Sunday, September 19, 2004

More on NCEP 

A reader pointed out a bad link from a previous post and suggested the improvement. Thank you.

I think this from the lay press says it better than I could.

Another PSA Without Outcomes 

I wonder if this Private Sector Advocacy’s (PSA) online Health Plan Complaint Form from the American Medical Association (AMA) really works?

If a Tree Falls in the Woods... 

Or, if there is no evidence, then is it a guideline?

The American Urological Association (AUA) released a "guideline" on premature ejaculation. At lease they are overt about it when they say:
The mission of the committee was to develop recommendations, that are analysis-based or consensus-based, depending on panel processes and available data, for optimal clinical practices in the diagnosis and treatment of premature ejaculation.
There are four major recommendations (my italics):
Recommendation 1:

The diagnosis of premature ejaculation (PE) is based on sexual history alone. A detailed sexual history should be obtained from all patients with ejaculatory complaints. (Based on Panel consensus.)

Recommendation 2:

In patients with concomitant PE and erectile dysfunction (ED), the ED should be treated first. (Based on Panel consensus.)

Recommendation 3:

The risks and benefits of all treatment options should be discussed with the patient prior to any intervention. Patient and partner satisfaction is the primary target outcome for the treatment of PE. (Based on Panel consensus.)

Recommendation 4:

Premature ejaculation can be treated effectively with several serotonin reuptake inhibitors (SRIs) or with topical anesthetics. The optimal treatment choice should be based on both physician judgment and patient preference. (Based on Panel consensus and review of data.)

Why couldn't they just say there is insufficient evidence (no good RCT's) to have the basis of a guideline?

I find it particularly ironic when the AUAnet | Clinical Guidelines page has a link ("To learn about how our guidelines are developed, click here.") that gives an error message.

Wednesday, September 01, 2004

More Screening Folly 

I'm pretty busy with sick people so I have a high threshold for screening tests. Unless there is good outcomes data and the interventions are clear, I am wary of the "raise awareness" people. I'm sure they mean well but they don't see their favorite disease screening as displacing something more important. I have to leverage my time.

This (Changing the Clinical Management of Hereditary Hemochromatosis: Translating Screening and Early Case Detection Strategies Into Clinical Practice) got my attention considering the mainstream source.

Considering the U.S. Preventive Services Task Force (USPSTF) and the CDC do not recommend screening, I wondered if anybody did?

A simple Google turned up no shortage of advocacy groups:
1. This one (Hemochromatosis Foundation, Inc.) is apparently having trouble with even more unscrupulous groups.
2. The most emotional award goes to the American Hemochromatosis Society. The physician guideline section even says...
All health care providers including hospitals, doctors, clinics, insurance companies and managed care facilities should screen everyone over the age of 18 years old, male and female, with a iron profile (see section 1.b ) every 1 to 2 years to measure their current iron storage status. Children ages 2-18 years should be monitored every 2-3 years with an iron profile if they have a diagnosed blood relative with hereditary hemochromatosis/iron overload. It should be further noted that “no physician should prescribe iron supplements or vitamins containing iron or vitamin C supplements without first determining the iron storage status of the patient, as otherwise, the physician may be put at risk for medical negligence.” (Victor Herbert, MD JD)

3. I even missed E-Health News : July is Hemochromatosis Screening Awareness Month.

Journal Access #2 

Bummer dude. Things are getting worse since a previous post. I've been getting JAMA and Archives of XYZ...electronically by way of my medical staff library. However, the institutional license recently changed so I no longer have access. I'm not an AMA member but I get a complementary copy of JAMA for reasons that I don't understand. The reason I care is the frequent mismatch between the actual data and the popular press spin.

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