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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.
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 Justman claims that the oath is outdated and paternalistic, dating to a time when doctors often did more harm than good.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
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 swogstat.org/PCPThome.htm.-Ed.]-Tina Neville, Univ. of South Florida Lib., St. PetersburgCopyright 2006 Reed Business Information.