The Great Prostate Debate: “We” Versus “Me”

Richard Reece

Posted 10/12/11 on MedInnovation Blog

The public demands certainties but there are no certainties.

H.L. Mencken (1880-1956)

The government, representing “We, The People,” is responsible for spending the public’s money intelligently based fact. The individual citizen, “Me, The Person,” is responsible for preserving his/her health based on what he/she perceives to be in his best interest.

With PSA screening for prostate cancer, these responsibilities conflict because the screening may do more harm than good. Prostate cancer is a common, slow moving cancer. Five times more men with it than from it, and the side effects of biopsy and treatment can be devastating.

Hence, the great prostate debate – whether to screen routinely for prostate cancer with PSA testing, and whether to biopsy and treat patients with marginally elevated levels.

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Prostate Cancer Screening – Is Science Winning?

Joe Paduda

First posted 10/07/11 on Managed Care Matters

Brian’s Note: Readers interested in this topic will also want to see “Can Cancer Ever Be Ignored” by Shannon Brownlee and Jeanne Lenzer, published yesterday in the New York Times Magazine.

The announcements this week that the United States Preventive Services Task Force has decided healthy men shouldn’t get the P.S.A. blood test is long overdue, but nonetheless very welcome news.

The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don’t.

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The Meeting That Wasn’t, Revisited

Kenneth Lin

First posted 10/05/11 on Common Sense Family Doctor

New York Times Magazine story published on the newspaper’s website this morning details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF’s scientific activities on a wide range of topics.

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Mammograms and Death Panels: Why the Preventive Services Task Force Keeps Pulling Its Punches

Kenneth Lin

First posted 8/18/11 on Common Sense Family Doctor

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their work, however, the USPSTF won accolades and respect for “calling it as they saw it,” sticking strictly to the evidence and writing screening recommendations that frequently conflicted with more expansive guidelines promulgated by other professional organizations.

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Prevention Politics Injures Patients

Kenneth Lin

First published 5/31/11 on Common Sense Family Doctor

PPIP is an acronym that officially stands for “Put Prevention Into Practice,” which serves as both the name of the Agency for Healthcare Research and Quality’s programs to disseminate the preventive care recommendations of the U.S. Preventive Services Task Force as well as the tagline for a series of case study questions about these recommendations that I wrote for the journal American Family Physician from 2008 to 2010. Given theunfortunate events that have occurred since the USPSTF became inextricably linked to the Obama health care reform bill, however, I now propose a new meaning for PPIP: Prevention Politics Injures Patients.

In a recent New York Times editorial, “Squandering Medicare’s Money,” Archives of Internal Medicine editor Rita Redberg, MD pointed out that the Medicare program paid physicians more than $40 million in 2009 for screening colonoscopies in patients over age 75, and $50 million in 2008 for PSA screening in men age 75 and older and Pap smears in women age 65 and older. That’s nearly $100 million alone for 3 tests that the USPSTF concluded have few or zero health benefits and have a high potential to cause harm, and it doesn’t count the additional millions (billions?) of dollars of additional testing and procedures that result from these unnecessary screenings. Dr. Redberg writes:

Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the [U.S. Preventive Services] task force’s recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.

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