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October 22, 2009

ACS, NY Post, ACIP, Dioxin
By Curtis Porter

Brawley and JAMA Against The World

Dr. Otis Brawley, chief medical officer of the American Cancer Society (ACS), is catching some heat after his recent statement in an interview with the New York Times conceding that breast and prostate cancer screenings have historically been oversold by physicians and misunderstood by patients and the media.

"The strident response underscores the fact that it was brave of Dr. Brawley of ACS to come forward and admit this even though it wasn't politically correct and caused a backlash among people in his own organization," says ACSH's Jeff Stier.

"One well-known expert on breast cancer was quoted as saying, in effect, that the more screening you have...

Testosterone!A new report in the current New England Journal of Medicine addresses a topic that has long aroused controversy in primary care, internal medicine, and geriatrics: Does supplementing testosterone in older men with low testosterone levels add to quality of life and functional enhancement?

The study, entitled "Effects of Testosterone Treatment in Older Men," was done by a multi-center group, The Testosterone Trial Investigators, led by Peter J. Snyder, MD, of the Perelman School of Medicine at the University of Pennsylvania...

Screen Shot 2014-08-19 at 1.41.27 PMCredit must be given to Charles Bankhead, a staff writer at MedPage Today for taking on a very difficult subject whether it makes any sense to perform cancer screens on seniors, and if so, when. While this may conjure up images of death squads or health care rationing, it is actually an important, pragmatic, and timely topic.

And this is not simply about cost savings. It is mostly about whether it makes sense to do certain tests regardless of cost. Are they useful? Do they do more harm than good?

In his piece entitled...

American women, and their doctors, have been thrown into a state of confusion by the release of a new study of the likely benefits--and possible harms--of screening mammography among 40-49 year olds. A federal panel--the U.S. Preventive Services Task Force (USPSTF)--analyzed examined recent studies and came to a very different conclusion than they did seven years ago: mammograms for women under 50 should be deferred, and women over 50 need only get the exam every two years.

(The panel also cast doubt on the benefits of clinical breast exams--performed by a doctor--and advised eliminating entirely breast self exams as useless in saving lives from breast cancer).

These recommendations--which have no official force--fly in the face of what I learned in medical school and...

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the US, accounting for nearly 52,000 deaths in 2014 alone. Screening for CRC can be effective in finding early changes in the colon and rectum, and early treatment diminishes the mortality risk. Yet many people who are eligible for screening (e.g. those aged 50 and over, as well as those with family histories of the disease) neglect to get screened, even though the CDC and other health agencies have developed Public Service Announcements (PSA) to advise people of these facts.

The Digital Tool

In an attempt to improve the use of CRC...

Screen Shot 2013-09-19 at 1.08.03 PMA constant theme in medicine over the past few years has been questioning whether routine screening for certain diseases is actually helpful.

For the most part, the answer is surprising and counterintuitive no.

For example, the use of the PSA test to detect prostate cancer does, in fact, lead to more diagnoses. However, this does not necessarily translate into saving lives. And the real...

Low-value health care reflects activities by patients and physicians that add little quantifiable differences to care, e.g., going to the emergency department instead of a physician for a sore throat. The poster child for low-value care may be screening programs aimed at populations with a low incidence of the problem being targetted, for example, PSA, prostate-specific antigen measurements in younger men. The problem is that while the test itself may be of low value and low cost, the subsequent reactions by physicians and patients may entail much more testing, false positives, and various harms including increased costs. Care cascades, while it may channel thoughts of the outdoors, fast running streams and natures bounty, in actuality refers to the health systems response to those low...

Facts vs. FearsIn today s Science section, NYTimes Jane E. Brody s Personal Health column has a headline that sums up much of what ACSH has been telling our readers over our 36-year history: Emotion is not the best medicine. Ms. Brody begins by using the widespread hysteria bordering on panic induced by the exactly two severe cases of Ebola virus (one fatal) diagnosed on our shores during the recent...outbreak?

There is indeed a serious outbreak of ebola hemorrhagic...

Screen Shot 2013-12-30 at 1.08.50 PMIn recent years a surprising amount of the orthodoxy of modern medicine has been challenged, and this has resulted in some counterintuitive, even surprising findings.

For example, the PSA test for detecting prostate cancer is so flawed that some healthcare professionals are in favor of doing away with it entirely. The primary reason: too many false positives, leading to unnecessary (and very invasive) procedures, with very few lives actually saved.

Annual physicals have been shown to not prolong life, and study...

A research report in the March 2 Journal of the American Medical Association (JAMA) pointed out that many members of National Football League (NFL) teams (57%, to be exact) had Body Mass Indices (BMIs) over 30 -- numbers that would put them in the range of body weight considered obese. Similarly, the March 9 edition of the Kansas City Star had an article listing the BMIs of a number of National Basketball Association (NBA) players -- who also came in at or close to 30. So what gives? It's hard to believe that these men, elite athletes all, are really carrying around a lot of excess body fat, which is what a high BMI implies. Or does it?

Researchers...