Health News Review

The New York Times reports about last night’s televised debate among Republican presidential candidates:

Newt Gingrich, the former House speaker, condemned a proposal of a government task force to end routine tests for prostate cancer in men, saying it would cause deaths. But the panel that made the recommendation concluded the test itself has caused unnecessary deaths and injuries.

Mr. Gingrich was referring to a draft recommendation of the United States Preventive Services Task Force that concluded after five clinical trials that healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to treatments causing pain, impotence and incontinence for many.

Bloomberg News offers a video clip of what Gingrich said in the debate

Gingrich called the US Preventive Services Task Force’s recommendation “the most recent US government intervention…(that) is basically going to kill people.” He also emphasized that “not a single urologist – not a single specialist” was on the task force.

Here are the current members of the US Preventive Services Task Force:

Virginia A. Moyer, M.D., M.P.H. (Chair)
Professor, Pediatrics
Baylor College of Medicine, Houston, TX
Chief, Academic Medicine Service, Texas Children’s Hospital

Michael L. LeFevre, M.D., M.S.P.H. (Co-Vice Chair)
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO

Albert L. Siu, M.D., M.S.P.H. (Co-Vice Chair)
Professor, Geriatrics and Palliative Medicine
Mount Sinai School of Medicine, New York, NY

Kirsten Bibbins-Domingo, Ph.D., M.D.
Associate Professor, Medicine, Epidemiology, and Biostatistics
University of California, San Francisco, CA
Co-director, UCSF Center for Vulnerable Populations
San Francisco General Hospital

Adelita Gonzales Cantu, Ph.D., R.N.
Assistant Professor, Family and Community Health Systems
University of Texas Health Science Center, San Antonio, TX

Susan J. Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor, Health Management and Policy
University of Iowa, Iowa City, IA

Glenn Flores, M.D.
Professor, Pediatrics and Public Health
University of Texas Southwestern, Dallas, TX
Director, Division of General Pediatrics
UT Southwestern Medical Center and Children’s Medical Center of Dallas

David C. Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of Pediatrics
University of Washington, Seattle, WA

George J. Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, Minneapolis, MN

Rosanne M. Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY

Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA

Bernadette Melnyk, Ph.D., R.N., C.P.N.P./P.M.H.N.P.
Associate Vice President for Health Promotion, Chief Wellness Officer, and Dean
College of Nursing
Ohio State University, Columbus, OH

Wanda K. Nicholson, M.D., M.P.H., M.B.A.
Associate Professor, Obstetrics and Gynecology
Director, Diabetes and Obesity Core Center for Women’s Health Research
University of North Carolina School of Medicine, Chapel Hill, NC

Carolina Reyes, M.D., M.P.H.
Medical Director, Maternal and Fetal Medicine
Virginia Hospital Center, Arlington, VA

J. Sanford (Sandy) Schwartz, M.D., M.B.A.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA

Timothy J. Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN

No, Newt, not a single urologist. But since when does it require a subspeciality in urology in order to evaluate evidence and in order to make recommendations to primary care doctors?

And no, Newt, not a single government bureaucrat in the group.


Merrill Goozner writes on his blog
:

Gingrich’s lie involved his claim that the U.S. Preventive Services Task Force recommendation that men forgo routine PSA testing for prostate cancer would kill men. First, the recommendation was based on scientific studies that showed the unnecessary biopsies and treatments triggered by the tests have killed at least 5,000 men over the last 20 years and left tens of thousands more, most of them elderly, with horrid side effects like impotence and incontinence.

Second, the USPSTF recommendation is precisely that. It leaves it up to men and their physicians to decide whether to continue with the tests. The government already has a law mandating Medicare pay for the tests. It would take an act of Congress to repeal the law, which isn’t likely.

Kudos to Bloomberg for posting this video clip and to Goozner for calling Gingrich on his dangerous rhetoric.

Addendum:

Kaiser Health News has now posted, “What Newt Gingrich Didn’t Say About His Cancer-Screening Expert.” More fact-checking, source-checking, and reality-checking that puts a huge dent in the credibility of Newt’s statements.

Comments

William Mange posted on October 12, 2011 at 11:54 am

Wow, I guess that something like this will require people to look into the overall affect of this treatment and screening. I would hope that people find out all of the facts before they decide to do this or not do this, and listen to what their doctors recommend for them.

Gary Schwitzer posted on October 12, 2011 at 12:43 pm

William,
Actually, many who have studied this issue say that, for most men, this decision should probably involve more than simply “listening to what their doctors recommend for them.”
This issue is a prime example of the need for shared decision-making, in which a fully informed man engages with his doctor in discussing his own (the patient’s own) personal values. Then patient and doctor can make a shared decision.
There’s an important nuance there – making this somewhat different than simply “listening to what their doctors recommend for them.”

Scotti posted on October 12, 2011 at 4:43 pm

How many cancers has PSA testing caught and how many lives were saved? If you list the lives lost then list the lives saved. Why the one-sided reporting?

Gary Schwitzer posted on October 12, 2011 at 7:25 pm

Scott,
It’s not one-sided reporting. What you’re asking for is impossible to accurately project.
Real observed harms can be documented. Lives saved is trickier to prove. The screened person may have had a relatively benign cancer that was not destined to cause harm. That, Scott, is the gist of the report.
Here’s what the report said about potential benefits:
“The possibility is very small that death from prostate cancer is less likely in men whose prostate cancer is detected by PSA screening rather than waiting for clinical detection, and the time to any potential benefit is long. No prostate cancer screening study, individually or combined with other screening studies, or study of treatment of screen-detected cancer, has demonstrated a reduction in all-cause mortality.”

Dan Maryon posted on October 19, 2011 at 1:36 pm

Why is there no mention of the statistic that since the introduction of PSA testing, annual deaths from prostate cancer in the U.S. have declined from approx. 42,000 to approx. 33,000. That is a very real statistic. Yes, the total number of cases diagnosed has gone way, way up, and yes, many men with low-grade cancers choose more treatment than is prudent and may end up with unnecessary incontinence/impotence. But the problem is that doctors have sold them on surgery or radiation in cases where it may not have been needed.
To throw out PSA testing is all wrong. If a physician hadn’t recommended a PSA test for me at 46, and a urologist done a second test 6 months later than showed substantial increase (but still only 3.7), I likely would not have been diagnosed with a very aggressive form of the cancer until it was in bones or organs. I’ll take the risk of impotence over the reality of bone pain and organ involvement any day, because I’m young and my cancer is aggressive (PSA doubling in a month or less if untreated).
We need other tests to screen out indolent cancers from aggressive. But it’s absurd to throw out PSA testing until something better is available. Change the recommendation to say that all physicians involved in prostate cancer screening and diagnosis need better training in how to recommend active surveillance until a clear need for surgical or radiation treatment is established.