Tuesday, February 9, 2016

Are Death Panels Now at Work on Prostate Screening?

Last week, a federal board advised men against getting regular prostate cancer screening tests. Two years ago, the same body advised women against getting regular mammograms before age 50. That advice brought charges that the government was trying to save money by sacrificing lives.

Are Death Panels Now at Work on Prostate Screening?

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Are death panels making a comeback? Last week, a federal board advised men against getting regular prostate cancer screening tests. Two years ago, the same body advised women against getting regular mammograms before age 50. That advice brought charges that the government was trying to save money by sacrificing lives.

The advisory board, known as the U.S. Preventive Services Task Force, is made up of 16 independent primary care providers with expertise in prevention. None of them are federal employees. They regularly review the latest medical evidence on disease prevention and recommend improvements.

The Task Force began work in 1984, and members since then have been appointed by presidents of both parties. Often, specialty societies adopt its advice in formulating standards of practice.

The Task Force’s work was largely uncontroversial until health reform debates started heating up in 2009. That’s when Sarah Palin and others linked the group to death panels. If they’re right, then we’ve had death panels for the last 27 years, starting with the administration of Ronald Reagan.

The task force’s latest recommendation, which will be finalized after a period of public review, weighed the effects of prostate cancer, which can be fatal, against the risks of treatment, which can be severe.  Early detection is often possible with a simple blood test for a substance known as prostate-specific antigen (PSA).

The problem with the test is that many prostate cancers grow slowly and will never become life-threatening. Unfortunately, doctors have no way to tell whether a case found early is going to be mild or virulent. That means many men with positive results undergo unnecessary treatment that can cause devastating side effects (like incontinence and impotence) and even death.

The Task Force concluded that these risks outweigh the benefits of early detection. But it was so concerned about the possible political fallout that it delayed releasing its recommendation for two years to give the controversy over mammography time to die down.

The prostate-screening recommendation has already faced one political attack. Newt Gingrich condemned it at a Republican debate this week, charging that it would cause deaths. He said it proved there really are government death panels and criticized the Task Force for containing no medical specialists (apparently ignoring the fact that 13 of its 16 members are physicians).

This week brought even more bad news for prostate cancer prevention.  A large controlled study found that vitamin E and selenium, both thought to be protective, were at best ineffective, and in the case of vitamin E, possibly harmful, the researchers wrote in the Journal of the American Medical Association.

If this is the work of government death panels, they are operating very strangely. Discouraging people from using a cancer screening test won’t save money unless the test is truly ineffective.

And the Task Force didn’t suggest that screening be prohibited. It advised men who are uncertain to consult their physician, just as it had for women who are uncertain about mammography. Are private physicians likely to be part of death panels?

Private insurance companies often use Task Force recommendations in deciding what to cover. But the government can’t stop covering PSA and mammography under Medicare, because coverage is mandated by law. So, have death panels moved from the government to the private sector?

Private researchers conducted the study on vitamins. Are they part of the conspiracy?

In fact, the Task Force is the opposite of a death panel. It presents Americans with the most current medical evidence and expert opinion so that they and their physicians can make informed decisions.

The real threat of death panels comes from politicians who would rather let ignorance determine our medical care.


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About this blog

Check Up is a blog for savvy health consumers, covering the latest developments, discoveries, and debates from the Philadelphia area and beyond.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, Drexel University Kline School of Law & Dornsife School of Public Health
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