How Centralized Government Medicine Will Work—Prostate Cancer Screening Example

The Washington Post is reporting today that a government appointed panel, U.S. Preventive Services Task Force, has recommended that using the prostate specific antigen test to screen for prostate cancer is likely to cause more harm than good. More harm than good for whom? The government task force concluded: 

"After about 10 years, PSA-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary," the 116-page review concluded.

The task force plans to recommend downgrading of PSA testing to a "D" rating. The D rating means that "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," according to the task force Web site.

OK as far as it goes. However, the Post further reports:

"Unfortunately, the best evidence is that while some men might be helped by screening, others would be harmed, and on balance the test is not useful overall," said Howard Brody of the University of Texas Medical Branch in Galveston.

On balance for whom? In this context it seems that the "balance" is being weighted toward what is good for the bottom lines of health care payors, not the patients. Others in the Post article disagree that the tests should not be provided to men: 

"The bottom line is that we should encourage screening because it will give men the full range of options to avoid death from prostate cancer," said William J. Catalona of the Northwestern University Feinberg School of Medicine.

That sounds right to me. Allow patients to obtain the information that they think is relevant to their health so that they can choose how they want to be treated. Men should expect to pay more for insurance policies that cover the test or pay for it out-of-pocket. The problem with centralized control over health insurance and care is that those payment options would be closed and patients would be stuck with the tests and treatments that others have decided are good for them.