Saturday, January 26, 2013

Illegal organ harvest from mishap victims..

Doctors illegally taking organs of mishap victims? - Hindustan Times
Apropos this article that appeared in a prominent national daily, I can only react with disdain. While I am not privy to details of the cases in question and cannot vouch for the moral standards of all my colleagues, I find the charges made or suspicions raised very very unlikely to be tenable not because doctors are above such behaviour but because it is scientifically unlikely. The medical profession hasn't done itself any favours by participating in illicit organ rackets in the past.
The only whole organ that can be taken out of a live person safely is a kidney. Since all these cases are medicolegal cases every tissue taken out has to be subjected to pathological analysis. Moreover the surgeon will need to have a genuine reason to open the victims abdomen ie bleeding or contamination.....in both these cases the organ even if removed is unlikely to be good for transplant. If the victim dies, the missing organs will be apparent at the mandatory post-mortem in these cases.
If the accident victim is brain dead, removal of organs with family consent is legal under the law, so the issue is different.
If the victim dies or is found dead on arrival organ harvest is again legal however these organs are not of good quality and no hospital in India at the moment uses these organs except cornea, bone and skin.
I think such articles create a paranoia and only discredit the organ donation system which is woefully inadequate in this country. Either these articles should be backed by conclusive evidence or they end up doing a great disservice to hundreds of thousands of patients who need life-saving organ transplants.

Tuesday, January 1, 2013

Life-saving drug for liver cancer.....gimmicks or reality

Woke up on New Year morning to read an article in the Hindu about a hospital in Coimbatore distributing a 'life saving' drug for kidney and liver cancer in conjunction with a pharmaceutical company.

The Hindu : Cities / Coimbatore : A life-saving New Year gift for cancer patients

The drug in question 'Sorafenib' has been much in the news in India mainly due to controversy regarding its high costs that has prompted the government of India to allow compulsory licensing to manufacture the drug at lower costs to generic manufacturers in India.

While I may be accused of being a cynic staring a hobby horse in the mouth, I would like to know why such largesse is not extended to other molecules that are effective in much more prevalent cancers in this country. Much larger numbers of patients in this country fall prey to oral, cervical, breast, hematologic and gastrointestinal cancers than kidney or liver cancers. However no such largesse or benevolence seems to be in view with regard to those drugs.

 I hold no brief for the original manufacturers of sorafenib, but it does seem a witch-hunt to single out this molecule for compulsory licensing in order to control costs. One cannot but suspect vested interests behind the move. If such efforts are applied across the board to all cancer drugs, I will be one of the first to welcome and applaud it.

Sorafenib is a drug that inhibits an enzyme that controls intracellular signalling pathways in liver and kidney cells and has been shown to have some effect on patients with primary liver cancer. In the only large trial (SHARP) testing the efficacy of sorafenib in primary liver cancers, patients on sorafenib had their life prolonged by a few months over those that did not receive sorafenib. So to indeed call the drug 'life-saving' is a bit exaggerated based on current evidence. Of course prolongation of life by a few months can be a great deal of comfort for the patient with advanced liver cancer but it must be clearly understood that current evidence does not support the use of drug as a curative measure....hence as the best available evidence stands today the drug is a 'life-prolonging' and not 'life-saving' drug.

The drug once started has to be continued life-long. It is not clear whether this free dole promised to patients will be continued for their life or whether after sometime patients will have to purchase the drug. The article seems silent on this.

The drug no doubt could have potential in combination with other potentially curative treatments like resection or transplantation but this potential has not yet been proven in published literature. The use in these circumstances is investigational and success based on anecdotal reports or single centre studies.

Therefore gimmickry and misplaced populism seems to be the order of the day in such events. 

I wish better sense will prevail among those planning such doles and those clamouring for them.