Monday, March 2, 2009


Do These Recommendations Make Sense?

Some days ago, Harpy sent an excellent post to our suggestion box. Sorry that it got lost in the shuffle.

Harpy wrote:

In the hopes that you're still checking the suggestion box, I want to know what you think of this:Millions of middle-aged American men who get tested regularly for prostate cancer but show no signs of the illness might benefit from taking a drug that substantially lowers their risk of getting the disease, according to new guidelines issued by two leading medical groups that treat prostate cancer.

The article goes on to say, "Each year, about 200,000 Americans are diagnosed with the disease, and about 29,000 die." And that the drug "...can reduce the risk of developing prostate cancer by as much as 25 percent."

And can someone tell me if this is really considered a benefit? About 71 men would have to take finasteride for seven years to prevent one case of prostate cancer. Kramer said a quick call to his Bethesda pharmacy showed that generic finasteride costs about $3 a day or around $1,080 a year, meaning that it could cost about half a million dollars to head off each case of prostate cancer -- while exposing dozens of men to unnecessary treatment and potential side effects, including incontinence and impotence. A small number of men taking finasteride also experience sexual side effects, such as a decrease in libido.

A link is below:

Elsewhere around the gland, there is a story today that GSK has received an FDA warning about one of its Avodart ads (which no longer runs), the gist of which is that the ad exaggerates the degree to which the prostate is shrunk by the drug and makes false claims re: Avodart's superiority in this regard relative to Proscar.


  1. Start looking at NNT (number needed to treat) for major drugs and the effect sizes. Not exactly huge for a lot of them.

  2. Indeed.

    So by what principles do we make such decisions on the level of policy? If insurance will pay for it?

    What are the principles employed in national healthcare systems?

  3. I'd rather have a prostate exam by Dr. Scissorhands than to take an unproven medication that will likely have adverse side effects, regardless of how much the insurance pays or doesn't. And what side effects have they not disclosed?

  4. A specialist in prostate health discusses standards of care, here:


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