Health News Review

Blogger Patrick Malone writes:

“The Award for Most Fear-Mongering Health Care Statement of the Year … goes to Skip Lockwood, head of a prostate cancer advocacy group called Zero. When the US Preventive Services Task Force recommended against routine screening of men with the PSA blood test, Lockwood said the PSTF’s advice “condemns tens of thousands of men to die this year and every year going forward…” … But don’t try to confuse the advocates with scientific facts. They’d rather play on emotions.”

Lockwood is Zero’s CEO. The group’s COO, Jamie Bearse, recently wrote on my blog about the chief medical officer of the American Cancer Society:

“Otis Brawley has killed more men by giving them an excuse to not be tested.”

Welcome to the management team of ZERO – The Project to End Prostate Cancer.

Comments

Steven Miles MD posted on October 10, 2011 at 11:52 am

Gary, I had thought that the award should go to M. Bachmann for her HPV vaccination causes ‘mental retardation.’ Clearly, she is edged out by Mr. Zero. However, the times require due consideration to the forces of nonsense. We should defer the award until New Year’s day.

Jamie posted on October 12, 2011 at 1:13 pm

Hi Gary -
It’s me again. You’re best friend. I wanted to share with you the research on PSA testing so the people who stumble upon your blog would know the truth. Further, it’s sad that you have sided with number-crunchers instead of doctors that the idea of prostate cancer testing causes more harm than good.
First the USPSTF misgivings:
- The Decision is based on the PLCO trial which has concluded to have extremely tainted evidence where men in the control group WERE tested for prostate cancer. USPSTF ignored the NCI’s recommendation following the discovery of the tainted results but plowed ahead to make recommendation.
- Not one urologist or oncologist sat on the group making the recommendation. If you’re constructing policy to the nation, you should absolutely get the opinion of people who work in the field. It’s like making fishing laws without consulting a marine biologist.
Onto the Research:
AUA data
-The PSA test and advances in treatment have led to a 40 percent reduction in prostate cancer deaths since the mid-1990s, and 90 percent* of all prostate cancers are now discovered before they spread outside the gland. The survival rate is nearly 100 percent* when prostate cancer is detected early, while the tumor is still localized and hasn’t spread. (*American Urological Association)
Annuls of Oncology
-A study published online in Sept. 2011 in the Annals of Oncology showed mortality from prostate cancer in the U.S. dropped an estimated 23 to 38 percent, depending on the age group examined, in the years 2002 through 2006, as compared to 1985-1989 — just before the PSA test was widely adopted.
Goteborg Study
-The results of the Göteborg Randomized Population-based Prostate Cancer Screening Trial, released in July 2010, showed a 44 percent decline in prostate cancer deaths as a result of PSA testing. In this Swedish study, partially funded by the National Cancer Institute, an analysis of some 20,000 men was conducted during a 14-year period.
-As a result of the Göteborg study, the National Cancer Institute in July 2010 acknowledged the “signification amount of contamination” in the PLCO study because of “men in the trial who had already undergone screening with a PSA test, which a number of researchers have said may preclude the (PLCO) trial from ever demonstrating a cancer-specific survival improvement.”
European Randomized Study (world’s largest randomized screening trial on prostate cancer)
-The European Randomized Study of Screening for Prostate Cancer (ERSPC) which began in the 1992, involved more than 182,000 men (ages 50 to 74) in seven European countries who were followed over a 17-year period.
-Four different analyses of the ERSPC data, based on an average 9 year follow-up review, show the following results due to PSA testing:
-37% decline in prostate cancer deaths. By utilizing a control group of men from Northern Ireland, where PSA screening is infrequent, this research shows a 37 percent reduction in prostate cancer deaths when compared to men who were PSA tested as part of the ERSPC study. (European Journal of Cancer, Oct. 2009)
-31% decline in prostate cancer deaths. This ERSPC analysis, which scrubs out data contamination issues and concentrates only on men who were actually PSA tested, shows a 31 percent reduction in prostate cancer deaths. (European Urology, July 2009)
- 27% decline in prostate cancer deaths. Another ERSPC analysis, also removing contaminated data, shows a 27 percent reduction in the prostate cancer death rate. (Reviews in Urology, Summer 2009)
-20% decline in prostate cancer deaths. Preliminary ERSPC findings in early 2009 noted that PSA testing produced a 20 percent reduction in prostate cancer deaths. (New England Journal of Medicine, March 2009)
I challenge you, Gary. I challenge you to produce a poll that shows more urologists and oncologists agreeing with the USPSTF than agreeing with the National Comprehensive Cancer Network – the real group that sets the standard in cancer testing. Further, please – I implore you – to write a blog about my comments here as they will shed a light on which one of us is bending science to fit philosophy.
Finally, the cost of health care is out of control and the struggle is on to reduce the burden. The prostate recommendation, like the commission’s equally bogus notion in 2009 to do fewer mammograms, is a failure of putting dollars in front lives. Americans trust doctors to their health, not the government.
We certainly need a better test and diagnosis methods for patients at risk for many diseases. And the fight continues to achieve that. Meanwhile, at the risk of practicing medicine without a license – which you often do, I would recommend men get tested, know the score and grade then make smart decisions on their treatment.
Best Regards,
Jamie Bearse

