July 1990
The young Urologist just finished his residency and there was new hope for men with prostate cancer. A protein referred to as prostate-specific antigen (PSA) had been identified and seemed to be a useful screening test to look for early prostate cancer.
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Curable prostate cancer is most often asymptomatic and a digital rectal exam (very operator dependent} was the only {albeit a poor one} available screening tool. The diagnosis numbers had not changed for many decades, and approximately 70% of all prostate cancer cases were incurable at the time of their discovery.
During the next 18 years, the backload of undiagnosed prostate cancer was detected and treated. The system came into a new steady state with the death rate of prostate cancer declining and almost all new prostate cancers were found at a curable stage. Since many prostate cancers grow slowly and do not impact life expectancy the next issue facing the urologic medical community was figuring out which cancers to treat. Studies from Europe were pointing toward the observation of cancers that did not have aggressive characteristics. Holding invasive treatment, unless over time there were signs of advancing disease. Things were looking very good for the future of American men who were diagnosed with prostate cancer.
2008
The United States Preventive Services Task Force composed of primary care physicians (not all practicing) and government bureaucrats reviewed the medical literature and recommended against PSA screening for men over 75 years of age. Despite the fact that American men were living longer and the old adage that most men died with, rather than of, prostate cancer was being challenged, this went into effect.
2009
The same task force recommended stopping screening mammograms for women under 50 years of age. The outrage from feminist activist groups was immediate. There are a few things a politician will respond to, and angry feminists are at the top of the list {think abortion}. Washington moved quickly and by statute screening mammograms for women under 50 became available. Unfortunately, women do not have a prostate, because if they did, the present prostate cancer resurgence would have undoubtedly been avoided.
2012
The United States Preventive Service Task Force decided to challenge the famous quote attributed to Einstein, that doing the same thing over and over again and expecting a different outcome is the definition of insanity, and recommended stopping all PSA screening.
The effect was drastic. Primary care providers stopped ordering PSA and to make things even more challenging they stopped doing routine digital rectal exams. Given early curable prostate cancer has no symptoms and there are no other screening tests for prostate cancer, the stage was set for trouble. And the clock began to tick.
Since no one was looking, the number of new prostate cancer diagnoses dropped precipitously. The government task force beamed with their brilliance.
2018
The government task force did not change its position but softened its rhetoric. Their new recommendation was a PSA could be obtained for a patient between 55 and 70 years of age, only after he discussed the risks and benefits of screening for prostate cancer with his primary care provider. The new recommendation didn’t change much. The patient didn’t get a rectal exam and if they didn’t ask for a PSA, most of them never got one.
2022
Ten years have passed since the task force’s recommendation to stop PSA screening. America’s tank of undiagnosed prostate cancer is starting to overflow. The National Cancer Association came out with its statistics and except for prostate cancer, almost all cancers across America were down. And to make matters worse, newly discovered prostate cancers are being diagnosed at an incurable stage.
To those of us that for the last three decades practiced Urology there was no surprise that a government agency made up of elites had Doubled Down on Dumb and put American men at risk. Einstein was right again and maybe his theory of time relativity is also coming into play because; American prostate cancer detection has moved back to the future. The date might as well be 1985.
Similar to the incompetent members of the US Preventive Task Force who brought about the Prostate cancer fiasco, instead of using competency and merit, President Biden has filled his cabinet with equity-chosen ideologues. In the guise of climate change, equity, and redistribution of wealth(socialism), these unqualified neophytes destroyed America’s energy independence (skyrocketing energy costs), spent trillions of dollars the country does not have, left Americans behind in Afghanistan, opened our borders to 6 million illegal immigrants along with youth killing fentanyl and lit the fires of inflation.
But perhaps the best American Government example of Doubling Down on Dumb and expecting a different outcome is the rising national debt.
The national debt is approaching 32 trillion dollars with a GDP to Debt ratio of 125%. It is generally thought when this ratio goes above 77% the country involved will have difficulty maintaining healthy growth or an adequate GDP. Just like the US Preventive Task Force’s incompetence that has resulted in a pernicious prostate cancer bubble, our entire Government (and many economists) has bought into the fallacious concept that because the American dollar is the world’s reserve currency, the United States can borrow, print and spend unlimited amounts of money.
These are the same Elite Ideologues who ignored the basic economic rules of inflation and flooded the world with too many newly printed dollars chasing too few goods, awakening the corrosive effects of inflation. The Federal Reserve has increased interest rates in hopes of bringing inflation down to less than 2%. But if inflation is not tamed quickly, over the next several years the US Government is going to have to refinance its debt at higher interest rates. The resulting annual interest payment on the National debt will approach 1 trillion dollars, and in effect, America will be insolvent. All the while China, Russia, India, Iran, Saudi Arabia, and others plot ways to end the American dollar’s dominance as the world’s currency.
The economic tsunami of this developing bubble is now starting to show signs of building. Just like the resurgence of Prostate cancer, it is not a question of if, but when the deficit bubble will pop.
2023
The future looks bleak, as America still has to contend with a President and US Senate who continue to Double Down on Dumb, expecting a different outcome, demanding that unworkable and disastrous policies continue to be funded and followed.
But America has been down before and came back stronger and better. We have a glimmer of hope. Republicans now control the House of Representatives and wasteful spending will stop. Real investigations will unearth the truth of Biden family corruption and how big tech and the FBI/DOJ’s involvement tilted the 2020 presidential election. And the SCOTUS will put a stop to affirmative action, and the legality of equity will fall with the decision.
But to fix the rest, America must stop Doubling Down on Dumb!
2024 is coming!!
Vote!!!!
