Tuesday, May 14, 2013

CONFLICT OF INTEREST

As a scientist, you tend to believe that your reason will protect against bias.  But reason itself is biased by information it gets from so called experts, culture and Media, to just mention a few sources.   But when an expert working for a drug company is "pitching" a few key messages to which you are sensitive, somewhere you wonder if the expert opinion is not coerced by someone else's suggestion.
Some of us who have seen the worst cases of Neuropathy induced by Taxanes, have become somewhat "sensitized" to the subject.  So to hear that a piano player or artist (who need needs fine hands for their craft) with Metastatic Prostate cancer has to choose between Docetaxel and Abiraterone.  To the sensitized oncologist, the choice is clear.  Abiraterone is the winner!  But was creating a fictitious case of the artist necessary?  Or is-it one of the techniques of brain manipulation?
During residency and fellowship, some directors of  programs banned lunches from drug companies and avoided drug companies contact with trainees.  These decisions are generally unpopular among the trainees who are precluded from free lunches, but are rid of drug companies' influence.  As a trainee, I myself had to question the necessity of such exclusive and drastic decision.  Ultimately, can we trust a trainee to make up his or her mind?  Drug companies on the other hand have their survival in mind and keep sharpening those messages that will influence your practice by any mean they can!

A gardener and writer, spare him the neuropathy! but of course! and the winner is Abiraterone!  But know this: soon or later, the Docetaxel conversation is bound to happen!  It is the power of the drug and the reliability in providing the cure!

How much confidence do you have by prescribing Abiraterone vs Docetaxel in a patient with metastatic prostate cancer, that you will have a response? and the winner is........  Oncologists, just come on and say it!  Let's say in a very symptomatic patient, which drug will you give first? That phase III will not occur in real life!

To mark this fact, researchers did not sleep! It has been reported, at the British Columbia Cancer Agency in Vancouver, they noted that the introduction of Taxotere in the treatment of Hormone Refractory Prostate Cancer has yielded an absolute 6.8% improvement of number of patients alive at 2 years.  That's a small town population alive because of the drug!  That's the power of a drug (when it hits or follows the law of nature!).  Make us believe more and more that the cure is within reach!   By the way, that 6.8% was also a 43 % relative improvement in men alive after 2 years! if you don't understand this statistic, well don't kill the messenger ! Just don't you look at ME as a Culprit!
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