My cancer is not random, it’s mine

There are three things profoundly wrong with a U.S. government panel’s recommendation to end blood tests for prostate cancer.

First, what does stopping the test do for a man? It makes him ignorant of what is happening in his own body. It makes him incapable of making a decision about his own health and fate. Since when and how is a lack of information better than information?

Second, prostate and testicular cancer are curable when caught early. Why the hell would we not continue to try to detect these men’s diseases?

Third, the panel treats men as a statistical pool, not as individuals. It says that overall, the test does not reduce deaths. Whether or not that’s so is of no concern to me. I’m not member of a pool or a data point in it. I’m not random. I’m one man with one prostate. It was cancerous.

The problem here is that medicine cannot yet detect the difference between fast-spreading — and often fatal — prostate cancer and slow-spreading tumors that take so long to grow that oftentimes something else kills their hosts first. So, yes, some tumors are taken out that would not have killed a man. But there is no way to know that.

So who wants to take that gamble? Not me. I had prostate cancer. I was told I could react with “watchful waiting.” But I chose not to. Of course, I did. Informed I had cancer in my body, I had to get it out. I have a responsibility to my family to stay alive so I can provide for them (among other things, I hope). I also have a responsibility as a member of an insurance pool to get a disease treated earlier and for less, if possible. If I let the disease progress, it could involve extremely expensive treatment — radiation, chemotherapy, hormone therapy, hospitalization — for a cancer that spreads from the prostate to the bones to the rest of the body. I know. That’s how my grandfather died.

Does the surgery have side-effects? Oh, let me tell you, it does. I’ve made no secret of them — quite to the contrary, my publicness about them inspired me to write Public Parts.

It has been two years since my surgery and I owe you an update. I am still impotent. I have tried Viagra and Cialis to no effect other than indigestion. I went through the ordeal of shopping for and buying a penis pump (once again being nice to my insurance pool by not buying the one that’s overpriced for those bringing prescriptions; I bought the exact same thing for much less with my own money). It did nothing but mangle and misform my already abused penis and cause pain. I am getting ready to get trained in the art of sticking a needle in my dick to make it engorge, if it still can.

Oh, yes, there are side-effects. The government wants to protect me from them while not protecting me from cancer, a cancer that could or could not kill me, no one knows.

That is my choice. It is a choice I can make only with information, information about my body the government now wants to keep from me.

Wrong. Profoundly, fatally wrong.

  • Definitely Wrong.

  • Sorry, but I don’t understand how this task force report is wrong. The government is not going to be keeping any information from you. You can get as many PSA tests as you want. In fact, the government task force is providing all of us with great information: their review of all the science indicates that PSA tests do not save lives and likely cause much unnecessary medical treatment. Don’t you want to know that information? Isn’t that information valuable when deciding whether to have a PSA test?

  • Matt Ricci

    So progressive in your transparency. I know you’ve always been open, but this was particularly blunt.

    I always appreciate how you write, thank you. Best of luck on your continued battle.

  • tcv

    Your commentary about impotence brings up a question. It’s a tough question, but since you seem agreeable to speaking about dangly stuff I thought you might answer.

    I’ve never been impotent. I have taken medication that inhibits the ability to have orgasms and that was … weird.

    I have noticed that there is a mind-component to arousal. (Of course there is.) What I am getting at is: When I feel arousal, regardless of the fact of whether I am erect at the time or not, there is a tiny mental urgency that I think never quite goes away. I’ve let it lie for a few days for whatever reason and the urgency fades and returns over and over again.

    When one is impotent, do you still feel that urgency in the mind?

  • Andy Freeman

    If a procedure or test is good enough for a member of congress to have as part of paid-by-me healthcare, it’s good enough for me.

    What? They’re more important, so the cost-benefit numbers are different? I don’t think so….

    I’m all for letting govt experiment with different ways to do healthcare. However, the experiments should be run on civil servants, politicians, the military, and aid recipients. (That’s roughly half of the US population.) Then we can decide about whether to do the same for the rest of us.

  • Brent Longborough

    Jeff, I admire the courage you’ve shown throughout your admirably public illness, but I think you’re wrong on this one. The basic message from all the research is that PSA testing is useless. A regular rectal exam is the way to go. That’s how I discovered an enlarged prostate which eventually required surgery but was not, happily, cancerous. During the treatment, PSA tests showed elevated levels, but it was the finger, and later the biopsy which cleared me.

