Monthly Archives: March 2009

It’s Time For Medicine To Make Quality Job #1

At first glance, a scientific paper presented at the 58th Annual Scientific Meeting of the American College of Cardiology in Orlando on Saturday is reasonably straightforward.  Dig a bit deeper, and the presentation highlights some of the serious issues facing us as we try to reconstruct our health care non-system here in the United States.


At heart (pardon the pun), the paper is reasonably straight forward: cancer specialists use drugs that can damage the heart.  What the researchers found is that those same specialists don’t do as well as they could when it comes to detecting and treating heart failure in those same cancer survivors who have received those same drugs.


The larger question is what are we going to do to address this issue and the quality of  all medical care we deliver and receive, when we don’t have the strong commitment and the systems in place to get the job done?  Maybe it’s time for the doctors in this country to step up to the plate, admit we have a systematic problem, and commit to getting the job done.


The authors examined the records of patients treated with cancer chemotherapy drugs known … Continue reading →

Screening For Prostate Cancer: Jury Still Out

Have you ever wanted something for such a long time that when it finally arrived you found yourself terribly disappointed? 


Maybe that’s the best way I can summarize my feelings about two studies reported today in the New England Journal of Medicine on the topic of prostate cancer screening and whether or not it really makes a difference.


For years we have been saying that there wasn’t sufficient evidence to prove that screening for prostate cancer saved lives.  That was almost always followed by a statement that we were waiting for the results of two trials in the United States and Europe.  “They will show us the answer” we said. In the meantime, millions of men continued to get tested and undergo treatment, even though no one could really say if we were saving lives, or just sending millions more men to unnecessary treatment with all sorts of side effects.


Well, my friends, the waiting is over.  The day has arrived.  And I don’t know that we now have any better idea whether or not prostate cancer screening actually works. 


Prostate cancer in the United States in 2008 was … Continue reading →

Setting The Record Straight About Cancer Screening

This must be the week for cancer screening stories and reports, some of which are clearly crafted to alarm people who read them or watch them.  A segment on this morning’s NBC Today Show is a case in point, along with the original story on the Reader’s Digest website which served as the basis for the TV segment. A report earlier this week about the “over diagnosis” of prostate cancer as a result of screening was another.


What was missing from these various presentations and reports is a sense of balance about who has said what, which organization has made what recommendation, and an honest commentary that is meant to inform rather than frighten.


When I read the original article and watched the video of this morning’s segment, I began to wonder how many people who viewed that information came away truly informed about the issues, the science and the facts (Matt Lauer’s concerns notwithstanding).


Let me make something perfectly clear: comments that screening for cancer isn’t the answer to reducing deaths from every cancer are not new.  Also untrue is the implication that those of us who advocate screening for certain cancers aren’t aware … Continue reading →

The Overdiagnosis of Prostate Cancer: Is It News?

An article and editorial in today’s edition of the Journal of the National Cancer Institute about prostate cancer screening highlight the differences between the messages of science and the expectations of the media and the public, and how the two intersect.


The end result is that the science message from the article may be converted into a bit more sensational story than suggested by the conclusions of the research.  After all, talking about science simply isn’t sexy.  Talking about how medical tests harm patients is a surefire way to capture the attention of the public.


The research, which is interesting and well done from a science point of view, deals with the difficulty we have getting our arms around the fundamental question of how many prostate cancers are diagnosed by screening for the disease  to find it early that would otherwise not cause a man harm or death.  This is what doctors call “over diagnosis.”


The paper starts out by noting that previous studies claim the over diagnosis rate for prostate cancer—which is the percentage of prostate cancers diagnosed that never would have been a problem for a man—has ranged from 25% to over … Continue reading →

Public Health Meets Policy: Colon Cancer Screening

It’s fitting that during Colorectal Cancer Awareness Month there is an intense discussion in the medical and regulatory communities and elsewhere about whether or not we should offer Medicare patients the option of a new screening test for colorectal cancer (CRC).


The test is called CT colonography (CTC), or virtual colonoscopy.  In short, it is a CT scan that can find polyps and cancers in the colon with x-rays.


As of now, the odds are against coverage for this test by Medicare.  But there is still time for the Centers for Medicare and Medicaid Services (or CMS, which runs the Medicare program) to review comments from interested parties and perhaps reconsider its recent preliminary “non-coverage” decision.


I previously wrote about CTC in 2007 when an article was published in the New England Journal which supported the use of this test as an alternative to traditional colonoscopy for CRC screening.  Another article published more recently in September 2008 reported on the results from a carefully done trial where CTC was compared with traditional colonoscopy as a screening test, and fared well.


In March of 2008, the American Cancer Society published new guidelines Continue reading →