Hands Off That Prostate!

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Quick, go get your March 26, 2009 issue of the New England Journal of Medicine.  I’ll wait…

Got it? Okay, flip to the two articles on prostate cancer screening.  See them?  No?  Okay, perhaps you’ve accidently picked up the Ladies Home Journal.  I know people get confused.  For the last time: 

New England Journal of Medicine = one of the most respected medical journals in the world.

Ladies Home Journal = a magazine (though I swear I was in a seminar not so long ago and the instructor quoted an article from LHJ as if it were peer-reviewed).

That’s okay…cut out the coupon for Birdseye veggies in LHJ while I tell you what the studies say in NEJM. 

Two large clinical trials, one American and one European, assessed whether screening for prostate cancer is effective. Both studies show that screening had little or no effect in reducing prostate cancer deaths. No tiny little studies were these either. 77,000 men in the American study and 182,000 in the European study.

These numbers are huge. I can’t even imagine how someone could manage a clinical trial with that many people. I once tried to organize a Pez dispenser collection and gave up when there were too many to keep track of. 182,000? Actual people? Damn.

So, the American study found no reduction in prostate cancer deaths after all the men had been tracked for seven years and two-thirds had been followed for 10 years.

The Europeans found a modest reduction in deaths after nine years but a high risk of needless treatment given. In fact, half the men diagnosed with prostate cancer would not have had clinical symptoms during their lifetimes. The European research suggests that roughly 50 cases of prostate cancer found through a screening program would need to be treated to prevent a single prostate cancer death.

The amount of unnecessary cancer treatment that has occurred in the name of the PSA prevention is sickening. Certainly these studies are not the final word and you should discuss screenings with your doctor.  And since both studies will continue to follow the men, it remains possible that the United States study will eventually find that screening can reduce the prostate cancer death rate.

I wouldn’t hold my breath.

In the meantime, no one is gonna touch my prostate…unless, you know, I know them really, really well.

Check, mate?

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A group of hospitals in eight cities around the world has shown that the use of a simple surgical checklist during major operations can lower the incidence of deaths and complications by more than one-third.  Impressive.

According to the New England Journal of Medicine, the rate of major complications in the studies operating rooms fell from 11 percent in the baseline period to 7 percent after introduction of the checklist.  Wow!  That’s quite an impact.

Inpatient deaths following major operations fell more than 40 percent from 1.5 percent to 0.8 percent upon implementation of the checklist.  Wow, again.  That is certainly an impressive — wait a second.  Did I just say 1.5 percent?  1.5?  One point five?  Percent?  I may be a little rusty on my statistics here (or as a rather dim-witted classmate once said to me “I never really got percents) but doesn’t that mean that more than one out of every hundred people undergoing major surgery dies?  Holy cow!  Lowering that to 0.8 percent still seems, well,  pretty crappy.

Sid Schwab, mostly retired general surgeon, wrote on his blog Cutting Through the Crap,

“If I’d had numbers like the pre-study ones in my practice, I’d have been kicked off staff.  Summarily, with the post-study ones, I might be on probation. “

And rightfully so.  Who are these surgeons and why are they allowed to continue butchering patients?  With plenty of fine and skilled technicians out of work and looking for jobs, perhaps a few of these terrible surgeons should be swapped out and replaced with a few average Joes.  Who knows…they might reduce their death rate…and stop that annoying drip in the scrub room sink.

Does Scoping Knees Help Arthritis?

Arthroscopic knee surgery for people suffering from osteoarthritis is a popular treatment but according to a new study published in the New England Journal of Medicine, knee arthroscopy doesn’t actually reduce joint symptoms or improve function when compared with nonsurgical treatment.

Canadian researchers examined the effectiveness of arthroscopic surgery, the process of making small surgical incisions and inserting a thin, flexible fiber-optic scope and other small instruments into the knee joint to remove pieces of cartilage and smooth the joint surfaces. Arthroscopy is used to repair osteoarthritis as well as other knee problems.

The study treated 178 patients with moderate to severe osteoarthritis of the knee and an average age of 60 years old.  All patients recieved physical therapy and medications such as ibuprofen or acetaminophen but 86 of the patients also received arthroscopic surgery. They were then tracked for two years.

The researchers found that both groups of patients experienced similar improvements in joint pain, stiffness, and function.  At the end of two years, the researchers concluded that compared with nonsurgical treatment, arthroscopic surgery of the knee did not improve joint symptoms or function for people suffering from osteoarthritis of the knee.

It is important to note that the study focused on arthritis-related knee problems — arthroscopic knee surgery is still beneficial in other conditions that affect the knee, such as meniscal and ligament problems.

Patients who have a combination of knee problems, such as osteoarthritis and a meniscal tear might also respond better to arthroscopy.

Source: Kirkley, A. The New England Journal of Medicine, Sept. 11, 2008; vol 359: pp 1097-1107.

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