I didn’t know who Emmitt Smith was. I didn’t know September was Prostate Cancer Awareness Month. I didn’t know what was going on in the weekend football game my husband was watching next to me on the couch. I was typing a clinic note because, in general, that is what I am doing if I am sitting down, regardless of the day or time. I am an academic physician with a large HIV clinic practice. HIV remains more common in men than in women; thus, I have a special interest in men’s health. When I heard the words “prostate cancer,” the television commercial drew my attention from my work.
The man speaking was Emmitt Smith, an acclaimed running back who played in the National Football League for many years. He said men should be screened for prostate cancer. My immediate response was—that’s not entirely correct. The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine; most medical providers and health care plans adhere to their recommendations. While multiple other, more aggressive guidelines exist, the USPSTF advises that men aged 55 to 69 years should have the opportunity to discuss the possible benefits and harms of prostate cancer screening with their doctor. In practice, we call this type of discussion “shared decision-making” between physician and patient. It actually is more difficult and time-consuming than simply ordering a blood test. While screening may reduce the chance of death from prostate cancer in some men, the testing process often entails invasive medical tests and treatments that may result in incontinence and erectile dysfunction. So, men electing to undergo prostate cancer screening is not a slam dunk. Wait, wrong sport.
Depend, the adult diaper company, was the sponsor of the advertisement. Could it be intentional that Depend, owned by Kimberly-Clark, wants more people to be incontinent so more people will use their products? That seems a bit paranoid. Yet it’s a giant corporation. Kimberly-Clark purveys brands that are so well known that the brand name is eponymous for the product itself, e.g., Kleenex and Depend. Doesn’t it have medical consultants to ensure accuracy? Why would it pay to broadcast unnuanced advice? Incidentally, the company is Depend, not Depends, which also threw me for a loop (to employ another masculine metaphor).
We all want men to get the care they need. Prostate cancer is more common in African American men and men with a family history of prostate cancer. Prostate cancer can be a deadly disease. Often, men do not seek care for their medical concerns, whether related to HIV, heart disease, or genital concerns, and this lack of care results in poor outcomes. Simultaneously, detection of many prostate cancers diagnosed solely by blood testing will not increase life expectancy, and treatment of these slow-growing tumors will only result in expense, mental anguish, and decreased quality of life due to impaired urinary and sexual function as a side effect of medical interventions, such as surgery. Each man must make his own decision in consultation with his physician, taking into consideration his risk, personal and family medical history, and health values.
September is over and we are on to another awareness month, and I have not seen the commercial again. Per the Depend website, Kimberly-Clark is donating money to prostate cancer research, which is laudable. However, they did mention it would max out at $300,000 which, again, given the size of Kimberly-Clark, is not much. It is a good thing to talk about common health concerns for men. But I am still struggling with how a paper product company can recommend a potentially unnecessary medical test on national television with no outcry. We are accustomed to pharmaceutical commercials telling us to “ask your doctor” for an expensive medication, and I will save my objections to that practice for another day. But in this advertisement, there is no recommendation to consult with your physician—just dubious medical advice.
Catherine Diamond is an infectious disease physician.
