Worshipping the power of tests to stave off death

Richard Ablin had an incendiary op-ed in the New York Times yesterday. He's the discoverer of prostate specific antigen and he writes: "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."

I've reported on prostate cancer before and noted the excellent This American Life episode in which researchers who have recommended curtailing the use of the PSA test talk about all the death threats had hate filled responses they got. So why is this such a big deal?

I think that people get so riled up about this because they've invested all their belief in this technological solutions. Get your cancer screenings early and often - in America this is the rock of scientific certainty upon which we build our faith. And it's not just faith that medicine will can save us, but that there is order to the universe - that we have control - that people don't just die meaninglessly. And when you take that away, when you say, "You know, this test really may do more harm than good," then you aren't just taking away a treatment, you are attacking a belief system.

Superstition - if we take Stevie Wonder's definition - is when you believe in things you don't understand. And most of us "believe in" medical technology without understanding it at all. If we lose that faith, we have nothing with which to face the empty vastness. Sure, we should be looking for better ways to cure cancer, but perhaps more importantly, we should be looking for better ways to face the unintelligible caprices and terrors of existence. These are problems we will never be able to solve, so the question is, how do we cope with the furies that will always and have always caused misery?

Our predicament is similar to that of the Protestants who colonized America. The Puritans had rejected as superstition faith in holy water and crucifixes—the pagan shields against unknown evil that had leaked over into Catholicism. The Puritans believed the New World seethed with devils, but they’d given up their occult defenses: the icons, saints, sacramental confession and the rest. Historian Keith Thomas thinks this is why Protestants executed witches, while Catholics, for the most part, did not. Today, instead of burning witches, we order tests. Medical technology has become our version of the occult. And it’s not particularly well suited to this role. Medical surveillance is costly, and every hospital visit carries risk. As a result, health-care costs have spiraled out of control, while patients have gotten sicker.

The solution, is a return of the witch doctor. The modern witch doctor would be a person with some medical skill, but more importantly, a person who can spend time with patients and listen long enough to understand what is really troubling them. The aid of a wise and experienced healer (even if their technique offers no actual physical benefit) is useful on two levels: First, we know that the meaning a patient affixes to a treatment has a powerful physical affect on healing. And second, a person’s attitude about their sickness is often more determinative of their quality of life than the cure.