Sunday, October 23, 2011

Inside Medicine: Science over politics

From the Sacramento Bee

Published: Sunday, Oct. 23, 2011 - 12:00 am | Page 17I

For more than a decade, I have raised questions about the efficacy of routine prostate cancer screening (PSA tests) for middle-age men at average risk of prostate cancer.

Yes, prostate cancer is a horrible illness, but the PSA test just isn't accurate and is plagued by serious problems.

After careful review, the U.S. Preventive Services Task Force has issued a new recommendation regarding the test. For men at only average risk of prostate cancer (no family history), the benefits of the test are unlikely to outweigh the harms.

Part of the problem is that most older men will eventually develop abnormal cells in their prostate. We have labeled these as "cancer" cells, but the vast majority of men will never be affected by these cells. For those who have the serious form of prostate cancer, we aren't sure how effective our treatments are and whether they actually prolong life. Nearly half the men who receive treatment are plagued by serious side effects like impotence and incontinence.

Why did it take so long to publish these recommendations when the science has been very clear for a long time? Our scientific community has been too timid to stand behind and defend good science in the face of political and emotional opposition. The opposition to most good medical guidelines – or good science in general – are those who feel the science stands in the way of their money, power, or self interest – urologists in the case of prostate cancer screening, oil companies in the case of offshore drilling or banks in the case of improper loans.

The task force was ready to issue these prostate cancer guidelines nearly three years ago, but it was broadsided by a political storm over similar recommendations against routine mammograms for women ages 40 to 50 with only an average risk of breast cancer. Similarly, that debate wasn't so much about the science as it was about politics, money and self interest.

At last the task force mustered its courage and tackled an issue that again has resulted in political controversy. My hope is that we can stay focused on the science.

These recommendations are only about good medicine. The task force has no political agenda, and it is not trying to save money. What doctors and the public need is unbiased, scientifically sound advice about what in medicine works and what doesn't. That is the charge to the exceedingly smart men and women who sit on the task force.

We have learned that too often we cannot trust those with a strong self-interest – those who make their living treating the disease in question or making the drug or device. The task is exactly the group of scientific experts who should be making these recommendations. Bravo.

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