An Opinion by Don Cooley

For a long time now a number of things have been bothering me in the way that we make our choices for various procedures or treatments, what is happening in the medical field and about lost truth and honesty. Let me list and go through each one. Remember these are my opinions based on my long years of experience with the medical community. This is not to be construed as anti-medicine, I am a large supporter of ethical, up-front, excellent medicine. I have little time for those that practice shoddy medicine and, in my opinion, we have too manyout there.

Table of Contents:

SINS OF THE DOCTORS

SINS OF THE PATIENT

WHAT HAPPENED TO THE TRUTH 

IT IS A WILD WORLD OF PROSTATE CANCER

SINS OF THE DOCTORS

1. We decide that if a Dr. B was trained by Dr. A we make the assumption that he has the skills of Dr. A. Does not matter that Dr. A may be the best in the world at doing a procedure - it is assumed that Dr. B must also be. We may have 15 years of data showing the skills of Dr, A and very little of the skills of Dr. B but he is ranked right up there with Dr. A. Dr. B makes it well known that he was trained under Dr. A and uses the figures from Dr. A. And of course Dr. B makes sure the patient knows that information.

I believe this is far from the truth and is illogical in many ways. First of all if this was true we would have to assume that every Urologists who trained under Dr. Walsh has the skills of Dr. Walsh - not necessarily so. And yet I hear time after time that a certain doc was trained by Dr. Walsh and therefore he is a great surgeon. What was that training - did anyone ever ask. Did he actually assist in 100 RP's, 10 or two or three. Even 100 would not give the skills that Dr. Walsh has acquired over years of research and study on how to do RP's.

2. We have a Dr. Z who trained under Dr. X and it is assumed that he is every bit at good at finding cancer by imaging as Dr. X. Yet he has not proven that over a period of time as has Dr. X. How much training did Dr. X give him - a week a month a year and was Dr. X there for every biopsy during that time. We just do not know that the second doctor will find the cancer with the skill of Dr. X. As a matter of fact there are a lot of doctors around who have probably done more biopsies than Dr. X and they do not have the skill that Dr. X has. It would be my guess that Dr. X will find cancer with a black and white screen where most doctors would miss it with the latest color Doppler. It is not the tool folks it is the man behind that tool that makes a success. Dr. Z rides on the shirt-tails of Dr. X and only the patient may suffer.

3. Than we have a doctor who does an occasional Color Doppler imaging of the prostate (never has done a biopsy) and it is believed that he can now only find the cancer but can tell that it is a Gleason of 7. Something that I don't believe even Dr. Lee has ever stated that he can tell the Gleason score from a image. Besides doesn't it make sense that he never can know if he sees a Gleason of 7 simply because he never can verify it. He does not locate the mass - call it a Gleason 7 and then stick a needle in it to verify that it is in fact a Gleason of 7. Besides that it is not the Gleason sum that it is important it is the grade that is important. Is it a 3, 4 or 5. When you consider that a Gleason 7 may be 94% Gleason grade 3 and 6% Gleason grade 4 (3+4=7) does one really believe that he can pick out that 6% which may be a little over the size of a pinhead by imaging - especially any Doppler machine..

4. And then in Brachytherapy we have a prominent Center of Excellence that gives a 1 1/2 day course in how to attract, set up and do seed implants where the students never even touch a patient. They will even give a Certificate to those that graduate and set up there practice and do a few implants. They become almost instant experts - the local center of excellence in their community. There claim to fame - "I was trained by Dr. Z" - and only the patient suffers.

5. Occasionally you see studies that are have a single doctor and who you know works in a facility that has many doctors working there. These other doctors have participated or done the procedures that is being written about but there names are not included on the study. This, to me, means that there was no internal review of what the doctor wrote or the other doctors declined to be named for various reasons. Therefore the doctor has unlimited chances to make the study anyway he wants before it is presented to an outside peer reviewed journal and the journal has no access to what the doctors in the clinic might have known. This makes the study itself less believable and more likely to have unknown manipulations. It is of far less value than a study that includes the doctors in that facility. And then when this is a poster abstract - is there any value????

SINS OF THE PATIENT

1. And then there are those who have met certain doctors and consider these doctors to be their friends and will defend them as being honest and of the "Well I have met the good doctor and know that he is honest, etc., etc., etc."

2. Then there are those who have been treated by a certain doctor or health practitioner (of various kinds) or have chosen a particular treatment or are taking certain herbal products and think that they are absolutely right. Don't care what the evidence is, don't care what the facts are, don't even read anything that might enlightened them a bit - just continue along with their tunnel vision sometimes until it is too late and even then will defend what they did and their health practitioner to their death bed.

3. We will have a procedure that has not proven itself in any study shown and is given special credence when a known doctor joins the board or organization. Does not matter that the doctor has no expertise in the field and may have never participated in the procedure. But because his name is there - some think that instantly the procedure is now OK.

