The Great Prostate Hoax by Richard Ablin

A recent study in the BMJ concluded that the massive breast cancer “prevention” program — having women get annual mammograms — had done more harm than good. Women were randomly assigned to get mammograms plus self-exam or self-exam alone. The death rate from breast cancer was the same in the two groups. However, women in the mammogram group were told they had cancer and received very painful and expensive treatment far more often than women in the other group. This being modern medicine, the true situation is even worse than what you read in any article about the (very negative) study. One critic has said that the randomization was not done properly. If true, this means that medical researchers, even when told exactly what to do, don’t do it, in ways that make a multi-million dollar study useless. In spite of billions of dollars and billions of hours spent on mammograms and billions of pink ribbons, we still know practically nothing about the environmental causes of breast cancer. (I suspect bad sleep is a major cause. Shift work is associated with breast cancer.)

A new book (to be published in March), titled The Great Prostate Hoax: How the PSA Test was Hijacked by Big Medicine and Caused a Public Health Disaster says that prostate cancer screening is no better. The book is by Richard Ablin, who discovered the prostate-specific protein used in the screening test. The trouble with the PSA test is simple. First, the reading is often high for reasons that have nothing to do with cancer. Second, prostate cancer is common (cancer increases as the fourth power of age) and usually benign.

In an interview, Ablin made some good points:

 The US Food and Drug Administration failed in its duty to the public: its advisers warned that routine PSA screening would cause a public health disaster, but it was approved under pressure from advocacy groups and drug companies. . . . The unfortunate reality is that no current data show that men who undergo PSA screening live longer than men who decide against it.

A few years ago Ablin wrote an op-ed about this.

5 Replies to “The Great Prostate Hoax by Richard Ablin”

  1. In the late 70s-early 80s my wife worked on a breast-screening research project. About the time she left, her boss, the P.I., was coming to the conclusion that annual population mammography was a bad idea. Years later, in Gerd Gigerenzer’s excellent book on Risk, I was impressed by his remark that in Germany asymptomatic mammography was not used by doctors for themselves or their wives, but it was used for their patients.

  2. Wouldn’t be the first time a multi-million dollar study was ruined by lack of statistical knowledge. The Women’s Health Initiative writing group (which had a lengthy roster of people with initials following their names) responded to criticism with this sentence (among others):

    “The CIs, interpretable individually at a single point in time as having a 95% probability of including the true hazard ratio…” JAMA, December 11, 2002—Vol 288, No. 22 p2823

    where CI is, of course, “confidence interval”. As anyone who has taken a first course in statistics knows, the interval includes the population parameter or it doesn’t. The “probability of including the true” parameter is either 0 or 1.

    That someone wrote this mistake into a draft is understandable; we all make mistakes. That no one in the entire writing group picked up this freshman mistake is horrific. The above article contains a link for the members of the writing group, but this link went inactive a long time ago (I wonder why!).

    Seth: I’ve taken a first course in statistics. I find no fault with their description. I don’t see why you say the probability of including the true parameter is either 0 or 1. You don’t know what they meant? Or how a 95% confidence interval differs from a 50% confidence interval? I seem to be missing something.

  3. Mish, a financial blogger, has a very interesting (incredible, IMO, due to the borderline malpractice) first-hand account of his experience with prostate cancer.

    Of course, an elevated PSA test is what precipitated the whole chain of events. Here’s my favorite quote concerning the PSA tests because it shows how unscientific MD’s really are in their thinking and understanding:
    I informed the oncologist that I was going to have a PSA test every month. He commented something along the lines of “Why do you want to do that? Every six months is sufficient. The tests are not that reliable.” That is not an exact quote, but is best as I can remember.

    My thought – which I did not express – was “What kind of mathematical silliness is that? The more unreliable a test is, the more tests one should take to weed out erroneous outlier results.”

    It’s a long piece but stays interesting and informative all the way to the end.

    Seth: I agree, I blogged about it.

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