Here’s a list of the recent fibs, misdirections, misstatements and outright lies uttered by a wide variety of opinionmongers in reaction to the new guidelines on prostate cancer screening with the PSA test issued by the U.S. Preventive Services Task Force.
“There weren’t any urologists on the task force!” This was uttered by none other than Newt Gingrich, former Speaker of the House and now-presidential candidate, during the Republican debate at Dartmouth College this week. The charge was also leveled by Dr. Patrick Walsh, University Distinguished Professor of Urology at Johns Hopkins Medical Institutions. (Walsh also pioneered “nerve sparing surgery,” a technique for removing the prostate that helps preserve a man’s ability to get an erection.)
They’re right: there were no urologists on the task force. Instead, there were 15 experts, all of whom have advanced degrees in addition to their medical training, and the statistical knowledge to parse medical evidence. You don’t need to be a urologist to dissect a scientific study, and there are plenty of urologists out there who wouldn’t know the first thing about doing so.
Perhaps Paul Goldberg, publisher of The Cancer Letter, said it best when describing the urologist Gingrich cited: “I wouldn’t call him an expert in prevention; I would call him a urologist.”
The task force’s recommendation is “going to kill people!” This one also came from Newt, and it has been repeated in various ways by any number of physicians and prostate cancer activists. Skip Lockwood, chief executive of ZERO, said, “Today's decision of no confidence on the PSA test by the U.S. government condemns tens of thousands of men to die this year and every year going forward…” Dr Deepak Kapoor, chair and CEO of a medical group that includes the nation’s largest urology practice, said “We will not allow patients to die, which is what will happen if this recommendation is accepted.”
Let’s take this in turns. First off, Lockwood’s math is all wrong: given that about 30,000 men die of prostate cancer each year in the U.S. even the most optimistic estimates for the effect of PSA screening don’t suggest that tens of thousands more would die without the test. Kapoor’s statement misses the point, too. He could have as easily said, “We refuse to continue killing men, which is what will happen if this recommendation is ignored.” This is something the advocates never talk about: the men who die as a result of further testing and treatment. About 1,000 men die each year after undergoing biopsies, mostly from infection. The statistics suggest that most men who die after biopsies actually didn’t have cancer. 1 out of 200 who undergo surgery die not from thier disease but from the treatment. Most of them had a cancer that was not destined to kill them.
Unless screening advocates are willing to ignore those deaths, or say that those men are simply less important than the men who die of cancer, it seems disingenuous at best to accuse the task force or anybody who questions the value of the PSA test of "killing men."
There’s no other test for prostate cancer, and “it would be barbaric to dismiss the PSA test before a suitable alternative is available.” This one is from an alert from the American Urological Association, pushing its members (and anyone else on their mailing list) to lobby Congress and the USPSTF against the recommendation. (Just in case you were wondering, yes: urology groups are whipping up opposition to the recommendations.) Here's the trouble with this argument: the AUA is perpetuating the myth that we must have some kind of screening for all kinds of cancer, because it’s an article of faith that "catching it early is always better." It would be a boon to mankind if we had accurate screening tests which could distinguish between dangerous cancers that need to be treated and the indolent kind that can be ignored. But we don't. Is the PSA test better than no test at all? That's a decision that each man needs to make for himself after being given the full story.