“…I think the Catholic Church was too much blamed in the case of Galileo – he was just a victim of peer review.” (Eric J. Lerner, The Big Bang Never Happened, 1991)
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” (Upton Sinclair)
I stumbled on the Lerner quote this morning, and thought it would be a nice way to introduce a subject in need of examination, PSA, or the prostate specific antigen, discovered by Richard Ablin in 1970. It has been his life’s work to inform the public on the true nature of the PSA test. Peer review, or enforced mediocrity, plays a large part in preventing the truth about various forms of quackery from seeing light of day. Ablin’s work against PSA does not stand the withering criticism of his peers, who are in it for the money. PSA testing, followed by unnecessary biopsies and prostatectomies, is big business. Ablin doesn’t get it.
Albin co-wrote the book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. Since it was he who discovered PSA, he has a right to speak up. (I fear, however, that in the U.S. the best place to hide something is in a book. )
Before discussing PSA, I was struck by similarities between it and AIDS. Both prostate cancer and immune deficiency are relatively small matters (vitally important to individuals but small in terms of the general population) blown wildly out of proportion. AIDS changed our behavior and forced us to stop trusting one another. I suspect it was somehow connected to population control, but the point is that it was foisted on us deliberately by false experts. These were lying liars telling their disgraceful lies with authority of the medical establishment behind them. “HIV,” if it exists at all, is a harmless passenger virus. It is still thought to be deadly by the public at large. It can be contained, we are told, by “AZT” – a failed chemotherapy drug from the 1960s that was repurposed, but which is itself deadly.
Behind these three-letter acronyms lurk some seemingly shady characters. In the matter of AIDS, it was Richard Gallo, and with PSA William J. Catalona. Both aggressively push their causes in the face of overwhelming contrary evidence.
More about AIDS down the road, but what confused me is that on this blog we have routinely exposed fake events, very large ones, where in reality no one was harmed. It left me with the impression that the people behind these events were a benign force, not as much evil as merry pranksters. But with AIDS and AZT, healthy people who would otherwise lead normal lives suffer, even die of the treatment. So too with PSA.
Since 2012 or so, doctors have been advised not to test men over age 50 for prostate cancer by use of the PSA test. I am 68. Last year I twice had a PSA test, first in May when it turned up higher than the year before, and again in November, which found it normal. I was never told that the current policy is not to use the PSA test on me.
What if the PSA had not been “normal”? My doctor would have recommended a biopsy of my prostate to test for cancer. If found, I would have endured a prostatectomy, and my life as a man would be over. It is not unusual in the wake of this procedure for men to experience incontinence and impotence. But that is better, we are told, than having prostate cancer, which is deadly.
Prostate cancer is most often benign and best left untreated, but three things need to be understood:
- If I have an aggressive prostate cancer, I will die from it. They cannot alter that fact. They might give me a few months extra by means of radiation or chemotherapy or a drug regimen known as “Provenge,” themselves a scourge on living organisms, but they cannot change my fate.
- Aggressive prostate cancer is the exception in men, not the rule. That is why, at my age, they don’t even want me PSA-tested.
- Prostatectomy is major surgery, and often leaves a man incontinent and impotent. Since it cannot stop an aggressive cancer (a “rabbit”) and is not warranted for a benign one (a “turtle”), it should be done only rarely, perhaps in younger men who have so much more time at stake. Aggressive treatment might then be warranted.
That scare word, “cancer,” is a large part of the reason why doctors can, knowingly or ignorantly, perform this potentially debilitating surgery. People panic when they hear it – “get it out of me! Cure me!” But our bodies are equipped with immune systems that serve us well for most of our lives. Our immune systems can and do contain cancers of various types.
This brings us to the PSA test itself. Ablin, discoverer of PSA, now campaigns against its use. It doesn’t tell us anything useful, he says. From his book:
“The soft-spoken academician [Hal Arkes, PhD] visually illustrated the results of the data: “Picture two auditoriums, each filled with 1000 men. One auditorium is filled with men who had PSA screening test, and one auditorium is filled with men who had not been tested – eight men in each auditorium will die of prostate cancer. As hard as it is for some people to recognize, these two auditoriums represent the statistical reality of prostate cancer.” (Page 44)
Ablin has what he calls the “four cruxes” of the PSA test:
- PSA cannot diagnose prostate cancer.
