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I know it's sacrilege (RE: Strum)

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Posted 6/24/2010 3:25 PM (GMT 0)
I realize that Strum is apparently one of the top experts in the field. Many of you seem to idolize him (well, the posts give me that impression) and probably with good reason.

At the risk of incurring the wrath of many (but what else is new), I do have a concern.

I often read his very lengthy, detailed responses on the P2P network. It is WONDERFUL that he does that. I don't see any other medico contributing so much time.

BUT, it seems that his posts are fraught with stinging criticism of other doctors. It seems that in EVERY post, he spends a lot of time criticizing. Basically, (almost) everyone else is wrong and he is right. The tone of his posts seems to indicate that there is only one way, his way.

I don't know. Sometimes the arrogance  makes me wonder. I just get suspicious when a person claims HIS way is the only chosen path, and I just get that impression from his diatribes.

OK, fire away!

Mel

Posted 6/24/2010 3:47 PM (GMT 0)
Mel, glad you had the courage to post what I am certain others have thought. We have a few guys here that seem to worship every word Dr. Strum says, as if it were written in gold. I think the good doctor has many good, thought provoking thoughts and ideas concerning PC, no doubt about that. But his style of bashing practically the entire medical community, except himself of course, is suspect. I don't like his general doctor bashing, which is probably why we have some here that have picked up that habit too. It shows in their posts.

His famous book is a good read, and no one should be afraid to read that perspective of our cancer. Not afraid of any source, and its up to each of us to decide to do what we do with the info we read. Dr. Walsh's book on PC, in my opinion (shots coming), is still a good primer on the entire subject, and of course, I think anyone would assume a surgeon has a surgeon's bias, but the book is full of good day to day practical advice. Not all this conspiracy theory and "I am the only one that is right" mentality.

Good post, but be prepared to get slammed by the 'experts".

David in SC
Posted 6/24/2010 4:26 PM (GMT 0)
Strum is blunt. He does get angry at the poor decisions many doctors make in diagnosing and treatments and always gives backup for his reasoning. I find this refreshing as most other doctors would never think of critizing another doctor. If he didn't give backup for his recommendations he wouldn't be nearly as effective.
Just reading the posts on this board and other sites and from my own expereince the standard of care for prostate cancer is pathetic; way too many misdiagonosis, too many reoccurrances and too many permanent side affects, too many tests that are not of any value and the tests that are of value rarely recommended.
I for one am glad someone is clearly saying "The emperor has no cloths".
If Strum just mouthed off without doing anything it would be a different story, but he has been on the forefront of providing patient education for 30 years, founding the PCRI dedicated to patient education, and devoting his time to change things.
You may not like the way he delivers the message, but ignore the message at your own risk.
He is open to all forms of treatments and is quick to jump on new ideas that seem to work, such as Combidex, MRIS, ADT3 and other drugs.
His main point is that most doctors do not nearly do enough investigation to properly determine the biology of an individual's pc before recommending a treatment and do not properly monitor a patient while on medications to see if those medications are really doing what they were designed to do and is quick to point this out.
Mel, If the patients on P2P, were treated properly initially by their doctors they would have no need to post anything. Almost all of the p2p patients are in failed treatments that haven't worked and many for good reason. I haven't seen him critize anything that was done properly in which the patient was thrilled with his treatment.
JT
Posted 6/24/2010 4:57 PM (GMT 0)
Is it possible to post an opinion with out either out right or subtlly knocking some one. We are all " smart " here, self discipline would go a long way.
Posted 6/24/2010 5:14 PM (GMT 0)
Mel, I'm not familiar with Strum, or his writings, so I can't comment on him in particular. But, I do like a healthy dose of confidence in the man/woman who is going to cut me and muck about inside.


Sheldon AKA Sleepless
Posted 6/24/2010 6:51 PM (GMT 0)
Not only Dr. Strum but others that contribute on P2P say similar things about other docs in general, as their expertise in many of them is lacking, is the truth. Here are some of the others that have verbage similar, I have seen their writtings over the years as a witness. I think the criticizm is not aimed at the 5-8% of real expert docs, but the 70% of average docs and especially the 20% of so called dangerous docs, as coined by Dr. Strums assessment. So I concurr some Mel, that yes their is criticizm, that is how things get corrected by airing them out and making them public knowledge. It helps destroy the mushroom effect, that patients find themselves in all to often.(put in the dark and feed B_ll$hirt)

Concurr with John T, Dr. Strum is one of the best, actually the best because of his free education on P2P, nobody does it better anywhere. I hope we clone him real soon!!!

