IPAB, PSA Testing – The Lies Continue

October 12, 2011

Aside from Texas Gov. Rick Perry and former Massachusetts Gov. Mitt Romney sparring over Romneycare and the million children without health insurance in the Lone Star State, there were only two moments during last night’s Republican debate when the focus turned to health care. Both involved outright lies, which were offered by former House Speaker Newt Gingrich and Minnesota Rep. Michelle Bachmann and were given nodding approvals from the other candidates on stage. Sadly, they went uncontested by the insipid journalists asking the questions.

Gingrich’s lie involved his claim that the U.S. Preventive Services Task Force recommendation that men forgo routine PSA testing for prostate cancer would kill men. First, the recommendation was based on scientific studies that showed the unnecessary biopsies and treatments triggered by the tests have killed at least 5,000 men over the last 20 years and left tens of thousands more, most of them elderly, with horrid side effects like impotence and incontinence. Even the inventor of the test, Richard J. Ablin of the University of Arizona, in an op-ed in the New York Times a year ago, called routine PSA testing “a public health disaster.”

Second, the USPSTF recommendation is precisely that. It leaves it up to men and their physicians to decide whether to continue with the tests. The government already has a law mandating Medicare pay for the tests. It would take an act of Congress to repeal the law, which isn’t likely.

Minnesota Rep. Michelle Bachmann, meanwhile, repeated the right-wing trope that the Independent Payment Advisory Board set up under the health care reform bill constituted a federal takeover of the health care for “300 million Americans.” Never mind that its recommendations for controlling costs will only apply to Medicare. And those recommendations, like the PSA test recommendations from the USPSTF, would have to be voted on by Congress. And even if enacted, they would only affect the 45 million elderly Americans on Medicare. They would have no effect whatsoever on the 150 million Americans with private health insurance, the 50 million Americans on Medicaid, the millions more in the military or Veterans Administration single-payer health care systems, or the 50 million Americans without health insurance.

After Bachmann mouthed the lies and the other candidates smiled, the flustered journalists went on to the next question without a single follow-up that tested the veracity of her obviously inaccurate statement. No one asked the next candidate: Since IPAB’s recommendations would need to be voted on by Congress and would only apply to Medicare patients and not younger Americans with private insurance, do you agree with what she just said? And if you do, do you support what Rep. Paul Ryan and the House Republicans want for Medicare which is to turn the program over to the private insurance industry and force seniors to pick up, according to CBO estimates, 68 percent of the tab through higher co-pays, premiums and deductibles?

I had some hope prior to this debate that a forum run by reputable news outlets like Bloomberg and the Washington Post (the interviewers, I hesitate to call them questioners, included long-time practitioners Charlie Rose and Karen Tumulty) wouldn’t degenerate into another 90-minute television commercial for Republican Party anti-government rhetoric. The earlier debates were run by Fox News, the Republican Party-aligned megaphone owned by Rupert Murdoch, so my expectations were lower.

Alas, the right-wing ascendancy in America has pushed mainstream media into its usual position when face-to-face with its professional responsibility to question the positions taken by conservative politicians mouthing ideological absurdities. That position, unfortunately, is prone.

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2 Responses to IPAB, PSA Testing – The Lies Continue

  1. Greg Pawelski on October 12, 2011 at 7:22 pm

    I worry that a lot of mis-information about important events will be repeated so often and so cleverly that it will be assumed to be accurate if not gospel by average voter. A lot of the real information and data is so damn complicated, I don’t know how anybody can keep up with it (unless you’re a paid lobbyist). That leaves a lot of facts vulnerable to political manipulation. The current crop of contenders are getting a lot of air time to present their particular version of reality. Example: “Obamacare”. Without checking, can you remember the actual name of the legislation? I doubt one person in ten can remember. It will be interesting to see if anything can be done before next election to re-establish some factual bases.

  2. Tim Bartik on October 15, 2011 at 6:07 pm

    If you believe that PSA testing should be left up to individual decisions of men, you should recommend that the Task Force upgrade their recommendation from a D recommendation (no one should test, harms outweigh benefits) to a C reommendation (testing should not be routine, individual decision).

    From reading this and your previous posts on this topic, it seems to me that your perspective is understandably shaped by cases of people close to you who were overtreated. But these mistakes in treatment decisions conditional on PSA results does not mean everyone should eschew PSA tests.

    More recent analyses of the European study results, which arguably is the best study, suggest that the “number needed to treat” to reduce one prostate cancer death is 18 treated to 1 death as of 12 years after the screening begins. This 18 NNT number implies that the treatment reduces the probability of death after 12 years by 5%. This probability of death must be weighed against a probability of serious side-effects of 30%.

    Some men may view a 5% risk of death as outweighing a 30% risk of side-effects. Others may not. Optimal decisions may be based on age, physical condition, and individual values.

    It is strange that the Task Force’s recommendation, if it stands as a D, may make it harder for men ages 50-64 to have insurance pay for PSA testing, while Medicare continues to pay for older men to get tested. If anything, the pattern should be that men in their 50s are more likely to benefit from testing than older men.

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