Essentially, as previously noted, the main controversy here is whether or not pancreas transplants are an effective therapeutic method for Type 1 Diabetes in the IDDM (insulin dependent melitus) diabetic patients. Paul Robertson (1998) notes that there are two opposing sides to this: simple approach or circumspect approach.
The simple approach basically states that yes and only because "pancreases are being transplanted therapeutically all over the United States and Europe on a daily basis" (Robertson, 1998, p.1868). Robertson (1998) describes that the process for pancreatic transplants became feasible in 1978 and since then almost 10000 have been transplanted. Pancreas survival after transplant has a fairly high rate at 70-90% with even higher rates being reported because some groups are highly selective of their recipients (Robertson 1998). What is important to note here that Robertson (1998) discusses is that when the procedure is successful, "recipients are totally insulin-dependent, have normal levels of glycemia and...report improved qualities of life" (p. 1868). However, there is a patient mortality rate of 12%. Having said this, this rate, as pointed out by Robertson (1998), is "uninterpretable because it resembles the natural history of IDDM [for over a] 20 year duration" (p. 1868). No case-matched study regarding pancreas transplantation has been performed and most deaths occur beyond 3 months post-transplant (Robertson 1998). Is this a really reliable and valid argument then?
Thus, because there have been no controlled studies regarding pancreas transplants in diabetic patients there has to be a more circumspect explanation, as well. Robertson (1998) points out that "[s]urgical history is replete with examples of operative procedures, some good, some bad, that were developed to the
point of daily use by the trial and error approach with rarely a thought about including sham operations or controls" (p. 1868). Such is similar with pancreas transplants. Yes, doctors want to relieve human suffering but this is not a method to evaluate therapeutic efficacy. When pancreas transplantation is successful, insulin independence and normoglycemia is reestablished and improves quality of life measures, there is undoubtedly less certainty about its impact on chronic diabetic complications inclusive of retinopathy, nephropathy and neuropathy (Robertson 1998). Essentially, there are some benefits but they cannot be conclusive only because of the fact that there have been no controlled studies conducted. Therefore, "[i]n the absence of randomized trials, this makes drawing defensible conclusions difficult, if not impossible" (Robertson, 1998, p. 1868).
Personally, I believe that the simple approach lacks validity and reliability just because pancreatic transplants have not been tested under controls. Conclusions are made tentatively. I don't think that pancreatic transplants are wrong, however, it is almost similar to giving a child a herbal remedy and telling them "I do not know if this will cure your cold or not, but we can try". To a certain extent, it is risky. Therefore, I think that it is quite important to test this therapeutic method under controls to make sure conclusions are reached as specifically as possible because human lives are at stake. Robertson (1998) notes that "[p]ancreas transplantation is here to stay until something better—presumably islet transplantation—comes along and is proven to be more efficacious" (p. 1869). I believe this is true but as I've argued, I do think that it is quite crucial that it is tested to provide concrete conclusions until the point comes whereby another therapeutic method for Type 1 Diabetes is found.
References
Robertson, P.R. (1998). Has pancreatic transplantation arrives as a therapeutic option in IDDM. The Journal of Clinical Endocrinology and Metabolism, 83(6), 1868-1869.
No comments:
Post a Comment