In Reply.—
Dr. Russell is absolutely correct in that the ideal study to determine the efficacy of a drug to relieve pain is a double-blind study with an appropriate placebo. We considered this but came to the conclusion that injection of the disk with a placebo in alternate patients was not feasible in our practice at that time. Such a study is now being done in two centers in the United States, but it will be some time before reports of the results are available.
It is true that there is a time lag between the chymopapain injection and achievement of optimal results and that the relief of pain reported by the patient could be due to natural recovery. This is true with any treatment, whether it be laminectomy for a herniated disk or antibiotics for pneumonia.
It is also true, as Dr. Russell says, that some studies indicate that
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