BMJ, 10 April 2014

Do you fear premature death? Many do, especially while reading those apocalyptic predictions during peaks of flu pandemics. Taking advantage of your fear, if somebody sold you Rs.500 worth of prophylactic magic pills assuring that’s the only way to keep flu away, without disclosing to you a private secret that the drug is in fact not as effective, isn’t that bad? The seller in question is the big pharma Roche, who chose not to fully disclose the bad results section of the clinical trial data while convincing governments across the world to buy stocks of the magic pill Oseltamivir (Tamiflu). To say that Roche and its shareholders made a fortune from Tamiflu sales is an understatement. The stockpiling of Tamiflu over years across continents was to the tune of about 10 billion USD. For the perspective, the cost of sending Chandrayaan to moon was 0.06 billion USD. Almost the entire stockpile of the wrongly sold Tamiflu is now lying unused. This Cochrane review on potential benefits and harms of Oseltamivir (Tamiflu) published in BMJ is one of the hottest in clinical academic circles the past month, with multiple discussions in many major medical journals. The reviewers had to expend unprecedented magnitudes of efforts to access complete data from Roche. Though Tamiflu is in no way related to rehabilitation, this study is mentioned here for being one of the landmark events in the right direction in recent times for healthcare; for providing the optimism that the WHO, and the FDA, and the NHS and big pharma can all be questioned with big data, when they choose not to be honest and accountable. “These findings provide reason to question the stockpiling of oseltamivir, its inclusion on the WHO list of essential drugs, and its use in clinical practice as an anti-influenza drug”. (If you are a medical or allied health professional and have never heard of the term ‘Cochrane’, you should consider reading this)

Spinal Cord, March 2014

 175 Cochrane reviews could be dud too. Here is the example. This systematic review on respiratory muscle training in tetraplegia has only surrogate outcomes of pulmonary function tests, and not hard clinical endpoints that matter to the individual. That, they say, is published in another review. Zzz.

255 Reading this ‘letter to editor’, I realized I’d never given a thought to post-partum breast-feeding issues in women with cervical spine injury. There are concerns about hypogalactia due to impaired sympathetic innervation, but seems there are ways around it.

Spinal Cord, April 2014

295 The proactive Swiss Paraplegic Center has come out with this good observational study on bladder stones among 2825 persons with SCI. No surprises. SPC and indwelling transurethral catheters were associated with the highest incidence of stones, shortest time interval and highest rate of recurrence. “Indwelling catheters (transurethral/SPC) are associated with the highest risk to develop bladder stones and therefore should be avoided if possible. If unavoidable, SPC are superior to transurethral catheters”. Intermittent catheterization, as expected, fared better in most outcomes, second only to voiding without use of a catheter.

313 This small Turkish study on 26 women with SCI, many months post injury, found that most women had not received any counseling about sexuality and pregnancy related issues. I’m not sure if things are any better over here.

Practice tidbits:

• Should you advise epidural steroids for patients with lumbar disc related back pain? Yes, says this review article, suggesting “strong evidence for short-term efficacy from multiple high-quality trials”.
• Do you often end up ordering investigations, prescribing medications and doing surgeries because of the delusion ‘if-you-are-a-doctor-you-need-to-do-something’ even if you know what you do is ineffective? You should read this news article on why more need not be always better.
• Do we have enough evidence to believe that strengthening program and electrical stimulation for children with cerebral palsy are actually useful in improving gait and functions? A recent systematic review concluded “Strengthening and electrical stimulation could increase muscle strength and gait”. A York CRD critical abstract of the review, though, opines “In this review small, varied trials, which may have been subject to bias, were pooled in an unorthodox and questionable way. The authors’ conclusion should not be considered to be reliable.”

Liked from twitter: People who think a computer can replace a doctor believe that what doctors do is make decisions. That’s about 10% of what we do