Come for the Politics, Stay for the Pathologies

Thursday, March 19, 2009

Prostate Cancer: What You Don't Know Won't Hurt You

The latest in a long line of dubious health studies (reported in the New York Times as well as the Wall Street Journal) concludes that the value of prostate screening may not outweigh the “risk.”  The risk being that you have the cancer treated, even though it might not have killed you even if you had not. They cannot be serious.

What exactly is the agenda here?

The United States portion of the study was conducted by the National Cancer Institute: a division of the National Institute of Health, which is a subset of the Department of Health and Human Services, which is funded by Congress. If you don’t think federally funded entities have agendas, do some more research.

National health care has been on the liberal political agenda since FDR, and threatening to become reality since the Clinton administration. National health care, everywhere it’s been implemented, relies on controlling health care costs through the rationing of services (which in Canada means you wait 3 years or more for a hip replacement).

The gist of this most recent “study” is that screening for prostate cancer identifies many cancers that probably would not cause death to the patient if left untreated. However, once identified,  results in costly treatment that might result in undesirable side effects.

Dr. Otis Brawley, chief medical officer of the American Cancer Society and head of the National Cancer Institute’s study provided an analysis of the study’s results for CNN.

The American study provided annual screening to more than 36,000 men and observed an equal number who were not to be screened. There is a median of 13 years follow-up. Because some men who were not supposed to get screened did, this is really a comparison of the heavily screened group compared to a less-heavily screened group. It found excessive “unnecessary diagnosis and treatment” with screening with no evidence of a mortality benefit. Therefore their conclusion is that some prostate cancers “do not need to be treated.”

Yeah Doc, but unfortunately, no one seems to be able to tell you whether your prostate cancer is one of those or not. A rather blasé attitude I think. More of a British “what you don’t know won’t hurt you” attitude than an American “better safe than sorry.”  But then, if it’s your prostate cancer and not mine, it’s much easier to cop that attitude. Besides, we all know how great the British Health Care System is.

And then there’s this from the National Institute of Health site itself regarding the study:

“All trials adhere to a common core protocol with mortality from prostate cancer as the primary endpoint. Some core elements are age at recruitment between 55 and 67, collection of baseline characteristics, exclusion of men with previous diagnosis of prostate cancer, individual randomization, information on contamination levels, and evaluation of cost effectiveness.

In the NYT article, Dr. Brawley contends

“For years, the cancer society has urged men to be informed before deciding to have a PSA test. “Now we actually have something to inform them with … We’ve got numbers.”

Yeah, you’ve got numbers. But I’ve got questions. For starters, since more members of the non-screening group wound up being screened than originally envisioned, how did that impact the outcome? And what specific treatment did the men who were diagnosed with cancer have? Did the men in the control “non-screening” group that were diagnosed with cancer have the same therapies as the non-control group? Were the cancers diagnosed in the two groups at the same stage? Dr. Brawley continues:

“The data suggest that we should be less concerned with the scientific question, "Does screening save lives?" We should be asking the question, "Do the quantified harms of screening justify the benefit?"

What the hell does that mean? First of all, “does screening save lives?” is the only pertinent question to ask. The “quantified harms” are only harms if you “assume” that treated prostate cancers were not lethal. And that, apparently, cannot be definitively proved. The data might “suggest” that to you, but it sure as hell doesn’t suggest it to me. Nor does this:

“In the European study, the average man whose disease is diagnosed through screening is 47 times more likely to have a needless diagnosis and treatment than to have his life saved.”

Again, how do you define “needless,” and how in the hell do you conclude this from the reported results? Because other men with the disease haven’t died? That’s a little outside my comfort zone.

In short the reported “results” of these 2 studies tell you essentially nothing. It looks like the real point of the early release of results (the studies will not be complete for another 4 years) is to cut back on 1) the cost of screening –

Dr. Brawley:

“I would be remiss if I did not say that most who encouraged prostate cancer screening were hoping to do good, but some lay and physician advocates encouraged screening and made it into a lucrative business.

and 2), the expense associated with the treatment and care of the diagnosed prostate cancer. Remember, “There are prostate cancers that do not need to be treated.” But again, it doesn’t appear from anything published that they can determine which cancers these would be. The summation of the CNN article is the kicker: “This type of behavior also has implications for spiraling health care costs and health care reform.”

By all means draw your own conclusions. But this is a study without a conclusion as far as I can ascertain, unless you consider “ignorance is bliss” a valid conclusion. As I pointed out in "Skepticism" statistics and epidemiological studies cannot replace real scientific methodology.

Do you really want these people in charge of your health care? Because they will be if Obama’s “health care agenda” gets rammed through Congress the same way the porkulus bill was.