“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.

AstraZeneca is developing an experimental cancer drug sonesitatug vedotin that has reported a reduction in the risk of death by 42% in patients with advanced stomach and related cancers. The findings from their Phase 3 clinical trial was presented at the European Society for Medical Oncology (ESMO) Congress in Madrid on October 25.

The global CLARITY-Gastric01 trial compared the drug, also known as sone-ve, to chemotherapy selected by the physician in patients whose cancer had progressed after previous treatment.

The findings showed that patients who received sone-ve lived a median of 10.6 months, compared to 6.4 months among those undergoing chemotherapy.

The trial included 532 patients with advanced gastric cancer, gastroesophageal junction cancer or oesophageal adenocarcinoma whose tumours expressed the protein claudin 18.2 (CLDN18.2). The findings spark hope that the drug could offer another treatment option for patients whose disease has progressed despite early intervention.

Susan Galbraith, AstraZeneca's executive vice-president of oncology haematology research and development, said, “A 5-month improvement in overall survival is very clinically significant in a difficult to treat patient population,” according to Reuters.

How Does Sonesitatug Vedotin Work?

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Sonesitatug vedotin belongs to a class of treatments called antibody-drug conjugates (ADCs). These medicines combine an antibody that identifies a target on cancer cells with a drug that kills those cells, becoming a target-focused treatment.

Sone-ve targets CLDN18.2, a protein found on the surface of certain stomach and related cancer cells. The drug is designed to deliver its cancer killing properties to these cells.

The trial enrolled patients whose tumours showed CLDN18.2 expression in at least 25% of tumour cells. This limit could make the treatment relevant to a bigger group of patients than therapies that require higher levels of the protein.

Rui-Hua Xu, professor of medical oncology at Sun Yat-Sen University Cancer Center and the trial's principal investigator, said, “These are remarkable survival results for Sone-Ve in 2nd- and later-line metastatic gastric cancer, a disease where patients face a poor prognosis once initial therapy fails.”

He added that the treatment could be a shift in cancer care for patients whose tumours express CLDN18.2.

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More About The Trial's Findings

The results are promising but the drug did not meet the trial's other primary endpoint, which is survival without disease progression.

Progression-free survival measures how long patients live without their cancer worsening or dying. Median progression-free survival was 4.2 months with sone-ve and 3.8 months with chemotherapy.

Serious side effects related to the treatment occurred in 36.4% of patients receiving sone-ve, compared to 44.8% who did chemotherapy. However, side effects related to stomach were more frequent with sone-ve, affecting 11.1% of patients compared to 6.3% in the control group.

It is important to note that the findings are from a clinical trial and do not mean the drug is approved for routine use. Further regulatory review is needed before it can become a treatment option.

Furthermore, AstraZeneca is also studying sone-ve in early treatment, where it could be used before patients have exhausted multiple therapies.

The company said the findings support investigating the drug in a bigger population of patients with CLDN18.2-positive cancers. The next phase of research will help establish its role in treatment and whether the survival benefit can be maintained when used earlier.

A Chinese-Russian surgical team has reportedly replaced a damaged section of a paralysed patient's spinal cord with tissue from a brain-dead donor, executing the world's first human spinal cord transplant successfully.

However, with no evidence of neurological recovery, scientists have been questioning whether the procedure can restore movement so far. The 12-hour operation was performed at the Sklifosovsky Research Institute for Emergency Medicine in Moscow on October 14–15, according to Chinese surgeon Ren Xiaoping, one of the doctors who participated in the procedure. The patient had sustained a severe spinal cord injury three years ago.

Ren told the South China Morning Post, “It was our Guangxi University of Chinese Medicine Second Affiliated Hospital and the Russian team working together.”

Moscow Mayor Sergei Sobyanin announced the procedure on October 16, describing it as a significant development in spinal surgery. “A patient who was threatened with complete immobility had a chance to recover. Now he feels good,” he wrote.

However, feeling well after surgery does not mean that a patient has regained movement. The surgical team has not publicly released neurological evidence showing whether signals can travel across the transplanted section.

How Was The Spinal Cord Tissue Transplanted?

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According to Ren, surgeons removed the damaged section of the patient's spinal cord and replaced it with tissue obtained from a brain-dead donor. They used microsurgery and polyethylene glycol (PEG), a substance that can fuse cell membranes to join the tissues.

This technique addresses one of the central challenges of treating severe spinal cord injuries. The spinal cord carries signals between the brain and the rest of the body. When it is severely damaged, these signals cannot pass normally through the injury, causing paralysis and loss of sensation below the affected area.

But joining two sections of tissue is not enough. Nerve fibres must establish functional connections across the damaged area and the tissue that is transplanted must receive blood supply. The recipient's immune system may also attack the donor tissue.

These challenges become important when the injury is several years old. Repairing a recently damaged spinal cord is different from replacing tissue in a patient with a longstanding injury.

Scientists Have Raised Questions

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Scientists have raised concerns about the evidence about whether it can restore meaningful neurological function in humans.

Melissa Andrews, a neuroscientist at the University of Southampton, questioned the quality of the animal studies supporting the technique and warned about the risks involved, according to New Atlas.

