Week after week, it’s a gem.
This week, Dr. Richard Lehman’s journal roundup on his blog for The BMJ starts with a parody of Edgar Allen Poe, goes on to channel Vincent Price, and then it gets darker.
He describes a New England Journal of Medicine paper on “Clonal Hematopoiesis and Blood-Cancer Risk Inferred from Blood DNA Sequence,” and concludes:
“But although the NEJM kindly makes this paper freely available to all, together with an editorial about Clone Wars, we are not about to see a new epidemic of haematological malignancies in older patients: we will just understand them better and probably devise new poorly predictive tests to worry people more.” (my emphasis added, as with all bold italics in this post)
Next, he’s on to another NEJM paper:
“A cure for myeloma may soon be within grasp, but—Edgar Allen Poe again—not quite yet. Carfilzomib is the latest agent to arrive but nobody quite knows where it fits in. Standard therapy for relapsed multiple myeloma now includes lenalidomide and dexamethasone, and the manufacturers of carfilzomib (Onyx Pharmaceuticals) decided to add it to this regimen in a randomised trial, which recruited 792 patients with relapsed MM. This is an interim report, showing a favourable effect on progression and on quality of life, but “the median overall survival was not reached in either group at the interim analysis,” which I think means that too many people in both groups were still alive to tell if this drug makes any real difference. Since its basic cost in the United States is $1 658 per 60mg vial, and all patients required many, many vials, it would be nice to know.”
Next, he analyzes a third NEJM paper on a drug for venous thrombosis – “one of the biggest markets in medicine.”
“Well, Isis Pharmaceuticals … have persuaded the NEJM to accept what appears to be a phase 2 open label trial of the drug in 300 patients about to undergo unilateral knee replacement, with enoxaparin as the comparator. Their drug had an equal protective effect with less bleeding. But when you are thinking of giving a preventive treatment to millions of healthy people, you need quite a lot more evidence than this.“
Ba da bing ba da boom for the New England Journal this week!
Lehman moves us on to a Lancet paper:
“Does the world need new stents? No, but device companies need new products for when current ones go off patent. And the Lancet needs to sell article reprints as part of its stated business plan. But do you, dear reader, really need to read a paper entitled “Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable polymer everolimus-eluting stent for percutaneous coronary revascularisation (BIOSCIENCE): a randomised, single-blind, non-inferiority trial?” I would suggest not.”
There are more gems in the journal review by Lehman this week. There always are. If you share my interests (sick though they may be), you’ll love Lehman’s work as he stays up late, perhaps as Poe imagined:
“Once upon a midnight dreary, while I pondered, weak and weary, Over many a quaint and curious volume of forgotten lore…”
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