“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.

In a significant breakthrough for faster diagnosis of tuberculosis -- the world’s most infectious disease --, the World Health Organization (WHO) has recommended tongue swab tests.

The new recommendations come as many people with TB do not produce sputum, but are contributing to transmission. The swab tests may not only expand access to testing but also enable early and timely treatment that can help break chains of TB transmission.

The updated guidance also includes recommendations for the use of near point-of-care molecular tests - the nucleic acid amplification tests (NPOC-NAATs) for drug-resistant TB and pooling of sputa as a diagnostic strategy for the initial detection of TB and drug resistance.

“The WHO has just issued recommendations on new near-point-of-care (NPOC) tests for the diagnosis of #TB; easy-to-collect tongue swab samples to expand access to testing; & a cost-saving sputum pooling strategy to increase testing efficiency for TB & RR-TB,” Tereza Kasaeva, Director - WHO department on HIV, Tuberculosis, Hepatitis, in a post on social media platform X.

“These new recommendations mark a major step toward making #TB testing faster and more accessible,” she said, while calling on countries to roll out the guidelines to close diagnostic gaps.

What Are Tongue Swabs

Tongue swabs are new, readily available, and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB, with and without drug resistance.

The global health body recommends using the low-complexity automated NAATs as initial diagnostic tests in adults and adolescents with signs and symptoms of lung TB.

However, in cases where respiratory samples such as sputum (expectorated or induced), tracheal aspirate, and bronchoalveolar lavage (BAL) cannot be obtained, tongue swabs may be used as initial diagnostic tests for TB.

Tongue swabs may be collected by trained personnel or self-collected with guidance from trained personnel.

Dr Rakesh PS, from the International Union Against Tuberculosis and Lung Disease (The Union), in a LinkedIn post mentioned individuals having no or minimal symptoms, and often cannot present respiratory specimens.

"Tongue swabs offer a practical way to include this otherwise “missed” group in the diagnostic pathway. By enabling testing of individuals who would otherwise be excluded, tongue swab–based testing can enhance the efficiency of active systematic screening," Dr. Rakesh said.

"Tongue swabs are a strategic alternative when obtaining a respiratory specimen is difficult or not possible -- and, when used appropriately, they can strengthen our fight against TB," he added.

What Are NPOC-NAATs

NPOC-NAATs are swab-based molecular tests for TB detection that can produce results from a primary sputum or tongue swab sample in less than one hour. These tests use instruments that can be battery-operated and do not require specialized infrastructure for use or storage.

The tests can be done in basic peripheral laboratories, such as those that perform smear microscopy, and health clinics, mobile units, or community sites that do not have laboratories.

They can be performed by health care workers with basic technical skills because they do not require laboratory methods like precision pipetting.

What Is Sputa Pooling

In sputum pooling, samples from several individuals are mixed and tested together. It is a proven strategy to improve testing efficiency and reduce costs in resource-constrained environments.

Global TB burden

While being preventable and curable, TB remains a top infectious killer, with an estimated 10.7 to 10.8 million new cases and 1.23–1.25 million deaths in 2024, as per WHO.

The infectious disease disproportionately affects low- and middle-income countries.

While TB incidence rates have shown a slight, uneven decline since 2015, the overall burden remains high, with 30 countries accounting for 87 percent of global cases, led by India, Indonesia, China, the Philippines, and Pakistan.

An increasing number of the National Health Service or the NHS UK doctors are now choosing to practise privately. This has happened at the backdrop of mounting pressures and burnout that reshaped the landscape of general practice in England. According to a recent BBC report on Care Quality Commission (CQC), data found a sharp rise in doctors registering to work outside the NHS.

In the five years to the end of 2025, the CQC received 1,238 new registrations for "independent consulting doctors" in England. This is a 212 per cent increase as compared to 396 doctors registering to work independently over the five years. Between 2024 and 2025, registrations rose by 58 per cent.

Independent consulting doctors provide care privately, either in person or online, across a range of specialties including general practice, skin conditions, women’s health and aesthetics.

"You Don't Have Time To Go To The Toilet"

Dr Yvonne Girgis-Hanna is among those dividing her time between NHS and private practice. Speaking to the BBC, she said full-time NHS work had become unsustainable.

“I could not work as a full-time NHS GP,” she said. “The days I do in the NHS, the next day I'm totally wiped out… You might have 30 face-to-face contacts, then extra telephone calls and paperwork. You just don't have time to even go to the toilet.”