    And the urologist said “almost every biopsy shows, at least, small traces of cells which are, rigorously, cancerous, but will never become dangerous”.

  • We’re at a place in medicine where we don’t know what to do in our policies or in our personal treatment decisions.
    “There are no reliable signs or symptoms of prostate cancer,” said Dr. Timothy J. Wilt, a member of the task force and a professor of medicine at the University of Minnesota.
    According to this doctor’s assessment, your successful outcome, Jeff, is the result of your making a lucky guess. The likelihood that anyone faced with the same data making the correct decision (to have treatment or not) is no better than chance. That’s no place to be but that’s where we are.
    I’ve been treated for depression since I was a teenager. I’m getting good results from an antidepressant that unusual and, because it’s unusual, damn expensive. The guidelines for treatment of depression in the general population don’t work for me.
    Truth be told, though, most treatments don’t work and many treatments can be more deadly than the underlying cause. (Adding Seroquel can trigger irreversible diabetes.)
    I got lucky in my choices. I did the research, was truthful with my doctors, and, yet, in the end, was lucky in my choice and being able to afford an expensive treatment regimen.

    • No you are leaving out the biopsy. The PSA trend merely led to the decision to have the biopsy and it is the biopsy that quite correctly found cancer. It was a biopsy that found my next cancer, thyroid. If I had let either just go I’d have been irresponsible and so would my doctors have been.

      • OK. I stand corrected. The biopsy correctly diagnosed your cancer. While s biopsy is dependent on the extent of the cancer and the skill of the physician, it is by far the best detection tool. (I have a friend whose intestinal cancer was missed because the needle took cells from healthy tissue rather than from the nearby tumors.)
        Leading to two more points. Before I get to those, though, I must note that I believe that routine P.S.A.s should continue for men over 40 and that we should focus our efforts on better, less invasive diagnostics and treatments. Unfortunately, as the article states, there’s a lot of money in play with the current schemes.
        Often our old weapons against big data are anecdotes. We have wonderful stories and terrible tales of things gone right or wrong against the odds.
        Unfortunately, stories can lead us astray. The anti-vaccination crowd relies on bad science energies by anecdotes to put their children at great risk.
        The other point is that we do have to gauge the costs of routine procedures, moderate some, and increase some other. (My final anecdote is that my melanoma was identified as the result of my HMO’s free annual physical. The cancer was excise and follow-ups detected a recurrence which was also treated.) Routine screening for depression, however, has led many people to be treated needlessly with powerful drugs in the hopes of catching the few for whom the condition is indeed deadly.

        ““They’re trying to kill me,” Yossarian told him calmly.
        No one’s trying to kill you,” Clevinger cried.
        Then why are they shooting at me?” Yossarian asked.
        They’re shooting at everyone,” Clevinger answered. “They’re trying to kill everyone.”
        And what difference does that make?” “

  • Now that I’ve discovered you and become a regular reader, I can’t help but comment on today’s post. Now that the government has decreed that regular screenings are no longer necessary, many people will stop getting them. By coincidence, I had a rectal exam this past Thursday. My urologist at Northwestern Medical Center in Chicago said the size of my prostate was fine but that I should definitely continue to get PSA screenings annually. Clearly, HE feels they’re still important. If I hadn’t had a routine physical two years ago regardless of the government’s lack of endorsement for annual exams, I wouldn’t be here today. I was found to have an enlarged lymph node that led to a biopsy that led to a diagnosis of Hodgkin’s Lymphoma. Fortunately, I was treated and am currently fine. It’s hard enough for many guys to overcome the cultural bias that suggests men are weak if–instead of bucking up–they cave and run to the doctor. But when the government says “don’t bother,” it provides them with yet another excuse to postpone regular medical attention. I couldn’t agree more with your conclusion.

    The other thing men don’t do, in addition to not visiting doctors as often as we should, is talk openly with each other about issues regarding our health, particularly around sexuality. Thank you for your healthy candor. You’re modeling signals a shift in the repressive culture men need to grow beyond.

    • Amen, brother.
      Glad to hear you’re OK. Keep it up.

  • And you knew I’d be weighing in on this one. My husband, a physician, died of prostate cancer almost fifteen years ago. He had several PSA tests, all of them above normal, but he and his urologist conspired in watchful waiting. Finally, after two years of rising PSAs, he had a biopsy, and another, and another. The fourth biopsy shows the cancer. The PSA had shown it from Day One.

