1988 BMJ (Clinical Research Edition)  
Viezvs Whenever a pharmaceutical manufacturer makes a real breakthrough it becomes rich: look at cimetidine, cromoglycate, and other truly innovatory drugs. Minerva was surprised, however, to read (Financial Times, 10 May) that zidovudine (AZT, Retrovir) is expected to make a fortune for Wellcome; apparently it is "on course to become one of the most successful products in drug industry history." Isn't that rather odd since the drug does not actually cure AIDS? Or is therapeutics still based
more » ... tics still based largely on hope? Patients with subarachnoid haemorrhage in whom cerebral angiography shows no abnormality have a good prognosis. A review in the "British Journal ofNeurosurgery" (1988;2:3341) of 148 such patients has provided further prognostic information; a normal CT scan at presentation is anotherfavourable pointer, as is a normal blood pressure. As economic constraints bite into clinical freedom doctors are asking questions about established patterns of management. For example, a careful analysis of 1532 patients with lung cancer (New England Journal ofMedicine 1988;318:1300-5) has shown that only 98 (6 4%) had metastasised to the brain but no other organs. The conclusion drawn was that prophylactic irradiation of the brain is not warranted in these conditions-the small gains are outweighed by the morbidity in the 93% of patients who do not benefit.
doi:10.1136/bmj.296.6636.1606 fatcat:k2b6nidjpbhlbl6c7lai2ef3vi