Slapped After Touching Breasts, Panel Fingers Prostate


High magnification micrograph of prostate aden...

Prostate Adenocarcinoma

 

The U.S. Preventive Services Task Force is at it again.  Health policy watchers will recall 2009, when the panel touched off a firestorm of criticism when it advised that women not undergo routine annual screening mammograms until age 50, and to make individual decisions regarding the risks and benefits of screening mammograms between ages 40-49.

After touching the breasts, and having their hands sharply slapped, they now have tried to finger the prostate.  For the anatomically uninitiated, reaching the prostate requires a more delicate approach.  The group is poised to recommend that screening for prostate specific antigen (PSA) should no longer be performed, challenging a long-accepted paradigm.

It’s possible the average man may shrug and say “Okay so I don’t need to get it checked.  Fine.”   But there will be resistance to the new guidelines, although it is unlikely to rise to the level seen following the mammography recommendation.

The new policy should allow many asymptomatic men to avoid the unneeded workups and all the resulting complications investigating elevated PSA levels.  If adopted on a wide basis, the likely effect on robotic prostate surgery, itself a subject of considerable debate, is likely to be slowing of the adaptation of this expensive, controversial technology.

Panels often face criticism when recommendations differ from popularly held notions of appropriate tests and treatments.   Determining guidelines for a population involves balancing costs against benefits.

It is very difficult to explain the logic and the statistics behind these recommendations to a lay population, who often are skeptical when apparently standard management is altered.  But even professional audiences may let emotion cloud their reactions to new paradigms.

All too often, accusations of rationing and ulterior motives cloud the conclusions, and anecdotal, rather than scientific arguments are used to challenge the new information.

Going forward, there will be more and more study of various types of tests and treatments.  New guidelines will inevitably emerge, replacing the old conventional wisdom.  As always, there will be various degrees of debate, and sometimes resistance.  In order to foster acceptance, panels should present the new information with as much care as was taken to generate it.  Similarly, refutations of panel recommendations should be based on scientific merits rather than emotion or anecdotal arguments.

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