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**MAY 21, 2025**
On the Prospect website
House Republicans Unite Around Sweeping Medicaid Cuts
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The health care section of the GOP mega-bill has advanced to the House floor, bringing millions of Americans one step closer to losing their health insurance. BY JAMES BARATTA
These 16 Democratic Senators Deserve a Primary [link removed]
Allowing yourself to be bought by the crypto lobby is unforgivable. BY RYAN COOPER
Trump's Labor Wreckers [link removed]
The president has put anti-union, anti-regulation fanatics in charge of worker safety and worker rights. BY HAROLD MEYERSON
Medicare Fraud? Insider Trading? Another New CEO? Just a Normal Week at UnitedHealth.
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While senators demand investigation of insider trading, the DOJ is reportedly looking into massive fraud. BY DANIEL BOGUSLAW
Kuttner on TAP
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**** Biden's Prostate Cancer
He followed bad official advice when he failed to get PSA tests.
In the cruel pile-on following former President Biden's diagnosis of advanced prostate cancer, one detail screamed out at me. Biden last got a PSA test 11 years ago, in 2014 [link removed].
In forgoing that screening, Biden was only following the official guidelines, which recommend that men over 70 forgo the test [link removed]. Those recommendations, based
on statistical studies, concluded that the tests are not indicated because most prostate cancers in older men are slow-growing; men in their seventies and eighties diagnosed with prostate cancer will probably die of something else; and high PSAs can lead to needless treatments, needless distress, and rare complications due to infections from biopsies.
How can I put this charitably? These recommendations are nuts. Any man over 70 who declines to get PSAs based on them is playing Russian roulette with his life.
Yes, on a statistical, "population-based" set of criteria, PSA tests for older men may not be indicated. But your life is an N of one.
In fact, some 32 percent of men over 70 have some form of prostate cancer. Most are slow-growing. Some, like Biden's, are aggressive. Had he gotten a PSA test earlier, he could have gotten early treatment and been spared what could be an agonizing death.
I literally have six friends and colleagues, three of them doctors, who
ignored the guidelines to forgo tests, and who are alive today because PSA tests detected aggressive prostate cancer. One other doctor friend, who followed the guidelines and did not get annual PSA tests, ended up with a serious form of cancer.
Yes, this small pool of people could be what researchers call "sample error," but it's a pretty impressive sample. In fact, the guidelines are controversial among practicing urologists [link removed].
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Here's my own story:
Beginning in my fifties, like most men, I started getting annual PSA tests. When my urologist retired, I was well over 60 and his successor told me that I should stop getting them: "You'll probably die of something else."
I responded, "You're fired."
I networked my way to a more
senior urologist. He's wrong, the senior man told me, and we continued doing annual PSAs.
One of the reasons cited in the guidelines for not giving older men PSAs was that biopsies, which are done when PSAs are high or borderline high, can be painful and can in rare cases lead to infection. I had one once, and I can attest that they are not fun. But more urologists now use local anesthesia for biopsies, and the painless and more definitive alternative to a biopsy is an MRI.
Another reason cited is that a high PSA can be a source of psychological distress. Seriously? Compared to a failure to detect aggressive cancer?
A third cited reason is that a high PSA finding can lead to needless interventions such as radiation or surgery. But a competent urologist will closely review the Gleason score and recommend intervention only when the cancer is found to be aggressive or advanced. The PSA test is only a preliminary screening.
Prostate cancer is the second-leading cause of
cancer deaths in men. It causes over 35,000 deaths every year. The vast majority of these could be prevented through early detection, via PSA tests.
Coda: The Trump administration is justifiably under fire for promoting junk science, with RFK Jr. as its worst offender. Other Trump officials at the FDA are actually on the verge of making it impossible for Americans under 65 to get COVID vaccines [link removed].
It is a cruel irony that bad science also existed before Trump, and Joe Biden is now paying the price. Whatever Biden's other sins in covering up his cognitive decline, he didn't deserve this.
~ ROBERT KUTTNER
Follow Robert Kuttner on Twitter
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