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Public unmoved by evidence-based medicine

Puppycow

Penultimate Amazing
Puppycow
Joined
Jan 9, 2003
Messages
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Location
Yokohama, Japan
Did you know that there are medicines available that have been scientifically shown to prevent cancer? I didn't until I read this article. Most people don't seem to know or care, however.

Much of what Americans do in the name of warding off cancer has not been shown to matter, and some things are actually harmful. Yet the few medicines proved to deter cancer are widely ignored.

Take prostate cancer, the second-most commonly diagnosed cancer in the United States, surpassed only by easily treated skin cancers. More than 192,000 cases of it will be diagnosed this year, and more than 27,000 men will die from it.

And, it turns out, there is a way to prevent many cases of prostate cancer. A large and rigorous study found that a generic drug, finasteride, costing about $2 a day, could prevent as many as 50,000 cases each year. Another study found that finasteride’s close cousin, dutasteride, about $3.50 a day, has the same effect.

Nevertheless, researchers say, the drugs that work are largely ignored. And supplements that have been shown to be not just ineffective but possibly harmful are taken by men hoping to protect themselves from prostate cancer.
. . .
And prostate cancer is not unique. Scientists have what they consider definitive evidence that two drugs can cut the risk of breast cancer in half. Women and doctors have pretty much ignored the findings.

Companies have taken note, saying that it makes little economic sense to spend decades developing drugs to prevent cancer. The better business plan seems to be looking for drugs to treat cancer. That is a sobering lesson, said Dr. Ian M. Thompson Jr., chairman of the urology department at the University of Texas Health Science Center in San Antonio.

“A scientific discovery that is very clear cut and that is not implemented by the public is a tragedy,” he said.
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There seems to be more of a market for the fake supplements and new-age nonsense flogged by celebrities than for evidence based medicines.

On a personal note: Now that I've learned that this medicine exists, I'm wondering if it's worth it? $2/day for a medicine that cuts the risk of prostrate cancer. I don't know about that. I'm a 39-year-old man, BTW.

My wife probably would not be interested in a prophylactic medicine for breast cancer because she has an anti-drug attitude that seems very common among the Japanese. For example, she suffers from pretty bad headaches on a rather frequent basis, but only takes a painkiller as a last resort after it becomes simply unbearable. Even then, she prefers to take one pill even though the standard dose for adults is two pills.

Then there's my daughter. She seems to have ADHD-like symptoms, but my wife doesn't think trying a medicine for her is a good idea. I don't really know what to think about that, but she is definately the more stubborn one in our marraige, and she thinks she knows better about these things than me.
 
If we are talking about a drug that the whole population (or all of one sex) need to take daily for the whole of their adult life, then it is not surprising that it hasn't caught on. 2$ per day for, say 70 years, that is 50,000$. For a reduced risk. And what about side-effects?

Hans
 
Yep, i thought the same. It COULD well be that the sideeffects are worse than the cure. It it WAS safe certainly the price would not be a matter for me but i would have to know the sideeffects first.

BTW my GP told me that studies based on autopsies show that 50% of all men die WITH Prostate cancer not FROM it.
 
Ove said:
*snip*It it WAS safe certainly the price would not be a matter for me but i would have to know the sideeffects first.

*snip*
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You are richer than me, then. I mean, this would probably not be the only drug you had to take; there is no doubt others, which can reduce your risk of some other ailment.

Let's face it: Even more than cures, prophylaxis is a matter of cost-benefit. On the face of it, preventing disease rather than curing it looks like a really good idea. However, if it means that you have to stuff the whole population with lots of preventive treatments to avoid things they might get to suffer from, then the benefits could quicly vanish in cost and, of course, side effects.

Hans
 
In Sweden finasteride is sold under the product name Propecia (I think english speaking countries call it Proscar) and requires prescription in Sweden. It is not sold as a prostate cancer preventative, but as a hair loss treatment. Since it is an androgenetic (not sure I translated that right, feel free to correct) it has some effect on male pattern baldness.

Side effects listed on the pack note are:
Less common: (fewer than 1 in 100 users) decreased sex drive, erectile difficulties, ejaculatory dificulties.



Unknown frequency: allergic reactions such as urticaria, rashes and swollen lips or face, gynecomastia, pain in the testicles, palpitations.

Some studies have shown that erectile problems may remain after discontinuation. Other side effects go away quickly as the compound leaves the body fairly quickly. Can also affect liver function slightly.

It is recommended that pregnant women do not handle broken or crushed tablets as the compound is taken up through the skin and cause birth defect in male embryos.

According to the May 2008 study, the rate of prostate cance was decreased by 30%, but I'm not sure what they mean as compared to what.

It can apparently be of some benefit to treat already diagnosed benign prostatic hyperplasia as well.



In combination with other risk factors some men showed infertility. Discontinuation will normalize, or improve sperm quality.
 
Um, I do not know how many trial sthere were but a ~28% reduction and a low chance of increased malignancy.

So the NYT seems to be just wanting to have a story, what other treatments are avaolable, what is the ratio of death from prostate cancer before considering a blanket preventative use.

rather shallow article, at least the snippet.
 
The problem is that they want Medicine to be Magick.

They want an assured result, not a probability. They want it to be inexpensive. They want it never to say "no."

And only woo can ever pretend to be all those things.
 
It should be pointed out that the study found that while there was a decrease in total prostate cancers, there was actually an increase in high grade prostate cancers - the kind you die from not with. This suggests that doctors are actually moved by evidence-based medicine, since the evidence would be inadequate to recommend its general use.

