Prostate ‘hoax’ book contains no conspiracy theories

Editor’s note: The following was written in response to a blog post by Henry Rosevear, MD (“The great prostate cancer ‘hoax’: A call to arms”), which discussed the book, “The Great Prostate Hoax: How big medicine hijacked the PSA test and caused a public health disaster.” Dr. Ablin is a co-author of the book.

Dr. Henry Rosevear’s blog post about my recently published book, “The Great Prostate Hoax: How big medicine hijacked the PSA test and caused a public health disaster,” does a disservice to the readership of the Urology Times by mischaracterizing the book’s central message. I welcome healthy debate, as long as it is fact based.

As noted, the PSA test was first approved in 1986 to monitor men with prostate cancer and later in 1994 as a screening tool. Dr. Rosevear argued that after giving a historical perspective, “The book quickly leaves historical reality and begins to make unfounded, usually illogical comparisons between PSA screening and, among others, the tobacco industry.” With due respect, Dr. Rosevear needs a “historical reality check.” As I discussed in “Hoax,” in 1986, the PSA test was also used off-label and promoted illegally to screen countless millions of men each year for prostate cancer, leaving several million men debilitated by unnecessary surgical procedures. Jules Harris, MD, a member of the FDA expert advisory panel during the 1993 PSA approval meeting, said in an interview, “The misuse of the PSA test is the biggest medical story of the past 30 years.”

After that, Dr. Rosevear dismissed the rest of the book, noting that it can be summarized in one passage he lifted from the introduction: “But in a large sense, the situation dramatized by John [a patient described earlier as being harmed by PSA screening] illustrates the grim reality of the health care system itself: encouraged by perverse incentives, many of the tests and procedures that doctors do are unnecessary, and quite a few are downright harmful.”

Dr. Rosevear obviously takes exception to that statement, so I’ll clear it up for him. In the early 1990s, RAND Health reported data showing that up to one-third of health care services were unnecessary. Most recently, Donald Berwick, MD, MPP, former head of the Centers for Medicare & Medicaid Services, stated that upward of 30% of all health care was wasteful. I would argue that one-third equals many, and that our fee-for-service payment system, coupled with a bloated bureaucracy, encourages perverse incentives. The massive waste, fraud, and abuse in our health care system is not unfounded; it is a matter of public record. And yes, many unnecessary procedures are “downright harmful.”

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In an attempt to jade his readers’ image of my book, Dr. Rosevear used terms like “conspiracy theories,” “unfounded,” and “illogical.” Sorry, there are no “grassy knolls” in “The Great Prostate Hoax.” In fact, every charge, whether involving a person, industry, or government agency, is backed by referenced data. To wit, there are more than 300 references in the “Notes” section. Moreover, prior to publication, my editor sent the manuscript to the New York law firm Satterlee Stephens Burke & Burke LLP for a month-long, line-by-line review to ensure that no statement was “unfounded.”

Dr. Rosevear made his own unfounded remark: “Clearly, Ablin and Piana have never seen a man expire from metastatic prostate cancer.” As detailed in Chapter Three, my father died of prostate cancer and I supervised his care from diagnosis to watching him go from a 185-pound frame to 95 pounds 1 year later at the time of his death.

At the beginning of his post, Dr. Rosevear said he’d recently read a “very disturbing book.” Rest assured, he’ll have plenty of company in that department. I wrote “The Great Prostate Hoax” to expose the public health disaster caused by the misuse of PSA and to hold the forces behind that human catastrophe accountable. So, in that regard, yes, it is a very disturbing book.

Dr. Ablin is professor of pathology at the University of Arizona, Tucson.

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