Even renowned oncologists can fall in love with their data. It takes the impartial analysis of an outside expert to see the confirmation bias that may be blinding the lead investigator of a Phase 3 clinical trial. Although Phase 3 trials are Level 1 evidence, they still must be graded by outside experts.
Here is a recent presentation of the combination of cabozantanib + atelolizumab for men with very advanced mCRPC. As you can see, the lead investigator and the peer reviewer came to opposite conclusions.
Whilst phase 3 randomised trials are the gold standard, their cost/funders interests and time mean they are limited. One area we have a lot of day to day control over is nutrition, there is so much choice and evidence is mainly observational. Also no incentive for pharma to investigate. I just aim for a very wide variety of mainly plant based food plus pomi-t and teaspoon of mixed shroom powder most days 🤷
But I understand feeling like taking control when your body has been hijacked. As long as one doesn't take harmful substances, and it doesn't keep you from following proven protocols or interfere with therapies or tests, why not?
Thanks, taking control got to be good for mental wellbeing. One of the most bizarre findings I recall seeing quite a while ago whilst looking at stats, life expectancy for stage 1 men was actually better than for undiagnosed men, I always interpreted that as people getting a wake up call and adopting a healthier lifestyle.
that is not necessarily true. I was seeing my primary doc regularly and having annual blood work. PSA had been in the 3 range, and was not concerning. The very next year PSA jumped to 10 and I was diagnosed with grade 5, stage 4 prostate cancer
Did your doctor perform a DRE in addition to the blood work? An abnormal DRE got me sent to a urologist for a biopsy, which was positive. My PSA at the time was only 2.7.
I had asked my PCP for a PSA test because I was getting up in the night and had an occurrence of urgency. I'm an RN, knew it wasn't a UTI, PSA was 15. Even my urologist said "slightly suspicious" on DRE even with elevated PSA. Stage IV and experienced physician's don't see it right away.
Yes psa means very little. Mine was never higher than 4.2 and the tumor was out. First biopsy was called a nodule no cancer a year earlier at psa 1.5. Wrong.
I was thinling about this the other day actually. When you read articles in the likes of Pubmed, is there any search parameter you can use to indicate that an article is peer reviewed? I couldn't find anything to help with that. It would be extremely useful.
Almost all Pubmed articles are peer-reviewed. The only exceptions are proceedings of expert conferences or votes on guidelines. Not all peer-reviewers are alike: the top journals attract the best peer-reviewers.
Peer review, Hmmm? It always makes me recall that the AMA was founded by ten docs and five businessmen from the pharmaceutical industry. Makes you think about how things work today.
Even peer review has the potential for bias. Studies show that reviewers are influenced by the status of the main author(s). Some scientific journals require the anonymity of authors and reviewers, but often this is not possible.
Been asked to do some reviewing in the past but I could not manage to find the time for that, but I don't remember the papers to be anonymous...or maybe the university only was known?
Nope. Software engineer, AI researcher (ex) PhD candidate, specialized in deep neural networks and genetic algorithms applied to music. Wow…it seems like 1000 years ago.
When the reviewers are anonymous - whom does one believe - the identified investigator or the anonymous? And who is more incorrect? When I consider a study I look into all the contributors, check their disclaimers and/or conflicts of interests, and look into the funding sources believing well-conducted studies reflect independent thinking free of marketing influences.
The reviewer sends his notes to the writer and the editor. What is published is what the writer wants, including any amendments he wants to incorporate. If other experts disagree, they send "letters to the authors" which, if accepted, are also published in following issues.
It is required that all authors, or presenters at a conference, disclose any conflicts.
Clinician opinions are universally acknowledged to be the weakest Level of Evidence (Level 5). If that's all we have, we can use it, but it is only a hypothesis. All research predicts for the average, not the individual.
Some of us will continue to watch the occasional video on a topic of interest....generally the presenters are well-established MDs with, one would hope, just as much or more knowledge than our local Docs...or shouldn't we ask for the opinions of local docs either?
I don't see any peer reviews of the content on HU, but I'll continue to peruse. I 've watched several videos by Kishan and other Docs, and I will continue to do so....just as believable as what I hear from local Docs IMHO.
That is a off-topic strawman argument. This thread is about research sources, not discussions with one's own doctors or anecdotes from fellow patients.
I’m a big believer in the scientific method, so think this can’t be said enough. I know we’re all desperate for a miracle cure, but be a little cynical, folks. If there was an easy answer to cancer, this forum wouldn’t even exist.
Do you see a role for AI in this review process? We know of algorithmic bias, which may be difficult to avoid, but the development of novel AI algorithms are currently a significant business trend in many fields. Why not medical epistemology also? Could AI at least have a seat at the review table?
I guess I am just your average “dumb ass” but I am amazed and marvel at the research process and the dedication to science and team effort it takes to go from hypothesis to findings and publication of results.
I watch my granddaughter as an undergraduate spend 20 to 30 plus hours each week leading a student team to do basic biological science research in addition to classes, studying, community servicing, shadowing physicians and gaining clinical experience and having a limited social life, while preparing for the MCAT. Just last week she gave up her Spring break to work in the lab to complete the fact gathering phase.
