Re: Magical Thinking in Complementary and Alternative Medicine (Skep

[Guest guest]

>

> Alan,

>

> I'm always interested when people say things like <snip> I

> believe in " evidence based medicine " , and I believe that the

> scientific method is the only valid way to determine what the

> evidence is. <snip> because so much of medicine as practiced

> today does not fit this bill.

>

> There was recently a discussion on this very point on another

> List demonstrating by reference to studies just how few of the

> procedures carried out today have any scientific validity. And

> of course much of the treatment where drugs are used 'off

> label' often has no more basis on rigorous scientific study

> than many of the non-drug approaches - less in many cases.

>

> I am not challenging you in any way, and pleas don't respond if

> you feel uncomfortable in doing so, but can oy share with us

> what your diagnostic process was and how you chose your

> treatment telling us what evidence you found to support the

> process.

Hello Terry,

I agree with you that some of the medicine practiced today does

not have much evidence behind it. In fact, as I understand it,

the " evidence based medicine " movement was not initially

motivated by a reaction to " alternative " medicine, but as a

reaction to licensed doctors who were administering treatments

that had insufficient evidence that they were effective.

I also agree that many published scientific studies aren't worth

the paper they're printed on. The pressure to publish is very

high and many who do publish don't really have anything useful to

say, but say it anyway. The problem is especially acute in

statistical association studies - where spurious associations are

often found and, for a variety of reasons which have been well

analyzed, are often published. There has been quite a bit of

discussion of this problem within the scientific community

itself.

My concern here was simply to distinguish medicine which is based

on actual scientific evidence from medicine which doesn't think

such evidence is even required - which is the case for most of

the " alternative " medicines. " Alternative " too often means that

the practitioners believe that the ordinary methods of scientific

experiment and validation aren't required. I could go on at

length about that but won't bore everyone.

As for my own treatment decisions, I think they were probably

based on a combination of reason and emotion that were not

greatly different from others.

I went into the process thinking that I would read the

literature, find the best treatment, and go for that. I soon

found however that no one really knew what the best treatment

was. The experts disagreed.

As near as I could determine, my Gleason 7 (4+3) cancer required

treatment and, from what I read, it looked like surgery and

radiation were both viable options. Neither promised a sure

cure, but it appeared that either one, if well done, would give

me a better than even chance of beating the disease.

At that point, my research seemed to reach a dead end and

personal factors came into play to make the final choices. I was

skittish about surgery because I once had a knee surgery that

left me limping for 10 years. I was also turned off by the

surgeon that my HMO sent me to. I discovered from his website

that he was a specialist in female incontinence, not prostate

surgery. He also struck me as a clumsy, careless person. I

could too easily see myself as harmed by surgery and not cured -

as had happened with my knee surgery.

I asked for a second opinion with a radiation oncologist and the

HMO sent me to a man who impressed me much more. So I was

leaning towards his treatment.

However, I work at the National Cancer Institute as a computer

programmer, so I went to the head of my department, an oncologist

and asked for her advice. She sent me to the Radiation Oncology

Department at NCI and I met some doctors there who impressed me.

They offered to put me in a clinical trial of MRI guided HDR

brachytherapy with additional 3DCRT. They also said that,

although they didn't recommend it, I could have Lupron if I

wanted it - which the other radiation oncologist had strongly

recommended.

Since I worked at NCI and believed in what they did there, I felt

some personal obligation to put my body on the line for their

clinical trials. I wouldn't have done it if I didn't trust the

people. But I did trust them and decided it was the right thing

for me to do.

So that's what I did. That was four years ago and, knocking

furiously on wood, it seems to have still worked out (I had my

latest PSA test last Thursday and still haven't gotten the

results.)

I have since come to believe that surgery could also have been a

good choice if I had found a better surgeon than the one I

initially met.

Throughout all of the decision making process I was conscious of

the fact that I was going to have to make my final decision based

on a mix of knowledge and ignorance. I was never going to get

all of the questions answered and never know for sure that the

choice I made would work out for me. I would be taking my best

shot and hoping for the best. At a certain point I decided that

further agonizing and second guessing wouldn't get me any further

along, so I took my shot and hoped for the best.

Alan Meyer

ameyer2@...

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[Guest guest]

You know, (author), you write succiently,(sp?), thank you. I am aware that prostate cancer is an understated field of contention. May I remind others that THEIR PERSONAL DECISION is the right decision. I elected external beam radiation followed with seed implants. After 3 years, I consistanly remain at 0.1. The radiation did eat me up and burn me out. My functions are returning and I am happy. It can only improve from here. Thanks.Cory

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