Friday, August 21, 2009

Mercy droppeth from heaven

Abdelbaset al-Megrahi, convicted of the bombing of Pan-Am flight 103 over Lockerbie in 1985 and in a Scottish jail since 2001, was released by Scotland yesterday on compassionate grounds: he is dying of cancer and has three months to live. Megrahi himself has always claimed to be innocent.

The relatives of US victims, as quoted in the media, are all furious. The relatives of the UK victims, on the other hand, are mostly supportive of the release, and several in fact remain unconvinced of Megrahi's guild.

The reaction of the US establishment has been equally furious, from the President down, but they were powerless.

Sample quote: "There is simply no justification for releasing this convicted terrorist whose actions took the lives of 270 individuals." (US attorney general Eric Holder)

Well, what about another terrorist, Luis Posada Carriles, against whom there is considerably stronger evidence that he masterminded the bombing of Cubana flight 455 in 1976, as well as numerous other terror attacks? Oh, but he was fighting the Castro regime in Cuba. He must be one of the good guys.

Monday, August 17, 2009

Prevention and cure

I'll keep this one brief. The message is "prevention is better than cure".

First: Everyone is scared of "swine flu". It may be impossible to prevent if you live and work in crowded places, but one can greatly minimise the risks by washing hands frequently (or using hand sanitiser gels, which one can carry in one's pocket) and not touching one's face with one's hands. And that way, you reduce the risk of a lot of other illnesses. On the other hand, if you do have suspected swine flu, this is what Tamiflu could do to you or your kids. Not pretty.

Second: a truly thought-provoking article on healthcare in the US, and why the focus is on cure rather than prevention, even inside hospitals -- even inside emergency rooms known for transmitting hospital-borne infections!

How much could society benefit if we spent a fraction as much on prevention (and education on prevention) as on cure?

Update: BMJ blog post on antiviral recommendations. And Sunil Mukhi, who starts with the best headline yet and doesn't let up from there. He makes a point that I had forgotten: what about spitting? Can we now start locking up spitters, Singapore-style?

Friday, August 07, 2009

Ghostwritten medical literature

How does one believe that a doctor's prescriptions are in your best interests? In India, the really good doctors are going by long experience with patients. The bad ones go by the marketing materials of pharmaceutical companies. Very few doctors read the medical literature actively. Yet, as a scientist, I would like to believe that the peer-reviewed medical literature should be the first resource for a good doctor in trying out new treatments.

And then one comes across stories like this New York Times article:

Newly unveiled court documents show that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women, suggesting that the level of hidden industry influence on medical literature is broader than previously known.

The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks of taking hormones to protect against maladies like aging skin, heart disease and dementia. That supposed medical consensus benefited Wyeth, the pharmaceutical company that paid a medical communications firm to draft the papers, as sales of its hormone drugs, called Premarin and Prempro, soared to nearly $2 billion in 2001.....

The court documents were unveiled after a request from the NYT and the journal PLoS Medicine, which has a blog post on the topic.

This is probably the tip of the iceberg. It is not the first time I have worried about the reliability of medical advice. But I don't think the utter corruption and depravity -- I wish I could think of stronger words -- of medical research has been so clearly exposed before.

When Jan-Hendrik Schön falsifies his research, other researchers end up wasting their time and money and the field is set back by a few years. When doctors lend their names to the publicity material of pharmaceutical companies, ordinary people suffer and possibly die. Wyeth now faces about 8400 lawsuits about the consequences of their "hormone replacement therapy", but no amount of money can compensate the victims. And what of the doctors who agreed, and continue to agree, to be a part of this sordid game? We can boycott individuals like Dr Gloria Bachmann, named in the article (I wonder how many will do so, though), but how do we find a doctor we can trust? Luckily we do have a very sound paediatrician, of whom I may write more later. But we have also had bad experiences with other doctors (I gave one example here, but it was not the only one).

The medical industry is constantly worried, with good reason, that people are going for "alternative" treatments that may range from good-but-of-limited-scope (ayurveda, naturopathy) to ineffective but probably harmless (homeopathy, the genuine kind) to possibly dangerous (additives in many so-called "herbal" or "homeopathic" medicines) to totally crackpot (chiropractic). It is indeed very worrying. But the people who go for these therapies have decided that the medical community is in the pockets of the pharmaceutical industry, and are looking out only for the industry's interests and not the patient's. This is unfair to the majority of medical practitioners, but I increasingly feel, accurate about the most high-profile and headline-hogging doctors, in this country and elsewhere. The medical profession has to find a way to tackle this, if patients aren't to be driven to cranks and quackery.