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Scott Reuben and the poison in medicine’s well

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In a stunning piece of timing after yesterday’s epiphany, this crossed my wire today:

“A Medical Madoff: Anesthesiologist Faked Data in 21 Studies” – Scientific American
http://www.scientificamerican.com/article.cfm?id=a-medical-madoff-anesthestesiologist-faked-data

“Beginning in 2000, Reuben, in his now-discredited research, attempted to convince orthopedic surgeons to shift from the first generation of nonsteroidal anti-inflammatory drugs (NSAIDs) to the newer, proprietary COX2 inhibitors, such as Vioxx, Celebrex, and Pfizer’s Bextra (valdecoxib). He claimed that using such drugs in combination with the Pfizer anticonvulsant Neurontin (gabapentin), and later Lyrica (pregabalin), prior to and during surgery could be effective in decreasing postoperative pain and reduce the use of addictive painkillers, such as morphine, during recovery. A 2007 editorial in Anesthesia & Analgesia stated that Reuben had been at the “forefront of redesigning pain management protocols” through his “carefully planned” and “meticulously documented” studies.”

More from the New York Times:
“Doctor’s Pain Studies Were Fabricated, Hospital Says”
http://www.nytimes.com/2009/03/11/health/research/11pain.html

And the Injury Board:
“The Fake Clinical Trials of Dr. Scott Reuben” http://cherryhill.injuryboard.com/fda-and-prescription-drugs/the-fake-clinical-trials-of-dr-scott-reuben.aspx?googleid=259290

It’s hard to convey the total horror of the event described here. This physician scientist, who ran the pain clinic at one of my old hospitals, published research that became the cornerstone of pain treatment in the US and abroad. After 13 years of successful, peer-review-published, desperately important work, he recently admitted the following:

• Not one single patient was ever enrolled in key studies.
• There was absolutely no basis for the numbers he cited; he invented them.
• He was paid a great deal of money to come up with certain results, and that is exactly what he did.

The most influential part of his career was a fraud.

The countless studies founded on his widely-publicized fictions are therefore meaningless, under the rules of scientific evidence itself.

The degree to which we depend on medical science to save us when we really need it — our helplessness at our times of greatest need — require us to have some faith in the processes that deliver our care. This isn’t just another massive fraud, it’s a devastating blow to the cornerstone of healing in the modern age. How can educated patients ever continue to believe that our doctors have anything of value to offer us? How can honest physicians bear to let this situation exist?

He could not have chosen a worse field to work in. In medicine, sooner or later, every field has to rely on pain medicine, and he has fouled the well from which the widest number of patients must drink. Scientific American got it wrong: Madoff was a piker, next to this.

The science of pain control and pain management has depended heavily on garbage cooked by a liar, served by intellectual catamites and eaten by the brainwashed. From there, it was inserted into me and mine, who were assured that this was the best that medical science had to offer.

Too bad there was no actual medical science involved.

…I apologize for the strong language. Can you think of more precise and telling terms to use instead? I’d be happy to change them, if anyone can come up with something better.

There are administrative questions such as, whatever happened to peer-review? Who the hell was looking at his notebooks and other physical evidence of scientific work? Why did it take 13 years for a “routine check” at Baystate to break his cover? What on earth were the most important science editors in the world thinking? How many of them are still employed — and why?

Those aren’t trivial, but they are not what looms largest in my mind. I think of Debbie, and me these past few years, and other friends I can’t name whose lives have been hopelessly distorted and sometimes horribly lost … because modern pain research has been built on one psychopath’s lies, which were funded and supported by a vast network of fellow liars, colluders, and the willfully blind.

It has sometimes occurred to me that the wrong people get sick.

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Refocus on what works: In memoriam

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Debbie died yesterday. She was a never-failing source of encouragement and intelligent support on one of my key online CRPS support groups.

She died on the table, while undergoing a medical procedure. I don’t know exactly what it was, and given my respect for patient confidentiality, it’s none of my business.

She’s the first person to die of my disease, to whom I felt personally attached. Needless to say, it’s sobering as hell.