Experiments involving PEG has shown some promise in animals but they do not prove that the technique can reconnect a human spinal cord successfully enough to restore movement.

The lack of publicly available evidence is another limitation. Details about the patient's injury, the precise location of the transplanted segment, neurological examinations after the procedure and changes in movement or sensation have not been disclosed. No peer-reviewed clinical report documenting the operation and its outcomes has been published.

Ren told New Atlas, “We have informed the patient of every potential risk and surgical outcome, and the patient's current condition is good.”

The operation is an experimental treatment, not proof that transplanting spinal cord tissue can reverse paralysis. Even if the patient survives the operation without major complications, recovery would depend on whether functional nerve connections develop and whether the brain can communicate with the body across the damaged region. Rehabilitation and long-term follow-up would be needed to assess any improvement.

Kerala's decision to switch from an expensive branded medicine for children with spinal muscular atrophy (SMA) with a much cheaper Indian-made alternative has sparked a dispute over the drug’s safety, regulatory procedures and parents' right to know what treatment their children receive.

Health Minister K Muraleedharan has defended the switch to Natco Pharma's generic risdiplam, which is sold as Natsmart. However, some parents and opposition leaders have questioned why bottles supplied to children at the Sree Avittom Thirunal (SAT) Hospital in Thiruvananthapuram were labelled “Physician's Sample” and “For Clinical Trials Only”.

The controversy has since expanded beyond the medicine's price. It now concerns how the drug reached the hospital and what evidence backs its use in children already receiving treatment.

Why Did Kerala Switch To The Generic SMA Medicine?

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SMA is a rare inherited disorder that causes progressive muscle weakness and wasting because of the loss of motor neurons. It can affect movement, swallowing and breathing. Its treatment may need to continue over a long period.

The branded risdiplam, Evrysdi, is manufactured by Swiss pharmaceutical company Roche. Its reported market price is around ₹6.2 lakh per bottle. Natco's generic alternative, Natsmart, is listed at ₹15,900 per bottle. The Kerala government has negotiated even a lower procurement price.

The difference could substantially reduce public expenditure. The state has been providing risdiplam free to eligible children through its KARE programme. Reports indicate that around 109 children are receiving treatment under the scheme.

The generic switch was intended to make treatment more affordable.. Public health expert B Ekbal has backed the decision, arguing that lower-cost medicines can expand access without compromising quality.

The debate is not over whether generic medicines should be used. Opposition leaders, including former chief minister Pinarayi Vijayan, say their objections concern the handling of the medicine that were labelled for clinical trials and the transparency of its distribution.

‘Clinical Trial’ Label Alarmed The Parents

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The controversy surfaced after families received bottles bearing the clinical trial and physician sample labels. Parents questioned whether their children had been given medicine intended for testing and whether they had adequately informed before.

Former Kerala health minister and CPI(M) leader K K Shailaja raised concerns about quality and the need for transparency and evidence before changing treatment.

“Just because a new company offers a price reduction doesn’t mean we can purchase everything. Besides price reduction, quality is what matters most. Some companies might lower prices just to push unsold products or for other interests,” she said, according to The South First.

The government says the labels indicate that they belong to sample stock and do not mean that the children were enrolled in a clinical trial.

Dr R Shankar, who heads the technical committee that evaluated the medicine, said, “If the concern is over the label, there was ‘physician’s sample’ written on it. It means it is a tested molecule. The container contains the same medicine.”

Hospital authorities said the disputed bottles were taken back after parents raised concerns. The minister has maintained that this was done to address their apprehensions, not because the government had concluded that the medicine was unsafe.

Muraleedharan has said the switch was based on an expert committee's recommendations and that the drug had received regulatory approval.

On October 24, he said, “People had concerns, but the doctors have addressed them. The treating doctors themselves have cleared the doubts.” He also said he would provide further clarification in the state Assembly on October 26.

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SMA Patient Says The Generic Medicine Worked For Her

Amid the concerns, SMA patient Seba P A has defended Natsmart, saying she has taken Natco's generic risdiplam since April through a patient assistance programme. “Taking Natsmart produces the same effect as when I was taking Evrysdi,” she said. “I have felt no issues due to the change in brand.”

Seba also said bottles supplied to her free of cost carried the same physician sample and clinical trial labels. She argued that the labels were intended to prevent the free medicine from being resold.

Is the Generic SMA Drug Safe?

Natsmart contains risdiplam, the same active pharmaceutical ingredient as Evrysdi. The Central Drugs Standard Control Organisation (CDSCO) has approved Natco's formulation for marketing in India.

They maintain that the generic medicine is suitable for patients and that the labels do not indicate an ongoing clinical trial involving the children.

However, questions have been raised about bioequivalence evidence, quality checks and the process followed before procurement. Bioequivalence studies are used to establish whether a generic formulation delivers an active ingredient into the bloodstream at a rate and to an extent comparable with the reference medicine.

The dispute therefore cannot be resolved by comparing prices or relying solely on individual patient experiences. Families need clear information about the product's approval, the evidence for its use in children, the significance of the labels and the safeguards in place to monitor adverse effects.