Spinal Cord, June 2014 Supplement
S5-6 ‘Wonder-drug that cures all diseases’- Sarvaroganivarani is a term which in many Indian languages means just that. Thanks to abundance of shrewd marketing by pharma and gullible people worldwide, there are two candidates that currently fit the ‘cure-all’ bill: vitamin D supplements and Botulinum toxin injections. In certain healthcare belief systems, these two drugs cure everything except probably cardiac arrest and HIV infection. So here goes one case report that claims Botulinum toxin significantly improved magnitude of intractable lower extremity neuropathic pain in a person with spinal cord injury. #YHIHF.
Spinal Cord, June 2014
472 Persons with spinal cord injury “spent 34.2% … of their acute hospital length of stay waiting for a Spine Rehabilitation Unit bed to become available.” No, that’s not the story in our institution. Surprisingly, it’s an article from Australia on process barriers for patients needing spinal rehabilitation. Better economy, sparser population, similar problems as here.
Archives of PMR, June 2014
1039 “Objective: To investigate short-term and long-term effects of repetitive peripheral magnetic stimulation (rpMS) on spasticity and motor function… Conclusions: Therapy with rpMS increases sensory function in patients with severe limb paresis.” This is an example of how NOT to write the conclusion of your study; here the objective was to study the motor system, but they inexplicably prioritize sensory system in the conclusion. Lesson: always write first about what you set out to find, not what you accidentally found. As in this instance, wayward conclusions are usually presented to camouflage the fact that the intervention was not effective in the outcomes that matter. “The magnetic stimulation, however, has limited effect on spasticity and no effect on motor function.”
1201 Robert Downey Jr continues to wow us with his fleet of remote voice-activated auto-assembling armored suits. Yet, a more elementary stuff, Functional Electrical Stimulation, is not commercially available for conditions other than foot drop. This American article on Implanted Neuroprosthesis for Restoring Arm and Hand Function reports that 2 persons with complete tetraplegia C4 or higher had improvement in hand functions that enabled them to perform a few daily activities. They used implantable muscle electrodes to stimulate muscles and spiral nerve cuff electrodes wrapped around the nerves to be stimulated. Implanted EMG electrodes in face/neck muscles were used to trigger the neuroprosthesis mediated limb movements. Fine. The question is, when can we order it on Amazon.in?
BMJ June 2014
Trisha Greenhalgh, the author of the bestseller How to read a paper, has generated quite a volume of online academic discussions with her article “Evidence based medicine: a movement in crisis?”. Do read this if you believe healthcare provision is an art that needs to be practiced as scientifically as possible. The author concurred when I wrote to her pointing out that the developing world perspective was ignored in the article.
Practice tidbits:
- I’ve always seen electric toothbrushes as a symbol of extreme laziness. And hence, was surprised to read a Cochrane systematic review that shows some benefits in using a powered toothbrush when compared with a manual toothbrush, in terms of reduced incidence of plaques and gingivitis. Long-term health benefits were unclear though.
- Unlike most of the newer medications in Rheumatology, moderate to high quality evidence of clinical benefit encourages continued use of Methotrexate in Rheumatoid arthritis. This review updated in June says about 16% discontinuations is to be expected due to adverse effects
- Do you believe in “general health check-ups”? If yes, please do read this BMJ editorial ‘General health checks don’t work’ that reiterates something that’s palpable for quite some time: “Doctors should not offer general health checks to their patients, and governments should abstain from introducing health check programmes”
Perspective: Do read this engaging blog by Richard Smith on why healthcare professionals should try more to be human than to appear super-human all the time. And also this thought provoking article on How mistakes can save lives.
In the news: Doing rounds last month in a few magazines were reports that the UK healthcare system is the best in the world (the worst: US. India is probably too low to be ranked). Elsewhere, stories emerged of a serial sexual abuser in the UK who was never brought to justice, and in fact, was given administrative posts in healthcare management for years, which he utilized to sexually exploit more people. If such a top ranking healthcare system could not identify/act decisively to purge a scum from the system in time, there is no way we could expect ours to, if a situation arises. #sigh
Liked on twitter: “It is easier to help patients learn something than to help professionals unlearn wrong things.”- somebody
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