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Feds to men: be happy, don't worry (about prostate cancer)

by Alan Markow, published

The feds have once again stumbled into our personal lives in a ham-handed manner that is unlikely to improve our health; instead, it is bound to damage the reputation of health care reform in the United States.  In a new finding due for official release this week, and based on what the New York Times calls “five well-controlled clinical trials”, the United States Preventive Services Task Force is calling for the end of PSA (Prostate-specific antigen) blood test screening for prostate cancer in healthy males.  The finding, says the Times, “could substantially change the care given to men 50 and older.”

According to the American Cancer Society, one in six men will be diagnosed with prostate cancer in his lifetime.  It is the second leading cause of cancer deaths in men in the United States (behind lung cancer), and is detectable mainly through a combination of PSA tests and – if called for – biopsies.

A 2009 finding by the same task force on breast cancer and mammograms stirred controversy when the group recommended delaying regular examinations from age 40 to age 50 in otherwise healthy women.  A similar uproar has already begun over the PSA ruling.

Let me put this one in personal terms.  I’ve just received my second prostate biopsy results, and I feel a new lease on life because the finding was negative.  Needless to say, I am happy to have had the opportunity to take this preventative step now rather than having to live with the thought that cancer might be developing in my body while some bureaucratic agency has predetermined that the nation can't afford to worry about it.

I'm sure there are perfectly reasonable statistics behind the task force findings, but the fact is no one wants to be lopped into an average or have their medical insurance provider told that it is okay not to cover certain procedures because the statistics say so.  Such is the nightmare scenario of national health insurance or socialized medicine. And it flies in the face of the way medicine is practiced at centers of excellence such as UC-San Francisco, where I received my screening for the possibility of prostate cancer.

During September of this year, the hospital’s highly-regarded Helen Diller Cancer Center was holding its own prostate cancer awareness month.  The male doctors were all growing beards as part of the campaign, and there were posters throughout the facility featuring the hirsute physicians looking determined to both avoid razors and beat cancer.  These were not people willing to stop or even delay their pursuit of prostate cancer prevention on the word of a panel of statistics-wielding bureaucrats.

Yet, this is exactly the style of bureaucracy that becomes the fodder of anti-health reform advocates who love to turn such groups of white-coated pronouncers into “death panels.”  If it’s my body that becomes ravaged with cancer when my insurance company precludes me from taking a PSA test or getting a resultant biopsy based on the Task Force findings, then this group might as well be a death panel.

The problem here is a familiar one – it’s not the decision of doctors and patients; instead, it’s up to the insurance providers.  And the U.S. Preventive Services Task Force has just given the insurance companies ammunition to deny coverage on one more preventive approach that might save lives but can’t be justified according to some mathematical formulation.  I’m just glad I got my test in before the big announcement out of Washington.  But what about the next guy?

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