Nature Medicine | Spoonful of Medicine

Trust no-one…

…would seem to be the message from three papers published over the past few days in different venues.

First, the NEJM published this past weekend a report showing that using a cholesterol-absorption inhibitor (ezetimibe) in combination with statins reduces LDL below what each drug achieves on its own but, alas, there is no similar additive effect on the progression of atherosclerosis.

Then, JAMA published today that rimonabant, the cannabinoid receptor inhibitor that promotes weight loss, has no effect on the progression of atherosclerosis either, although the authors do warn that more studies are needed before we know for sure if this is the case.

Last, a study in PLoS Medicine published yesterday claims that people with Alzheimer’s disease are better off without neuroleptics for the treatment of their psychiatric symptoms. These drugs seem not to have significant beneficial effects to outweigh their side effects.

It would seem that every time we look at a drug using higher-magnification lenses we uncover something to discorage us from its use. At this rate, I don’t look forward to a future in which the only thing you can buy safely from a drugstore will be aspirin.

P.S. Who comes up with the names of these clinical trials? ENHANCE and STRADIVARIUS? You must be joking! If only their outcomes were as uplifting as their names…

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    Sergio Stagnaro MD said:

    Certainly, these news – published in famous peer-reviews – are intriguing and reasons of accurate considerations on their causes. In fact, there are a lot of events which account for the reason that such as papers let us say that It would seem that every time we look at a drug using higher-magnification lenses we uncover something to discorage us from its use. Among these causes is ovelooking Single Patient Based Medicine.In my opinion, these cited articles seem fascinating and important, although authors overlook the existence of Single Patient Based Medicine (SPBM), cited in the web site of EC (http://www.google.it/search?q=cache:U5A-DtWmRDsJ:europa.eu.int/comm/health/ph_information/documents/ev_20030710_co01_en.pdf+single+patient+based+medicine+and+stagnaro&hl=it&ie=UTF-8 Pg 36) as well also in PLOS website (1-6). In a few words, notoriously there are thousands suns above the clouds awaiting us (Indian old proverb). In my view, both EBM and SPBM must be utilized associated to obtain the best diagnostic, and therapeutic monitoring at the bed side. First of all physicans have to recognize since birth individuals Biophysical Semeiotics Constitutions and relative Inherited Real Risk, pre-metabolic syndrome, and all clinical refined syndromes account for the reason SPBM foundation has been a natural event (1-8). Not all individuals are born equal! In every day’s practice, doctors must and can nowadays define precisely the biological situations on whatever single patient. In other words, healing physicians must and may firstly answer the question: What kind of patient is this? (1-5). From biophysical-semeiotic view-point, doctor recognizes promptly and clinically all numerous known constitutions, possibly present in an individual, and then the possible congenital “real risks” of most common and severe human diseases: e.g., absent Oncological Terrain (3, 4), (www.semeioticabiofisica.it) it is useless considering malignancy among other diagnoses. In addition, even in presence of oncological terrain, a biological system does not necessarily be involved by “real risk” of cancer: for instance, breasts of woman with oncological terrain can perfectly be normal, as we observe in most cases. In fact, a woman with oncological terrain is not necessarily at real risk of breast cancer. Independently of criticism, more or less constructive, really some times absurd, which derives from crass, a-critical acceptance, due to blinkered doctor’s attitude, of a paradigm of EBM (5), teaching this theory has surely benefit by its practical application. In my opinion, however, to reach further and remarkable advantages in clinical decision, therapy, in programming clinical researches, and to avoid useless procedures, due to the ignorance of both biophysical-semeiotics constitutions and syndromes, it is unavoidable utilize usefully “also” SPBM, nowadays an useful reality thanks to Biophysical Semeiotics (5).

    References.

    1. Stagnaro-Neri M., Stagnaro S. Sindrome di Reaven, classica e variante, in evoluzione diabetica. Il ruolo della Carnitina nella prevenzione del diabete mellito. Il Cuore. 6, 617, 1993 [ MEDLINE]

    2. Stagnaro-Neri M, Stagnaro S. Co Q10 in the prevention and treatment of primary osteoporosis. Preliminary data. Clin Ter. 1995 Mar;146(3):215-9 [ MEDLINE]

    3. Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Ediz. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm

    4. Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004. . http://www.travelfactory.it/semeiotica_biofisica.htm

    5. Stagnaro S., Stagnaro-Neri M., Single Patient Based Medicine.La Medicina Basata sul Singolo Paziente: Nuove Indicazioni della Melatonina. Travel Factory SRL., Roma, 2005. http://www.travelfactory.it/semeiotica_biofisica.htm

    6) Stagnaro Sergio. Single Patient Based Medicine: its paramount role in Future Medicine. Public Library of Science.2005 http://medicine.plosjournals.org/perlserv/?request=read-response

    7) Stagnaro Sergio. Newborn-pathological Endoarteriolar Blocking Devices in Diabetic and Dislipidaemic Constitution and Diabetes Primary Prevention. The Lancet. March 06 2007. http://www.thelancet.com/journals/lancet/article/PIIS0140673607603316/comments?totalcomments=1

    8) Stagnaro Sergio. Role of Coronary Endoarterial Blocking Devices in Myocardial Preconditioning – c007i. Lecture, V Virtual International Congress of Cardiology. http://www.fac.org.ar/qcvc/llave/c007i/stagnaros.php