Gentlemen, What's Your PSA?
I don't really want to know your PSA number. I don't even know Mr. Chauvinist's PSA number, I just know his doctor gave him a passing grade.
In the course of his annual physical today his doctor asked if he had heard about the U.S. Preventative Services Task Force's recommendation that ya'll just skip your PSA tests as long as you're feeling ok. Cause, you know, not that many men die from undetected prostate cancer. Or something.
Our doctor is one of those no-nonsense outspoken Christian types. And according to Mr. Chauvinist, she had a few choice words for the USPSTF! She's not alone.
Dr. Deepak Kapoor, chairman and chief executive of Integrated Medical Professionals, which includes the nation's largest urology practice, disagreed to the New York Times, saying "We will not allow patients to die, which is what will happen if this recommendation is accepted."
What do liberals have against health screenings? It's not like a blood test is all that invasive. You just can't help but think their plan for reducing spending on health care is for more people to die young. Remember a similar recommendation last year for women to forgo mammograms? "If we don't test people, we won't find anything. If they happen to die prematurely, well... that's a shame, but we'll save money on the screening end and on the treatment end! It's a win/win for government." Was it Stalin who said, "One death is a tragedy. A million deaths is a statistic?"
Get your screenings while they're still available.
Oh, and ObamaCare delenda est.
P.S. Is anyone else disturbed that we even have a U.S. Preventative Services Task Force, let alone one making recommendations like this?
P.P.S. Why do the British papers do so much more reporting on our government's scandalous malpractice than our own media?
- Comment (25)
- · Quote
- · UnfollowFollow (1)
- Pages:
- 1
- 2
Comments:
Sep '10
Re: Gentlemen, What's Your PSA?
My score is 9-9-9
May '10
Re: Gentlemen, What's Your PSA?
The irony here is that one of the major underpinnings of the left's socialized medicine nirvana is the ability of prevention to allegedly hold down long term costs.
Speaking of irony, here is a Presidential proclamation from just last month:
"I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2011 as National Prostate Cancer Awareness Month. I encourage all citizens, government agencies, private businesses, nonprofit organizations, and other groups to join in activities that will increase awareness and prevention of prostate cancer."
But now just one month later, things appear to have changed. Though perhaps the thinking of the USPSTF is that now that we are aware of Prostate Cancer, we no longer need to screen for it....
Feb '11
Re: Gentlemen, What's Your PSA?
The New York Times ran an interesting article on the PSA test a few days ago. Excerpt:
Prostate Test Finding Leaves a Swirl of Confusion
By TARA PARKER-POPE
For men living with a diagnosis of prostate cancer, the news that the P.S.A. test does more harm than good has been unsettling and confusing.
After all, that is the test that first led to their diagnosis — and, often, a painful and traumatic course of treatment. ...
... This week, the United States Preventive Services Task Force is expected to announce its recommendation against routine testing for blood levels of prostate-specific antigen, the protein that can be a signal of prostate cancer. The panel says research shows that over all, the test does not save lives and leads to unnecessary surgery and radiation treatment for slow-growing cancers that would never have caused harm. As for faster-growing, invasive cancers, there’s no proof that P.S.A. tests and earlier treatment offer any overall benefit.
Feb '11
Re: Gentlemen, What's Your PSA?
The USPSTF has a well-earned reputation of meticulously unbiased reviews of the medical literature. I disagreed with their recommendation about mammography for women in their 40s, but other than that I think their recommendations are entirely sensible. And they have no power other than persuasion. If you want to have tests with no proven benefit (or tests which have been proven to be harmful) no one can stop you.
Here's my summary of their prostate cancer recommendation this week. Please give it a read. If you like, I'll be happy to continue the discussion.
Conservatives shouldn't fall into the trap of politicizing non-political events. Data should be allowed to speak for itself.
What's my bottom line with patients now? I certainly would recommend against the test for anyone over 65 as the harms clearly outweigh the benefits. From 50 to 65 I would have a detailed discussion with the patient and let him decide while making it clear that I have no confidence that the test, on balance, is helpful.
I'm 43. I hope we have more conclusive data in the next 7 years.
Dec '10
Re: Gentlemen, What's Your PSA?
Thanks, Doctor Bean. I'll read your summary.
But first, I will add two thoughts after reading the NYT piece. It doesn't sound to me like the test is the problem. It is the interpretation of the data and what men and their doctor's decide to do with it.