The other docs that say similar things:
Dr. Barken* (* also post on P2P or have in the past)-outspoken
Dr. Lam*
Dr. Scholz*
Dr. Meyers
Dr. Leibowitz
Dr. Lee
Dr. Sartor
Probably alot more out there too.

*Note -I know that  Dr. Strums book was used by UsToo PCa organization in Arizona as their Bible-Primer-Textbook on PCa...call that a clue. Other books don't cover neary what his does.

Posted 6/24/2010 7:05 PM (GMT 0)

I understand. Just today I got a P2P digest. Part of his comments (just some bits and pieces):

>>>>>>>>>>>>>>>>

Now, here is where the current medical care is or appears to me to be
sorely deficient. A good TRUSP report should DETAIL the gland volume
and any abnormality seen in terms of changes in echogenicity. It
should also comment on the capsule and on the seminal vesicles. So,
you are missing what is often missing and what I consider to equate
with "fraud" insofar as physicians not submitting a FORMAL report for
a procedure such as TRUSP. Rarely do I see this done and I truly
consider this fraud in that a procedure should routinely have a
standard form associated with it. Sorry, but after 40 years in
medicine I find it abhorrent to see the slop and laziness that is
involved in the most sacred of professions and one in which another
person's life is entrusted to us docs. See the PRiMER regarding a
reasonable TRUSP reporting form.

 PLEASE do not confuse this useful test
with the ridiculous DEXA bone density that is called the gold standard
but should be considered the lead standard...

What an absurd joke on the
patient.

 >>>>>>>>>>>>>>>>

Frankly, when I first started reading his stuff, it was a breath of fresh air. Yes, here is someone not afraid to tell it like it is. But, frankly, after reading many of his posts, I just don't know. He is so abrasive and so cock sure of himself. We all read this and say "way to go." But, you know, there are many quacks with the same kind of intensity/passion. Incidentally, I am not calling Strum a quack. Far from it. But I just get a bit suspicious when I keep reading this stuff. Methinks he might be a bit too sure of himself. There are things that have been established as SOP, yet he dismisses them.

Bottom line: I know he is famous and he has written an important book, but I don't know if I would want him as my doctor. But that might be to my detriment. I do agree that he sure seems to back up what he says.. But it gets so complicated that it is hard for me to always be sure of what he is saying.

Mel

 

Posted 6/24/2010 10:21 PM (GMT 0)
Mel,
Another perspective is that Strum and the doctors Zufus mentioned all have seen tens of thousands of PC patients and 99% are those that have failed treatments from other doctors or those going in for a 2nd opinion. These doctors are not the ones that a patient would see first. They are in the best position to see the lack of knowledge that many doctors treating pc have. As evidenced in the above quote, he is trying to educate both patients and doctors.
A little of Strum's background: he was a pathologist and worked with Liebre (sp) on the first hormonal blockage medications. His aproach to PC is on the biological and molcular level; not on the mechanical level like surgeons and radiologists. I think he is correct in that you have to approach this disease from the biological perspective and listen to the clues that the biology is giving you instead of relying on a purely mechanical approach to the disease. The 1st 5 doctors I had were pure mechanics who missed all the biological signs of my PC and said I had BPH. Dr Scholz, Strum's former partner, immediately recognized the signs and said there were only two possibilities for the way my psa was acting; micromets or a large transition zone tumor, and then he methodically went about testing both possibilities. He knew the mechanics of 13 negative biopsies and MRIs didn't match with what the biology was showing.
If you understand PC from the biological level you know why most scans and tests are worthless; you also know when surgery and radiation are not going to work. You also understand the effects of cetain meds and the biological espressions of when they are working and when they are not. This is the knowledge gap that Strum and others are trying to close. The vast majority of doctors treating pc are not skilled in the biology and use a mechanical approach without truely understanding the nature of PC on the molecular level.
JT
Posted 6/24/2010 10:27 PM (GMT 0)
It seems to be an occupational hazard of surgeons to be ultra-self-confident. That is how they can open you up without their hands shaking :)
Posted 6/24/2010 10:39 PM (GMT 0)
mel, i still think some of your original point is being missed. the dr. in question is no doubt an outstanding genius in his field, but he is still very egotisitical and one sided, and that kind of person makes my "suspicious" hairs stand up too. he's not a god, he doesn't have exclusive knowledge that no one but him knows. for the averarge patient with PC, they aren't going to be dealing with some one of a kind, eccentric doctor. They are going to work with whom they have resources for in their area, and based in part to their network providers on their health insurance carriers. and its foolish to think one can't get good care just because their uro or uro/surgeon isn't at the molecular level of their cancer. there's a practical side to medicine and there's a research/theoretical side too. both are needed, both are important.

