Prophet or Profit?

Last night on the Colbert Report, Deepak Chopra was asked whether he was a prophet. Deepak then spelled it p-r-o-f-i-t. That notion sums up the state of American medicine. Everything is touted as a major advance, whether it is a treatment heart disease, cancer or hot flashes. Too often however, the supposed benefit turns out to be an illusion, or to be overstated,  and —as noted on our masthead skim milk often masquerades as cream.  It’s hard to escape the notion that monetary gain has something to do with the claim.

Some recent news items illustrate this

1. Black cohosh and soy—For years our naturopathic and health food friends have touted this as a treatment for hot flashes. The only problem is that when tested in an objective manner, (noted here also) in controlled randomized studies there is no evidence of benefit over a placebo.

2. Vitamin E: This has been promoted for what ails you. All manner of pills and capsules have been marketed catering to the hopes of consumers that this will give them long life and ward off a variety of problems.  Most recently there was a report on vitamin E’s inability to improve cognitive dysfunction (prevent Alzheimers disease). Other uses recently  questioned include the prevention of heart disease and cancer. Vitamin E does not appear to be effective in any of these indications.

3. Prostate cancer treatment: There was a widely reported non randomized study in JAMA (also noted here) last week. The headlines claimed a major advantage for patients aggressively treated for prostate cancer versus those who were simply observed (wait and watch)–i.e. fewer in the treatment group died.  The study seems to prove an advantage for aggressive treatment. However, what was not emphasized in the news reports was that those who died most often died of other illnesses—not prostate cancer. Just 8% of treated patiennts who died actually died of prostate cancer while only 6.8% of those not treated died of the disease.

Huh? fewer patients died of prostate cancer in the non treated group? What’s going on here? The problem with this study is that patients with significant illnesses besides their prostate cancer were not treated for prostate cancer because of their limited life expectancy from other illnesses. Thus what was reported as an advance in treatment, fewer people dying if they are treated, would seem to be the result of patient selection.

This study was widely publicized but is unfortunately flawed.  It gives cover to those who want to aggressively treat every patient with prostate cancer.  Patients live longer with treatment, right?  Wrong!!  The flaws are too evident and call into question the conclusions.


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