The disease of Sigmund Freud: oral cancer or cocaine-induced lesion?

Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States

Background: Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. Objective: This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Results: Medical cocaine use decreased by -62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by -69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased to 48.7 in 2018. Conclusion and Relevance: If these pharmacoepidemiological patterns continue, licit cocaine may soon become a historical relic. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly.

Cocaïne et lésions destructrices centro-faciales : à propos d'un cas

INTRODUCTION

Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed.

CASE REPORT

A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made.

CONCLUSION

CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.

Historical Vignette: Attempted treatment of Sigmund Freud's oral squamous cell carcinoma by vasectomy (Steinach Operation) in 1923

BACKGROUND

At the beginning of the 20th century, the Viennese physiologist Eugen Steinach proposed to treat the effects of physiological ageing by vasectomy. After experimenting his theory with animal, he published his results, and convinced scientists to apply this method to humans (ie men). The scientific community has been convinced by these pictures of the interest of these vasectomies, and many patients undergo it for the purpose of physical, mental and sexual rejuvenation, including Sigmund Freud.

OBJECTIVES

The aim of this study is to explain How Sigmund Freud decided to do this operation.

MATERIALS AND METHODS

We read and analysed a set of articles and books about Sigmund Freud live and the rejuvenation theory with the help of Sigmund Freud Museum (London).

RESULTS

Freud suffered from a cancer of the right maxillary diagnosed in 1923 for which he underwent a first surgery of excision on April 20, 1923 followed by radiotherapy and a lot of another surgery to treat reccurences. Probably in despair or wanting to heal himself, he decided to have a Steinach vasectomy.

DISCUSSION

Sigmund Freud knew Steinach's theories through his scientific publications, including his work on the «treatment of homosexuality» (sic!); he even tended to believe that biological methods were more reliable for «treating homosexuality» than his psychoanalyses. Because cancer was considered a disease of old age, vasectomy rejuvenation seemed to be useful (and potentially effective) in treating cancer, according to Freud.

CONCLUSION

Even Sigmund Freud, who was a great scientist, was fooled by the scientific results of a badly conducted study. We must keep a critical eye on new medical developments.