Re: Medical Research-Evidence
- From: "Skeptic" <bcs002b@xxxxxxxxx>
- Date: Tue, 30 May 2006 23:44:02 GMT
"Herman Rubin" <hrubin@xxxxxxxxxxxxxxxxxxxx> wrote in message
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In article <KlZeg.9501$No1.5144@attbi_s71>, Skeptic <bcs002b@xxxxxxxxx>
wrote:
"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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Here is a comment from UK:
..................
Actually they divided the human male population into two groups: those
cancers described as aggressive (undefined) and not aggressive (also
undefined). However, the 1% risk group was for the non-aggressive
tumors
over a 15-year period. You snipped that. It is a scandal with billions
being spent on treatments so little has been spent on evaluation. The
big
money is in treatments.
So George, what do you think should be done about prostate cancer? If a
55
year old, otherwise healthy man, is diagnosed with Gleason 4+3 prostate
cancer (intermediate risk) after a screening PSA of 5.6 (elevated for his
age) the data and medical knowledge suggest that he stands an improved
chance of survival with surgery (and proabably also with radiation
therapy).
Should he not be offered these? What do you think should be done? I know
that if that were me at that age and health, today, I'd go under the knife
for a radical prostatectomy. Does that mean I'm foolish? What would you
do?
You and the other physicians should really look over the
information, come up with the best guesses of the
probabilities of the various results for each type of
treatment, and let the patient make the decision.
Physicians have NOT done their job in evaluating the
information, leaving it to cookbook statisticians to
provide meaningless summaries (p-values with little else).
That may well be true in some cases. In this case, prostate cancer, you're
incorrect. This disease has been explored ad nauseum. The entire picture
is taken into consideration, such as digging deep to see if the patient has
other comorbid diseaeses that would likely preclude living long enough to
worry about dying from prostate cancer, whether or not there is a family
history of the disease, of longevity, etc., and many many other things.
Statistics don't even get mentioned in my discussions with patients. A
"cook book" approach is not used, and the exact same clinical situation can
yield two very different decisions.
Some years ago, there was a "60 Minutes" program in which
someone with prostate cancer hired a medical reporter to
look up the literature for this purpose and provide the
information.
A spokesman for the AMA stated that the medical reporter
should be charged with practicing medicine without a
license, especially as one of the treatments was not
currently approved by the FDA. On the contrary, the
full information should be presented to the patient,
and the FDA should not have the right to approve or
disapprove in cases like this.
I'm not a member of the AMA and they don't speak for me.
.
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- Re: Medical Research-Evidence
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