The wildly controversial prostate-specific antigen test (PSA) continues to be the subject of studies and debates. Does it help prevent prostate cancer, or is its use actually destructive, subjecting people to unnecessary surgeries? Results and opinions vary too widely, at the moment, to conclude anything with certainty.
Yet the expression of opinions about it would seem fundamental to medical school professors involved in the issue, and you’d think a respectable school like the University of California Davis would encourage its faculty to be part of the debate.
Yet Davis, already dealing with one med school fiasco, now has another, because a dean there got so angry at a professor’s published disapproval of PSA that he told him
he would be punished in two ways. First, he would lose his position in the doctoring program [a special training program he’d put together], and second, he would lose the funding support for a Hungarian student exchange program that he organized.
Why so angry?
Well, money’s involved. The doctor decided to write an anti-PSA opinion piece when he realized that a seminar at Davis was “primarily a sales pitch about the prostate specific antigen (PSA) test, and that its main message was that men should get tested regularly beginning at age 40.” University seminars aren’t supposed to be homes for hucksters, especially when what they’re selling might hurt people. I mean, of course it happens, as in this case at the University of Toronto; but it’s not supposed to happen. Not to mention that professors have a right to say what they like without deans and university lawyers making threats against them, as they did in this case.
August 26th, 2012 at 3:29PM
“Well, money’s involved.” Like many non-professors, I thought our universities and professors were above all that money and power stuff. Boy, was I a fool.
At one local university you won’t find a single professor who’ll cross the “doctor line”—the standard-issue party line put out by Big Medicine’s Iron Pyramid of medical societies, hospital associations, Big Pharma, medical equipment makers, and health insurers. They’re pretty good, I suppose, at providing intellectual cover for HMOs and upmarket chatter for CME classes.
I don’t mean professors who shun public statements because they feel unsure of their ground, or feel a nuanced, academic thought will be misconstrued by partisans. When Ohio’s medical societies insisted there was a scourge of frivolous medical malpractice suits, not one professor I’m aware of pointed out there were no medical malpractice suits that had ever reached settlement or trial without expert testimony. Not one professor pointed out (the Ohio Bar Association did) that so-called medical malpractice reform shifted the cost of medical incompetence from the offending physician to the person who was harmed by him.
August 26th, 2012 at 3:42PM
Note that we first wrote about this case in June on Health Care Renewal here:
http://hcrenewal.blogspot.com/2012/06/administrators-at-pepper-spray-u-found.html
Our summary was:
“So UC-Davis seems to be another academic medical institution run by people more interested in bringing in commercial support than the academic medical mission, including the support of free speech and academic freedom. Its case is another example of how leadership that seems hostile to the mission in one instance is likely to be hostile to the mission in other instances.”
August 26th, 2012 at 4:41PM
FWIW-health insurers sponsor a local university’s sports events, establishment doctors donate big-time and serve as trustees, full-time faculty and staff are covered by tax-free group health insurance for which they pay a pittance, and, I suppose, well-educated professors may feel a kinship with well-educated medical doctors, so there’d be an unpleasant psychological cost to publicly saying, “Hey, something’s wrong!”
While adding this comment, I couldn’t help but think there are young professors in Havana, Pyongyang, and Kinshasa who learn to play ball and get ahead.
August 26th, 2012 at 6:20PM
I have written a bunch about these cases on my blog. See for example http://phylogenomics.blogspot.com/2012/07/quick-post-story-about-ucdavis.html http://phylogenomics.blogspot.com/2012/06/updates-on-ucdavis-academic-freedom.html http://phylogenomics.blogspot.com/2012/06/report-on-egregious-academic-freedom.html
As a UC Davis Professor I find some of the behaviors of the administrators appalling. I note, it seems that at least some of the higher ups on campus are not too impressed either. See http://phylogenomics.blogspot.com/2012/06/ucdavis-provost-ralph-hexter-very.html for example. But still waiting to see if there are any repercussions …
August 26th, 2012 at 6:27PM
Many thanks for those links, Jonathan.
August 26th, 2012 at 9:30PM
I fear that the textbook/online course publishing/production industry may soon begin wielding parallel power to that of the pharmaceutical industry, and by similar means: studies that show their copyrighted approaches/materials (and only theirs) are effective, self-serving testing/assessment regimes, etc., “professional development” which is really an extended sales pitch, etc., etc. Local decision-making, and locally-crafted and revised courses, where the main “value added” comes from student-student and student-teacher interaction, are likely to get little attention and/or low marks in such a regime, because they can’t be packaged and sold.
Mind you, this is not an argument against online teaching (of which I do a good deal, all of the hand-crafted variety) or MOOCs (which, at least currently, I see as falling more in the “service to the broader community” than the regular university teaching category). It might be a potential danger as schools and publishers attempt to find ways to monetize MOOCs, probably by offering some sort of credit/credential-earning/assessment add-on.
But I fear that many of the same forces are present: powerful businesses that want to maximize their profits, a more or less captive customer base, and calls for “evidence-based” practices that offer an opportunity for funded/steered research.
August 27th, 2012 at 7:45AM
(1) The whole PSA debate is pretty stupid (really); it is my impression that the prostate cancer issue has become tangled up with the breast cancer issue, which is very different – you don’t see guys having their prostates cut out because their brothers had cancer.
(2) A very large proportion of physicians regard the movement against the PSA test as an assault, on shaky statistical grounds, on the professional judgment of individual physicians treating individual patients – as they see it, they’re defending traditional medical ethics against fashionable business methods.
(3) The big money here isn’t the tests, it’s the surgery. “Watchful waiting” doesn’t pay the hospital’s bills.
August 27th, 2012 at 12:53PM
I’ve seen at least one case of a for-profit publisher hinting in an online discussion of open access that vocal advocates of open access might find it hard to publish if they shoot off their mouths too much.