Do you remember the Aesop’s Fable about the Fox and the Grapes?

A FAMISHED FOX saw some clusters of ripe black grapes hanging from a trellised vine. She resorted to all her tricks to get at them, but wearied herself in vain, for she could not reach them. At last she turned away, hiding her disappointment and saying: “The Grapes are sour, and not ripe as I thought.” (1)

The above is a fable about persistence. Might the outcome have been different if the Fox has been more persistent? One would never know. See how easy it was for the Fox to despise what seemed unattainable.

..

You may wonder where I am going with this but bear with me. A number of things happened in the last few weeks that makes me ask the question: Why would you not want to know? Why would you not want to know why all of a sudden you feel lousy?…Why all of a sudden you feel tired all the time?…Why all of a sudden you simply stop feeling ‘right’? Something is wrong but you are reluctant to investigate what it is. In my experience, I am unaware of any serious medical condition that would not benefit from early diagnosis. Well, don’t trust my experience; let us examine the facts together. Table 1 is a pool of the effect of early diagnosis on some medical conditions:

Table 1 - Effect of Early Diagnosis

These are just some examples and there are lots more. The prognosis (positive or negative) of any one disease can only be made after diagnosis. Armed with such fact, why might you not want to know if something is wrong? Any of the following could perhaps be possible reasons?

• The fear of the worst case scenario. Because you fear the worst, you might not want to know. I will say this: if you already have the worst case scenario, you have just raised the stakes without adequate treatment or intervention. If you take the example of prostate cancer, then you are denying yourself the chance of a near 100% cure by not acting soon.
• You are not insured. If you are in a society where you have to pay for healthcare and you are not insured (or cannot pay), then you might be at a loose end and might feel the best option is to not know since you will be in no position to deal with the financial consequence of knowing. I will advise you to carefully consider your options before making such a drastic decision. Helps are sometimes available from unlikely sources. Now let’s say you live in the UK, with the NHS and its characteristic free access to urgent medical treatment. Why would you still not want to know?!
• You knew someone who wanted to know but ‘what good it did him! He was dead before you could say fetch!’ You need to understand that people are different and diseases may affect people differently. What makes you think you have the same condition anyway? You are better off knowing, even if you are likely to die before you could say fetch! I bet you wouldn’t.

Now to my main point: If you consider all the really serious conditions, the early signs and symptoms may appear innocuous. Take Multiple Sclerosis, a common neurological condition affecting 1 person in 600 in the UK. One of the common non-specific symptom is fatigue ‘…associated with specific neurological symptoms, fluctuates with heat, exercise or as the day proceeds, and is alleviated by short period of rest’ (6). Now will you associate this symptom with MS straight away? No one can. Diagnosing these conditions can be a challenge in itself. Not everyone with fatigue will have MS! However, if after all explanation are exhausted and you still feel unwell, then you must not be the Fox in Aesop’s fable. Keep going back for further investigation and you may even buy yourself valuable time.

Have a merry Christmas and a Happy New year.

(1 votes, average: 4 out of 5)

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Reference

1. http://www.aesopfables.com/cgi/aesop1.cgi?2&TheFoxandtheGrapes

2. ME Diagnosis: Delay Harms Health; Early diagnosis: why is it so important? A report from the ME Alliance; http://www.afme.org.uk/res/img/resources/ME%20Diagnosis%20Report%20master.pdf

3. Early Diagnosis of Alzheimer’s Disease: Clinical and Economic Benefits; Bennett P. Leifer, MD; J Am Geriatr Soc 51:S281–S288, 2003; http://www.blackwell-synergy.com/doi/abs/10.1046/j.1532-5415.5153.x

4. New Perspectives in Multiple Sclerosis: An Expert Interview With Mark S. Freedman, HBSc, MSc, MD
http://www.medscape.com/viewarticle/546714

5. http://www.articlehere.com/Article/Prostate-Cancer-Symptoms—Benefits-of-Early-Diagnosis/14242

6. Making the diagnosis of Multiple Sclerosis: J Palace: J. Neurol. Neurosurg. Psychiatry 2001;71;3-8, doi:10.1136/jnnp.71.suppl_2.ii3
http://jnnp.bmj.com/cgi/reprint/71/suppl_2/ii3.pdf

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I hope we do more than this though!

courtesy of nousernamesarefree channel

- Kazeem

(1 votes, average: 3 out of 5)

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Pfizer has decided to withdraw its novel inhaled insulin, Exubera..not because of safety problems…not beacuse of negative response from patients but because ‘too few patients are taking EXUBERA’ (1)

How could this be? Diabetic patients have been crying for a less painful way of administering insulin for years..Here is a product that requires no injection but prescibers are not using it.

Low take up should have been anticipated

If you examine the datasheet for this product closely you will find that there are specific reasons why the low take up of this product is not surprising. I have identified these below:

The prescriber will always play safe

Diabetes mellitus occurs because of a lack of insulin or resistance to its action. The decision to put someone on insulin is generally the last resort for type 2 patients and the mainstay for type 1 patients. The effect of inappropriate control of blood sugar can result in serious consequences for the patient - retinopathy, neuropathy and nephropathy to mention a few.

Let us forget about the evidence for one moment (these are undoubtably important). Exubera is inhaled - yes. Another class of drug which are administered by inhalation are drugs for relieving asthma and other respiratory conditions. The evidence here for the appropriate use of inhaled medication is not good. It has been suggested that one of the reasons for poor asthma control is the inappropriate use of the devices. The prescriber has this at the back of his mind.

