I thank the authors for highlighting this difficult topic with a very
thought provoking article.
In immunosuppressing a patient with neurological disease, as with
anything a physician does to a patient, there are potential risks to take
into account and to be weighed up against the proposed benefits. Indeed,
this sort of "cost-benefit" analysis is a central tenant of decision
making in much of life outside of me...
I thank the authors for highlighting this difficult topic with a very
thought provoking article.
In immunosuppressing a patient with neurological disease, as with
anything a physician does to a patient, there are potential risks to take
into account and to be weighed up against the proposed benefits. Indeed,
this sort of "cost-benefit" analysis is a central tenant of decision
making in much of life outside of medicine also.
It is generally accepted that in order to proceed, the benefits
should outweigh the "costs". It is clear that PCP prophylaxis is effective
at reducing the incidence of PCP, but at what cost? In patients with solid
-organ transplant for example, this is fairly clear as the incidence
appears high, as noted in the authors references.
The problem is that we have little knowledge of the incidence of PCP
in patients immunosuppressed for myasthenia gravis, for example. My
personal feeling is that this risk is much lower, but there is little
evidence in the literature to support this.
When considering that around 15% of patients develop side effects
whilst taking trimethoprim-sulfamethoxazole, and these can (in rare cases)
be fatal, it is not clear in my mind that the cost-benefit analysis for
patients with neurological disease swings in favour of the widespread use
of PCP prophylaxis. Put simply, would enough cases of PCP be prevented to
outweigh the risks posed by the side effect profile of the medication?
To help us make this decision we need clearer data on the incidence
of PCP in patients with neurological diseases who are being prescribed
immunosuppressive medication.
This is a superb book that deserves to be better known, at least on
my side of the Atlantic. In addition to Barker's outstanding depiction of
WW1 Britain, the sympathetic and revealing exploration of the physician-
patient relationship is peerless. Interested readers should know that
Regeneration is the first book in a trilogy, though neither is quite as
good as Regeneration. The second book, The Eye in the Door, is qui...
This is a superb book that deserves to be better known, at least on
my side of the Atlantic. In addition to Barker's outstanding depiction of
WW1 Britain, the sympathetic and revealing exploration of the physician-
patient relationship is peerless. Interested readers should know that
Regeneration is the first book in a trilogy, though neither is quite as
good as Regeneration. The second book, The Eye in the Door, is quite
good. The final book, The Ghost Road, is a bit uneven but the final
section of this book, describing an infantry assault in the closing stages
of the war, is an absolute tour-de-force of sympathetic description.
I thank the authors for highlighting this difficult topic with a very thought provoking article.
In immunosuppressing a patient with neurological disease, as with anything a physician does to a patient, there are potential risks to take into account and to be weighed up against the proposed benefits. Indeed, this sort of "cost-benefit" analysis is a central tenant of decision making in much of life outside of me...
This is a superb book that deserves to be better known, at least on my side of the Atlantic. In addition to Barker's outstanding depiction of WW1 Britain, the sympathetic and revealing exploration of the physician- patient relationship is peerless. Interested readers should know that Regeneration is the first book in a trilogy, though neither is quite as good as Regeneration. The second book, The Eye in the Door, is qui...
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