Robin's name was the invention of polymath Mike Snaith, who thought it would be a suitable nom-de-plume for the sort of column that David Scott, then Editor, envisaged. I trust that he approved. Both David and Richard Watts daringly allowed Robin his head, and he can recall only one editorial intervention on matters of content. Perhaps his only regret is his failure to provoke more than the occasional response, even when being provocative. Maybe he never went far enough; in a previous incarnation as Editor of a Student Union Newsletter (20 pages, monthly, cyclostyled and collated by hand, 200 copies circulated, complete set minus first edition could be made available) he was hauled up before the Dean twice. So what went wrong? Old age, they say, mellows one. I hope not.
A facility with words can be a curse; Robin remembers sounding off once, during a meeting at which the length of a prize essay was to be reduced to 1500 words to encourage entrants. Robin foolishly snorted he could knock off that number in an hour. So he was hoist by his own petard when, a few weeks later, one of those at the meeting asked for a thousand words within a week. But it was done. Within two days, just to prove a point.
And goodness mehow Robin has batted on about the tribulations of trialspoor entry criteria, poor selection, small sample sizes and so onand wondering who will take up the banner, when along comes Ioannidis (
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Anyway, enough of me. I always thought that getting a gong lifted one from being plebeian, so many congratulations to Pat Woo on her CBE. Pity that Hospital Doctor belaboured the point unnecessarily by referring to her as Professor Patrician Woo.
T cells or B cells? Robin wonders whether the prime culprit will ever be decided before he retires and doesn't have to bother any more. Lupus nephritis is a nasty thing, and it looks like the B cells are in charge here because if you zap them with rituximab the nephritis subsides ( Sfikakis et al., Arthritis Rheum 2005;52:50113[CrossRef][ISI][Medline]). But then T helper cell activation is reduced ... still, if it works, who cares?
Likewise there is a temptation not to care about why drugs like methotrexate actually workexcept that one's patients often ask, and it's a bit of a cop-out to ask them how many hours they have got to listen. But now we can suggest that it suppresses T-cell activation and adhesion molecules, but not by causing lymphocyte apoptosis (
Johnston and colleagues, Clin Immunol 2005;114:15463[CrossRef][ISI][Medline]). And Robin won't, he thinks, get many who ask to have that explained. However he has increasing numbers of people asking to come off it. This seems partly related to the actions of the National Patient Safety Agency following a death from overdose. The NPSA recommendations on monitoring seem rather stringentindeed for many they are unachievableto the extent that Robin suggests an alternative acronym decode (Nanny's Particularly Suffocating Advice). Especially as Yazici and colleagues report that methotrexate is among the safest treatments and that discontinuation is rarely due to lab test abnormalities, but for clinical reasons (
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We all know what is related to rheumatoid arthritis severity, but what about psoriatic arthritis? Brockbank et al. suggest that dactylitis may be a marker (
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The benefits of herbs are unclear, although the risks may be high as Robin has said before, not least because some contain other substances. From Thailand comes a report on Duhuo Jisheng Wan, which seemed in a trial of 200 patients with OA to be of similar efficacy to diclofenac ( Teekachunhatean and lots of others, BMC Complementary and Alternative Medicine 2004;4:19[CrossRef][Medline]). However they found a similar number of adverse events as well. What is worse is that the herb tested comes from the Min-Kang Drug Manufactory,Yichang, which is listed on an excellent website (http://home.caregroup.org/clinical/altmed/interactions/Herb_Groups/Adulteration_an.htm) as being contaminated with paracetamol (that from Plum Flower is kosher, if that isn't a mixed metaphor). So perhaps this trial of diclofenac against paracetamol should be relocated in the Annals of Already Accepted Axioms which, abbreviation-wise, would head every alphabetical list.
So, there it is. Robin will down his pen, hang up his thinking cap and trust that his musings have amused, confused, and diffused a little knowledge. Living in the shadows and being mischievous has been fun. In signing off, Robin will offer a last website address through which you might learn something of the goblin who has been privileged to serve his friends and others at the start of the 21st century (http://website.lineone.net/~andrewbamji/index.htm) and trust that this final clue to his identity will relieve those who had some nagging feeling that they knew exactly who Robin was. But what's the betting that 50% of you (plus or minus 2 standard deviations) were wrong?