A trite modern metaphor for the absence of good options refers to those choices that are only “better than a sharp stick in the eye.” I was recently faced with a medical problem where I had to decide whether I had an option superior to a sharp stick in the eye.
NLST data clearly demonstrate that lung cancer screening is effective and safe and reduces lung cancer-specific mortality by at least 20%. There is no possible reason for CMS to further delay or restrict lung cancer screening for those at high risk.
When the media reported earlier this year that giant drugstore chain CVS had announced that it would stop selling tobacco products, it appeared to be a sudden, independent, and ethically responsible business decision. In fact, there is important background and subtext.
Although e-cigarettes are being put forward as a safer alternative that delivers nicotine without carcinogens and assists smokers to quit, I remained concerned that evidence suggests the products are marketed for purchase and use by children. How else can one explain brands featuring flavors like Gooey Butter Cake, Snicker Doodle, Extra Sweet Cotton Candy, Bananalicious, and—the most outrageous—Gummi Bear.
It is difficult for me to reconcile such diametrically opposed views of the value of screening in our lives, with some researchers suggesting that no women should undergo breast cancer screening, regardless of age.
The tobacco industry has, in effect, caused the biggest toxic spill in history, one that has very literally killed millions of Americans. It is time that the courts compel the industry to clean up their mess.
The first obvious problem with peer review is delay. On other occasions, I observed what appeared to be strong and persistent bias on the part of reviewers that ultimately led to rejection or intrusive revision of the manuscript.
In the late 1960s, I quickly learned that a large proportion of requests for narcotics in this population were spurious. Patients would simulate renal stone, acute myocardial infarction, and many other painful illnesses in order to obtain narcotic drugs.