« Allen Frances on over-diagnosis in psychiatry | Main | Andrew Gelman on Gary Gutting »



Feed You can follow this conversation by subscribing to the comment feed for this post.


but but but Perkins is rich so he must be correct

Bill Gardner (@Bill_Gardner)

civisisus --
You are right. How did I miss that?


Neutral observer of the debate here, with an honest question. I understand USPSTF's concerns, but aren't they ignoring the marked decrease in mortality due to prostate cancer (~50%) that has been enjoyed since deploying PSA monitoring? Corellation != causation, but there seems to be no better biomarker for monitoring this surreptitious disease and it's undoubtedly contributed to improved management. Shouldn't they be advocating for smarter screening (start earlier, screen LESS frequently, don't treat low-risk pts), instead of recommending against it altogether? Or maybe maintaining the "I" rating until more data is collected?

I'd love to read a good debate on this topic, as both sides seem to be just sounding-off in their respective corners at this point.

Bill Gardner (@Bill_Gardner)

Neutral observer,
Those are excellent suggestions. There is clearly individual variation in risk, and higher risk individuals would be more likely to benefit from treatment. There many ways to do smarter screening.
So why isn't the USPSTF recommending this? I think that it is because there are few data on alternative PSA screening strategies. What we have is data about routine screening at age X. The USPSTF is extremely -- many feel, excessively -- conservative in its recommendations.

Ravi Singh

The Göteborg study in Sweden showed that PSA screening is effective when used in the 50 to 64 age group, in comparison to a non-screened control group.
The PLCO trial showed that this benefit is less clear cut when you go up to 74 years, and when you use a control group in which many have been screened at some point.
The USPSTF could have concluded that the Goteborg study was a smarter approach, and recommended PSA screening for men aged 50-64. Instead, they have decided to throw the baby out with the bathwater.

Bill Gardner (@Bill_Gardner)

Good suggestion, and as I said, the way to disagree with the USPSTF is with data, not libel.

The comments to this entry are closed.

My Photo

Become a Fan