Sorry to hear about new media columnist and academic Jeff Jarvis' diagnosis of prostate cancer.
Also sorry to see that he publicly promotes PSA screening without a hint of the uncertainties or controversies surrounding it. He wrote:
I also hope to be one more guy to convince you men to get get your PSA checked: a small mitzvah in return for my luck. And when we talk about the cost of screening in the health-care debate, I'll stand up to say that when you're the 1-in-100, screening is worth it.
I think he misses the point. It's not the cost of the screening itself. He frames it in an apparent financial cost framework. I'll frame it in a true human cost framework: all the false positives, all the early pseudo-disease that is found that never would have harmed a man, all the often unnecessary biopsies and treatment - and anxiety - that occur as a result.
Continuing his non-evidence-based crusading, Jarvis promotes his treatment choice:
I'm opting for robotic surgery - geek that I am, how could I not?
How could he not? Easily. By analyzing the evidence - or lack thereof. The US Agency for Healthcare Research & Quality reminds consumers that uncertainty surrounds robotic surgery as well as many other prostate cancer treatments:
"There isn't enough research yet to tell us how well they work compared with other treatments."
I'm happy for him that he's happy with his choices and I truly wish him the best of luck. But when he strays outside the boundaries of evidence with his advice to others, I wish he'd keep his story to himself.
Gary,
If I hadn't been screened, my cancer wouldn't have been found. It has been confirmed by two labs from the biopsy. I have it.
I choose to get the cancer out of me.
I watched prostate cancer kill my grandfather.
I'm not a statistic. I'm one person who got the test and got the diagnosis and now will get rid of the cancer, I hope.
It's really quite simple.
Jeff,
I just read the latest of what you posted on your blog. You wrote:
"But take this advice seriously: Don’t take medical advice from a talk show host – or a blogger – just because they have a platform to spread it. The virtue of publicness has its limits."
I couldn't agree more. That was the entire point of my blog entry.
If you had written this with your original entry, I may never have criticized you for your earlier comments.
Regardless, I wish you the best of health.
Let's be clear about one other thing in Jeff Jarvis' response to me.
He said his cancer was found by "screening." But he also said his grandfather died of prostate cancer. That puts him in a higher risk category than most other men. And in that case it's not really a screening test. It's monitoring a higher-risk individual.
Screening means doing the test in healthy men without a family history, without signs or symptoms.
The US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years. And it recommends against screening for prostate cancer in men age 75 years or older.
That's why broad stroke recommendations to the general public of American men to be "screened" are troublesome.
As this exchange illustrates, it's uncomfortable (to say the least) to raise questions about someone's heartfelt statements after learning he has cancer.
But silence isn't fair to those who may be influenced by the advocacy of one person... especially in cases where there isn't one best choice.
And so we face the delicate, yet vital, diplomacy of pointing out the facts... or absence of facts... in a domain dominated by swirling fears, hopes, myths & misunderstandings.