Health News Review

Too often, the demands of same-day journalism dictate that today’s announcement is reported and then journalists move on to the next day’s announcement and the next day’s journal study without a chance to step back and reflect.

Appropriately, some journalists are taking/finding the time to reflect on last week’s prostate cancer screening recommendations from the US Preventive Services Task Force.

      • “People are taking a closer look not just at cancer screenings, but at all medical tests and procedures, says Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice. Concern about “overtesting” and “overtreating” patients is growing because of a rising recognition that these interventions often have risks and serious side effects.”There is something going on, not just in cancer,” Woloshin says. “There is some sort of shift, and it’s encouraging. It feels like this is the beginning of a sea change in attitudes towards testing, treating and overdiagnosis.”
      • She also quotes Dartmouth’s Dr. Gil Welch:  “It’s hard to make a well person better, but it isn’t hard to make them worse.”
  • The Washington Post’s Brian Vastag has a very thoughtful piece in which he writes:
      • “THE PSA TESTS SAVED MY LIFE!!!” one man wrote in an e-mail to The Post, calling the government task force a “death panel.”He was expressing a cancer narrative that runs strong in our culture. It goes like this: I got a cancer test. It showed a suspicious result. A biopsy (which snips out a bit of tissue) then revealed that I had cancer. I chose treatment. Surgery, radiation or chemotherapy got rid of the cancer. I’m cured now.The test saved my life.Well, maybe.

        With prostate cancer, there’s a problem with that story: There’s often no way to know if a particular case would have been fatal if left untreated. That is, it’s impossible to know if the treatment really cured you — or if you would have lived a long life without it.

        It’s an unsatisfying — and confusing — reality of prostate cancer. ……                                                                                                                                                              

No one says: I got a PSA test. It was high, so I got a biopsy. The biopsy caused pain for weeks and made me bleed. But I didn’t have cancer. Good thing I got that test.

No one says: I got a PSA test. It was high, so I got a biopsy that showed I had a small, low-risk tumor. I got surgery. Now I wear a diaper and can’t make love to my wife. And I wonder if I really needed to go through all that.

….

The practice feeds a story we all want to tell ourselves: I did something. I was cured.

Well, maybe.

 

 

Comments

Susan Fitzgerald posted on May 29, 2012 at 12:24 pm

The Health Care Blog has an entry that asks, “how important should the anecdote be?” And to the point of the WaPo column, for every anecdote of a man who feels saved by prostate treatment, EVIDENCE suggests there are many more – untold – anecdotes of men who feel their lives greatly diminished for the zealous attack on a few cancer cells that probably wouldn’t have killed them, but has left them impotent and incontinent.

If we want to talk about evidence versus anecdotes, it’s important to get all the anecdotes, not just those that reinforce our wishful thinking about the health care system.

Michael Wosnick posted on May 29, 2012 at 4:15 pm

As I wrote in my own blog, we will continue to see the inappropriate use of PSA and other screening tests as long as cancer evokes an unreasonable and morbid fear in patients:
http://www.michaelwosnick.com/screening-for-prostate-cancer-psa-testing-or-not/

Robert Schambach posted on May 30, 2012 at 3:36 pm

As far as the PSA screening goes, my father was diagnoised with prostate cancer at age 66. He underwent the surgical removal of the prostate. I never knew what the type of prostate cancer he had or which alternatives he was offered. The clinic and hospital where he was diagnoised and where the surgery was preformed, is (or was in his time) in my opinion very pro-surgery. Since then, I have been getting a PSA screening every year. I have read about the disease and I am informed of my options if a “high” result is reported. The best protection for a patient in any situation is to become informed about their disease and to make informed decisions about the progress of their health care.Case in point: My mother died recently and while she was hospitalized a small tumor was visualized on her urethra, the urologist reccommended that the kidney, urethra and adrenal gland be surgically removed. He said that within 5 years the tumor could grow and block her urethra. My mother was 84 at the time and had been hospitalized for about a month with a kidney and sytemic infections. My family said not “No!” but “H*ll No!” The surgery, if she survived, and recovery would have taken away any quality of life she had remaining. Do not always blindly follow a physican’s advice.