“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

The US has reported 3,437 cases of the drug-resistant fungus Candida auris across 27 states so far this year, according to the latest data from the US Centers for Disease Control and Prevention (CDC).

The figure is about 1,000 fewer than the 4,290 cases reported during the same period last year.

The states reporting the highest number of cases this year are:

• California: 873
• Texas: 433
• Tennessee: 283

The CDC clarified that an increase in reported cases does not necessarily mean the fungus is spreading more rapidly than usual.

"An increasing number of cases does not mean the fungus is transmitting at a more rapid pace than usual," the CDC said.

The agency added that while C. auris cases continue to rise every year, the rate of increase has slowed since 2022.

Most Strains Resistant to Common Antifungal Drugs

A CDC analysis published earlier this year, based on 8,033 C. auris samples collected in 2022 and 2023, found:

• More than 95% were resistant to fluconazole, a first-line antifungal drug.
• 15% were resistant to amphotericin B.
• 1% were resistant to echinocandins.
• Fewer than 1% were resistant to all three major antifungal drug classes.

Why Is Candida auris a Concern?

Candida auris is a type of fungus that can cause serious infections in the human body. It was first identified in 2009.

The CDC said that the drug-resistant fungus continues to pose a major challenge for hospitals, nursing homes, and other healthcare facilities because it is difficult to treat and control.

"Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings," the CDC said.

"Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts," it added.

Why Is Candida auris So Difficult to Control?

Unlike many other infections, Candida auris spreads easily through contaminated medical equipment and direct person-to-person contact. It can also survive for long periods on surfaces and is resistant to many commonly used disinfectants, making outbreaks difficult to contain once the fungus enters a healthcare facility.

Health officials say the steady rise in cases each year points to ongoing transmission in healthcare settings.

Symptoms and Health Risks

Candida auris can infect:

• The bloodstream
• Wounds
• Ears
• Other parts of the body

Symptoms vary depending on the site and severity of the infection. Some people may carry the fungus without showing any symptoms.

The CDC noted that most people who develop Candida auris infections are already seriously ill, making it difficult to determine how much the fungus contributes to death compared with their underlying medical conditions.

The fungus is particularly concerning in hospitals and nursing homes because it can survive on surfaces such as doorknobs, counters, and bed rails. Its resistance to multiple antifungal drugs makes infections difficult to treat and eliminate.

English actor and former Blue Peter presenter Peter Duncan recently urged health authorities to make focal therapy more available for prostate cancer patients. He said after describing the treatment as "life-changing" following his own diagnosis in 2019.

This comes as new evidence has been emerging that the minimally invasive approach can offer satisfactory cancer control compared to traditional treatments, while also significantly reducing long-term side effects.

The 72-year-old broadcaster revealed that he was initially offered a prostatectomy, a surgery that removes the entire prostate gland. Instead, he opted for focal therapy, a targeted treatment that destroys only the cancerous portion of the prostate while preserving healthy tissue.

"It was a complete success, and I've only experienced very minor after-effects, allowing me to continue with my life as before," Duncan said, while backing Prostate Cancer UK's campaign for wider NHS access to the treatment. "Many men aren't given the same chance I was, and that needs to change."

Importance Of Focal Therapy In Prostate Cancer Treatment

Also read: Tadalafil: Common Male-Potency Drug May Raise Glaucoma Risk In Men, Finds Study

Duncan's campaign comes amid growing clinical evidence supporting focal therapy for selected patients with localised prostate cancer.

A recent report from researchers at Imperial College London and Imperial College Healthcare NHS Trust found that focal therapy shows promise in cancer treatment compared to surgery and radiotherapy while causing far fewer complications in some patients.

Amy Rylance, Director of Health Services, Equity and Improvement at Prostate Cancer UK, said the delay in wider approval is leaving thousands of men with no access to treatments that could preserve their quality of life.

"Without a timeline from NICE, we simply don't know how long men will have to wait for approval on the NHS," she said. "Thousands of men will have to deal with life-changing side effects simply because of their postcode."

More About Focal Therapy

Also read: WHO Cancer Agency Flags 3 Common Medicines As Carcinogenic: What It Means For Millions Of Patients

Unlike prostatectomy or radiotherapy, focal therapy targets only the tumour inside the prostate. The treatment may use high-intensity focused ultrasound (HIFU) or cryotherapy to destroy cancer cells while preserving the surrounding healthy tissue.

Because the rest of the prostate and surrounding nerves are preserved, patients may generally face a much lower risk of urinary incontinence, erectile dysfunction and bowel problems.

