Our culture has taken a strange turn where the truth is relative, and where conspiracy theories rule the day. News sources and social networks are rife with political agendas, fake articles, and disguised advertisements. This chaos harms our social welfare, but can also impact physical health. Misleading news reports of new clinical studies make it difficult to discern medical fact from fiction.
I spend hours in clinic justifying recommendations to patients when they conflict with something they read on Facebook. Some patients think I have a hidden agenda or think I am ignorant and uninformed. In principle, I adhere to evidence-based practices and professional guidelines, however antiquated that may seem.
Given that a major part of my practice is prostate cancer I am especially impacted by media effects. In 2012 the U.S. Preventative Services Task Force (USPSTF) recommended against PSA screening for prostate cancer. The Associated Press headline at that time announced: “Routine Prostate Cancer Test Not Recommended.” That recommendation was based on 2 clinical trials that compared prostate cancer deaths in men who underwent “routine screening” versus “usual treatment.” It was recently shown that 90 percent of patients in the “usual treatment” group had PSA testing. Based on this, it is not valid to conclude that there is no benefit to screening. One would expect that the USPSTF would have issued a retraction, and that the press would have criticized the USPSTF’s methods. Alas, there has been little mention of the issue, and PSA screening continues to be held in exile.
Another screening modality currently in jeopardy is the digital rectal exam (DRE). The Huffington Post website posted ,“The Most Common Prostate Cancer Screening Method is Obsolete.” This was based on a weak study published in Current Medical Research and Opinion that concluded that DRE exposed men to uncomfortable examinations for minimal gain. There is a large body of evidence supporting the importance of the DRE. Nonetheless, the media selected this one limited study as proof that it is all wrong.
Finally, treatment for prostate cancer is under attack. CBS news proclaimed: “Study: No Evidence that Treating Prostate Cancer Makes a Difference.” This was in response to a New England Journal of Medicine report that examined death rates in men with localized prostate cancer randomized to monitoring, prostatectomy or radiation. The study showed no difference in cancer-related death among the groups, but it did show that treatment lowered the incidence of metastasis. Minimal emphasis was placed on that benefit. In that study, 76 percent of men had low-risk disease. We know that low-risk prostate cancers pose a low risk for death, so findings of the study were not surprising. However, the headline implies that the results apply to all prostate cancers, which is not true. Men with intermediate and high-risk disease who avoid treatment run a much higher risk of dying from their disease.
One day this situation will be a case study on how inaccurate reporting by the media can cause a health hazard. Sensational headlines generate “clicks” and “likes,” the measure of success in today’s news business. Study limitations or nuances may be reported, but readers are immediately biased by the tone of the headline. The current theme regarding prostate cancer in the press is, “Don’t look for it and don’t treat it.” Headlines need to be less biased, and articles need to be more balanced and objective. Since 2012, more men have presented with high-risk and metastatic disease. Many men will die as a direct result of bad information.
Blame also lies partly with urologists. Overtreatment of prostate cancer has historically been a real issue. The USPSTF recommendation and other reports strengthen the public perception that urologists have conspired to profit off a harmless disease. It needs to be clearly emphasized that prostate cancer is dangerous and kills 26,000 men annually. We need to communicate how new genetic tests, imaging studies and treatment strategies are transforming the way we manage prostate cancer. We also need to improve the scientific quality of clinical studies, and there should be a policy whereby medical experts coordinate with news agencies to more accurately report study findings. The medical establishment needs to provide a sanctuary for facts in this world of uncertainty.
Matthew N. Simmons is a urologist.
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