Tuesday, 19 June 2012

Vioxx and deductions


I started my last rotation last week, meaning that in 6 weeks time I will have finished my forth year of medical school! This rotation is focused around rheumatology and orthopaedic surgery, meaning joints and bones. This is the last major speciality that I don't have any real clinical experience of, so in a way it is nice to be rounding off that basic medical knowledge of knowing a little bit about something from each speciality. Seeing as my final year is just repeats of rotations I have done already, but with more expected from me, it means I can no longer use the excuse that 'I haven't studied that yet' when my family or friends ask me difficult medical questions!

I spent some time in a physiotherapy clinic as part of this rotation, and I was very impressed! The person I was working with only looked a few years older than me, but she had an amazing well of knowledge on muscular conditions, their causes and good ways to treat them with exercise regimes. A totally different ball game to the things we are taught in med-school (basically just the anatomy). They actually get to heal people with their hands, all her patients seemed so happy with her and by moving their limbs around she healed them - I have decided that physiotherapists are the medical equivalent of Jesus, and any patient I see with any joint or muscle problem for the rest of my career would definitely benefit from a referral to a physio!

As well as spending time with the physio this week, I spent time in a nurse lead clinic for those on biological therapeutic agents for inflammatory joint conditions. This was much more medical, and much more related to those years of lectures I have been through. Very complex though; I think rheumatology is going to take some time to get my head around. The biologic agents these patients are on are basically antibodies which have been made in a lab, which are injected to reduce the levels of inflammation (and thus help their inflamed joints). They all have names ending in __mab such as infliximab. These are very expensive, costing about £20,000 a year per patient, but they really do seem to help. I bet the patients are happy that they don't have to try and foot their own bills! In this clinic I met a person who had suffered a number of heart attacks some years ago, as he had been put on the drug Vioxx. As can be seen by the link, this drug was pulled off the market after it was found that the drugs company who had tested it had withheld information showing that it increased the risk of problems such as heart attack. After all, if you have spent millions developing a new drug, no-one will take it if it might kill them, so that isn't the sort of information you want available to the general public! I remember it being mentioned in a lecture in my first (or second) year, how it was found by using the 'track back changes' function on word when looking at the research they had submitted; meaning that it was previously included but was purposefully removed. Ruthless...  The first time that I had met someone affected by this, and he was remarkably un-bothered by it all. I would probably still be trying to sue them!

I also noticed that (of the admittedly rather small sample size) more than 50% of the patients with Rheumatoid Arthritis (RA) we saw were keen ornithologists, often going on field trips to see birds. RA is believed to have appeared as a disease in the last few hundred years, as while there is evidence of skeletons being affected by different arthritis-related-illnesses, there is no evidence of skeletons with RA before this time. People have guessed that this may be a new environmental substance, or viral infection, that is leading to this 'new' seeming (and certainly not uncommon) disease. Using my expert medical-student knowledge, and this huge sample size of 5 patients, perhaps birds may hold the answer, perhaps they somehow lead to us developing RA, through some kind of parasite or virus they can pass on. If this turns out to be the case, you know where you read it first!

If my brilliant scientific deduction is to be proved correct, we will have to be the ones to do something about it. Birds are inherently lazy...

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