ppp 02-16-09

Quote of the day: A government that robs Peter to pay Paul

can always depend on the support of Paul.

George Bernard Shaw (1856 - 1950),

Everybody's Political What's What? (1944) ch. 30

It used to be water and fire. Then came electricity. A few years later telephone became more than a luxury … a necessity. For about $20 per month you could be connected to the world (you just had to pay for long distance by the minute). Radio was a major form of entertainment… then came broadcast television. Much after color TV came cable TV. “Movies” (aka silent films) were replaced by “talkies”. Motion pictures moved briefly to large video disks then on to video tape (remember beta?) then on to DVDs. The present generation is called Blue Ray. The comic book character, Dick Tracy, had a wrist radio for communication but today any cell phone does more that was imagined then. Before I capitulated and bought a cell phone a friend of mine said “I would rather give up cable tv than my cell phone”. I soon found out that the cell phone was, indeed, a game changer.

A similar progression has occurred with medicine. Originally, tree bark was used to treat fever and pain (it contained a substance much like aspirin). Other plants had medicinal purposes; opium, belladonna, digitalis, to name a few. Before the Harrison Narcotic act of 193 the combination of heroine and aspirin could be purchased over the counter (much like a modern day Percodan). Look at the progression in antibiotics to see how far we have come: from sulfonamide and penicillin to modern 5^th generation cephalosporins, antivirals and antifungals. Today pharmaceutical companies have software (I forgot the progression from fingers to the abacus to vaccume tube computers to PCs to super-cooled super computers) that can design molecules to fit receptors and today’s generation of medicinal chemist can actually MAKE the molecules. Chemical engineers develop ways to scale up the process to make it work for mass production.

We all tend to take for granted the technology into which we are born. Kids today couldn’t imagine a day without text messaging, email, and DVDs. They also assume that whatever disease that they might encounter (IF they ever get old) will be easily cured with the latest medicines and devices. Several things are now working against this. The microorganisms that we are trying to eradicate with antibiotics, antiviral and anti-fungals develop resistance to them. The same companies who have been developing additional generations of drugs are coming under pressure from counterfeiters, “reimportation”, patent losses, and added government regulations. The recent economic twists and turns aren’t helping anything.

Assuming that present cell phones, blue ray, and cd’s are the pinnecal of technology for all time is similar to thinking that all of the drugs we now have will be all we will need to cure (or at least control) diseases for all time. Generic houses are not interested in discovery so innovation in medicinal chemistry remains in the hands of the “ethical” pharmaceutical companies. Maybe our children wil realize this and treat the brand name drug companies in a kinder, gentler way… if nothing else, out of a sense of self interest.

ps. Best answer this week to the question "How are you?" was "It's Thursday but it's my Friday but it feels like Tuesday... I'm confused"

pps. Please note that some of the links may not be up for very long and that

Cases of patients loosing seizure control when switched to generic anticonvulsants have prompted some to call for generic drug substitution bans. The call should be for closer scrutiny of generics to enforce bioequivalence.

Patients may not be taking all of the medications that they are prescribed due to the economic situation. Many prescriptions are never filled and patients are trying the “stretch” the drugs they do buy just a little longer each month.

The spending on pain relief has tripled in 10 years. It could have something to do with the aging of America or the availability of higher priced dosage forms… or both.

Adding bone marrow aspirate from the iliac crest (hip bone) to fractures of long bones help the healing process. This technique was used on my sister during her recent back surgery. The bone marrow cells differentiate into osteoblasts within 24 hours. Suzzie is on the mend.

Kiddie vaccination requirements have been going up for years as more vaccines become available. By putting 5 vaccines in one shot, the Happy Meal of vaccines, kids receive the necessary vaccinations… and on time!

ACCP published the 10 most frequently visited articles for 2008. From daptomycin to propofol to smoking cessation… can 534,192 eyeballs be wrong?

Ketorolac by the nasal route has been accepted for review by the FDA for use against pain. Let’s hope that it doesn’t do to the nasal mucosa what it does to the gut.

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