John Galbraith Simmons studied philosophy at Northwestern University, graduating with honors, and also holds a degree in developmental studies from Long Island University. His newest book, written with Justin Zivin, is tPA for Stroke: The Story of a Controversial Drug. The book, which will be published in November, looks at the history of tPA which can drastically reduce the long-term disability associated with stroke if it is administered within the first three hours after the event occurs. In the original article below Simmons looks at Beau Biden’s recent stroke.
Details around Beau Biden’s “mild stroke” on Tuesday, May 12, remain unclear, although his reported symptoms were paralysis, numbness, and headache. He and his family, and his political entourage, currently are limiting their contact with the press while portraying him as alert and in possession of “full motor and speech skills.” Stroke is a genuinely disorienting event, so some initial reluctance to disclose may be understandable — for now.
But Beau Biden, 41, may help put a public face on the larger issues around stroke, a disease much neglected in terms of public awareness. Stroke is the leading cause of adult disability and third leading cause of death (after the sum of cancers and heart attack) — and receives little attention relative to its importance. Most germane are two issues. First is whether Biden’s stroke was appropriately treated as an acute emergency. Second, but no less significant, is whether his stroke was ischemic (due to a blood clot or blockage) and if he received the FDA-approved drug for stroke, known as tPA.
At present, indications are that Biden or family members made the right call — which, for stroke signs and symptoms, always means 911. He was taken by ambulance to Christiana Care Health System, one of the largest hospital systems in Delaware. Christiana Care is a certified primary stroke center that would in effect insure that if he were eligible for treatment, and if tPA was appropriate, he would have received it. After suffering his stroke on Tuesday morning, Biden was later in the day transferred to Thomas Jefferson University Hospital in Philadelphia. No explanation for the transfer was forthcoming but reports continued to be positive for a full recovery.
tPA, which stands for tissue plasminogen activator, is the only approved treatment for ischemic strokes, which are caused by blood clots or blockages and account for about 85% of all strokes. A “clot-busting” drug, tPA is not difficult to administer but must be given within four and a half hours after symptoms start, and a computerized brain scan is first required to rule out a bleeding, or hemorrhagic, stroke. Although approved by the FDA for stroke in 1996, tPA has had a long and difficult road to widespread acceptance among physicians, while potential victims remain for the most part disturbingly unaware of it.
For the present, Beau Biden’s “mild” stroke is worthy of headlines because he’s young, the son of a U.S. vice president, and a rising political star in his own right. Although strokes are more common in older people, Biden’s problem is not rare. But the genuine story, it may turn out, will be to enhance public awareness of stroke as a hyperacute event. From Biden and his family, we will be waiting to hear better and more detailed news.