Paris Under the Occupation

Sartre's attempt to justify France's apparently cowardly behavior under the ...


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How Medical Activism Has Inflated the Diagnosis of Prostate Cancer and Depression

by Stewart Justman


Artificial Epidemics: How Medical Activism Has Inflated the Diagnosis of Prostate Cancer and Depression

ARTIFICIAL EPIDEMICS: How Medical Activism Has Inflated the Diagnosis of Prostate Cancer and Depression

In the mid-1990s I found myself on a committee charged with reviewing medical expenditures under my university’s health plan. Like the rest of the country, the members of the plan had fallen in love with anti-depressants, which accounted for our largest single drug expense—several hundred thousand dollars annually, as I recall. When someone around the table commented that this was a lot of money to be laying out for mood-altering pills, a defender countered, “If they prevent one suicide, they’re worth it!” Argument ceased. No one in the room, including myself, was aware that anti-depressants actually increase the risk of suicide, particularly in patients up to twenty-four years of age.

As it happened, my health plan also recommended prostate-cancer screening for all men over age fifty and offered it free. At the time I was not only unaware of any argument against early detection of cancer, I could not have conceived of the possibility of such an argument. The principle that early detection saves lives seemed as intuitive as an axiom, or rather it would have seemed so if I had thought about it at all. Like millions of other men, I therefore signed up for PSA (prostate-specific antigen) testing. Only later, after I began an irreversible journey, did I come to learn that the merit of prostate-cancer screening was hotly debated in the medical literature right from the beginning of the PSA era twenty years ago, and that the harms of PSA testing were and are much more certain than its benefits. I had no idea a screening test could harm. Once that fallacy was cleared up, I asked my Wellness Program to provide information about PSA testing, both pro and con, to eligible men. Arguing that if she provided for informed consent in the case of PSA testing she would have to do so for other tests too, the Wellness administrator refused.

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