Fw: Steroids in spinal cord injury ?

[Ivan Hronek]

----- Forwarded Message ----
From: "Miller, Sanford" <Sanford.Miller at nyumc.org>
To: Ivan Hronek <ivanhronek at yahoo.com>
Sent: Thursday, April 24, 2008 12:04:24 PM
Subject: RE: Steroids in spinal cord injury ?

Ivan,

Keep them coming; I'm enjoying the discussion. Maybe you could send this
to the Trauma list as well as Anesthideas:

You may be sued, but it seems to me that any expert can cite enough
evidence that steroids don't work to satisfy any jury. Obviously this
also depends on the jurisdiction involved--and if the jury feels the pt
should be reimbursed whether the defendant is responsible or not--it
happens.

Some people wondered why steroids became standard of care in the first
place given the weakness of the results of NASCIS 2. Easily explained:
The initial publication of the results of the study in 1990 was preceded
by 6 weeks by an enthusiastic press release and facsimiles sent to every
hospital emergency department in the United States by the National
Institute of Neurological Disorders and Stroke (NINDS). The influence of
such an endorsement has to be profound, and the adoption of the
treatment was widespread and almost immediate. 

Couple of other things likely helped the process along. NASCIS 3
elicited a prepublication press release from NINDS that was almost as
enthusiastic as the first one, and the Corcoran Review of medical
treatment od SCI was written by Bracken, *the lead author of the NASCIS
studies*. It was, surprisingly ;-), also enthusiastic about steroids.

There are a couple of questions I've never seen anyone attempt to
answer:

1. Experienced statisticians, including Bracken (who is not an MD, but a
PhD epidemiologist and statistician), were involved in reducing the raw
data. If the results were no better than what appears in the reports,
why the insistence on the part of both Bracken and the NINDS that
megadose steroids truly represented a major advance in the treatment of
acute spinal cord injury? Why was NINDS sufficiently impressed with
NASCIS-2 to fax all of the hospital emergency departments in the United
States in advance of publication about its findings? And why the
laudatory prepublication press releases about both studies from NINDS?

2. The 4 papers describing the NASCIS results were published in three
major medical journals. Given their obvious deficiencies, how did they
get by all of the reviewers?

I have some speculations about this, but they certainly put all of the
parties involved in a very poor light. I'm truly glad that this many
years later, most people seem finally to be doing the right thing.

Sanford M. Miller, MD
sanford.miller at nyumc.org 




________________________________

    
    ----- Forwarded Message ----
    From: "candymsnjd at aol.com" <candymsnjd at aol.com>
    To: trauma-list at trauma.org
    Sent: Thursday, April 24, 2008 6:51:43 AM
    Subject: Re: Steroids in spinal cord injury ?
    
    i am involved in a case right now where it is being insisted
that it is the SOC and should have been given in the ED!!!
    this issue needs to be resolved as it is a minefield and still a
ripe area for the?plaintiffs lawyers 
    
    
    -----Original Message-----
    From: Offner, Patrick <PatrickOffner at Centura.Org>
    To: Trauma &amp; Critical Care mailing list
<trauma-list at trauma.org>
    Sent: Wed, 23 Apr 2008 4:41 pm
    Subject: RE: Steroids in spinal cord injury ?
    
    
    
    We still do it--but talk about not doing. We keep being told
that it is
    the "local standard of care" and to not do it would get us sued.
    Moreover, our spine surgeons(who don't read any literature as
far as I
    can tell) still order it. Unfortuantely my vehement
protestations fall
    on deaf ears... 
    
    
    Patrick J. Offner MD MPH
    Chief, Surgical Critical Care
    St Anthony Central Hospital
    
    

------------------------------------------------------------
This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure, or distribution is prohibited. If you have received this email in error please notify the sender by return email and delete the original message. Please note, the recipient should check this email and any attachments for the presence of viruses. The organization accepts no liability for any damage caused by any virus transmitted by this email.
=================================


      ____________________________________________________________________________________
Be a better friend, newshound, and 
know-it-all with Yahoo! Mobile.  Try it now.  http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