By Gene Franks
All men naturally desire to know.--Aristotle.
In the great Renaissance novel Gargantua et Pantagruel, Rabelais told of a judge who decided cases by throwing dice. Rabelais approved, reasoning that with the dice the accused had a chance. In the French courts of the day, the accused had no chance at all. In the tribunals of modern medicine, the patient-accused would usually get a fairer shake if dice were the testing method.
The doleful inaccuracy of mammography (see Marilyn Kaggen's article on "Breast Cancer," from our article archive), which can lead to slicing off healthy breasts, is well documented. But women are not the only victims of inaccurate tests. Men get the same raw deal with the much-advertised prostate specific antigen (PSA) blood test. Here is Bina Robinson from the Autumn, 1993 Civil Abolitionist:
In 1989, PSA-producer Schering Plough Corporation paid the Burson-Marsteller public relations firm $1.2 million to launch Prostate Cancer Awareness Week and promote the use of the test as a general screening device for detecting the presence of prostate cancer, even though it had been approved only for monitoring.
Today 92% of urologists report routine use of the test for men over 50. It costs $50-$80 and produces false positives, leading to further testing, in 20% of the patients. It also produces false negatives in 25% of patients who actually do have prostate cancer. In short, it may be of value to 55% of the patients screened. Economists estimate that screening all American men over 50 would add $28 billion a year to national health care costs.
Doctors disagree on whether a test with such a high rate of false negatives and positives should be used routinely, but the decision is being made by patients who request it as a result of the cleverly-contrived Prostate Cancer Awareness Week and the backing of the American Cancer Society. The irony is that detecting of those with prostate cancer cells may not be helpful. A Veterans Administration study of 111 men found no difference in the death rates of those who underwent surgery and those assigned to "watchful waiting."
Dr. John McDougall (Your Good Health, Jan./Feb. 1994) agrees that "there is harm from early detection" of prostate cancer, "mostly because detection leads to treatment." Prostate cancer, second only to lung cancer as a killer of men, has become a major source of surgeries of questionable necessity and merit.
Over a decade ago, before the prominence of the pitifully inaccurate PSA, Dr. Robert Mendelsohn warned: "Surgeons tend to do needle biopsies of the prostate in older men without telling them that in a significant portion of these men, say about 30 percent over the age of 50 and 50 percent over the age of 60, that the biopsy will yield malignant-looking cells which will never become malignant in reality." Many of the "cancer cures" touted in cancer establishment promotions involve removal of just such "cancers" that were better left alone. (Incontinence and impotence are the frequent "complications" of both surgery and radiation treatment of the prostate.) Even U.S. News and World Report (11-22-93) recommends that some men with prostate cancer would do best to forgo all testing and quotes Dr. John Wennberg of Dartmouth Medical School, who coined the term "watchful waiting," as saying that prostrate treatment "at best offers limited benefits for most patients" and that some patients, especially older ones, would do best simply to "put the diagnosis of cancer out of their minds, if they can, and perhaps even consider forgoing monitoring." Prostate Cancer Awareness Week was designed to not let you put it out of your mind.
Do you know who sponsors Breast Cancer Awareness Month (BCAM), with its monotonous "early detection is your best protection" slogan? Hint: it isn't a benevolent non-profit group that loves women and wants to protect their breasts. The sole financial sponsor is Imperial Chemical Industries (ICI). ICI, a multi-national with sales approaching $30 billion annually, is among the world's largest producers of chlorine- and petroleum-based products (paints, plastics, explosives. pharmaceuticals). ICI founded Breast Cancer Awareness Month in the early 1980s and has spent several million dollars promoting it. ICI approves or vetoes every poster, pamphlet and advertisement used in the campaign. "Not surprisingly," writes investigative reporter Monte Paulsen, "carcinogens are never mentioned in BCAM's widely distributed literature," ("The Politics of Cancer," Nov./Dec. 1993 Utne Reader.)
Certainly a conglomerate that sucks in thirty thousand millions of dollars each year is investing wisely by putting a million or so tax-deductible dollars into a program that covers its corporate ass by blaming the victims of its products for their misfortunes. The implicit BCAM message is always the same: "If you get breast cancer, it's because you weren't a good girl. You didn't get your checkups." The blame-the-victim strategy, hallmark of the AIDS campaign as well, is a familiar tactic. But for ICI, BCAM is an even sweeter deal since it happens that Zeneca Pharmaceuticals, an ICI spin-off enterprise, is the maker of the leading chemical treatment for breast cancer.
Tamoxifen citrate (Zeneca's trade name is Nolvadex), a $500 million per year product, will not cure breast cancer, but is said to slow its progress. (Does this remind you of AZT?) Clearly, "early detection" is a priority, since a woman who detects cancer earlier becomes a Nolvadex customer earlier. But it doesn't stop there. Nolvadex is currently approved only for treatment of existing breast cancers. It is known to cause blood clots, uterine cancer, and liver cancer, but the assumption is that the benefit to women with breast cancer outweighs the risk. Last year, however, the National Cancer Institute (NCI) began a study with 16,000 "healthy" U.S. and Canadian women, half of whom will receive Tamoxifen to see if the anti-estrogen drug will prevent cancer. Dr. Samuel Epstein, professor of occupational and environmental medicine at the U. of Illinois Medical Center in Chicago, calls the test "a scientific and ethical travesty" and says that conducting it "verges on criminal recklessness." The test will cost $70 million taxpayer dollars (almost half of NCI's annual breast cancer research budget) and will, of course, benefit ICI immensely should Tamoxifen-takers have a few fewer breast cancers than the control group. If this should happen, Monte Paulsen concludes, "Nolvadex will become a multi-billion-dollar-a-year drug. Every woman on the planet would be a potential customer. In the meantime, ICI continues to sell almost a half a billion dollars worth of treatment each year for a disease that it may be causing by selling tens of billions of dollars worth of toxic chemicals each year."
