Short Takes On News & Events

What Newt Gingrich Didn’t Say About His Cancer-Screening Expert

By Jordan Rau

October 12th, 2011, 2:00 PM

At last night’s GOP presidential debate in New Hampshire, Newt Gingrich condemned the government’s latest effort to discourage men from reflexively getting blood tests for prostate cancer by citing the views of Dr. Andrew von Eschenbach. Gingrich stressed some of Eschenbach’s prestigious bona fides, including heading the National Cancer Institute and practicing at one of the country’s major cancer centers.

But Gingrich omitted other interesting parts of Eschenbach’s background, including  his affiliation with one of Gingrich’s think tanks and a think tank of a major proponent of the PSA blood test.

First, here’s what Gingrich said at the debate in response to a question about wasteful spending in Medicare:

I am really glad you asked that, because I was just swapping e-mails today with Andy von Eschenbach, who was the head of the National Cancer Institute, the head of the Food and Drug Administration. But before that, he was the provost at M.D. Anderson, the largest cancer treatment center in the world. And he wrote me to point out that the most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people. So, if you ask me, do I want some Washington bureaucrat to create a class action decision which affects every American’s last two years of life, not ever.

I think it is a disaster. I think, candidly, Governor Palin got attacked unfairly for describing what would, in effect, be death panels.

And what von Eschenbach will tell you if you call him is, the decision to suggest that we not test men with PSA will mean that a number of people who do not have — who are susceptible to a very rapid prostate cancer will die unnecessarily.

Gingrich didn’t mention that the “death panel” claim about the law has consistently been debunked as false. Nor did he say Eschenbach is listed as a “senior advisor” for Gingrich’s think tank, the Center for Health Transformation. Eschenbach also is listed as a senior fellow with the Milken Institute, whose founder, Michael Milken, credits the blood test for saving his life.

Is he an expert on the value of screening tests such as the PSA? Paul Goldberg, publisher of The Cancer Letter, a weekly newsletter covering cancer politics and research, disputes that.

“I wouldn’t call him an expert in prevention; I would call him a urologist,” Goldberg said. He said Gingrich’s laudatory praise of Eschenbach was “eminence-based medicine,” not “evidence-based medicine.”

KHN has been unable to reach Dr. Eschenbach. We called Gingrich’s campaign headquarters, but a campaign worker said they didn’t have his contact information.

jrau@kff.org

5 Responses to “What Newt Gingrich Didn’t Say About His Cancer-Screening Expert”

  1. Scotti says:

    Uh, so Mr. Gingrich affiliated himself with an expert in the field (and, without question, being a urologist AND the former head of the NCI qualifies him as an expert on this matter) who very likely influenced his opinion and this is wrong how? You don’t seriously think that a candidate for president is going to take the precious few seconds he/she has during a debate to run through “full disclosure” every time an individual is mentioned, do you? Did you disclose YOUR affiliations to your audience prior to writing this piece? No, there was no “Full disclosure, I am paid by KHN to represent the following views.” And wouldn’t a non-partisan viewer understand that the two have a relationship (the guy has Mr. Gingrich’s personal e-mail)? And why would Dr. Eschenbach’s affiliation with think-tanks that support his opinion be wrong? The entire premise of your argument is to attack the messenger and not the message. Do you not have a cogent argument?

  2. Mr. Gingrich has unfairly characterized the US Preventive Services Task Force as a ‘death panel’, when it is instead a prime example of how we should be carefully shepherding our limited public health care delivery funds using the best clinical science available. Why should the taxpayer be asked to pay for screening tests which have suboptimal results? Urologists, such as Dr. von Eschenbach, are understandably motivated to test as many of their male patients as possible, and not just because the screening test will produce more urologic work for their practices. But, viewed from a population perspective, the application of PSA screening has failed to reduce mortality due to prostate cancer. So, if you, as an individual, would like to use the PSA screening test anyway, why is it wrong for the cost to be yours to bear?

  3. Scotti says:

    “…a prime example of how we should be carefully shepherding our limited public health care delivery funds …” The USPSTF makes “recommendations” to the overall (public/private) healthcare community NOT just public (gov’t run) institutions. Generally speaking, the private healthcare community follows those recommendations.

    “Why should the taxpayer be asked to pay for screening tests which have suboptimal results?” One man’s “sub-optional results” is another man’s life. And, unless the individual is in one the the gov’t managed care programs, the “taxpayer” doesn’t pay for his procedure–he does by paying for his premiums (something he can do better while he is alive).

    “So, if you, as an individual, would like to use the PSA screening test anyway, why is it wrong for the cost to be yours to bear?” I DO bear those costs–through premiums, co-pays, etc. If, however, you are asking why I shouldn’t I be asked to foot the whole bill… The answer is simple. I don’t pay into a gov’t program for my healthcare and the gov’t should NOT dictate what my doctor and I should decide.

  4. It is sad that this issue has become so political. But the task force recommendations do highlight the fact that screening and early detection does not necessarily lower costs.

  5. Jonathan Weinkle says:

    @Scotti,

    Your doctor is no more likely than Gingrich to vet their sources, and certainly not to take the time to comb through hundreds of studies to figure out whether you need a PSA test or not. So large bodies, including the USPSTF but also the major professional societies issue recommendations that comb through the evidence (and in the case of the USPSTF, publish not only their conclusions but the details of the methodology that led to the recommendations – go to Annals of Internal Medicine and you’ll find them with each newly published rec). The interesting thing? Specialists tend to recommend more tests and more intervention in their own fields. So the urologists professional society and the ACS recommend PSA; none of the other large recommendations have any enthusiasm for the test at all, and my own reading of the evidence (I’m a general internist who has the PSA discussion with my patients several times a week) is solidly in agreement with the USPSTF, based on reading the studies over the past 2 years as they’ve come out. In similar fashion, the ACP and AAFP both recommend Pap smears every three years for women over 30 with no history of abnormal results; most gynecologists still do them yearly and don’t stop at age 65. Bias is subtle; most doctors assume that they are free of it but that most of their colleagues are not. Denial is subtle, too.

    If Newt is really worried about government intervention in healthcare killing people, he should stand up to those in his own party that want to see the community health centers’ budget cut, threatening the only source of healthcare for nearly 20 million uninsured and publicly insured Americans. Unless, of course, he only means people with private health insurance, in which case he should be far more worried about insurance company intervention in healthcare killing people, like the young man to whom I was supposed to donate bone marrow a few years ago until his insurer balked a few weeks before the transplant. That man died at age 23.

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