The War on Drugs: Wasting Billions and Undermining Economies

Whilst accurate figures are hard to come by, global spending on drug law enforcement certainly exceeds $100 billion each year. Given current economic conditions it is more important than ever that spending is effective and not a waste of taxpayer money.However, the huge investments in enforcement have consistently delivered the opposite of their stated goals—to reduce drug production, supply and use. Instead they have created a vast criminal market. This in turn has substantial social and economic costs, through crime and ill health, far exceeding even the billions in enforcement spending.There are huge opportunity costs to wasteful expenditure on this scale. As drug enforcement budgets continue to grow, other areas are being starved of funds, and cuts in government budgets are hitting public services and support for the needy.Despite the appalling track record of failure, the level of value-for-money scrutiny applied to drug enforcement spending has been almost zero, at both national and international levels. At a time of global economic crisis, after literally trillions wasted over the last half-century, it is time to meaningfully count the real economic costs of the war on drugs. This report is part of the Count the Costs series. Count the Costs is a collaborative project between a range of organizations that, while representing a diverse range of expertise and viewpoints, share a desire to reduce the unintended costs of the war on drugs

Alternative World Drug Report: Counting the Costs of the War on Drugs

Launched to coincide with publication of the 2012 UN Office on Drugs and Crime's World Drug Report, this report by Transform, a grantee of the Open Society Foundations, exposes the failure of governments and the UN to assess the extraordinary costs of pursuing a global war on drugs, and calls for UN member states to meaningfully count these costs, and explore all the alternatives After 50 years of the current enforcement-led international drug control system, the "war on drugs" is coming under unparalleled scrutiny. Its goal was to create a "drug free world." Instead, despite more than a trillion dollars spent fighting the war, according to the UNODC illegal drugs are used by an estimated 270 million people and organized crime profits from a trade with an estimated turnover of over $330 billion a year—the world's largest illegal commodity market.In its 2008 World Drug Report the UNODC acknowledged that choosing an enforcement-based approach was having a range of negative "unintended consequences," including the creation of a vast criminal market, displacement of the illegal drugs trade to new areas, diversion of funding from health, and the stigmatization of users. It is unacceptable that neither the UN or its member governments have meaningfully assessed these unintended consequences to establish whether they outweigh the intended consequences of the current global drug control system, and that they are not documented in the UNODC's flagship annual World Drug Report.The Alternative World Drug Report fills this gap in government and UN evaluations by detailing the full range of negative impacts resulting from choosing an enforcement-led approach:Wasting billions and undermining economiesHarming international development and security, and fuelling conflictThreatening public health, spreading disease and causing deathUndermining human rightsPromoting stigma and discriminationCreating crime and enriching criminalsCausing deforestation and pollutionThe report, available for download at left, also describes the other options for controlling drugs, including health led approaches and legal state regulation and control. It ends with a call on UN member states to count the costs of the war on drugs, and properly explore all alternatives that might deliver better outcomes

Alternative world drug report.

This Alternative World Drug Report has been produced by the Count the Costs initiative to describe enforcement related costs, and to start to fill the gap left by official government and UN evaluations. Recent political developments suggest there is a growing demand for a more balanced and comprehensive evaluation of the wider impacts of current drug law enforcement strategies, and also for evidence-based exploration of possible alternative approaches. In particular, the debate on the future of international drug control has moved decisively into the political and media mainstream for the first time. This phenomenon is now reaching critical mass as member states move into a new era following the 2016 UN General Assembly Special Session on the World Drug Problem and into negotiations for the new 2019 global drug strategy. In keeping with this new era, this report also outlines all the major policy options available to governments, and suggests that countries individually and collectively engage in reviews that scrutinise the effectiveness of the current system, and compare it with alternatives that could achieve better outcomes. Ultimately, this report represents a call to apply science to an area of policy that has eschewed adequate scrutiny for far too long. The world is increasingly willing and able to count the costs of the war on drugs, explore the alternatives and gradually move towards the shared goal of a healthier, safer world

