Health News Review

About 20 months ago, Dr. Michael Wilkes of UC-Davis and a colleague wrote an editorial in the San Francisco Chronicle, “PSA tests can cause more harm than good.”  He questioned his institution’s public event for men focusing on prostate cancer screening.  Excerpts of the editorial:

“Sadly, most men are never told the facts about the test, nor are they encouraged to make their own informed decision. The UC Davis course doesn’t even acknowledge a problem with prostate cancer screening. Its expert presenters – including two urologists and a professional football player (!) – will tell you that you need to “know your (PSA) statistics” beginning at age 40. …

We can’t say why UC Davis offers this course that ignore scientific evidence, but we wonder whether it just might have to do with money. Testing for and treating PSA-identified cancer is a large part of the practice of many urologists so it may not be surprising that urology groups take a far more positive stance on the test than almost any other doctors. They also fund a pro-PSA lobby that now includes the National Football League.

Health care spending is threatening to wreak greater and greater havoc on our economy. That’s not to say we shouldn’t invest in treatments that lead to improved health, even when they’re expensive.

And UC Davis, the NFL and surgical device companies have the right in our society to promote events in order to increase their profits. But we worry when companies and doctors with a conflict of interest sponsor what could be considered an infomercial endorsement to unsuspecting men without telling them they might end up being harmed as a result of a simple PSA blood test.”

Last week, InsideHigherEd.com reported that hours after that editorial was published, UC Davis administrators kicked off a series of steps to remove Wilkes from leadership positions he had held.  Excerpt:

Now, a committee on academic freedom at the university that investigated allegations of intimidation and harassment against Wilkes has found them to be true. The faculty committee said in its report, a copy of which was obtained by Inside Higher Ed, that the actions of the university administrators cast doubt on its ability to be a “truthful and accountable purveyor of knowledge and services.”

The group has asked the dean and other top officials at the university’s school of medicine to write letters of apology to the professor, admit to errors of judgment, stop proposed disciplinary actions against him and take steps to prevent future violations of academic freedom.

At the end of last week, the UC Davis Academic Senate Representative Assembly voted 52-0 to:

  • affirms the right of academic freedom of Professor Michael Wilkes and all other faculty to publish scholarly articles and professional expert commentaries that address ethics and societally relevant critiques.
  • call upon the Dean, Executive Associate Dean, and the Health System Counsel of the School of Medicine of the University of California, Davis, all to:

1. Accept promptly and publicly responsibility for serious errors in judgment;
2. Write individual letters of apology to Professor Wilkes;
3. Rescind in writing all disciplinary actions that have been stated, proposed, or taken
against Professor Wilkes.

Also:

  • Resolved, That the Representative Assembly of the Davis Division of the Academic Senate expresses severe disapproval of the notion that the University of California may take legal action against professors whose scholarly publications or professional expert commentaries may be perceived by University administrators to be injurious to University interests.
  • Resolved, That the Representative Assembly of the Davis Division of the Academic Senate calls upon the Chancellor of the University of California, Davis, within six months to:

1. Take concrete steps to prevent future violations of rights of academic freedom and
report to the Davis Division the steps that have been taken to this end.
2. Have the Dean of the School of Medicine take appropriate training to prevent
academic freedom violations.

Finally, in a 50-0 vote, the Assembly added a resolution:

That the Representative Assembly condemns Health System and Campus Legal Counsels for drafting inappropriate and apparently threatening letters that violated a faculty member’s right to academic freedom.

 

Comments

Susan Fitzgerald posted on June 15, 2012 at 11:53 am

Anxiously awaiting to hear of university response to said Assembly actions. Guess this is what comes of running universities like a business, and thinking of its departments as revenue generators. All threats to revenue are countered immediately and severely. Truth and academic freedom (and the public) be damned.

Gary Schwitzer posted on June 16, 2012 at 1:10 pm

For more background, see this entry on The Tree of Life blog by Professor Jonathan Eisen of UC-Davis:

http://phylogenomics.blogspot.com/2012/06/updates-on-ucdavis-academic-freedom.html

J d smith posted on June 17, 2012 at 12:09 am

FYI I am a urologist.
PSA is a screening device. It is not a diagnostic test. It is a probaility index.(ie your risk of having a prostate cancer ) Asumming an examination that excludes other causes of a PSA elevation,a PSA between 4.1 and 10 in a 50 + year old male will fInd about 20 – 30 % of of these men with a prostate cancer. Cure rates or excellent survival rates of about 75 to 85% can be expected.
Until the pathology report and other staging is done, risk factors can not determine what if any treatment can or should be offered.
All men will have a prostate cancer if they live long enough. The incidence increases with age.
An informed consent or “shared decision making” discussion should be done with each stage of this process as it should be with most medical care.
As a patient you need to understand why something will be done. What are the reasons for and against it and what are the alternatives. Medicine is not absolute.
We rarely find advanced cancers in patients anymore in screened patients ,unless their PSA’s are higher than twice normal. The treatment options or a watchful waiting approach can be tailored to a patients choice . PSA is about choice and understanding . The decision is yours!

    Gary Schwitzer posted on June 17, 2012 at 8:40 am

    Dr. Smith,

    Thanks for your note.

    Yes, PSA is about choice – including the choice a man has on the upfront decision about whether to choose to be screened.

    Shared decision-making should come into play on the screening decision as well.

Maggie Mahar posted on June 18, 2012 at 11:37 am

What happened is extraordinary– and it is all tied up with universities thinking of themselves as corporations, rather than institutions of learning.

As for PSA “screening,” Gary is right– at the very least, a man should be given a choice about being screened. Though given what we know about the risk/benefit ratio of PSA screening, it’s not at all clear why a doctor would bring it up in the first place. Most men with prostate cancer will never suffer symptoms.

Until we have a screening test that discriminates between the prostate cancer that will cause problems and those that won’t, “screening” seems a bad idea. Once a man is told that he has prostate cancer, it is very hard for most men to choose “watchful waiting.” The typical response is “I have CANCER! Someone must do something NOW.” This leads to unnecessary treatments, and life-changing side effects.

Prostate Cancer has become Big Business-.

Ron Byrd posted on June 19, 2012 at 9:43 am

Apparently this isn’t the first time Dr Wilkes caused a stir on this topic. See this link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122189/bin/bmj_324_7332_255_a_index.html