How do med students find the time to publish and do research on top of studying, clinical rotations, etc required while taking their exams so they can be competitive for their chosen residencies?
How do practicing physicians attempt to stay current with all the new trends and knowledge in their specialties, etc while maintaining a practice and seeing patients all day.
Just read yesterday that the average med students selected for residency in dermatology had on average 16 publications since entering med school in that field. The competition for top residencies is overwhelming.
If it is not obvious reading the above these people are dedicated, hard working, brilliant and self sacrificing individuals dedicated to science.
When I read comments on this forum and other places how doctors are perhaps not always knowledgeable about new practices or current trend's, etc, I think how is it possible or even reasonable to even think that is possible to achieve this and maintain any sort of work/life balance.
Having watched this process first hand let’s not be to cynical about it and suspect that there is always a something going on behind what is visible. In 99 percent of the cases these are brilliant minds dedicating their efforts to help care for people or further expand the science of their chosen fields.
It goes without saying that on this forum we have a number of those people who we need to thank for their dedication and service to this community because without them many of our questions would go unanswered.
I recently listened to Vinay Prasad slam contact-02 and keynote-564 (a kidney cancer trial) for being not just useless, but unethical, because the control arm was not given best standard of care, but a deliberately substandard care to make the intervention arm look better.
You have to wonder how these trials even get ethics approval to go ahead. I think the FDA needs to bear a lot of the blame.
Very good points that I have overlooked in the studies and trials I have read. This makes so much sense to have that second set of eyes to review the data. As a professional in the building design sector, we do a similar thing with construction documents to be sure something has not been missed and it is incredible valuable. In our case it could identify a safety and/or welfare flaw in a design of building or structure where occupants might be in danger.
It is easy to develop tunnel vision, when we work on something for too long a time without outside input.
AGREED, Peer Review is invaluable and an essential part of medicine. So why was that concept taken out of the equation when it came to Covid 19? You seem to be a smart man, surely you have an explanation for the blatant disregard for Science during that time.
Peer review was indeed done for Covid 19. The fact that you think it wasn't says that you are subject to conspiracy theories. Judging by what I see on social media, you are not alone in your delusions. Perhaps psychotherapy can help. At any rate, that is an inappropriate topic for this forum.
I've read enough medical journal articles to support my claim, I'm not a conspiracy nut, and for you to dismiss me as in need of therapy says a whole lot more about you than it does me. You're very closed minded and with dictatorial personality traits. You're an embarrassment to this forum. I think it's a very appropriate topic, as Many believe the MRNA technology will be used to treat, and perhaps even cure cancer one day.
I have been on Teva - Dutasteride for BPH for 4 + several years . I understand when taking this medication you have to double or even multiply your PSA by 2.5 times the longer you are on it .
My last lab PSA was 8.2 " What is the real PSA - Is it 16.4 or does the 8.2 already reflect the doubling from 4.1 ?
I am attempting to clarify this matter to calculate my PSA Density .
I have a 80 cc prostate and have suffered from BPH for several years .
I have recently been diogonised with Gleason 3+3 + 6 prostatee cancer , found on my 2nd MRI Fusion Transparineal Biopsy . 6 cores of 15 in the target area were all Gleason 6 Plus 2 just outside were High Grade PIN . The core involvement ranged from a high of 70 % to a low of 20% . Overall % tissue involved 19 % . ( As noted % involvement in most extensively involved cores 2 @ 70 % --- others 1 @ 20 , 1 @ 30 , 1@ 40 , 1 @ 60 . )
PSA at the time of both Biopsies 8.2 % . Ist MRI : Increased T2 Signal PI-RADS 5 .
My 1st MRI Fusion Transperineal Biopsy was a 5 core Biopsy . -- Result Negative .
The Urologist maintained " He hit the target" . He was the former Head of Surgery & Head of Urology at a Major Hospital in Toronto . Still practing, he is a leader in latest State -of-the- Art and emerging treatments and Robotic Surgeries .
Following this negative result which was in conflict with BOTH MY MRI which showed the same T2 and RADS 5 . My 2nd MRI was with & without contrast .
I am considering a 2nd opinion on my 2nd Biopsy results in an attempt to eliminate any misdiagonosed Gleason 6 which may be G7 .
At age 84+ I have commenced AS with the typical followup precedures . Regular PSA Testing , consultations with my Urologist , an MRI and later a Confirmatory Biopsy .
p.s. My 2nd Biopsy was performed by a different Urologist -- Different Major Treatment &
Reasearch Hospital . Ranked 5th in the world . Princess Margaret Hospital , Toronto.
Thanks for clarifying that. The extra cores taken are only counted as a single core. It's a good idea to get the biopsy cores read by the lab at Johns Hopkins ($400):
Are you referring to Dr. Jonathan I. Epstein ( G6 Cancer-or-not cancer ) who has just been suspended for allegedly bullying his associates to support his wife's Pathology Results ?
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Lets list our rays of hope, the treatments on the horizon - please contribute to this knowledgebase.
A critical review of Provenge. Your inputs welcomed?
