Right-wing culture war over prostate cancer screening harms trust in medicine | Polly Toynbee

IIf the country seems to be moving away from reason and trust in science, the blame usually lies with modern phenomena such as social media and its fantastical influencers. Or about the strange anti-vaccine, anti-fluoride, anti-evidence madness of US Health Secretary Robert F. Kennedy Jr. But the campaigns against the United Kingdom The decision of the national screening committee to limit prostate cancer screening tests was taken by British strongholds who claim to be “common sense”. They include two former Conservative prime ministers, David Cameron and Rishi Sunak (who consider themselves sensitive people, unlike Boris Johnson and Liz Truss), joined by their conservative/reform media, particularly the Mail and the Telegraph, and a host of prominent campaigners such as Stephen Fry, a fountain of knowledge on quality improvement.

The National Screening Committee (NSC) has long resisted the call for universal prostate cancer screening of all men, even though the cancer kills 12,000 men a year in the UK. I was a member of the committee in the 1990s, and it was besieged by requests for drug testing. prostate cancer and many other conditions. These have often been refused for unreasonable cost, but this decision is about the harm to the men, not the money.

This week, new Health Secretary James Murray wisely endorsed the committee’s recommendation that only a small group with a high-risk gene should be tested regularly. Additionally, more black men will now be included in the Transform randomized controlled trial to see if screening them would reduce deaths from prostate cancer, as it does today. twice as likely to develop the disease.

NSC chairman, oncologist Professor Sir Mike Richards, praises Murray for quickly endorsing the committee’s recommendation, undeterred by a vigorous campaign for wider screening. Here is the evidence from the NSC: For every 1,000 men aged 50 to 60 years old who have a prostate-specific antigen (PSA) blood test, one life will be saved. But 12 men will be overdiagnosed and told they have a cancer that would never be life-threatening. They may be overtreated with unnecessary surgeries and radiation, causing life-altering harm, including permanent incontinence (requiring pads to treat leaking urine) and severe erectile dysfunction.

Richards argues forcefully that the harms of screening outweigh the benefits, beyond the men most at risk. He tells me that many are so alarmed by When they are told they have a tumor, they do not accept advice that regular monitoring would be enough: they panic and demand radical treatment which then harms them. He is not even convinced that one or two lives out of 1,000 people screened are truly saved: these men may have died of something else. He says: “Lithuania is the only country with a universal testing program, but its mortality rate is not better. »

When asked whether the NHS should provide anything, the public generally say yes. So when Ipsos asks them for the “Daily Mail”Ending unnecessary prostate deaths», 86% want broader screening of people at high risk men.

In an era of poisonous culture wars, this selection decision fuels racism and misogyny, with criticism claiming a “two-tier” control service. On the announcement that black but not white men will be added to the trial, here is Zia Yusuf, home affairs spokesperson for the Reform Party, I’m posting on X this week: “The day the entire political establishment claims we don’t live in a two-tier country, they announce it. Note that the NHS does not make ANY medicines available exclusively to white people.”

Some men’s groups have long protested to the committee that women are favored by universal breast cancer screening, ignoring what the science says about the very different relative effectiveness of the two tests. And here’s Amanda Platell from the Mail this week: “This decision on prostate cancer makes men second-class citizens. The news that health experts advising the government have rejected a call for mass screening for prostate cancer made me shudder.” (Note the condescending word “boffins”, suggesting that the science is beyond readers’ understanding and is dubious common sense.)

When the Telegraph reported on testing news this week as part of its ‘Tests Save Lives’ campaign, some comments repeated these themes: “This is scandalous. Prostate cancer screening should be available to all men in the vulnerable age group, but only to those who have lived and worked here for many years.” “Women have been screened for breast cancer for decades and it has saved many lives. Now breast cancer screening is available to men and even those at higher risk are being denied it. Equality?” “The NHS is now run by women – for women. » “Rationing prostate cancer screenings? How do you think women would react if breast cancer screenings were rationed to the same extent? Outrageous AMB (anti-male bias).”

All these provocations have real consequences. Andrew Wakefield’s discredited claim that the MMR vaccine causes autism has caused lasting damage, as vaccination continues to decline. This hesitancy towards vaccination has been compounded by Covid scaremongering. The World Health Organization says 95% of children need to be vaccinated to eradicate measles, but the rate fell to 88.9% last year and the UK lost its status as a measles-free state. FullFact reported last year an increase in false information and a loss of trust.

Professor Bobby Duffy of King’s College London launches a major survey of trust in science for the Wellcome Trust, observing the rapid collapse of trust in the US since 2016, with a widening gap between Republicans and Democrats (Democrats trust evidence more). Duffy says Nordic countries are at the top of the scale the trust scale and the US at the bottom, the UK is now closer to the US end of the spectrum. These darkening waves of unreason coming from the far right should indeed send shivers down the spine.

• Polly Toynbee is a Guardian columnist

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