tPA for Stroke

Without warning stroke can paralyze, blind, or kill. Some victims recover, but many do not and may even suffer another disabling or fatal attack. The drug known as tPA can drastically reduce the long-term disability associated with stroke, but despite its near-miraculous capabilities and the growing support of most neurologists, it has been slow to win acceptance as the standard of care in emergency departments nationwide. tPA for Stroke chronicles how this remarkable drug came to be tested in stroke victims, its early years in development by the pharmaceutical giant Genentech, and its eventual marginalization due to a convergence of unfavorable political, fiscal, and medical circumstances. For instance, initially many stroke specialists were unconvinced that the drug's benefits outweigh its risks (tPA was originally developed and is still used for cardiac patients). Moreover, neurologists called upon to assess stroke patients have not typically been trained to make decisions in emergency settings--and tPA must be given within a scant few hours after stroke. These and other factors have continued to delay the drug's universal acceptance as the most effective treatment available, and to hamper the general public's awareness that such a treatment exists--a troubling state of affairs that Zivin and Simmons argue must be rectified. Instilling the knowledge that anyone, at any time, is susceptible to stroke, from the old and infirm to the young and healthy, tPA for Stroke is a clarion call to awareness in a rapidly changing healthcare environment in which stroke, long a disease in thrall to resignation and pessimism, must be neglected no longer.

Justin Zivin, M.D., Ph.D., is a Professor of Neurosciences at the University of California San Diego. For more than thirty years he has conducted research in acute stroke therapy both for basic science studies and clinical trials. He has been continuously funded for this research by federal agencies since 1979. John Galbraith Simmons studied philosophy at Northwestern University, graduating with honors, and also holds a degree in developmental studies from Long Island University. He has published four novels, written for television and film, and is also the author of The Scientific 100: A Ranking of the Most Influential Scientists, Past and Present and Doctors and Discoveries: Lives That Created Today's Medicine. He lives in New York and Paris.

To the Reader
PART ONE: Discovery
Chapter One Code Stroke on Market Street
Chapter Two Clotbuster: The Natural History
Chapter Three Dead or Alive
Chapter 4 Brain-O
PART TWO: Change, Resistance, and Transformation
Chapter Five The Brain Doctors Cometh - Slowly
Chapter Six What Emergency?
Chapter Seven Money and Brain
Chapter Eight Deer in the Headlights
Chapter Nine Call 911, 112, 15...Even 999
Chapter Ten Persistence of a Most Controversial Drug
Chapter 11 Through the Looking Glass
Post-Script The NINDS Stroke Study: A Personal Statement
List of Interviews Bibliography