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tPA for Stroke: The Story of a Controversial Drug, by Justin A. Zivin, John Galbraith Simmons
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Without warning stroke can paralyze, blind, or kill. Some victims recover, but many do not and may even suffer another disabling or fatal attack. The drug known as tPA can drastically reduce the long-term disability associated with stroke, but despite its near-miraculous capabilities and the growing support of most neurologists, it has been slow to win acceptance as the standard of care in emergency departments nationwide.
tPA for Stroke chronicles how this remarkable drug came to be tested in stroke victims, its early years in development by the pharmaceutical giant Genentech, and its eventual marginalization due to a convergence of unfavorable political, fiscal, and medical circumstances. For instance, initially many stroke specialists were unconvinced that the drug's benefits outweigh its risks (tPA was originally developed and is still used for cardiac patients). Moreover, neurologists called upon to assess stroke patients have not typically been trained to make decisions in emergency settings--and tPA must be given within a scant few hours after stroke. These and other factors have continued to delay the drug's universal acceptance as the most effective treatment available, and to hamper the general public's awareness that such a treatment exists--a troubling state of affairs that Zivin and Simmons argue must be rectified. Instilling the knowledge that anyone, at any time, is susceptible to stroke, from the old and infirm to the young and healthy, tPA for Stroke is a clarion call to awareness in a rapidly changing healthcare environment in which stroke, long a disease in thrall to resignation and pessimism, must be neglected no longer.
- Sales Rank: #1812184 in Books
- Published on: 2010-12-03
- Original language: English
- Number of items: 1
- Dimensions: 6.50" h x .80" w x 9.50" l, 1.05 pounds
- Binding: Hardcover
- 208 pages
- ISBN13: 9780195393927
- Condition: New
- Notes: BRAND NEW FROM PUBLISHER! 100% Satisfaction Guarantee. Tracking provided on most orders. Buy with Confidence! Millions of books sold!
From Booklist
Each year 750,000 individuals suffer a stroke, an interruption of the blood supply to the brain often caused by a clot. In this well-written, well-researched, yet biased book, the coauthors passionately tell the tale of a clot-busting drug called tissue plasminogen activator that can reduce long-term disability. The authors feel that tPA (the only FDA-approved drug for acute stroke) is overcriticized and underused. The history of the drug trials and approval process is surprisingly interesting, but Zivin (a doctor who was an early tPA investigator) and Simmons (a novelist and science writer) give short shrift to the fact that if the drug is administered too late, it can increase the risk of bleeding in the brain. Yet Zivin and Simmons recount numerous success stories of stroke victims who regain normal functioning with the help of tPA. One neurologist, who had had reservations about the drug, suffered from a stroke himself, got tPA, and regained his speech and mobility. Zivin sees “no villains in this story,” and just wants to increase awareness of a potential miracle drug. --Karen Springen
Review
"When science, medicine, politics, biotech, government, ego, the law, and public health all collide, the resulting marvelous thunder is this extraordinarily insightful book into the development of the only proven treatment for the number one combined killer and crippler - stroke. As told by those closest to the truth, this story is gripping yet painful, wonderful yet concerning, and reads like a fictional medical thriller yet is a historical documentary. Every person and family afflicted by stroke and even those worried about having a stroke must read this so they will know what reality is." --Steven R. Levine, M.D., Professor and Vice Chair, Neurology, and Associate Dean for Clinical Research & Faculty Development, The State University of New York (SUNY) Health Science Center - Brooklyn
"A fascinating and well-written saga of a dispute that illustrates many of the weaknesses of the U.S. biotechnological and medical enterprise."--Robert Bazell, Chief Science and Health Correspondent, NBC News
"Every important new drug deserves its own biography, and tPA for Stroke is a splendid bio, told in painstaking and eye-popping detail, of tissue plasminogen activator, one of the most powerful--and controversial--products of the biotech age. Justin Zivin and John Simmons succeed not only in recounting a stirring scientific odyssey of ingenuity and persistence; they explain why a successful new treatment for stroke is not more widely used against one of the most debilitating afflictions of humankind. A provocative book that will enlighten, and perhaps infuriate, researchers, doctors, and patients." --Stephen S. Hall, author of Wisdom: From Philosophy to Neuroscience
"There is no comparison to this book, which will help increase awareness of stroke and stroke treatment. I thank the authors for their efforts." --Doody's
"tPA for Strokes serves as a loud and effective wake-up call to the public to understand why they are still not likely to get effective stroke care unless they are fully informed. If they read this book, they will be informed consumers and will know the importance of recognizing stroke symptoms, acting immediately, and getting the stroke patient to an appropriate stroke center." -- James C. Grotta, M.D., World Neurology
"This book is an interesting read for those of us who are stroke enthusiasts, and for those who are not; I recommend it wholeheartedly to both groups!" -- Arani Nitkunan, Department of Neurology, St George's Hospital, London, Advances in Clinical Neurosciences and Rehabilitation
"The aim of the book, according to the authors, was to raise awareness of tPA and, at the end, one does feel convinced of its status as a revolutionary neurological drug. This book
is an interesting read for those of us who are stroke enthusiasts, and for those who are not; I recommend it wholeheartedly to both groups!" -- Arani Nitkunan, Department of Neurology, St George's Hospital, London, Advances in Clinical Neuroscience and Rehabilitation
"Stroke physicians, whether specialist or in training, will be curious about reading this account of the story of tPA, as will those with an interest in medical history." --The Lancet
Featured in Brain: A Journal of Neurology.
