A recent recommendation that healthy men age 50 and older no longer undergo a routine blood test for prostate cancer is sure to be controversial and likely to be widely ignored. But the public should resist reflexive opposition to findings that challenge common practices, like this one by a prestigious medical panel that found the PSA test actually does more harm than good.
If the nation is ever going to contain surging health care spending without compromising the quality of care, individuals have to be willing to change ingrained beliefs when presented with evidence that they're outdated. It won't be easy. We've been told for decades that regular screenings, such as prostate specific antigen (PSA) tests and mammograms, are the best way to detect cancers early, when they can be treated most successfully. When our lives are at stake, conventional wisdoms die hard.
But the U.S. Preventive Services Task Force -- a committee of independent experts assembled by the U.S. Department of Health and Human Services -- concluded in a final report published this week that PSA screenings generate a lot of false positives. These spur needless anxiety, biopsies and other expensive diagnostic exams. And even when PSAs reveal cancer, the result is often costly treatment, with bad side effects, such as impotence or incontinence, for a disease that progresses so slowly that most elderly men, if untreated, will experience no ill effects and eventually die of some unrelated cause.
The PSA remains useful. Men with symptoms, or in high risk groups such as African-Americans or those with a family history of the disease, should consult their doctors about the value of the test for them.
"Talk to your doctor" is also sound advice for women in their 40s who, the task force said in 2009, don't benefit from routine mammograms. Or those ages 50 to 74 who it said should have the scans every two years rather than annually.
It's easy to be skeptical that such recommendations are more about saving money than lives, especially when they come from experts advising the deficit-wracked federal government, which mandated that insurers cover such preventive care with no out-of-pocket charges to policyholders. But they're harder to discount when they come directly from doctors
Nine medical specialty boards -- including the American Board of Internal Medicine, American College of Cardiology and the American Society of Clinical Oncologists -- recommended in April that doctors perform 45 common tests and procedures less often. They advised against such practices as including electrocardiograms in routine physicals, doing MRIs whenever a patient complains of back pain, or CT scans when a patient faints but has no other neurological symptoms. They concluded that such tests add costs while doing nothing to improve patient outcomes.
It's estimated that unnecessary tests, treatments and hospitalizations, together with futile care at the end of life, account for as much as a third of the $2-trillion annual tab for medical care in the United States. That money should be put to much better use. But for that to happen the public has to accept that more care is not always better care.