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Showing posts from September, 2013

Free Prostate Screening! What's the catch?

I just got an email from a hospital where I sometimes practice with a picture of two aging but clearly active and vital men standing on a beach with the words "Free Prostate Cancer Screening" printed below in an attractive font. The hospital is sponsoring the screening, along with the urology clinic affiliated with the hospital. The advertisement gives guidelines for who should avail themselves of this service, including men as young as 35 years old if there is a family history of prostate cancer and otherwise 55 and older, with no maximum age.

The prostate is a walnut shaped gland that surrounds the urethra, in front of the rectum and just prior to the penis. It produces prostatic fluid which helps carry sperm to wherever they eventually end up. Prostate cancer screening, that is checking a man's prostate cancer via a rectal exam and also performing a blood test for PSA (Prostate Specific Antigen) has been of questionable utility for decades, and finally last year the …

What is "overdiagnosis"?

I got an invitation in my e-mail a couple of days ago for a dinner presentation to the Central Oregon Medical Society given by H. Gilbert Welch M.D. on the subject of overdiagnosis. I was intrigued. A little less than a year ago Dr. Welch, an internist and professor at Dartmouth Medical School and Archie Bleyer M.D., a former pediatric oncologist and now a research professor at Oregon Health and Sciences University wrote a controversial article presenting compelling evidence that regular mammograms lead to death and disability related to aggressive treatment in many of the patients who were diagnosed with breast cancer but that it did not significantly improve survival.

Dr. Welch has been studying overdiagnosis for a couple of decades and has written two books, Should I Be Tested For Cancer-maybe not and here's why and Overdiagnosed: making people sick in the pursuit of health. I have peeked at the second one and found it to be well written, with a non-physician audience intended…

Water and hand sanitization: some thoughts about technology and hygiene and how not to get sick or make other people sick.

This summer has been full of adventures in and around water, alongside people with and without disease caused by infectious intestinal organisms. It's been lots of fun, and I dearly yearned not to be slowed down by explosive vomiting and diarrhea. Because of this intense yearning not to feel like crap, I have been doing lots of studying and thinking about both hand hygiene and water purification and have been experimenting with various techniques and technologies.

Most infectious ills of the gut are transmitted by the fecal-oral route. The bacterium, parasite, virus or other unspecified microorganism must make its way from the feces (or sometimes vomit) of the infected person to the mouth of the new host to be ingested, thence to infect and cause disease. For many conditions it does not take many organisms to cause infection, and some of the causative entities can survive outside of a host in pretty unfriendly environments for various amounts of time (up to around 2 weeks for nor…