4. Then there is the poster who is discussing treatment Y and said that he hasn't seen very good results and reports on one very advanced prostate cancer patient who tried it for awhile and it failed. Therefore it hasn't been very good in that posters experience. Yet where he may have seen something work for a few patients - he thinks it is sent from heaven. Let alone that it has failed in 90% of the cases but he doesn't see those failures - not because they aren't there but because he does not want to see them and shuts them out.

WHAT HAPPENED TO THE TRUTH

What has happened to truth, honesty, logic, scientific evidence and even common sense in our world. Since when is it acceptable for a doctor to outright lie to a patient and when we call a spade a spade there are those who get very upset. Why is it that we now overlook the facts and defend out illogical thinking based on nothing more than our own ignorance to those facts.

There are doctors out there that I have often met, who are thought to be great doctors, that I would never send a patient to. There are great doctors out there that I have never met that I frequently refer men to. I know a lot of the ins and outs about this field of prostate cancer and the medical professionals simply because I talk to many and keep my ears open, I know the little groups that are formed and who rub each others backs and the outsiders, to that group, who are never even considered as being a top doc and are consistently lied about. I know of doctors who have lied to Congress, to patients, to their University colleagues and yet well respected in their medical community of a great University. I know doctors who consistently lie to their patients and when the treatment fails - the patient accepts it to be his fault not that the doc lied to them and gave them a treatment doomed to failure. I know the little fights that go on at each convention between the warring factions. There is so much information that I accumulate that perhaps no one else ever does that I can put 2 and 2 together and sometimes come up with 4. I know doctors who many of you think are the best there is and yet they are not given any recognition in the medical community for their the knowledge that you believe they have.

Their are doctors out there who are doing experimentation on their patients under the guise of treatments based on little scientific evidence on men but frequently on work done in the lab. I know prominent doctors who have called me, written to me and to challenge what I have said and I know that they know that I am right. I also know doctors that have contacted me and have thanked me for what I have done. I have had employees of doctors contact me and thank me for some of the stands I have taken with the comment - if you only really knew what I know.

There are doctors who are being paid to push a product, do a study, write reviews and articles. There are doctors who are small and large stockholders in the companies whose product they use. Doctors are paid to go to conventions by various companies, given vacations to conferences in exotic places where meetings are a few hours in the morning. Many Doctors are takers and consider it their right to do so. But do they tell a patient - nope they just continue to push the product and take what they can. Does this effect you the patient - certainly I believe it does.

Over a period of time, about 6 years now, I have been highly criticized for my comments about certain doctors, certain treatments, etc. Yet every post I make is based on past studies, records etc. In these criticisms there is never a time that they tell me I am wrong and use facts, figures, studies to prove their point. They just know that this doctor wouldn't do such a thing or believe such a thing or perform such a thing. I have asked time and time again to prove that I am in error with facts, truth and knowledge - rarely is that done. They just go out on some "hokey pokey" "far out" "around the mulberry bush" diatribe to prove that I am wrong. No scientific evidence just gobbledygook of their unproven beliefs. Even when I make complimentary remarks there are those that have to construe it around to being an attack.

IT IS A WILD WORLD OF PROSTATE CANCER

There are a million stories out there and I have heard the biggest share of them directly from patients and even from doctors who keep me posted on the going on in their community, I get reports and questions from the press, and even an occasional query from government officials. But really all one has to do to understand the treatment of this disease is to read, understand and interpret the studies and I do that for hours every day. Certainly I am not always right, I do misinterpret things but until someone can prove me wrong with evidence based on studies, facts or accepted truths - I will stick to my guns and call a spade a spade regardless of the cloak it is wrapped in - but when proven wrong I am the first to admit it.

If I hear, read, see something, at least in my way of thinking, I believe is wrong - I really don't care whose name is attached to it. In my mind there is never any consideration given to who may have authored the study, the presentation, etc. I simply call it as I see it (and then get blamed for my bias).

But that is the way I am and the way I work and what I will continue. I see my position here as not a moderator but an active participant providing all the information I can to the members in these groups to make them the best educated members about prostate cancer that I can. I post things that I don't always agree with and others post things that I may not agree with. In these cases I see my job to bring out the other side of the story, the other research, the other thinking. Again truth and honesty play an important role in my doing this. I have developed many sources of information over the past 6 years. In addition I accumulate a lot of background information that I use in my thinking - this information I cannot always talk about. My education comes from my study of studies, from doctors, from background information and, most of all, from reading the experiences of others on some 20+ groups/lists that I read daily.

It is a wild prostate cancer world out there with much misinformation from well sounding people, someone has to try to make some sense out of it all and try to lend some logic and draw some conclusions. That is what I try to do but sometimes I fear it is a lost voice whistling in the wind.

But that is the way the cookie crumbles!!!

Don Cooley

October 31, 2003

Page Reviewed and/or Updated:

September 21, 2008