“Outrageous…an earthquake…an enormous game changer” – but it was there for all to see for 7 months!

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News coverage of the US Preventive Services Task Force’s new recommendation against prostate cancer screening (published today in the Annals of Internal Medicine) was often hyperbolic and sensational, ignoring the fact that today’s published recommendation first appeared in draft form in October – fully 7 months ago – and that it was available for public comment for two time periods late last fall.

In some regards, some of today’s news coverage was similar to the news coverage of the USPSTF breast cancer recommendations in 2009:

  • treating the news as if it were surprising and unexpected
  • treating this as if it were a brand new idea that came out of the blue
  • labeling this as “a government task force” without explaining the makeup of the USPSTF

It was not surprising, was not unexpected, and the rationale and supporting evidence was posted online for anyone to comment on for 7 full months.  Where was all the news coverage of that opportunity for the past 7 months?

CBS’ Dr. Jon LaPook was overly simplistic when he led with this line:

“For 20 years, the message has been the same: Get a PSA test every year or two, detect prostate cancer early — and save your life.”

That’s just wrong.  You would have had to be living under a rock for the past 20 years to think that was the only message on prostate cancer screening for the past 20 years.  In 1994 – 18 years ago – I produced the first decision-support video on prostate cancer screening and it clearly laid out the tradeoffs between the benefits and harms of prostate cancer screening.  So to say that the message above was the only message for 20 years is inaccurate.

ABC’s Diane Sawyer called it “an earthquake about testing for prostate cancer” and moaned to Dr. Richard Besser “Ohhh..this is another one of those curves, another debate in the medical community…what are people supposed to do?” Well, you don’t make it any easier with that Chicken Little “the sky is falling” drama. (Besser’s packaged report was far more reasonable than the anchorwoman’s lead-in and closing chat.)

NBC’s Brian Williams called it “an enormous game changer.” Again, this game has been changing for all to see for decades already.  Robert Bazell countered some of the American Urological Association rhetoric about “outrageous…irresponsible…men should still be able to choose” by pointing out that, indeed, men can still choose and that the USPSTF simply makes recommendations.

Richard Knox on NPR retold the story that Dr. Otis Brawley of the American Cancer Society has told about how…

“…an especially candid hospital marketing director bragged to him about the financial advantages of his institution’s free PSA screening sessions. He recounts the story in his recently published book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.

“The marketing guy was really proud of his prostate-cancer-screening business plan,” Brawley told Shots. “If they screened 1,000 men at the mall … they got 135 guys coming in [to the hospital’s clinics] to figure out why they had an abnormal test. And they would end up collecting an average of $3,000 per guy off of that.”

From there, many biopsies would reveal prostate cancer, and nearly all of them would have surgery or radiation, he says. The ones who got radiation, the marketer told Brawley, “reimbursed at almost $80,000 a guy.”

“I asked him, ‘How many lives will you save if you screen a thousand guys?’ ” Brawley recalls. “And he took his glasses off and looked at me as if I was a fool and said, ‘Don’t you know, nobody knows if this stuff saves lives? I can’t give you an estimate on that.’ “

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Greg Pawelski

May 22, 2012 at 11:09 am

This PSA screening issue reminds me of the anemia drug issue. The FDA first warned about prescribing drugs for anemia in cancer patients in early 2007. It wasn’t until 4 years later, the issue seemed to be finally resolved: using pharmaceutical EPO in cancer is harmful, like in increasing mortality in cancer patients.

And it wasn’t until this year that it was exposed that dozens of doctors influenced their colleagues to use pharmaceutical EPO for unapproved indications such as cancer-related fatigue (anemia). There have been several nuclear explosions in clinical oncology. Interestingly, it is the highest levels of academia who are most tainted.

But as in the anemia drug issue, the PSA screening issue will probably play out as one more cudgel to beat the more reasonable and gentle practitioners, who either largely avoided such abuse or were led down the path by the path by the scholars, who will themselves skip out unfazed.

Susan Fitzgerald

May 23, 2012 at 6:48 pm

Wow, when people talk about “taking the profit out of health care,” they really need to see that Brawley/PSA anecdote. Most people just think it means getting rid of the CEOs. Ironically, the very existance of health insurance leads to higher costs and more spending. It’s the proverbial deep pocket that guys like this want to get their hands into.

Cornelia Baines

May 29, 2012 at 12:00 pm

It’s the breast screening ‘controversy’ all over again – except radiologists like to scream ‘unconscionable’ rather that ‘outrageous’jhen they don’t like USPSTF guidelines. We need a better informed public that can understand the true benefits and true hazards of screening and a public that can also recognize conflict of interest when it is staring them in the face.

Alan Cassels

May 29, 2012 at 4:15 pm

Great that you’re documenting the backlash, Gary. We can’t forget the two words that spell the most profit for PSA testing: Robotic Surgery. With millions already invested in high-tech robots, and hospitals hoping to get some serious ROI from removing prostates, and ads making men giddly for the surgery, you can surely see what a solid moneymaker this is. As one physician told me quite glibly: we could absolutely erase prostate cancer in America if we asked all men to have their prostates pre-emptively removed.