Today is National Take Back Your
Unused or Expired Drugs Day: Don’t Miss It

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It’s not too late to clean your medicine cabinet out and take your unused prescription drugs out to a designated location. You have until 2 pm in New York City to bring your medications in. Check for the nearest location.

Were you aware of this in your area? I wish that there was more promotion of this in my area.  Do you think that Americans should have regular access to safe drug disposal?

What’s the Patient Got to Do with It?

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Here we are discussing the prostate cancer screening guidelines, but what bothers me is that the patient is brought in as a footnote at the end of the analysis. I find it really dispiriting that there is so much lip service to “patient-centered” medical homes, outcomes research, and more, yet the patients are on the periphery of the discussion. Heck, we are an industry now, except it is all from the outside looking in!

Maybe, before academics, policy wonks, and patient engagement companies hole up and review the evidence on important issues affecting you and me, they ought to open the general topic for public commenting and questioning that is out there for everyone to see.

I know what you are thinking –and of course, it has occurred to me too: I am talking chaos. Well, perhaps…but…maybe we must do better. What if we had more feedback loops where patients and the public enter into real-time discussions at the front end, when priorities are being set, where care is being given?

In some parts of the world, medical technology assessment discussions bring patients in from the start before decisions are made on whether or not to cover specific items. What about webcasts available on demand where the logic of evidence reviews is easy to find? What about more Q&As bringing patients in? Maybe the questions asked would shift if patients participated as real partners. Maybe the answers would be more understandable.

We need more of this in the US. Without it, we perpetuate distrust, anger, and a mockery of the science.

On the Urology Workforce, Targeted Screening,
And the US Preventive Services Task Force

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It is abundantly clear that the US Preventive Services Task Force Draft Guidelines on Prostate Cancer Screening will not be welcome news to many urologists. I have attended numerous annual meetings of the American Urological Association, the physician organization for urologists. The majority of papers  concern that walnut-shaped gland, the prostate, usually taking up prostate cancer or an enlarged prostate, AKA BPH (benign prostatic hyperplasia). Some urology practices focus  exclusively on the prostate. Urologists will need to readjust.

As one doctor who has nothing to do with the US Preventive Services Task Force told me: “There is plenty of honest urology for them to practice….stones, incontinence, kidney cancer etc. But even in the world of prostate cancer a good 20% to 30% of patients have bad enough disease that they deserve attention and, perhaps, more of it than they have been given in the past due to the crazed gold rush towards the low-risk men.” I agree totally with this statement. If Americans could vote with their feet, I think too that they would want urologists to treat the truly important areas in urology, rather than a disease that the odds are will not cause trouble for most men.

Jeez, it would be welcome news if the public understood this and if it was talked about more openly. As a reporter, I have witnessed the fleeing of docs from real medicine to cosmetic surgery and the rich. How refreshing it would be if urology began to turn out more doctors that patients need.

On another note, the Draft Recommendations that will be released officially tomorrow are expected to address concerns of high-risk individuals. The word is out that there will be a call for research into whether or not there should be targeted screening. In other words, should high-risk men (e.g. because of family history) be screened, and at what intervals? That should come as some comfort to people who worry that the high risk will be lumped into one healthy asymptomatic category.

The comment period begins after the official release tomorrow. If you have thoughts about the draft recommendations, positive or negative, get them on the public record. There’s plenty that patients and the public  will want to mull over. Ask questions and don’t leave it to someone else.  I’ll be following this issue, providing follow-up links on where to send your comments, and more.

With Breast Cancer Awareness Overexposed, Hard to See Many Patients Want Science, Not Pink

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Nothing has me making a beeline for the exit more  than disease awareness events– and when it comes to Breast Cancer Awareness Month, the sheer overexposure of the disease makes me yearn to cover anything but it. I know I am not alone.  Most of us have been touched by breast cancer. It’s Breast Cancer Awareness Month, in the unlikely event that you haven’t noticed. I don’t see how you could miss it: weekend sections in newspapers ran tons of stories, and there will be an infinite number more. Pink ribbons sit on the top of the masthead of many newspapers. My local drugstore is even asking whether I’d like to round out my cash register receipt with a contribution to the Susan B. Komen Foundation. You cannot escape it.

I have been dreading this month. Unfortunately, the pink madness is driving people away. “I ignore the breast cancer stuff because I strongly feel they are hogging the limelight,” an independent reporter told me. “There are plenty of other diseases. My mom died of breast cancer, but I resent their intrusion for an entire month.” When I asked another colleague how she planned to get through the onslaught of news, she responded emphatically: “With earplugs and blinders.”

Fortunately, many thoughtful bloggers and advocates, like @jodyms, @harriseve, @MarilynMann, and Fran Visco are dedicated to educating the public about risk, science, and optimal decision making. I’ve also just discovered Gayle Sulik, author of Pink Ribbon Blues. Our Bodies Ourselves (OBOS), the groundbreaking women’s health collective turned 40 this weekend, releasing an updated edition. It has been a critical force, in pushing for fair and scientifically based women’s health care first in the United States, and now setting its goals on global health. I applaud them all.

I have been working hard on another post on breast cancer that will address some of the science or lack thereof that underpins breast cancer initiatives. In the meantime, I am curious what you folks think. IMO, the discussion needs to move away from the pink ribbon to considering far less frivolous issues.

But the larger question is this: If you could pick the top 3 concerns for patients with breast cancer, what would they be?