By Senator Kay Hutchinson and Andrew von Eschenbach
Of all the ways government inserts itself into Americans' everyday lives, one of the most insidious is its impingement on the doctor-patient relationship.
Even advocates of President Obama's healthcare overhaul must be shocked at the idea of a panel of bureaucrats deciding whether Americans are allowed access to life-saving cancer screening.
Yet that is exactly what has happened with the recommendation by the United States Preventive Services Task Force (USPSTF) against routine prostate-specific antigen (PSA) screening in healthy men, regardless of age.
The USPSTF is a board of primary care physicians charged with compiling preventive medical advice. Before the Obama healthcare bill was rushed through Congress, the USPSTF had the power to advise, but not rule by fiat. That, for all intents and purposes, has changed. Under the terms of the new law, insurance companies are required to offer certain preventive services at no additional cost to patients. Whether a test qualifies is based solely on a favorable rating from the USPSTF.
This is tantamount to giving a task force - not a single member of which is a urologist or oncologist - the power to dispense medical care. While the USPSTF is undoubtedly well-meaning, this decision is clearly misguided and could have a devastating impact on lives.
The American Urological Association expressed outrage at the decision, saying, "We have seen a 40 percent reduction in prostate-cancer-specific mortality in the United States over the most recent 20 years of PSA-based screening. ... It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations, such as African-American men."
The PSA is not perfect, in part because it does not differentiate between malignant and benign cells. But it is undeniable that it has saved lives. Before the test was available, 80 percent of men diagnosed with prostate cancer were already in advanced stages; today, that number has dropped to 20 percent and the death rate has declined significantly. Not only has the PSA saved thousands of lives, early detection has saved countless men from the pain and discomfort of cancer treatment. Rather than discounting the test wholesale, we should be directing our scientific efforts towards refining and improving the test.
At the heart of the USPSTF's argument is the proposition that the cost and harm of the test outweigh the benefits. This is a truly astounding position for a panel comprised of people whose sworn professional oath is to "first do no harm." Whether or not to test is a judgment that should be made on an individual basis, by patients who are informed of the risks and benefits of testing and doctors who know their patients' histories. The idea that a remote panel could make a wholesale decision on behalf of the 120-million-plus adult men in the United States is both shocking and chilling.
The PSA is currently the only means of early detection of prostate cancer. That it is not perfect makes very little difference to the men whose lives it has saved or to their families. No one is demanding that the test be used in every case; but to deny access to everyone - particularly the underprivileged, who cannot simply pay for the test themselves - is an abrogation of duty by the doctors charged with overseeing preventive medical care in the United States.
Hutchison, a Republican, is the senior U.S. senator from Texas; Eschenbach, a urologic oncologist, is the former head of the National Cancer Institute and a prostate cancer survivor.