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Dissolves
Blood
Clots
Ananya Agrawal
Streptokinase Plasminogen
Streptokinase
Plasmin
Dissolves Thrombus
Thrombus, a common cause of heart attacks, can be dissolved using a cheap drug. A
cheap drug with one crucial ingredient it owes its name to. Streptokinase-an enzyme that
converts a blood protein called Plasminogen into the enzyme Plasmin-is that ingredient.
Streptokinase is far from the only enzyme used for a medical purpose. Erythropoietin is
given to anaemic patients to make more red blood cells. Asparaginase is another enzyme
that is used to aid in treatment of Acute Childhood Leukemia. Even Cystic Fibrosis can be
treated using deoxyribonuclease, or DNAʼase breaks down extra DNA in the mucous.
Penicillin, the first antibiotic, can be enhanced using an Enzyme Inhibitor. Bacteria can
develop immunity to Penicillin using enzymes called beta lacatamase which break down
penicillin. The active site of beta lactamase can be blocked using an antibiotic called
Augmentin which uses certain enzymes in it. Thus, enzymes have started to play an
integral role in medical treatment and with the boom in biotech industries and research,
this is sure to increase to greater heights.
Streptokinase has one major limitation which increases the time it requires to act. It can
only perform this chemical conversion in a fluid. This means that instead of being injected
into the thrombus-agents like tissue plasminogen activator(tPA)can-it has to be injected
into the blood stream. This increases the time it takes to have an effect.
However, thrombolytic agents cannot be used by all patients. Patients prone to internal
bleeding can suffer from a possibly fatal internal hemorrhage as the plasmin will interfere
with the bodies natural blood clotting for healing. However, in the case that the patient is
prone to internal bleeding, there are methods to solve the problem. Drugs that strengthen
the heart are given to the patient. Even then, this can lead to arrhythmias (irregular and
possibly fatal heart beat rhythms)
Along with this, if a dose of streptokinase is administered within 2 hours of the heart attack,
the thrombus can be cleared with a change of no permanent damage to the circulatory
system. However, if it is administered between 2 and 4 hours of the heart attacks
commencement, myocytes (muscle cells) start to get destroyed but the damage will be
less severe than otherwise.
ISIS 3 Debacle: Cheaper can be Better
In the 1990s, a medical comparison covering over 42,000 heart patients in over 20
countries found that from three “clot-busters” or thrombolytic agents, the cheapest is as
good as, if not far better than its competitors.
Said to be the largest medical comparison ever, the “3rd international study of Infarct
survival” compared the drugs
• Streptokinase
• tPA
Both these drugs are commonly used enzyme based Thrombolytic agents and are fairly
successful at their job, with varying side effects.
Other studies have proven that tPA, much more expensive, is marginally more fast and
effective, for the time-being, saving an extra one patient for every hundred treated.
However, it cost ten times as much, leaving doctors in a dilemma. Should they
use a drug that is only marginally more effective with a far greater
cost, or use the cheaper drug, bringing up the question for the
cardiologist, “which 1% of their patients should the
cardiologist sacrifice to save money?”
According to the
Genentech, a manufacturer of tPA, based in San Francisco, the entire comparison is very
unfair. Quoting its official statement: “The trial used duteplase, a form of tPA made be
Wellcome but which is no longer manufactured. Gentech makes alteplase, which is a
single chain molecule; duteplase, is a double-chain. Because duteplase is not clinically
equivalent to alteplase, ISIS-3 results cannot be applied to alteplase.”
At present, in the United States of America, over half the heart patients are treated using
tPA. This is far more than in Britain, another country where tPA is commonly administered.
Now it seems that doctors, the once clean practice, is going this way too. The once
compulsory Hippocrates Oath, has now been send into the recesses, hidden behind a lust
for money. The oath states:
“I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses,
making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and
if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in
male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of
precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed
me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no
one else.
I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them
from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly
I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are
engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice,
of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of
men, which on no account one must spread abroad, I will keep myself holding such things shameful to be
spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with
fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be
my lot”
One line from this traditional oath sticks out, “I will neither give a deadly drug to anybody if
asked for it, nor will I make a suggestion to this effect”
In one aspect, this has already been broken by the FDA. Between 1985 and 1986, almost
22,000 people died in the United States of America only because of unnecessary testing
when it had already been allowed and administered in a country like France.
RCTs of clot busters like streptokinase have been showing that they can saw the lives of
heart attack patients since the mid 1970s. Even then, the researchers have doggedly gone
on with the trials till the 1990s, denying treatment to tens of thousand patients
Its not always patients who have the tried and tested route who suffer. In the trials in the
70s, the harmful drugs were also re-tested over and over again, only to make money for
the researchers, the drug companies and the doctors. It is one of the main reasons why
alternatives like tPA are still so widely used and preferred over safer Streptokinase, for
money.
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