Saturday, October 09, 2004
Brave New World - Authorship for Dummies
I wonder what this says about society in general...
Hmm.
"The most atrocious part of the book can be attributed to Tinkerbell, Paris' teacup Chihuahua. The heiress delves into the world of creative writing, assuming the role of Tinkerbell, and she really didn't want to go there. Tinkerbell tries "never to swear even when [she's] barking mad. A well-bred dog does not swear, even when she's barking or growling." Oh, the world can sleep better now knowing that Tinkerbell Hilton does not swear."
Golly, and she does poor fiction as well.
Maybe it's a recessive gene. Maybe it's cross-cultural as well? snicker
*****
Vioxx Woes
The Vioxx scandal still shows no signs of abating, and by this time nearly everyone and his grandmother knows at least that Vioxx exists.
I've read all manner of reports now alternately condemning and defending it, penned by authorities and ignoramuses alike.
To me, the endrun is - Vioxx is a cox-2 specific inhibitor with no evidence of increased efficacy over conventional non steroidal anti-inflammatory agents, for example voltarol (diclofenac) in patients without peptic ulcer disease.
In the NHS, Vioxx was practically unattainable to the lowly casualty (ie A&E / ER) practitioner since it was clearly indicated for only a subset of patients with existing peptic ulcer disease (PUD) - although the same could not be said of GPs who apparently could prescribe it at their discretion.
I saw many a patient with non-specific abdo pain (ie came in in intense agony, but not with clinical signs of an acute abdo, which resolved with a cocktail of strong painkillers and antacid preperations) who actually responded well to drugs like voltarol, and sent many home with low-doze omeprazole / pantoprazole coverage till their GPs could organise an oro-gastro-duodenoscopy for persistent symptoms to exclude peptic ulcer disease (and, I was always careful to add on the discharge letter, "treat as appropriate" since some - a very very select few - GPs follow letters to the T, and no further... must be all that time spent playing golf and going on holiday with the family eating into their clinical practice time...)
I did see a fair number of cases of NSAID induced gastritis and several perforated peptic ulcers, but my argument against the indiscriminate use of vioxx at the time was more along the lines that greater discriminatory use of conventional NSAIDs, +/- antacid or PPI cover was probably the more sensible action - although at the time there was no suspician of increased cardiac risk, and the known, theoretical renal risk seemed rather remote in otherwise healthy patients : this cardiac risk thing comes as a shocker to us all. Quite possibly the only reason I was against vioxx was because I'd been brainwashed by the skint NHS system into always reaching for the cheaper drug, and instinctively shying away from flashy, new-fangled medications that might actually do our patients good. Laughs.
What I cannot stomach, however are the reports that attempt to defend Vioxx by stating that the absolute risk of a cardiac event remains small with Vioxx. That seems to be just plain irresponsible to me, and I for one am glad Merck Sharp and Dome didn't attempt to defend Vioxx on those grounds, and instead pulled the drug from the market (which makes one suspect that they may have already known about this, ah, minor technical glitch with their wonderdrug?) the second word came out. Be as it may, Vioxx doubles to triples risk of a cardiac event, and that is a highly statistically significant result. Even should a single individual's risk remain low on the drug - think about how commonly the drug was being prescribed when it was pulled from the market : It was the new Bread almost - not even "the next best thing to come along since sliced bread". Small absolute risk in a large number of patients = (relatively) large - and intolerable absolute number of deaths or cardiac events... far worse than a small absolute risk in a small number of patients (which is the best-case scenario for Vioxx in the case of that long-forgotten ideal, "intelligent prescribing). One can't help but wonder just how many people paid the ultimate price for their GP's moment of weakness in being wooed over to the Dark Side by some babelicious... babe... in black (ie drug rep) or some fancy corporate-style Drug dinner party.
The thing that puzzles me though, is the number of ordinary joes coming to Vioxx's defence, stating that they'd rather risk dying than be in pain (I'll try to find that URL sometime. Saw it online somewhere). There are so many alternatives to Vioxx on the market which have been shown to work just as well. Is it really worth dying to prove a point?
Must be the new age Martyrdom.
*****
Bush and Kerry, Fight!
Just in case anyone missed these gems, JibJab.com have created two hilarious spoofs of the whole Presidential Elections thingummy. Link discovered courtesy of msn.com. A MUST SEE. Rated 10 out of 10 purple hearts!
*****
Do the Running Man
2.4 km, 10.50 but in mitigation, there were new challenges not previously seen in the gym, namely hills.
ouch argh.
It was beautiful weather for it today though, cool, slightly breezy, very fine drizzle. Made me think of London in Summer. hehe.