Gary Schwitzer posted on October 12, 2011 at 1:46 pm

Jamie,
You wrote that “it’s sad that you have sided with number-crunchers instead of doctors that the idea of prostate cancer testing causes more harm than good.” Are you, yourself, blind to the number of evidence-based doctors – yes, doctors – who have pointed out how screening can cause more harm than good?
It is becoming a tired old argument that has no merit when you write:
“Not one urologist or oncologist sat on the group making the recommendation. If you’re constructing policy to the nation, you should absolutely get the opinion of people who work in the field. It’s like making fishing laws without consulting a marine biologist.”
Cute, but without argumentative merit.
Give me an evidence-based primary care physician – with no subspecialty conflict of interest – when it comes to making recommendations for primary care medicine. That is, after all, what the USPSTF is charged with.
Since when does it require a subspecialty in urology in order to evaluate evidence? Who knows? With a little training, you might be better able to evaluate evidence yourself.
So your “challenge” to me “to produce a poll that shows more urologists and oncologists agreeing with the USPSTF than agreeing with the National Comprehensive Cancer Network” is a non-starter with me.
I don’t happen to believe that prostate cancer screening recommendations should be determined by polls. You can do your own poll and do whatever you want with it.
Finally, you make one more egregious error when you claim that I am “practicing medicine without a license.” In fact, if you’d done your homework, you would have seen that part of my stated policy on my blog is this:
“We don’t give medical advice so we won’t respond to questions asking for it.”
How much more explicit than that can I be?
Meantime, you are the one who gives health care advice when you write that you “recommend men get tested.”

Rose Hoban posted on October 19, 2011 at 1:21 pm

In 2009, the Association of Health Care Journalists had it’s annual conference in Seattle. Journalists were invited to tour some of the robotic surgery labs at U of W. There, we met surgeons who were practitioners of prostate surgery using the DaVinci robot. Even they admitted that the patient outcome data for using the robots was equivocal, at best. They also noted that Medicare reimbursement for robotic surgery was considerably higher than for ‘traditional’ prostatectomies.
Jamie, you note that health care costs are ‘out of control’ but the data point to the fact that testing, such as PSA testing, is one of the drivers of those rising costs, with questionable benefit.
Taking this little slice of the prostate cancer debate, PSA testing annually costs hundreds of millions a year, paid in large part by Medicare. Treating all of those false positives and folks who can’t bear carrying the ‘cancer diagnosis’ with them and who chose treatment over watchful waiting costs hundreds of millions a year. “Advanced” treatments, such as DaVinci cost, on average $10K-$15K more per patient, and the large majority of patients now choose robotic surgery, totaling hundreds of millions a year.
You can’t tell me 1) that urologists don’t have a financial interest in maintaining the status quo of testing and treating (and getting reimbursed for every test and procedure and office visit) and 2) that in this case, “prevention” is cheaper when there are so many false positives as a result of testing.
Personally, I’m glad there are no urologists on the USPSTF PSA committee. That seems to make sense. I’d trust them more to put data before dollars than folks who are making bank off of all that testing and treatment.
The goal behind the USPSTF is to determine better outcomes, when it comes with less cost attached, so much the better.
Rose Hoban, RN, MPH