Biden’s Prostate Cancer and the Tyranny of the Experts
Ezekiel Emanuel is an opponent of long life. So why did he back someone so old for president?
By Allysia Finley
Joe Biden in Washington, Oct. 24, 2024. Photo: Chip Somodevilla/Getty ImagesJoe Biden’s stage 4 prostate cancer diagnosis raises many questions, not least why a U.S. president with access to the best healthcare in the world didn’t have routine blood screenings that could have caught the disease before it turned deadly.
One possible culprit is an excessive deference to so-called experts, many of whom believe older people shouldn’t be screened for cancer because they are likely to die in short order anyway.
This is the view of liberals like Ezekiel Emanuel, an Obama and Biden adviser, who want to put government in control of all Americans’ healthcare.
A Biden spokesperson last week said the former president hadn’t received a prostate-specific antigen blood test since 2014, when he was 71 or 72.
A high level on the test can signal cancer, though it can also raise false alarms.
On the flip side, it doesn’t miss many cancers.
In 2008 the U.S. Preventive Services Task Force—an independent panel of putative experts that reviews evidence for preventive screenings and treatments—categorically recommended against screening men 75 or older for prostate cancer.
Four years later, the panel advised against PSA screening in all men.
The panel in both instances deduced that men who get a high reading on the test might undergo unnecessary treatments, carrying risks like erectile dysfunction, for cancers that may be slow-growing and unlikely to shorten their lives.
After advanced cancers increased, the panel modified its recommendation in 2018 to suggest physicians discuss risks and benefits of screenings with patients ages 55 to 69 while recommending against screenings for those 70 and older.
But why don’t the experts trust older patients and their physicians to make informed decisions based on their individual benefits and risks?
If a patient’s PSA levels come back high, a doctor may refer him for follow-up tests and possibly a biopsy, which can show how aggressive a cancer is.
Based on all the test results, an oncologist can discuss treatment options, including watchful waiting for slow-growing tumors.
To be sure, all this testing and treatment is costly.
Dr. Emanuel, 67, an oncologist and architect of the Affordable Care Act, has lamented what he views as excessive healthcare spending on older people.
In 2014 he wrote an essay in the Atlantic titled “Why I Hope to Die at 75,” pledging to forgo treatments and screenings once he had lived three-quarters of a century.
“No screening for prostate cancer at any age,” he wrote.
“When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me.”
Living too long “renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived,” he mused.
“Half of people 80 and older with functional limitations.
A third of people 85 and older with Alzheimer’s . . . Even if we aren’t demented, our mental functioning deteriorates as we grow older.”
His essay was a stronger argument for why Mr. Biden shouldn’t have run for president in 2020 at 77, let alone for re-election at 81, than for why older Americans should forgo healthcare.
If Dr. Emanuel truly believes people older than 75 are too decrepit to be much use to society, why did he support Mr. Biden’s 2020 presidential bid?
Dr. Emanuel said after Mr. Biden’s disastrous debate performance last summer that Mr. Biden was “sharp and perceptive” during the 2020 campaign.
Yet his cognitive difficulties have long been apparent, and his cancer likely would have been caught earlier had he received the annual PSA testing that Dr. Emanuel inveighed against.
The incidence of advanced prostate cancer notably soared after the Preventive Services Task Force recommended against PSA screenings.
A 2020 study in the Journal of the National Cancer Institute found that advanced cancers rose 5.2% a year between 2010 and 2016 among men 75 and older, with a much sharper increase among white men.
Why hasn’t the task force, most of whose members were appointed by Mr. Biden’s health and human services secretary, Xavier Becerra, revised its prostate screening recommendation?
Who knows, though none of its members are oncologists.
Judging by their biographies on the task force website, their chief focus is advancing diversity and equity.
Mr. Biden’s prognosis is greatly improved thanks to treatments such as Pfizer’s pill Xtandi.
His administration selected Xtandi for Medicare “negotiations”—i.e., price controls—under the Inflation Reduction Act because of the medicine’s high sales and success rate.
Had the law been in effect a decade ago, Xtandi might not be a treatment option for Mr. Biden.
That’s because the law makes small-molecule drugs like Xtandi eligible for price controls seven years after they have been on the market.
This shot clock discourages drugmakers from testing medicines for new uses.
Xtandi was first approved in 2012, but its label was only extended to metastatic hormone-sensitive prostate cancer—the type Mr. Biden has—in 2019.
Many of the same experts who oppose cancer screenings for seniors also back government price controls on medications.
What do they care if older people die sooner because fewer life-saving treatments are developed?
0 comments:
Publicar un comentario