Archive for April, 2006

What I’m Reading Today

Saturday, April 29th, 2006

The miscellanious round-up, while I wait for the coffee to infuse my system enough to pack and wander my way towards the airport.

Pfizer Boldly Advertising Celebrex Again – but with a big ol’ warning about the risk of heart attack and/or stroke.

I took Celebrex for a year, maybe more, and have to admit it made my life a lot easier during that time. At the very bottom of the article, Michael Krensavage, a drug industry analyst at Raymond James, says “I would try an ibuprofen first.” Well, thanks Michael K – but I did, and I was taking like 10 ibuprofen a day, which is never good for the liver, and still getting no pain relief. One Celebrex later, and I could move without wanting to cry (this was back when my rotar cuff was torn).

All drugs carry risks and benefits. It’s up to you and your doctor (note: doctor, not pharmacist) to determine what the right drugs are for you.

And lest anyone think last weeks Bones episode The Graft in the Girl, was just more scary science fiction, Stolen body parts linked to patients’ illnesses; several lawsuits claim tissue transplants were infected with viruses and other germs. Four men, one of whom worked for a tissue provider, have been charged with carving up corpses and selling their parts without consent. And oh yeah, they’re diseased and old and damaged parts.

Quite literally the entire plot of the last Bones, down to almost the exact same name of the tissue company. Life, meet art. Art, meet life.

GlaxoSmithKline, Europe’s biggest drugs manufacturer, yesterday defended itself against accusations that it is turning healthy people into patients by “disease mongering” and pushing “lifestyle” treatments for little-known ailments. Charming, ‘cept I don’t believe a word of it. I’m actually having fun collecting a list of all the drug advert commercials I see – I figure it will make a nice column for The Daily.

I particularly love the line “It is easy to trivialise things when you don’t have them. If people did not want the treatments, they would not seek them.” …or, you know, people wouldn’t think about it being an issue if they weren’t told it was one. We spent a while talking about the concept of taught illness in my philosophy of medicine class last quarter. Perhaps I should interview Sara for the article, heh.

Wired has another take on the pill pushers, noting that although Novartis employs some of the most brilliant minds in the pharmaceutical research field, developing impressive leukemia fighting drugs like Gleevec, their fourth most profitable drug is Lamisil.

Lamisil treats toenail fungus. It’s not life threatening. It turns your toenails yellow. And for three months and about $850, you can cure it. And 10 million Americans have, or are trying. And yet, in those numbers, a very small percent have had what you might call a significant reaction to Lamisil – they’ve died.

And yet because of their effective marketing campaign, with Digger the Dermatophyte, a campaign costing them $236 million in three years, Americans are lining up to take a drug that only completely cures 38% of them.

That’s a pretty low cure rate for a mostly invisible (after all, most of us wear closed-toed shoes) fungal problem that does nothing other than making your toe nails yellow.

Can I market a new cure for toenail fungus? I’ll call it… Polimisil. It’s a simple treatment, involving the application of a tinted liquid substance that dries to the toenail, masking the originating colour of the nail. You get approximately 60 treatments per bottle, each treatment lasting about a week. And for this amazing cure, I’ll only charge you $40 a bottle! That’s less than $1 a treatment!

C’mon, you know you want to!

On the other side of the pharmaceutical fence, (wow, I’m just all big pharma lately), Genzyme won FDA permission to sell a new drug to treat Pompe disease, a rare inherited enzyme disfunction. One of the problems with big pharma is that since they are businesses, they have incentive to develop and produce drugs for common problems, like arthritis, so they can make lots and lots of money. Practically speaking, this means that rare diseases, like Pompe, are often overlooked, because there is simply not the client base that would justify the research and development costs.

In doing something right for a change, our government has developed an incentives program for companies developing treatment for these rare illnesses; in fact, that’s what Genzyme specializes in.

0

Faith Healing and the Body

Tuesday, April 25th, 2006

Tonight’s episode of House dealt with the idea of faith healing, something that comes up a lot these days in medical journals. What is the power of prayer? Does faith healing work? Can miracles happen?

I realize it’s a symptom of my interdisciplinary training, and perhaps of being under Phillip’s thumb in particular, but I think a more interesting question is why miracles can’t happen? After all, a miracle is just that which we don’t understand. As has been often remarked, our technically is magic to those who don’t understand how it works, as is often our medicine. The typical example is a cell phone in the rain forest, although I’d argue there’s an awful lot of technology and medicine that might as well be magic for our understanding – there is simply the belief, the faith that it will work, because someone is being told it will work.

How is that so different than hearing a faith healer tell you the same?

Of course, we of the rational, medical type say we have medicine, we can take the time to understand how technology works. But we can’t fully understand how the body works; we keep finding new things, miracles keep being rationalized and understood, filed away into things to learn and knowledge to distill.