Focal therapy is not suitable for everyone. Specialists say it is generally considered for men with localised, clinically significant prostate cancer where imaging and biopsy show that the tumour can be accurately targeted.

Patients still require long-term monitoring after treatment to ensure the cancer has not returned or progressed.

Can Focal Therapy Help?

Prostate cancer is the most commonly diagnosed cancer in men in the UK. According to Prostate Cancer UK, around one in eight men will be diagnosed during their lifetime, with the risk increasing with age, family history and Black ethnicity.

While surgery and radiotherapy remain the standard treatment options to treat prostate cancer, advocates argue that expanding access to focal therapy could help thousands of eligible men receive effective treatment with fewer long-term side effects.

Duncan hopes sharing his own experience will encourage both policymakers and patients to consider the option where appropriate.

In a first for India, Maharashtra has allowed qualified homeopathy practitioners to prescribe certain modern medicines after completing a one-year Certificate Course in Modern Pharmacology (CCMP).

The decision has sparked strong opposition from the Indian Medical Association (IMA) and several doctors' bodies, which have announced protests, citing concerns over patient safety, medical education, and professional standards.

What Is The Debate All About?

Under a Government Resolution (GR) issued on August 3, Maharashtra has allowed BHMS graduates who have completed the one-year Certificate Course in Modern Pharmacology (CCMP) to register with the Maharashtra Medical Council (MMC). The registration allows eligible practitioners to prescribe specified modern medicines under the state's policy.

The MMC began registering CCMP-qualified practitioners on August 5. According to reports, one practitioner has been registered so far, while around 2,500 applications remain pending.

The IMA has warned of a nationwide strike if the Maharashtra government does not withdraw its decision. In a letter to Maharashtra Chief Minister Devendra Fadnavis, signed by IMA National President Dr. Anilkumar J. Nayak and Secretary General Dr. Sarbari Dutta, the association demanded immediate withdrawal of both the GR and the CCMP course.

Why Is the IMA Objecting?

The IMA has raised the following concerns:

• No approval from national regulators:

• Opposition to dual registration:

• Matter pending before the court

• Concerns over medical education

What Is the CCMP Course? Why Was It Introduced?

The Certificate Course in Modern Pharmacology (CCMP) is a one-year program introduced in Maharashtra in 2016 by the Maharashtra University of Health Sciences (MUHS). It is designed for BHMS (Bachelor of Homeopathic Medicine and Surgery) graduates and trains them in aspects of modern pharmacology and allopathic medicine.

The CCMP course was introduced following a major agitation by homeopathic associations, including a 13-day indefinite hunger strike in Nagpur in 2013, demanding legal rights to prescribe essential modern medicines.

According to the Maharashtra government, the objective was to strengthen healthcare delivery, particularly in areas facing shortages of doctors.

To facilitate the course, the state amended the Maharashtra Homoeopathy Practitioners' Act, 1960 and the Maharashtra Medical Council Act, 1965 in 2014, after the legislation was passed by both Houses of the State Legislature.

The IMA now argued that the situation in 2014 when the MMC Act was amended is very different from the situation now.

The medical body cited the cancellation of "bond system for MBBS graduates due to the nonavailability of vacant posts for them even in rural areas- signifying sufficient availability of MBBS doctors".

What Does the CCMP Course Include?

According to the government, the one-year CCMP curriculum was developed by expert committees at MUHS after comparing the BHMS and MBBS syllabi to bridge gaps in training.

The course includes:

• Training in modern pharmacology
• Practical laboratory procedures
• Rotational hospital training in clinical subjects of allopathy
• Teaching at government and private medical colleges
• Examinations conducted by the Faculty of Medicine, MUHS

The government says the program is intended to make registered homeopathic practitioners competent to prescribe specified modern medicines and improve access to healthcare in the state.

But the IMA has argued that such "short-term certification or bridge courses cannot substitute for comprehensive medical education". They also warned that permitting cross-practice would compromise patient safety.

What's Next?

The Maharashtra Association of Resident Doctors (MARD) began an indefinite statewide strike on August 3. On August 5, doctors across Mumbai withdrew routine outpatient department (OPD) services in protest against the government's decision.

Doctors from Pune are scheduled to join their counterparts in Mumbai for demonstrations at Azad Maidan on August 6. The IMA has warned of a nationwide strike if the Maharashtra government does not withdraw the decision. The IMA Kerala State Branch has also extended support to the Maharashtra doctors' protest.