Hint: there is big money to be made from fear
If you’re a man you’ve probably had some concerns about your prostate. You may have had some problems and your doctor has likely suggested you get a PSA test. You probably have had a number of these tests already. Your doctor has likely talked to you about the benefits of early detection and these screenings have become so common-place that few people question whether there are any downsides to screenings. What could be wrong with screening? Well, as commentator Paul Harvey used to say in his years of broadcasting, “Stay tuned for the rest of the story.”
I wouldn’t say my wife, Carlin, and I are health nuts, but we do pay a lot of attention to our health. We try and eat well, take supplements, read all we can about the latest practices that can help us live long and well, and see our doctor regularly.
When I was in my thirties I told my doctor about burning when I urinated. It was a minor annoyance, but I wanted to have it check out in case it was something serious. My family doctor referred me to a urologist who performed a digital-rectal exam, did a PSA test, diagnosed my condition as prostatitis, and put me on medications. When one didn’t work, he put me on another, then another one. He kept having me come back again and again. When nothing worked he said he wanted to “scope my urethra,” which was frightening and painful. But I tried to be a good patient and follow doctor’s orders.
He told me my prostate was enlarged and that a small surgery would likely clear things up. When I said I wanted a second opinion he seemed insulted. I found another doctor who actually listened to me and asked what was going on in my life rather than giving me drugs and wanting to operate. I talked about the stress at home and at work. He took me off all the medications and suggested I try something new: Drinking 8 to 10 glasses of water a day. My symptoms cleared up in a month.
I learned some important lessons:
- Following doctor’s orders can be harmful.
- Doctors often don’t know what is causing a problem, but are reluctant to say they don’t know.
- Most doctors are action oriented and would rather do “something” than “nothing.”
- Drugs and surgery are considered “something.” Listening to what is going on in your life and giving you lots of water is considered “nothing.”
- Our body often has great wisdom to heal itself if we don’t scare the bejezus out of it and fill it with drugs it doesn’t need or procedures that look for a disease that isn’t there.
As I got older I started getting regular prostate exams on the recommendation of my doctor. I didn’t like the rubber gloved finger up my butt, but if it kept me from dying from prostate cancer, it seemed a small price to pay. The PSA test was a blood test that didn’t hurt and seemed a simple and easy way to keep me healthy.
Early on my yearly PSA tests were uneventful, though I realized that my fear level went up as I thought about the dangers of getting cancer and then worrying while I waited for the results. But all was well until one of my tests came back with an elevated PSA. My family doctor referred me to a urologist who said I should have a prostate biopsy to be sure I didn’t have prostate cancer.
Just hearing the word “cancer” scared the hell out of me. I thought of a friend who had recently been diagnosed with prostate cancer. It never occurred to me to question the value of a biopsy and agreed to have it done. He told me it would be quick and easy and wouldn’t be painful. He was wrong, wrong, wrong!
He had me lay on my side and directed me to pull my knees up to my chest. Some numbing medication was used before inserting a not-so thin probe into my rectum. Once the biopsy device was situated, the doctor told me to relax (not so easy) as he retrieved a number of thin, cylindrical sections of tissue with a hollow, spring-propelled needle. Each time he “pulled the trigger,” the needle was propelled through the lining of my rectum into my prostate gland. There was a significant discomfort as the sample core was removed. He took 12 samples from various parts of the prostate looking for possible cancer.
I was very shaky following the procedure and wondered whether the benefit was worth the fear, pain, and discomfort involved. I was given a powerful antibiotic which I was assured would prevent any infections from occurring, which worried me. After all you’re shooting needles through your rectum into the prostate gland. Infection seemed like a real possibility. Although I was told that very few people get an infection as a result, I was one of the few who did. The infection was so bad I had to have a catheter inserted into my bladder and walk around with a urine bag for a month.
In two other articles I wrote, “Is the Test Worse Than the Disease?” and The Health $care Industry and the Prostate, I described my experiences and why PSA testing may be more harmful than helpful. Here are some of the things I learned doing research for the articles and looking for ways to take care of my own health and the health of other men and their families.
The PSA test promises more than it delivers.
Dr. Richard Ablin, the man who discovered PSA in the 1970s, has been saying that the test doesn’t do what people think it does. In his book The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster he says,
“The test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, PSA testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.”
Our fear of cancer does not match the reality.
“American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer,” says Ablin, “but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.”
So, 84% of us are not going to get prostate cancer and of the few who do, 97% of us will survive. These facts lowered by fear level.
Many experts believe that slow-growing, non-lethal, lesions should not even be called “cancer.”
A group of experts advising the nation’s premier cancer research institution has recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment. The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
Would you rather hear you have a “cancer” or an “IDLE?”
The fear of cancer can be worse than the problem itself.
When Winston Churchill told the nation during war that “the only thing we have to fear is fear itself,” he wasn’t aware that he was talking about a medical and scientific reality. In her book, The Fear Cure, Lissa Rankin, M.D. says,
“We now have scientific proof that fear can make you sick.”
She points out that fear can cause us to develop heart disease and may even contribute to the growth of cancer. So our fears and anxiety about cancer may well cause us to develop the very thing we’re afraid of getting. Reducing fear can save lives.
The Medical-Industrial Complex makes big bucks promoting fear.
Fear may be bad for people, but it is good for big business. Otis W. Brawley, M.D., chief medical officer for the American Cancer Society, understands the source of the problem.
“It’s the doctors, it’s the hospitals, it’s the hospital systems, it’s the insurers. It’s the drug companies, it’s the lawyers and it’s even the patients. Everyone is at fault for the fact that the system really is not failing. Quite honestly, failure is the system.”
He points out that a seemingly helpful “free PSA screening” offered by a local hospital is actually a way to increase sales of products and services. He remembers talking to the department head planning a screening who explained the dollars and cents.
“If they screen 1,000 men, they’ll have 145 abnormal,” says Dr. Brawley. “They’re going to charge about $3,000 to figure out why each of the 145 abnormals is abnormal and that’s how they charge for the ‘free’ screening.”
“About 10 of that 145 won’t come to this hospital … Now of the 135 that they have, 45 will die of prostate cancer and the others are going to get radical prostatectomy at about $30,000 to $40,000 per case. With a percentage they’re going to get [radioactive] seeds at about $30,000 a case. IMRT radiation therapy at the time was about $60,000 to $70,000.”
He asked the department head how many lives would be saved by the screening and subsequent procedures. “I don’t know. Nobody has ever shown that prostate cancer screening saves lives.” And that was back in 1998. Costs and profits have gone up considerably since then.
Dr. Brawley offers his assessment of the current craziness surrounding PSA screening.
“Quite honestly, a whole bunch of doctors have drunk the Kool-Aid. They don’t actually understand that prostate cancer screening may not save lives. The fact that some of them make money off them helps them to not understand, of course.”
Remember this isn’t the opinion of someone who knows little about the realities of cancer and what real patients experience. This is the experience of a man who has spent his life treating people. He’s a man who isn’t afraid to stand up and tell the truth even if it’s a truth many of his colleagues don’t want to hear. Before you get screened, you may want to forgo the Kool-Aid and get the facts.
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