Prostate cancer, like breast cancer, seems to go through major reviews and revisions around its management. This is not really surprising of course. Please read my article on my website called The Limits of Medical Science published in the South African Medical Journal, in which I discuss the serious limits to what science can know of biological systems. The nature of human biochemical individuality, genetic individuality, emotional-mental and psychospiritual individuality means that there is no way science can ever know how anyone will respond to a drug, or any management approach.

The originators of Evidence Based Medicine (EBM) intended that this approach would represent an analytic approach to medicine by which the results of clinical and basic research, clinical experience, observation and empathy with the patient are combined to provide the most appropriate treatment and care by the medical clinician.

[Evidence Based Medicine Working group, Evidence Based Medicine. A new approach to teaching the practice of medicine.JAMA.1992;268(17):2420-5]

A mere 4 years after publication of the concept, the authors complained that the EBM concept was being widely misinterpreted through its almost exclusive reliance on evidence from randomized clinical trials for the determination of treatment and care regimens.

[Sacket DL et AL. Evidence Based Medicine: What it is and what it isn’t. BMJ.1996;312:71-72]

I think it is important that doctors recognize that basis of EBM as the way it was intended is the way Integrative Practitioners work with their patients. The reason why the EBM approach has been distilled to include only the results of clinical trials is due to the pressure of pharmaceutical companies, on the one hand, and the tendency of doctors to want clear statistics to present to patients. EBM as its originators intended is much more fluid, is patient centred, takes into account the experience of the practitioner and sees each situation as unique. It is as much art as science and this approach does not fit in well with medical journals, or the current approach to the ‘science of medicine’.

PSA and Prostate Cancer (continued)

What have we covered so far? (SEE part 1)

i.      A high PSA does not mean prostate cancer but can be high in other conditions such as prostate hypertrophy. It is most often nothing more than an indicator of the size of the prostate. A great deal depends of course on the context in which the PSA is done. A constantly rising PSA, especially after any invasive treatment (surgery or radiation) where the PSA had fallen down to low levels, is however very significant. Nevertheless one does need to take into account what is referred to as the PSA “bounce” after such invasive treatment. The PSA bounce phenomenon is the increasing PSA levels sometimes seen within one to three years after completing radiation that is not due to increasing number of cancer cells. After radiation therapy the PSA falls slowly and may intermittently increase over a number of years. While the exact cause is not known, it is thought to be due to partially damaged normal prostatic cells and/or the long time it may take for lethally damaged cancer cells to die and stop producing PSA. Clearly this should not happen after total prostatectomy in which the whole prostate has been removed.

       Stock RG et al Prostate-specific antigen bounce after prostate seed implantation for localized prostate cancer: descriptions and implications. International journal of Radiation oncology biology physics 2003;56(2): 448-453

ii.     More men die with prostate cancer than of prostate cancer. Nevertheless prostate cancer remains the most commonly diagnosed solid tumour and the second most common cause of death due to malignancy among males in the USA and many other countries.

Hypertension has always puzzled me, and I guess still does, despite all the reading and research I have done on the subject.

Until the sphygmomanometer was developed hypertension was never a medical diagnosis; it then suddenly became a disease to be treated quite aggressively at times, when clearly it is really just a symptom.

While there are a few known causes, the majority of people with high blood pressure have what is called essential hypertension in which the underlying cause is unknown. Nevertheless good research work over the last 20 years clearly points to a number of pathophysiological factors which contribute to the hypertension. I will discuss these factors later in this section, but the overwhelming feeling I have at the end of my probing and reading is that hypertension management has been driven by specialists with personal agendas and pharmaceutical companies pushing their own monetary goals; very little seems to be focused on what is best for the patient.

Evidence-based Medicine is clearly not the criteria used by hypertensive committees in putting together the various management protocols directed at doctors and specialists to manage their cases. A great deal is just the politics of medicine and financial incentive. That is my conclusion, and the deeper I go the more disturbed I become about the way medicine is practised today.

Angiograms, Stents and Bypass operations: Do they save lives?

And how do these invasive approaches compare to lifestyle changes?

The hype around all the conventional medical approaches leaves the impression that patients with coronary heart disease are better off with modern and sophisticated approaches to the investigation and management of coronary heart disease rather than the more simple and natural approaches of lifestyle changes. There are also the assumed benefits of invasive approaches over medical treatment with drugs.

In this report I will examine the science and hopefully clarify the issues involved.

Myocardial infarction continues to be the most common cause of death despite these  invasive surgeries and the assumed preventive medical approaches of treating hypertension and reducing cholesterol levels with statins, and increasing medication of people for stress and depression. Doctors need to question the validity of drugs and surgery to treat coronary heart disease as the treatment of choice, as heart disease continues to be such a serious problem.