Re: Yammer about "risk" of PCa Screening

A bit of wisdom from one of the best and brightest:

"With all of the talk about the hazards of PC diagnosis and
unnecessary treatment, the PSA remains, without any doubt, the best
and most useful biomarker for a common malignancy in the history of
medicine. The problem, dear Brutus, lies within the lack of
perspective of the physicians who abuse the tool or are not
sensitive
to the understanding of biology and whether or not invasive
interventions are called for. It is the typical "bull in the China
shop" approach of many of the "scientific" community that screws up
the distinction between the message and the messenger.

It is analogous to the joke about the man lying in a bed in the
ICU talking
to the new patient that was just wheeled in to the unit. "Whatever
you do" said the 'veteran' patient, "don't push that call button for
the nurse. If you do that, a bunch of doctors and nurses will come
running in and start pounding on your chest." So, whatever you do,
say so many doctors, don't order a PSA since a diagnosis of PC may
occur and a physician may remove your prostate or give you radiation
or something else that can harm you."
--Stephen B. Strum, MD
Medical Oncologist
PCa Specialist

"Steve Jordan" <mycroftscj1@cox.net> wrote in message
news:y8Ibn.35842$Fm7.2140@newsfe16.iad...

>A bit of wisdom from one of the best and brightest:

-- skramer remarks

My favorite is, "I don't get PSA tests because I understand they sometimes
give a false positive."

I want to grab them by the collar and ask, "What are you? Retarded?!?!?"

(But only an arrogant jackass would use "retarded" as an insult.)

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 02/04/10
Illegitimati non carborundum

Steve Jordan wrote:
> A bit of wisdom from one of the best and brightest:
>
> "With all of the talk about the hazards of PC diagnosis and
> unnecessary treatment, the PSA remains, without any doubt, the best
> and most useful biomarker for a common malignancy in the history of
> medicine. The problem, dear Brutus, lies within the lack of
> perspective of the physicians who abuse the tool or are not sensitive
> to the understanding of biology and whether or not invasive
> interventions are called for. It is the typical "bull in the China
> shop" approach of many of the "scientific" community that screws up
> the distinction between the message and the messenger.
>
> It is analogous to the joke about the man lying in a bed in the ICU talking
> to the new patient that was just wheeled in to the unit. "Whatever
> you do" said the 'veteran' patient, "don't push that call button for
> the nurse. If you do that, a bunch of doctors and nurses will come
> running in and start pounding on your chest." So, whatever you do,
> say so many doctors, don't order a PSA since a diagnosis of PC may
> occur and a physician may remove your prostate or give you radiation
> or something else that can harm you."
> --Stephen B. Strum, MD
> Medical Oncologist
> PCa Specialist

That was a very interesting quote.

My sense is that, just as many doctors misinterpret the PSA test,
either doing nothing when they should do something, or doing too
much when they should hold off, so too many doctors will
misinterpret the criticisms made of the PSA test. Instead of
concluding that the PSA test should be used intelligently, they
will conclude that it shouldn't be used at all.

On the whole, I believe that most doctors do far better than
us lay people at figuring out what to do about our health,
but they are still human, and still subject to failings that
negatively affect their patients.

Alan

On 2/8/10 4:53 PM, Alan Meyer wrote:
> I believe that most doctors do far better than
> us lay people at figuring out what to do about our health

Ah, yes .. but which ones fit that mold, and regarding which ailments?
Most know how to handle PSAs and statin side effects, but my docs sure
as hell did not. And very few doctors know squat about how to manage
soft-tissue ailments (e.g., muscle and tendon problems not requiring
surgery) beyond RICE and/or drugs; the experts in that field are the
good massage therapists, IMO.

My strong advice for anyone with at least average intelligence and
inquisitiveness is to know enough about one's ailment to distinguish
between good and bad diagnosis and treatment advice.

I.P.

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:mb4cn.7512$4N4.3759@newsfe24.iad...
> On 2/8/10 4:53 PM, Alan Meyer wrote:
>> I believe that most doctors do far better than
>> us lay people at figuring out what to do about our health
>
> My strong advice for anyone with at least average intelligence and
> inquisitiveness is to know enough about one's ailment to distinguish
> between good and bad diagnosis and treatment advice.

