“The pen is mightier than the sword” was written by Edward Bulwer Lytton in 1839 for his play “Richelieu; or the Conspiracy.” He was a politician as well as an author and believed that written communication and intellectual discussion would achieve more to change society and politics than violence and physical force.
This was certainly not a new idea and even a glance at Wikipedia shows other writers using similar phrases for over 2500 years. The Assyrian sage Ahigar, who is believed to have lived during the 7th century BCE, wrote the first known version of this phrase – “The word is mightier than the sword”
Our medical review on this website, (due for an update), clearly shows that the change from negative pressure ventilation, NPV, to positive pressure ventilation , PPV, in the 1950’s was not a planned decision related to their relative evidence of efficacy, but occurred because of the convenience of not having to manage and nurse a patient inside a large “iron lung” tank, and ironically, a shortage of these large and expensive devices during the polio epidemics of the 1940’s and 1950s.
At that time the commonest ventilatory support requirement was to assist patients with the paralytic form of polio, who typically had normal healthy lungs, but reduced muscle power to breathe, so all that was required then was to inflate their relatively compliant lungs and allow them to deflate spontaneously under their own elastic recoil. At that point in time therefore, both PPV and NPV were only required to inflate the lung and then ‘switch off’. Since then medicine has moved on and different categories of patients with a wide variety of respiratory diseases have posed challenges that have been managed mainly with increasingly sophisticated PPV devices. Hence, PPV technology has been developed while for most centres NPV has ‘stood still’.
Consequently, since then NPV has been largely disregarded, so there is a whole generation of anaesthetists, respiratory medicine and intensive care doctors who are unaware of the research and continuing use of NPV in children and adults of all ages. However, important advances have been made with various forms of NPV delivery in some centres and the science and clinical aspects have to be presented and discussed with the present generation to persuade them to consider re-introducing negative pressure devices into the treatment of respiratory diseases alongside PPV.They are unaware of the benefits of NPV and do not alwaysfully appreciate the complications and disadvantages of PPV. Unfortunately the manufacturers continue to produce and promote the increasingly sophisticated and expensive ventilators to try and overcome the disadvantages of PPV. These expensive devices are beyond the finances of the majority of the world’s countries.
Whist we write this website, blogs, magazine articles and correspondence, our main aim is to publish in peer reviewed medical and scientific journals.The peer review of our research and papers has the extremely important role of ensuring that our work is validated as being as accurate, truthful and scientifically recognised as posssible. Many of the Exovent team members have been reviewers for a wide range of scientific and medical journals and fully understand the importance of this role. In this way we hope to gradually persuade medical colleagues and enablers in all disciplines to consider re-introducing NPV into the NHS and worldwide.
The introduction of the Internet has brought about a massive increase in information, available in milliseconds with the click of a mouse. Unfortunately, it has also meant that we have been deluged with misinformation, fake news and poor non-peer reviewed science. The number of poor “scientific” publications has dramatically increased and so-called “predatory journals”, whose main aim is to generate income and wealth, are worringly increasing. Despite claiming to do so, they frequently do not carry out expert peer review and publish rapidly to gain fast income.
We look forward to the day when we can perform original clinical and scientific research on our CE marked negative pressure Exovent-type devices and publish it in peer-reviewed journals.
Prof. David Howard, Chair, Exovent charity, UK 1189967
