Sigh of relief

My marks for winter semester went out last week. These were my first "real" medicine marks, since last semester was all about basic sciences. And the first mark I got in the Fall was not as good as I expected. I felt very anxious because I absolutely had no idea what to expect this time...

And, at last, I know how I did in my exams. And I am positively surprised. Actually, the one I feared the most, I had the best mark. Since I started this program, I have been pretty bad in guessing my marks.  Well, it doesn't change anything, anyway... I'll just enjoy this short moment of hapiness. And then, go back to revision, for exams in less than a month. Go Go Go!

Don't worry, I am still very much grounded to the Earth and I don't think I am so much more brilliant than the rest of my family and friends... I was unable to change channel on the television for Princess this weekend... this problem shows that:

1- Even though I can succeed in studying medicine, I could be under average in other area of life.

2- I don't watch enough tv...

Ethics

A few years ago, my brother lost a child to a terrible genetic disease. In this case, there was nothing to do; when the diagnostic was established, there was nothing we could do. Not a single experimental treatment. Well, when this Precious Little Sunshine was conceived, she was handed a bad set of genes and that's it.

A week ago, my sister sent me an article that was published in the newspaper about a family's battle for their little one. The child has the same disease our Little Sunshine had. In the last few years, research had progressed. There is currently an experimental treatment available in Canada for the condition. Unfortunately, this child was born 17 days too early to fit the criteria, so was ineligible. I am taking shortcuts here, but let's just say, the parents didn't take no for an answer, got the magic formula, asked some lab, that is making drugs for animal (and not human), to synthesize the medication and travelled to Mexico to have it injected in their child. And now, they have to go to Mexico every 45 days or so to give it to the child, since no physician here or in United States would agree to do it.

I felt this article was more an editorial about big bad pharma and the health care system not trying to save this baby's life. Maybe it was not the journalist intention, but it is how I felt it. And I felt criticized. I worked for almost a decade in clinical trials. I believe I have some ideas on how things work and why they work that way.

I do not have to agree or disagree on how the parents handled the situation. I do not judge if they did right or wrong. They did the best in this situation for their family.  Would I be in the same situation, I have no idea what I would do. All I have to say is that I am impressed with their creativity and resilience.  

Even though sometimes, from the outside of this closed little world that is clinical trials, we can have the impression that the decisions are made only to save money and bring the drug to the market as soon as possible, it is not exactly how the decisions are made. First, even though we are treating patients one by one, the decisions are taken at another level. The investigator (physician who treats patients) follows a protocol designed to demonstrate if the drug works. Each criteria is there for a reason and we have to trust the judgement of the statistician and specialist physician involved in the design of the protocol. 

There is a pretty solid safety net around research as well. Regulatory bodies (Health Canada or FDA) and the institution ethic committee review the protocol and decide if it is ethical and if the benefit that can be expect outweight the risks taken. These people approve a protocol, and therefore it is not to be taken lightly or not followed.

I feel sad that people always complain about pharma, one way or another. When you are in a situation, you see one tree but not the whole forest. A trial is done with the forest in mind. Decisions cannot be made on the basis of only one individual. If the investigator do not comply with the protocol, the results won't be admissible. 

Unfortunately for this child, he was ineligible for this trial. But, when I think of all the other babies that can be treated if this medication works and get to the market sooner because the investigators were compliant with the protocol and there was no delay, I understand the reason. 

I am not giving my blessing to everything the pharma world does, far from it. I try to keep a critical mind. I do not have all the specifics about this case, so it is very difficult to comment or make a judgement... but there is a possibility for compassionate use of a drug for this kind of situation. From the outside, it looks like it was a perfect case for this kind of program. Why the child couldn't receive the drug this way, I have no clues.  And I hope from the bottom of my heart that a viable long term solution will be find very soon for the child to receive the drug that seems to help him.

When someone asked my brother what he thought of the situation, his answer was:  "I do not necessarily agree with the way they did it, but when you are there, you could do anything. However, it shows that the research is progressing and this is a good news." I am so proud of you! I love you, Brother! 

"Summer" semester

I survived my exams... Well, I believe I did. The results are not out yet, so I hope I did ok. I was surprised how relaxed I was when I got there. I even felt almost ready (you can never be ready, but at some point, you know that studying more wouldn't get you a significant advantage, so you go to bed).

And then, I had a fantastic, amazing, incredible 4 days without any studying to do. I didn't open any med school book. I enjoyed a 4-days weekend with some friends who came to visit. We had missed them so much, it was very good to see them. We all enjoyed the visit, and I was surprised how the kids were so happy to see each other as well. I thought that at 6 and 9, after 4 months of not seeing each other, you don't mind that much, but they showed me that it's not the case, and we had a lot of fun.

And I was back in my books for what we call "summer semester". Did I say summer? Well, that's what it's called... Not what we have! I have some doubts really that there is going to be a summer this year... I was gone from this region for too long I think, and I didn't remember... Or my memory lost the information (kind of a psychodynamical defense mechanism). It is freaking cold here! (and yes, I know that you think it is very cold this year in the Big City, but you won't win this one.) Today, May 6th, it snowed! Yes, I assure you, actual snow. Very depressing! I have an above-ground pool and it is still frozen on top. Again, very depressing! When do you think we will be able to use it, if it is still frozen on May 6th? Ok, for people who know me, they know that the answer is probably never, because I don't put a toe in a pool if it's not over at least 82 degrees Farenheit.  (it's weird that we use Celcius for almost everything, but when it is for pool temperature, Celcius don't seems right). 

Anyway, I am back to school for another month and a half. My last exam of that semester is the day Princess finishes school as well, and it is also her birthday. So you can imagine the party we are going to have. I am currently going through tough material (locomotor: all the musculo-skeletal system) in a very short period of time. The hardest part, however, is that I seem to have misplaced my motivation. It's nowhere to be seen right now... Everything feels heavier. I have spoken to my colleagues and it appears to be a very common disease among us. Feel better to know that it's not just me... People had told me that I would have some very tough time. I suppose this is it, even though I don't see is that difficult. Not comfortable, but still doable. Our current problem is a patient who has rhumatoid arthritis, which I find very interesting. Therefore, working on this one seems easier. I might be on my way to get back my motivation. (I wish as well the sun could be there with my motivation and might finally come back!)