What do you get when you cross 3 pediatricians, 4 internists, 3 family doctors, 2 epidemiologists, 2 nurses, a PhD, an obstetrician, a perinatologist and an occupational medicine doctor? Unfortunately, this is not a joke. You get a Federal Government panel, given the imprimatur as experts on a medical subject that if any one of them individually treated, would be considered malpractice. This would be the U.S. Preventative Services Task Force (USPSTF), an ad hoc committee charged with making recommendations about clinical preventative services. They have just issued their findings that there is no role for routine PSA screening in men to detect prostate cancer. The real question is why do we need such an agency?
There are no doctors on this panel who treat prostate cancer. You would not go to a pediatrician or obstetrician if you had this disease, so how does it make sense to aggregate 16 such people and have them opine on a subject that they know about only from a book?
The conclusions of this committee were reached using a relatively new statistical gimmick called “meta-analysis”. This allows the pooling of small studies to create an enormous one with what statisticians refer to as “strength”, which is based entirely on large numbers of patients. It does not account for the quality of the study itself, and bad methodology of small studies can be concealed by pooling data, which is what happened here.
The American Urological Association (AUA)-the true experts in this area- has denounced these recommendations. It is particularly stinging that these recommendations were released during the largest meeting of urologists in the world- the AUA annual convention in Atlanta, where over a quarter of the program is devoted to discussion about prostate cancer. I know this is true because I attended it.
Some relevant facts about prostate cancer- it is the second most common cancer in men worldwide, but in the US. It is first, and is the second leading cause of death in men. Prostate cancer worldwide has the highest prevalence in the US, where it affects 125 of every 100,000 men, and in African-Americans it is 185. When compared to the rest of the world where PSA testing is not routinely done, the death rate from prostate cancer is the lowest in the US. Here, the 10 year survival of men with prostate cancer has risen from 53% in the pre-PSA testing era to 97% now.
These statistics are just part of the story. Prior to PSA testing, 25% of men who were diagnosed with prostate cancer already had spread of the disease to their bones. Now it is less than 5%.The USPSTF got it completely wrong when they recommend waiting to get a PSA until a man has symptoms of prostate cancer. For many men, these symptoms do not occur until late in the disease, when they can suffer miserably from the side effects of advanced disease. 30,000 men die annually from this disease and this number will rise significantly because of these recommendations. It will set back the advances made in prostate cancer by over 20 years.
This is just the latest attempt by the USPSTF to limit effective screening methods for cancer. In 2010, they made recommendations to significantly curtail screening mammography for breast cancer in women. Now they are recommendations, but soon, when Obamacare is fully implemented, these will be policy, not suggestions, and will have the full force of law behind it. Other screening programs will soon be on the chopping block, like colonoscopy for colon cancer screening.
The reason behind this is simple. It is about money, power and control. On the UTPSTF web site, it states that over 1000 PSA tests were necessary to save a single life from prostate cancer. Someone in Washington has decided what the value of a human life is, and what would be the acceptable cost associated with saving it. This is called “comparative effectiveness” and is what happens in a socialized healthcare system, like in England, where resources need to be allocated prudently, and healthcare is rationed. This is the essence of Obamacare- a system where medical decisions have been taken away from patients and their doctors and transferred to bureaucrats in Washington.
Just two final notes - my friend, a family medicine doctor, sent me an email that 3 of his patients called today to get a PSA before it was unavailable. And for the record, President Obama was screened for prostate cancer with a PSA within the past year.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.
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