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6 steps to avoid fraud.
- manan vasenwala (9 October 2004)
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Come on, people! Re: 6 steps to avoid fraud.
- Adrian S. Blaj (10 October 2004)
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Re: Come on, people! Re: 6 steps to avoid fraud.
- J.D. Lee (14 October 2004)
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Angell on Big Pharma (short version)
- George B Haycock (25 October 2004)
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Goals Change In Medicine's 'War On Cancer'
- Gregory D. Pawelski (15 November 2005)
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A Pill For Every Ill - Even Cancer
- Dr. Herbert H. Nehrlich (19 November 2005)
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The drug companies and the boycott of new theories and new treatments
- Carlos Monteiro (8 April 2006)
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manan vasenwala, consultant-cardiologist k.k.heart center, aligarh-202002.india
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food, flattery, friendship, free samples, all lead to fraud. 6 steps to avoid the latter. (1)always show great scepticism to their claims, (2)always be non-committal, (3)always consult good, and latest texts, (4)never beleive the reprints, pamphlets, brochures that are doled out by them, (5)never prescribe a new drug till it is time-tested.usual time it takes for fatal/serious/alarming side effects to appear is a couple of years. if you are lucky it may be earlier. don't rush in where angels fear to tread. be patient as nothing will be lost, as you are not the saviour of mankind as they will try to convince you of, (6)lastly always imagine yourselves taking the drugs you have prescribed for others and see if you feel comfortable! Competing interests: None declared |
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Adrian S. Blaj, Psychiatrist Chase Farm Hospital, Enfield, London, EN2 8JL
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Come on, people! Some of us view the drug reps as pests or plagues! Fortunately they are only human beings who just happen to earn a living like anyone of us in this ever competitive market place. To bluntly refuse listening to their views is akin to avoiding using internet search engines simply because one may stumble across, say, pornographic sites! Does it matter where the information comes from? I guess it matters in the end but what really matters is our informed judgement based on a healthy balance between the pros and cons. I think I am not wrong if I say that drug companies, drug reps, etc are just a medium or shall I say 'tools' in the clinician's hand for as long as the clinician works in the best interest of the patient. As a corollary, it would probably be unethical to withold the treatment with a new scientifically-tested drug if for instance one has a competent and informed patient who has tried everything so far to no avail. Competing interests: a networking dinner from time to time |
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J.D. Lee, Medical Director of Pharmacy Services Marshfield WI 54449
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Dr Blaj may be correct but only if he/she realizes that what the rep says is at best a partial truth. The rep is presenting a one-sided argument for the drug, in a message crafted by marketing professionals and honed in focus groups and by other methods to maximize sales, not to fully disclose the pros and cons - Vioxx comes to mind. The goal of the rep is to establish a personal relationdship with you and to convey a message that makes you feel good about prescribing his product. We would do as well if we paid for our own educations about pharmaceuticals and the reps found more productive work. Competing interests: None declared |
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George B Haycock, Professor of Paediatrics Guy's Hospital, London SE1 9RT
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Readers who want a flavour of Marcia Angell's excellent book, but who might not wish to go to the lengths of buying it, may like to know that an article which is in effect a synopsis of the book was published (by the same author) in the New York Review of Books, July 15, 2004. The title is 'The Truth About the Drug Companies', and the full text is freely available online at: http:www.nybooks.com/articles/17244. Competing interests: None declared |
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Gregory D. Pawelski, Retired 19565
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The needed change in the "war on cancer" will not be on the types of drugs being developed, but on the understanding of the drugs we have. There are already over 100 different therapeutic drug regimens out there, and 400 are in the pipeline. Any one or combination of them can help cancer patients. The system is overloaded with drugs and under loaded with wisdom and expertise for using them. There are many cancer drug regimens, all of which have approximately the same probability of working. The tumors of different patients have different responses to chemotherapy. Tumors grow and spread in different ways and their response to treatment depends on these unique characteristics. The amount of chemotherapy that each patient can tolerate varies considerably from patient to patient. It requires individualized treatment based on testing the individual properties of each patient's cancer. Under this approach, scientists study how an individual's cancerous cells respond to drugs. Doctors have learned that even when the disease is the same type, different patients' tumors respond differently to chemotherapeutic drugs. More and more physicians and patients are turning to "individualized therapies" to treat cancers, not just "targeted therapies." Without individualized testing, it's difficult to determine which drugs are best for patients who don't respond to standard therapies. Herceptin is only for the estimated 20% of breast cancer women at risk for recurrence. However, Gene Expression Assays are panels of markers that can predict the likelihood of cancer