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A PSA On PSAs

Thursday, March 19, 2009  |  posted by Hugh Hewitt

In the world of broadcast, “PSA” means “public service announcement.” In the world of cancer treatment, it means the screening test that men get in order to evaluate their risk of prostate cancer.

Yesterday two big studies were released on whether PSA screening produces more good or more harm. The reporting on the studies –examples are found in the New York Times, the Washington Post, USA Today and the Wall Street Journal– made a hash of the results, and could actually lead to men not getting screened which could lead to their early deaths from cancer.

“My greatest concern is that if we don’t handle this thing appropriately, we can hurt a bunch of people,” The American Cancer Society’s Otis Brawley told USA Today. “There is a group of men who should be getting PSA and who might not because of what they hear.”

That is the key message that Dr. Kenneth Tokita of the Cancer Center of Irvine told me on air yesterday. (The transcript of his interview is here.) PSA testing does indeed lead to diagnosis of aggressive cancers and to treatment that saves lives, Dr. Tokita assured my audience. But lousy reporting of the complicated results from the studies could easily influence men away from having the test or serious evaluation of the results. The New York Times’ piece seems the most irresponsible, headlinged as it is “Prostate Test Found To Save Few Lives,” and with the opening paragraph:

The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found.

An e-mail arrived last night from Dr. Bruce Malkowicz, who is the Co-Director of Urologic Oncology at the University of Pennsylvania, and the Thomas D. Stichter Memorial Professor of Urologic Research for the University of Pennsylvania Health System. It provides the sort of analysis of the studies that the New York Times ought to have provided:

Dear Hugh,

I am a professor of Urology and was listening to your show when I was alerted to the NYT post on the NEJM studies which were released today. A quick download of these and the editorial were quite interesting and I think it was great that you decided to discuss this issue today. I could not listen to your guest interview because I was called away to help with some clinical situation. The issue of screening for prostate cancer [CaP] is an important and controversial topic. What I was struck by in scanning the articles and what was confirmed in the editorial is the fact that while these are large trials, the reports are INTERIM ANALYSIS and not the final results of these studies. What is confirmed by the current data is our sense that prostate cancer is an over treated entity. It does not affirm or reject the role for screening. The European study actually suggests that the death rate from CaP may be reduced by 20% with the use of screening strategies although the statistical validity for this is marginal. Since this question is not answered there is definitely a role for active disease detection as part of overall male health. The key issue at this time is make a well informed decision on whether to pursue aggressive therapy or active observation. Although one can not separate the all the aggressive lesions from the slower growing lesions, general parameters exist to help categorize this to some degree. The data from these reports suggest that low risk patients can feel more comfortable in following an ACTIVE, scheduled program of follow up instead of rushing to more aggressive treatments and their side effects. Those patients with intermediate and higher risk tumors would be taking their chances. Total ignorance of the situation is not appropriate. It is true that some people can be made chronic patients with elevated PSA values that are false negatives and we have tried to deal with this by telling patients the basic statistics associated with PSA determinations. The prudent choice based on the available evidence is to first choose if you want to be ignorant of the entire situation or not, realizing that a positive lab test will probably lead to a biopsy and not testing may miss a curable cancer. Once biopsied and diagnosed, an effort needs to be made by the patient and potentially treating physicians to choose observation or therapy based on the available data and the patient’s preferences.

Medical studies are enormously complicated and difficult for journalists to translate for the public.

But if you are going to try and provide that translation, at least do a decent enough job to assure that you don’t send a false message to the public that there is no down-side to skipping screening. Experts like Dr. Tokita and Dr. Malkowicz are pretty easy to find and to quote at length in order to get the story right. The screen you skip on the advice of some sloppy journalist could be the one that could have saved your life.

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CPSIA Update

Wednesday, March 18, 2009  |  posted by Hugh Hewitt

Walter Olson of Overlawyered.com and Gary Wolensky of Snell & Wilmer join me for a CPSIA update today.

The outrage over the AIG bonuses is over $165 million in taxpayer money.

The cost of CPSIA is at least $3 billion in perfectly safe inventory that must be destroyed and tens of thousands of lost jobs –and it could be fixed if Congress bothered to take a day to do so.

For more on the CPSIA meltdown, see this conversation between me and Nancy Nord, chair of the Consumer Products Safety Commission from last Friday.

To reach Wolensky, e-mail gwolensky@swlaw.com.

The Study Said What?

Wednesday, March 18, 2009  |  posted by Hugh Hewitt

The New York Times reports on a couple of head-scratching studies:

The PSA blood test -the screening test for prostate cancer -saves few if any lives and exposes large numbers of men to risky and unnecessary treatment, two large and rigorous studies have found.

The findings raise new questions about the rapid and widespread adoption of the test, which measures a protein released by prostate cells. It was introduced in 1987 and quickly became a routine part of preventive health care. Experts debated its value, basing their views on data that often involved statistical modeling and inferences.

Now, with the new data, cancer experts said men should carefully consider the test’s risks and benefits before deciding to be screened. Some may decide not to be screened at all.

Dr. Kenneth Tokita of the Cancer Center of Irvine will join me today to discuss these studies. Dr. Tokita is one the preeminent prostate cancer specialists in southern California. I have a number of friends who have been diagnoses with prostate cancer in the past few years, each of whom would never have received their early diagnosis and completely successful treatments without the PSA test as part of their regular medical exams. The article summarizes the findings this way:

The reason screening saved so few lives, cancer experts say, is that prostate cancers often grow very slowly, if at all, and most never endanger a man if left alone. But when doctors find an early-stage prostate tumor, they cannot tell with confidence whether it will be dangerous so they usually treat all early cancers as if they were life-threatening.

As a result, the majority of men, whose early-stage cancers would not harm them, suffer serious effects of cancer therapy but get no benefit. Others, with very aggressive tumors, may not be helped by screening because their cancer has spread by the time it is detected.

While it may make sense to forego treatment if medicine develops the ability to distinguish between deadly and non-deadly cancers, the MSM should be very careful about broadcasting a message that cancer screening is an unnecessary luxury.

“And it would dash any fig leaf of bipartisanship for the agenda.”

Wednesday, March 18, 2009  |  posted by Hugh Hewitt

That’s Mike Allen’s assessment of a proposed health-care and carbon-tax jam down via the Budget Resolution, an end-run around the Senate’s 60 vote rule, which has previously only been used for tax code changes impacting the budget, not major policy proposals like an overhaul of health care and cap-and-trade.

The Washington Post has the story here, and a long background on the Obama Administration’s health care debates is in the New Republic here.

The best argument against the jam down is in the dismal results of recent past jam throughs.

Last fall the Congress pushed through the Consumer Products Safety Improvement Act (“CSPIA”) which is causing the needless destruction of billions of dollars of goods and crippling whole industries. (Here’s my interview with CPSC Chair Nancy Nord on the CPSIA meltdown from last Friday.)

The stimulus bill itself had numerous screw-ups within it, hidden from view and correction because of the speed with which it was advanced.

The AIG bonuses are a result of carelessness and haste on the part of Team Obama.

Imagine what will happen to your health care or the country’s entire economy if the mad dash methodology is adopted for medicine or cap-and-trade. The Senate should be in full revolt over the stripping away of its institutional role, and the MSM should be mocking the idea that this was ever a president committed to bipartisanship.

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