Compliance problems, placebo effect cloud trials of topical analgesic

Article Abstract:

Capsaicin, the active chemical in hot peppers, is a promising topical analgesia agent (pain reliever applied to the skin), but many clinicians are dubious about its effectiveness. The merits of this agent were debated at a recent meeting of the American Academy of Neurology. A controlled study showed that capsaicin relieved pain in a group of patients with diabetic peripheral neuropathy (sensory loss and pain in nerves). Many patients experienced burning; the burning intensified if too much capsaicin was applied, or if it was applied to warm skin. The benefits of this agent increased as the drug was used longer. Skepticism focussed on the statistics used to demonstrate the compound's effectiveness; 10 patients who dropped out of the study due to discomfort were not included in the analysis. In one study of people who had peripheral neuropathies due to infection with human immunodeficiency virus (HIV, the virus associated with AIDS), 10 completed the study, but more either refused to try capsaicin after the initial sensations, or stopped due to pain or other problems. Of the remaining 10 subjects, only three wanted to continue with capsaicin. In general, people with peripheral neuropathies seem strongly influenced by the placebo effect (a positive effect from an inactive drug). One advantage to capsaicin is that it can be used with other drugs (such as dideoxyinosine, which is used to treat AIDS) without causing complications. In spite of the mixed reviews, the pharmaceutical company that manufactures capsaicin for analgesic purposes, GalenPharma, is actively promoting its product (Axsain) for diabetic neuropathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Product/Service Evaluation, Drug therapy, Analgesics, Peripheral nerve diseases, Peripheral nervous system diseases, Capsaicin, Diabetic neuropathies, Axsain (Medication)

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Determining more good than harm is not easy

Article Abstract:

Three strategies for evaluating the efficacy of medical treatment are discussed. The strategies include the use of large, simplified randomized controlled trials (RCTs), appropriateness research and requiring early RCTs by withholding reimbursement until patients are enrolled in the trials. In appropriateness research, a panel of medical experts reviews relevant literature and then judges the efficacy of various treatments and their applicability to a variety of ailments. Randomized controlled trials of large sample populations allow for the collection and analysis of sufficient amounts of data to ensure reliability. Simplification of questionnaires and other methodological procedures would also increase data collection. Requiring early randomization trials would ensure that all treatments were subject to some randomized evaluation. The strategy that shows the most promise is the development of regularly updated databases, such as the one on pregnancy and childbirth pioneered by Iain Chalmers and colleagues in England.

Research, Models, Management, Clinical medicine, Medical research, Methodology, Research methods

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Rational suicide: no longer 'crazy'?

Article Abstract:

Health care professionals may be changing their viewpoint about physician-assisted suicide. Physicians who help terminally ill patients commit suicide have often been regarded with disdain by the medical community. Jack Kevorkian is a Michigan physician who has helped several terminally ill patients commit suicide. Michigan has made physician-assisted suicide a felony, but California and Oregon almost passed proposals to legalize this practice in 1992. The American Association of Suicidology (AAS) believes that all suicides should be prevented. Some physicians are changing their viewpoint about physician-assisted suicide because of experiences with terminally ill family members. One physician who spoke to the AAS changed his viewpoint after his mother had a stroke. Physician-assisted suicide should be strictly regulated if it becomes legal to prevent any type of wrongdoing.

Suicide, Ethical aspects, Right to die

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