From Candy Crush to OCD—The Secrets of Compulsion

There are any number of things that drive human behavior, from the basic craving of hunger to more complex feelings like anger and compassion to ethical or spiritual motivations such as a sense of duty or altruism. But none of these drivers is as psychologically mystifying—and, to many people, as unsettling—as compulsion.

“Compulsions come from a need so desperate, burning and tortured it makes us feel like a vessel filling with steam, saturating us with a hot urgency that demands relief…But while compulsions bring relief, they bring little enjoyment, and while with one part of our brain we desperately wish to stop them, with another we are desperately afraid of stopping.”

That striking and lovely passage—and I wish I didn’t have to abridge it—is from the introduction to Can’t. Just. Stop. An Investigation of Compulsions, by Sharon Begley, the senior science writer at STAT, former correspondent at the Wall Street Journal and Newsweek, and one of my favorite science writers hands down. While the book doesn’t hit shelves until February, I began reading an early copy last night and, with some degree of compulsion, couldn’t put it down.

As compelling a read as it is, the book is equally timely. The U.S. Seems to be going through an epidemic of anxiety. In any 12-month period, according to the National Institute of Mental Health, just over 18% of adults suffer from an “anxiety disorder”—of which nearly 23% of these cases (representing 4.1% of U.S. Adults overall) are considered “severe.” And according to a growing body of evidence, Begley reports, one response to such anxiety can be a compulsion.

It’s no secret we’ve become a nation of obsessive Facebook-checkers, Candy Crush’ers, Pokemon Go-ers, and Tweeters—with one fellow about to hold the highest office in the land compulsively, it would seem, sending message bursts in the wee hours of the morning. But for some—the hidden checkers, repeaters, hoarders, and “just-right’ers” (those who have to adjust picture frames or books on a shelf to make sure they’re perfectly aligned)—the compulsion is a never-ending antagonism to normal life.

Begley expertly escorts us across the psychological boundary between OCD (obsessive-compulsive disorder) and OCPD (obsessive-compulsive personality disorder), shows us how a game like Candy Crush or Angry Birds can pull deep levers in the human psyche, and with great humanity helps us experience what it’s like to know with near certainty that your cat Fred is not in the refrigerator but feel a tug of urgency to check nonetheless.

If there is a light at the end of the seemingly endless tunnel that is OCD, it emanates from the science that’s helping us understand the connection between this psychiatric disorder and its neurological basis. Every so often, it appears, a glitch develops in an “error-detection” message router between the brain’s orbitofrontal cortex, anterior cingulate, and caudate nucleus.

It’s a wiring problem, Begley explains, “not the ‘chemical imbalances’ that the public—thank you, direct-to-consumer pharmaceutical ads—has been brainwashed into believing are the cause of mental disorders.” Somehow, the “worry circuit” that exists in healthy brains turns into the “OCD circuit.” And that “somehow” is related to both nature and nurture, she says.

No, Begley’s book isn’t likely to stop you from playing Candy Crush—but it will make you more forgiving of yourself when you can’t seem to stop.

More news below.

Clifton Leaf

@CliftonLeaf

[email protected]

DIGITAL HEALTH

IBM Watson helped uncover five new genes connected to ALS. IBM's flagship supercomputer has helped researchers at the Barrow Neurological Institute discover five new genes linked with the deadly degenerative condition Amyotrophic Lateral Sclerosis (ALS), commonly called Lou Gehrig's disease, the organizations announced Wednesday. "We are very excited about this discovery," said ALS expert Dr. Robert Bowser, director of the Gregory W. Fulton ALS Research Center at Barrow Neurological Institute, in a statement. "ALS is one of the most complicated diseases to unravel and there is no cure. We hope that the use of IBM Watson for Drug Discovery will allow us to identify new and more effective treatments for ALS." For the project, Watson was fed information about genes that have already been linked with ALS, as well as the latest research on the disease and its genetics. The supercomputer then used its machine learning and artificial intelligence capabilities to create a ranking of 1,500 genes and proteins in order of likely connection with ALS. The result? Eight of the top 10 identified genes were, in fact, linked with ALS, researchers found in followup work—and five of them had never been identified before. "We could have individually looked at the 1,500 proteins and genes but it would have taken us much longer to do so," said Bowser. "IBM Watson for Drug Discovery, with its robust knowledge base, was able to rapidly give us new and novel information we would not otherwise have had."

