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  1. 1
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    Bogdanovist

    It’s tricky. I don’t know much about this issue, and that’s really the point. Can I trust a plausible sounding article I read on the internets, with lots of links to ponderous thing written by people with weighty titles in front of their name, ahead on my GP/urologist?

    Encouring men “to get informed and make up their own minds” sounds very sensible, but it’s precisely because people do this that we have low vaccine rates leading to infant deaths from previously (almost) extinct diseases, people buying expensive pumpkin seeds to cure cancer, wearing holograms on their wrists to ease arthritis, drinking distilled water to prevent migraines etc etc.

    Unless you’re a trained specialist in the area you simply cannot reasonably parse the over abundance of ‘information’ available on the internet in order to trump your doctor’s opinion.

    If there is a problem here with medical practice, the quacks have to sort it out ASAP, with ruthless oversight from the relevant regulatory agencies. But encouraging people to spend their nights ‘getting informed’ about their medical options by reading some blog will, on the balance, lead to far more harm to far more people than telling them to trust their doctor. The doctors don’t always get it right, but they get it right (or closer to ‘right’) than the collective ramblings on the blogosphere ever will.

    In this instance, you may well be correct, I really don’t know. But as a general principle it is a murderous path to follow suggesting that people can trust the internet better than medical consensus, as flawed as that can be.

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  2. 2
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    Shooba

    Bogdanovist. The short answer to your question is … yes. You should take the word of Simon Chapman and Norman Swan over the word of your GP/Urologist. The American Cancer Society, Cancer Research UK, Cancer Council Australia, the Australian Government and countless other bodies have all rejected the idea of screening for all men. It is simply bad public policy.

    Urologists are at the coalface, and see men with prostate cancer survive treatment after an early detection, so it is understandable that they feel that men should get tested. But what they cannot say for sure is that each of those men would have eventually died from that illness. In fact, on average, 48 men are unnecessarily treated for prostate cancer for every solitary man for whom treatment is lifesaving.

    GPs often order the PSA test out of habit or because they assume men want to know. This is a fault on their part and the good GPs will talk you through the issues first before ordering the test.

    Wayne Swan’s (shockingly rude) rant in the clip above is indicative of a serious problem – men using their own individual experiences to make up their minds about the wider issue. Would Wayne Swan have died without his treatment? Perhaps. But to advocate that all men be tested is irresponsible on his part. Often men in his situation form the hardline view that the test is infallible because the alternative (that they are now impotent/incontinent for no good reason) is too much to bear.

    In a nutshell, that is why the PCFA (formed under Mr Swan’s watch) and the urological society (as I said, at the coalface) are the only groups to still advocate PSA testing for all men.

    I would recommend you read Simon Chapman’s book (linked above). It is a very short and succinct weighing of the facts and evidence. Ultimately it shows that for an individual the choice should be there, but the test is so deeply flawed that it is simply dangerous to say that all men should be tested.

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  3. 3
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    db

    Bogdanovist wrote:
    “it is a murderous path to follow suggesting that people can trust the internet better than medical consensus”

    However here the item on the internet is noting but a window into a portion of the medical community which shows us there is not medical consensus on this issue.

    We’re not talking about a few people worried about vaccinating their kids but instead the head of Cancer Council Australia for a decade (Professor Alan Coates) and an experienced medical journalist that practised medicine as a specialist before working for the ABC (Dr Norman Swan). A book launch is a million miles away from “collective ramblings on the blogosphere”.

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  4. 4
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    Doctor Whom

    My father had prostate cancer. It wasn’t detected for years. It was possibly what eventually killed him.

    I get a PSA about each year or so. Occasionally I get a digit up my anus. (Stop sniggering in the back row – my doctor does it)

    I have no illusions that these will do anything but keep me in the know a bit.

    If I get a warning- I’ll have to think a lot. Then maybe act – maybe not.

    Screening for prostate cancer doesn’t make any sense.

    Screening for Bowel Cancer does.

    Trying to introduce evidence into policy decisions can get one’s head cut off. Or contract not renewed. I know.

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  5. 5
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    Leo Braun

    “The real challenge is to get men to be tested”! Anyone seeking to ascertain the viability of the conditional PSA tests bulk-billing ought to peruse 18-01-10 dated attachment received by me on 22-01-10 within the email dispatched from Canberra as a consequence of my complaint emailed to the Minister for Health on 15-11-09 … https://croakey.org/psa-screening-is-a-public-health-disaster-says-cancer-doc#comment-1622

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  6. 6
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    Bogdanovist

    @db I appreciate what you’re saying, however how does one, who is not an expert, distinguish from this claim of non-consensus within the medical establishment and the kinds of claims made (for instance) at http://www.avn.org.au? In both cases individuals with apparently suitable qualifications, who most of the general public are not familiar with, are held up as examples of non-consensus. In both cases their are books and book launches one could also point to as further ‘evidence’.

    How can who does not understand the details themselves tell the difference?

    Lets look at the PSA situation. Lets assume that PSA screening can certainly help some men, but on average will cause more harm than good due to the many more men it will harm without due cause. On this score screening would not be good public health policy, even if individual cases it may have helped, even to the point of saving lives.

    Now, lets apply the same logic to the idea of disseminating medical advice to men via the internet (including reccomendations to read books) as opposed to their GP/specialist. In some cases (PSA screening for instance) it may be of benefit, causing men to question their GPs advice and potentially avoid uneccessary mutilation. However, overall, the advice given by a GP/specialist is far better than that an untrained individual could obtain via the internet/books. So even though in some cases (such as this, for arguements sake) someone could choose a better option than their doctor, as long as they happened to have read the ‘correct’ advice, overall they are far more likely to come to harm by self assessment of their needs, with input from the internet/books than they are by trusting their doctor.

    By a consistent application of logic, you can see that unless the medical establishment is wildy and frequently wrong, then the best course of action is to advise that people trust their doctor. That isn’t to say this should not be discussed at all in a forum like this, however the take home message here is ‘listen to Doctor Swan’, whereas it really should be ‘raise your concerns with, but then listen to, your doctor’.

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