I’ve written about the need to attribute deaths from this disease correctly. I’m preparing my own final papers. These thoughts are nothing new.

But today, they are biting deep.

I’ve recently become highly politicized over rights abuses and intolerable corporate stature in my country. I have privately — and quietly — become convinced that the US healthcare system is so completely predatory, so opposed to its own mandate, that it will never offer healing for anyone in my position.

Debbie’s death has broken through my professional anxiety about appearing detached and scientifically sound. I have, at long last, become politicized about the most important subject in my life, after 25 years of personal and professional involvement up to my back teeth.

I have minimized my discussion here of what actually works. That dishonest omission has done us all a great disservice. I’m going to discuss what works, whether or not it’s FDA approved, pharmaceutically profitable, or adequately studied.

Medical studies are a shining example of the fact that we inspect what we expect, not necessarily what we need. The fact that studies have not been done on most modalities, or not rigorously done in double-blind experiments, doesn’t mean the modalities don’t work.

It means the studies need to be done. Period.

Where I understand the mechanisms of action, I will explain them. Where studies don’t exist, I’ll detail what should probably be explored.

But I have had enough of silence. I will not die as Debbie did. I will not die on the table. I certainly will not die saturated with soul-destroying pharmaceutical-grade poisons, as so many of us do.

I will find a better way. I will find a way that works. I’ll do my best to persuade others to study the modalities involved, and to fund the studies. My legislators will learn to recognize my name on sight, because their slavish debt to the pharmaceutical industry is absolutely intolerable and it’s up to me, and others like me, to convince them of that.

I wish Debbie a painless and peaceful rest. I hope her extraordinary husband finds enough strength and comfort to manage life without her.

For myself, I want the intelligence, resources and strength to find a solid cure, make it happen, and spread the word.

No more silence. It’s too much like consent or, worse, collusion.

I do not consent to the deaths of my friends.

With my eyes now open, I’ll no longer collude.

Let’s find a real way out.

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Facial recognition is wholistic

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This blog has been on hiatus as I’ve been dealing with a body-hostile healthcare system, insurance sociopaths and delusionally self-infatuated doctors, and I didn’t want to take it out on the science.

This charming study turned up today and led me back here:

http://www.sciencedaily.com/releases/2011/12/111202155755.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

‘ScienceDaily (2011-12-02) — “Face recognition is an important social skill, but not all of us are equally good at it,” says a cognitive psychologist. But what accounts for the difference? A new study provides the first experimental evidence that the inequality of abilities is rooted in the unique way in which the mind perceives faces.’

The brain uses a wholistic method for recognizing faces, whereas recognizing objects is more analytical — meaning that the object is parsed out by the brain and assessed in chunks. Doesn’t work well on faces, though.

One very pleasing, intelligent thing to note: these researchers concluded that the logical next step is to train people to use their brains more effectively — not to look for yet another drug to fiddle with one part of a complex process and leave the patient more helpless than before.

My own facial recognition has plummeted with the evolution of CRPS, but it’s a skill I acquired rather late in life. I’d always recognized people by the way they held themselves and moved — a different region of the brain entirely. So I trained myself to recognize faces as such.

I’m not sure I could recapture that ability, but when a few other mental faculties are more predictable, I’m game to try.

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Assumptions & memory: elders are sharper than we think

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I’m intrigued by how much more capable the elderly are than we’ve been led to believe. Since only the luckiest and most sensible of us will even survive to be old, that makes a certain amount of sense.

CRPS, which typically attacks people in their “most productive” years (implicit assumption alert!), has shown us that many medications useful in CRPS, which have been given to the elderly like candy for decades (calcium channel blockers, antidepressants, benzodiazepines) have a serious effect on memory and cognition — which was documented only because we don’t expect 38-year-olds to suddenly lose their ability to track simple tasks.

But the elderly get no slack. If your whip-sharp grandad suddenly can’t remember your kid’s Little League scores, who’s willing to relate it to the meds he just started for his heart?

And who cares enough about grandpa’s brain to go to bat for him, and insist that the doc find another way to handle things? Hint: what you eat & what you do, do matter. Visits with nutritional consultants and PTs can be prescribed.

