The "Subtle Corruption" Of Prostate Cancer Screening

I have to post this excerpt from Naomi Freundlich's blog, Reforming Health. It gets to the heart of why screening for prostate cancer is better at generating revenue than it is at saving lives:

On Prostate Cancer Screening, Warren Buffett and Ignoring Science

Here she writes about Otis Brawley, the chief medical officer of the American Cancer Society and an oncologist at Emory University:

"[Otis Brawley's] new book, “How We Do Harm: A Doctor Breaks Rank About Being Sick in America” sheds a needed light on the financial conflicts that determine the kind of care we receive, and at a recent meeting of the Association of Health Care Journalists, he said that health care today suffers from “a subtle form of corruption.”
...
Brawley bemoans the lack of science and evidence to back up many of the most-used treatments and interventions for major ills like diabetes, prostate cancer and heart disease. He calls out drug companies, hospitals and doctors for valuing profits over patient care and calls for a greater emphasis on prevention and evidence-based care."

About prostate cancer, Naomi cites a paper by Brawley where he says:

“Many men who thought their lives were saved by being screened, diagnosed, and treated for localized prostate cancer are perplexed to learn that so few benefit. They may be even more amazed that this is not a new finding. What is new is the fact that many health professionals are finally accepting it as true.”

And here she transcribes some of Brawley's address as keynote speaker at Health Journalism 2012, the annual conference of the Association of Health Care Journalists. This part is unbelievable ... Brawley is recounting an experience he had on a visit to a hospital in 1998 while an Assistant Director at the National Cancer Institute. During the visit a marketing executive explained to Brawley the publicity value and financial rewards of a free prostate screening program:

This is the marketing director speaking, as recounted by Brawley:

“If they screen 1,000 men they’re going to have 145 abnormals. They’re going to charge about $3,000 to figure out what is abnormal about these abnormals, that’s how they pay for the free screening. About 10 of the 145 won’t come to this hospital so that’s business for their competitors, but they’ll get 135 times $3,500 on average. Of the 135, 45 are going to die of prostate cancer and the other percentage are going to get radical prostatectomy at about $30-40,000 a case; there’s a percentage that’s going to get seeds at about $30,000 a case; a percentage were going to get radiation therapy that (at the time) was about $60,000. Then [the marketing executive’s] business plan goes further, he knows how many guys are going to have so much incontinence that diapers aren’t going to do it so he had in his business plan how many artificial sphincters urologists were going to implant. And then he was a little apologetic because there was this new thing called Viagra that screwed up his estimates for how many penile implants he was going to sell because guys were upset about impotence related to prostate cancer treatment.”

Brawley says, “this is 1998, I ask him, if you screen 1,000 people how many lives are you going to save? He took off his glasses and looked at me like I was some kind of fool and said, ‘Don’t you know, nobody’s ever shown that prostate cancer screening saves lives, I can’t give you an estimate on that.’”

These practices, according to Naomi, are still in effect today, 14 years later. ________