Wednesday, October 19, 2011

PSA Testing: Are Death Panels Arriving Under Cover of “Scientific Evidence”?

A recent widely publicized and controversial study released by the federal U.S. Preventive Services Task Force “will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer,” according to Rob Stein of the Washington Post:

Task force chairwoman Virginia Moyer said the group based its draft recommendations on an exhaustive review of the latest scientific evidence, which concluded that even for younger men, the risks appeared to outweigh the benefits for those who are showing no signs of the disease.

It’s notable that the study was done under the purview of the same bureaucrats charged with administering federal health care programs, including ObamaCare:

The 16-member independent panel is organized by the Department of Health and Human Services to regularly assess preventive medical care. Its recommendations have a widespread impact, especially on what services Medicare and private insurers pay for. The group’s influence was enhanced by the new federal health-care law, which will base some of its requirements for coverage on the group’s ratings.

The proposed recommendations come as doctors, researchers and policymakers are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment. (Emphasis added)

According to Stein, “The test … has significantly increased the number of prostate cancer cases being diagnosed at very early stages.” Despite this fact, however:

[I]t has been a matter of intense debate whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without knowing they had it.

Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men are simply monitored closely to see whether the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.

What is actually being said here? Note the vagueness surrounding terms like “appeared to outweigh”, “increasingly questioning”, “intense debate”, “not clear precisely”, and “doctors are uncertain”, and contrast that mush to the acknowledged fact that PSA testing “significantly increased” early cancer detection. Yet, this study is cited as a possible justification for “requirements for coverage” over both government and “private” coverage – imposed by HHS. Keep this in mind.

The recommendations drew immediate and forceful rebuttal:

The “decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward if families are to believe the out-of-date evidence presented by the USPSTF,” said Skip Lockwood, chief executive of Zero, a patient-advocacy group. “A decision on how best to test and treat for prostate cancer must be made between a man and his doctor. This decision is coming from a panel that doesn’t even include a urologist or medical oncologist.”

Several other experts agreed.

“The bottom line is that we should encourage screening because it will give men the full range of options to avoid death from prostate cancer,” said William J. Catalona of the Northwestern University Feinberg School of Medicine.

J. Brantley Thrasher of the University of Kansas Medical Center said, “It appears to me that screening is accomplishing just what we would like to see: diagnose and treat the disease while it is still confined to the prostate and, as such, still curable.”

I didn’t devote much attention to Stein’s article (which was carried on the front page of the New Jersey Star-Ledger on 10/7/11) until two letters-to-the-editor were published in the 10/13/11 Ledger. Tina Levorse of Parsippany and John Schlager of Springfield strongly objected to the proposed recommendations, citing personal experiences regarding early prostate cancer detection thanks to PSA tests. But it was Levorse’s perceptive LTE that got my attention. Entitled “Are death panels here?” she wrote:

While I’m not a big Sarah Palin supporter, it appears she was right. The Obamacare death panels are here.

I left the following comments:

In the past two months, I had two close friends diagnosed with early stage prostate cancer thanks to PSA screening. After biopsies and consultations with their doctors, both are now pursuing courses of action they deemed best in their individual circumstances. Both Levorse and Schlager provide indisputable logic as to the value of regular screening.

On the face of it, the U.S. Preventive Services Task Force’s “recommendations” appear to make no sense at all. But, viewed within the context of the government’s ongoing takeover of healthcare, it makes perfect sense. The Federal government now controls almost 90% of healthcare spending, both directly through programs like Medicare and Medicaid and indirectly through its crony arm, the quasi-private health insurance industry. Consequently, the government now has a vested interest in controlling costs. The deep, inherent conflict of interest is apparent, and should scare all of us. Early screening leads to early detection, which leads to a much higher survival rate, which leads to more people living longer lives, which leads to – higher costs to government.

I believe Ms. Levorse has nailed it. Death panels are inherent in government-run medicine, and may be arriving under cover of “science”. Of course, there are no explicit death panels written into ObamaCare or any other government program. There don’t have to be. Through the bureaucratic tyranny set up by ObamaCare, those recommendations and others like them will become mandatory, and restrictions will be written into the guidelines doctors must follow. The freedom of the doctor to focus on the best interests of his patient and the freedom of the patient to decide for himself based upon his doctors’ recommendations, will be lost to professional bean counters. Such are the consequences of surrendering to government the responsibility for paying for one’s healthcare.

