Re: Delayed Treatments for Prostate Cancer


"george conklin" <george@xxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"george conklin" <george@xxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
I want to operate only on those people who I think I will be doing a
service for by either improving the quality of their lives or
increasing the length of their lives.


And that is the problem: personal opinion in place of science.



With prostate cancer, some cases are pretty obvious - such as a high
grade cancer with no evidence of spread in an otherwise healthy man
with a life expectancy well in excess of a decade - you treat him.

Still with only self-selection to show what benefit the treatment is.
That is the whole problem: 100 years of surgery with only the idea that
cutting into something helps a person.


Whether it be with
surgery or XRT, he would be best served with treatment. An older or
sicker man with no evidence of metastasis, you probably use XRT.
Cancer that has spread to distant sites, you go with hormone treatment.

You are just telling me what current practices are. High-dose
chemotherapy for breast cancer was no more effective than regular
treatments, which surprised everyone once the real science was done.
Men have not insisted on such studies for prostate cancer. Sad. But
they are underway now. After 100 years. Sad.

A few points:

1. Breast cancer? I don't treat that nor have I mentioned in any
context in this discussion.


Stop trying to be dense. Conventional wisdom on cancer treatments
turned out to be wrong when given proper scientific study. HRT proved to
be harmful when given work which was not contaminated by self-selection.
Women have insisted on good research. Equivalent quality research is not
yet done for prostate cancer.

You're jumping around from breast cancer to HRT to prostate cancer and back.
Do you even know what you're trying to say?

2. Prostate cancer surgery has changed dramatically in recent decades
and is actually undergoing another period of change. I don't know what
your 100 years is in reference to.


The surgery technique is irrelevant.

Lol... no, but that comment is.

3. Patients come to us not only for our expertise and objective
knowledge, but also - at least in the vast majority of cases - for our
opinions about how to proceed. Opinions of the treating physician are
valuable to patients.


Opinions, opinions, opinions, no science.

Patients seek doctors for both opinions and science. Science does not
always have a clear cut answer and opinions/judgments are needed.

4. Allow me to post a link to web site that explains "level of
evidence". http://www.eboncall.org/content/levels.html
This will be a good start for you. You seem to think a retrospective
review is good quality evidence, but in *fact* it is not.

That may be conventional wisdom, but it just enables you to ignore
real-world outcomes in favor of looking for studies that are never done.
And your emotional responses make sure that when they are done, you will
reject them.

No emotional responses. Just facts. We are not dealing with "conventional
wisdom" here - this is a real/accepted stratification for evaluating the
quality of evidence of medical studies. Retrospective studies rank among
the bottom. Fact. If you disagree, write a book and prove otherwise.

It is considered Level 4
evidence (of 5 with 1 being best). A prospective randomized controlled
trial is Level 1B with the only better level of evidence being a
systematic review of Level 1B prospective randomized controlled trials.

In fact, studying the outcomes of EVERYONE is the only way to go.

Not feasible.

Studying self-selected

Not self selected, halfwitted wonder - RANDOMLY selected. That is where you
get the best quality of evidence - randomly selecting folks into a blinded
and controlled study.

persons in clinical studies is always heavily biased in terms of what you
want to find in the first place. And you know that, it just is not
convenient for you to mention it since you are in the business of surgery,
not science.

I'm in both. You're in neither.


.

Relevant Pages

  • Re: Delayed Treatments for Prostate Cancer
    ... sicker man with no evidence of metastasis, ... Cancer that has spread to distant sites, ... Equivalent quality research is not ... Opinions of the treating physician are ...
    (talk.politics.medicine)
  • Re: Delayed Treatments for Prostate Cancer
    ... the length of their lives. ... grade cancer with no evidence of spread in an otherwise healthy man with ... sicker man with no evidence of metastasis, ... Opinions of the treating physician are valuable to ...
    (talk.politics.medicine)
  • Re: Delayed Treatments for Prostate Cancer
    ... grade cancer with no evidence of spread in an otherwise healthy man with ... Still with only self-selection to show what benefit the treatment is. ... Equivalent quality research is not yet done ... Opinions of the treating physician are ...
    (talk.politics.medicine)
  • Re: A Typology of Scientism
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