She now sees private patients in Essex, charging from £129 for a 20-minute appointment, with options of up to an hour. Longer consultations, she told the BBC, allow for continuity of care reminiscent of the “cradle to grave” model that once defined family medicine.

Demand, she argues, is the central strain on NHS general practice. With practices receiving roughly £120 per patient annually, frequent attenders can stretch resources thin. “If you imagine £120 for somebody that might be presenting 20 times, it is very little,” she said.

Patients Pay For Time And Familiarity

A 2024 LaingBuisson report noted that 13 per cent of GP consultations were private, which is up by 3 per cent two decades ago. This is because, some patients want faster access and longer appointments. Vanessa Ravazzotti, 51, told BBC that NHS wait worsened her symptoms and heightened anxiety. This is when seeing a private GP felt "mentally better". "She knows me; I know her."

Ian Miller, 85, who has arthritis, told the BBC he found short NHS appointments difficult and disliked seeing different clinicians. Private care offered familiarity and focus: “You immediately get down to the problem.”

Greater Autonomy, But Less Affordability

Dr Karen Benson, who works privately from a pharmacy in Hertfordshire, said the environment is calmer. “I haven't got constant interruptions… it's a much more relaxed atmosphere." She said she is better able to offer longer appointments and address the root cause of the illness. However, some patients switch back to NHS for specialist referrals that they cannot afford privately.

Dr Oliver Denton of the British Medical Association (BMA) told the BBC that while it is difficult to pinpoint a single cause, “with growing pressures within the NHS it is no wonder more may be considering looking to work outside the health service.”

The meningococcal B vaccine (4CMenB) is completely ineffective in preventing gonorrhea -- a sexually transmitted infection (STI) --, especially among high-risk groups like gay and bisexual men, according to the results of the world’s largest randomized control trial (RCT).

Gonorrhea is a common bacterial STI caused by the bacterium Neisseria gonorrheae, and is transmitted through unprotected sex.

Even as antimicrobial resistance in gonorrhea has increased rapidly in recent years, Australian researchers explored the efficacy of 4CMenB against the disease.

The large randomized, placebo-controlled trial involving 587 gay and bisexual men showed that the risk of gonorrhea incidence remains essentially the same even after vaccination.

“Across both arms, the gonorrhea incidence was virtually the same -- at around 48 per cent per year, indicating very clearly that the vaccine had no effect on preventing gonorrhea,” said Professor Kate Seib, from Griffith University, in Australia, who led the trial.

In light of the study, the researchers stressed the need to explore other options to combat gonorrhea, such as condoms and regular testing.

The 4CMenB Vaccine

While meningococcal disease (caused by Neisseria meningitidis) and gonorrhea (caused by Neisseria gonorrhoeae) are distinct infections, both are caused by Neisseria bacteria, which share 80-90 percent genetic material.

The bacterium N. meningitidis primarily causes meningitis and septicemia, and observational studies have shown that meningococcal B (MenB) vaccines such as the 4CMenB offer 33-40 percent cross-protection against gonorrhea.

However, the latest study, presented at the Conference on Retroviruses and Opportunistic Infections in Denver, US, found no protection against gonorrhea.

The study “provides strong evidence that the 4CMenB meningococcal vaccine is not effective at preventing gonorrhea in gay and bisexual men who are at high risk of contracting it,” Seib said.

According to the US National Institute of Health, the 4CMenB vaccine is a highly effective, protein-based vaccine designed to protect against invasive meningococcal disease (IMD) serogroup B.

Approved in over 50 countries, it offers 71-95 percent effectiveness in infants and 100 percent in adolescents.

What Is Gonorrhea

Gonorrhea is a common STI, and sexually active people of any age can get the disease and pass it on to partners, and even to their baby during childbirth.

Gonorrhea is the second most common STI caused by bacteria, just behind chlamydia.

As per data from the World Health Organization (WHO), in 2020, there were an estimated 82.4 million new infections among adults globally.

The NIH noted that nearly 1 million new gonorrhea infections occur in the United States every year. About half of these infections occur in people ages 15 to 24.

The symptoms of Gonorrhea in men include:

• White, yellow, or green discharge from the penis
• Pain or burning (possibly severe) when peeing
• Testicular pain and swollen testicles.

Notably, the condition also occurs in women, but up to 50 percent of them won’t experience symptoms. This increases the risk of spread to other partners.

• Common symptoms in women include:
• Unusual vaginal discharge (white or yellow).
• Pain in your lower abdomen or pelvis.
• Pain during sexual intercourse
• Pain when you pee
• Bleeding between periods