About the Author
Justin Zivin, M.D., Ph.D., is a Professor of Neurosciences at the University of California San Diego. For more than thirty years he has conducted research in acute stroke therapy both for basic science studies and clinical trials. He has been continuously funded for this research by federal agencies since 1979.
John Galbraith Simmons studied philosophy at Northwestern University, graduating with honors, and also holds a degree in developmental studies from Long Island University. He has published four novels, written for television and film, and is also the author of The Scientific 100: A Ranking of the Most Influential Scientists, Past and Present and Doctors and Discoveries: Lives That Created Today's Medicine. He lives in New York and Paris.
Most helpful customer reviews
7 of 9 people found the following review helpful.
The problem with scientific proof
By Terrigal
While I enjoyed reading this book, I was hoping for an explanation as to why tPA in stroke was and is such a controversial issue. For any reader hoping this this would be made clear by reading this book, you may well be disappointed. That is not to say that the reasons can't be divined.
Firstly, Dr Zivin's clear enthusiasm for a search for a stroke treatment that might work, seeps out of every page. You get the distinct impression that his Nobel Prize acceptance speech has already been prepared. It is this enthusiasm, on my reading, that largely explains why tPA is still under-utilized. Rather than adopt the scientific frame of mind that sets out to disprove a thesis ( thus steering clear of potential cognitive biases that can infect research methodology) researches in this field seem to have abandoned this safe methodology in their enthusiasm for positive results. Consequently, when critics of tPA are mentioned in this book, there is very little intelligent analysis of why they disagree with what the authors desperately hope becomes the standard of care. For example, in discussing Dr Hoffman's influence on the debate in chapter 6, the authors cite his skepticism and distrust of pharmaceutical industry as though this is a vice rather than a virtue of the scientific methodology. The analysis of Hoffman, for what it's worth, is simply an ad hominem attack, rather than what one might have hoped for in a book purporting to be the story of tPA, some engagement with his arguments. There is none of this. The truth, whatever it is in relation to tPA in stroke, apparently cannot handle dissenting views. The authors appear to be genuinely mystified at the way science is safely advanced. On page 67 they have Jim Grotta saying
"Here we had a treatment and rather than embracing it and trying to get people to treat stroke, we had the stroke experts who were trying to throw arrows at the data." Indeed. We all hope they would. Rather we are offered an explanation for why the experts might throw arrows at research data, that hints at their venality rather than their cautious skepticism.
Secondly. I am always skeptical of authors who use narrative in the hope of convincing the public of the righteousness of their point of view. It just doesn't help settle a scientific question, by having a Judy or a John or a Kevin or a Natalie undergo a contested treatment and have a favorable outcome as though this settles the question. Of course the authors chose a favorable outcome. It might have served their 'cause' if they'd picked the opposite; an unfavorable outcome.
Buy this book. It is certainly worth reading but not for the reasons that the authors intended. If you wonder why science seems increasingly dogmatic and religious in their approach to dissent then this book will give you insight. The same shrill dogmatism infects global warming debates such that we may never know the truth of the matter.
If I wanted to prove tPA in stroke really works, I'd have teamed up with my harshest critic rather than discount the critic's virtue that keeps all scientist on their toes: skepticism.
7 of 9 people found the following review helpful.
A Must Read
By Dahlin
In 1991 my step-mother entered the nursing wing of the retirement community in which she and my physician father lived. Over the next two years I often passed by the patients lined up in wheelchairs, unable to move or to speak, disabled by stroke. tPA for Stroke describes this state of helplessness as a fate worse than death. I would have to say it is a fate a thousand times worse than death. So when I first heard of a new drug that could often prevent such disability, I could not understand why it was being used so infrequently. Justin Zivin will answer this question for you in a book that although at times is laced with scientific words puzzling to the layman, is ultimately readable, fascinating and informative. Eighty percent of the way through the book I was silently screaming "sue the bastards" and I am not an advocate of malpractice suites. More importantly everyone who has a loved one with the potential of having a stroke or who has the potential of having a stroke, and that must be just about everyone, needs the information in this book. tPa for Stroke is a must read.
4 of 10 people found the following review helpful.
A Much Needed Book
By Sambo Gonzales
This book is a shocker. It answers the question of why this remarkable drug, tPA, which can immediately prevent a lifetime of horrifying silence and immobility, is not in universal use by hospitals.
There are two reasons.
Firstly, the book describes the lazy, unprofessional attitude of Neurologists, who are the primary specialists called upon to treat stroke. Apparently, medical students who choose to specialize in Neurology deliberately and specifically choose a specialty that has no middle of the night calls or other kinds of emergency response required of them. They want a laid back, totally relaxed work format where everything can take two or three days, or longer. High pressure, emergency care of patients is not something they want to get into.
The second reason is that Emergency Room doctors are scared of initiating a tPA injection in case severe cranial bleeding should occur, resulting in criticism and, possibly, a law suit.
The book describes how these two groups have fought tenaciously for years at scientific meetings to prevent tPA from becoming a standard of treatment. They would rather that a patient enter a dark, horrifying crippledom for the rest of their lives rather than disturb the historical paradigm of not doing anything for the stroke victim except performing low priority surveillance.
These two authors have performed a superb public service and are to be strongly commended for their humanity and decency.
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