Amazing medicinal contractions

Here are some poetic words that were set down a few millenia ago by a Hebrew sage:

“There are three things that are too
amazing for me,
four that I do not understand:
the way of an eagle in the sky,
the way of a snake on a rock,
the way of a ship on the high seas,
and the way of a man with a maiden.”

The proverb threaded its way into my mind this morning as I read an article about, and I’m not kidding,  possible FDA approval of a new cancer treatment. It’s funny how the mind skips around in its associations, retrieving from some cerebral neuron or other this snatch of a phrase or that fragment of a visual memory. And sometimes I cannot even decide if the memory is based on an actual experience, or something I imagined, or some stupid movie or tv show.
Or, at least that’s the way this poet’s mind works. The inner workings of a truly analytical mind, such as that of my son, or my wife when she’s caring for a patient, are surely quite different from mine. It’s a good thing I have them around to look out for me as my neurons start to misfire a few signals, or perhaps become a little too rigid in their connective malleability.
It was the snake image in the biblical verse above that wrapped itself around my brain as I read, and tried to understand, Michael Shulman’s posting on Seeking Alpha about evaluating Dendreon stock. The pharmaceutical company is working toward FDA approval of their new treatment for prostate cancer, which they have named “Provenge.”
As I read Mr. Shulman’s analysis of the events surrounding FDA approval for Dendron’s proposed new treatment, I was amazed at the complexity of it all. If we consider the many years of research and development required for a new medical treatment, and then the possibllility of FDA rejection after so much capital investment, and then market projections of the treatment’s value when and if it ever hits the market, and then the treatment’s hoped for efficacy…it’s amazing.
It’s like a snake upon a rock. How in the hell does that creature ever get from place to another? My mind strives to comprehend the alternating muscular contractions that propel a legless body along a flat surface.
Then one filed-away mental picture leads to another, and I’m remembering the archaic symbol for medical treatment–a snake spiraled around a rod.
The practice of medicine in our  biologically complex world is truly an amazing phenomenon.
From this layman’s perspective, even a diagnosis must be a crapshoot, not to mention the prognosis and indicated treatments. From an internal medicine physician’s perspective, though, it’s a highly educated guess; one in which the “educated” component costs him/her twenty years of rigorous training and how many hundreds of thousands of dollars?
And then he/she has to figure out, along with the other myriad medical decisions, how to evaluate new drugs coming onto the market for patients to use?
And the pharmaceutical company had to raise enough capital to take a millions-dollar chance on the new treatment?
And the stockholders had to evaluate whether the years-long R&D is worth their risk?
And the FDA has a public responsibility to determine if the treatment is effective without being destructive?
And the hospital accounting department has to send a bill to the patients to whom treatments were prescribed?
And the insurance company has to decide if all this decision-making that preceded their viewing of the expense is medically effective/efficient?
And Medicare/Medicaid, etc has to pass payment judgements on every patient’s case?
And Congress can piece together a reform for this  whole system?
And juries can decide if malpractice has occurred?
Mr. Shulman’s speculation on Dendreon stock, and the ensuing discussion, will open your eyes to a few of the complications that confound medical progress in our diseased world.
It’s like a snake upon a rock I tell ya…amazing.  It’s a wonder we ever get any new medicines, or medical treatments, at all.



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