Continuing Medical Education: Changing Patterns of Care

By | September 16, 2011

The ancient Greeks understood the difference between Sophia (Σοϕια) and Techné (Τεχνη) as well as the value of both. If your sword was in need of repair Aristotle and his metaphysics were not likely to be of help, whereas the blacksmith and his hammer were. The same is true when treating the pain of cancer.

Sometimes the goal of a medical lecture is to announce some revolutionary new product or technique and sometimes the purpose is to describe new usage patterns for an old group of therapies. The ancient Greeks even had two different words to describe these two types of knowledge, Sophia (Σοϕια), which connotes wisdom or understanding and Techné (Τεχνη), which describes and art or skill. It is in the latter sense that I will be speaking this afternoon at Hollywood Presbyterian Medical Center. I am assuming that very few people in the audience are unaware of the existence of these devices, but I would wager that many of them regard intrathecal drug delivery systems as an exotic form or therapy reserved for end-stage cases. Instead I hope to teach them that IDDS is part of the mainstream treatment for a significant number, if not a majority of cancer pain sufferers.

I think that a major reason for this misconception has to do with technical and economic advances in care. The new pumps are smaller, lighter, easier to use and more versatile than previous models. Competition and improved pharmacy and manufacturing techniques have lowered the cost of this form of therapy, and I expect the introduction of Johnson and Johnson‘s, Codman Medstream pump either later this year or early next year to accelerate this trend. This is a pump which has been used successfully in Europe for years now and which is just waiting for FDA approval. This will break the Medtronic Synchromed II‘s near monopoly on the IDDS market and hopefully make this form of therapy available to many more patients.

Finally I hope that I can instill a sense of excitement into the audience about the care of cancer patients in pain. I hope to show them the care of cancer pain is not simply writing prescriptions for drugs which will depress consciousness and slowly rob these patients of their humanity, but rather an active and creative endeavor, albeit more techné than sophia which will restore function and add meaning to their lives.

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