Wednesday, February 09, 2011

Ethical blinders?

Is this a case of ethical blinders?

Today's New York Times has an important story about the ineffectiveness of removal of lymph nodes for certain women with breast cancer. That is a significant result of clinical research. But read this:

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published.

And they felt no need to spread the word quickly to other hospitals and to breast cancer patient advocacy groups and help women across the world avoid the surgery and its after-effects? (As noted in the article, "It can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.")


Anonymous said...

Paul, results from the study were presented at a couple national conferences and preliminary results were published in a surgical journal as well. Anyone in the breast cancer field would have been aware Of the results already. The results are a little surprising, and followup is slightly on the shorter end --- so this is unlikely to be uniformly adopted until followup lengthens a few years

Paul Levy said...

So, it is just good enough for some people and not others? How would you explain that to a woman is now reading this who had the surgery at a hospital that either was not aware or chose not to pay attention.

OTOH, if the conclusion is not strong enough scientifically, why have some centers adopted the practice?

Paul Levy said...

Or, are you just saying that this is one of those cases where the judgment lies with the surgeon and oncologist? If so, do we have an assurance than the patients are being presented with a full explanation, pro or con?

It would be interesting to compare what they are telling patients at hospitals that have adopted the new approach versus those that have not. It is clear from the article that the doctors at MSK, for example, are leading their patients in a particular direction. What words do they use to explain that to patients, compared to those used by another hospital that has not yet changed direction?

Bart Windrum said...

It's taken me a long time to finally come to understand the phrase "the practice of medicine." I understand medicine's intrinsic ambiguity.

Does this BC scenario boil down to a(nother) failure to disclose?

mdspencer said...

Yay, Paul -- I'm so glad you raised this. These people talk as if it is all sewn up and they just have to get dumb doctors to agree. But it's the patients who bear the impact of following one study or another and this is going to have a lot of transparency if it's going to take off.
If I were in the target group they used, I would prefer lymphedema to any risk of more cancer. One study would not convince me. I'm astonished they got anybody to agree to be in it. I'd like to see some information about that -- what did they tell those patients?????

HPJ said...

Hi Paul! Thanks for an interesting blog. I'm skeptical about changing the practice based on one study. What about Fleischmanns&Pons Cold fusion study ( and Wakefield's MMR vacationion study ( Neither study has been sucessfully repeated. Thus I'm surprised that practice is changing and I'm questioning the interior motives and common sense.

PJH said...

BBC ( gives a more balanced view of the study than NY Times.