Ask and you’ll receive their biased opinion

from the LA Times Booster Shots section by Thomas Maugh II March 8, 2010
If you visit a Chevy dealer to buy a new car, the odds are pretty good that he is not going to recommend that you purchase a Ford. And he is even more likely not to recommend that you hang on to the perfectly good car you already own. Perhaps not surprisingly, the situation is very similar when men visit physicians who treat localized prostate cancer: Surgeons are more likely to recommend surgery, and radiation specialists will call for X-rays or proton beams, researchers reported Monday in the Archives of Internal Medicine. Only if a man visits a disinterested primary-care physician is he more likely to be offered the alternative that some experts consider optimal — no treatment at all until the tumor has begun to progress into a more life-threatening form, a concept known as watchful waiting.

The situation may arise, at least in part, because there is such a smorgasbord of potential treatments available, including surgery, radiation, chemotherapy and watchful waiting. If a man chooses surgery, it can be performed by conventional surgery, laparoscopically or with the assistance of a robot. If radiation, it can be delivered conventionally, with proton beams, or by implantation of radioactive seeds, an approach called brachytherapy. What makes the decision even harder, Dr. Michael J. Barry of the Foundation for Informed Medical Decision Making in Boston wrote in an editorial accompanying the report, is that there is an “embarrassing” absence of clinical trials comparing the therapies. The only trial for men over 65, in fact, found that surgical removal of the tumor was no more likely to improve survival than watchful waiting. The National Cancer Institute is now sponsoring a trial to compare treatment to monitoring, but results are not expected until later this year. Until those results are available, however, men rely on their physicians to help them make a decision, and those decisions, framed by anecdotal experience, are likely to be biased.

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