NY Times article - interesting

From NY Times:

The Sting of Ignorance
By JERRY AVORN
Boston

LATE on a summer afternoon not long ago, the water at Lucy Vincent
Beach on Martha's Vineyard was warm, and the toxic jellyfish that had
plagued bathers weeks earlier had floated out to sea. Body-surfing in on my last wave, I suddenly felt as if someone had whacked my leg with a lead pipe studded with nails. On the 1-to-10 pain scale we use with
patients, I would have called it a 14. When I rubbed the area with my
hand, my whole palm stung. Apparently those toxic jellyfish hadn't all
left.

A crowd of passers-by gathered to offer tips from the tainted well of
conventional wisdom. "Use ammonia." "Rub in some meat tenderizer."
"Apply vinegar."

Soon a small army of bronzed youths in official-looking tank tops
arrived carrying enormous medical kits. One poured sterile water on the sting area; another rubbed it with an ice pack. A third worked an
alcohol-based anesthetic into the wound. Each treatment made the pain worse.

Eventually our group attracted the attention of a nurse strolling down the beach. A year-round Vineyard resident, she had seen her share of vacation-related medical emergencies. "You've removed the tentacle,
haven't you?" she asked matter-of-factly. No one, including the
medical-professor patient, had thought of this. She took a piece of gauze and pulled off a slimy, transparent string laced with
neurotoxins. It had continued to send those toxins into my leg for the first 20 minutes of my care. They are particularly activated, I would
later learn, by distilled water, by mechanical pressure (as from an ice pack), and by alcohol-based topical medicines - all the treatments I
had so earnestly been given.

Now the pain began to abate. I drove home and reached for three of the
most useful medicines I know: aspirin, acetaminophen (Tylenol) and the
Internet. As the first two began to take effect, the third revealed a
study published in February in The Medical Journal of Australia.

The clever Aussies (whose beaches are also infested by toxic jellyfish)
had conducted a clinical trial that randomly assigned sting victims to
application of hot water (to deactivate the poison) or icepacks. The
trial was stopped halfway through because the hot-water group did so
much better that it would have been unethical to continue. I didn't
discover this through any proprietary medical search engines. I used
Google and Wikipedia, and it took about two minutes.

Coincidentally, much of my work is about defining which medications
work best for which conditions, and how to close the gap between that knowledge and the care patients typically receive. My research group
constantly comes across effective treatments that are underused, and
poor-choice drugs that are widely prescribed. Even when good clinical
trial data on a regimen or medicine exist, no coherent system ensures that the message gets out to doctors and patients. As a result, many
treatment choices are driven by habit, old information or glitzy promotional campaigns.

My aquatic encounter was a small example of what millions of patients confront daily, in much more serious circumstances. The nation faces two yawning medical information gaps. First, we need more studies
comparing treatments to each other, as that simple Australian trial did. Drug companies don't usually do such tests, preferring to evaluate their new products by comparing them to placebos. (The drugs usually
win.)

The National Institutes of Health, facing its first real-dollar budget cut in generations, isn't likely to expand its mandate in this direction. But what about the insurers, private and governmental, who pay such a large share of the nation's $220 billion annual drug bill? They could support such studies with the rounding error of their annual
budgets - and then save billions if the findings were put into practice.

The second problem is that much of the knowledge we do have is not
communicated to the people who need it. Drug companies are adept at barraging doctors and patients with slick messages touting their most
expensive products - even if they are no better than older, more
affordable standbys. Maybe if Merck held the patent on hot water, my
well-intentioned beach squad would have known all about the Australian study. But that's a poor way to ensure that patients receive the right care.

We need an unbiased, efficient system to get the word out to practitioners on what works best. My colleagues and I have done pro
bono research aimed at developing such an approach. Because the drug industry is so adept at changing beliefs and practices, we've taken a few leaves from its book.

In a program financed by the Commonwealth of Pennsylvania, called the
Independent Drug Information Service, we scan the medical literature for the best evidence on how to treat a given medical problem (like
high cholesterol or arthritis), boil it down into user-friendly packets of information, and then send nurses and pharmacists out to doctors'
offices to recommend optimal treatments. The information we provide is
unbiased and noncommercial, and we don't offer free trips to golf
resorts. The resulting savings from more cost-effective prescribing
could more than cover the costs of programs like this.

The approach has been adopted in several Canadian provinces, and
Australia runs a continent-sized program to update its primary care
doctors (though I don't know if it addresses jellyfish injuries). The
government covers expenses, but scientific content is determined by
nonprofit professional organizations. Their recommendations are transmitted in person by "outreach educators," in concise newsletters, and electronically to doctors, health workers and patients.

If the Vineyard beach first responders had known of the latest research
results, they wouldn't have done everything they could to transfer
toxin from the jellyfish tentacle to my leg. All of us need access to
current, noncommercial medical information. Besides helping to contain our runaway medication expenditures, programs of this kind could prevent a lot of needless suffering - by patients and doctors alike.

Jerry Avorn, a professor at Harvard Medical School, is the author of
"Powerful Medicines: The Benefits, Risks and Costs of Prescription
Drugs."

[jboyhk]

I think the author is extremely ignorant.

There are countless studies comparing the drugs.

http://qualitycounts.com/drugs/hypertension/fpcalcium_channel_blockers.html

A quick internet search (since the guy was on the internet perhaps he should have done the same) shows this site which shows the many studies comparing different blood pressure medications.

Also his line 'Drugs usually win' against placebo's is hyperbole on a grand scale. If this was the only truth in that article amongst all lies I would have praised him.

[beamishboy]

couple of weeks ago i heard a v late radio program from austrailia..all about their methodology & emphasis on trial-based decisions-a sensible use of research & medical dollars is possible with public healthcare..as for jellyfish sting?**** on it!

[jboyhk]

Australia is pretty good for country with a national health care system. However, this is also the same country that only had defibrillators in 1/3 of their ambulances.

It was only the incident when the richest guy in Australia (Kerry Packer) had a heart attack on a Polo field and was lucky enough to have an ambulance with a difibrillator drive buy.

After that event, he made a deal with the govt that he will share the cost of putting them in 100% of all ambulances.

[beamishboy]

not informed well enuff to debate overall quality of care in austrailia...and the program mentioned was in formulative stage,,,but attempts are being made to find best-use of new meds&procedures and re-examining of accepted trade practices(the one cited was stretching prior to exercise)without the biased imput of corporate funded research-and that's a goodthing!  gotta go watch the daily show now...cheers

[mycoldfeet]

As a Paramedic in a beach town, I had to deal with jellyfish stings, catfish spine punctures, stingray (once) every year. And each Ambulance Service works under a Doctors license, and by the protocols he approves, I've used the meat tenderiser non-spiced (lol) some success, but EMP (emergency medical Products) came out with a clear gel for jellyfish stings has lidocaine in it for immediate relief, but patient must not be allergic to novacaine or any of it's derivitives. Most new emergency medicine is first tested in the field, like the new oxygen carrying blood substitute in trials in the west, small town had to sign documents that they would use it in case of emergency. Is carried on the Ambulances.

[friole]

I scanned the article and didn't see one reference to hepatitis C.  What's up?  Recognition?

[jmjm530]

I enjoyed the article a lot. Thought it made some very good points. Thanks for posting it.