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stethoscope-1586565591-190x155In the current New Yorker, Dr. Atul Gawande, well-known expounder of healthcare issues and endocrine surgeon at Harvard, discusses some of the more outrageous exploitations of healthcare economics in his lengthy article, Overkill.

The genesis of this re-exploration of the costs of America s medical care was his 2009 piece in the same journal, The Cost Conundrum, in which he compared two cities in Texas as to their Medicare expenditures. He found, to his expressed amazement,...

Screen Shot 2014-09-17 at 2.29.56 PMOne of the main themes in medicine over the past year or two has been the value (or lack of same) of screening as a tool to prevent early death.

Accepted medical practices have been challenged, as data become available that are not only counterintuitive, but in some cases almost heresy.

Examples include:

Is routine mammography harmful or helpful?

Should the prostate specific antigen (PSA) test be used at all?

Do annual exams save lives?

We have written about these issues frequently-...

After reviewing new evidence since its previous recommendation, the United States Preventive Services Task Force (USPSTF) is still advising against routine screening for ovarian cancer. The recommendation is very much in keeping with its recent recommendations for breast cancer screening and PSA screenings for prostate cancer.

The Task Force found that annual screening in women who do not possess known risk factors for ovarian cancer (certain genetic mutations, Lynch syndrome, a family history of the disease), does not reduce the number of deaths from the disease and can actually lead to more harm than benefit.

In yet another controversial announcement, the U.S. Preventive Services Task Force (USPSTF) is recommending that healthy postmenopausal women put away their vitamin D and calcium supplements, stating there s not enough evidence to demonstrate that either prevents bone fractures. The decision hails from the same panel that advised against PSA testing for men last month and just like the PSA guideline, the latest recommendation is spurring lots of controversy and confusion among both physicians and the public.

But perhaps the recommendation isn t so outlandish after all. For instance, according to the Institute of Medicine (IOM), most Americans are...

Two newly-issued studies dealing with care of older men have just been released. Both emphasize the complexities faced by mature patients, a group which comprises a larger and larger segment of our population.

The Journal of Clinical Oncology reported yesterday that men over the age of 75 faced with high-risk prostate cancer often get less intense and thus often poorer treatment than younger men. The researchers found that this was true even when adjustment was made for the fact that older patients are more likely to suffer from indolent (i.e. slower-developing) cancers.

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Our top stories for Monday, April 29, 2013: The shocking truth about American teens and driving under the influence, and why some asymptomatic men still opt for regular PSA testing.

The post Your Monday medical wrap appeared first on Health & Science Dispatch.

http://www.youtube.com/watch?v=QSaEn7NCMwg

If there is one area that has been clouded by confusion in recent years, it is the detection and treatment of prostate cancer. The prostate specific antigen (PSA) test, which became a routine screen in 1994, has come under considerable fire lately, even to the point that groups such as The United States Preventive Services Task Force, the American Urological Association, American Cancer Society, and American Society of Clinical Oncology now recommend against using it for routine screening purposes.

The main limitation of the test is that it detects all types of prostate disorders: cancers,...

The practice of screening healthy people for conditions before they have symptoms has gone out of control, according to Dr. H. Gilbert Welch. In an op-ed in today s New York Times, Dr. Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, makes a controversial proposal: We would all be better off, he says, if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be. In other words, doctors should stop focusing on giving healthy patients people without health complaints tests for all sorts of potential ailments, and instead target those who actually have...

Prostate cancer is a much-discussed form of cancer in the medical literature. In part because of its sheer impact on all men but also because of the disparities in assessment, treatment, and outcome often couched along the lines of that social construct, race. Prostate cancer, given its recurrent prominence in our news cycles of late, may be a helpful way to begin to disentangle social determinants and genetics when we insist on discussing a disease stratified by race.

Some Context

  • Prostate cancer is the second leading cause of cancer-related mortality in men, following only lung cancer.
  • The incidence is low in Asian men, higher in Northern Europeans, and highest in African-American men. In the US, the incidence is 64% greater in African-...

Cancer of the prostate gland is extremely common – so common, in fact, that in some form it will affect most men if they live long enough.  It is the second-most diagnosed cancer in American men, behind non-melanoma skin cancers.  Many prostate cancers grow slowly, are confined to the gland itself, do not cause serious symptoms, and do not require intensive, if any, treatment. Others, however, are aggressive and can spread quickly.

Given such variability, the significant side effects of some treatments, and the dread that many people experience with a cancer diagnosis, deciding what to do about prostate cancer can be vexing for both doctors and patients.

There are two common ways to screen for cancer in the prostate, a small walnut-shaped gland in males that produces the...