The Shipwreck of the Singular

December, 17, 2012 | 5 Comments


  1. Thalidomide has returned, after having been found to be effective for several conditions including multiple myeloma. Thalomid is the brand name sold by Celgene Corporation, and is now licensed in Canada In certain trials in recent years, “thalidomide demonstrated benefits in multiple myeloma patients and is being made available in Canada to treat those patients who are 65 years of age or older.”
    In 1998, thalidomide was approved by the US Food and Drug Administration (FDA) for the treatment of leprosy. In 2006, a new FDA approval was granted for thalidomide in combination with dexamethasone for the treatment of multiple myeloma. Thalidomide is also approved in other countries including Australia and the European Union.
    Health Canada has “carefully reviewed” data on thalidomide and the drug is only available through a controlled distribution program called RevAid. This means only doctors and pharmacists registered with RevAid can give out the product, and all patients must be registered in the program. Prescriptions only last for a limited number of days and women patients who may become pregnant must have regular checkups to make sure they are not pregnant while taking the drug, and must use two forms of contraception. Patients must also not donate semen or blood during, and four weeks after their thalidomide treatment. (Perhaps abstaining from sexual intercourse might be safer.)
    Never let it be said that BigPharma will miss any chance to use drugs that have been languishing in their warehouses.

  2. Many years ago, it was recommended that consent forms should be written at no higher than an 8th grade level since many patient did not actually understand them. I don’t believe that was ever done. Now we find, to no surprise that medication guides, provided to patients with certain prescription medications, “fall below the threshold of acceptable standards for patient print materials set by both professional societies and the federal government,” reported in the Journal of General Internal Medicine.
    The authors assessed 185 FDA-approved medication guides and rated only one as “suitable” overall for readability and ease of use. Only seven guides had an 8th grade reading level or less. None provided reviews or started with context. Roughly 30 of the guides had been assessed in 2006; some had improved readability, but others had declines.
    In addition, about 450 English-speaking adult primary care patients were asked to rate their comprehension of medication guides for Ritalin, morphine sulfate, and Aranesp. The mean comprehension score was low (53 out of 99).
    The authors recommend that a uniform standard for medication guides be developed.
    How, then, is informed consent to be given?
    Journal of General Internal Medicine article (Free)

  3. It was painful to read about the last hours of MP Ann Clwyd’s husband, who she charged was neglected and callously treated as he lay dying in a Cardiff hospital. She’s right; this shouldn’t happen to anyone. But is a culture of cruelty among nurses to blame? (It sounded too much like the scapegoating of schoolteachers over here, and for similar reasons.) I found a columnist in the Guardian who tried to give a nurse’s-eye view of the problem:

    “After I sent out a single tweet asking nurses to come forward with their opinions, my inbox was flooded within minutes. Nurses and their sympathetic colleagues were desperate, it seemed, for the public to understand that in many cases they are simply unable to fulfil their duties because the resources are not available.

    “One nurse told me that she worked a shift where there was no clean linen available in the entire hospital and patients had to lie in their beds naked: “I hated seeing my patients like that.”

    “A trainee midwife talked about a patient who went into labour when there were no available beds for 125 miles: “She ended up having an antepartum haemorrhage. She wouldn’t have made it if this had happened a few hours earlier in transit.”

    “A mental health nurse emphasised the effect on morale: “We are struggling and distressed because we know our patients are not getting the support they should, and feel we aren’t meeting our code of conduct as we can’t provide care to the standard that we should. Colleagues are regularly in tears.”

    “Doctors contacted me to support the nurses they work with. One explicitly blamed a perceived decline in compassion on cutbacks: “Compassion time is squeezed out of the day and sacrificed on the altar of efficiency.”

    That last quote is striking. It’s a bizarre world where we’d have to defend “compassion” in medical care, even purely for its own sake and as a value all its own. But what kind of “efficiency” can you have in the long run in a health care system where the individual patient is silenced and dealt with like a thing? At too many hospitals in the U.S. – and practically all the nursing homes – the labor of registered nurses is considered too expensive a commodity to “waste” on feeding the patient, talking to him or taking him to the toilet. That’s done by harried, poorly trained aides whose labor sells for less than that of grocery store cashiers. If our patient can’t get from the bed to the toilet, is it because he’s dizzy? Because his legs are weak? Because he’s losing the will to live? The aides may not know, and the nurse will have no idea, because she won’t be summoned until there’s a crisis.

    If your goal is simply hold down costs or “maximize billable hours” this may look like efficiency – but if your goal has something to do with healthier people, it’s the opposite of efficiency. It seems to me to be very like what’s happening in psychiatry and elsewhere, with medications being dispensed on an assembly-line basis as a substitute for care. Maybe we ought to say that a drug – a safe drug – is a chemical that comes with people attached. People who are allowed to give a damn.

  4. That is very, very good. A chemical that comes with people attached.

    It’s always the luck of the draw when forced to interact with anyone at all in the old fashioned ‘caring profession’. It has all gone pear shaped, not only with lonely old people who no-one cares about, but with someone who walks in the door of a surgery and says ‘I don’t feel very well on this drug.’ From then on the decisions are out of your hands. Once, again, Russian Roulette.

    No one contemplated Thalidomide. It was horrific and yet, nothing happened for over fifty years. An apology was granted not long ago. This week, these seriously disfigured people are to receive some money because they are old now, and it is difficult for them to chop vegetables, when they have no arms or legs and, which they did manage, but now they are old, they now cannot.

    I am hoping that we do not have to go through fifty years of blatant denial regarding ssri injuries, and although, we kept our arms and legs, something valuable and intrinsic to our life was taken from us. Taken from us, and worse, thrown back in our face.
    By this, I mean, us, watching the incredible twists and turns of an industry, designed to weaken the sufferers, not strengthen them……..and that is the curse of new ‘medicine’ today equipped with the ‘drug dealers’……….’modern’ doctoring……
    This is another Thalidomide and where are we now…………..
    We have gone back fifty years……….and who would have thought it??

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