You gotta put yourselves in the shoes of these urologists to think about why they don’t believe in PFS. I imagine it could go something like this:
I’m a urologist that has been prescribing proscar for BPH for 20 years. Many of the patients I have prescribed it to are older, maybe they had existing sexual dysfunction because of age or the BPH, and it was an obvious choice to give them Proscar rather than surgery which can cause permanent ED itself. Some guys may develop ED after taking Proscar but they’re old so the cause is very unclear, they don’t care as much as younger guys would, and nobody really connects the dots that Proscar patients could have PFS. I’ve never prescribed Propecia because that’s what dermatologist do.
Now I see younger guys coming in with PFS, they’re super angry, and none of my tests can find a cause. They’re even more angry that I don’t an answer for them and I’m not inclined to believe them because I’ve prescribed Proscar for 20 years and never had a problem. The fact that they’re aggressive and angry makes me think they’re kind of crazy so I determine its psychogenic.
I’ve read some of the PFS studies (or maybe not even because I am very busy and don’t read every boring medical study in my field) but I don’t know what to think. Due to my lack of information, I tend to learn on Merck for answers to fill in the gaps and wouldn’t think they would lie to me because that would be illegal (obviously a naive viewpoint).
That being said, I’ve mentioned this before and some of the more ambitious and ego driven doctors might get aggressive in response to PFS patients which drives them closer to Merck. They don’t think they’re doing the wrong thing but this is how they fall into that trap. I do believe that very few of these people realize what they’re doing is ethically bad. There are a few though that are shameless sociopaths though.