Re: Medical Research-Evidence


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In article <KlZeg.9501$No1.5144@attbi_s71>, Skeptic
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in
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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.

And the results are so slim that the options remain as obscure
today
as
they did 30 years ago when my father started looking into it for
himself.


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.

And that is the problem......

My patients don't want to hear about P values.

Your patients or YOU?

my patients. what part of that was not clear?

You merely transit your insecurities to those you operate on. I had
thought
that academic physicians, if you are one (no id), at least could discuss
with patients the problems very marginal research involving expensive
mutilations for small benefits, if any, 10 years out. Even if more
research
confirms the Scandanavian data, which it so far has NOT, you are dealing
with very small benfits at a very great cost, both pysical and economic

One can discuss these things in great detail and not have to mention if
the
p value showed statistical significance between two groups. In the real
world, the overwhelming majority of patients don't want to hear about p
values. Most don't know what they are. Quoting statistics is simply
disengenuous anyway, since *which* study do you use? We do this for some
things, such as incontinence rates after surgery because it is one of the
most bothersome and common complications. I quote my patients up to a 10%
chance of some sort of incontinence and that is base on my own patient
series in worst case scenarios - my true rate is closer to 5%, but others
would quote higher and others still lower numbers for this .. and they all
have data to support them.





.

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