Deloitte: Health care will be faster to adopt blockchain than other industries. A new Deloitte survey suggests that health care may well become the first major industry to adopt blockchain on a wide scale. In fact, 35% of health care and life science respondents to the survey said that they planned to deploy the digital ledger tech at the heart of Bitcoin within the next year. But plenty of challenges remain. For one, the technology is still pretty new to many large industry executives, and certain sectors are far more savvy about blockchain than others (such as financial services). And some survey respondents said they think the tech may be a little overhyped. Still, the applications in the scattershot U.S. Health industry are 0bvious: a digitally linked trail of transactions could make it far easier to keep track of claims and avoid payment mix-ups. Earlier this year, Capital One announced that it was partnering with blockchain startup Gem to bring the technology to health care. (Healthcare IT News, Coins2Day)

TiGenix raises $36 million in stem cell treatment-funding IPO. Belgium-based biopharma TiGenix has raised a gross $35.65 million in its NASDAQ IPO, the company's second attempt at a public offering in the U.S. A good chunk of the money will be used to fund a U.S. Late-stage clinical trial of TiGenix's Cx601, a stem cell therapy being tested in Crohn's disease. TiGenix has already conducted phase 3 trials of the treatment in Europe but wants to sponsor a second one in America in a gambit for FDA submission some time next year. The approximately $36 million net was a bit of a disappointment for the company, which had been aiming to nab $43 million. But it will also continue to receive support from Japanese pharma giant Takeda, which has teamed up with TiGenix on its experimental stem cell tech.

INDICATIONS

The FDA approved way fewer new drugs in 2016. The Food and Drug Administration (FDA) is out with its latest report on new drug approvals. And it underscores a massive drop compared to recent years, especially a record-breaking 2015 that saw 45 new therapies get the green light. This year, that number fell to just 19 (as of December 9th). For comparison, the agency approved an average of more than 36 new drugs per year between 2011 and 2015; the last time it approved fewer than 20 was 2007 (note: "new" drugs don't encompass follow-on indications for existing treatments, like for next-gen cancer therapies that can treat multiple cancers). Dr. John Jenkins of the Office of New Drugs says that parts of the reason for the plunge was that the FDA had acted earlier than expected on five drugs, making them part of the 2015 cohort, and that filings for new drugs in general had fallen this year.

It begins: Feds file first charges in massive generics price-fixing probe. The Department of Justice has charged two former Heritage Pharmaceuticals executives, Jeffrey Glazer and Jason Malek, for conspiring to fix the prices of generic drugs and collude to split up the market. The relevant treatments were an antibiotic and a diabetes medication, and the charges are the first in what's expected to be a wave of indictments in a massive generic pharmaceutical price-fixing scheme that the Justice Department has been investigating for several years. At least a dozen of the world's biggest generic drug makers have been part of the investigation, including Endo, Teva, and EpiPen maker Mylan. Glazer and Malek are actually also facing a lawsuit from their former employer, who accuse the two of "[looting] ens of millions of dollars from Heritage by misappropriating its business opportunities, fraudulently obtaining compensation for themselves, and embezzling its intellectual property." (Reuters, Coins2Day)

Genentech CEO to step down after 6 years at the helm. Genentech chief Ian Clark is leaving his perch at the biotech giant (part of Swiss pharma titan Roche) at the end of the year and will be replaced by Bill Anderson, the current head of North American Commercial Operations, the company announced on Wednesday. As Endpoints notes, Genentech has long been a global leader when it comes to next-generation cancer drug research, and Clark oversaw the launch of 15 new therapies over the course of his executive tenure. That includes Roche/Genentech's critical approval for Tecentriq, the third so-called checkpoint inhibitor cancer immunotherapy treatment approved by the FDA (behind Merck's Keytruda and Bristol-Myers Squibb's Opdivo), earlier this year.

THE BIG PICTURE

Flint residents are still opting for bottled water over tap. The Flint water crisis of the last year continues to affect residents' water consumption behavior, with many people continuing to opt for bottled water over potentially contaminated tap water. That's despite the fact that recent tests have shown that Flint's water quality has improved and city officials' assertions that drinking tap is perfectly safe as long as households use a filter. That's a risk too far for many residents, who likely won't feel safe as long as lead pipes continue to be present in the water delivery system. And while Flint is an extreme example, the phenomenon isn't just local: bottled water sales are slated to outpace those for soda thanks, in part, to America's dilapidated water infrastructure. (NPR, Coins2Day)

Obama official to scientists: Stand up to Donald Trump. Obama administration Interior Secretary Sally Jewell had a stark message at the American Geophysical Union’s annual meeting this year: don't let Donald Trump and his cabinet picks undermine the scientific process. "Your science matters," she said in her keynote address. "I urge you to stay the course and keep up your commitment to your work." Later, Jewell also said that scientists should be vocal about any Trump administration attempts to hobble scientific work. "I encourage people to speak up and to talk about the importance of scientific integrity," she said. "And if they see that being undermined to say something about it." A number of Trump appointees, including his choice to lead the Department of Energy, former Texas Governor Rick Perry, have been criticized as wishing to dismantle the very organizations they will be tasked with running. (TIME)