Death by Bureaucracy
by Newt Gingrich
Earlier this month, a panel appointed by the Department of Health and Human Services made a recommendation so detached from the good of individual patients it could only have come from government bureaucrats. They recommended eliminating screening for the most common cancer among males nationwide.
The United States Preventative Services Task Force (USPSTF) is composed of 16 government-selected experts whose recommendations often influence the reimbursement policies of Medicare and private insurers. The range of members’ backgrounds is narrow considering the group is charged with advising the federal government and other healthcare providers on specific medical procedures: almost all are academics or administrators rather than practicing physicians. The panel includes experts in pediatrics and newborn care, in mental health and geriatrics, but not a single urologist who actually takes care of prostate cancer patients.
Despite lacking any specialist who deals with the issue, the panel issued a recommendation this month to stop using the only available test to screen for prostate cancer. PSA tests, which measure levels in the blood of a marker known to be elevated in men with prostate cancer, are the sole method of screening other than digital examination by a doctor, which cannot detect the most common form and usually identifies those cancers it can much later, when they are less curable.
Without the PSA testing, many men will have no way to know they have the disease until it has developed into a much more dangerous problem. In some cases, it will be a too late by the time they discover it.
What is the basis for the panel’s recommendation to discontinue screening that can save lives?
It has nothing to do with the merits of the test. Instead, these government-appointed experts advised against screening because they disagree with what some doctors and patients choose to do with the information once they have it.
Prostate cancer is a complicated issue, and elevated PSA is not always a sign that a man should enter treatment. In some cases, men can live with benevolent cancers and remain healthy for years. In many other cases, it is simply unclear even from biopsies whether the cancers are benevolent or lethal, as both kinds register on test results.
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