Friday, January 09, 2015

Young doctors suggest use of evidence and disclosure

A follow-up to an earlier post. Jonathan Giftos, a resident phsyician in primary care and social medicine at Montefiore Medical Center, and his colleague Dr. Sam Cohen attended this session:

Lenox Hill Hospital, part of the North Shore-LIJ Health System, is offering a free informative evening on Thursday, January 8th from 6-7:30 p.m. with David Samadi, MD, chair of urology and chief of robotic surgery, about what women can do to help keep the men in their lives healthy and happy.  

I include excerpts of Jonathan's report on Facebook without further comment:

Drinking a beer with Dr Sam Cohen after going toe-to-toe with David Samadi at his shameless, chauvinistic, pandering and misleading talk promoting en masse PSA screening in an unselected patient population, described famously by Shannon Brownlee as "the loss-leader for robotic surgery." 

Unsurprisingly, there was no conflict of interest disclosure. Gross deception as he described "screening" as a uniformly good thing that the government is trying to take away in order to save money. Characterizing women as emotional, shop-a-holics and then exploiting their worries over their husbands' health to promote evidence-less medicine for profit was also a highlight. That an academic medical center like North Shore-LIJ Health System allowed this to happen is deeply problematic.

Sam and I got the mic for about 5 minutes. Challenged his blatant disregard for USPSTF recommendations. Challenged his conclusion that because there isn't a better test out there we might as well continue using one that is known to cause more harm than good. He dodged the conflict of interest question and essentially told us to go back to Brooklyn. 

There were no other dissenting views in the room. He ignored my question as to whether someone who earns close to $8 million dollars a year off this test should disclose their conflict of interest when promoting a test so indiscriminately. He responded to Sam's question re: the data that shows en masse the PSA to be more harmful than good by bringing up the wife of a former patient who was diagnosed with early prostate cancer to go on record and "teach us" why the PSA saved her husband's life. The audience clapped. The intellectual dishonesty was tough to watch. He concluded by saying that Elizabeth Hasselbeck is on board with his approach, as we should be. 

All in all, an enormously frustrating event to attend. But glad to stand up against the shameless exploitation of our patients and our healthcare system for financial gain.

Now, what to do with this lousy t-shirt.


nonlocal MD said...

The audience clapped. The government is trying to take away screening. Wow.
I suggest Dr. Giftos send this report to the AUA as well as the CEO of the hospital. Nothing may be done, but an attempt must be made.

AnnFriedmannMD said...

This post gives me hope for the future of medicine.

Anonymous said...

The more this gets publicized, the better. Is it possible to talk to them one on one and ask their facts and where they got them? That might be telling or if they're donors, shills, etc.

Beverly Heywood Rogers said...

From Facebook:
Good for them. We need more residents to call out this crap. "Educate the young, regulate the old."

Andrew Barnes said...

From Facebook:

Very grateful to Jonathan and Sam for trying to wake people up, and it is too bad no one would listen.

pheski said...

The problem is that the default process is to decide with the gut (using System 1) and then use motivated reasoning to rationalize (abusing System 2). Irrational decision making is only changed by evidence of the individual consciously decides to use System 2 and gives it a chance to override System 1.

Irrationally, I keep trying to use evidence **informed** medicine.

(I prefer evidence-informed over evidence-based, because I don't want the evidence to force people to do things that are inconsistent with their values or preferences.)

Graham Walker said...

We give the PSA a black/caution rating on theNNT.