct effect on cognitive function.2–4 Furthermore, cognitive impairment with clinical features indicative of subcortical damage has been shown to be associated with insulin resistance.5 Therefore, interventions aimed at early diagnosis and treatment of abnormal glucose metabolism should be added to Gauthier and colleagues’ prevention tools. We declare that we have no conflict of interest.
*Luca Mascitelli, Francesca Pezzetta
is starting a programme of research into the neurophysiological effects of lysergic acid diethylamide (LSD) and other compounds to discover whether, or how, they might be used as an adjunct to psychotherapy. Unfortunately, since I have been told that we would not get ethics approval in the UK, we have been forced to pursue the research elsewhere. This is a great pity because we understand that, were ethics permission granted, several UK research groups are extremely able and willing to do this important work. I declare that I have no conflict of interest.
Amanda Neidpath offi[email protected] The Beckley Foundation, Beckley Park, Oxford OX3 9SY, UK 1
The Lancet. Reviving research into psychedelic drugs. Lancet 2006; 367: 1214.
I declare that I have no conflict of interest.
[email protected] *Comando Brigata alpina “Julia”, Via S Agostino 8, 33100 Udine, Italy (LM); and Servizio di Cardiologia, Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy (FP). 1
2
3
4 For Royal Pharmaceutical Society Code of Ethics and Standards see http://www.rpsgb.org/ethics
5
Gauthier S, Reisberg B, Zaudig M, et al, on behalf of the participants of the International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild cognitive impairment. Lancet 2006; 367: 1262–70. Kalmijn S, Feskens EJM, Launer LJ, Stijnen T, Kromhout D. Glucose intolerance, hyperinsulinaemia and cognitive function in a general population of elderly men. Diabetologia 1995; 38: 1096–102. Stolk RP, Breteler MMB, Ott A, et al. Insulin and cognitive function in an elderly population: the Rotterdam study. Diabetes Care 1997; 20: 792–95. Okereke O, Hankinson SE, Hu FB, Grodstein F. Plasma C peptide level and cognitive function among older women without diabetes mellitus. Arch Intern Med 2005; 165: 1651–56. Geroldi C, Frisoni GB, Paolisso G, et al. Insulin resistance in cognitive impairment: the inCHIANTI study. Arch Neurol 2005; 62: 1067–72.
Reviving research into psychedelic drugs
For Beckley Foundation website see http://www. beckleyfoundation.org
1980
I would like to endorse The Lancet’s comments about the need to revive research into psychedelic drugs (April 15, p 1214).1 I am the director of the Beckley Foundation, a charitable trust that
his or her religious or moral beliefs, it does require pharmacists to respect patients’ decisions and beliefs and to advise them of other ways that they can access the required service to ensure that their care is not unduly compromised. If a pharmacist’s beliefs or personal convictions prevent him or her from providing a particular service, the pharmacist must disclose this fact before accepting employment to allow procedures to be put in place to enable patients to access the services they require. In such circumstances the Code of Ethics and Standards requires that a pharmacist must not condemn or criticise the patient and that either the pharmacist or a member of staff must advise the patient of an alternative source for the service requested.
Royal Pharmaceutical Society and conscientious objectors In her Comment (April 15, p 1219),1 Katrina Bramstedt highlights conscientious objection by US pharmacists to the prescription of emergency contraception. Readers might be interested to learn the position with regard to pharmacists working in Great Britain who might have similar objections. The Royal Pharmaceutical Society is the regulatory and professional body for pharmacists in Great Britain. Our Code of Ethics and Standards requires that pharmacists act in the interests of patients and the public. However, as with other regulators of health-care professionals, the Society recognises that a pharmacist’s beliefs or personal convictions might prevent him or her from providing a particular professional service (for example the supply of emergency hormonal contraception). Although the Code does not compel a pharmacist to provide a service that is contrary to
Lynsey Balmer [email protected] Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London SE1 7JN, UK 1
Bramstedt KA. When pharmacists refuse to dispense prescriptions. Lancet 2006; 367: 1219–20.
Department of Error Ramzy RMR, El Setouhy M, Helmy H, et al. Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment. Lancet 2006; 367: 992–99—In figure 2 of this Article (March 25, 2006), the red squares should represent antibody prevalence in grade 1 children and the blue circles antibody prevalence in grade 5 children.
Winblad B, Kilander L, Eriksson S, et al, for the Severe Alzheimer’s Disease Study Group. Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebocontrolled study. Lancet 2006; 367: 1057–65— In this Article (April 1), the vertical axis of the NPI graph in figure 5 should read, from the bottom up, 1, 0, –1, –2, –3, etc. Also on that graph, the light blue line should represent donepezil and the dark blue line placebo.
www.thelancet.com Vol 367 June 17, 2006
In their Seminar on mild cognitive impairment,1 Serge Gauthier and colleagues list useful tools for the prevention of cognitive decline. Identification of mutable factors in the early stages of cognitive decline can be critical to effective prevention. In this setting, increasing evidence suggests that insulin concentrations could have a direct effect on cognitive function.2–4 Furthermore, cognitive impairment with clinical features indicative of subcortical damage has been shown to be associated with insulin resistance.5 Therefore, interventions aimed at early diagnosis and treatment of abnormal glucose metabolism should be added to Gauthier and colleagues’ prevention tools. We declare that we have no conflict of interest.