And second, the position of liberals and the NYT, but I repeat myself, is that no one should be making a profit in medicine. Therefore, these urologists, who are exploiting the fears of men and castrating them for money, are evil and should be stopped. From the NYT:
"Treating patients with prostate cancer is a highly profitable business in the United States, and much of the practice of urology is dedicated to this fight. If men no longer get screened routinely, urologists will see a steep decline in patient visits and income. But Dr. Kapoor rejected the notion that profit plays any role in his defense of screening.
“That I’m going to treat patients that don’t need therapy is morally repugnant,” he said."
While I have no doubt that some men have undergone unnecessary treatments, I'm pretty sure men's lives are being saved.
Dec '10
Re: Gentlemen, What's Your PSA?
"Treating patients with prostate cancer is a highly profitable business in the United States, and much of the practice of urology is dedicated to this fight."
I've heard dermatologists make half their money from removing tattoos. Should we outlaw tattoos? Wait...
Feb '11
Re: Gentlemen, What's Your PSA?
WC: But because our current system is largely paid by third parties (i.e. not by the patient) lots of care which is either without benefit or actually harmful is delivered. So in a third party payment model the profit motive can actually harm patients. I can't tell you how many useless tests I've advised my patients not to have.
In a regular free market in which patients pay, patients would be much more savvy in educating themselves about the benefits of whatever they're about to pay for, and many fewer worthless services would be delivered. But now, patients will demand anything because "it's covered". Urologists have been for decades notoriously over-aggressive in treating prostate cancer, because there is no opposing force saying "diagnosing this 80 year old with prostate cancer can't possibly help him". If the 80 year old had to pay, he'd figure that out.
Dec '10
Re: Gentlemen, What's Your PSA?
You and I agree on this third party payer problem. Awful distortions result. No question.
I just want to understand what you're saying about the 80 year old. Is it that 80-year-olds tend not to get the aggressive cancers, or that they shouldn't undergo extensive and often quality-of-life altering treatments at their age? We already agree that if they had to pay for treatment, it would probably affect their decision.
Feb '11
Re: Gentlemen, What's Your PSA?
It's explained in more detail in my post linked to above, but the basic issue is that prostate cancer is very slow growing and typically takes a decade or more to hurt anyone. That means that an 80 year-old with newly diagnosed prostate cancer is exceedingly unlikely to be harmed by it, and very likely to die in the next decade of something else. The benefits of prostate screening (if any, again, see the post) are delayed many years but the harms are immediate.
Dec '10
Re: Gentlemen, What's Your PSA?
My hope was to die young and leave a beautiful corpse, but, sadly, I've probably tripped over the threshold already.
Mar '11
Re: Gentlemen, What's Your PSA?
Government efficiency = Drop the PSA & let the TSA do a DRE
Jun '10
Re: Gentlemen, What's Your PSA?
Very timely for me. I just hit the 60 mark (still waiting on a shower of gifts from Ricochet). My PSA has been on the high side of normal for a while and my family doctor has now referred me to a urologist, who on Thursday will perform an examination (think the "Moon River" scene in Fletch) and perhaps do a biopsy. No government bureaucrat, thank heaven, was involved in that process.
I respect the observations of Dr. Bean but am glad that my physician is calling the shots, and not a "task force." I have every expectation of a happy outcome.
I completely agree re older patients. My father, when he was about 80, was diagnosed with probable prostate cancer. He had a very bad heart and the doctors wisely told him to not worry about it. He didn't, and died four years later when his heart finally gave out on him.   But the course of treatment (or non-treatment) was a decision between my dad and his doctor. Throwing a bureaucrat into that process fills me with a double-secret Voldemortian dread.
Edited on October 15, 2011 at 8:16pmFeb '11
Re: Gentlemen, What's Your PSA?
Ooh. The Main Feed! Congrats Western Chauvinist! It looks like the editors think that a lively discussion of statistics and a particularly gross male organ will really drive traffic.
Tabula Rasa: Best of luck to you. I hope it all turns out boring.
May '11
Re: Gentlemen, What's Your PSA?
As a physician, I mostly agree with Dr. Bean's assessment above but as a conservative skeptic, i.e. pessimist, I question that the USPSTF is as apolitical as he asserts. Please remember that the most cost effective healthcare delivery system would provide no medical care and everyone would die.
