Peter A Ubel

• A 73-year-old man requests a prostate-specific antigen (PSA) test from his primary care physician, but the physician does not believe the test is in the patient's best interest.

• A woman with metastatic colon cancer has continued to progress on standard therapy. She asks her oncologist whether she should enter a Phase I trial or, instead, enter a hospice program.

• A woman with a strong family history of breast cancer, and a BRCA-1 mutation, asks her genetic counselor to explain the pros and cons of a prophylactic mastectomy.

• A 55-year-old man with myelodysplasia comes to a cancer referral center to see whether they think a bone marrow transplant is feasible in someone his age.

Patients interact with a wide range of clinicians, seeking help in deciding how to prevent, detect, or treat cancer. Many of these decisions are difficult—sometimes because there is not great evidence about the risks and benefits of specific healthcare interventions, such as the role of PSA testing in preventing mortality and morbidity from prostate cancer; sometimes because the evidence, although solid, is so complex that it is difficult for patients to process the information in the time they have to make a decision; and oftentimes, because the decisions involve difficult value judgments, in which there is no right or wrong decision for all patients, because the best choice varies depending on patient preferences.

How should clinicians handle these difficult situations? When should they make clinical recommendations and when should they let patients decide what is best? How can they explain uncertainty to patients in ways that they can understand? Or should they even bother to do so?

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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