- There is no specific level of PSA that detects prostate cancer.
- The PSA test cannot distinguish an indolent cancer from an aggressive cancer.
- Prostate cancer is age-related. If a group of asymptomatic men between 60 and 69 years old have PSA-prompted biopsies, more than 65% will be positive for prostate cancer.
The PSA test is meaningless. There is a 65% chance that I currently have prostate cancer. I could have a PSA of 11 and not have cancer, or a PSA of 1.2 and have it. There is an even larger chance that I will die by some other cause.
So what’s going on here? As with AIDS, doctors are harming instead do of helping their patients, violating their oaths. My older brother had an annual physical in 2008 that showed an elevated PSA (4.0 ng/mL is the (arbitrary) standard). So at age 64 he underwent a biopsy that showed he had prostate cancer. Was it aggressive? I do not know, and I don’t think he knew either. He trusted his doctor, who he thought was saving his life. He underwent radical surgery that changed his life.
Steve was a vibrant man who neither smoked nor drank and who was a serious runner (he qualified for and participated in the Boston Marathon). The surgery stopped him in his tracks. In 2011 he died from cancer deep in his intestines, and I long suspected a connection between the prostate surgery and spread of cancer throughout his body. The Ablin book offered no evidence of such a connection. Prostate cancer, when a rabbit, will metastasize to the bone and result in a painful death.
Millions of men have had the PSA test since 1986, when it was first approved by the FDA as a means of monitoring treatment of men known to have aggressive prostate cancer. The test was never meant to be administered to the population as a whole, as it was not shown to be useful screening device in detecting cancer.
So why did Food and Drug Administration sit idly by and do nothing about this massive and illegal off-label use of the test? Ablin is not willing to condemn the whole of the FDA for corruption, so I will do so in his stead. It is because of “regulatory capture,” that is, the power of large corporations to insert their people as foxes guarding the public hen house.
Hundreds of thousands of men have undergone unnecessary and debilitating surgery. Urologists have prospered, as have the manufacturers of elaborate and useless equipment such as two-story high machines that use radiation to destroy the prostate. Add to that the corporations that sell erectile dysfunction equipment and boner pills and adult diapers. It is obscene.
I cannot and do not say that each an every urologist who performs an unnecessary prostatectomy is knowingly harming his patient. We are far too complex and self-deceiving as humans for such broad-brush statements. That is why I opened above with the Upton Sinclair quote. I can only say that in the upper reaches of large medical corporations that profit from sale of devices and drugs, that there is a intent to deceive the public. It is well understood as one scales the upper reaches of the business world that sociopaths abound.
“While running for president of the United States, the former New York City Mayor Rudy Giuliani announced in a 2007 campaign advertisement, “I have prostate cancer, five, six years ago. My chance of surviving prostate cancer – and thank God, I was cured of it – in the United States? 82%. By chance of surviving prostate cancer in England? Only 44% under socialized medicine.” (Page 219)
This illustrates two fatal flaws in our health care system – celebrity endorsement, and widespread use of advertising to reach an ignorant public with false messages. Neither should be allowed. Giuliani merely repeated a lie, perhaps knowingly, as I know he has willfully lied about other matters. Regardless of his intent or level of knowledge, his words about prostate cancer are wrong, harmful and dangerous.
Mark Twain’s told us about lies, damned lies, and statistics. Gerd Gigerenzer and Odette Wegwarth of the Max Planck Institute in Berlin published a paper in the British medical Journal, “Five-Year Survival Rates Can Mislead, dealing with the Giuliani matter. These are Ablin’s words dealing with the paper:
[They explained] that the higher survival rate in United States, publicly advertised by Giuliani, is merely a statistical mirage. The earlier detection of prostate cancer due to routine PSA screening in the United States led to an exaggeratedly elevated survival rate, but the men did not live significantly longer than their counterparts in the United Kingdom. One poignant message was missing from [Gigerenzer and Wegwarth’s] paper: not only did the US men not live longer than the UK man, they suffered immeasurably more unnecessary procedures and treatments because of routine PSA screening. Spearing sacred medical cows, like “early detection leads to cure,” is fraught with peril. (Page 219)
I long ago read that in Europe, prostate cancer was monitored but not aggressively treated. There was no point as, statistically speaking, men receiving treatment in the U.S. were living no longer than their European counterparts. I think I even knew this at the time that my brother underwent the surgery. But, like him, I did not know to question the doctors. So it is with some embarrassment that I admit that last year I allowed myself to have the PSA test. I just blithely went along.