If we have learned one thing, it’s that the body is an amazing thing. Who’s to say that the power of the placebo effect, the mind, isn’t enough to help some people? We know, scientifically, medically, that positive thinking does positively affect our health, including to help us recover from illness. Who knows?

We don’t, so it gets filed away as faith healing fakery and fraud. But in ten years, perhaps it will have a Latin name and a textbook. That’s the way knowledge goes, a part of life for both miracle and medicine.

0

The Daily: Finding Saviour in a Sibling

Monday, April 24th, 2006

Finding a savior in a sibling
Publish Date: 2006-04-17

This at last is bone of my bone and flesh of my flesh.

The paper reads, “‘Designer Baby’ clinic to charge ?6,000 a child.”

That’s a lot of money, even for an in-vitro fertilization (IVF) kid. The second sentence in the article explains, in a simple phrase, why: Savior siblings.

Savior siblings are not a new concept, and parents have been creating them for years.

Parents of sick children will, after all, go to great lengths to help their child, and savior siblings are children born in the hope that they will be genetic matches for a sick relative.

This option took on new life in 2000, when Adam Nash was born.

The Nash’s had a little girl with a disease that causes leukemia, and often death at a young age. Doctors theorized that cord blood from a donor would extend Molly’s life and prevent leukemia.

(Cord blood contains adult stem cells. The recipient is irradiated, killing his or her original bone marrow, and then infused with the blood. The stem cells migrate to the bone and begin creating new marrow.)

Molly’s parents underwent 4 rounds of IVF therapy combined with pre-implantation genetic diagnosis (PGD), ultimately creating 24 healthy embryos. Of those embryos, five were a match for Molly, and one implanted and was brought to term.

At Adam’s birth, the cord blood was collected; a short time later it was infused into Molly.

Today, Molly is an active sixth grader, thinks her younger brother is a pest, and adores her baby sister, Delaine.

Until now, Adam and the handful of other savior siblings have been a relative rarity. Most insurance companies will not cover IVF, let alone an IVF/PGD combination, and the out-of-pocket cost is staggering.

If the prospective parents can get around the cost hurdle, they still have to find a doctor, or a willing team of specialist doctors, to assist them. While many doctors have the expertise, the controversy around the practice has limited its availability.

This controversy is what brings designer-baby clinics to the news this week.

What, exactly, is that controversy?

First, people criticize the idea of savior siblings by saying that instead of each individual being an end unto themselves, savior siblings are used as a means to an end and that children should be wanted solely for being that child, not for being spare parts for another.

But the argument almost never stops at this admittedly valid concern.

Instead, it deviates.

It ceases to be about savior siblings, or even about a baser debate around IVF/PGD and whether it is an active form of eugenics.

The argument goes from what is possible to potential, from medicine and eliminating disease to a blonde-haired, blue-eyed, post-Nazi era, speculative fiction-fueled, designer-baby slippery slope.

This, inevitably, is where the debate circles and stops, going no further. That’s the shame in this whole mess.

Saying that creating babies that are free of a genetic disease, or are tissue matches for siblings, will lead to a genetically designed race of tall, blonde, buxom and blue-eyed babes who can all play the piano like Beethoven while writing like Austen is a non causa pro causa fallacy.

This sort of causal fallacy says that if A happens, then by a small series of indeterminable steps, Z will eventually happen and since they are tiny steps, we won’t be able to draw a line that should not be crossed.

And if Z shouldn’t happen, then neither should A.

The problem with this argument should be very clear: Anything has the potential to be used for ill.

What we should focus on is not the technology, but the people using it.

What we should focus on is not trying to stop medicine from preventing illness and curing disease, but making sure people are educated about the possibilities inherent in technology.

We should be discussing the idea of savior children and whether it’s okay for a human being to be created as a means to an end, or if those who’re so intentionally created have more thought gone into them than most.

0
Posted in Academics, Spring 06, The Daily |

Strangeness Abounds

Sunday, April 23rd, 2006

My parents just left, taking away the first carload of my stuff. Almost all my books are gone, as is one of my shelves, my teacups, a hanging lamp, other stuff. Anything small and free that could be lifted and removed.

The place doesn’t feel bare, or stripped – I put my foot down about a few items – but it does feel larger, emptier…

6 weeks.

I’ll be gone in 6 weeks.

0

Shay Saves the Day

Wednesday, April 19th, 2006

I took Shay’s advice, after pounding my head against my thesis so long I swear I’ve a large purple bruise on my forhead. I collected together all my writing in one document, in roughly the order I thought it should all go in. I then expanded around each section, explaining what else I thought needed to go in around these fuller paragraphs.

Suddenly, I have 20 pages of thesis. Which is between 1/3-1/5th of the way done with the project, and 20 pages more than I had yesterday.

More importantly, by far more importantly, I actually feel, now, like this is something I can do.

0