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Prostate Cancer ‘Death Panel’? You Decide – OpEd

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“By calling for a halt to screenings, the panel is recommending an end to a serious search for the second most lethal cancer in adult males in the US, second only to lung malignancies.” — Kate Randall, “US government panel calls for halt to prostate cancer screening”, World Socialist Web Site

A government task force has decided that you don’t need to know whether you have prostate cancer or not even though though more than 28,170 men will die from the disease this year. (according to the American Cancer Society’s estimates)

The United States Preventative Services Task Force, which serves under the Department of Health and Human Services in an advisory capacity, is recommending that physicians stop giving their adult male patients the PSA test even though the harmless blood-test has reduced the death rate from prostate cancer by 44% since its inception 3 decades ago. The USPSTF believes that the screening may be doing more harm than good. Here’s how they sum it up on their web page:

“Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”

—USPSTF Co-Chair Michael LeFevre, M.D., M.S.P.H., May 22, 2012

And, there’s more, too:

“The Task Force concludes that many men are harmed as a result of prostate cancer screening and few, if any, benefit……The members of the USPSTF face the same concerns and fears about health challenges as other people. This decision was reached only after extensive consideration and thoughtful debate. It is based on science and rooted in the knowledge that while everyone wants to help prevent deaths from prostate cancer, current methods of PSA screening and treatment of screen-detected cancer are not the answer.” “Screening for Prostate Cancer”, United States Preventative Services Task Force)

“Extensive consideration”, “thoughtful debate”, “based on science”? Wow. It all sounds mighty impressive doesn’t it? Did I mention that– according to Northwestern University’s Dr. William Catalona—there “were no prostate cancer specialists on the task force. Nor was there a urologist, medical oncologist or radiation oncologist.”

Nice panel, eh? What kind of experts are they? Lobbyists?

And that get’s to the heart of the matter, doesn’t it; because what people really want to know is whether the USPSTF can be trusted or if they have some ulterior motive in mind, like cutting costs for insurance companies so they can pad the bottom line.

I’m not going to even pretend that I think the USPSTF is “legit”. In fact, I think Kate Randall over at the World Socialist Web Site nailed it when she made this observation in a recent article:

“In line with Obama administration’s “reform” of the health care system, the mantra is repeated that people are being needlessly “overtested” and that eliminating testing will result in better health outcomes. The real motivation is the drive to slash costs for employers and the government, resulting in a drastic reduction in care for the vast majority of Americans.” (“US government panel calls for halt to prostate cancer screening”, Kate Randall, WSWS)

Bingo. Denial of service means bigger profits. There’s nothing more to it than that. The USPSTF can dress it up in all kinds of official-sounding gibberish, but it’s really all about money. Less testing means more money and happier shareholders. The HMOs get rich while you die. Yipee.

Last week, KCRW radio had an informative program on prostate cancer on Warren Olney’s “To The Point” titled “Is Less Medicine Good Medicine”. You can hear the entire show here

One of the panelists on the program was Dr. William Catalona, the man who invented the PSA test. Catalona cogently refuted nearly everything that the other “pro industry” guests had to say. Here’s a bit of what he said:

“Since the beginning of the PSA prostate cancer screening, the death rate has been reduced by 44%, and the percentage of men who present with very advanced stages of cancer at the time of diagnosis, has been reduced by 75%…There’s really no downside to getting a blood test. It’s just a simple blood test. So men should get the blood test, and if the blood test should turn out abnormal, then the man can always decide whether he wants to proceed with the biopsy and treatment.”

… I think the USPSTF has misinterpreted the data. They have overestimated the risks and underestimated the benefits. And if their recommendations are implemented, than statistical teams from the National Institutes of Health show that we would move the field back 20 years and that the number of men with metastatic disease would go back to what it was by 2025. So it would double or triple the prostate cancer death rate……”

“The NIH has determined that 70% of the reduction in the death rate is directly attributable to PSA testing. But even setting that aside, if you just consider the percentage of men who present with metastases, Virtually, all men who present with prostate metastases, end up dying of prostate cancer. And there’s nothing else that could effect the metastases rate, and the rate has dropped by 75% during the PSA era, and is projected to go back to what it was without PSA testing. So the groups that have been funded by the NIH, by the university of Michigan, the Fred Hutchinson Cancer Center, say that the reduction is due to PSA testing. There’s really no way to deny that PSA testing has reduced the prostate cancer death rate…”

Catalona was challenged by one of the panelists who said that patients’ could still get a PSA test if they asked their doctor for it. Here’s how Catalona responded:

“The recommendation is that ALL PSA testing should stop on ALL men….and that includes high-risk men like African Americans Prostate cancer is the second biggest killer among men …..Again,there is no risk in taking the PSA test…They’re trying to create the impression that if a man has a blood test he’s going to be harmed.” (doctors can identify aggressive tumors..The combination of treatment and active surveillance can cut the death rate nearly by half.”)

The way to beat beat cancer is through early detection, which is why the PSA test is helpful. That doesn’t mean the test is perfect or that the various treatments don’t involve considerable risk. They do. But, so what? Would you rather be in the dark or know that you have cancer?

And, just listen to the pathetic reasoning behind the task force’s recommendation. (This is a quote from one of the pro-industry panelists)

“If the tests show that your PSA levels are elevated, then the doctor will push for more tests which could involve a biopsy. (which will indicate whether sample cells are malignant.) “The problem is that you are then on a treadmill of medical care where the risks are not only from the biopsy which is painful and it can have side effects.” (including incontinence or impotence)

Yes, the treatment options can be life-changing, but, once again, so what? Adults want to make these decisions by themselves with the help of their families and their physicians. They don’t want some bogus death panel making those choices for them.

Don’t be bamboozled by these phony-baloney front-groups who claim to have your best interests at heart. Get the test and make up your own mind.

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Mike Whitney

Mike Whitney writes on politics and finances and lives in Washington state. He can be reached at [email protected]

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