Read the case below and answer the following questions:

Consider the case of patients who are diagnosed with low-risk prostate cancer. Most prostate cancer cases in the United States are detected using a screening test called the prostate-specific antigen test (PSA). There is considerable evidence that many PSA-detected cancers are over diagnosedthat is, the patient would have lived out the natural course of his life without ever knowing he had prostate cancer if not for having taken the PSA test.At Memorial Sloan Kettering Cancer Center (MSKCC) in New York, one of the preeminent institutions in cancer research and treatment, "active surveillance" is generally recommended for men with low-risk prostate cancer and is preferred over treatments such as surgery and radiotherapy that can cause side effects, including incontinence and erectile dysfunction. This recommendation is consistent with the National Comprehensive Cancer Network guidelines and the American Urology Association guidelines. In active surveillance (AS), patients are carefully monitored with PSA tests, repeat biopsies, and physical examinations; if there is a sign that the disease has progressed to a higher risk category, patients are recommended for treatment (e.g., surgery or radiation therapy). An AS program typically includes lab tests and exams every six months, and a repeat biopsy every two years, to detect any disease progression. When Dr. Behfar Ehdaie, MD, MPH, began practicing surgery at MSKCC, he found that only about 60% of the patients for whom he had recommended AS complied; all others opted for surgery or radiation and were unwilling to accept active surveillance as recommended. Other doctors at MSKCC had similar rates of compliance when they recommended AS. Moreoverand understandablyeven the discussions a doctor would have with patients who agreed to AS were lengthy and difficult.

1) Why were so many patients unwilling to accept an expert's recommendation, even though the doctor would arguably have made more money by proposing surgery, and even though surgery and radiation have significant quality-of-life detriments? What could be done differently to achieve better patient outcomes? (5 Marks)

2) What is Logic of Appropriateness and do you it is useful in offering a solution without money or muscle to the above situation? (5 Marks)