More problems with the standard of care for prostate cancer

Dr. Weeks’ Comment:  Woe unto those innovative doctors whose care exceeds the standard of care…. for, by being better they are criticized for not adhering to the standard of care.   Yet history tells us that the standard of care (i.e. “what most doctors do or resist doing”) is an amorphous standard which is constantly being nudged along albeit a good 20-40 years behind what basic scientists discovered.  The classic example is scurvy:  Dr. James  Lind  of HM Royal Navy figured out how to successfully treat scurvy and wrote a book in 1753 entitled  “A Treatise of the Scurvy”  . However, here is the tragedy:  it took almost 50 years for British doctors back in the UK to adopt the successful cure! It wasn’t until 45 years had passed with countless deaths and suffering that Gilbert Blane, the Chairman of the Navy’s Sick and Hurt Board, declared in 1798 that scurvy can be prevented and treated with citrus in general and limes in particular (hence the Brits are called “limies” and the British Navy ruled the waves !)   Only then did the “standard of care” catch up with clinical excellence. Any one using Dr. Linds treatments prior to  1798 would be in violation of the “standard of care” and subject to discipline by the doctors guild – regardless of clinical success and grateful patients!   

Lockstep uncritical adherence to the tyranny of the majority is oft times a suboptimal option and we ignore the opinions of  the  “respectable minority”  at our peril.

Today we have a new shift in the standard of care:  Here we have the venerable PSA test – prostate specific antigen,  a test your doctor has undoubtedly recommended for you if you are a male over 60 years old. Yet now we are told, it has no merit and harms more than it helps and is NO LONGER RECOMMENDED.  Have some fun, ask your urologist if you need your PSA tested and listen to the conflicted doctor try and speak both from his years of clinical experience as well as his allegiance to the thought leaders who dictate the standard of care. 
OCTOBER 7, 2011
Panel Faults Widely Used Prostate-Cancer Test 

A key federal advisory panel is poised to recommend that healthy 
men shouldn't be screened with a widely used blood test for prostate
cancer, indicating that the test offers more harm than benefit. 
The U.S. Preventive Services Task Force will recommend a "D" rating 
for prostate specific antigen, or PSA, testing, said a person 
familiar with the draft document. A "D" rating means "there is 
moderate or high certainty that the service has no net benefit.
 Report Resets Prostate Testing Debate 
A high-profile federal report recommending that most men shouldn't get 
 prostate-cancer screenings may have little immediate effect on how 
 doctors use the test for healthy men.  But the report, released Friday
 by the U.S. Preventive Services Task Force, is expected to reframe the
 debate surrounding the test so that patients are far  more aware of its
 risks. About half of men between 65 and 75 now are getting the blood
 test, research shows. The task force's draft statement recommends
against screening for prostate-specific antigen, or PSA, for men with
 no symptoms of the disease.



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