*Luca Mascitelli, Francesca Pezzetta
is starting a programme of research into the neurophysiological effects of lysergic acid diethylamide (LSD) and other compounds to discover whether, or how, they might be used as an adjunct to psychotherapy. Unfortunately, since I have been told that we would not get ethics approval in the UK, we have been forced to pursue the research elsewhere. This is a great pity because we understand that, were ethics permission granted, several UK research groups are extremely able and willing to do this important work. I declare that I have no conflict of interest.
Amanda Neidpath offi[email protected] The Beckley Foundation, Beckley Park, Oxford OX3 9SY, UK 1
The Lancet. Reviving research into psychedelic drugs. Lancet 2006; 367: 1214.
I declare that I have no conflict of interest.
[email protected] *Comando Brigata alpina “Julia”, Via S Agostino 8, 33100 Udine, Italy (LM); and Servizio di Cardiologia, Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy (FP). 1
2
3
4 For Royal Pharmaceutical Society Code of Ethics and Standards see http://www.rpsgb.org/ethics
5
Gauthier S, Reisberg B, Zaudig M, et al, on behalf of the participants of the International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild cognitive impairment. Lancet 2006; 367: 1262–70. Kalmijn S, Feskens EJM, Launer LJ, Stijnen T, Kromhout D. Glucose intolerance, hyperinsulinaemia and cognitive function in a general population of elderly men. Diabetologia 1995; 38: 1096–102. Stolk RP, Breteler MMB, Ott A, et al. Insulin and cognitive function in an elderly population: the Rotterdam study. Diabetes Care 1997; 20: 792–95. Okereke O, Hankinson SE, Hu FB, Grodstein F. Plasma C peptide level and cognitive function among older women without diabetes mellitus. Arch Intern Med 2005; 165: 1651–56. Geroldi C, Frisoni GB, Paolisso G, et al. Insulin resistance in cognitive impairment: the inCHIANTI study. Arch Neurol 2005; 62: 1067–72.
Reviving research into psychedelic drugs
For Beckley Foundation website see http://www. beckleyfoundation.org
1980
I would like to endorse The Lancet’s comments about the need to revive research into psychedelic drugs (April 15, p 1214).1 I am the director of the Beckley Foundation, a charitable trust that
his or her religious or moral beliefs, it does require pharmacists to respect patients’ decisions and beliefs and to advise them of other ways that they can access the required service to ensure that their care is not unduly compromised. If a pharmacist’s beliefs or personal convictions prevent him or her from providing a particular service, the pharmacist must disclose this fact before accepting employment to allow procedures to be put in place to enable patients to access the services they require. In such circumstances the Code of Ethics and Standards requires that a pharmacist must not condemn or criticise the patient and that either the pharmacist or a member of staff must advise the patient of an alternative source for the service requested.
Royal Pharmaceutical Society and conscientious objectors In her Comment (April 15, p 1219),1 Katrina Bramstedt highlights conscientious objection by US pharmacists to the prescription of emergency contraception. Readers might be interested to learn the position with regard to pharmacists working in Great Britain who might have similar objections. The Royal Pharmaceutical Society is the regulatory and professional body for pharmacists in Great Britain. Our Code of Ethics and Standards requires that pharmacists act in the interests of patients and the public. However, as with other regulators of health-care professionals, the Society recognises that a pharmacist’s beliefs or personal convictions might prevent him or her from providing a particular professional service (for example the supply of emergency hormonal contraception). Although the Code does not compel a pharmacist to provide a service that is contrary to
Lynsey Balmer [email protected] Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London SE1 7JN, UK 1
Bramstedt KA. When pharmacists refuse to dispense prescriptions. Lancet 2006; 367: 1219–20.
Department of Error Ramzy RMR, El Setouhy M, Helmy H, et al. Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment. Lancet 2006; 367: 992–99—In figure 2 of this Article (March 25, 2006), the red squares should represent antibody prevalence in grade 1 children and the blue circles antibody prevalence in grade 5 children.
Winblad B, Kilander L, Eriksson S, et al, for the Severe Alzheimer’s Disease Study Group. Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebocontrolled study. Lancet 2006; 367: 1057–65— In this Article (April 1), the vertical axis of the NPI graph in figure 5 should read, from the bottom up, 1, 0, –1, –2, –3, etc. Also on that graph, the light blue line should represent donepezil and the dark blue line placebo.
www.thelancet.com Vol 367 June 17, 2006