tag:blogger.com,1999:blog-1732132352927731247.post3642617015927002534..comments2024-03-16T00:27:31.848-07:00Comments on Hooked: Ethics, Medicine, and Pharma: What Drug Companies Promote PSA Testing?Howard Brodyhttp://www.blogger.com/profile/00599587504924835039noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-1732132352927731247.post-42456553625184055322010-09-07T12:52:15.645-07:002010-09-07T12:52:15.645-07:00As someone who suffers a very different urologic c...As someone who suffers a very different urologic condition, I am amazed at how little research (in comparison to other organ systems) is dedicated to urology, as a whole. It all seems very geared toward cancer yet even then, there seems to be disagreement as many MDs will say more people die with prostate cancer than from prostate cancer. <br /><br />It just strikes me odd that this organ system, particularly in men, is left to fend for itself on the basis of physician's experience rather than scientific literature. Is this because drug companies indirectly or directly dictate medical studies based on their products? Outside of cancer and ED, there seem to be little uro. organ specific products for men, when there are a host of uro. diseases.stop smoking helphttp://www.stopsmokinghelper.orgnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-72164217299653397582010-08-30T08:29:38.686-07:002010-08-30T08:29:38.686-07:00@Howard
Yes, I know.@Howard<br /><br />Yes, I know.Marilyn Mannnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-15891461728028312352010-08-30T08:08:12.524-07:002010-08-30T08:08:12.524-07:00Marilyn: Despite the steady growth of evidence aga...Marilyn: Despite the steady growth of evidence against routine PSA testing--the two recent NEJM articles are really just the last in a long series of reasons not to do the test-- the "cancer screening mafia" if I can be so rude as to call them that has persisted in demanding the use of the test, basically telling women that if you don't nag your husband to have this test done, you're murdering him. The basic problem is that once we label something as "cancer screening" it becomes God and motherhood and issues of evidence fly out the window. Fortunately, even the don of the mafia, the American Cancer Society, is now apparently admitting to second thoughts about PSA. Thanks for your comments, HowardHoward Brodyhttps://www.blogger.com/profile/00599587504924835039noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-55450536987331444262010-08-29T14:26:32.770-07:002010-08-29T14:26:32.770-07:00A family member is in Suburban Hospital in Bethesd...A family member is in Suburban Hospital in Bethesda, an affiliate of Johns Hopkins. I noticed today that there is a sign in the lobby urging men to "take care your health" by coming in for free prostate screening. I was more interested in getting to where I was going than investigating the sign, so I'm not sure if it was specific about what they were offering, but I assume it includes PSA testing.Marilyn Mannnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-79038194326164719452010-08-27T17:42:07.348-07:002010-08-27T17:42:07.348-07:00Well, as a loyal reader of your blog and since you...Well, as a loyal reader of your blog and since you responded …, it’s my understanding that one cannot distinguish between prostate cancer that would never cause symptoms and one which would kill you. I presume that a Gleason score of 10 was once a 6? Also, there are flaws in the studies that you mention. For example, many in the “unscreened” group were tested for PSA. Moreover, going to a certain urologist web site reveals a more recent study, which is more favorable to PSA screening http://press.thelancet.com/tloprostmort.pdf And surgery isn’t the only treatment option. In any case, I agree with your last statement, that men need to be informed of the risks and benefits of PSA testing.Janhttps://www.blogger.com/profile/13033541586719019988noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-55325261182078475832010-08-27T11:44:48.757-07:002010-08-27T11:44:48.757-07:00Jan, I did not plan with this post to get into all...Jan, I did not plan with this post to get into all the details of the debate over PSA screening, but I suppose some of it is inevitable. Ablin's article mentions cost, but among the many evidence-based physicians who have been arguing against PSA for years, their major concern is not cost but patient mortality and morbidity--how many men end up with major prostate surgery based on biopsy findings that reveal a cancer which ideally would have been left alone and would never have caused symptoms. Of the two major studies published last year in the New England Journal, one showed no benefit at all from PSA testing. The other showed a slight benefit, but that for every 1 man whose life was saved, 47 will suffer some serious harm. Men at a minimum need to be informed of those odds before they receive a PSA test. Thanks for commenting, HowardHoward Brodyhttps://www.blogger.com/profile/00599587504924835039noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-82359362541236071602010-08-27T04:46:16.108-07:002010-08-27T04:46:16.108-07:00Ablin's op-ed article says "the test is h...Ablin's op-ed article says "the test is hardly more effective than a coin toss." At the usual cut-off, PSA sensitivity is 20% and specificity is 94%. This is much better than a coin toss. He also talks about "painful prostate biopsies." With an anesthetic, the biopsy is not painful (ok some urologists fail to use an anesthetic). While side effects are still a concern, treatments have improved.<br /><br />Ablin is worried about the cost of PSA testing. Most men are worried about what happens to them.Janhttps://www.blogger.com/profile/13033541586719019988noreply@blogger.com