Papers p 299

I used to tell patients having difficulty deciding what treatment to choose for their early prostate cancer that they could get any medical opinion they wanted. Some colleagues have long preferred no treatment (watchful waiting), whereas others have thought radical prostatectomy the most reliable treatment. Several referred all such men for external beam radiotherapy. I used to make the point that if three good doctors could offer such different treatments to the same individual then there couldn't be that much difference between the treatments in terms of their efficacy. Pauker and Kassirer have recently argued that when key elements of outcome are similar between two or more treatments patients should focus on other, more personal considerations when making their decisions.1

It looks as though I will have to modify my advice. The survey of urologists reported on p 299 shows that patients can no longer get any opinion they want.2 If they are young (aged 70 or less) they will be offered radical …