Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Monday, January 5, 2015

The Montillation of MOC

Supposedly, the last week and a half has been a vacation for me. True, I wasn't working. And I watched a lot of dumb TV. Baked bread. Etc. But I also attempted to study for boards. I did this by running through questions in the Beat The Boards question bank. And I made a list of factoids I thought would be important for me to remember for the exam-important either because I got the answer wrong, or I got it right but the information still seemed to just be hovering on the edge of my memory's awareness, not reliable enough to count on in a pinch.

Some of the factoids:

5-10% of whites are poor CYP 2D6 metabolizers.

Lifetime prevalence of alcohol dependence is 12.5%.

8% of non-twin siblings of someone with schizophrenia will develop schizophrenia, but 12% of dizygotic twins and 47% of monozygotic twins.

Not all of the factoids include statistics, but the ones I have difficulty remembering do. I'm not even sure if they're true.

In fact, I've been doubting the accuracy of a number of review questions. For example, this question came up:

A phase I clinical trial is conducted to accomplish which one of the following goals?

A - Permit safety and efficacy data to be collected for new drugs

B - Compare the results of people taking a new treatment with the results of people taking the standard treatment

C - Determine if a treatment results in fewer or more side effects

D - Evaluate side effects of a new treatment that were not apparent before

E - Determine the effects of drugs in populations which were not originally tested

Now, feel free to look this up, but I'm pretty sure the purpose of a Phase I Clinical Trial is to take a drug that some company is trying to get FDA approval for, and which has already been tested in animals, and to try it in healthy volunteers, to see if it's safe for humans.

None of the above answers is correct. Consider:

Choice A is wrong because the purpose is to collect safety and not efficacy data. In fact, it makes no sense to collect efficacy data in healthy volunteers.

Choice B is wrong because that's not the function of a Phase I trial, and in any case, to get a drug approved by the FDA, you just need to show it's better than placebo, not than some other treatment that works perfectly well, which is dumb but that's how it is.

Choice C is wrong  because "fewer or more side effects" than what?

Choice D is also wrong from a test-taking standpoint because "not apparent before" is one of those phrases you're not supposed to choose, and before what?

Choice E could be correct, if what's meant by it is testing for tolerability in human rather than animal populations, but clearly, they don't want you to pick E.

You can decide which one you'd choose, but the answer they listed as correct is, "A-Permit safety and efficacy data to be collected for new drugs".

Well, it occurred to me, maybe thy Beat The Boards people know it's wrong, but they're using a question from an actual board exam, and that was considered the right answer. In which case, that's the answer I want to choose.

But what if they don't know it's wrong?

So I emailed them and asked. That was on December 29th. Their support people got back to me right away, and said they'd pass on the question to the education department people, who will get back to me within 72 hours. I'm assuming that means business days, because I haven't heard from them yet, and New Year's Day intervened. Clearly, I'm being generous.

I started to muse about this issue in a broader way. There's the obvious question: What do I get out of an exam if all I'm doing is giving them the answers they want, even if they're wrong or meaningless? It reminds me of:

The Montillation of Traxoline  

It is very important that you learn about Traxoline. Traxoline is a 
new form of zointer. It is montilled in Ceristanna. The 
Ceristannians gristeriate large amounts of fevon and then bracter it 
to quasel traxoline. Traxoline may well be one of our most lukized 
snezlaus in the future because of our zointer lescelidge. 

1. What is traxoline? 

2. Where is traxoline montilled? 

3. How is traxoline quaselled? 

4. Why is it important to know about traxoline?

Could you answer all the questions about Traxoline? I bet you could.