Re­search fund­ing doesn’t match level of dis­abil­ity

Cape Breton Post - - LIFESTYLES - Keith Roach To Your Good Health

DEAR DR. ROACH: I read a lot about re­search for can­cer and HIV, and noth­ing about money spent for help with arthri­tis. That one strikes al­most ev­ery­body, with age. Is some re­search in progress for in­vent­ing a sub­stance that can be sprayed on joints af­flicted with a loss of car­ti­lage to make them slip­pery? How much money is pro­vided for arthri­tis com­pared with other dis­eases? — E.M.

AN­SWER: Fund­ing for re­search in a par­tic­u­lar dis­ease is de­cided by a large num­ber of fac­tors — ev­ery­thing from the public health bur­den of a dis­ease to the ef­fec­tive­ness of the lobby by a par­tic­u­lar group of sup­port­ers. An in­ter­est­ing pa­per look­ing at Na­tional In­sti­tutes of Health re­search was done a few years ago, show­ing that, ad­justed for the amount of dis­abil­ity at­trib­ut­able to a par­tic­u­lar con­di­tion, there are two con­di­tions— HIV and breast can­cer — that have much higher fund­ing than oth­ers. I don’t mean to sug­gest that breast can­cer or HIV have “too much” fund­ing. I would like to see a ma­jor in­crease in re­search fund­ing over­all.

The ba­sic sci­en­tific un­der­stand­ing gained from re­search­ing these im­por­tant con­di­tions is ap­pli­ca­ble to many dif­fer­ent ill­nesses. How­ever, there are other dis­eases that have much less fund­ing given the amount of dis­abil­ity they cause in the pop­u­la­tion. Arthri­tis gets rel­a­tively lit­tle fund­ing com­pared with HIV and can­cer. In­ter­est­ingly, the two con­di­tions that get the least amount of fund­ing con­sid­er­ing the amount of suf­fer­ing caused by them are de­pres­sion and COPD. While I might wish for more over­all fund­ing for re­search, it does seem from this pa­per and oth­ers that the dis­tri­bu­tion of fund­ing isn’t as eq­ui­table as pos­si­ble.

De­spite a rel­a­tive lack of fund­ing, there is still much re­search be­ing done on im­prov­ing the car­ti­lage lin­ing the joints, one ma­jor site of dam­age in os­teoarthri­tis. Stem cells are one pos­si­bil­ity. Un­for­tu­nately, a spray-on sub­stance hasn’t quite been worked out yet.

DEAR DR. ROACH: I’m in the mid­dle of a dis­pute be­tween my neu­ro­sur­geon and car­di­ol­o­gist, and would ap­pre­ci­ate your opin­ion. I’m a 70-year-old male with ex­ten­sive car­diac is­sues, in­clud­ing a heart at­tack, stent, ab­la­tion and A fib. I have a pace­maker/de­fib­ril­la­tor im­planted in my chest. I re­cently was di­ag­nosed with a her­ni­ated disc, and the neu­rol­o­gist wants to per­form surgery. He in­sists that I stop tak­ing my daily 81-mg aspirin seven days be­fore surgery. My car­di­ol­o­gist ab­so­lutely re­fuses to al­low this, and states that stop­ping the aspirin could be life-threat­en­ing. The neu­ro­sur­geon will not op­er­ate un­less the aspirin is stopped. Nei­ther doc­tor will budge. Am I doomed to a life of back pain, or is there some al­ter­na­tive? — R.G.J.

AN­SWER: I’m sorry, but I can’t over­ride ei­ther your car­di­ol­o­gist or your neu­ro­sur­geon. Both are do­ing their best to make sure you are safe, from their re­spec­tive points of view.

When surgery is ab­so­lutely in­di­cated, we some­times use hep­arin (or one of its newer cousins) by in­jec­tion for the week be­fore surgery. It wears off much more quickly than aspirin does. So, by stop­ping it right be­fore surgery, you are only with­out an an­ti­co­ag­u­lant for the few hours dur­ing the surgery, and you restart the aspirin as soon as the neu­ro­sur­geon al­lows. This plan min­i­mizes bleed­ing risk dur­ing surgery and also clot­ting risk in the days be­fore surgery.

If your back is bad enough to be worth both of these risks, then I would ask both your car­di­ol­o­gist and your neu­ro­sur­geon whether they would con­sider this plan.

The book­let on back prob­lems gives an out­line of the causes of and treat­ments for the morecom­mon back mal­adies. Read­ers can or­der a copy by writ­ing: Dr. Roach — No. 303, 628 Vir­ginia Dr., Or­lando, FL 32803. En­close a check or money or­der for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2015 North Amer­ica Syn­di­cate Inc. All Rights Re­served

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