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The public face of medicine
About the author: 

Two kinds of therapies recently in the news have had very different coverage in the medical press, compared with the versions you and I are given in the daily newspapers

Two kinds of therapies recently in the news have had very different coverage in the medical press, compared with the versions you and I are given in the daily newspapers.

The first, covered in this issue, has to do with two studies showing a definite, indisputable link between vasectomy and the development of prostate cancer.

After it was published, GP magazine in effect told its doctors to tell their patients that the risk of prostate cancer following a vasectomy is minimal.

Incredibly, the story quoted the two studies which examined over 74,000 men who'd had vasectomies. The studies showed that vasectomy raised the prostate cancer risk by 56 per cent to 66 per cent. In other words, having a vasectomy doubles your risk of getting cancer.

Those patients who'd had their operation done 20 years ago faced a whopping risk of between 85 and 89 per cent. So, eight or nine of every 10 men who'd had a vasectomy for that long could face prostate cancer.

Pretty damning evidence, we would have thought. And yet the article attempted to claim that compared to other methods of birth control the condom? rhythm? vasectomy is "still one of the safest". Family Planning Association director Doreen Massey announced, "These studies do not tell us that vasectomy causes prostate cancer."

A month later, the Lancet published its editorial (see p 4) announcing that medicine hasn't a clue about how to screen for or treat breast cancer, and hence why it has organized a conference about it. Nevertheless, the newspaper articles produced in its wake, notably one by Thomas Stuttaford in the Times, call for more, rather than fewer, mammograms.

It's obvious what's going on here a double standard. Those studies that have been done (usually after the drug or treatment is in universal use) often point to unacceptable risks or general ineffectiveness, conclusions that medicine privately voices in its own literature yet ignores in any dialogue with patients or in the press. The profession saves its doubts and disappointments about treatments for medical literature sometimes overtly (as with asthma drugs or angioplasty), sometimes by inference (as in studies showing disappointing results with the hemophilus influenzae B , or Hib vaccine). Nevertheless, these doubts only see the public light of day when one of the victims sues or a public agency announces withdrawal of a drug. Even when a prestigious journal calls for a halt to a particular treatment until more studies are done, as the British Medical Journal did with hormone replacement therapy recently, these warnings seldom get heeded by the medical rank and file unless a drug is actually withdrawn.

Maybe it's time that the public face of medicine the seemingly deliberate evasion of inescapable conclusion, the stubborn clinging onto a point of view finally be exposed for what it is: not a science or even an art, but mainly a sham.

!ALynne McTaggart


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