As I have stated before, I could easily dedicate most of my life just disseminating what the good Dr has written and what it means. At best I can only just pick and choose just a handful of his articles to further explore for the benefit of both you and I. I liken this to purchasing a top sports car. Yes all you need to do is chuck the key into the ignition and start the thing up and off you go. But wouldn’t we better drivers if we know all the engine modes available, how it performs at peak, what are the respective suspension modes and how it handles in the wet?
Surely our drive would be smoother and more enjoyable if we had at least a cursory knowledge of what happens under the hood and the many options available to us?
In the very same way let’s break down just this one article to further our understanding of this amazing 'magic juice' you and I hold. Tonight I present to you Dr Felson's evocative article a on trial set up.
Let me start of with a quote from the article:
“At a time when advancing understanding of osteoarthritis (OA) has created opportunities for new treatments, development of treatments has remained considerably behind advances in other rheumatic diseases”.
Let’s break this down into Mozzie terms -We are now understanding more and more about what OA comprises of and how it works. We now know for the first time, that the bone and the cartilage have actual connections. Lets go to a separate independent quote: "Although cartilage degradation is the characteristic feature of osteoarthritis (OA), it is now recognized that the whole joint is involved in the progression of OA. In particular, the interaction (crosstalk) between cartilage and subchondral bone is thought to be a central feature of this process". 1
Dr Felson infers that in this environment, opportunities are many but development of treatments is lacking! This sets up the canvas for us to create a masterpiece...
Indeed what an opportunity for us in this ‘catch up’ phase to bridge the gap and paint something memorable which will positively affect millions....
Continuing through Dr Felson's article...
“prevention of cartilage loss and reduction of pain correlate weakly at best, and in at least some patients, reduction in pain may actually increase joint damage, making it impossible to demonstrate dual treatment effects on structure and pain in such scenarios”
...yes but the good Dr now is aware of us and this relationship of preventing cartilage loss AND pain reduction in the one NON foul sweep may finally be established! This impossibility in Mozz eyes is changing right before us, just like the pure pain relief spreading through the OA patient by week four or so. I mean that the good Dr no doubt has seen the light in PAR and iPPS and the impossible may slowly become possible...Dr Felson goes on to state...
“treatment effects on pain‐sensitive structures such as bone and synovium may be more achievable than preventing cartilage loss”
Again look at what we have: we have the real possibility that we can achieve BOTH, pain reduction AND stopping, halting the progression of cartilage loss, a scenario not conceived or contemplated at the time the good Dr wrote that article! No wonder he is excited as we too should be.
Dr Felson points out that the current rate of knee replacements are high at 700,000 per year but you know what? He states that this will be 3,000,000 per year in 2030. Why? Why will this increase so much in just ten short years? I again quote from the article,
“This high rate of knee replacements can be ascribed in large part to the inadequacy of nonsurgical treatments with respect to pain relief, long‐term adherence, and delay of disease progression. Development of treatments that relieve pain and delay the need for knee replacement is a high priority in clinical practice and in the public health arena..”
It’s like he is dreaming of PAR’s solution as a premonition... it’s what iPPS exactly does. Dr Felson also suggests...
“Further, the residual joint pain after knee replacement in 20–30% of patients may suggest that pain mechanisms not addressed by arthrectomy persist.”
This has ramifications for us, as Gan-Gans pointed out in his slightly earlier post back on the 30th of Dec 2019: https://hotcopper.com.au/threads/research-reports-and-media.4850908/page-7#post-42163277, there is scope for us in a post operative sense to relief pain and inflammation in this area, 20-30% of some 700,000 ops is significant wouldn’t you say??
Reading further through this wonderful article, it may be obvious but cartilage loss doesn’t hold a candle to pain, again I quote the master; “Pain is by far the predominant concern that drives patients to seek care”. And this, my Paradigmers is what will drive our future sales (again my views).
Pain relief WITHOUT the addiction.
Pain relief WITHOUT the side effects.
How about this quote that’s truly an ugly one? “in a randomized trial of indomethacin versus azapropazone treatment of hip OA, use of the more effective pain reliever, indomethacin, led to earlier joint replacement and more cartilage loss”.
Paradigmers, this is our competition, this is the current std of care, Mozzarc view of the std of care? Pathetic. But there is nothing else apart from “grin and bear it” (Mont’s Dr) or surgery.Dr Felson then goes on to state there is a relationship between BMEL and cartilage loss.
Getting to the crux of the article, trial patient selection isn’t as straight forward as one might think: “selection of subjects at higher risk of progression may actually work against selecting patients or knees whose disease progression is preventable with biologic agents”. How? Because the patients that are too far gone don’t show much respective ‘relief’ as opposed to some patient that still has a fair amount of cartilage left as an example. Yes indeed the trial selection and design will be critical but having Dr Felson on board will be like getting Babe Ruth on a team in Baseball... batter up.
New York Yankies Babe Ruth and Lou Gherig making a formidable team....I liken it to Dr Felson and Paul Rennie now on the same team as each other.
Don’t forget, this is just one article that Dr Felson has written out of hundreds! The good Dr batting for us soon at FDA headquarters? Simply Amazing .
DISCLAIMERS
My views here, you must do your own research, form your own independent opinions. Yes of course I'm positive and enthusiastic but I certainly don't know everything nor the future and what it holds and what might happen. Express caution in any investment but this looks to me like one that's going to go some ways outta da ball park.
(20min delay)
