Category: Commentary

A few weeks ago the Economist Magazine offered up the lament that comparison shopping is very difficult to do when it comes to medications because the underlying studies have not been done. It is difficult enough for pharmaceutical companies to get new drugs past their regulatory hurdles via Randomized Controlled Trials against a placebo control. Once that goal has been reached, drug companies feel free to peddle their new medications at will, perhaps allowing the implicit assumption to be propagated that newer is better.

Only a few weeks after the appearance of this article (Jan 12th issue, p. 68), this very issue was brought to the front pages with the published finding that two newer anti-cholesterol drugs, Vytorin and Zetia, may not hold an advantage over older drugs, such as Zocor, that have gone off patent. (Vytorin is a combination of Zetia and Zocor.) In the immediate task of reducing cholesterol levels, Vytorin did appear to offer an advantage. But this numerical advantage did not seem to yield a clinical payoff in terms of reduced plaque buildup in coronary and carotid arteries. Also the trendlines were worse for heart attacks, strokes, and the incidence of associated medical procedures such as angioplasties and bypass operations. This deterioration did not reach statistical significance, but one had expected better on the basis of the cholesterol numbers. On balance, there did not seem to be any selective clinical benefit from using the more expensive new drugs. One could even go so far as to say that the basic cholesterol hypothesis was being called into question. Continue reading “Comparison Shopping in Medicines”

Sometimes we who work with neurofeedback have the impression of living in a parallel universe. We live with a view of reality that is attaining increasing confirmation via formal studies while at the same time becoming much more clinically effective, yet it is a view that appears to be almost completely disconnected from mainstream thinking. This state of affairs is not unfamiliar to people who have studied Thomas Kuhn’s “The Structure of Scientific Revolutions,” but it is still somewhat breathtaking to see how long the split between the old and new paradigms can persist in the real world. Continue reading “Parallel Universes”

We have just seen the new movie, The Diving Bell and the Butterfly, which opened here recently in limited release. I had read the book some years ago because of its graphic telling of the story of locked-in syndrome. Jean-Dominique Bauby, editor of the French edition of Elle, had a brainstem stroke that left him entirely paralyzed except for movement in one eye. The other eye, bereft of episodic lavage, is sewn shut as he rages inside, unable to object.

Initially I could not imagine how this story could be made into a movie. My point of comparison was the movie made of Dalton Trumbo’s book, “Johnny Got His Gun,” which is an ordeal to watch. A couple of favorable reviews overcame my natural resistance, and we were very much rewarded. A story like this must be told with some humor mixed in, and this one does so. The ham-fistedness of the French doctors; the friends who can’t find the right words to say; the fly that lands on his nose. Then there is the steadfastness and earnestness of the therapists, affronted when he tells them that he wishes simply to die. And there is the poignancy of the call from his mistress while the mother of his children is sitting in the room tending to him, and of the flashback to his giving his aging father a shave. Continue reading “The Diving Bell and the Butterfly”