Consumer Health Digest #08-32

Your Weekly Update of News and Reviews
August 5, 2008

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., and cosponsored by NCAHF and Quackwatch. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

Expert panel advises against PSA screening after age 75. The U.S. Preventive Services Task Force (USPSTF) has recommended against prostate-specific antigen (PSA) screening for men age 75 and older. [Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 149:185-191, 2008] This blood test measures a substance that can rise when prostate cancer is present but can also rise with benign enlargement and inflammation. It is clear that the test can detect early cancers, but false positive tests can produce harm because they trigger further diagnostic and therapeutic procedures that can have adverse effects. In addition, because many prostate cancers do not progress to a serious stage, some men who are treated after PSA detection would never have developed cancer-related symptoms during their lifetime. The latest USPSTF report concludes that for men younger than 75 years the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined from currently available evidence. However, for the first time since it began reviewing the data, the expert group has concluded that for men 75 years or older, "there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits." The full report can be read online.

Psychiatrists doing less psychotherapy. A study of office-based psychiatrists has found that between 1996-7 and 2004-5, the percentage of visits involving psychotherapy declined from 44.4% in to 28.9% and the number of psychiatrists who provided psychotherapy to all of their patients declined from 19.1% to 10.8%. [Mojtabai R; Olfson M. National trends in psychotherapy by office-based psychiatrists. Archives of General Psychiatry 65:962-970, 2008] This decline coincided with changes in reimbursement, increases in managed care, and improved effectiveness and greater use of medications. There has also been a substantial, long-term decline in the amount of psychotherapy training in residency programs, which increases the risk that patients who are suitable for psychotherapy that can address underlying stresses may not be advised to seek it. Managed care programs favor drug treatment (with or without psychotherapy by a nonpsychiatrist) because it costs less per patient than psychotherapy. Psychologists, clinical social workers, and clinical mental health counselors now dominate the psychotherapy marketplace.

Warning issued about homeopathic "look-alikes." Consumer Reports has found that some consumers are confused by the display of similarly packaged homeopathic products adjacent to genuine over-the-counter (OTC) drugs. The editors advise: "Check whether over-the-counter products are labeled homeopathic. If they are, don't buy them." [Homeopathic drugs: Look-alike medicines. June, 2008.]

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