The Amarin Problem..
Very much like a fourteenth century papal schism we now have great divide in medicine. On one side we have medical research scientists, most of them PHDs and on the other side we have clinicians who are MDs. Simplistically I place the MDs, in the campsite of the "creationists" and the PHD researchers with Darwinians. Since medical schools and their departements are run by the MDs, the researcher are relegated to second class and we have situations like the Vascepa fiasco.
Before the first quarter of the 20th century medical research was not much more than cutting up tissue or trying differnt substances hoping to see some improvement in whatever the disease was you were looking at. The technology explosion of the second half of the last century continues to peel the layers of mystery off pathophysiology and reveal more of nature's secrets.
Unforunitely the clinicians have not kept pace in many areas..While the scientists probe and study the hidden mechanisms, the clinicians are sticking to the same old "peanut butter and jelly" approach. This is what we used to call outcomes studies, and now goes by the new name of "evidenced based medicine"...realy it's just the old "Let's try peanut butter and jelly and see if that works"..Simply put..the researcher work at trying to find the answers, the clinicians operate on the basis of faith.
It's very sad and financially ruinous for people who want to apply the the information uncovered by researcher to the clinical sphere. Nobody realy has a good handle on whether statins work. We know they block cholesterol sysnthesis in the liver. Is that a good thing? Since choleserol is a vital structural component of cell membranes, is the building block of many vital homones, is crutial nerve transmission, and is a compnent of the mitochodria, we should know more than we do about these powerful drugs before we start treatin everone with them. The problem is the clinicians think lowering cholesterol will improve atherosclerosis...the researcher know the evidence for this hypothesis is very shaky...
But the clinicians are in charge.
":>) JL
