This and that

1) Not that Prostate Specific Antigen screening needed another nail in its coffin, but this should make us think twice about a lot of issues in medical practice. It's gotten a bit of media attention, so you may already know that a large group of investigators has found no survival benefit for prostatectomy in men diagnosed with localized cancer through PSA screening. The story is a bit more complicated than that, and as always, don't rely on me or anyone else other than a physician who knows your personal situation for medical advice. The study certainly doesn't rule out that there may be a benefit of treatment for men with particularly high PSA levels, and this is only about localized, early stage cancer to begin with. But it does give pretty compelling evidence that until and unless we can do a much better job of figuring out which prostate cancers are going to cause problems and which ones aren't, surgery or other treatment for this category of cancer does more harm than good.

Of course, a lot of men have been through it, and many have paid the price in urinary incontinence and sexual dysfunction, as well as pain and suffering. They aren't going to want to believe it was all a waste. And the doctors who made a lot of money treating them aren't going to want to believe it either. But there have been too many of these stories.

2) On a completely different subject (or maybe not) I happened to see a new sight today -- an ambulance labeled "bariatric unit." It was double wide. Apparently this ambulance company gets enough calls for people who need special lifting equipment and extra room that they went out and made a capital investment. Not only that, but there's a factory that builds these ambulances. If we could put the money we save on not doing prostatectomies into preventing there from being so many 400 pound people, that would be a double win.

3) There is a movement going on to un-name stuff after Joe Paterno, with my employer in the vanguard. Paterno was a Brown alumnus, so when he became a famous demi-God the university naturally wanted to claim him. The football coach was officially titled the Joe Paterno Perfesser of Guys Smashing Into Each Other -- okay, not exactly, but something like that -- and the freshman athlete of the year was given the Joe Paterno award. No more. In fact all previous winners of the award have now been notified that they are now just the freshman athlete of the year, not the JPFAotY. You might think the lesson has something to do with a tragic flaw and a life of great works being undone by a single moral error. No, it doesn't. The whole Paterno mythos was always bogus. Winning big time "college" football games is not compatible with moral purity, ever.