Open letter to Dr Curtis Nickel aka "Mr Prostatitis"

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Open letter to Dr Curtis Nickel aka "Mr Prostatitis"

Post by webslave »

Here is the email I sent to "Mr Prostatitis" today. I want all sufferers and patients to know just how badly misinformed the official urological situation still is, as is clear when the chapter on our condition in Campbell's Urology (Campbell-Walsh Urology — the bible of urology) is so poor.
From: Chronic Prostatitis Admin <webmaster@chronicþrostatitis.com>
Date: 28 April 2012
Subject: Your article in Campbell's Urology on Prostatitis and Related Conditions
To: Curtis Nickel

Hello Dr Nickel

Just got my copy of CU, 10th edition. Some comments on your article on CP/CPPS
  1. Page 353 you say "antianxiolytics" can be used in treatment. There is no such thing as an "antianxiolytic". This is the second time I've seen you use this term. The word is "anxiolytic".
  2. Your coverage of the Wise-Anderson protocol on page 347 under the rubric "Perineal or Pelvic Floor Massage and Myofascial Trigger Point Release" is really hopelessly inadequate. The section fails to mention several recent positive studies published in Urology, and ends on a downbeat and faintly condemnatory note: "A recently reported NIH pilot study of men and women with chronic pelvic pain treated with either relaxation massage or specific pelvic massage therapy demonstrated improvement in women but could not corroborate these findings in men (Peters K, presented at AUA annual meeting, May 19, 2008)."

    At my forum, I routinely see men reporting cures or near-cures using the methods developed by Wise and Anderson (and their predecessors), so I think you are doing the entire patient population a disservice by damning this treatment modality with faint praise.
  3. Your diagram called "Figure 11–8. A suggested therapeutic algorithm for the treatment of patients presenting with CP/CPPS" on page 351 is woeful. The recommendations for Category III are firstly up to 4 weeks of antibiotics (almost uniformly unsuccessful), followed by either anti-inflammatories or alpha blockers (both of which have scant support in recent literature and almost no anecdotal support at my forum), and then phytotherapy (at last, should be a Tier 1 treatment) but also Finasteride (what? this is not BPH! I've seen NO success stories using this) and Elmiron (again, this is not IC, and there is virtually no support in the literature), followed by surgery (good grief!), TUMT (thin to no support in lit.) and Neuromodulation (scant support). Ordinary physiotherapy is eschewed in favor of exotic, ineffective, invasive and potentially harmful treatments.

    Image
    This diagram wilfully ignores modern developments and research, and instead makes recommendations that border on the reckless. It is highly irresponsible for you to publish a flowchart that could lead to actual harm to patients.
In short, a horrible effort, riddled with errors and omissions, more suited to the 8th edition of CU, not the tenth. Thomas Stamey called Chronic Prostatitis the "waste basket of clinical ignorance", and you seem set to continue the tradition.

Rgds
admin
https://www.ucpps.men/
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Re: Open letter to Dr Curtis Nickel aka "Mr Prostatitis"

Post by webslave »

Dr Nickel replied (see below), which is to his credit, although he glosses over the meat of my objections by saying his words are over 3 years old (then why not update them?) and that I have misinterpreted him.

The only way he can claim I have misinterpreted him is in the diagram above. In the box labelled "Neuromodulation", a term normally reserved in this field for implanted electrical devices, Nickel has put a little asterisk and underneath he has written, in small font, "* Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation". So he's effectively hiding the most important treatment modality under an asterisk at the end of a long chain of harmful and useless treatments. Way to go, Curtis.

Two more things about his response irk me
  1. The way he implies that because he has seen "many thousands and thousands of patients" he is an expert who cannot be wrong, and that all my points are "misunderstandings". This is arrogance, deflection and a refusal to listen (behaviours that most patients have come to expect from urologists).
  2. The way he assumes that we only hear from chronic, treatment-resistant patients at this forum. If he had bothered to read the forum, which he hasn't (even though I gave him free access years ago), he would see that many of our members are symptomatic <6 months (and you have to have symptoms for a minimum of 3 months to be classed as having the condition).
So your answer was a FAIL, Mr Prostatitis.
Dear Admin

Thanks for your interest. I always welcome constructive comments from patients (everything I know about this condition I learned from the many thousands and thousands of patients I have managed over the last 25 years). I appreciate your concerns and understand your issues. Too bad we could not sit down at one of the many research and/or clinical meetings examining these problems and discuss them. I have learned a lot from the patient focus groups that we routinely run. I am sorry you misinterpreted some of the comments written over 3 years ago in a dynamically changing field. Please remember that patients who are successfully treated and do not end up with this disabling chronic condition, are probably not involved in your forum. Again, thanks for taking the time to email me. Keep up the good work with your forum.

Curtis Nickel

J. Curtis Nickel MD FRCSC
Professor of Urology, Queen's University
CIHR Tier 1 Canada Research Chair in Urologic Pain and Inflammation
Kingston General Hospital
Kingston, Ontario, Canada, K7L 2V7
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Re: Open letter to Dr Curtis Nickel aka "Mr Prostatitis"

Post by webslave »

Follow-up: Dr Nickel has written a nice email asking for our co-operation and assistance, so I have moved this thread out of the public forums to the members only forums.

I replied :
Yes, I am definitely eager to work with you in any way that can
further research and assist this patient group. I apologise for the
harsh tone I took. I am very defensive of my members and I expect
nothing but the best, and most up-to-date, to be printed in
Campbell-Walsh.
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Re: Open letter to Dr Curtis Nickel aka "Mr Prostatitis"

Post by webslave »

Just to show how pervasive the incorrect thinking encapsulated in the abovementioned diagram has become, here is an example of it being used in a 2012 Korean study:
http://pubmed.ncbi.nlm.nih.gov/22379583
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