A shortened version of what first appeared on this blog now appears on the op-ed page of the Buffalo News.
Advertisments do not give the whole story. But the reality is that many men are embarrhased to talk about prostate issues, thus die from prostate cancer.
A decade or so ago it was believed that men died with prostate cancer, not from it - such a belief was absolutely false.
Now it is known that men can die from prostate cancer, but many physicians and people not in healthcare are under the misconception that prostate cancer is not worth diagnosing, because nothing can be done.
Advirtisments about prostate cancer awareness and screening save lives, period. The advertisments also dispel the uotdated nihilism philosophy regarding prostate cancer treatment.
The robotic devices are to create less morbidity, not more money.
Your article was a disservice to those of us who daily fight cancer.
I want to respond to several things you wrote.
You stated that “Advertisements do not give the whole story.” That was the point of what I wrote. Far less than the whole story was given in this promotion.
You are simply wrong when you state: “A decade or so ago it was believed that men died with prostate cancer, not from it - such a belief was absolutely false.” Many men do, indeed, die with prostate cancer silently inside of them – not from it. Your statement is simply not based in fact.
You also seem to counter arguments that I’m not making. Obviously some men die from prostate cancer. I didn’t write that “prostate cancer is not worth diagnosing.”
I wrote about an incomplete promotion of prostate cancer screening – one that used the questionable practice of inducing men into screening by offering prizes – and one that failed to discuss the existing controversies, uncertainties, the known harms of screening, and the importance of careful, shared decision-making to weigh the potential harms against the potential benefits.
If you’re fine with such a one-sided promotion, good for you.
If you don’t need a complete description of harms as well as benefits, that’s your choice.
Good luck to you.
Thank you for your reply.
To Clarify: men do die from prostate cancer and some die with, but not from prostate cancer. We do not apriori, know which category a given person will fall into. Thus we tend to treat cancer aggressively, rather than watch it. Because the disease affects millions to tens of millions of men, even the low percentage of those with a life threatening version of prostate cancer are a significant number.
I have met dozens of prostate cancer patients in my medical training, and every physician I observed mentioned the option of Watchful Waiting. Patient's I've met in OH, MI and NY have not been railroaded into treatment. I do know one in-law in Arkansas, who felt he was only offered the surgical option rather than radiation therapies, hormone therapies or watchfull waiting, he has since shunned medical care.
Some of the issues are not directly what you wrote, but what advertisements are trying to overcome. Not too long ago there were no treatments for prostate cancer, so the attitude among many people was, why diagnose an illness you cannot treat. Now we can treat it, but some people - even some practicing physicians don't acknowledge that fact.
We also have a psycho-socio-legal-economic environment in which physicians practice medicine, not a scientific environment. Such a situation means if a cancer is not treated, someone will be sued. If a patient has healthcare to treat an indolent or benign appearing lesion today, he or she may not have the insurance to treat it at a later date. Some patients have very poor compliance, even with the greretest of efforts by the medical community and government aid, and will 'fall through the cracks' if not treated immediately. All these factors weigh into whether to treat or not; and when to treat.
I do not know what is 'too far' regarding advertising efforts to get people into health screening. I assure you, physicians and other healthcare staff are so acutely aware of Conflict of Interest that we are uncomfortable accepting a simple Thank You from a patient without being worried - a pharmaceutical representative pen or fruit basket from a happy patient is considered conspiracy. The discussions and controversies to which you refer are better discussed in person with a patient, not in an advertisment.
I am not aware of harm from simply screening for prostate cancer. In this medical era Patient Autonomy is paramount. There is rarely a procedure performed without truelly informed consent. In fact, patient's occasionally are everwhelmed by their autonomy and state, "you're the doctor, tell me what to do" to their physicians. Patients are given both verbal and written consent, then even the consent is documented. We go into laborous detail of every concievible side effect, and even the inconcievible ones, such that we scare the heck out of every patient. Every informed consent contains documentations of Side Effects and usually mentions something about the patient dying from the procedure - even a simple hangnail removal may mention risk of death.
Thus your concerns that an advertisment is going to lure people into the program, then have them whisked off to an unnecessary procedure is not as likely as you fear. I am less worried about the one sided promotion, because I have more confidence that the physicians I work with provide truely informed discussion regarding the risk and benefits of any issue and allow the patient to be involved in the decision making process.
One fallout of your article is blogs saying terrible things about Roswell Park, especially regarding the greed motive. Yes, this is a capitalist society and it costs money to obtain a medical education (I have over $250,000 student loan debt) and hospitals have operating expenses. I have trained at several institutions in Residency and Fellowship and recently began my Attending career at Roswell Park Cncer Institute, because of what I experienced when I interviewed here. Although new here, I consider everyone to be very collegeal to the entire staff and patients. In a Capitalist society, where much greed is in the news daily, I feel the people at Roswell Park are focused on patient care and not the almighty dollar.
Again, allow me to correct some things you imply that I said when I really didn’t say them.
I never said anything about “whisking” men off to an unnecessary procedure. This is an issue only you raised – even though you said it “is not as likely as you fear.” I never said anything about fearing t hat.
I never said anything about Roswell Park being focused on “the almighty dollar.” This is an issue only you raised.
Finally, though, let me raise your awareness about what’s published about the poor quality of discussions between physicians and men about prostate cancer.
A paper in the Archives of Internal Medicine less than a month ago –
http://archinte.ama-assn.org/cgi/content/abstract/169/17/1611?etoc - shows how the quality of the discussion men are having with their physicians about prostate cancer screening does not reflect shared decision-making. The discussion often focuses on the benefits of screening without mentioning the harms. And in fact many men weren't even asked about their preferences regarding screening.
From the paper describing the study:
"The finding that 30.1% of subjects underwent PSA testing without first discussing screening... is a disconcerting finding. Only 20.6% of discussions presented both the pros and cons of screening and elicited the subject's preferences for testing."
The authors conclude:
"Given the challenges of meeting these expectations in routine clinical encounters, alternative strategies, such as decision aids, need to be considered to ensure a process that engages patients in decision making, provides them with information about alternative strategies, and facilitates the incorporation of their preferences and values into the medical plan."
This page contains a single entry by Gary Schwitzer published on October 22, 2009 7:14 AM.
Attempted clarification by Cancer Society was the previous entry in this blog.
What the FDA sees that doctors and patients may never know is the next entry in this blog.
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