tPA for Stroke: The Story of a Controversial Drug / Edition 1

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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.

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Editorial Reviews

Doody's Review Service
Reviewer: Maria I Aguilar, MD (Mayo Clinic Arizona)
Description: This is a very well-written chronicle, with a subtle nonfiction flavor, of how the drug tPA came to be tested and approved for use in stroke victims. It is a one of a kind book, entertaining and educational, yet scientifically based with well-supported content.
Purpose: The purpose is to tell the story of how tPA was tested in stroke victims and how it achieved FDA approval for the treatment of acute ischemic stroke.
Audience: The audience for this book includes the general public, stroke victims and their families, medical students, medical residents, physicians, researchers, lawyers, and all those at risk for stroke. The authors are credible authorities in the field.
Features: The book covers the emergence of tPA as the standard of care treatment for stroke in a unique, entertaining, and credible way.
Assessment: There is no comparison to this book, which will help increase awareness of stroke and stroke treatment. I thank the authors for their efforts.
From the Publisher

"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.

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Product Details

  • ISBN-13: 9780195393927
  • Publisher: Oxford University Press, USA
  • Publication date: 12/3/2010
  • Edition number: 1
  • Pages: 208
  • Sales rank: 1,043,092
  • Product dimensions: 6.30 (w) x 9.30 (h) x 0.90 (d)

Meet 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.

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Table of Contents

To the Reader

PART ONE: Discovery

Chapter One
Code Stroke on Market Street

Chapter Two
Clotbuster: The Natural History

Chapter Three
Dead or Alive

Chapter 4

PART TWO: Change, Resistance, and Transformation

Chapter Five
The Brain Doctors Cometh - Slowly

Chapter Six
What Emergency?

Chapter Seven
Money and Brain

Chapter Eight
Deer in the Headlights

Chapter Nine
Call 911, 112, 15...Even 999

Chapter Ten
Persistence of a Most Controversial Drug

Chapter 11
Through the Looking Glass

The NINDS Stroke Study: A Personal Statement

List of Interviews

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