Re: Delayed Treatments for Prostate Cancer


"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
news:edtGg.102381$FQ1.65956@xxxxxxxxxxxx

"george conklin" <george@xxxxxxx> wrote in message
news:z0tGg.7052$Sn3.1902@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
news:6IrGg.6779$aJ.5192@xxxxxxxxxxxx

"george conklin" <george@xxxxxxx> wrote in message
news:7mqGg.11538$0e5.5494@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

"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?


This is the essence of your self-absorbed business. When good research
is done on cancers, the results are often surprising. Women have insisted
on the research years ago. Men have not, and I view YOU as good example of
WHY it is not been done. Basically you dodge, dance and zig and zag and
quibble, but in the end you think all answers have been had and you can
continue on as you always have.



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.


The issue is to what degree surgery, by any technique, is going to do much
for a patient. You point to a 3% difference over 10 years as a major
victory, even while the big studies, much delayed, are just getting started.
One has been going 10 years with no results announced yet.


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.


Opinions kill. Judgment is needed because of bad science.


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.


Accepted does NOT mean effective. Most alternatives are just
alternatives, without much difference in final outcomes. The whole debate
is not whether brachytherapy is really effective, but whether is is AS
effective as surgery, which is itself unevaluated except through the usual
self-selection of patients and a loud industry shouting at the patient.


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.


No, just not done because the money is in treatment, and almost nothing
in evaluation. It is not done now because of the social setup of the
medical/industrial complex.


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.


It is hardly random since only 1 or 2 places take place, and there is
no evidence that those who turn down traditional cancer care are random
either. It takes real courage to say no to people like you pushing surgery
and whatever is traditional.


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.

You are in an applied area, not a science area. Your whole push here is
for more of the same.


.

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
    ... On the one hand you have Shakespeare, ... is claiming that *your* personal opinion is binding on everybody else. ... Your demands for more evidence would be a little more credible if you ... opinions are binding on everybody else. ...
    (talk.origins)
  • Re: A critique of the BBC aquatic ape programme and the transcript.
    ... > problem and consider each and every possibility where the evidence ... You are entitled to your opinions about wading and swimming and whatnot ... gone through review and published in *reputable and ... that I'm somehow hydrophobic is both ignorant and unfounded. ...
    (sci.anthropology.paleo)