recurrence in various populations. By testing the gene expression markers of a patient, oncologists can identify those patients unlikely to benefit from chemotherapy from those that would, saving the other 80% of cancer patients the added expense, suffering and even death from having to take chemotherapy. What a cancer patient would like ideally, is to know whether they would benefit from adjuvant chemotherapy. If so, which active drugs have the highest probability of working, which Chemotherapy Sensitivity and Resistance Assays can test for drug activity against a tumor, and what drugs are relatively non-toxic in a given patient , which Pharmacogenomic Testing can identify. Whether a patient would benefit from adjuvant therapy depends on two things: (1) whether the tumor is "destined" to come back in the first place and (2) whether the tumor is sensitive to drugs which might be used to keep it from coming back. The gene expression markers (assays) actually can be calibrated to provide information both about the possibility of recurrence and also chemosensitivity. The problem is dissecting one from the other. Studies to date have just looked at whether people had a recurrence. You can identify gene expression patterns (via assays) which correlate with this. But it can be hard and even impossible to tell what exactly you are measuring: is it intrinsic aggressiveness of the tumor? sensitivity to adriamycin? sensitivity to cyclophosphamide? sensitivity to taxol? sensitivity to tamoxifen? You find a gene expression panel which correlates with something, but picking apart the pieces is hard. You can begin to do this if you combine gene expression studies with cell culture studies. Use the cell culture as the gold standard to define the difference between sensitivity and resistance. Then see which pattern correlates with which for individual tumors and individual drugs. It can theoretically be done (and certainly will be done, over time), but it's not easy. And then you come to the 1,000 pound gorilla of a question: What effect will the different individual drugs have in combination in different, individual tumors? This is where cell culture assays will always be able to provide uniquely valuable information. But it's not one versus the other. The best thing is to combine these different tests in ways which make the most sense. One month's worth of herceptin + avastin costs $8000. That's without any docetaxel and blood cell growth factors and anti-emetics. If nothing else, we can't afford too much trial and error treatment. Sources: Human Genome Project Information: http://www.ornl.gov/sci/techresources/Human_Genome/medicine/pharma.shtml Human Tumor Assay Journal: http://www.weisenthal.org/ ACGT, Inc.: http://www.acgtinc.com/gene_expression.htm Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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Of all the words of Dr. Pawelski one statement struck me: "Whether a patient would benefit from adjuvant therapy depends on two things: (1) whether the tumor is "destined" to come back in the first place and (2) whether the tumor is sensitive to drugs which might be used to keep it from coming back." He seems to be mixing science with the nebulous shenanigans of destiny. If the tumour is destined to come back, meaning if the patient was meant to die sooner than expected, then any hope resting with adjuvant therapy or any other interventional strategy must have scant chance of success.. My personal observation has been, over now more than 3 decades, that not much has changed in the outcome of most cancers, chemotherapy notwithstanding. As much as it hurts and shames us (thinking of the trillions spent on "cancer research/looking for a cure") we need to stand up and say openly that our current approach to the most dreaded disease of modern times is all wrong. It is totally idiotic in my view to keep searching for new chemo drugs or regimens or for bigger and better radiation dispensers. Even cutting out the tumour is nothing more than a rather primitive measure. I realise we do not have any real answers, answers that any patient ought to be able to expect from Modern Medicine, so it won't do to discard the tried and shaky methods cut, burn and poison. Yet. Over many years, there have been "healers" who dabbled in the treatment of cancer, they were hounded mercilessly and many deserved to be. However, those who achieved definitive results were hounded even more, jailed and eliminated if at all possible. The most recent case was that of Dr. John Holt, a highly qualified Australian doctor who achieved a 25-30 % cure rate in terminal and very advanced cancers. While conventional medicine cannot equal this it did not stop its leaders from shutting him down. At least they did it in style and behind closed doors. What we need in this world is a fresh approach for cancer which would put much emphasis on the prevention of those cancers that our way of life causes. Which amounts to about 90 % I would say. Perhaps Prince Charles could spare some time? Competing interests: None declared |
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Carlos Monteiro, President Infarct Combat Project
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On the other hand the vested interests from Drug companies can harden the boycott of new theories and treatments. An example is the myogenic theory of myocardial infarction with its compatible prevention and treatment of acute coronary syndromes by cardiac glycosides, continuously suppressed in medical publications and discussions. So, the myogenic theory is still hidden from doctors and general public since its development in 1972 (1, 2). 1. A New Explanation Strengthen an Old Remedy and Shed Light to the Coronary Heart Disease Enigma. ICP, April 7, 2006 at http://www.infarctcombat.org/media/040506.html 2. “Two Heart Disease Theories, Same Therapeutic Treatment” by Carlos Monteiro with comments by Dr. Thomas Cowan, Fourfold Healing Newsletter of November/December/05 http://www.fourfoldhealing.com/NL%20NovDec%202005.htm and bibliography at http://www.infarctcombat.org/FH2005-ref.html Competing interests: None declared |
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