This US News & World Report story reports on a small study measuring brain activity, but makes it sound like a major step forward. The specifics of the study are glossed over, no connection is made between brain activity and clinical symptoms or outcomes, and there’s no mention of cost or potential harms. In addition, the story relies on a news release from the research university where the study was done and canned quotes from the study author.
People coming into emergency rooms with psychotic symptoms is a common enough occurrence that there are established treatment guidelines. The symptoms may be caused by any number of things, such as drugs of abuse or medications, as well as mental illness or other medical conditions. To manage patients, antipsychotic drugs are often administered. These drugs come with a raft of side effects, so a treatment that could quell symptoms quickly with fewer side effects would certainly be useful.
There is some evidence that cannabidiol might be helpful for acute psychosis, though much more is needed. News coverage of current research can be worthwhile if it puts new findings into context.
The article did not mention costs of cannabidiol.
Internet sources of cannabidiol can cost 4 to 20 cents per milligram, though the dosage and quality of these products is not regulated. The study used a 600 mg dose, so the cost would be $24-$120 for a single dose. The FDA-approved version of the drug (approved for childhood epilepsy, not psychosis) runs $32,000 a year, although insurance may cover some of that cost.
The headline claims that CBD reduces symptoms of psychosis, but never provides any evidence that is true.
We’re told that people with psychotic symptoms who received cannabidiol “showed decreased abnormal activity” in MRI scans of brain activity. The very next sentence states: “These results suggest that CBD can help re-adjust brain function to normal levels.”
Did normal “brain function” mean no more psychosis? We’re not told. More importantly, brain activity is not a symptom.
The article made no mention of possible side effects of cannabidiol, which can include tiredness, diarrhea, and changes of appetite/weight. These effects are considered mild, but we maintain that the potential for untoward effects deserve consideration.
The article does not help readers evaluate the study’s strengths or weaknesses. This was a randomized clinical trial (a strength) done in 33 subjects (a small enough number to be a weakness). Additionally, there is no mention of the timing between administration of the study drug (just a one-time dose) and measurement of brain activity (at baseline or follow-up).
More importantly, the article does not help readers how abnormal brain activity relates to overt (or obvious) psychotic symptoms — or that normalizing brain activity has clinical significant effects.
Further, there is no mention as to why participants “experiencing psychotic symptoms but not yet diagnosed with psychosis” were chosen. In the larger clinical trial by the same investigator, the CBD compound was given in individuals with overt psychosis. The reason for the selection of this study population is unclear, as is the duration of therapy.
No disease-mongering here, although more could have been said about the frequency of psychosis and which disorders it’s most commonly associated with.
The only source quoted in the article was a study author.
An independent perspective is crucial to convey the significance of this study and its findings.
The article does mention older antipsychotic drugs, but does not compare their effects on the main outcome — abnormal brain activity. One might expect a comparison of side effects between traditional antipsychotics and cannabidiol, which is likely where the latter would seem advantageous (if the therapeutic effects are equivalent, which is not at all clear).
We’ll give this a satisfactory rating because the article mentions the FDA approval of the drug for epilepsy, which implies that its commercially available. But it’s not clear if the dosing would be similar.
The story indicates there is previous research that shows a connection between CBD and how it affects psychosis.
The article appears to rely heavily on this King’s College London news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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