Do No Harm: How a Magic Bullet for Prostate Cancer Became a Medical Quandary

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A fascinating medical detective story about the unusual reception for a promising new drug by a skeptical medical community reluctant to abandon its age-old Hippocratic Oath of "Do No Harm." Stewart Justman explains how a pill called finasteride, proven to dramatically reduce the incidence of prostate cancer, was found to be also associated with a distinctly higher rate of aggressive cancer. As urologists and oncologists were presented with a strange mix of eurekas and cautionary notes, physicians adhered to their best principles and remained wary of massive application. For now, the drug is deemed too risky: the medical dictum of avoiding harm has inhibited its use on a grand scale, though statistically there is much in its favor. Do No Harm is engrossing reading about medical science and, finally, a reassuring tale of the triumph of tradition over novelty.

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Editorial Reviews

Midwest Book Review
An excellent choice for either leisure readers or medical students.
Booklist - Donna Chavez
Justman rewardingly performs the alchemy of mixing science, medicine, and literature.
Justman rewardingly performs the alchemy of mixing science, medicine, and literature.
—Donna Chavez
Publishers Weekly

In 2003 a medical study reported that a steroid called finasteride (approved as a treatment for hair loss) "significantly cut the incidence of prostate cancer in men at low risk." But it also had a dark side: clinical studies indicated that men who did develop cancer while taking the drug tended to get more aggressive tumors. English prof and PEN Award winner Justman (Seeds of Mortality) examines why, despite finasteride's potential, American doctors have shied away from giving it to their male patients, and attributes it to the traditional oath to "do no harm." Justman claims that the oath is outdated and paternalistic, dating to a time when doctors often did more harm than good. He also cites those who say the benefits of finasteride far outweigh its risks. But he acknowledges that the FDA has not approved finasteride for cancer prevention, and he neglects to consider adequately as a contributing factor the sword of Damocles that swings over so much of modern life: liability lawsuits. Justman tends to be prolix and repetitious. This book may appeal to readers interested in medical ethics and the history of science, but is unlikely to have much draw for general readers. (Apr. 4)

Copyright 2007 Reed Business Information
Library Journal

Has the concept of "do no harm" become obsolete with many medical researchers now focusing more on preventing diseases than curing them? Justman (liberal studies, Univ. of Montana) uses the results of the Prostate Cancer Prevention Trial (PCPT), made public in 2003, to examine risk/benefit ratios as they relate to chemoprevention. In this seven-year study, 18,882 men aged 55 or older were given daily dosages of either a placebo or the drug finasteride (sold by Merck under the name Proscar) to determine finasteride's efficacy in preventing prostate cancer. The results were mixed: those who took finasteride did show a lower incidence of prostate cancer overall, yet members of this same group exhibited an increased potential for high-grade tumors. Here, Justman addresses the questions the study raised-specifically, Is the risk of aggressive cancer in a small percentage of men justified if a large number avoids cancer entirely? In a rambling examination full of literary examples, Justman looks at the historical view of the Hippocratic oath and how it applies to today's medical research and treatment methodologies. Recommended for academic or medical libraries interested in bioethical case studies. [Read about the PCPT at]-Tina Neville, Univ. of South Florida Lib., St. Petersburg

Copyright 2006 Reed Business Information.
Kirkus Reviews
Thoughtful review of a cancer-preventing drug that doctors don't use-probably for good reasons. Finasteride (sold by Merck as Proscar) blocks conversion of testosterone into the even stronger dihydrotestosterone. Blocking this conversion shrinks the prostate gland, which swells as men age, often obstructing the urinary passage. In 1992 the FDA approved finasteride to treat benign prostatic hyperplasia. Researchers immediately wanted to learn if a drug that repressed normal prostate cells might do the same to malignant cells. In 1993, nearly 19,000 volunteers aged 55 and older began a study in which half took finasteride and half didn't. After ten years, the men taking finasteride were shown to have a 25 percent lower chance of developing prostate cancer. That was the good news. The bad news was that among the smaller number who did get cancer while taking finasteride, a higher percentage developed more aggressive, less curable cancers. Given a drug that prevents cancer in many patients but might harm a few, doctors have made a choice: They don't prescribe it. Since finasteride may save lives, some authorities accuse doctors of focusing too much on individual patients to the detriment of society. Justman (English/Univ. of Montana) maintains that this is the right choice. He recounts cautionary tales of occasions when physicians or other experts decided individuals must suffer for the greater good; his evidence includes the Tuskegee study, in which African-American sharecroppers were denied treatment for syphilis. He agrees with general medical opinion that it's wrong to conclude, if the number of cancers prevented by finasteride exceeds the number induced, that the drug has a "netbenefit." A unique glory of scientific medicine is a vivid awareness of our ignorance, Justman writes. Until doctors understand what causes prostate cancer and how finasteride works to prevent it, they prefer to observe a guiding principle of the Hippocratic Oath: "First, do no harm."An eloquent account of the medical profession's sometimes cautious approach to advancement.
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Product Details

  • ISBN-13: 9781566636278
  • Publisher: Dee, Ivan R. Publisher
  • Publication date: 4/25/2008
  • Pages: 256
  • Product dimensions: 5.83 (w) x 8.87 (h) x 0.95 (d)

Meet the Author

Stewart Justman won the PEN Award for the Art of the Essay for his book Seeds of Mortality, published by Ivan R. Dee in 2003. He lives in Missoula, Montana.

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