I regard Ablin’s book as vitally important, even life-saving. It is not often I merely put up a book and say “read it,” as books can be mere propaganda, just like so many other mass media outlets.
“Books are different from all other propaganda media,” wrote chief of the CIA’s Covert Action Staff, “primarily because one single book can significantly change the readers attitude and action to an extent unmatched by the impact of any other single medium [such as to] make the most important weapon of strategic (long-range) propaganda.”
That’s a snippet from the book The Cultural Cold War by Frances Stonor Saunders. She describes how the CIA from its inception boldly inserted itself in every medium from books, magazines, music and art to control our perceptions.
So now we have two books warning us about hazards, and are in need of objective reasoning. Should Ablin be trusted, or is he merely another soldier on a contrived and unstated mission?
In his book, Ablin condemns the widespread abuse of the PSA test, the greed of the urology profession, the indifference to suffering caused by unnecessary medical procedures. My instincts say “trust”, because …
- He discovered PSA;
- He fought against its use in screening the general population;
- He has taken on big medicine, and so is now vilified and pushed to the margins;
- His writing makes sense. He (and co-author Richard Piana) worked hard to make complicated subjects understandable, the sign of good-functioning minds.
On September 30, 2010*, [Michael Wilkes, M.D.] published a powerful op-ed piece in the San Francisco Chronicle titled “PSA Tests Can Cause More Harm Than Good,” in which he stated:
“The large majority of PSA discovered “cancers” would never cause any problem whatsoever if they went undetected… Most of the men treated would’ve been just fine if they never knew about the cancer. But when they’re treated (whether with surgery, radiation, chemotherapy), the majority suffers really life affecting effects, such as impotency and/or incontinence.… Contrast this to the comments of PSA discoverer Dr. Richard Aplin, who called it “a hugely expensive public health disaster,” with accuracy “hardly better than a coin toss.”
On the very same day that Wilkes’ op-ed article was published, an executive associate dean wrote a letter to the [University of California at Davis] medical school associate dean for curriculum stating that Wilkes would no longer continue as a doctoring instructor of record and the resources for student exchange program that he had championed would be eliminated. [The] dean was also informed that Wilkes’s “departmental space” would be reassigned. …
In effect, Wilkes, a prominent professor commended by his peers and students for his contributions to academic, was having his career dismantled because he wrote an op-ed piece voicing concern about over-the-top promotion of PSA screening. (Page 183)
(*Link is dated October 1, 2010, an important fact.)
Wilkes eventually won out. None of the threats were carried out, and they had a nice academic freedom food fight at UCD over the matter. The investigating panel concluded that the article was published on October 1st and the email was sent the day before. Ablin cites the article as appearing on September 30th, which is apparently wrong. But … something is fishy here. It seems unlikely that an out-of-the-blue threatening email would be sent to a man unless the man had somehow threatened the institution they both worked for.
I have seen and read about so much of this, in science, medicine … heavy-handed bullying of anyone who speaks up or out. The don’t-rock-the-boat mentality keeps most doctors and scientists in line. The few who do speak out are ostracized, marginalized, pilloried, or even fired and forced to make an honest living. It is a sad state of affairs.
The message from Ablin is important and needs to be spread far and wide – do not trust the PSA test. If your PSA is elevated, it could be due to a bumpy car ride or a romp in the hay the night before. (I suspect that vigorous exercise, like running, might elevate one’s PSA.)
Do not undergo major surgery due to a threat that is probably not a threat. The best treatment for prostate irregularities is intelligent motoring. Allow for a DRE (digital rectal exam), a far less invasive procedure (and one that we all enjoy). If irregularities are noted, monitor your health and watch for other symptoms. It could be just an infection, or it could be a benign cancer best left untreated. Those are far more likley than aggressive cancer.
I speak only for myself: If I learn I have aggressive cancer, my option will be pain management as I leave the scene, nothing more. That is my choice. My advice to you: Be informed. Otherwise, as always, you are on your own. Experts* are not to be trusted.
*Experts offer us … “data and jargon. [They are] a breed of people dedicated to obscurantism and the acquisition of information for its own sake, cloaked with mystique and omnipotence. (Brian J. Ford, The Cult of the Expert, 1982)