~Please read~Clare responds to 'Dr. Moore Responds'

From: clareS (anonymous@medispecialty.com)
Thu Jan 9 16:17:13 2003


Dear Dr. Moore:

Okay, okay, I wasn't going to jump into this as I'm busy enough as it is, but hey, there's some things I really gotta say here :o)

Perhaps I might suggest that you put your credentials on the figurative table here, and no, I'm sorry but a bit more than "OB/GYN" and "all lot of experience" would be appreciated.

You stated that "A real scientific experiment involves a placebo arm, where patients are given similar treatment but without the "magical" cure or medicine. Because as all of you know some people don't form adhesions- this means that sometimes "nothing" works to prevent adhesions. And that's where barriers like Intercede (and probably this Spraygel) failed."

Perhaps you are not aware that trials for SprayGel have been quite successful overseas, and that there are ongoing clinical trials (yes, with a placebo arm) currently underway in the USA as I type. I went to the PUBMED site that you laud, and I simply typed in SprayGel, and lo and behold this is what I found!!

"1: Hum Reprod 2001 Dec;16(12):2718-23 Related Articles, Links

Evaluation of a sprayable polyethylene glycol adhesion barrier in a porcine efficacy model.

Ferland R, Mulani D, Campbell PK.

Women and Infants Hospital, Providence, RI 02905, USA. roger_ferland@brown.edu

BACKGROUND: The formation of adhesions following pelvic surgery remains one of the leading causes of infertility, small bowel obstruction and re-operation for pelvic pain. A novel hydrophilic polyethylene glycol based adhesion barrier (SprayGel) is formed by simultaneously spraying two liquid precursors onto surgical sites. The liquids polymerize to form a gel that effectively coats and adheres to tissue. After about 5 days, the hydrogel layer is absorbed and subsequently undergoes renal clearance. It is believed that the presence of such a barrier would inhibit the formation of adhesions following surgical insult. METHODS: A porcine adhesion model was developed wherein bilateral uterine horn transection and re-anastomosis, along with peritoneal side wall excision was performed via laparotomy. In each animal (n = 10, including the pilot study) one pelvic side wall was treated with adhesion barrier, while the contralateral side remained untreated. RESULTS: At second look laparoscopy, 90% of the untreated sites had adhesions, compared with 30% of the treated sites (P = 0.006). Also observed were statistically significant reductions in the adhesion extent (P = 0.029) and adhesion severity scores (P = 0.023) at the treated sites. However, if the pilot study was excluded (n = 8) the differences obtained were no longer significant. CONCLUSIONS: Polyethylene glycol (SprayGel) merits further investigation as an effective barrier to the formation of post-operative adhesions in this porcine model.

PMID: 11726601 [PubMed - indexed for MEDLINE"

~And~ "1: Fertil Steril 2001 Feb;75(2):411-6 Related Articles, Links

Evaluation of the SprayGel adhesion barrier in the rat cecum abrasion and rabbit uterine horn adhesion models.

Dunn R, Lyman MD, Edelman PG, Campbell PK.

OB/GYN Associates, PA, 7550 Fannin, Houston, Texas 77054, USA. obgynassociates.com

OBJECTIVE: To evaluate the efficacy of a new adhesion barrier in the prevention of postoperative adhesion formation. DESIGN: A double-blind controlled study of the efficacy of SprayGel in reducing postoperative adhesion formation in two animal models. SETTING: Animal care facility of a contract testing laboratory. ANIMAL(S): Sixteen Sprague-Dawley male rats were randomly allocated into two groups in the cecum abrasion model. Twenty New Zealand white female rabbits were randomly allocated into two groups in the uterine horn abrasion model. INTERVENTION(S): In the rat model, the cecum was abraded with gauze and the abdominal wall was abraded with a scalpel. Treated animals received SprayGel coating on injured surfaces; control animals received no treatment. In the rabbit model, uterine horns were abraded with a scalpel. Treated animals received SprayGel coating on injured surfaces; control animals received no treatment. MAIN OUTCOME MEASURE(S): Postoperative adhesion formation. RESULT(S): In the rat model, SprayGel was found to significantly reduce the incidence of adhesions, which formed in 7 of 8 control rats compared with 1 of 8 treated rats. In the rabbit model, SprayGel was found to significantly reduce both the extent and severity of adhesions. CONCLUSION(S): Application of SprayGel in two animal models reduced formation of postoperative adhesions. Further investigation in large animal and clinical settings is warranted.

PMID: 11172849 [PubMed - indexed for MEDLINE]"

There you have 2 studies, one on humans sitting right there in front of you! With all due respect, I suggest that you, Dr. Moore could have done the same, and got the identical results. The clinical trials on Spraygel are not anecdotal, and the results are not "magical" - the results are a significant reduction of adhesions at second look laparoscopy which merits more studies (currently underway).

