Newt Gingrich reignited the “death panels” meme during Tuesday night’s GOP presidential debate in New Hampshire, arguing that the U.S. Preventive Services Task Force’s draft recommendation that men shouldn’t be routinely tested for prostate cancer was “going to kill people.” The panel found that the test does more harm than good, noting that “The common perception that early detection prolongs lives is not supported by the scientific evidence.” Gingrich disagreed:
GINGRICH: I am really glad you asked that, because I was just swapping e-mails today with Andy von Eschenbach, who was the head of the National Cancer Institute, the head of the Food & Drug Administration. But before that, he was the provost M.D. Anderson, the largest cancer treatment center in the world.
And he wrote me to point out that the most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people. So, if you ask me, do I want some Washington bureaucrat to create a class action decision which affects every American’s last two years of life, not ever.
I think it is a disaster. I think, candidly, Governor Palin got attacked unfairly for describing what would, in effect, be death panels.
And what Von Eschenbach will tell you if you call him is, the decision to suggest that we not test men with PSA will mean that a number of people who do not have — who are susceptible to a very rapid prostate cancer will die unnecessarily. And there was not a single urologist, not a single specialist on the board that looked at it. So, I am opposed to class intervention for these things.
Some doctors like Von Eschenbach may disagree with the panel’s recommendations, but the scientific evidence demonstrates that the risk of additional testing and treatments — like biopsy, surgery, and radiation — outweighs the benefits of early detection. Part of the problem, the science concludes, is that the PSA doesn’t actually detect prostate cancer, but rather “reveals how much of the prostate antigen a man has in his blood,” so it triggers additional testing. Nor does it “distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.” And so the panel concluded that for healthy men who have no other symptoms of prostate cancer, the cancer grows slowly and they end up dying of something else without ever knowing about the disease and avoiding the cascade of treatments and complications that come with diagnosis. For instance, according to the task force, “one million men received surgery, radiation or both as a result of a PSA test from 1986 to 2005,” but about about 0.5 percent of those who received surgery after a PSA test died within 30 days. The treatment also “significantly increased risks for incontinence, impotence and other health problems.”
As Jonathan Cohn observes, ultimately, this is an intensely personal decision. “Do you want to have a test for a cancer that might not be lethal and that might lead you to treatment that could harm or even kill you? Not every patient will answer that question the same way. Not every doctor will either.” This panel or the Affordable Care Act won’t make that decision for you — “nobody is going to stop physicians from giving the test. Nobody is going to stop patients from getting the test. Nobody is going to stop insurers from paying for the test.”
The government will consider the panel’s recommendations when forming the basic benefit packages that insurers will offer beginning in 2014. But its science-based conclusions are just one factor in a complicated process that will certainly take into account the opinions and expertise of doctors like Von Eschenbach and consumer groups that disagree. The Prevention Task Force considered the science and efficacy behind the PSA test, which is a good starting point for making any kind of medical decision.
Kaiser Health News looks into Von Eschenbach: “He is listed as a “senior advisor” for Gingrich’s think tank, the Center for Health Transformation. He is listed as a senior fellow with the Milken Institute, whose founder, Michael Milken, credits the blood test for saving his life.”