Perhaps mild infections are like mild cancers

File:Gleasonscore.jpgI was listening to a superb TEDMED talk yesterday by Otis Browley at our TEDMED at UA simulcast. He was speaking about the dramatic overtreatment of prostate and some breast cancers when they were in their early stages. Late in the 18 minute talk, he recounted an anecdote that I had not heard. It had to do with Dr. Donald Gleason and a meeting he had more than 50 years ago. Gleason is best known for the eponymous “Gleason Score” for prostate cancer.

Anyway, the story goes that he (Gleason) was attending a task force meeting with his peers. He was uncomfortable with using the term “cancer” for early-stage prostate disease. He favored “adenosis”. He was outvoted.

I can’t help but see the parallels 50 years on when we speak of wound infections. Are we overdiagnosing mild wound and diabetic foot infections? Certainly these need to be contained, but perhaps we can do so without calling them infection.

Words and language and taxonomy are important. I think they also change over time. To look forward, let’s look back on our forefathers less we risk suffer adenosis atrophy.

Cheers, -DGA

One thought on “Perhaps mild infections are like mild cancers

  1. Not sure where you are taking this argument, David. I'd start by not giving antibiotics to clinically uninfected ulcers…still an issue worldwide in some units. I suspect you will need to figure out some compelling observational evidence of the safety of NOT treating clinically infected ulcers before you will get support for the placebo-controlled trial of no-antimicrobial-treatment-for-infected-ulcers. Though we do know topical antimicrobials are fine for mild infection…

    If one is being provocative, however, what about all those patients who come in with a foot infection and say “it was fine until the podiatrist treated my ulcer last week”. We then say, “no, no, you don't understand….the podiatrist just REVEALED the infection you already had”. But do we know that? What we do know is that in other domains of medicine, a surgical procedure without antibiotic prophylaxis on a contaminated or dirty operative field has a substantial post-operative infection rate. Why not a first sharp debridement of a necrotic or sloughy diabetic foot ulcer? But again…I am not advocating everyone is given prophylaxis! Just agreeing there is a lot we dont know.

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