Diabetes is a strong risk factor for cardiovascular disease. A significant proportion of patients presenting with Diabetes (especially type 2 ) probably have other risk factors such as smoking, hypertension and obesity. Well you can’t use Exubera if ‘You smoke, start smoking, or if you quit smoking less than 6 months ago; You have an unstable or poorly controlled lung disease (such as unstable or poorly controlled asthma, chronic obstructive pulmonary disease, or emphysema)’ (1)

That rules out a lot of candidates then.

When you put all of these in the pot…the patient is either excluded or the prescribers will stick to tried and tested interventions.

Getting the pricing right

If Pfizer accepts that this is not going to be a drug for everyone, it must price the product appropriately. Less volume, more expensive drug. With tight squeeze on NHS drug budgets, it will be difficult, if not impossible, to allow an expensive inhaled insulin to be freely prescribeable. PCT will watch the pattern of prescibing this drug like a hawk (well…understandably!). In actual fact, I feel Exubera is reasonably priced considering the time and costs of developing this delivery system (table 1):

Undoubtedly, this drug will not be for everyone. It will only be suitable for a niche patient group. Hence Pfizer pricing model should have reflected this. I don’t have the facts but I suspect, Pfizer was less conservative with its estimations of target patients (why else will there be a need to withdraw the product now?). Should the price have been set higher, with the proviso to reduce price or even refund some cash to the NHS if take up of drug prove to be higher?

General Practitioners want new ways of treating conditions which will bring benefits to the patients and I suspect they will actively look for patients who will benefit from the use of a particular new drug.

My Concern

You lure patients into the promise of a novel intervention and then have to withdraw it because not enough people has taken it up! What happens to the patients already stabilised on this therapy? I am sure we all agree that this is a useful drug…why not give it a chance.

My challenge to pharmaceutical companies is this…when pricing a new drug, be realistic about the potential take-up of the product and price the products appropriately. This threat of withdrawal or intention to withdraw is no good to anyone.

(2 votes, average: 4.5 out of 5)

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how to suffocate a maggot

-88Jwd

(1 votes, average: 4 out of 5)

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—>

we must remember to place this on our wall….for the sake of sanity

-88Jwd

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Is there no end to Google’s talents? Most people are talking about Google…we should all now start speaking googledygook: I will define this as a language (usually unintelligible) spoken by someone trying to cram a lot of the word ‘google’ into a statement - maybe to show some affection for the technology behemoth or to loath it or even just to brag to colleagues or whoever cares to listen about how smart you are (or think)! Google polarizes opinions: You either love or hate it…Like the famous Marmite adverts.

Check out this example of googledygook:

‘We are now developing a Google-like video ad solution to challenge YouTube. Our solution will defeat Google’s dominance in search which will generate a lot of ad revenue for our shareholders, who have sworn an oath never to allow a Google buy in!’

Well I managed to squeeze in 3 Googles into the above statement…I wonder if you could do better…I am no expert in googledygook..

Kazeem

(1 votes, average: 4 out of 5)

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well done: thebuttonmushroom

(1 votes, average: 4 out of 5)

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MHRA statement [23.05.2007]

-88Jwd

(1 votes, average: 3 out of 5)

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1. PubMed

2. Attract

-88Jwd

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.

.
How nebulous are the following?:

[a] If you smoke whilst pregnant, there is a good chance you could kill your baby through spontaneous abortion or sudden infant cot death! Even if your baby survives, he/she may arrive too early or have a low weight. That can’t be good…can it?

[b] Passive smoking (breathing in other people’s cigarettes smoke) can make you cough, give you sore throat, make you sneeze, give you headache, make you feel sick. And these are the easy stuff! Long term, you are likely to get recurrent chest problems and infection, high risk of heart and lung disease and if you are pregnant, pass those nasty gases to your unborn child!

[c] OK, you live in a bubble! You are not pregnant and you smoke by yourself! What about the risks to yourself? Yes, nicotine from cigarette will leave you wanting more, make you depressed, irritable, restless, light headed and may leave you a nervous wreck.

[d] Check out the endless list of illness caused by smoking (2)

Mark your diary:

Make 1st of July a day you decide to quit. When you are ready, speak to someone - a professional who will support you on the road to quitting. Speak to your Doctor, Speak to your Local Pharmacist or NHS direct (3). Majority of your local pharmacies are now in a position to offer 1 to 1 smoking cessation advice.

Remember, when you stop smoking now, your blood pressure and heart rate will return to normal after 20 minutes, and after 8 hours your blood oxygen level will return to normal. After 24 hours all the carbon monoxide clears from your body. Your risk of heart attack falls to about half after 5 years. After 10 years, your risk of developing lung cancer falls to about half.

What you need to do now:

[a] Prepare yourself to quit

[b] Enlist the support of close friends and relatives

[c] Keep a diary of when you smoke. If you can, avoid the particular situations which encourage you to smoke.

[d] Book a 1 to 1 appointment with your healthcare professional.

[e] Get prescription for the right type of product to help you quit.

[f] If you do start smoking again, don’t worry, just start again from [a] above and this time promise yourself to stay off for longer than before.

[g] Remember to reward yourself when you succeed -celebrate success.

NO ONE WILL BE HAPPIER THAN YOU! - ENJOY A SMOKE-FREE YEAR

-88Jwd

References:

1. Smokefree: http://www.smokefreeengland.co.uk

2. ASH - Action on Smoking and Health: http://www.ash.org.uk

3. NHS Direct - http://www.nhsdirect.nhs.uk

(1 votes, average: 3 out of 5)

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