    By the time he had the surgery, they couldn’t get it all, and it escaped into his lymph system. Five years later he was dead. His tumor, on a Gleason Scale of 1-8, was a 7. 1-3 are those slow growers. Everything else is dangerous.

    You can’t lump men together as a bunch of statistics. That’s nice from a public health standpoint, but not for the patient. And are the side effects of treatment unpleasant? Damn right they are. We ended up with a penile implant after the shots and the pump proved unsatisfactory.

    I understand the theory of false positives and overtreatment. But I do think people have a right to make choices, and if doctors tell men (who avoid treatment anyway) they don’t need to have a PSA, they will gladly avoid it and inadvertently die in some cases. Let’s have a little granularity in these regulations, please.

  • Sam tapsell

    Your treatment and side effects would always be worthwhile if you had a 50% chance of death that could be reduced to 0.
    The overall numbers are very different though, and most men have unnecesary interventions, and some of those who have surgery or radiotherapy will succumb to cancer still.
    Until we have better genetic typing of the cancer we risk causing greater harm, physical and emotional.

  • Kudos for sharing in such detail. Not enough people speak plainly about health matters.

  • cm

    This really shows the problem with emotional involvement.

    Sure there are cases where screening has detected cancers and lead to a timely cure, but is this the best use of resources?

    If you have x dollars to spend on screening then it should be spent to get the highest benefit. That is going to mean that some people don’t get service but it means that far more do.

    • How horrendously condescending: “emotional involvement.” You bet your ass a human life is emotional. How ridiculous of you to suggest otherwise. The test costs $30 max. Getting the cancer treated now could save huge money if left to later. The decision is mine for my life. Emotional? You bet your sweet ass, it is. But is your side scientific? Not at all. Science is an idiot and an ass in this case because it cannot tell aggressive cancers from those that aren’t. So science is mute and helpless as to the gamble. That decision must be made by a — oh, no, emotional — human being.

  • Steve Mays

    I am glad you are at peace with your decision. My doctors were way out in front of this study and gave me the information — and option– to choose. And I chose not to rely on the PSA screen. Just not reliable enough for my money. I don’t begrudge you your choice, don’t begrudge me mine.

    • Good for you, Steve. What information *did* you get?

  • James

    I read the article and am having difficulty seeing the point. Based upon the best science available (including thousands of deaths following what may have been unneeded prostate surgeries), an expert panel is offering advice that a certain test for otherwise healthy men over 50 appears to offer no net benefit in terms of lives saved. It doesn’t appear to be banning the test or saying people can’t have it at all. It is not saying that a doctor can’t use their judgement to suggest the test if there are factors that it has benefit to a specific patient. As you note, the test itself is cheap enough that paying for it is not an issue for the vast majority of patients.

    So, if we don’t use science to suggest testing guidelines, what should we use? Anecdote? Lobbying by advocates? Tossing darts at the wall or flipping coins?

    Taking this point further, do you object to evidence-based recommendations and panels as a whole? Should there be testing guidelines at all, or should we simply test eveybody for everything using every possible test? As it is, for every test, there are guidelines for its use. If you set the age guideline at 50, are you discriminating against someone who is 49?

    There may also be negative effects associated with the overuse of a test, from cancer due to radiation exposure to false positives that lead to unneeded treatments. I myself underwent a totally useless surgery that took out a section of lung that turned out to be harmless scar tissue from a histoplasmosis infection. A “routine” chest X-ray as part of a physical started the path to having a chunk of non-smoking lung ripped out in my 30s because it “might” be cancerous. My left side still aches a dozen years later.

    What about men who might have developed prostate cancer in their 40s or women who may have developed breast cancer in their 30s? Current guidelines for PSA tests and mammograms exclude them. Are you OK with that or should men over 40 also be getting PSA tests? How about men over 30? At what would even you go, OK, we are really hitting the point of diminishing returns here. I ask this is all seriousness.

    There are people who develop colon cancer years before they hit the age where colon cancer screenings are the norm. Should colonoscopies by offered to lower age groups? If you had to make the decision on colonoscopies, how would you make it? Would you want evidence or would you be pursuaded by the anecdotes of the person who died of colon cancer in their 40s?

