My regular readers know the controversies and challenges posed by prostate cancer. It is very common. Over half the men who die at advanced age of other causes will have prostate cancer on autopsy. It is very slow. From the time that prostate cancer is detectable on biopsy to the time that it causes symptoms or shortens life can be as long as a decade. It is not very lethal. Because it tends to affect older men, most men diagnosed with it tend to die of other causes. Though it does kill t...
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Are Bisphosphonates to Blame for Baffling Bone Breaks?
This week ABC World News aired a story about a possible side effect of osteoporosis medications. The family of medications involved in this story is called bisphosphonates and includes Fosamax, Actonel and Boniva. These medications have been proven to prevent fractures in patients with osteoporosis (very low bone density). Apparently, some doctors had noticed the occurrence of an unusual kind of fracture, a break in the thigh bone between the hip and the knee, in some women who had been takin...
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American Cancer Society Revises its Guidelines for Prostate Cancer Screening
About a year ago I reviewed the controversies of prostate cancer screening, especially the conundrum that we still don’t know whether finding prostate cancer early saves any lives. I concluded by citing the US Preventive Services Task Force (USPSTF) recommendations that the evidence is insufficient to recommend for or against screening for prostate cancer in men age 50 to 75. The USPSTF recommends against screening men older than 75 as the evidence suggests that harms outweigh...
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Carotid Stenting Still Controversial
Almost 800,000 Americans suffer a stroke every year. Strokes are the third most common cause of death in the US, and are frequently disabling to those who survive. These sobering numbers are despite the substantial improvement in recent decades in stroke prevention through the use of medications that lower blood pressure and cholesterol.
This week’s hubbub relates to carotid arteries, the large arteries in the neck that carry blood to the brain. But before we dig into the details we have to ...
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Twelve Years Later, the Truth about Vaccines and Autism
Ideas have consequences. False ideas, especially popular false ideas, can cause harm. For example, the very popular false idea “corduroy pants and wide lapels are far out, man” made an entire nation ugly for about a decade. And some false ideas do even more harm than that.
In 1998 the British medical journal The Lancet published a paper authored by Dr. Andrew Wakefield that claimed to link autism to the vaccine against measles, mumps and rubella (MMR). The study looked at 12 children (that’...
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To Clot or to Bleed?
Aspirin has long been known to prevent strokes and heart attacks in patients with a previous stroke or heart attack. But aspirin has potentially serious side-effects. Aspirin can cause stomach ulcers, and it inhibits blood clotting raising the risk of life-threatening bleeding.
If we knew in advance that a patient was going to be in a car accident or have a bleeding stomach ulcer, we would discontinue the aspirin a week before the event and minimize the bleeding risk. (This is exactly what w...
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New Mammogram Recommendations Betray Women, Doctors and Science
This week the US Preventive Services Task Force (USPSTF) revised their recommendations for screening mammograms. Their recommendations have ignited much controversy and have weakened the credibility of a formerly objective scientific body.
This post is longer than usual. It deals with an important subject in some detail. For the readers who like to delve into the details and see the data, set this aside for when you can give it some time, follow the links, and check out the articles yourself...
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Should You Have a Pap Smear?
Last week I lamented that we can prevent so few cancers. Cervical cancer screening is one of the success stories of prevention. Regular pap smears can drastically decrease the risk of cervical cancer and makes death from cervical cancer virtually unheard of.
Cervical cancer is a sexually transmitted disease, caused by human pappilomavirus (HPV). Pap smears check for telltale changes in the cervix that happen after HPV infection. Over many years these changes lead to cervical cancer.
But w...
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Proactive or Paranoid? When Vigilance is Valueless
What a better topic for Halloween than fear?
All of us when hearing of a coworker or loved one who has been diagnosed with a life-threatening illness wonder if we could be next. “What if I have lung cancer? Should I get checked out? There must be some tests I can get to make sure I’m OK.” Those who take an active role in staying healthy are confident that they could do more to make sure they don’t get some dreaded disease. Most cancers, after all, are preventable, right? Or at least they ...
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Vaccines: Fighting Fear with Information
Diversity of opinion is a mark of any free society. Whenever I hear the latest conspiracy theory, see a commercial for a ghost-investigating “reality” show, or hear the latest quack cure advertised on radio, I remind myself that the spread of wacky fringe ideas is a consequence of liberty. And, though I wish my fellow citizens would develop a bit of skepticism, I wouldn’t want anyone preventing them from hearing, watching or believing all that nonsense.
So it’s a major victory when facts fina...
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