I find your suggestion that we do our own research high-handed, and insulting. Obviously, you have very little idea whom you are addressing with such a sweeping assumption. I find your comments regarding Dr. Krschinski in Germany ("Dr. K should remember the first rule of medicine, Primum non nocere- first do no harm. And if his treatment works, then prove it. It's quite simple to prove medical therapies work, I would love to start using his techniques tomorrow if they worked.") simply deplorable, as well as unprofessional. That is why I ask you to put your credentials on the table - I have a difficult time believing that you are who you say you are, and not some bored troll. These Drs in Germany have proven that their medical treatment works (at least as far as significant reduction of adhesions is concerned) so you'd best do your research and get busy!

On a more basic note, Dr. Moore, people with problematic adhesions deal with very real issues, and it is Drs who believe only what they have been taught who do us (and all of their patients) a disservice.

Best wishes. Clare

At Thu, 9 Jan 2003, Dr.Moore wrote: >
>Some pretty harsh responses from this board. I suspected that would be
>a likely response. I have had a lot of experience with adhesions and it
>is a very frustrating problem. And I have done a lot of surgery to
>remove adhesions (in fact I did a laparoscopic lysis of adhesions
>today), with mixed results.
>
>To dispel a few incorrect statements-
>1) I am only 33, so my knowledge is not outdated. I finished residency
>in 1999.
>
>2) Never did I say "Go home and deal with it" although this may be
>better advice than that given by some of the people on this website. You
>see the problem with "I did this and now I'm better" advice (called
>anecdotal evidence in medical terms) is that it just isn't valid.
>
>A real scientific experiment involves a placebo arm, where patients are
>given similar treatment but without the "magical" cure or medicine.
>Because as all of you know some people don't form adhesions- this means
>that sometimes "nothing" works to prevent adhesions. And that's where
>barriers like Intercede (and probably this Spraygel) failed.
>
>I always tell my patients that if a treatment is not proven to work, but
>works for them (eg herbal supplements) they should do it. As long as it
>is not super expensive (eg flying to Germany and paying out of pocket
>for surgery) and isn't harmful (like surgery can be). Dr. K should
>remember the first rule of medicine, Primum non nocere- first do no
>harm. And if his treatment works, then prove it. It's quite simple to
>prove medical therapies work, I would love to start using his techniques
>tomorrow if they worked.
>
>Finally, do your own research. THE PLACE for researching medical
>literature is PUBMED. Here is the website, search for your self- the
>website gives you abstracts (short summaries of the experiments/clinical
>trials) and the original source so you can go to the library and look at
>the original articles. Here is the website:
>
>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
>
>Oh, one last point- The "you don't know what we're going through"
>argument also doesn't work in medicine. I don't know Dr. K's story,
>but I doubt he has pelvic adhesive disease. And I assure you that to be
>a good cardiologist you don't have to have a heart attack and to be a
>good neurosurgeon you don't have to have a brain tumor.
>
>At Wed, 8 Jan 2003, Koolinsask@aol.com wrote:
>>
>>Dear Dr.Moore, yes, I would have to agree with Sally, the sad part is, you
>>nor any doctor out there, can relate to what pain we go through, the daily
>>struggles, the depression, some of us are unable to work any longer, many of
>>us are very young, with very young children, just beginning our lives!!!!!
>>Only to be stripped of a "normal life". Too many doctor's tell us to go home,
>>suffer, sorry there is nothing we can do! This attitude has got to stop, we
>>need help, and we for so long have relied on our caregiver's to educate
>>themselves, to help us......well, it hasn't happened, we have come together
>>here on this forum, to help one another, to give support, to FIND help...if
>>that means spending money, money in which, is nothing when it comes to one's
>>health, then so be it!!!!!! I would also advise yourself, and hundreds of
>>other's out there, to please consider, researching, and try to understand
>>what it is that each and everyone of us is going through, it's an utter
>>nitemare!!!!! Please, i am not trying in anyway shape or form, to discredit
>>anyone doctor out there, but rather, pleading with you , to learn more, and
>>instead of telling us to go home, tell us, you are trying, you are
>>researching, and that you CARE, AND UNDERSTAND!!!!! We are all human, just
>>like your' wife, your' daughter, son , husband, mother , father etc......we
>>want to live, we want to see our children grow up, we want to take care of
>>our children, and get through our day's , just like you do!!!!!!!!!!! Thank
>>you for at least dropping in, and maybe reading through some of our stories,
>>that is a very nice first step....please, come back, and inform us, of any
>>new happenings that you may find out there!!!!!!
>>
>>Cherryl


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