-- skramer remarks

I suspect a man of say 90 IQ (average) can probably learn as much about
prostate cancer, say from miosis to assuming room temperature, as a doctor
of 110 or 120 IQ can learn about prostate cancer along with all other things
he needs to know with regard to the human body from conception to death. As
always, one needs only apply himself to that endeavor.





PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 02/04/10
Illegitimati non carborundum

On Feb 8, 7:44*am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
> "Steve Jordan" <mycrofts...@cox.net> wrote in message
>
> news:y8Ibn.35842$Fm7.2140@newsfe16.iad...
>
> >A bit of wisdom from one of the best and brightest:
>
> -- skramer remarks
>
> My favorite is, "I don't get PSA tests because I understand they sometimes
> give a false positive."
>
> I want to grab them by the collar and ask, "What are you? *Retarded?!?!?"
>
> (But only an arrogant jackass would use "retarded" as an insult.)
>
> PSA 16 10/17/2000 @ 46
> Biopsy 11/01/2000 G7 (3+4), T2c
> RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
> PSA *<.1 *<.1 *<.1 *.27 *.37 *.75 * * * * * * PSAD 0.19 years
> EBRT 05-07/2002 @ 47
> PSA *.34 .22 .15 .21 .32 * * * * * * * * * * * *PSAD 0.56 years
> Lupron 07/03 (1 mo) 8/03 and every 4 months there after
> PSA *.07 .05 .06 .09 .08 .132 .145 * * * *PSAD 1.40 years
> Casodex added daily 07/06
> PSA undetectable since. *Next Assay 02/04/10
> Illegitimati non carborundum

Thanks for catching yourself there.

I.P. Freely wrote:
....
> My strong advice for anyone with at least average intelligence and
> inquisitiveness is to know enough about one's ailment to distinguish
> between good and bad diagnosis and treatment advice.
....
Good advice.

In addition, we have to learn to distinguish between good doctors
and bad ones, where by bad ones I particularly mean doctors who
don't listen to their patients, don't care what the patient thinks,
don't keep up with their field, and don't say "I don't know" when
they don't know.

I can forgive a doctor for not knowing too much about one of my
ailments. But I'm not so forgiving to the guy who ignores what
I tell him and bullshits me to cover his ignorance.

Alan
don't

On 2/9/10 11:28 AM, Alan Meyer wrote:
> I'm not so forgiving to the guy who ignores what
> I tell him and bullshits me to cover his ignorance.

I suspect the year I spent in strong pain from elbows to knees from my
statin drugs could have been prevented or mitigated if either of my VA
physicians had been willing to look at the clinical trials I tried to
show them regarding the impact of grapefruit juice on statin serum
levels and the impact of statins on anyone building muscle strength. One
of those docs is the same one who delayed my rapidly rising PSA for
years, possibly giving it time to ultimately kill me.

Blindly trust no one with anything vital.

I.P.

I think the days of "Blind Faith" in anyone with M.D. following their name
is over for most of us with average intelligence.

My youngest daughter is a pediatrician who regularly speaks of second
opinions, doctor/patient communication. She has opined several times that if
you don't get the answers you want or don't understand the physicians
explanations, keep asking or get another physician. I had a cardiologist who
would almost answer questions with "Because I told you so."

He's gone from my address book.

Tom

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:k%jcn.83169$BV.63227@newsfe07.iad...
> On 2/9/10 11:28 AM, Alan Meyer wrote:
>> I'm not so forgiving to the guy who ignores what
>> I tell him and bullshits me to cover his ignorance.
>
> I suspect the year I spent in strong pain from elbows to knees from my
> statin drugs could have been prevented or mitigated if either of my VA
> physicians had been willing to look at the clinical trials I tried to show
> them regarding the impact of grapefruit juice on statin serum levels and
> the impact of statins on anyone building muscle strength. One of those
> docs is the same one who delayed my rapidly rising PSA for years, possibly
> giving it time to ultimately kill me.
>
> Blindly trust no one with anything vital.
>
> I.P.