Linda
 
fls said:
It should be pointed out that the study found that while there was a decrease in total prostate cancers, there was actually an increase in high grade prostate cancers - the kind you die from not with. This suggests that doctors are actually moved by evidence-based medicine, since the evidence would be inadequate to recommend its general use.

Linda
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Well that makes a big difference.

Oh well.
 
Puppycow said:
Did you know that there are medicines available that have been scientifically shown to prevent cancer? I didn't until I read this article. Most people don't seem to know or care, however.



There seems to be more of a market for the fake supplements and new-age nonsense flogged by celebrities than for evidence based medicines.

On a personal note: Now that I've learned that this medicine exists, I'm wondering if it's worth it? $2/day for a medicine that cuts the risk of prostrate cancer. I don't know about that. I'm a 39-year-old man, BTW.

My wife probably would not be interested in a prophylactic medicine for breast cancer because she has an anti-drug attitude that seems very common among the Japanese. For example, she suffers from pretty bad headaches on a rather frequent basis, but only takes a painkiller as a last resort after it becomes simply unbearable. Even then, she prefers to take one pill even though the standard dose for adults is two pills.

Then there's my daughter. She seems to have ADHD-like symptoms, but my wife doesn't think trying a medicine for her is a good idea. I don't really know what to think about that, but she is definately the more stubborn one in our marraige, and she thinks she knows better about these things than me.
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The artcile mentions one example: finasteride for prostate cancer. (brand names: Propecia, Proscar)

Firstly, it does not 'prevent' prostate cancer - it reduces the risk by perhaps 20% based on one study. There is also a need to examine the anomaly that suggests it increases the chance of aggressive variants. It may actually increase the risk of death from prostate cancer despite decreasing the incidence.

Secondly, there are contraindications - patients should not be taking this if they have blood pressure anomalies, as it dramatically increases the risk of stroke or brain hemorrhage.

Thirdly, the side effects are pretty much guaranteed: impotence, hypotension, decreased libido, erectile dysfunction, low ejaculate volume.

The clinical decision is that the medical harm from complications and side effects if the population were to take this preventatively far exceeds the potential reduction in medical harm from prostate cancer.

In other words: if all the men in the population took this, they would be exchanging a 20% reduction in an already small risk of being diagnosed with prostate cancer (and may actually have a higher risk of dying of prostate cancer) with a large risk of dying from complications of blood pressure, and living for years with the undesireable side effects.

Remember that while a quarter of a million men are diagnosed annually with prostate cancer, relatively few will die of it (compared to other cancers) - it is one of those types of cancer that people can have without harm for decades and ultimately die of natural causes. There has been some research based on postmortem examinations that suggest possibly most men have prostate cancer when they die of other natural causes.


ETA:

Sorry, didn't read down to FLS' posting. Sorry for duplicate information.
 
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I am trying to rationalize the claims in this article with the anti-vax claims that doctors are in the pocket of Big Pharma.

Actually, it's not worth the effort.
 
My doctor advised me that the best way to keep your prostate healthy is to use it as often as possible. He has something like 8 kids, so I know he means it.
 
fls said:
It should be pointed out that the study found that while there was a decrease in total prostate cancers, there was actually an increase in high grade prostate cancers - the kind you die from not with. This suggests that doctors are actually moved by evidence-based medicine, since the evidence would be inadequate to recommend its general use.

Linda
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I discussed this with my colleague who is an oncologist.

Evidently the interpretation of the paradoxical results is not that finasteride increases the incidence of high grade tumours, but that they believe it makes them easier to detect with DRE and verify with biopsy. The prostate is not as enlarged, so aggressive tumours are noticeable earlier.

Still: he advises against prescribing for prophylaxis, as the target population is already contraindicated because of the severity of side effects and greater risk of m&m due to conflicts with other medications than the benefit justifies.
 
blutoski said:
I discussed this with my colleague who is an oncologist.

Evidently the interpretation of the paradoxical results is not that finasteride increases the incidence of high grade tumours, but that they believe it makes them easier to detect with DRE and verify with biopsy. The prostate is not as enlarged, so aggressive tumours are noticeable earlier.
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I realize that that was one of the explanations investigated. It illustrates nicely the need for more relevant outcomes, like death.

Still: he advises against prescribing for prophylaxis, as the target population is already contraindicated because of the severity of side effects and greater risk of m&m due to conflicts with other medications than the benefit justifies.
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Yeah the side effects remind me of that well-worn claim...you don't live any longer, it just feels like you do. :)

Linda
 
fls said:
I realize that that was one of the explanations investigated.
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I wasn't even under the impression that it was 'investigated' so much as asserted.




fls said:
It illustrates nicely the need for more relevant outcomes, like death.
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Agreed. Binary is hard to quibble with.



fls said:
Yeah the side effects remind me of that well-worn claim...you don't live any longer, it just feels like you do. :)
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And it's not incompetence for a GPs to weigh risks and benefits for their patients and decide in favour of quality of life.
 
So much for the claim that "doctors have ignored the findings," eh?

No, they haven't ignored them. They just UNDERSTAND them much better.
 
blutoski said:
I wasn't even under the impression that it was 'investigated' so much as asserted.
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Really? Because, of course, the study design would not allow for that conclusion to be drawn.

Here's an example of published information addressing that question.

http://www.ncbi.nlm.nih.gov/pubmed/17848668

Agreed. Binary is hard to quibble with.
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I wasn't thinking of binary so much as following EBM's recommendations for outcome studies (rather than surrogates).

Linda
 
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