Like dynamite, it comes in a small package, but packs a tremendous wallop. Dr. William Feldman’s road map to Take Control of Your Health(Key Porter Books)is a refreshing astringent to the hubris of the purveyors of current preventive medicine.

The author questions the usefulness of PSA testing, more than one prenatal ultrasound and routine colonoscopy.

Professor emeritus at the University of Toronto, Dr. Feldman is not against prevention, which is nothing less than the holy grail of reducing medical costs and waiting lists. Dr. Feldman reasons prevention is indeed magic, but his book shows that many of the outdated customs of current prophylactic practice are defective.

Take prenatal ultrasounds. If the first is normal, there is no evidence to show a second or third trimester examination will have any significant effect on pregnancy outcomes.

Prostate-specific antigen testing? In 1989, the U.S. Preventive Service Task Force recommended against any routine screening for prostatic cancer. Granted there is an epidemic of routine PSA testing, but Dr. Feldman repeats the epigram, “You die with prostatic cancer not because of cancer.” Anyway, he cautions to await the outcome of a 180,000-man research project conducted over 10 years that is due to be published this year.

Cholesterol screening
As for cholesterol, Dr. Feldman says, “There have been no randomized controlled trials showing that average or low-risk adults, who are screened(for cholesterol) are better off than those who are not.”

The barrage of questionable treatment continues.

Colonoscopy is the current “must-have” procedure in Ontario but, according to the Agency for Health Care Policy and Research Evidence, “No studies to date have been completed that show mortality reduction associated with screening colonoscopy.” Of course, fecal blood is a prime indicator, but Dr. Feldman question the value of the colonoscopy otherwise.

The author nails his banner to evidence-based medicine, the randomized controlled trial and the strict role of no conflict of interest in any author publishing a research report.

Dr. Feldman confounds the practitioner a little further when he suggests that when prescribing a therapy regimen, “Tell them to think it over and go to the Internet to get other thoughts,” he says.

Too bad Dr. Feldman is emeritus professor. The teaching staff of the University of Toronto would be stronger with his presence.

Charles Godfrey is writing a history of Toronto’s Sunnybrook Medical Centre.