Don't Blame The American Cancer Society

In the 1990s, health insurers, HMOs, PPOs, actuaries, and their "quality" evaluation certifying agencies, couldn't demonstrate that they were increasing survival (a meaningful endpoint - the "real thing") so they decided to boost their marketing appeal by convincing employers,  their insured, unsophisticated government bureaucrats and other "hangers-on," that  requiring providers to do lots of mammograms and  high numbers of prostate specific antigen tests constituted appropriate proxies for the real thing.  Of course, that wasn't true, but by hyping  untruths often and loud enough, and  casting  an aura of doing good, potential clients and some public charities interested in specific disease types spread the word for their own fund raising and economic purposes.

Today, the truth about excessive mammography for breast cancer and over-testing (using the PSA) for prostate cancer was published (New York Times, 10/21/09, page 1). We can now understand that some of the "good" that was done was actually unnecessary evaluation, testing and treatment which had no effect on patient outcome. The "sunshine enema" when the surgeon comes out of the operating room and tells the family that "we got it early" inferring "cure" (when actually the disease that was found was only possibly cancerous) has been exposed. We need to be more skeptical, to question the confidence limits of  treating physicians in the correctness of their diagnoses. Public skepticism about proposed treatments and the very real risks inherent in surgical procedures, radiation therapy, weird diets and drug treatment should be reflected in a demand for peer-reviewed scientific evidence that what is being proposed, is appropriate.