In the news of the past several days are reports that the American Cancer Society is about to concede that screenings for breast and prostate cancer — long touted as the holy grail of preventive medicine — have instead led to a great deal of over-treatment, and worse. Plus admission by the Centers for Disease Control and Prevention that their pooh-poohing of Chronic Fatigue Syndrome has left a lot of folks suffering, perhpas needlessly, for decades.
Who in the world is there left to trust?
I do trust my physicians at Kaiser, and continue to hope the crafters of our elusive health reform bills are looking in Kaiser’s direction. My breast cancer was detected through a regular mammogram. How frequent these screenings should be is still a matter of debate, but in my case early detection led to a quick mastectomy, a small price to pay for living happily a few more years after. (The ever-after business is not a principal to which I subscribe.) On the other hand, small as my tumor was, who’s to say it might have sat there harmlessly a few more years untreated? Please don’t get me wrong; I would not have opted for waiting to see. Just wondering.
I’m not so sure about prostate cancer screening. But since what seems nearly every man I know over 65 has been diagnosed with prostate cancer after a routine screening, it’s possible to wonder about this too. An October 21 New York Times article cites a new analysis by Dr. Laura Esserman, a professor of surgery and radiology at the University of California, San Francisco and director of the Carol Frank Buck Breast Cancer Center and Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center, San Antonio that “runs counter to everything people have been told about cancer: They are finding cancers that do not need to be found because they would never spread and kill or even be noticed if left alone.” We the healthcare consumers aren’t getting any breaks. Here’s a whole new dilemma to mull over and decide upon: to screen or not to screen, to treat or not to treat. In one group of gentlemen friends I know, others newly diagnosed with prostate cancer are invited to hang out for an hour or so and listen to the pros and cons of the various treatment options — because within the group are men who have gone down at least 4 or 5 different paths.
Another re-evaluation, this one a little more sinister, centers around the dismissive attitude long held by the venerable Centers for Disease Control and Prevention, guardian of our national health and welfare where things like viruses and other causes of infectious disease are concerned. In a Times op ed piece titled ‘A Case of Chronic Denial‘, Hillary Johnson reports on a recent study in the journal Science about a virus found in prostate cancers which will be referred to here by its shorter name, XRMV. It now turns out that there may be a link between XRMV and Chronic Fatigue Syndrome, more commonly referred to these days as CFIDS, and the work now going on in this area of research could be significant in treatment of the latter. Having had a number of friends and family members suffering from CFIDS, I admit to being among those who occasionally thought it might be partly in one’s head, but also aware of the degree of misery and disability CFIDS can bring.
This space is not a health authority. It is, rather aimed at those of us 50-somethings and over, many of whom have trusted many of the above. Trust is good. Open-mindedness is better. Questioning might be best of all.
Science, including public health, is an evolving process. People do research, the conduct experiments, and sift through data and they come to a conclusion that seems justified based on all of that. Cholesterol and atherosclerosis is a good example, for centuries no one even knew that either existed. Fairly recently it was discovered there was a link between the amount of cholesterol in the blood and heart disease. Then they discovered that there were two kinds of cholesterol, the good kind (LDL) and the bad kind (HDL). Ten years from now they will discover something new.
We naturally want safe, decisive answers to our health concerns but most of the time they just don’t exist. There are no silver bullets out there, just the best ones we have at the moment.
Thanks David, you are surely right. I didn’t mean to be slamming science (except the CDC, which I generally admire, does seem a little culpable here.) My intention was just to point, once again, to the growing need for the individual to take responsibility for his or her own healthcare decisions, which means learning as much as possible about potential treatments and interventions.