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November 22, 1995

Medicine—More Than Molecules and Money

Author Affiliations

Washington University School of Medicine St Louis, Mo

JAMA. 1995;274(20):1587. doi:10.1001/jama.1995.03530200023026

To the Editor.  —In Dr Eisenberg's1 article challenging the current emphasis on technological advances in medicine and cost containment, his limited presentation of the controversy on screening and treatment for prostate cancer as an example lacks balance and does not accurately reflect the current literature.Eisenberg incorrectly implies that screening for prostate cancer with prostate-specific antigen (PSA) testing detects latent cancers and that patients are being subjected to unnecessary surgery. This concern is not borne out: about 90% of PSA-detected cancers have histological features of cancers that would be expected to progress during the patients' lifetimes.2Eisenberg cites studies3,4 claiming that screening for prostate cancer may cause more harm than good; however, these studies contain outdated, nonrepresentative data. By basing his analysis solely on these studies, Eisenberg underestimates the lethal potential of prostate cancer and perpetuates the erroneous assumptions, questionable utilities, and flawed data included in these

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