Seriously, What's Up, "Doc"?

​The other day, actor/director Ben Stiller wrote a long and thoughtful article for the website Medium about his life being saved by having an early PSA exam that had discovered prostate cancer when he was 46, earlier than such tests are recommended.  The piece was pointed, but exceedingly low-key and even-handed, discussing how he had conversations with his doctor about what to do, and how they took no action for a year-and-a-half, but rather continued testing and watching results.  And as the PSA number kept rising, they finally determined at that point it was best to act.

He also included a further-thoughtful comment about how although it's generally recommended to start testing men around age 50, because there can be early problematic results he then added, "I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened. After that an informed patient can make responsible choices as to how to proceed."

Very low-key, all from a personal point-of-view of his experience, making clear he wasn't a doctor, but giving a rounded look at potential options one should have available.  Not even recommending a PSA test at the early age of 40, but simply noting that one be given the option to merely discuss the test with their doctor at that point.  And make an informed, responsible choice what to do.

It's a perspective I tend to agree with, in part for personal reasons because I was diagnosed with prostate cancer very early (though just a year past the "50-year" line), but with an extremely low PSA number, far under what's usually considered problematic at all, almost not measuring enough to raise a doctor's interest.  But my beloved doctor had been watching the number for several years (from before I was the magic 50) and even though it was SO low, saw that it had been going up for a while, and so suggested it might possibly be a good idea to have a biopsy, but totally up to me.  Since the odds were so long against anything, he felt whatever I wanted was best, though thought it worth double-checking.  Given the alternative of being wrong, I felt it smart to, oh, what the heck, have it tested further. And it was indeed smart, because it turned out to be cancerous.  All's well now, and has been for a long time.  But I also would have agreed with Mr. Stiller because I come from a family of doctors -- my father and brother -- and have spent a lifetime hearing them discuss such things.  Caution, awareness, study, patterns, letting the body heal where appropriate, and being aggressive in medical action when necessary.  Not to mention problems of putting things off until too late and not paying attention to details and what your body is telling you.  And more.

So, that's me.  But back to Ben Stiller's article.

A few days later, after Mr. Stiller's article appeared, the Huffington Post published a incredibly surprising piece by their "Senior Healthy Living Editor," Anna Almendrala.  ("Incredibly surprising" herewith will be defined as "recklessly self-righteous.")  Because I found the piece so profoundly wrong-headed, I'm not gong to link to it -- not only on general principle, but also because I don't want anyone to read it and think because it's from the "Senior Healthy Living Editor" it must make sense and therefore follow anything it says.  If you're driven out of curiosity, though, and want to search for it, the title is "Ben Stiller’s Essay About Prostate Cancer Is Moving But Not Scientific."

I rarely post comments to articles online.  I haven't done so in years.  But as I read this Huffington piece it kept getting worse and worse, and while I knew I could always reply right here, as I am now, I also knew that unless I responded directly at the source -- and where there was a far, far, far, far bigger readership -- there was a risk my head might explode.

I actually sent two replies -- since I was still so pissed off, I did some additional research and discovered more information after sending the first comment.  I've edited the two together and fixed a few phrases to read more smoothly which I will post below.

I think what I write will be clear even without anyone here having to read the follow-up "challenge" or any of the articles linked from it.  As I said, you can always go back and track it down to read on your own.  But what I have here brings up specific points that the author makes, so I don't think reading it is necessary.  Or healthy.

And so, what I wrote was --

This is just a ghastly irresponsible artice.  Mind-numblingly so. First, there is NO downside to getting the PSA test, other than paying for it.  It's just drawing blood.  In fact, it's the same blood drawn if you go in for a check-up and the doctor is going to check your cholesterol -- which is A Good Thing.  They then test that exact same blood, not just for cholesterol, but also the PSA level.  If a person then doesn't want to act on the results, they don't have to.  Second, the American Cancer Society article the author links to does NOT say anywhere, as the author suggests, that prostate cancer "is so slow-growing as to never be fatal."  That's just mad-up dangerous gibberish by the author.  (Prostate cancer  tends to be slow-growing in very elderly men, who generally pass away of other illnesses first.  But it can be aggressive in younger men.). Third, Mr. Stiller's article clearly states to check with a doctor.  In fact, all he suggests is that men have the "opportunity to discuss the test with their doctor."  That's it.  Discuss it.

It is not a test that man at the age of 40 are generally recommended to take -- although even Anna Almendrala herself acknowledges there are many cases where it's actually appropriate for men who are 45...or even that very-same age of 40 as she notes...to discuss having the test!  So, she's quibbling about just a few years or about whether you might fall into in the right group when it comes to a life-and-death risk??  Furthermore, when one does hit 50, even the American Cancer Society article that she links to says -- absolutely clearly -- "Most groups that recommend informed decision making suggest men of average risk consider screening" when reaching that age.  So, again, she's nit-picking about a few years over what is just a general guideline.  About merely discussing the test!  No doctor would ever say you can't possibly get prostate cancer until you hit 50 exactly so, gee, don't worry.  It's not likely to get it -- for most men.  It's not common -- for most men.  But some groups (as the author notes) actually do get it as early as 40.  And even if you're not in one of those group, it is foolhardy to think you can't slip over by a few years -- because this is uncertain life, not a precise math equation.

A question for the author: let's say that most men with prostate cancer won't die of it.  (And let's not even take age or other factors into account.)  How willing would you be to actually, literally RISK YOUR LIFE on not being one who luckily falls into that "most" category -- for any reason -- but especially simply because you decide not to just simply discuss it with your doctor, let alone have blood drawn from you (that was probably even already drawn for another reason) and tested??  No matter how imperfect the test is, it provides massively more information on which to make a thoughtful decision (with your doctor) than burying your head in the sand.  And hoping you're lucky.  Fingers crossed!!  Considering what else might end up being buried if you toss a coin and guess wrong, this was just a shocking horrible article.
​
But let's go a step further.  Because while writing this, I decided to be fully informed (which ultimately is all that Ben Stiller is suggesting...) and check the credentials of the author, who is listed as the "Senior Healthy Living Editor." I figured that, of course, she would have a medical background to be in this job position and most especially to also give such medical advice. And so I wanted to see how in-depth that medical background is.

Her bio says, "She graduated from U.C. Berkeley in 2006 with a double major in Rhetoric and Spanish and has previously worked for Sojourners and Brave New Films." 

Well, just freaking swell. A double-major Bachelors degree in Rhetoric and Spanish. Not even continuing on through academia for a Masters degree in Rhetoric.  Or a PhD in Spanish, where she could at least call herself a doctor, albeit in the Liberal Arts.  Well, just freaking swell.  Thanks for the advice, "doc."

Bien, eso es simplemente maravilloso.

To be clear, it's perfectly fine to discuss the practice of medicine without being a doctor.  The problem is attempting to come across as an expert while hiding behind a title.  I have no medical background either, but then I'm not giving medical advice here. Nor was Ben Stiller. I'm just offering opinion on why it might be better to talk to your doctor rather than paying attention to someone trying to pawn off apparent medical experience as a "Senior Healthy Living Editor" about a risk to your life when what their background is in is...Rhetoric.  And Spanish.

Rhetoric -- "speech designed to persuade."

Alas, even there with such fine credentials, being this wildly unpersuasive it gets an F. Though I will gracefully assume her Spanish is excellent.