Re: Cardiac Anomalies - is something going on or is this nor
Nomad, as someone who has witnessed his own share of medically-preventable tragedies (my mother was one of them), I understand your anger. But speaking more generally, and not to focus on any individual case, part of the problem may be that people expect drugs to be 100% safe. They aren’t, and if they are “only” 99% safe, i.e., significant side effects in 1% of the users, this may not be identified on the basis of studies with relatively small subject pools, as one of the links you posted notes. Studies with larger pools take more time and resources, at the same time that there may be a pressing need to get a potentially life-saving drug on the market. While I certainly understand there is a lot of greed and corruption in big pharma, they do get it from both sides, lawsuits when someone dies from an effect that was not recognized when the drug was approved, and complaints when it takes years for a drug to reach the market. Sure, pharma wants a quick review so they can start making money, but the public clamors for these drugs, too. Remember all the anger against the FDA when it was felt they weren't accelerating the process of getting AIDS drugs on the market.
Xarelto, a drug I’ve taken off and on for several years with no problems, may be a good example. The link says there have been 18,000 lawsuits, and 370 deaths linked to the drug. Xarelto is used by millions people (as the link notes, it’s a billion dollar industry), so while 18,000 sounds like a lot of complaints, it probably represents less than 1% of the users. That’s unfortunate, but that number has to be put against the number of strokes that are prevented by its use. It would be nice if we could have a miracle cure for everything, but the reality is that there are benefit-risk ratios for everything. Or as we say in the Clinic, there's a balance between false positives and false negatives, between sensitivity and specificity.
There's a great deal more to medical error than drugs, of course. My brother is a former doctor, and for years tried to get his peers to keep and publish accurate records so that the exact sources of iatrogenic deaths or other failures could be identified and corrected. He finally gave up in frustration; they didn't want to. But without denying the role of doctors, part of the problem, as with drugs, is the same with all modern technology. As it becomes increasingly more complex, it becomes increasingly more difficult to track, let alone understand, all the consequences.
Finally, while I don’t think there’s anything wrong with us old folks doing high intensity exercise, I wouldn’t latch too firmly onto studies of gene transcripts. We really don’t know that much about what most of these genes are doing, particularly when some messages are up-regulated and some down-regulated. It’s certainly simplistic to equate larger numbers of messages altered with more beneficial effects. I don’t think the authors are doing this, but it’s possible, e.g., that expression of some genes is affected as a compensatory reaction to an unusual level of physiological stress or insult. This could be why there was a large set of genes affected only in older subjects. Speaking as a molecular biologist, I’d put more stock in the positive physiological and cellular effects of this exercise, also documented, than in sheer numbers of messages transcribed. Actually, speaking as a cyclist, I put even more stock in just how I feel after a hard ride.
Nomad, as someone who has witnessed his own share of medically-preventable tragedies (my mother was one of them), I understand your anger. But speaking more generally, and not to focus on any individual case, part of the problem may be that people expect drugs to be 100% safe. They aren’t, and if they are “only” 99% safe, i.e., significant side effects in 1% of the users, this may not be identified on the basis of studies with relatively small subject pools, as one of the links you posted notes. Studies with larger pools take more time and resources, at the same time that there may be a pressing need to get a potentially life-saving drug on the market. While I certainly understand there is a lot of greed and corruption in big pharma, they do get it from both sides, lawsuits when someone dies from an effect that was not recognized when the drug was approved, and complaints when it takes years for a drug to reach the market. Sure, pharma wants a quick review so they can start making money, but the public clamors for these drugs, too. Remember all the anger against the FDA when it was felt they weren't accelerating the process of getting AIDS drugs on the market.
Xarelto, a drug I’ve taken off and on for several years with no problems, may be a good example. The link says there have been 18,000 lawsuits, and 370 deaths linked to the drug. Xarelto is used by millions people (as the link notes, it’s a billion dollar industry), so while 18,000 sounds like a lot of complaints, it probably represents less than 1% of the users. That’s unfortunate, but that number has to be put against the number of strokes that are prevented by its use. It would be nice if we could have a miracle cure for everything, but the reality is that there are benefit-risk ratios for everything. Or as we say in the Clinic, there's a balance between false positives and false negatives, between sensitivity and specificity.
There's a great deal more to medical error than drugs, of course. My brother is a former doctor, and for years tried to get his peers to keep and publish accurate records so that the exact sources of iatrogenic deaths or other failures could be identified and corrected. He finally gave up in frustration; they didn't want to. But without denying the role of doctors, part of the problem, as with drugs, is the same with all modern technology. As it becomes increasingly more complex, it becomes increasingly more difficult to track, let alone understand, all the consequences.
Finally, while I don’t think there’s anything wrong with us old folks doing high intensity exercise, I wouldn’t latch too firmly onto studies of gene transcripts. We really don’t know that much about what most of these genes are doing, particularly when some messages are up-regulated and some down-regulated. It’s certainly simplistic to equate larger numbers of messages altered with more beneficial effects. I don’t think the authors are doing this, but it’s possible, e.g., that expression of some genes is affected as a compensatory reaction to an unusual level of physiological stress or insult. This could be why there was a large set of genes affected only in older subjects. Speaking as a molecular biologist, I’d put more stock in the positive physiological and cellular effects of this exercise, also documented, than in sheer numbers of messages transcribed. Actually, speaking as a cyclist, I put even more stock in just how I feel after a hard ride.