May 19th, 2011 by GarySchwitzer in News, Research
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We simply don’t know why more news organizations can’t do an adequate job of explaining the limitations of observational studies – most notably, that they can’t prove cause and effect.
Yes, they can show strong associations. But they can’t prove cause and effect.
NBC Nightly News, as one example recently, inadequately explained the latest suggestion that coffee consumption can lower the risk of prostate cancer. In the anchor lead, Brian Williams framed this as another case of flip-flopping science, lightheartedly talking about what they say about “all those medical studies…if you don’t like the findings, wait for the next study.”
The story seemed puzzled at how the same “lab” 30 years ago reported that coffee was linked to an increase in pancreatic cancer. NBC said the researchers later said they got it wrong. This time – with the prostate cancer link – they say they got it right. Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
May 1st, 2011 by admin in Opinion
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The rise of prophylactic double mastectomy in women with increased risk of breast cancer has been a topic of recent discussion. In particular, this trend has been observed amongst women with the diagnosis of unilateral carcinoma in situ, or pre-invasive breast cancer. While it has been known that in women with genetic cancer syndromes, including BRCA1 and BRCA2, double mastectomy reduces risk, the efficacy of the approach is uncertain in women with other risk profiles, yet more women and surgeons seem to be doing it.
Knowing when to test, treat and act is part of art of medical practice. The ability to convey this information effectively is also an art. Both patients and doctors may have a hard time embracing watchful waiting with respect to many forms of cancer and pre-cancer. In the case of cancer of the cervix, it is known that infection with human papillomavirus (HPV) is causative in cancer development. However, only a small percentage of those infected actually go on to get cancer. Low grade dysplasia, a condition that is early in the cervical cancer development continuum, frequently spontaneously resolves without treatment. Fortunately, in the case of cervical cancer, there is now a vaccine to prevent high risk HPV infection.
“Watchful waiting” has been most discussed as a treatment strategy for prostate cancer. Read more »
*This blog post was originally published at ACP Internist*
April 6th, 2011 by GarySchwitzer in Health Policy, News
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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*
March 24th, 2011 by GarySchwitzer in Opinion
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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*
December 30th, 2010 by admin in Better Health Network, News, Research, True Stories
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Gene Goldwasser died last week. He was 88, and he was my friend.
I wrote previously about a series of conversations I conducted with Gene and Rabbi A.J. Wolf a few years ago. I met Gene one spring day after calling to invite him to sit in on a class I was teaching to a small group of medical students about social issues in healthcare.
I’d read about him in a book called “The $800 Million Pill,” by Merrill Goozner. In the book, Goozner writes the story of Gene’s two-decade hunt to isolate the hormone erythropoietin (EPO).
Part of the story relates how Gene tried to interest traditional big pharma companies in his discovery, only to be brushed aside. Instead, Gene wound up sharing his discovery with what became Amgen. The company went on to make a windfall from recombinant production of the hormone and licensing it as a drug for patients with anemia and kidney failure. Read more »
*This blog post was originally published at ACP Internist*
