The Pharmaceutical Journal
Vol 277 No 7413 p196
12 August 2006

This article
Reprint   Photocopy

PDF 70K, Acrobat Reader

An effective analgesic that has acquired a bad name more
The original worldwide web examined more
Let us find time for standing and staring more
Using the owl as a symbol more

An effective analgesic that has acquired a bad name

An editorial by doctors from Newcastle-upon-Tyne in the 14 June issue of the BMJ gives some interesting facts about a current misunderstanding among clinicians regarding the possible applications of ketamine. This drug has a reputation as an intravenous anaesthetic and analgesic but it is also well known to be subject to abuse. It is not sufficiently recognised that oral ketamine is an effective analgesic in pain attributable to cancer and chronic non-malignant conditions. However, its reputation as a drug of abuse has made clinicians hesitant about its value in relieving pain.

The drug was established for use in hypovolaemic patients and in difficult situations such as battlefields because of its evident safety and its relatively few serious adverse effects when given orally in subanaesthetic doses. One major factor curtailing the drug’s use in such circumstances was its effects on the central nervous system, which include alterations of body image and mood, sensations of floating, vivid dreams, hallucinations, delirium and drowsiness. Hallucinations, in particular, led to the abuse of ketamine as a recreational drug.

Despite this disadvantage, ketamine has found a role in the treatment of refractory neuropathic pain and nociceptive pain, an effect related to its antagonistic effect at the N-methyl-D-aspartate glutamate receptor. Vigilance is necessary for cognitive and psychotropic disturbances, and cardiovascular changes must be monitored regularly during chronic prescribing.

Treatment is best initiated in specialist centres, but once established in patients relatively simple clinical monitoring is called for. Concern is legitimate about the potential for misuse of ketamine, but the evidence suggests that orally it is effective as an analgesic in cancer and chronic non-malignant painful disorders.

Back to Top

The original worldwide web examined

We have reached a time when the term “web” is usually taken to mean something quite distinct from its meaning to the student of natural history. Webs are essentially attributable to spiders — a worldwide group of creatures found in every terrestrial habitat from tundra to tropical rainforest.

Articles appearing in the 23 June issue of Science bring out some interesting facts relating to spiders and their complex engineering feats. Web-making spiders suspend a network of support strands composed of silky compounds, attach radial spokes to it and then weave into the structure a sticky spiral that snares their prey and secures a food supply.

Two groups of spiders, the deinopoids and the araneoids, manufacture different adhesives for the trapping spiral, suggesting to some naturalists that two lineages were involved, an idea no longer held. The more ancient silk recipe was for capture spirals to be made in dry silk, the prey being attached by electrostatic forces. Then araneoids used a pair of glands to produce a viscous glue attached to the support line.

The advantage of this was that effort was spared and the adhesive was 13 times stickier per unit volume. Also the web did not reflect ultraviolet light and so was less visible to insect prey.

An examination of insects trapped within a fossilised web preserved in amber, discovered at an early Cretaceous site in Spain and about 110 million years old, revealed strands of adhesive silk associated with a spider 2mm long that was remarkably similar to living spiders of today. The web was vertically orientated and apparently of great elasticity, suggesting that araeoid web capture originated long enough ago to have influenced the early evolution of diverse groups of flying insects.

Orb webs are therefore of great antiquity in the story of evolution.

Back to Top

Let us find time for standing and staring

Arrogance plays a leading part in the social structure of today. Without it, politicians would feel themselves to be voices in the wilderness and councillors would cease to counsel.

The Latin word arrogantia implies presumption, aggressive and overbearing conduct and insolence towards others. The equivalent old Greek term is hubris, which implies intentionally dishonouring behaviour. It was once a religious entity and concerned conduct that would be punished by the gods, and earned heavy condemnation from the moralists. Acts of full-scale hubristic nature by powerful leaders rightly deprived the sinners of human sympathy.

In today’s society we have daily to contend with sheer arrogance. It is not only personal but extends to far wider fields. At the simplest levels arrogance is believed to arise as a reaction to a feeling of inferiority driving a person to demonstrate an air of superiority that is really a fiction. If I can shout louder than my neighbour, the reasoning goes, I must be mightier. But the problem goes deeper, far beyond the personal dimension.

As a race of bipeds changing the face of the earth, we must eventually take responsibility for our influence on other species of animals and plants, on climate and on pollution of the environment that results from our constructive and destructive activities. We react promptly enough to threats on what we call human rights, while we overlook the threats we present in gathering our food, playing our games regardless of others and generally destroying our environment.

Our outlook is shortsighted, despite a growing awareness that so many living things are interwoven with our own daily lives. Most people seem to be too preoccupied in racing to fit more and more into their day than in the quality of their lives and their relationships with others, human and otherwise.

The best counsel, it seems to me, would be to relax a little and engage a little of the standing and staring mode of living. We must learn to be content with what we have without always hankering after bigger and better luxuries.

Back to Top

And I quote …

Using the owl as a symbol
“Owls, being associated with night, are used in many cultures as symbols for two things — first for death, and second, rather differently, for wisdom. Going out in the dark brings danger of death. But, if you have to go out, then it is surely a good thing to have with you a creature that can penetrate the darkness”.
— Mary Midgley: The owl of Minerva (2005)

Back to Top