    This sort of evidence-based discussion takes place with everything related to health care, from tests to vaccines to procedures to whether an annual physical is even needed for otherwise healthy young adults.

    It is also true there is a certain amount of national resources (public and private) realistically available to pay for all these tests (and everything else in health care). If you will literally run out of money before you run out of tests and populations that might derive some (perhaps minescule) benefit, then what is the rational ordering of priority? Again, is it to be science & cost-benefit or anecdote & advocate lobbying?

    I ask: What is a process you would defend to set guidelines for medical testing (including PSA), particularly when it comes to age cut-offs? If you were serving on a panel tasked with making these decisions, what factors would you personally consider in your decisions?

    • Jeff’s Test


      With all due respect to your difficult experiences with cancer, and we understand that this may be covered more extensively in you book or elsewhere in your writings on the web. This is a great question. Can you answer this question right here in your blog?

      James says:

      I ask: What is a process you would defend to set guidelines for medical testing (including PSA), particularly when it comes to age cut-offs? If you were serving on a panel tasked with making these decisions, what factors would you personally consider in your decisions?

      • Ignorance is not a policy. I’d stick with the current guidelines.

      • Jeff’s Test

        That’s a careless and incomplete answer. Try again.

  • One comment!
    ” The U.S.A. Some of the best medicine on the planet ,That no one can afford” …

  • john

    Couldn’t agree more. Had the same experience 8 years ago and did the same thing you did.Having same problems you are. Don’t give up and try the needle. It does work most of the time.

  • Peter

    Jeff ..

    Thank you so much for you openness and straight forward approach to an extremely difficult topic.

    Many men do not discuss their health issues at all, especially in the public realm.

    You have helped many men by opening up this subject, and for that you are a true leader and inspiration.

  • Jeff — I realize I am late to this post but it has been nagging at me so I thought I should finally put something down in writing.

    First, what does stopping the test do for a man? It makes him ignorant of what is happening in his own body. It makes him incapable of making a decision about his own health and fate. Since when and how is a lack of information better than information?

    The FDA panel found that far too many men were making the wrong decision about their own health and fate as a result of the information. The thrust of its recommendation was not to criticize the information that a PSA test provides — but to criticize the responses to that information that patients were making. There are powerful financial incentives, institutional preferences and cultural prejudices pushing a patient towards choosing self-destructive action over healthful inaction in the face of a positive PSA test. Change those forces and the information does no harm.

    Second, prostate and testicular cancer are curable when caught early. Why the hell would we not continue to try to detect these men’s diseases?

    Because, in the majority of cases, prostate cancer does not need to be cured since it will not be fatal. Furthermore, a high PSA score often does not indicate any prostate cancer at all, let alone a lethal cancer, yet triggers expensive and invasive follow-up procedures just in case it does.

    Third, the panel treats men as a statistical pool, not as individuals. It says that overall, the test does not reduce deaths. Whether or not that’s so is of no concern to me. I’m not member of a pool or a data point in it. I’m not random. I’m one man with one prostate. It was cancerous.

    Let’s try a thought experiment.

    Because of the PSA test, 100 cases of prostate cancer are discovered. Because of those financial, institutional and cultural pressures, 50 men decide to undergo treatment, many with slow-growing cancers, many inappropriately aged. Because of the treatment 10 of them end up impotent. Yet only two of the 50 (you and I) would have died of the cancer. The other 48 underwent unnecessary treatment.

    You say that the impotence of your ten fellow patients’ impotence “is no concern to me.” Yet the same PSA-plus-surgery system that (mis)treated them was the one that saved your life. How many men are you willing to see castrated so that you can live?

    Anyway, given the fact of your grandfather’s prostate cancer, the FDA panel would place you in that minority of men that would still undergo routine PSA testing. Its recommendation would not change the course of your treatment one jot.

    • Andrew,
      Yes, the problem is not with the information but with the treatment but why then treat the information rather than the treatment? The problem, again, is that there is no way of knowing what is mistaken treatment. Until there is, there’s a gamble and the question is whose gamble is it: the pool’s or the patient’s?
      Do you regret having your prostate taken out? Do you wonder, as, of course, I do, whether it was unnecessary? I’m sure you, too, wish you had *better* information so we could have made better decisions.

  • “Whose gamble is it: the pool’s or the patient’s?”

    It is my understanding that the FDA panel found that the pool, taken as a whole, makes a losing gamble.

