Concern for truth: driving defensively when confronting a zombie epidemic.

The newly approved drug Diclegis(®), indicated for the treatment of nausea and vomiting associated with pregnancy, has a very interesting background story going back more than 50 years, in which science, celebrity individuals, the media, and the courts crossed paths. The story illustrates how concepts of truth, evidence, objectivity, and disinterested inquiry can become distorted in various ways, and this is especially relevant and prevalent in today's media environment of cable television, talk radio, and especially the Internet.

Clobazam: a newly approved but well-established drug for the treatment of intractable epilepsy syndromes.

Clobazam, a 1,5-benzodiazepine, was introduced in the 1970s as an anxiolytic and antiepileptic drug. Despite worldwide usage, it was only recently approved in the United States (seizures associated with Lennox-Gastaut syndrome). This article reviews historical and recent data to help practitioners better understand clobazam's clinical properties and usage. In many clinical trials, open-label studies, and retrospective reviews, clobazam was generally associated with ≥50% seizure reduction for more than half of Lennox-Gastaut syndrome patients, with approximately 10% achieving freedom from drop attacks. Efficacy is persistent, with little evidence for development of tolerance. Clobazam's safety profile appears to be similar to that of other benzodiazepines, but with substantially decreased sedation and increased psychomotor performance. Studies suggest clobazam acts through potentiation of gamma-aminobutyric acid type A receptors in a manner similar to other benzodiazepines. However, clobazam appears to display greater selectivity for receptors responsible for anticonvulsant activity than for those involved in sedation.

Review of palonosetron: emerging data distinguishing it as a novel 5-HT(3) receptor antagonist for chemotherapy-induced nausea and vomiting.

IMPORTANCE OF THE FIELD: Since the advent of the 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) in the 1990s, dramatic improvements have been achieved in the field of antiemetic therapy. The enhanced prevention of delayed and overall chemotherapy-induced nausea and vomiting (CINV) offered by palonosetron, a second-generation 5-HT3RA and aprepitant, the first neurokinin-1 receptor antagonists (NK-1RA) represent the only significant treatment advances in the past decade. While initial trials of single-dose palonosetron indicated a potential benefit over first-generation 5-HT3RAs, only recently have new data become available, increasing the weight of evidence distinguishing it as a new 5-HT3RA in the class. AREAS COVERED IN THIS REVIEW: History of antiemetics and palonosetron, including clinical trials and pharmacological research, and literature published between 1981 and 2010 are covered. WHAT THE READER WILL GAIN: Unique pharmacological characteristics of palonosetron exhibiting prolonged half-life, high receptor affinity, allosteric interactions and positive cooperativity with 5-HT3 receptor resulting in long-term alteration and internalization of this receptor may explain the clinical observation of palonosetron. TAKE HOME MESSAGE: This review of recent progress in antiemetic therapy focuses on the newest data on palonosetron and discusses future trials and implications for clinical practice, with the overall goal of learning from history.

Dexamethasone for intracranial neurosurgery and anaesthesia.

Dexamethasone is frequently administered to patients with brain tumours having neurosurgery, and is often given for other purposes by anaesthetists. This review outlines the rationale for its use by both specialities, and discusses its potential adverse effects.