We can't solve these problems in 200 words or less, but I urge everyone to try to find a physician working within a small practice to be their doctor. Do everything in your power to make sure he or she knows who you are and values your support. Get to know everyone in the office, if you can, and bring cookies often when you visit. You need all the help you can get to navigate the morass of medical care.
Feb '11
Re: Gentlemen, What's Your PSA?
Tabula Rasa: No one is "throwing a bureaucrat" in any clinical process. The USPSTF just reviews data. All decisions are between doctors and patients. But in regards to your dad, his doctors would have been wise to read the USPSTF more diligently. Why did they check a PSA on an 80 year old with heart disease? If you're just going to ignore the results of the test, better not to do it.
Feb '11
Re: Gentlemen, What's Your PSA?
Southern Pessimist: Totally agree with your advice. But, regarding your skepticism of the USPSTF, the data that they review is completely open to the public. Read the Annals of Internal Medicine article that publishes their findings. (I link to it in my post, which I linked to in my first comment.) Then you can make up your own mind about whether their conclusions are supported by the data or not. There's no secret funny business here. All humans have biases, but if the data is disclosed everyone can judge for himself. And, by the way, this prostate cancer analysis had nothing to do with cost-effectiveness, just with whether screening helped or harmed.
Like I said, I disagreed with their conclusions about mammography in women in their 40s, but I think on this one they are on the mark.
Jun '10
Re: Gentlemen, What's Your PSA?
Why it was done on my dad I don't know. It may have been one doctor who had it done and another who said it was meaningless. At least they didn't try to "cure" him at that point in his life.
On my concern about bureaucrats under Obamacare, the problem is that the law is so opaque that no man on the street knows where bureaucrats will stick their officious noses. All I know is that with scores of new "boards," bureaucracy will be in a lot more places than it is now. As a lawyer, I've learned that bureaucrats always seek to broaden their power. That fills me with Voldemortian dread.
Finally, thanks. Boring will be fine for me.
Edited on October 15, 2011 at 8:46pmRe: Gentlemen, What's Your PSA?
Back in April, I posted a piece entitled Prostate Cancer: New Procedures for Diagnosis -- and Cure that may be pertinent to this debate. I was a guinea pig back in March in a National Institutes of Health study of new procedures which make possible a targeted (as opposed to a scatter-shot) biopsy, which is capable of distinguishing slow-growing from aggressive prostate cancer. Within a few years, I suspect, this will be available to everyone -- and it will change everything. The physicians I met at NIH argue that the use of the PSA test and follow-up biopsies have dramatically reduced the number of deaths from prostate cancer. Take a look at my post if this is of concern to you.
Edited on October 15, 2011 at 8:50pmMay '11
Re: Gentlemen, What's Your PSA?
Doctor Bean: Southern Pessimist: Totally agree with your advice. But, regarding your skepticism of the USPSTF, the data that they review is completely open to the public. Read the Annals of Internal Medicine article that publishes their findings. (I link to it in my post, which I linked to in my first comment.) Then you can make up your own mind about whether their conclusions are supported by the data or not. There's no secret funny business here. All humans have biases, but if the data is disclosed everyone can judge for himself. And, by the way, this prostate cancer analysis had nothing to do with cost-effectiveness, just with whether screening helped or harmed.
Like I said, I disagreed with their conclusions about mammography in women in their 40s, but I think on this one they are on the mark. · Oct 15 at 11:26am
As a former primary care physician I shouldn't go here, but I don't need a board of primary care providers speaking with the weight of the federal government to advise me.
May '11
Re: Gentlemen, What's Your PSA?
Paul A. Rahe: Back in April, I posted a piece entitled Prostate Cancer: New Procedures for Diagnosis -- and Cure that may be pertinent to this debate. I was a guinea pig back in March in a National Institutes of Health study of new procedures which make possible a targeted (as opposed to a scatter-shot) biopsy, which is capable of distinguishing slow-growing from aggressive prostate cancer. Within a few years, I suspect, this will be available to everyone -- and it will change everything. The physicians I met at NIH argue that the use of the PSA test and follow-up biopsies have dramatically reduced the number of deaths from prostate cancer. Take a look at my post if this is of concern to you. · Oct 15 at 11:49am
Edited on Oct 15 at 11:50 am
Thanks for posting that. It describes a perfectly rational and effective approach to the issue but it is expensive to say the least. This conversation illustrates the dilemma we face. How much is your life worth and can you afford it?