    Sure, part of the problem is that the information is not good enough. But only part. Surgeons are knife-happy. The healthcare system incentivizes proactive procedures. The culture is cancer-phobic.

    Isn’t the panel pointing out that a universal PSA test functions as an enabler to these malfunctioning aspects of he healthcare system? If a factoid of information (a high PSA score) is more often than not misconstrued and used as a pretext for mistaken action, then how can we call that information valuable?

    And, no, I do not regret having my prostate cut out. At the same time, I am certain that there are thousands of men being permanently mutilated every year because they mistakenly choose action over inaction. The same system that saved my life, mutilates them. Is that a civilized system?

  • Anonymous Intactivist

    Jeff, I can only assume that by “already abused penis” you are in part referencing circumcision. I’m sure you’re aware by now that circumcision (by design) amputates the most sexually sensitive parts of the male genitalia, and leaves what’s left to dry out and become covered by a thick callous over time, which certainly can’t help in your situation.

    You might look into (non-surgical) foreskin restoration, which won’t get back any of the lost nerves/special structures, but can restore what’s left to it’s natural, sensitive mucous membrane state, and would also give you back the natural gliding functions of the penile skin.

    Restoration works by promoting skin expansion through gentle stretching, similar to what’s done for women growing new skin as part of breast reconstruction, for example.

    Here is a beginner’s guide:

    Good luck

  • First, what does stopping the test do for a man? It makes him ignorant of what is happening in his own body. It makes him incapable of making a decision about his own health and fate. Since when and how is a lack of information better than information?


    Especially at a time when we stand to learn more about our health than in the last century or so: “Microbes may indeed be subtly changing our brain early on — and for what purposes we cannot yet say” … “Our results suggest that during evolution, the colonization of gut microbiota has become integrated into the programming of brain development, affecting motor control and anxiety-like behavior

    (The Germ Theory of Government). Not to mention the health of our government too.

  • George Mason

    Agree or disagree, credit Jeff with the courage (although he may not count it so) to open this forum.

  • That’s pretty crazy. I hope you are able to find some sort of a resolution to this. Some of those medical situations baffle me. It make one wonder if the reasoning can be traced to a money trail, when there doesn’t seem otherwise to be any logic behind their reasoning.

    I like to find the silver lining in situations. This wouldn’t be an easy one to put it lightly and I respect that you shared it with dignity. I hope that there is some semblance of a silver lining that can be found somewhere within this situation for you Jeff.

  • Whether you like it or not, statistics matter in medicine. To argue otherwise on emotional grounds or because “I had cancer” is irrelevant, absurd, and harmful because it undermines science-based medicine. Every medical procedure carries risks as well as benefits. Some medical procedures actually do more harm than good, and statistics are the tool by which the medical community figures out which procedures benefit patients and which do harm. Prior to the 20th century, for example, bloodletting was a common treatment for many illnesses including cancer. The statistical work of Pierre Charles Alexander Louis ended the practice and saved lives by showing that bloodletting actually increased rather than decreased the likelihood of death among patients who received it. If Jeff Jarvis were blogging in the 1800s, I imagine that he would be arguing strenuously that Louis’s statistics don’t matter because Jarvis is an individual who actually has had cancer, and therefore he deserves to receive bloodletting regardless of what the statistics say.

  • I just went back and read the New York Times article that Jeff referenced in his blog post, explaining the reasoning behind the advice of the U.S. Preventive Services Task Force to stop performing the PSA blood test on healthy men over the age of 50. This is the paragraph that I find most telling:

    “As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications.”

    In other words, the PSA test actually hastened the death of 5,000 men. If its net effect on mortality was zero, this would imply that the PSA test led to treatments which prolonged the lives of another 5,000 men.

    It may well be that Jeff Jarvis is one of the men whose lives were prolonged by the PSA test and the subsequent treatment which he received, although nothing in his blog post demonstrates that this is indeed the case. But even if that is the case, all it would mean is that Jeff’s life was prolonged while someone else’s life was cut short due to overly aggressive surgery. I can understand why Jeff might prefer that outcome, but I’m sure the other guy who died would disagree. That guy wasn’t “random” either.

    • The information from the test is not the problem. What is done with it is. Simply not knowing is not the solution.

