Evidence Says No, Dr Says Yes

This is a very loooonnnng but fascinating article that covers a wide range of issues , all related to the title...

https://getpocket.com/explore/item/when-evidence-says-no-but-doctors-say-yes?utm_source=pocket-newtab

It was too long for me to get through. I did read half of it and skimmed the rest.
It talks about, among other things, the 4 reasons why cardiologists continue to send patients with stable angina for stent placement in the absence of evidence to its benefit, to the weaknesses in almost all RCTs, including the one that got Provenge approved (I believe it was the “IMPACT’ trial?).

It’s worth a read, maybe in two sittings if you are short on patience.

"According to interviews with surgeons, many patients they see want, or even demand, to be operated upon and will simply shop around until they find a willing doctor."

My response before was a bit short as I was at work at the time. Some points I got from the article (all of which seem reasonable to me):
1. Doctors don't always keep up with current research.
2. Patients sometimes have more current information than the docs.
3. Patients are willing to doctor shop for the answer/treatment they want - despite medical advice or research support.
4. Hospitals, doctors, and medical companies can profit from unneeded treatment.
5. Doctors often feel pressured to do unneeded treatments because they worry the patient might get worse if not treated.
6. Research is sometimes wrong or poorly done - many studies are flawed or biased.
7. The medical community changes slowly even when faced with accurate research and well done RCTs.

The problem, like many we face, is layered, complex, in need of a solution, but that fix isn't easy and will require many things to change.

Andrew

"1.Doctors don't always keep up with current research.
2. Patients sometimes have more current information than the docs."

Let's see, I explained to husband MO that Provenge doesn't only collect blood once (as he told us), but I also explained to him why they use three collections rather than two or more than three. When husband's ALP went up during Chemo and the MO wasn't sure why, I suggested that maybe he should stop taking his statin until after chemo. I also told him about Zytiga being approved back in October 2017 before he knew about it (got a phone call apology from him on that one). Now husband GP wants him to consider going back on a statin, and I've told him that's a great idea, I'll get him a list of the ones that work best with PCa/Zytiga and that he shouldn't except a script for just any statin. I think the MO and I now have a friendly competition to see who can find trials or treatments first. I've noticed lately he's upped his game. LOL

Note: MO is not a PCa specialist, just a general MO. There is supposedly a PCa specialist on staff, but I would bet I spend as much time if not more on research than he has time to do.

Based on the article, I'm pretty much convinced that the meniscus tear surgery I had last July was unnecessary. My PCa treatment, on the other hand, was probably necessary, given my G3+4 pathology.

Yes, nice summary by InTheShop. Saved me some time...

ASAdvocate said...

What I have heard is that NONE of the urologists would advise their children to choose that profession. None. Various reasons, often earning potential.

Not surprised to hear this...their lucrative, aggressive overtreatment of favorable risk PC bubble has burst...

...and the burst bubble is also unfavorably affecting their lucrative secondary markets: artificial sphincters, inflatable penile prosthesis, penile slings, and other hardware, plus their cut on PDE5-inhibitor prescriptions...for the millions of male customers who stepped onto the slippery slope of treatment with no evidence of benefit (but hey, not everyone understands evidence.

Once a loyal customer, always a loyal customer.

Post Edited (Blackjack) : 6/6/2019 12:12:05 PM (GMT-6)