"If we can cut the lag time from 30 years to a decade or less, that's 20 years of lives saved," said Nils Daulaire, president of the Global Health Council, an advocacy group in White River Junction, Vt.

The sentiment, however valid, is a measure of the degree to which the public-health world has become accustomed to death on a mass scale.

The adverse effects of smoking during pregnancy on fetal development are, in part, due to nicotine. These effects may be due to the actions of nicotine in fetal circulation or on placental functions. In pregnant rats, vaccination with a nicotine immunogen reduces the transfer of nicotine from the maternal to fetal circulation. However, extrapolation of these results to pregnant women might not be valid due to the well-recognized differences between human and rat placentas. In the current investigation, the effects of nicotine-specific antibodies on the transfer of nicotine from the maternal to fetal circuit of the dually perfused human placental lobule were determined. Two types of nicotine-specific antibodies were investigated; nicotine-specific mouse monoclonal antibody (Nic311, K(d) for nicotine 60nM) and IgG from rabbits vaccinated with a nicotine immunogen (Nic-IgG, K(d) 1.6nM). Transfer of the antibodies from maternal to fetal circuits was negligible. Both rabbit Nic-IgG and, to a lesser extent, mouse monoclonal Nic311 significantly reduced nicotine transfer from the maternal to fetal circuit as well as the retention of the drug by placental tissue. These effects were mediated by a substantial increase in the protein binding of nicotine and a reduction in the unbound nicotine concentration. Therefore, the data cited in this report suggest that the use of nicotine-specific antibodies might reduce fetal exposure to the drug, and that antibody affinity for nicotine is a key determinant of the extent of nicotine transfer.

Immunotherapy is a novel potential treatment for nicotine addiction. The aim of this study was to assess the safety and immunogenicity of a nicotine conjugate vaccine, NicVAX, and its effects on smoking behavior. Smokers (N = 68) were recruited for a noncessation treatment study and assigned to 1 of 3 doses of the nicotine vaccine (50, 100, or 200 microg) or placebo. They were injected on days 0, 28, 56, and 182 and monitored for a period of 38 weeks. Results showed that the nicotine vaccine was safe and well tolerated. Vaccine immunogenicity was dose-related (P < .001), with the highest dose eliciting antibody concentrations within the anticipated range of efficacy. There was no evidence of compensatory smoking or precipitation of nicotine withdrawal with the nicotine vaccine. The 30-day abstinence rate was significantly different across the 4 doses (P = .02), with the highest rate of abstinence occurring with 200 microg. The nicotine vaccine appears to be a promising medication for tobacco dependence.

- The patients are much sicker than those found in the community. In general, the vast majority of psychiatry is handled by primary care doctors, with the more complicated patients seeing psychiatrists. And of those that require a psychiatrist, only a few require hospitalization. And of those that require hospitalization, it's the sickest that tend to end up at HCMC. Most psychiatrists tend to see way more depression than schizophrenia, with full-blown psychosis rare. Not at HCMC.

- Of the patients I've followed so far, the major problems have been pseudo-dementia (dementia secondary to severe depression, in this case secondary to bipolar disorder), poorly controlled paranoid schizophrenia, relatively newly diagnosed paranoid schizophrenia, residual-type schizophrenia and substance abuse (alcohol and crack), schizoaffective disorder, catatonic-type schizophrenia, aggression secondary to Huntington's Disease, dementia secondary to muscular dystrophy, suicide attempt secondary to schizoaffective disorder, suicide attempt secondary to major depressive disorder, and agitation secondary to multiple strokes. Of those patients, about 75% have a history of chemical dependency, and over 90% are in the psych unit on a 72 hour hold, a court hold, or have been committed.

- The doctors who work there are special. They all have a natural affinity for the practice environment of HCMC. Some people speculate that this trait is indicative of psychopathology, but at the least it indicates a desire to work with the sickest of the sick psychiatry patients, a great many of whom are poor, uninsured, and/or homeless.

- In addition to the doctors, I also work with nurses, nurse practitioners, occupational therapists, mental health workers, social workers, and psychologists on a regular basis. Throw in the occasional consult from another service (medicine, endocrinology, cardiology, neurology), the lawyers involved in the court hearings, and mental health and chemical dependency workers from the community, and it's a full house!

Another news blurb is here.

Here is the Cajun Dome's webpage. And here is where they are located, according to Google.