i am not putting the good doctor down, or taking away from his skills or passion. sheer passion alone isn't a good marker by itself. history is full of good intentions that went wrong. and when you think you are the only one right and everyone else is wrong, watch out.


david in sc
Posted 6/24/2010 10:50 PM (GMT 0)
Ok, for the sake of discussion, a monkey wrench in the spokes: I want the meanest, most arrogant, self-assured and expertly trainind and experienced guys alive taking my life in his hands, either with surgery or the other options we have He don't have to wipe by brow or bring me flowers, but he better be the best at what he does, I'll get the good bedside manner from the cute nurses... smilewinkgrin smhair smhair smhair smhair tongue
Posted 6/24/2010 11:28 PM (GMT 0)
James:

You make very good points. I've had some physicians that were gruff (no bedside manner) but superb. I was totally pleased. I don't need hand-holding. But someone with that kind of ego who is "always correct" while preaching, basically, that everyone else is a boob, raises my suspicions.

Mel

Posted 6/24/2010 11:40 PM (GMT 0)
Gentlemen,

Interesting discussion. I too read Dr Strum's notes to others and have gleaned some useful information from them. I do find his communication style a bit condecending and see no need for him to disparage the others in his profession. I still have faith in the medical schools in the U.S. to turn out some very good and competent physicians. As my boss always says to me the amount of difficulty one will put up with in an employee is directly related to the employees effectiveness. Of course he is not referring to me. :) Just speaking in general.

Still one must appreciate the personal time taken by Dr Strum without compensation and the depth of his reply even if the tone is a bit high handed. I sent one of his responses to a dear friend who was having a fluctuating PSA and at least two negative biopsies and he replied that he got more out of reading the posting than he had gotten from his Urologist in three years.

Don
Posted 6/24/2010 11:56 PM (GMT 0)
Where does this myth come from? That you can't have a good doctor, and he/she be nice at the same time? No one has ever said or insinuated that you choose a doctor who is "nice" over one who is the better doctor. I think only men could come up with such a silly notion on their own.

And I agree with Don above, the medical colleges still turn out a lot of good doctors. Not saying they are all great, but sometimes the tone here with some is that most doctors are only average or even bad, that sends another dangerous message out to the average patient that only has the average means to deal with their illnesesses.

David in SC
Posted 6/24/2010 11:59 PM (GMT 0)
I think the other point is that Dr. Strum is a pathologist/oncologist/educator. He is not a surgeon or a radiologist. It would be natural that he thinks pathology and biologic understanding of PC is misunderstood by surgeons and radiologists. He also is critical of pathologists who are less than careful about their profession. Someone posted the other day that their path report had numerous discrepancies in the report and a section crossed out and handwritten in. That is both disgusting and unsettling.

As had been stated, he is still just a man, and I am sure his stats overall don't come out significantly different than the nomograms.

The science of PC diagnosis and treatment is indeed indebted to him, no matter what his style.
Posted 6/25/2010 12:13 AM (GMT 0)
I've always found in my experience the bigger the a------e, the the sharper they are in their field, any field. A caveat however, would be the sharpest of the pack are gentlemen/women in all regards. Its rare, but there are great doctors, who have great bedside manners, like in all fields. I've never read Dr Strum, but will now. I bet he would really be great, if he could overcome some character faults. Alas, me too!
Posted 6/25/2010 12:47 AM (GMT 0)
Mel,
Your remarks on Strum are fair because he is the one drawing the line in the sand when talking about colleagues. I have seen it. I personally would like to see more of his involvement in todays research studies than taking shots at the medical institution.

I agree for the most part that many people are putting too much faith into a few guys treating prostate cancer. Treating them and talking about them as the prostate cancer Gods. I have news for these folks. The moment that you have placed that much trust into your doctor, you have reversed the pendulum in the other direction of "balanced". And I have heard a couple doctors boldly proclaim them selves as "the best" or "one of the best". Ok...So now we know who the best is...I was wondering. I'm glad they made it clear.

Let me say this much. I applaud doctors who take time in their community to help others. Mine does that and I find it refreshing. Strum started PCRI with that intention. Vogelzang and Chodak and a few others, started UsTOO. While I personally consider PCRI to be a biased organization, I am a member and attend their conferences. Why? Because I remain open as to what they are saying and doing for I may need it in the future. Just as I do with other organizations I am a member of. Which then, not just to agree with zufus ~ but to also offer counterpoint, I would suggest to anybody who is really into their doctor...beware ~ you just might be missing something valuable.

Tony
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