I realize that I am treading on thin ice with this blog post. What I have to say might be perceived as being insensitive to gender issues. In addition, I might be perceived as being critical of medicine and those who practice it. While my post clearly points out the relevance to both sexes, I might be partially guilty on the medical charge. Those who know me are aware that I have issues with modern medicine, but I promise not to indulge in outrage. This time.
The New York Times published an article last Sunday on one breast cancer survivor’s view of the effort to detect and treat breast cancer. I think it well worth reading. The link to the article is below:
To be honest, the article supported my well known pre-conceived ideas and prejudices. As a result, I would have let it pass without writing if it had not been in the New York Times. As you may know, the NY Times is a tireless cheerleader for the issues and groups talked about in the article. The Times printing this article is a bit like Christianity Today printing an article in support of gay rights. It is not only surprising but any concern about political agendas and ulterior motives is removed.
The article is not an expose of bad people, greedy people or evil corporations, though people and profitable companies are featured. The article is about the train crash that is modern medicine in the United States. A train wreck caused by our, yours and mine, inability to deal with uncertainty and risk. It is about the lack of a coherent narrative in our society about risk, commerce and responsibility.
The article focuses on breast cancer and the paradox of mammograms. We all know that mammograms are good. We all know that medicine, funded by all the activities supported by the color Pink, is doing everything it can to cure breast cancer. But medicine is composed of people, a multitude of people, from those who walk the 5 K’s to those working in the research laboratories. Everyone involved has only the best of intentions. But they all have house payments and would like to get promoted. And just like all of us, they like to feel good about what they do.
It is indeed unfortunate that the results of the mammograms are full of ambiguity. What do we do about that? The tests are ambiguous, but there is a lot of money to be made from the tests and the resulting treatments. In the article the author makes the case that a lot of money is spent for very little effect. She also makes the case that a great many people are harmed, with relatively few people helped. But efforts to weigh benefits against costs are easily demagogued. Besides, spending the money and getting the tests makes us feel good.
Some lines of research don’t get much money. Marginal treatment improvements are attractive because they are likely to succeed and can provide heart warming stories for the website and television. Everybody can sit back and bask in success. Careers are advanced and decision makers are lionized. On the other hand, research into fundamental causes and non-standard treatment options takes a very long time and usually leads nowhere. As you might guess, research failure is very bad because careers are affected and decision makers questioned. There might even be lawsuits and liability actions in the courts.
The article focuses on breast cancer, but it could have been as easily about prostate cancer. It is just that prostate cancer doesn’t have the Susan G. Komen foundation, the New York Times and the marketing bonanza that has developed. Yet.
Just as women get mammograms, men get PSA tests. I get my PSA test for prostate cancer every year, Since I have a history of prostate cancer in my family, it is very likely that I will be faced with a question similar to the one raised in the article some day. The PSA test, just like mammograms, diagnoses many phantom cancers. Again like the mammogram, the PSA test is unable to distinguish between relatively benign cases that do not require treatment and aggressive forms of the disease. And in a final similarity to mammograms, the PSA test frequently misses the really bad cases of the disease because the window in time for catching them is usually very short. There is also a substantial infrastructure that exists as a result of the PSA test for jobs, careers and invitations to benefit dinners with celebrity speakers.
What will I decide to do if and when my PSA test comes in with a bad number? I don’t know.