Progress and Poverty—1965 Version

The first hard X-ray laser, the Linac Coherent Light Source (LCLS), produces 120 shots per second. Particles injected into the X-ray beam are hit randomly and in unknown orientations by the extremely intense X-ray pulses, where the femtosecond-duration X-ray pulses diffract from the sample before the particle structure is significantly changed even though the sample is ultimately destroyed by the deposited X-ray energy. Single particle X-ray diffraction experiments generate data at the FEL repetition rate, resulting in more than 400,000 detector readouts in an hour, the data stream during an experiment contains blank frames mixed with hits on single particles, clusters and contaminants. The diffraction signal is generally weak and it is superimposed on a low but continually fluctuating background signal, originating from photon noise in the beam line and electronic noise from the detector. Meanwhile, explosion of the sample creates fragments with a characteristic signature. Here, we describe methods based on rapid image analysis combined with ion Time-of-Flight (ToF) spectroscopy of the fragments to achieve an efficient, automated and unsupervised sorting of diffraction data. The studies described here form a basis for the development of real-time frame rejection methods, e. g. for the European XFEL, which is expected to produce 100 million pulses per hour. (C)2014 Optical Society of Americ

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Purpose Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. Methods: A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primarycare for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. Results: We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12–1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04–1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08–1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This diferential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. Conclusions: We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients’ demographic background

Improving the quality of care pathways for sarcoma patients and the advantages of using WCISU’s (Welsh Cancer Intelligence Surveillance Unit) national cancer registry

Introduction Soft Tissue Sarcoma (STS) diagnosis is difficult due to its nature and the variability of its occurrence on the body. To improve patient outcomes a better understanding was needed of the care pathways experienced by the patient from initial presentation to final treatment. Objectives and Approach Several items of information are necessary, within the data, to identify a care pathway. A correct STS diagnosis, a presentation date or first investigation date, a diagnosis date and any subsequent treatment dates. Identifying cases in hospital data, using International Classification of Diseases (ICD10) codes - C40, C41, C47 and C49 - based on cancer site - can miss cases and cause difficulties when trying to distinguish the difference between the investigation and treatment stages. Having access to WCISU’s national cancer registry, proved advantageous and enabled the routine data to be validated. Results Attempts to identify differences between investigative and treatment procedures using the procedure codes available in hospital data was unhelpful due to variations in coding. However, WCISU’s national cancer registry records all cases of cancer diagnosed in Wales using both ICD10 and International Classification of Diseases for Oncology codes to record cancer morphology. In addition, it records the date of diagnosis and treatment start dates. Using the cancer registry it was possible to cross-check the cases extracted from the hospital data and identify the diagnosis and treatment dates. By matching the treatment dates back to the hospital data it then became possible to analyse the procedure codes to see how many treatments were being delivered, the type of treatment and the periods covered. Conclusion/Implications Once accurate diagnosis and treatments dates were identified, it was possible to drill further into the hospital data to see the finer detail of the procedures the patient received. Utilising independent data sources made it possible to develop an enriched view of patient care pathways from diagnosis through to treatment

Three-Dimensional Reconstruction of the Giant Mimivirus Particle with an X-Ray Free-Electron Laser

Citation: Ekeberg, T., Svenda, M., Abergel, C., Maia, F., Seltzer, V., Claverie, J. M., . . . Hajdu, J. (2015). Three-Dimensional Reconstruction of the Giant Mimivirus Particle with an X-Ray Free-Electron Laser. Physical Review Letters, 114(9), 6. doi:10.1103/PhysRevLett.114.098102We present a proof-of-concept three-dimensional reconstruction of the giant mimivirus particle from experimentally measured diffraction patterns from an x-ray free-electron laser. Three-dimensional imaging requires the assembly of many two-dimensional patterns into an internally consistent Fourier volume. Since each particle is randomly oriented when exposed to the x-ray pulse, relative orientations have to be retrieved from the diffraction data alone. We achieve this with a modified version of the expand, maximize and compress algorithm and validate our result using new methods.Additional Authors: Andersson, I.;Loh, N. D.;Martin, A. V.;Chapman, H.;Bostedt, C.;Bozek, J. D.;Ferguson, K. R.;Krzywinski, J.;Epp, S. W.;Rolles, D.;Rudenko, A.;Hartmann, R.;Kimmel, N.;Hajdu, J

Three-dimensional reconstruction of the giant mimivirus particle with an X-ray free-electron laser

10.1103/PhysRevLett.114.098102Physical Review Letters114909810

Combined hepatic and renal transplantation in primary hyperoxaluria type I: Clinical report of nine cases

