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Will Doctors Actually Change Their Recommendations Given The New Cancer Screening Guidelines?

Cancer. Just the word is scary. Actually, that’s the problem. Once you say that word, the average American will do anything — ANYTHING! — to just get it out of my body!!! Whether or not they have it, whatever the actual numerical chances of their ever developing it, no chance for detecting or treating it should ever be neglected. EVER! Ask any Med-mal lawyer. Better, ask any twelve average people off the street (i.e., the ones who are going to wind up on a jury). “The doctor didn’t do every possible test/procedure, and now the patient has CANCER? String him up!”

Hence we have the new guidelines for PSA testing. (Given that many patients with prostate cancer have normal PSAs and lots of patients with high PSAs don’t have prostate cancer, it doesn’t seem semantically correct to call it “prostate cancer screening”.) Surprise! Turns out that not only does PSA testing not save lives, but that urologists don’t really care. Certainly not enough to stop recommending PSAs to just about everyone they can get their hands on.

Nor do breast surgeons have any intention of modifying their recommendations, not only in light of new understandings of the limitations of mammography, but even as Read more »

*This blog post was originally published at Musings of a Dinosaur*

Harvard Medical School Provides Tips For Improving Bladder Control

I was hiking in the woods recently with a group of women friends when something caught my attention. It wasn’t an interesting bird or plant, but the surprising number of “pit stops” my friends needed to make.

Their frequent detours into the bushes struck me because I had just finished working on Better Bladder and Bowel Control, the latest Special Health Report from Harvard Medical School. According to the report, incontinence is the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. In the United States, about 32 million men and women have some degree of incontinence. For women, incontinence is a common but rarely discussed result of childbirth and aging—that could explain the pit stops of my hiking friends, who were all mid-life mothers. For men, incontinence is most often a side effect of treatment for prostate disorders.

Many things can go wrong with the complex system that allows us to control urination. Read more »

*This blog post was originally published at Harvard Health Blog*

Pain Medicines Used More Frequently By Men With Erectile Dysfunction?

The use of Motrin, Aleve and other non-steroidal anti-inflammatory drugs (NSAIDS) is associated with erectile dysfunction, according to a study by scientists affiliated with Kaiser Permanente.

cantgetenough 300x200 NSAIDs Linked to Erectile DysfunctionThe apparent link surprised the scientists. They had hypothesized that the commonly used pain-killers would actually reduce the risk of erectile dysfunction since NSAIDS protect against heart disease, which has in turn been linked to the troubling condition.

To reach their surprising conclusion, Steven Jacobsen and colleagues used data from Kaiser’s HealthConnect EHR, an associated pharmacy database, and self-reports about NSAID use and erectile dysfunction from an ethnically diverse population of 80,966 men between the ages of 45 and 69.

After controlling for age, ethnicity, race, body mass index, diabetes, smoking status, hypertension, high cholesterol and coronary artery disease, the scientists found that men who used NSAIDS at least 3 times per day for at least 3 months were 2.4 times more likely to experience erectile dysfunction than those who did not consume them on a regular basis. The link persisted across all age categories.

Remarkable in its own right was the finding that overall, 29% of the men in the study reported some level of erectile dysfunction.

The authors emphasized that their findings do not prove that NSAID use causes erectile dysfunction. For example, the study findings could have been confounded by factors not considered by the scientists (such as subclinical disease or the severity of the comorbid conditions that were studied), and the chance that NSAID use was actually an indicator for other conditions that caused erectile dysfunction.

In addition, the scientists recognized that their study had some limitations. These included an inability to temporally link NSAID use and the development of ED, and possible selection bias.

As a result, they cautioned men against discontinuing NSAIDs based solely on the findings of their study. “There are many proven benefits of non steroidals in preventing heart disease and for other conditions. People shouldn’t stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it’s worth a discussion with his doctor,” Jacobsen said in an interview.

The write-up appears in the Journal of Urology.

*This blog post was originally published at Pizaazz*

Should Elderly Men Be Screened For Prostate Cancer?

A study in the Journal of Clinical Oncology found that “that men in their seventies had prostate cancer screening nearly twice as often as men in their early fifties, who are more likely to benefit from prostate cancer detection and treatment.” An American Society for Clinical Oncology news release includes this quote:

“Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good,” said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. “We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year. These results emphasize the need for greater physician interaction and conversations about the merits and limitations of prostate cancer screening for men of all ages.”

The US Preventive Services Task Force states that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years, and it recommends against screening for prostate cancer in men age 75 years or older.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Are Urologists Being Seduced By Robots?

Maggie Mahar’s Health Beat blog tipped me off about a Bloomberg opinion piece by an Oregon urologist that begins by stating:

“The decision to opt for medical care that relies on the most costly technology is often based on blind faith that newer, elaborate and expensive must be better.”

Later, he focuses specifically on robotic surgery devices:

“They are costly and require significant re-training for surgeons. Yet consumers hungrily seek out surgeons versed in their use. If a surgeon recommends an older, less expensive technology, many patients will shop for a surgeon willing to use the newest and costliest devices, even if the added benefits are unproven and the risks may be greater.

Hospitals do nothing to discourage this and engage in the kind of tawdry marketing more familiar on late-night infomercials by using patient testimonials. “I cannot believe how quickly I recovered,” a vigorous-looking patient is quoted as saying.

As a surgeon I have to ask: Where is the data? Was the recovery any quicker than in a procedure done without a robot? Would another surgical approach have served the patient as well? And cost a lot less?

We are all keepers of the health-care system treasury. In making treatment choices, physicians and patients alike would do well to ask: “If I were paying for this out of my own pocket would I choose this treatment, or am I just being wowed by the cool factor at someone else’s expense?”

In the first decade of practice I was enthralled with the amazing new technology. Moving into my second decade I hope to temper some of that enthusiasm with a bit of good old-fashioned fiscal responsibility.”

It should be noted that the urologist/author discloses in the editorial that he is is founder of a medical device company with its own surgical system.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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