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Wednesday, October 12, 2011
Also appeared in the Westport News, 10/12/2011 - Letter to the editor.
The several-day old report by he U.S. Preventive Services Task Force Healthy men don’t need PSA testing for prostate cancer, sparked enormous controversy in professional and lay circles. I will not go through the back and forth arguments, which are described in detail in major newspapers like the New York Times and the Washington Post, but just give additional food for thought.
There is no question that with PSA testing, many more prostate cancers are diagnosed now and the number will increase as time goes on, and as newer techniques for screening become available.
There is also no question that in many cases, men are treated for prostate cancer when, at least in retrospect, they shouldn’t have been treated. Maybe because they did, or would have, died of other causes, or because the complications were worse than the disease.
It may be true that, overall, PSA testing does not presently lead to increased survival. Some men treated for prostate cancer definitely increase their life span. Others may not, or may even have complications that will shorten their lives.
But, in my opinion, these are not good enough reasons to stop screening men for prostate cancer. Not testing only decreases the amount of information we have, which creates ignorance, not knowledge. And this type of ignorance is not a solution to the question of how to treat prostate cancer, or any other cancer. More than 28,000 men die each year of prostate cancer, and literally ignoring the problem will not solve it.
The issue is that men have the right, and perhaps the obligation, to know if they harbor the cancer. And it is the responsibility of the medical profession to refine its techniques so that Medicine can better identify which patient has a better change to benefit from prostate cancer treatment and who may be hurt by it. As these techniques are refined, prostate cancer survival will increase, just as survival from many other types of cancer is increasing.
I feel that the Task Force report was seriously flawed, and I suspect was motivated by reasons other that good medical decision-making.
On a personal note: my prostate cancer was diagnosed over 5 years ago on the basis of a rise in my PSA, which was still considered normal. On the basis of the post-op pathology report, I know that, had I not had the surgery done at that time, I would have been in big trouble today.
Monday, October 10, 2011
The five must do lifestyle changes that will help you stay out of trouble if you have diabetes, or if you are at risk for the development of diabetes, are:
· Follow a healthy diet
· Maintain an optimal body weight (Body Mass Index not higher than 25)
· Engage in recommended amounts of physical activity
· Don't smoke (don't even think about it)
· Keep alcohol use to no more than 1 drink a day for women, and 2 drinks a day for men.
According to data released earlier this year by American Diabetes Association, diabetes was the seventh leading cause of death in the US in 2007. Last year it was the sixth. In reality, the number is much, much higher, because diabetes is a major contributor to heart disease and stroke.
The economic burden to individuals and the country as a whole is enormous. Costs attributable to diabetes in 2007 were $116 billion in direct medical costs and $58 billion in disability, work loss and premature mortality. Again, this does not account for the contribution of diabetes to the cost of heart disease and stroke.
Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.
All of these numbers are undoubtedly underestimates. Many case of diabetes continue to be undiagnosed.