Sunday, February 16, 2014
It is pleasing to report the ongoing success of the International Urology Journal Club on Twitter. The first 12 months experience has culminated in the publication of a manuscript in the journal European Urology. This is the highest impact journal in the field of urology at 10.476.
Link to the article is at:-
The manuscript is expected to be indexed on Pubmed any day from now.
The 48-hour asynchronous format has worked well for time poor surgeons who find it difficult to commit to a designated on line meeting time. The format has also enabled global involvement given that time zones are no longer an issue. This is not to cast criticism at the fixed time journal clubs. As a relatively small surgical specialty, global involvement is necessary to have sufficient participation to make it viable. Larger specialty interest groups enable regional fixed time journal clubs to flourish.
Following on from our model is the commencement of a respiratory and sleep medicine journal club (#rsjc) and one from the general surgeons (#igsjc). We are eager to see that they succeed.
We will see more online journal clubs and hopefully more data to quantify participation and value as a CME learning tool.
Sunday, February 2, 2014
I normally do not read inflight magazines from airlines as they find them quite boring. They are generally full of articles about travelling to exotic places or buying expensive products that only those who have so much money (that they do not know what to do with it) will have any interest. This week, I was flying on the luxury carrier Emirates for the very first time and during the process of checking out all that they had to offer on my very long haul flight from Sydney to London via Dubai, I flicked through their inflight magazine.
I was taken by surprise to see a very prominent advertisement by a urological surgeon offering his surgical services for the treatment of prostate cancer. Given that I practice in this same subspecialized area of surgery, this naturally caught my attention.
Prior to seeing this advertisement, I had become aware of Dr David Samadi for all the wrong reasons. I had become aware of his name through overhearing discussions amongst US urologists over a number of years when attending the Annual Meeting of the American Urological Association. I would frequently hear urologists discussing him with the gist of the discussion being summed up with the frequent rolling of the eyeballs or groan every time his name was mentioned. Whilst urologists were careful not to verbally state anything negative about him, it was clear that they did not think favorably of him. At the time and as an outsider, I really didn’t take that much notice as any gripes US colleagues had about him were not particularly relevant to me.
So when I saw this advertisement in the Emirates inflight magazine, I immediately recognized his name and remember it being associated with groans and eyeball rolling. As I read the advertisement, I now found myself rolling my eyes and groaning in disbelief. It was almost like US urologists saying to a previously disinterested me, ‘told you so’.
|Mobile phone captured image from the January 2014 Emirates inflight magazine|
The statement that really got my attention was his claim of a “97% prostate cancer cure rate”. When we talk about cure of cancer, we generally mean total and permanent eradication of the disease. Whilst one could argue through dictionary meanings that cure can mean recovery from disease or restoration of health, I think that the average person would interpret cure of cancer being total and permanent eradication of cancer. My personal view is that prostate cancer doctor can come close to providing a 97% cure of prostate cancer and data shows that this is probably impossibility unless the subjects were all men with such low volume indolent disease that they did not need surgery in the first place. Why is this an issue? The statement can give cancer sufferers unrealistic expectations. The statement is unquestionably a draw card to consider his services as it gives hope and promise of an exceptional chance of success but I am sure that. I did call him out on Twitter to clarify his claim of 97% cure rates and was not surprised that he chosen not to respond.
I did call him out on Twitter to clarify his claim of 97% cure rates and was not surprised that he had chosen not to respond.
The statement “96% of patients regain continence” is not defined. Continence as far as I am concerned means a man who does not leak urine at all. If we look at the prevalence of incontinence in ageing men, a 96% continence rate is higher than for men who have not undergone prostate cancer surgery. It would be very easy to make a ridiculous suggestion that the surgery seems to give better urinary control rates than if you did not have surgery and one should therefore line up to have surgery with cancer being a mere technicality. – again I emphasise that this is a ridiculous suggestion but it does raise the question as what is meant by this claim. What is meant my continence? Does it include the men who are wearing one pad per day or doesn’t wear a pad but drips urine everytime he has a cough or sneeze. Undefined, the figure is very impressive and all those attracted by such figures should seek to clarify exactly what is meant be this. The population of men in whom you operate can make a difference as well – older men are more likely to have incontinence than younger men as one example.
For both continence and sexual function, definitions are everything and without them, I am concerned that presentation of such exceptional results will create unrealistic expectations. I am sure that the man with locally advanced cancer will be appropriately counseled that he would not fit in the group with such good results but the advert would have done its job of pulling him in through the consultation door so that he can then told what he really can expect. Should there be a asterixed disclaimer as in every good advertising offer that 'conditions apply'.
The statement “When you’re the best in the world” also raises questions. What evidence does he have that he is a superior surgeon clinically and technically than anybody else in the world? How does he benchmark this? Is it fair to claim that just because you have had patients from 40 different countries that this must mean that you're are the best? Is this international spread of patients have any relationship to international based marketing strategies?
I am currently registered as a medical practitioner with the Australian Health Practitioners Regulatory Authority. AHPRA has strict advertising guidelines. There is also a code of conduct published by the Royal Australasian College of Surgeons (and endorsed by the Urological Society of Australia and New Zealand) that dictates my appropriate behavior as a surgeon. If I were to have written such an advertisement, I would unquestionably be investigated by AHPRA and run risk of punitive actions and I would also stand a significant chance of being stripped of my surgical diploma from the RACS for breaches to our code of conduct. Dr Samadi is not required to adhere to Australian licencing regulations or code of conduct but in my opinion, there appears to be a lower bar for this behaviour in the United States. In Australia, any statements that have a likelihood of being misinterpreted as well as not being able to be substantiated are taken seriously and run a high risk of punitive sanctions and reputational loss. Having previously been registered with the General Medical Council of the UK (when I worked there years ago), I can also say that their guidances on these matters are equally, if not more, restrictive. It is important to state that these restrictions are not to make life harder for doctors to promote their practices, but to protect the public from misleading or unsubstantiated claims.
As a urological surgeon, I personally feel embarrassed to see such a colleague resort to advertisements in international inflight magazines to market their surgical practice. Maybe I'm just a bit old fashioned with my attitude to medical advertising. I was further embarrassed as a surgeon to see Dr Samadi refer to his twitter followers as fans. I hope that does not include his patients.