I was struck by the recurring themes in this week's health news and planned to blog about it today. But Lindsey Tanner of AP beat me to it with her story, "Experts say US doctors overtesting, overtreating."

She begins:

"Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggest that too many Americans - maybe even President Barack Obama - are being overtreated.

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

A combination of both is at work, but now new evidence and guidelines are recommending a step back and more thorough doctor-patient conversations about risks and benefits."

I had picked up on that same theme in this week's news:

• An independent panel convened this week by the National Institutes of Health confronted a troubling fact that pregnant women currently have limited access to clinicians and facilities able and willing to offer a trial of labor after previous cesarean delivery.

• A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests.

• CT scans may pose cancer risk, new research indicates: Doctors, patients should weigh risks vs. rewards of medical imaging. (Chicago Tribune story.)

• Controversy over "value-based insurance design" that tries to address the problem of underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable. (Kaiser Health News story.)

• Expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there's clear evidence that they improve outcomes. (MedPageToday.com story.)

• Dr. Richard Ablin's op-ed in the New York Times, "The Great Prostate Mistake." Excerpt:

"Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit."

• And the letter to the editor that followed:

To the Editor:

I can only wish that Richard J. Ablin's article had appeared years ago and spared me and probably many others needless pain and anxiety.

In 1997, at the urging of a couple of friends, I walked into a clinic feeling great and a bit foolish. P.S.A., 9-plus. Biopsy, of course (ouch), and I was told of a "little suspicious gray area" on a film. Lab test result, positive. Doctor recommendation: surgery or radiation.
I decided against both and never looked back, and have lived happily and healthfully ever after.

By the way, the 10 or 15 percent chance of bad side effects (I asked) from surgery is really far higher, from what I've read and heard. Watchful waiting is still the best suggestion any doctor can offer.

Robert S. Corya
Indianapolis, March 10, 2010

• CBS' Harry Smith's live colonoscopy coverage that never touched on any questions about evidence for colonoscopy and some of the questions that have been raised about the overselling of colonoscopy - perhaps resulting in the decline in use of a $20 blood stool slide test.

While Smith's colonoscopy was being televised, I was attending a meeting entitled, "First, Do No Harm," hosted by the US Agency for Healthcare Research & Quality. The purpose of the meeting was to guide future AHRQ research on how to get doctors and patients to stop pursuing approaches for which there is net harm - not benefit. Clearly, health care in the US struggles even with the clearcut issues of cutting back in the face of net harm - much less in grey areas where there is uncertainty about harms vs. benefits.

But kudos to Lindsey Tanner of AP for trying to tie together the week's news in the way she did. We could have stories like that every week. And if we did, we'd have a lot smarter health care consumer population.

Here's another problem with the practice of TV networks using physician "contributors" to comment on health care news. They may have a clear conflict of interest that is not addressed.

When the American Cancer Society released its updated guidelines on prostate cancer screening today, Fox News reported:

"Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City, said he thinks the new guidelines could cause unnecessary deaths.

"In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer," Samadi said.

"Knowing your PSA is power, it is educational; you follow it all the time. You can find a silent prostate cancer that will not affect you, and there is a possibility to over-diagnose, but that's a risk the patient needs to take. You could also find cancer that could lead to death."

The number of prostate cancer deaths continues to decline because of regular screening, Samadi added.

"I really recommend (the age) of 40 as a baseline age," Samadi said."

Doesn't Fox see that he has a blatant conflict of interest on this topic as one who runs a robotic surgery center? There are countless ways to counter these short quotes from Dr. Samadi, but I'm not going to run through them here. Read the Cancer Society report and you'll find all of them there - in dispassionate, non-conflicted, evidence-based depth.

Look at how Katie Hobson of US News & World Report included an expert urologist's input, and one with a much more open-minded and balanced perspective.

"... the gist of all this is a firm end to the notion, still held by some clinicians, that screening for prostate cancer is "the same as colorectal cancer screening or cholesterol screening," says Durado Brooks, director of prostate and colorectal cancers for the ACS and coauthor of the report.

"There has to be a conversation," says John Davis, assistant professor in the department of urology at the M. D. Anderson Cancer Center in Houston. "And these guidelines give some very nice bulleted points and Web links you could build into an information sheet and give to patients."

The American Cancer Society has just released updated guidelines on prostate cancer screening.

Because of the uncertainties of benefits vs. harms of such screening, the ACS puts a new emphasis on shared decision-making and on the use of patient decision aids to help men.

Excerpts from ACS statements released today:

"As it has since 1997, the American Cancer Society advises against a general recommendation for men to undergo screening, instead saying testing should only occur when a man is provided the opportunity to learn about the limitations and potential benefits of screening and treatment.

...The guidelines now outline the uncertainties regarding the balance of benefits and harms associated with screening. They clearly state that every man should be told of the uncertainties, risks and potential benefits of screening, and that no man should be tested without receiving this information."

On the problems with big community screening events:

"The American Cancer Society discourages participation in community-based prostate cancer screening programs unless those can adequately provide for an informed decision-making process and appropriate follow-up. For men who have limited or no access to other sources of care, community-based screening programs may provide the only opportunity to make an informed decision about testing. Men who are contemplating screening through these programs should first receive high-quality objective informed decision-making, either through interaction with trained personnel, or through the use of validated, high-quality decision aids, appropriate to the target population. Since virtually all men age 65 years and older have health insurance through Medicare, they should be discouraged from participating in community-based screening programs, and should be referred to a primary care provider."

The Foundation for Informed Medical Decision Making (disclosure: they support this HealthNewsReview.org project) posted a video clip with its president, Dr. Michael Barry, reinforcing the shared decision-making message.

For now, the Foundation's shared decision-making program on prostate cancer screening can be seen online. Check it out.