Saturday, 29 December 2012

Bad pharma?

I've just finished reading Ben Goldacre's most recent book, 'Bad Pharma'. For those who are not familiar with Goldacre, he's a doctor and a journalist/writer on medicine and science. 'Bad Pharma' is subtitled 'How drug companies mislead doctors and harm patients' and presents a detailed list of issues to justify this statement.
The books main allegations surround the conduct of clinical trials. Goldacre makes a number of concerning points about trials funded by drug companies, backing up his statements with references to research findings:
  • drug companies don't systematically publish the results of all trials that are conducted. Trials that produce negative results are significantly less likely to be published than those that find positive results;
  • drug companies don't always stick to the initial trial definition. For instance, in some cases they change the duration of the trial so that it finishes earlier than planned -usually at a point when the trial results appear favourable in terms of the performance of the drug being tested;
  • drug companies sometimes change the criteria that is to be used to judge the successful outcome of a trial after the trial has started, typically the newly selected criteria will present a more favourable outcome than the originally selected one;
  • drug companies sometimes run trials that focus not on end points that really matter to patients but on proxy measures that may or may not really correlate to those 'real' end points (e.g. such as judging the success of a trial of a statin drug by looking at how it lowers blood cholesterol rather than by looking at how many heart attacks it prevents).
These problems with the conduct of trials mean that it is virtually impossible for doctors to judge whether one drug is better than another and this has a direct impact on patients. Goldacre goes so far as to say that the lack of reliable and comprehensive trial data results in preventable deaths.
In addition to the concerns on the conduct of trials, the chapter on the way in which pharmaceutical companies market their products is also very disturbing. Goldacre states that pharmaceutical companies spend twice as much money on marketing as they do on research and development. He describes how there is a great deal of research that shows that this marketing effort has a real impact on the prescribing patterns of doctors and other medical professionals - even though most doctors are confident when asked that their own decisions on prescribing are not changed by exposure to this marketing.
I found 'Bad Pharma' to be a very interesting and concerning book and it is well worth a read if you are interested in medicine or science. Even if only half of Goldacre's claims are true then there is something very wrong that must be resulting in real harm to patients. My one caveat on the book is that Goldacre seems to be something of a lone voice on this topic, he states himself that the professional medical associations, medical journals, regulators, legislators and the pharmaceutical industry itself do not see the situation in the way that he does - though the words 'they would say that, wouldn't they?' do come to mind here!
On a different topic, I received my ninth round of Trabectedin chemotherapy on 27th/28th December. As usual the infusion itself went smoothly and I wait to see how the side effects develop this cycle. I've been having increasing issues with fluid retention so that's my main concern.
Finally, to close this post, a couple of recent night shots of Bath abbey.


Friday, 21 December 2012

Merry Christmas!


As  you can see, we're all set for Christmas. Our tree is around 9 feet tall, it should be interesting getting it back out of the house after the festivities are over. We're looking forward to spending Christmas at home and have both Katie and my families coming to visit during the next few days. 
The timing of my treatment has worked out very well. I was due to have my next chemotherapy on December 25th, I'm very pleased that the hospital don't schedule chemotherapy on Christmas day or Boxing day and I'm now due to go in for cycle nine on the 27th. I had a routine appointment with my oncologist on Thursday; I told him I was hoping to have a glass of wine sometime during Christmas, he checked my latest blood test results and said that it would be ok for me to do that - hooray! 
Last week I read the results of a phase II clinical trial that looked at the use of a drug called Sorafenib in the treatment of advanced soft-tissue sarcomas (LMS is a soft tissue sarcoma). The results suggest that Sorafenib may be a useful treatment especially for people who have had a number of prior chemotherapy regimes. Of 35 LMS patients in the trial, 38% experienced a six month period during which their tumours did not progress further following treatment with Sorafenib. Whilst the small sample size means that the results must be treated with caution, they indicate a  similar level of effectiveness to many of the approved LMS chemotherapy agents.
Sorafenib is not the only drug for which trial results published in 2012 suggest usefulness in the treatment of LMS, similar findings came out of a phase III trial of Pazopanib. These drugs are not cures but they do provide additional options for patients that have exhausted the exisitng approved systemic treatments of which there are relatively few. It is great to see that today there are new treatments being identified for LMS as for many years there has been very little progress on the treatment of this disease. Here's hoping that there are more developments in the treatment of this and other cancers in 2013.

Merry Christmas to you and your families!


Sunday, 2 December 2012

Chemo is like a box of chocolates...

Well, not really - I like chocolates! Paraphrasing Forrest Gump's famous line
'My momma always said, "Life was like a box of chocolates. You never know what you're gonna get."'
does seems appropriate though when I compare how I feel after my most recent chemo, which I received last week, and how I felt at the same time in my previous cycle. For no particular reason I can think of I've been feeling much better this time around. Almost all the side effects have been less pronounced and I've even felt well enough to be able to walk into town to join the christmas shopping crowds. It is only day six of my cycle as I write this so I hope I'm not speaking too soon, but cycle eight has started well.
I went out to Slimbridge for a morning a week or so ago, it was pretty slow up there but I did find an obliging mute swan to snap:

It's my 44th birthday today and Katie is cooking me "toad in the hole" with onion gravy as a treat - one of my all time favourite foods and one of the best reasons to look on the "bright side" that I can think of!