      • Well, that’s not true. The problem is that the information from the test seems to be useless in helping people make effective decisions about their health. Once someone knows that they have prostate cancer, they are likely to respond exactly as you did: “So who wants to take that gamble? Not me. I had prostate cancer. I was told I could react with ‘watchful waiting.’ But I chose not to. Of course, I did. Informed I had cancer in my body, I had to get it out.” This is a perfectly understandable reaction, but by “getting it out” you were also gambling. There was a risk that you might die from the surgery. (Obviously you won that bet.) There was also a risk that you might survive the surgery but suffer significant impairment. (Evidently you lost that bet.)

        Your reaction was understandable, but are you certain that your decision was actually in your best interests? Maybe the information you got from that test merely drove you to injure yourself and put your life at risk. Maybe without the test you would be perfectly healthy right now, blissfully unaware of your prostate cancer, and destined to die eventually of old age without ever suffering any harmful consequences from the cancer at all.

        Suppose instead of “cancer” you learned that you had a capsule containing deadly poison embedded in your body. The likelihood of it ever actually leaking and killing you was 1 in 1,000. The likelihood of your dying from attempting to have it removed was 1 in 4. Common sense and arithmetic would tell you that the safest course of action would be to leave it alone and hope for the best, but every day you would still be worrying about it. So would knowing about it help you or hurt you? Knowing about the capsule would not provide you with any actionable information that could improve your chances of survival.

        In the case of the PSA test, the difference between your chances of dying from the cancer vs. dying from the treatment is not this exaggerated, so the choice you had to make was not as clear-cut. Nevertheless the test did not provide you with clear information about the best way to maximize your chances of survival. Its main effect, therefore, was to increase your anxiety and to motivate you to undergo surgery which may not have actually been in your best interest.

        It isn’t always the case that “more information is helpful.” This is especially a dilemma with medical information, some of which uncovers things that do not actually benefit patients and may even harm them. Genetic testing, for example, has the potential to prompt people to get unnecessary surgeries. There is also a danger that it could become the basis for actual discrimination by insurance companies or employers against people with genetic predisposition to diseases that they do not in fact even have.

        I can understand why you made the choices you made about your prostate cancer, but your condemnation of the U.S. Preventive Services Task Force for its recommendation on the PSA test is off base. For a helpful corrective on this, you might want to check out Merrill Goozner’s blog. Goozner is a journalist who used to work for the Center for Science in the Public Interest and has been writing and researching about medical issues for a long time. He doesn’t work for the government and isn’t beholden to anyone, but he understand the science. Here’s his take on the PSA test:

  • The study by itself is not the problem.

    It’s the fact that government is likely to “ration” health care based on these decisions. In a society where virtually everyone over 65 is held to the whims of government as to what can and cannot be covered, and more and more are put under this umbrella as medicine becomes more and more under government controls.

    There may be no such thing as a “death panel” but the functional equivelant exists in many of the decisions that are based on averages and not individual needs/choices.

    But so long as we seek systems where more and more people are steered into governemnt run health plans, we will have more decisions based on averages, that discount the individual.

    We need to turn things around away from government managed health care (and even private bureaucratic health care at that) and more towards a system where most people self-finance their health care and if economic concerns make one choose to avoid tests that may not be as fruitful on the average, it will be their own choice to make, not some governmet study.

    Medical financing needs to be more open, or to use a phrase coined here, more “Googly”.

    • Wrong on multiple points. First, it is NOT true that “the government is likely to ration health care based on these decisions.” As Merrill Goozner points out, “the USPSTF recommendation is precisely that. It leaves it up to men and their physicians to decide whether to continue with the tests. The government already has a law mandating Medicare pay for the tests. It would take an act of Congress to repeal the law, which isn’t likely.”

      I happen to think that it is not a good use of government money to spend it on tests and therapies that are more likely to harm than benefit patients. In this particular case, however, it is simply not true that funding will likely be eliminated.

      I also have to say that it is rather paradoxical to be saying that (1) the government should fund this test, and (2) we need to move away from government managed health care toward a system where people self-finance. If you care at all whether your ideas are consistent from one thought to the next, you will have to admit that the only way to move toward a system where people self-finance their health care is to eliminate government funding for tests and treatment, not to maintain funding.

      I wholeheartedly disagree, by the way, with the idea that the government should be spending less on health care. The United States government is unique among industrialized nations in its failure to provide universal health care to its citizens. The result is that we pay nearly twice as much per capita for health care than any other country, while leaving a huge percentage of our people uninsured. The result is that millions of people in this country go without regular medical exams and other basic tests and treatments that are proven to improve health and extend life. Instead of talking about imaginary “death panels” or imaginary “rationed care,” you ought to be concerned about the people who are actually being deprived of needed health care.

