Health News Review

Fox News uses Dr. David Samadi, a New York urologist and “Chief of Robotics” at his NY hospital, as a “medical contributor.”  We’ve seen and heard him promote his pet approaches in the past.  He did it again this past Sunday, touting his own favorite approach over another approach known as the Cyberknife, along with sidekick physician medical news contributor Dr. Marc Siegel.

I asked one of our medical editors, Dr. Richard Hoffman, to comment on the segment. His areas of research interest are prostate and colorectal cancer screening and prostate cancer treatment outcomes, with expertise in clinical epidemiology, health services research, and meta-analysis. He wrote me:

The Fox segment seemed designed to confuse audiences. The host begins by describing a new robotic radiosurgery (Cyberknife) that the expert commentator then explains is neither a robotic procedure nor a surgery while at the same time showing clips from one of his robotic surgical procedures.   The banner graphic across the bottom of the screen reads “radiosurgery vs. robotic prostatectomy,” but Dr. Samadi launches into an infomercial-like presentation touting only the advantages of surgery, including citing the new techniques that reduce surgical complications.  However, his “innovative” SMART surgery techniques appear to be a robotic adaptation of the nerve-sparing prostatectomy pioneered decades ago by Dr. Patrick Walsh.  Furthermore, numerous studies actually suggest that treatment complications (primarily sexual dysfunction and urinary incontinence) are comparable between robotic and open prostatectomy—and usually occur less often following radiotherapy than surgery.

The points about PSA levels dropping to zero after surgery, the more accurate staging with surgery, and the challenges in performing prostatectomy after radiation are true, but are used to disingenuously suggest that surgery leads to better cancer control and survival—even though there are no data from head-to-head comparisons supporting this contention.  Dr. Siegel earnestly proclaims that he does not want to compare the procedures (and why not?) but rather rely on the art of medicine–which compels him to recommend the skills of his esteemed colleague, the urologist Dr. Samadi.  Whether a professional acquaintanceship with a radiation oncologist would change Dr. Seigel’s artistic temperament is unclear.

The segment never addresses an important issue underlying any treatment decision for prostate cancer–the substantial risks of overdiagnosis and overtreatment.  An estimated 23% to 42% of prostate cancers detected by screening would never cause problems during a man’s lifetime.  Providing any treatment, however artfully delivered, for men with these low-risk cancers is thus potentially unnecessary and harmful.

Mind you, questions can and should be raised about the Cyberknife approach (and have been previously on this blog).

But this Fox “News” segment was over-run with conflicts of interest and confusing, one-sided testimonial.  

Clearly, Samadi’s PR machine is in high gear, because today he sent out a news release touting his robotic approach over both the Cyberknife and high intensity focused ultrasound (HIFU) – the latter in the news today based on a British study.

Presumably he had to pay to send out the news release.  Presumably he didn’t have to pay for his Fox News free publicity.   Each approach delivered the surgeon’s pro-surgery advocacy.   But one was supposed to be a news segment.  At least that’s the way it was labeled.

Samadi and Siegel also got a big Forbes column placed two weeks ago, touting, “The New World of Prostate Cancer,” with the same message that “surgery is better than radiation or watchful waiting.”





Alex Muacevic posted on April 18, 2012 at 1:36 am

It is very interesting to see for me as an European physician how increadible biased one can present himself in a very egomanic way in US press and TV contributions to do self promotion rather than information. This colleague is clearly confusing patients at the highest level and his comments do not help to find the right tretament method for individuals concerned.

James G. Schwade MD posted on April 18, 2012 at 1:53 pm

The Cyberknife is a technology for delivering a high dose of irradiation in a small number of treatments, or “fractions” to a very tightly confined and precisely defined space. It consists of a light weight linear accerator on a robotic arm. It’s robotic!! It’s not surgery, but a form of radiation therapy. At the Cyberknife Center of Miami, 12th site in the world and first in SE USA, we’ve been using it for prostate treatments since we opened in 2003. There are several centers which have published 5 year data on Cyberknife and prostate cancer, and light virtually all of the early stage prostate cancer treatments it’s highly effect. There is none which is clearly superior to any other. The choice is dependent on patient preference for one or another based on various factors such as time, surgery or no surgery, side effects and complication differences. But they are all effective.
This piece on Fox was horribly misleading, inaccurate and purely self-promoting. It’s a terrible disservice, and they ought to present something more accurate, balance and useful. JGS

david samadi posted on April 18, 2012 at 8:11 pm

All the information given on Fox News House Call given by Dr. Siegel and myself is well researched and well studied. You are just putting some information about Cyberknife and it is not helping anybody. Show me the publication, the entire 41 patients from Stamford. GIve me a break. No sexual function outcome and no long term continence. The job of an expert specially in prostate cancer is to review the case and offer the right choice to the patient. I am not sure what kind of physician you are and what you practice, but I would do a bit more research before you post something online.
Everything on that interview is extremely accurate, we talked about staging which is precise with surgery, you dont get that with radiation. I said cyberknife which they call it robotic radiosurgery is misleading and confusing the patients and it is. It is not surgery it is only radiation. We dont need to get technical about hypofractionated radiation, most people that read these articles need to know what it is than bunch of fancy words. Surgery in the hands of experienced surgeon whether open or robotic results in excellent continence and potency. Surgery after radiation is very hard and that is also accurate. One size fit all is bad medicine and you have to personalize the care for each paitent. I would advise you to look at the video and pay more attention.
I also invite you to come to my operating to see a real robotic surgery not one that is done by computer and the docs are just watching the rays flying across the room. Good luck. You have to be honest with you patients, that is rule number one.