Bugger, mom is calling me for yet torture on the tinkly ivories. Can't feign sleep this time...
Hmm.
"The most atrocious part of the book can be attributed to Tinkerbell, Paris' teacup Chihuahua. The heiress delves into the world of creative writing, assuming the role of Tinkerbell, and she really didn't want to go there. Tinkerbell tries "never to swear even when [she's] barking mad. A well-bred dog does not swear, even when she's barking or growling." Oh, the world can sleep better now knowing that Tinkerbell Hilton does not swear."
Golly, and she does poor fiction as well.
Maybe it's a recessive gene. Maybe it's cross-cultural as well? snicker
*****
Vioxx Woes
The Vioxx scandal still shows no signs of abating, and by this time nearly everyone and his grandmother knows at least that Vioxx exists.
I've read all manner of reports now alternately condemning and defending it, penned by authorities and ignoramuses alike.
To me, the endrun is - Vioxx is a cox-2 specific inhibitor with no evidence of increased efficacy over conventional non steroidal anti-inflammatory agents, for example voltarol (diclofenac) in patients without peptic ulcer disease.
In the NHS, Vioxx was practically unattainable to the lowly casualty (ie A&E / ER) practitioner since it was clearly indicated for only a subset of patients with existing peptic ulcer disease (PUD) - although the same could not be said of GPs who apparently could prescribe it at their discretion.
I saw many a patient with non-specific abdo pain (ie came in in intense agony, but not with clinical signs of an acute abdo, which resolved with a cocktail of strong painkillers and antacid preperations) who actually responded well to drugs like voltarol, and sent many home with low-doze omeprazole / pantoprazole coverage till their GPs could organise an oro-gastro-duodenoscopy for persistent symptoms to exclude peptic ulcer disease (and, I was always careful to add on the discharge letter, "treat as appropriate" since some - a very very select few - GPs follow letters to the T, and no further... must be all that time spent playing golf and going on holiday with the family eating into their clinical practice time...)
I did see a fair number of cases of NSAID induced gastritis and several perforated peptic ulcers, but my argument against the indiscriminate use of vioxx at the time was more along the lines that greater discriminatory use of conventional NSAIDs, +/- antacid or PPI cover was probably the more sensible action - although at the time there was no suspician of increased cardiac risk, and the known, theoretical renal risk seemed rather remote in otherwise healthy patients : this cardiac risk thing comes as a shocker to us all. Quite possibly the only reason I was against vioxx was because I'd been brainwashed by the skint NHS system into always reaching for the cheaper drug, and instinctively shying away from flashy, new-fangled medications that might actually do our patients good. Laughs.
What I cannot stomach, however are the reports that attempt to defend Vioxx by stating that the absolute risk of a cardiac event remains small with Vioxx. That seems to be just plain irresponsible to me, and I for one am glad Merck Sharp and Dome didn't attempt to defend Vioxx on those grounds, and instead pulled the drug from the market (which makes one suspect that they may have already known about this, ah, minor technical glitch with their wonderdrug?) the second word came out. Be as it may, Vioxx doubles to triples risk of a cardiac event, and that is a highly statistically significant result. Even should a single individual's risk remain low on the drug - think about how commonly the drug was being prescribed when it was pulled from the market : It was the new Bread almost - not even "the next best thing to come along since sliced bread". Small absolute risk in a large number of patients = (relatively) large - and intolerable absolute number of deaths or cardiac events... far worse than a small absolute risk in a small number of patients (which is the best-case scenario for Vioxx in the case of that long-forgotten ideal, "intelligent prescribing). One can't help but wonder just how many people paid the ultimate price for their GP's moment of weakness in being wooed over to the Dark Side by some babelicious... babe... in black (ie drug rep) or some fancy corporate-style Drug dinner party.
The thing that puzzles me though, is the number of ordinary joes coming to Vioxx's defence, stating that they'd rather risk dying than be in pain (I'll try to find that URL sometime. Saw it online somewhere). There are so many alternatives to Vioxx on the market which have been shown to work just as well. Is it really worth dying to prove a point?
Must be the new age Martyrdom.
*****
Bush and Kerry, Fight!
Just in case anyone missed these gems, JibJab.com have created two hilarious spoofs of the whole Presidential Elections thingummy. Link discovered courtesy of msn.com. A MUST SEE. Rated 10 out of 10 purple hearts!
*****
Do the Running Man
2.4 km, 10.50 but in mitigation, there were new challenges not previously seen in the gym, namely hills.
ouch argh.
It was beautiful weather for it today though, cool, slightly breezy, very fine drizzle. Made me think of London in Summer. hehe.
Bugger, mom is calling me for yet torture on the tinkly ivories. Can't feign sleep this time...