  • Dan Murphy

    Liked your book, Jeff, but your opinion on PSA tests….as a family physician that has wrestled with inappropriate screening measures (e.g. Chest x-rays to screen for lung cancer in smokers: MANY surgeries resulted, no lives were saved), you seem to have arrived at multiple wrong conclusions. Possibly starting with your conclusion that getting the PSA done saved your life. You may well have been, in fact are very likely to have been, in the huge majority of people whose prostate cancer will never kill them. How many guys that are 60 years old have a bit of prostate cancer in their prostate on autopsy (for deaths from causes OTHER than prostate cancer)? About 60%. How many will die of it? Very, very few. Go up to autopsies on 80 year olds: about 90% of their prostates have cancers. How many will die of their prostate cancer? So few that PSA screening is not recommended (even by urologists) past the age of 75.

    Your contention that someone is going to take PSA screening away from you: Pshaw! And shame! The USPSTF did NOT say to refuse to do PSA’s, it said that routine screening is not recommended, in low risk males. If metastatic prostate cancer runs in your family (my father’s PSA was over 2000 when it was first checked, after he had urinary symptoms for years, and he did die from it), USPSTF thinks: go for it.

    Here’s something that we need to think about. Medicare has to make rational decisions about how to spend public funds on health care. It costs $5 million dollars of prostate cancer screening to save ONE life from prostate cancer. Hmmm. Basic treatment for diabetes and hypertension save lives at dirt cheap dollar amounts. Intervening early on mental health issues (e.g. schizophrenia) can provide a restored lifetime of health and employability. And it’s dirt cheap to do. Don’t quibble about “rationing health care”. It’s already rationed. Ask the 45 million folks without health insurance. Ask my employed patients that used to have a $10 copay, and now have a $2500 dollar deductible. Come down off your top 1% income throne and join the rest of us that want affordable, evidence based medicine for the many, rather than what we have in the U.S.: a system that is 50% more expensive than our nearest competitor, and ranks almost at the bottom of industrialized nations for objective measures of providing good health.

    Funny, how in your book, you can champion freedom of information, and laud the benefits of governments that openly share (as did the USPSTF) information, and list internet connectivity as a right. Funny because you rank connectivity to the Internet as a right, but not a right to healthcare. Funny because when the government is public by default (the USPSTF), and private by necessity, your response to such information borders on rabid (see the last line of your original post: what arrogance), and is a case in point as to why policy makers are often duped into keeping their conclusions private: they fear irrational, emotional, “I had prostate cancer, and I thinks EVERYONE should get PSA’s done”. Such thinking lead to a 1000% (yes, three zeroes, as in one thousand) increase in surgeries for prostate cancer, and a barely detectable (if detectable at all, in some studies) decrease in the death rate by prostate cancer. Arggh. Next you’ll be wanting total body CT or MRI scans on everyone, because you know what? That too, somewhere, in some lucky individual, might save a life from cancer. Why don’t we do it? Look it up. The studies have been done. They show disastrous results.

    • Affirming Dan Murphy, with less detail:

      The USPSTF (draft) recommendation does not say “Stop PSA testing healthy men.” Quoting from the draft recommendation:

      “The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.”

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  • Greg

    Thoroughly agree. I am 62 and diagnosed about 12 months ago. Doc said they found one spot and proceeded to tell me that I had all these choices which boiled down to ‘watchful waiting’ from his viewpoint. Come back and see me in6 months he said and let me know. Well bugger that, I had already done some research and went to another Doctor who up front said that the numbers (gleeson and PSA) did not stack up and in his opinion,I had something more serious. Bio’s later he found a further three spots in the Prostate. I then with him, underwent Nerve sparing radical surgery. Now 12 months later I am happy to report that the surgery was a success- no cancer. His words “Its gone and it won’t come back!” Erection is there but not of rock hard standard and may be described as a continuing work in progress. Drugs help but somewhat capable on it’s own. Physical fitness helps enormously both in immediate recovery and now as I was very fit going in to surgery. Bottom line is get a second or even a third opinion, do it early and do the checks. The clowns that suggest the dropping the blood tests are exactly that – Clowns.

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