Desire to Detect Prostate Cancer Early Disdained as "Religious" Pursuit by American Cancer Society Spokesman
I never cease to be amazed at the sense of superiority that drips from the pores of some people who work in the sciences. I find this quite irritating, which was brought to a head for me this morning when I read a story about prostate cancer screening.
For years, we have been told repeatedly and often to get screening tests for cancer because, logically enough, the earlier you catch the disease the greater the likelihood of surviving. That remains true of cancers such as of the breast--get those mammograms--and the colon--get those colonoscopies. But apparently, research increasingly indicates that this general rule may not necessarily apply to the early detection of prostate cancer.
Whether this is true or not is worthy of reasoned discussion. But catch this looking-down-his-nose comment by a representative of the American Cancer Society about men and doctors who seek to detect prostate cancer early through PSA blood testing. From the story:
"Americans have been getting screened for prostate cancer because there is this religious faith that finding it early and cutting it out saves lives," said Otis W. Brawley of the American Cancer Society. "We've been doing faith-based screening instead of evidence-based screening. These findings should make people realize that it's a legitimate question about whether we should be screening for prostate cancer."Yes it is a legitimate question, but deciding to screen is hardly irrational, which is what Brawley was saying by calling prostate screening a "religious faith." Indeed, the question has been--and remains--unsettled. For example, last year the Annals of Internal Medicine published this recommendation from the U.S. Preventive Services Task Force about prostate screening:
Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years (I statement). Do not screen for prostate cancer in men age 75 years or older. [Me: This is because prostate cancer grows so slowly in elderly men that the patient is likely to die from other causes long before the disease becomes life-threatening.]Whether or not to conduct PSA tests for prostate cancer is a questions men and their doctors should carefully explore. But just because a few studies now show that it may not extend lives doesn't mean that anyone who elects to get a PSA screening is engaging in an irrational medical practice.
posted by Wesley J. Smith @ 12:33 PM
9 Comments
9 Comments:
I know,I read that comment and feel like I've fallen through the rabbit hole or something...
A large part of medicine is "faith based," as the ACS guy put it (although I prefer to think of it as "tradition," or "the way it has always been done"). I think that the vast majority of obstetrics is either tradition-based or fear-of-lawsuits based medicine.
It is ridiculous for this guy to put down men who get PSA tests. Your second quote shows why: "current evidence is insufficient." I think if current evidence is insufficient, we better err on the side of caution. With the new robotic technology for removing prostates, the risk of side effects is greatly lessened. And many doctors are treating less aggressively than they used to, by watching and waiting.
However, prostate cancer is not always a benevolent disease; I had a hospice patient whose prostate cancer spread to his bones. So we need to strike a cautious balance. I'm sure there will be more research on this in the future that will help settle the matter.
"Religious?" Where did that come from? Obviously it's the new pejorative. Logic is religious now. Well that shows where they stand re logic. "Studies" -- another shibboleth. Yet another effort to get people off the planet and "save costs." Never mind the cost to life and humanity and the victims, of course.
Heather: Good point about "faith-based" and the medical establishment, which seems to have arrogant and inordinate faith in itself and in its own credibiity and ability to influence and steamroll, while having set fidelity to the Hippocratic principles aside.
"Religious?" Where did that come from? Obviously it's the new pejorative. Logic is religious now. Well that shows where they stand re logic. "Studies" -- another shibboleth. Yet another effort to get people off the planet and "save costs." Never mind the cost to life and humanity and the victims, of course.
Heather: Good point about "faith-based" and the medical establishment, which seems to have arrogant and inordinate faith in itself and in its own credibiity and ability to influence and steamroll, while having set fidelity to the Hippocratic principles aside.
No wonder the numbers next to the flags of nations here keep rising apace. I wouldn't be surprised if it's 100K for the U.S. by the end of this month. Big jump from yesterday, maybe because of Natasha Richardson, too. There are a lot of people out there now who've been through the "pvs," "brain dead," "removal from life support" ordeal re a loved one. This attempt to denigrate people's desire to get available medical treatment out of pure good sense is just another facet of the agenda.
Obviously he just thinks that the word "religious" is an insult. Which is pretty insulting. The thing is, too, that these guys can never do anything by half measures. I mean, who knows, maybe five years ago this guy was out saying that only religious nuts _wouldn't_have early testing for prostate cancer. Maybe he still says that about mammograms.
I do think that doctors' "utilities" (as philosophers like to call them) often get silently factored in to recommendations about screenings. Early screenings always have pros and cons. The patient may have different opinions about how big of a deal a false positive result is than the doctor has, especially if a false positive results in a lot of ultimately unnecessary anxiety and unnecessary invasive further testing.
And this is true of the screenings they are still recommending.
Hello. It's Tabs. I used to work for the oil company but I got laid off today so personally I hate everything, and I may rant a bit about this guy to get it off my chest. Please feel free to ignore the following statement:
Oh for crying out loud!! Science *IS* half faith! We have faith that scientific law will continue to hold up under all circumstances, and when they don't - and believe me, there are times they don't, just ask Einstein and why he had to fudge his equations to get the "steady state" answer he wanted - then our faith feels shaken! But faith is what keeps us going back and re-examining the evidence, because we have faith that we will figure out what's going on. That's the beauty of science. You have faith in something higher than yourself - in the math and the laws and properties and all the things that *make* science. Which, to me, is why I believe in God, but heck, you don't have to belive in God to believe in things that need faith.
You have faith that problems can be solved through rational thinking and the proper application of science. You have faith that humans can overcome their deficiencies, no matter if they're hard-wired in or not, because human consciousness is something apart from the human body, and the mind can control the brian and the rest of the body, and we can overcome our hatreds and prejudices if we are willing to change our minds and work for it.
We have faith that people can make their lives better by both positive thinking and positive moving. I may be laid off, but my life isn't over, nor will I sit loafing around collecting unemployemnt because I feel depressed. I will feel sad for a while, and I have faith that things can change if I work to change them.
And maybe I'll get hit by a truck tomorrow. In which case, I know that I leave behind a legacy of good things in my life, and I have faith that my life was not in vain. Even this moment of sadness and pain has something to add to the value of my life. Even if this is how my life ends, that's not ALL that my life was. And something about me has helped others in some way. I can go to my reward with faith in my human purpose.
Having "faith" in science is a GOOD thing! It's what encourages us to grow up, to learn all that we can learn, as we were designed to. Having "faith" in anything is what keeps us going, makes things worthwile, and keeps us happy. It's what ultimately gives us meaning.
You don't have to have faith in God to know that life has meaning, and that is something worth having faith in. So, I prefer to have "faith" in science. If my faith is misplaced, I will still have learned something.
Bah on everyone today.
T.E: Well, you may have lost your job today, but you are in fine form nevertheless! It's the oil company's loss, and your next employer's and job's gain. I have every faith that you will land on your feet, like a cat.
A fine job Obama did talking down the economy. He should put just put his bowling ball in his mouth; going onto a talk show isn't sufficient damage control, not when it's him talking.
Ianthe,
Your sweetness and strenght are very much appreciated. You're in fine form as well, and I agree with you, Obama isn't exactly making himself popular. The first hundred days and so far the economists that are rating him are saying he's tanking. Time will tell.
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