DrugMonkey : Repost: MDMA Case Reports
May 14, 2008
A recent post of Zuska’s discusses the pejorative use of “anecdote” to dismiss personal accounts of gender bias. The generic argument will be well familiar to many scientists who are used to sneering at sources of insight that are limited to individual data points. I concur in many cases however I also value anecdotal observations much in the way that commenter Sanguinity identified a number of useful applications of the anecdote in science including the following:
- suggest a new direction for query/research.
…
In that last case, the anecdote is a potential source for a vast new amount of information, but only if you don’t dismiss it out of hand as “just an anecdote.”
This reminded me of a post I wrote previously on the value of anecdotal case reports describing MDMA-related fatality and medical emergency.
The singular of data is “anecdote”.
We all know this hoary old scientific snark. Pure Pedantry ponders the utility of Case Reports following a discussion of same at The Scientist.
The Pure Pedantry Ponder identifies “rare neurological cases” as a primary validation for the Case Study, but the contribution goes way beyond this. Let’s take YHN’s favorite example, drug abuse science and MDMA in particular.
To summarize, when MDMA started coming to the attention of scientists in, oh, the early 80s the thought was “hmm, looks like an amphetamine, let’s study it like an amphetamine”. This is where the “neurotoxicity”, “locomotor activity” and “drug discrimination” stuff came in. Bouncing forward, we can see the emergence of thermoregulation, ambient temperature, vasopressin as a relatively late interest. Where did this come from? The case reports of medical emergency and death. Which, while rare, are not of the singularly “rare neurological case” variety with which we are familiar from neurology101. Still, the MDMA Cases play a key role, I submit. Why?
The fact is, animal lab type drug abuse researchers get very far away from their subject matter in some cases. Understandably so. First, there is no guarantee they had much familiarity with the druggies in college in the first place and MDMA/Ecstasy likely postdated them. “Them” being the PIs who are sadly as of this writing very much not likely to be young enough to have been in college in the mid eighties. So they know all about the cocaine and the weed and the LSD but emerging drugs? Not so much. Their undergrads and even grad students could tell ‘em but how often do the PIs listen? Then there’s just the general trend that even by the post-doc days scientist are just moving away from the youth culture, don’t you know? Finally, while scientists got to do a bit of tasting back in the 70s, those days are long gone.
So instead we have a bunch of out-of-touch old fogies who think MDMA is just another amphetamine, should be studied like just another amphetamine and can’t see why there are different approaches needed. Case reports provide needed stimulus to new experimental approaches, needed support for the arguments that other things need to be investigated about this drug, etc. Don’t believe it? Then why did NIDA have to come out with a Program Announcement in 2004 (yes, 2004!) saying in essence, “For God’s sake will you please submit some proposals other than the mechanisms of so-called serotonin neurotoxicity?”. [Current R01 and R21 versions of the PA].
Time will tell but the field may have missed the boat a bit by not paying enough attention to MDMA related Case Reports. Giorgi et al have reported a potential sensitization of seizure threshold following a particular regimen of MDMA in mice. Experimentally, this is relatively novel stuff. But reading the case reports with the hindsight, there are clear indications of seizure as possibly being a primary cause of medical emergency (it has been generally been assumed to be thermogenic seizure subsequent to the high body temperature). Time, and some additional experimentation, will tell if this was a missed foreshadowing from the case reports or not…
So yeah, I find a big role for case reports. Not just for the unique cases but also to lay down a record of some interesting phenomena that might bear looking into in a systematic way.
Another comment responding to Zuska’s observations is also particular apt for the interpretation of MDMA case reports and well-controlled animal studies. This is so brilliant:
If it’s ’science and stats’, then deniers argue that it’s just averages and impersonal statistics, and it doesn’t speak to the experiences of an actual individual woman, who are presumably doing *just fine*. If it’s anecdotes, then deniers argue it’s not based in hard facts and on real distributions, and that that it doesn’t speak to the experiences of an actual individual woman, who are presumably doing *just fine*. And thus we achieve a sort of Schroedinger’s paradox for women’s issues in science, in which any proof that women are having a shitty time is simultaneously neither quantitative nor anectodal enough. It’s beyond ‘moving goalposts’, it’s like a quantum singularity generating goalpost probabilities so indeterminate as to be inachievable.
This is exactly the way the MDMA advocates dismiss the anecdotal evidence on the one hand (”exceptionally rare congenital effect, musta’ been the heat, dehydration, overdose, etc, etc”) while denying the experimental science on the other (”animals are not humans, massive overdose, oral administration, etc”).
