The elephant in the room is of course bevacizumab (brand name Avastin) which was not part of this comparison. Avastin is 30 times cheaper than Lucentis and the two have been found to be equally effective in treating diabetic macular edema on the relevant outcome, eyesight, used in the current analysis. Manufacturer-sponsored studies show that Avastin carries a higher risk of death than Lucentis, but the company has essentially failed to push the more expensive option in UK, where costs are better controlled than elsewhere.

Unsurprisingly, the disclosure sounds as follows:  “This project was completed by Dr. Dewan as part of his research elective as a fourth-year medical student at Washington University School of Medicine (WUSM). No funding was received from any source for support of this project. [...] Dr. Kymes receives research support from Genentech and Pfizer. He acts as a consultant for Pfizer, Allergan, Genentech, and TreeAge (maker of the software used in this project). Dr. Apte acts as a consultant for Genentech, Eyetech, Allergan, Ophthotech, Alimera, Regeneron, and Baxter.” Roche owns Genentech and sells both Avastin and Lucentis.

More unsurprisingly, the Medscape story title is “Diabetic Macular Edema: Pricey Option May Be Cost-Effective”.

After reading this and the preceding paper, I am still unclear where is PSA screening coming into the picture. The participants were required to be previously diagnosed with prostate cancer by any means. I could not find anywhere a sign that they were required to be asymptomatic before their PSA was first measured. But after this diagnostic was made and after they agreed to participate in the study, their PSA was measured again, quite opposite to the order of action in real-life screening, where PSA measurement come first, diagnosis – later. Because the study does not start at PSA screening time, the number of unnecessary biopsies to get to this sample size is not available. Unsurprisingly, in the study population, the PSA had a (pardon the pun) healthy increase to a median of 7, whereas in-real life screening, difficult questions are asked at 4.

If the hypothesis was, as the title says, surgery helps well-diagnosed patients, then yes, the authors have provided evidence, although I am not sure whether this is novel. The novelty, PSA screening helps, is not supported. Eighteen years in the making, PIVOT remains an informative trial, but does not answer today’s questions.

One extraordinary appearance makes up for all that. Paul Nurse, the Nobel Prize winner who discovered the enzymatic mechanisms of cell division, points out that the science field is up for grabs for lower classes. He says he did not go to the opera, did not go to the theatre, so he never considered an arts career. On the other hand, science was open for all. It did not matter what your class was. It was a more leveled field. Maybe that is what he felt during the late sixties, when he was in school.

Something else puzzles me. The two consequences have been linked for long. Cancer-induced muscle loss is a major cause of death, or so the generally-accepted wisdom goes. By this logic, anabolic steroids would be also useful. Some (rare) trials do show that. But even an increase in burger intake would help. For some reason, the medical community prefers to extend patients’ lives by three weeks, only if they suffer and pay as much as they would in three years. What is ActRIIB adding? If survival is increased by muscle mass increase, why not go for burgers?

I am intrigued about what ActRIIB blockade does to normal bodies. Can it be used by bodybuilders? Can it be used in cattle? If  not, does the muscle mass have a set point, along the lines of the body mass set point maintained by leptin?

On the other hand, should one make it, the chances of dying during the weekend shift is about 10% lower than on Wednesday. It is now unclear if, over the weekend, the puerperal fever carriers must be called to work or rather sent home.