Back to this study:
http://www.sciencedaily.com/releases/2011/11/111104102129.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

These wonderfully sensible scientists framed an exact goal: they “set out to investigate how implicitly held negative stereotypes about aging could influence memory performance in older adults.”

They specified “implicit” stereotypes, in other words, ones we’re not aware that we’re responding to. (The kind that patients and doctors hold about each other all the time.)

When the tests were run with the stereotypes laid in, the older people did worse on the memory tests. When the stereotypes were made irrelevant to the outcome, the elders did as well as the youngsters. On the same type of test.

Which should tell you just how pernicious and evil those assumptions we make about old people are. When grandma’s memory starts playing up, ask her if she has started any medicine recently. Find out what it was for and how else that can be addressed. Ask if it’s the smallest possible dose that’s prescribed.

Give up the idea that pills solve problems freely, and recognize that each one imposes a tax on the body and brain.

If grandpa doesn’t mind losing his mind but won’t give up his risotto and vichyssoise, maybe the pills are fine, but if he simply assumes the doctor is offering the best deal without showing him alternatives, maybe it’s time to talk about alternatives.

Because doctors default to doing what’s easy and predictable — just like the rest of us! That’s not always what’s best for a mentally or physically active person. They seem to deal with a lot of lazy idiots, and if you or your elders are neither, it takes a lot of effort to bust them out of their groove and get them to think things through.

Try taking it seriously, because nobody should be forced to lose their mind before they lose their pulse.

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Preoccupation & CRPS-RAD

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Last week, I was busy capturing files from FaceBook to save for a new website, http://crps-rad.ning.com/. It’s very much in development, so please let us know what you think.

It will soon be at http://crps-rad.com but that’s another story.

This is the real-world launch of a FaceBook group that became sufficiently important and popular that it had to get off those godawful training wheels and get a real site. It will shortly have the research and translations into plain English, the discussions and threads, and the ongoing evolution of prevention and management, of CRPS and its comorbidities that the FaceBook page has — and, I hope, far more.

Now if only FaceBook were easier to work with. HAH.

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Vascular growth and brain protection

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“A nourishing protein that promotes the growth of neurons and blood vessels appears to stop the progression of a genetic disease that causes degeneration of the cerebellum, according to new preclinical research. The disease, spinocerebellar ataxia type 1, typically strikes people in the 30s and 40s and eventually causes death.”

The key protein is called Vascular Endothelial Growth Factor, VEGF. It is known to stimulate the growth of healthy blood-vessel linings. We know for a fact that healthy blood vessels are important to maintaining healthy brains! Without them, we get strokes, not to mention this type of ataxia.

The funding-hungry researcher’s first thought is, “How do we turn this into a drug?”

The smart clinician’s first thought is, “How do we improve vasculation, oxygenation and circulation in safe, endogenous, sustainable ways from youth onwards?”

Don’t need FDA approval for that. Just takes fresh food, fresh air, clean water, and safe activity.

Clinicians, if you’re puzzled about how to get all that for your patients, call your legislators (use the link on the right to find them) and share your concerns. Those letters after your name are worth more than you might think.

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SSRI can improve cognition after a stroke

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This came out 2/2010, right in the middle of my being horribly overdosed on SSRI and SNRI medications:

http://www.sciencedaily.com/releases/2010/02/100201171523.htm

(This is where I give myself points for not being violently and irrationally opposed to the class of drugs that did me, personally, so much harm. It’s important not to throw the baby out with the bathwater.)

129 patients were divided into roughly 3 groups, one of which got 5-10 mg Lexapro daily, another got placebo, and the third were assigned to “a problem-solving therapy program developed for treating patients with depression.” (No idea what program that is and they weren’t specific about it.)

The Lexapro group had the best neurocognitive scores after 12 weeks, though the author doesn’t say by how much, or how they processed the data. These are both important issues in scientific studies, since some differences are significant and others are just curious, and how you arrived at those figures can have a considerable effect on how seriously your readers should take them.