Purpose and patients and methodsThe purpose of this article is to report the experience of three centers with combined hepatic and renal transplantation for pyridoxine-resistant primary hyperoxaluria type I (alanine:glyoxylate aminotransferase [EC 2.6.1.44] deficiency), with particular emphasis on the selection criteria and timing of the operation. Nine patients with this inherited disease were treated by combined hepatic and renal transplantation. The former replaces the enzyme-deficient organ while the latter replaces the functionally affected organ.ResultsOne patient with gross systemic oxalosis died in the immediate postoperative period and another died 8 weeks postoperatively of a generalized cytomegalovirus infection, having shown evidence of biochemical correction. One patient with particularly severe osteodystrophy at the time of the operation died 14 months postoperatively from renal failure due to progressive calcium oxalate nephrocalcinosis involving the transplanted kidney, plus thromboembolic disease. He also had very extensive systemic oxalosis. An additional patient with severe osteodystrophy died 9 months postoperatively. One patient developed hyper-rejection of the kidney and died later of gastrointestinal hemorrhage. The four long-term survivors (22 to 38 months) have remained asymptomatic from the standpoint of their renal disease, with resolution of any manifestations of systemic oxalosis that they may have had. They are either employed or continuing their education.ConclusionsA prolonged period of end-stage renal failure treated by dialysis regimens that are suitable for non-hyperoxaluric renal failure and extensive systemic oxalosis, particularly oxalotic osteodystrophy, are poor prognostic features. We propose that hepatic transplantation should be considered as definitive treatment before end-stage renal failure develops. This should be supplemented by renal transplantation with vigorous pre- and perioperative hemodialysis to deplete the body stores of oxalate. Although some authorities would reserve hepatic transplantation for patients in whom renal transplantation has failed, we suggest that combined liver and kidney transplantation is appropriate in patients who have never had a renal graft. Furthermore, the time has come to consider hepatic transplantation before any irreversible renal damage has occurred in these patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29475/1/0000561.pd

Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV):an open-label randomised controlled phase 3 trial

Background The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer, a disease affecting younger patients, is rapidly increasing. Cetuximab, an epidermal growth factor receptor inhibitor, has been proposed for treatment de-escalation in this setting to reduce the toxicity of standard cisplatin treatment, but no randomised evidence exists for the efficacy of this strategy. Methods We did an open-label randomised controlled phase 3 trial at 32 head and neck treatment centres in Ireland, the Netherlands, and the UK, in patients aged 18 years or older with HPV-positive low-risk oropharyngeal cancer (non-smokers or lifetime smokers with a smoking history of <10 pack-years). Eligible patients were randomly assigned (1: 1) to receive, in addition to radiotherapy (70 Gy in 35 fractions), either intravenous cisplatin (100 mg/m(2) on days 1, 22, and 43 of radiotherapy) or intravenous cetuximab (400 mg/m(2) loading dose followed by seven weekly infusions of 250 mg/m(2)). The primary outcome was overall severe (grade 3-5) toxicity events at 24 months from the end of treatment. The primary outcome was assessed by intention-to-treat and per-protocol analyses. This trial is registered with the ISRCTN registry, number ISRCTN33522080. Findings Between Nov 12, 2012, and Oct 1, 2016, 334 patients were recruited (166 in the cisplatin group and 168 in the cetuximab group). Overall (acute and late) severe (grade 3-5) toxicity did not differ significantly between treatment groups at 24 months (mean number of events per patient 4.8 [95% CI 4.2-5.4] with cisplatin vs 4.8 [4.2-5.4] with cetuximab; p=0.98). At 24 months, overall all-grade toxicity did not differ significantly either (mean number of events per patient 29.2 [95% CI 27.3-31.0] with cisplatin vs 30.1 [28.3-31.9] with cetuximab; p=0.49). However, there was a significant difference between cisplatin and cetuximab in 2-year overall survival (97.5% vs 89.4%, hazard ratio 5.0 [95% CI 1.7-14.7]; p=0.001) and 2-year recurrence (6.0% vs 16.1%, 3.4 [1.6-7.2]; p=0.0007). Interpretation Compared with the standard cisplatin regimen, cetuximab showed no benefit in terms of reduced toxicity, but instead showed significant detriment in terms of tumour control. Cisplatin and radiotherapy should be used as the standard of care for HPV-positive low-risk patients who are able to tolerate cisplatin. Funding Cancer Research UK. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license