Why People Love Medical Tests
A segment of the U.S. Population now regards the human body as a two-legged automobile. If something malfunctions, they take it to the mechanic.--William Harris, M.D.
A seldom-discussed aspect of medical costs and hazards is medical testing Testing is a sacred cow. Many who reject allopathic medicine's slash/poison/bum treatment style subscribe to the "better safe than sorry'' logic that sustains one of the industry's most lucrative branches.
The extensiveness of medical testing is stunning. Speaking of the early 1980s-- and since then greater numbers have assuredly been achieved--Dr. Edward R. Pinckney noted: "When all direct and related costs for medical testing are added together--including office visits and hospital charges--the annual bill for medical testing, in 1983, came to about 160 billion dollars, or about half of the entire cost of all medical care" ("The Accuracy of Medical Testing," in Dissent in Medicine: Nine Doctors Speak Out.)
Doctors often excuse their obvious over-exuberance in ordering tests by saying that much "defensive" testing is necessary to protect them from lawyers. This is no doubt true. But the "better safe than sorry" philosophy has been very successfully promoted in an effort to make testing a synonym of prevention in the popular mind. This is, without doubt, one of the Church of Medicine's most lucrative beliefs.
Testing has become Big Medicine's darling for several reasons. The most obvious is that the tests are very profitable for doctors. Doctors buy test equipment for the same reason that merchants put in vending machines. An electrocardiograph machine, according to Dr. Pinckney, can pay for itself in a few months and easily yield a profit of $20,000 per year if the doctor uses it only once or twice a day, which is easy enough since, after all, it is better to be safe than sorry. In spite of highly touted advances in diagnostic testing, Dr. Pinckney says, doctors diagnose the probability of less than half of all heart attacks that end in death.
Doctors also love tests because they offer an opportunity to prospect for business at the patient's expense. Did you ever hear of anyone who went to an eye doctor for an exam and found that he didn't need glasses? The routine "physical" gives the medical doctor virtual carte blanche to look through one's inner spaces for things that need fixing. This very profitable search for villains within led Canadian physician Dr. Mercer Rang to coin the term "Ulysses syndrome." Ulysses wandered about the planet for a dozen years after the Trojan war seeking rights to wrong and monsters to vanquish. When a physician undertakes a series of investigative adventures through one's inner caverns in search of a Cyclops to exorcise, the patient is exposed to all the considerable physical, mental and financial hazards of Ulysses syndrome.
Another reason the medical community loves diagnostic testing is that it is so wonderfully unreliable. One test leads to another and to another. Tests are rated according to their sensitivity (their ability to indicate the presence of the disease the doctor-adventurer is searching for) and their specificity (the test's ability to show a negative, or normal, result when the sought-after disease isn't present). Accuracy is determined by balancing specificity and sensitivity. The PSA prostate cancer test discussed above by Bina Robinson is 80% specific and 75% sensitive, therefore 55% accurate. In practical terms, a man's chances of finding out if he has prostate cancer by submitting to the PSA is about 5% better, and $75 more expensive, than by simply flipping a coin: heads I have it, tails I don't. Incredibly, some very expensive tests are less than 50% accurate.
A widely-used X-ray test for the condition known by doctors as "gastro esophageal reflux" and by TV commercial viewers as "heartburn' requires the patient to swallow a chemical called barium and submit to X-rays, often in an inverted position. It is considered only about 33% accurate. But not to worry. At least ten other tests, most of them almost equally inaccurate, can be used to verify the X-ray test. The most reliable of these is also the least expensive. It involves simply swallowing a pill hooked to a string, then pulling it back up to measure the pH. It is 80% accurate, costs $10, and involves the least degree of risk, but it is seldom Dr. Ulysses' test of choice. According to Dr. Pinckney, the well-known stress electrocardiograph test, which costs from several hundred to more than a thousand dollars, is less than 40% accurate. Moreover, of every 10,000 people who take this test, which seeks to record the heart's action during physical exertion, at least four have a heart attack while the test is being performed.
Why, then, if tests are expensive, inaccurate, undignified, and unsafe, do people flock to doctors' offices to have them performed? Much, surely, has to do with the totally illogical myth that testing equals prevention. How having one's breasts X-rayed prevents cancer is a mystery that only the high priests of Medicine can fathom. Dr. Pinckney's opinion--and he has written two books on the subject of testing--is that medical testing flourishes mainly because people will sacrifice almost anything to be the center of attention. They will endure being stabbed, hooked to Frankensteinish machines, given chemical enemas, photographed upside down and poked and prodded in private places--all for the feeling of importance they get from having all that attention lavished upon them. Probably it has to do with being weaned too early or not getting enough attention from mommy and daddy
While I can't disagree with Dr. Pinckney, my own view is that the allure of testing has as much to do with our fear of dying as our craving for attention. However irrational it may seem, we seek reassurance from the Doctor/Priest: "Doctor, I have sinned. Consult the Oracle and tell me what must I do to be saved." The Doctor then performs the high-tech hocus pocus we have been taught to believe in and solemnly gives us the Oracle's decision. If our sins have been grave, a heavy penance is exacted. What we long to hear is: "What you feared was cancer is only gastro esophageal reflux. Take these magic pills. Go and sin no more."