“…reported changes in neuropsychological performance resulted in an improvement in related activities of daily living” — which makes perfect sense. When all is said and done, healing of any kind is about what more you can DO afterwards! Doctors, patients, and significant others tend to lose sight of that, getting lost in the compelling drama of symptomatology, misery, and pain. It’s not that that isn’t important, but being able to take care of yourself — or making it so your patient can do so — is absolutely primal.

This study used low doses, which I suspect is key to unimpaired cognitive function — not to mention avoiding the usual side effects of this class of drugs, as they did.

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Warning: Starvation and alcoholism don’t mix

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The latest candidate for Dept. of the Blitheringly Obv.: Young people eating too little and drinking too much is worse than doing either alone. No, really??

Lasting damage to memory and thinking, more bad choices, and increased likelihood of developing chronic conditions later in life, are far more likely because the damage from each form of fashionable self-abuse compounds the other.

This idea is certainly high on the head-desk quotient, but the article is mostly clear and sensible:

http://www.sciencedaily.com/releases/2011/10/111017171506.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

They mention that the risks to women are higher ounce per ounce, but don’t say why; that vagueness is annoying and wrong, and science is far enough along to know better.

The idea that real food might be good for you is kind of a shocking idea, to some. Encourage them to get used to it. Fresh salad, berries, roast chicken, apples, baked potatoes, butternut squash … There are worse things. Like brain damage, cirrhosis, kidney failure, strokes, chronic fatigue, and HIV.

And looking really bad by 30.

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New info on HIV in the central nervous system

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My first nursing job was on an HIV/AIDS unti in 1991. I seem to remember learning, in the early ’90s, that we knew that co-infection with different HIV strains meant the person would get sicker quicker and be harder to treat (but trying to get HIV positive people to use condoms etc. with other HIV positive people was practically impossible in those days), and that people with these co-infections had much higher rates of dementia and a more aggressive disease generally.

This study — finally, and despite the facile title — gets more specific about what happens with HIV in the CSF (cerebrospinal fluid):

“Distinct AIDS viruses found in cerebrospinal fluid of people with HIV dementia”

http://www.sciencedaily.com/releases/2011/10/111006173443.htm#.TpG92FJMVMI.mailto

By and large it’s excellent work: the info on HIV in the macrophage is intriguing, as is the implied interplay between the seroactive HIV and the CSF-inhabiting HIV.

The implied determination to get more people on the horrifically aggressive HAART pharmaceutical regime is disappointing, for 2 important logical reasons:

1. This intensive regime, itself, has powerful and often irreversible effects on the following: mitochondrial survival, bone mineralization, memory & cognition, and digestion & absorption. That means teeth crumble and bones turn chalky, nutrition in food becomes unavailable so it’s harder to maintain, and most of all, those of you who’ve read my work on mitochondria and on iatrogenic brain damage know how horrifying I find it to cavalierly trash those vital systems, most notably in the absence of any real efforts to support them in the face of iatrogenic — let alone pathologic — assaults.

2. The lack of any indication that the HAART drugs are any better at crossing the meninges (the covering over your spine & brain that forms the “blood-brain barrier”) after this study, than they were before this study. That’s an oversight that invokes a sardonic laugh. Heaven forbid the provider should actually pay attention to the patient and start the meds when needed, rather than assaulting the system maybe years before it’s necessary in the hope of staying one month ahead of one strain’s breakout. Bad math, you see?

It would be good to move away from the meme that drugs are the best, first, last, and finest answer. They’re one part of it and they’re easy to monitor, but we have to get a lot better at much more basic human care.

Good science. Stupid clinical take-away. But good science.

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Re-myelination from stem cells

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Scientists at Case Western Reserve have found a way to persuade pluripotent stem cells to become the specific type of cell that produces myelin and to re-myelinate living mice:

Mice stem cells guided into myelinating cells by the trillions

For once, I’ve got no logical criticisms to make. This is brilliant work which fills me with hope for those of us dealing with demyelination and all the havoc it causes. Here’s hoping it translates well into human models, and soon.

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