This should be another wakeup call to Americans, but for too many, it probably won’t be. But one thing is for sure: No study connected to government financing can be trusted, given the government’s massive role in healthcare.

I am by no means a medical professional or expert. So, I can not and will not offer opinions on the accuracy of the study or its conclusions. But that is really beside the point. The point is, these government studies can not be trusted. The entire character of this article proves the point. How can anyone be sure of the motives behind the conclusions?

The vagueness of the arguments against PSA screening must raise suspicions in light of HHS’s ObamaCare-mandated “cost containment” mission. Add to this deep conflict of interest an inherent contradiction. The article states early on that “the risks [of PSA screening] appeared to outweigh the benefits for those who are showing no signs of the disease”. The express purpose of PSA screening is precisely to detect “signs of the disease” via the red flag of high or rising PSA levels. As a 62-year-old man anxious to get many more quality years out of his life, I have a vested interest in getting an early jump on any health issues that I may confront. In light of the acknowledgement that it is “not clear precisely what PSA level signals the presence of cancer,” who would it be best for me to depend upon most, my doctor’s advice or some distant panel’s mandates? As I said in my comments, I have two friends dealing with PSA-detected cancer. Who knows: I may be next. Yet government officials who do not know I exist have the power to deny me my unalienable right to exercise my own judgement on this matter, by their control over healthcare spending - financed by me, and countless others like me, to boot. And that’s the point: They don’t focus on any individual:

“Unfortunately, the best evidence is that while some men might be helped by screening, others would be harmed, and on balance the test is not useful overall,” said Howard Brody of the University of Texas Medical Branch in Galveston.

No human being is “overall”. And here we come to the essential difference between government-run and free market healthcare – the irreconcilable clash between collectivism and individualism; between a non-existent statistical average and actual living breathing thinking individual men. There is no compassion behind the bean counters’ and their “greater good of society”. There is only a callous disregard for the value of individual lives. I do not mean to imply that every member of the government bureaucracy and his or her panels is callous. I mean to say that callousness is inherent in their jobs, by virtue of the fact that their “overall” findings disregard the unknown “some men [who] might be helped by screening”, and by the unknown agendas of the political masters whose funding they depend upon. They can be nothing but callous, because that’s the nature of the beast. Central planning by definition must focus away from any concern for the best interests of individual men and the judgements of individual doctors in favor of the statist apparition - the public health.

Leaving the treatment decision “between a man and his doctor” is a moral hallmark of the free market and the doctors’ Hippocratic Oath. Snatching decision-making power away from millions of men in favor of a 16-member independent [?] government-sponsored panel – which, incidentally, will also undermine the Oath - is the hallmark of government-run medicine. This is the fundamental issue here, regardless of whom is right about the value of PSA testing. As a layman, studies such as this can be a factor in my decision-making. But they should not pinch hit for my decision-making rights.

To again quote Skip Lockwood, “the decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward.” This reminds me of a question I remember being posed by a champion of government-run medicine some years ago: “If socialized medicine is so bad, where are the victims?” The answer – “They’re all dead.”

1 comment:

Mike Kevitt said...

Not all bureaucrats are callous, but callousness is in the nature of their job, and, I add, the job is, itself, callous. The job was put there by others, as were the bureaucrats who perform those jobs. Who put'em there? Somebody is truly callous and of callous aforethought. These jobs and countless other jobs and functions outside the proper function of government, but smuggled in by the guise of properness, are not only callous, but, also criminal. Not all bureaucrats are callous or criminal, but their jobs are both. And, there are true crooks behind them. And, the bureaucrats, even if "innocent" (my quotation marks), are still performing, not just callous, but criminal acts by legislated (of all things) criminal plans or, designs, not legitimate government functions by law. That's what can't be obeyed morally, but only by practicality, if needed. That's what must be done away with. If, indeed, nobody behind it is of a callous or criminal mind, but is merely ignorant (which I doubt), then due process must, in principle, be used in doing away with it. If not ignorant, but of criminal mind, still use due process, but be quite summary about it.