Advocates of PSA testing campaign to silence critics

Advocates of prostate cancer screening have launched a national campaign to silence the editors of the American journal wjm—the Western Journal of Medicine—after the editors wrote an opinion piece in the San Francisco Chronicle arguing that such screening may cause more harm than good.

In the piece the editors, Michael Wilkes and Gavin Yamey, discussed the unreliability of the screening tests used to detect prostate cancer—the digital rectal examination and the prostate specific antigen (PSA).

They also argued that false positive tests cause considerable morbidity related to the complications of prostate biopsies and that screening often picks up slow growing tumours that would never have become clinically apparent. There is no evidence, they said, that screening all healthy men would change the outcome of the disease.

Within hours of the piece being published, advocates of PSA testing sent a joint email alert to urologists, national prostate cancer support groups, and charities around the country. These groups then bombarded Dr Wilkes and Dr Yamey with emails accusing them of having the deaths of hundreds of thousands of men on their hands.

A member of a prostate cancer listserv (email discussion group) urged other members to put “continued pressure” on the San Francisco Chronicle to “offset the damage done.” His email also urged members to write to the editors' bosses to have them fired. The wjm is co-owned by the University of California and the BMJ Publishing Group, so he wrote: “Write to their bosses at University of California Davis and the Office of the President. Tell them to fire these imposters. Tell them these folks should be silenced.”

The chancellor of the University of California and the dean of University of California Davis have been overwhelmed with letters demanding that the university takes disciplinary action against Dr Wilkes and Dr Yamey.

Gavin Yamey, deputy editor of wjm, said: “Our piece provoked this angry and often abusive backlash because it challenged the widespread belief in America that every man should know his PSA. This belief is promoted by an extremely powerful pro-screening lobby, which has a major financial stake in diagnosing and treating prostate cancer.”

Support for the position of the editors of the wjm came from Dr Muir Gray, programme director of the National Screening Committee of the NHS. He said: “The views of Yamey and Wilkes are supported by the evidence.

“There are issues of conflict of interest in the United States, and there is also a male health agenda. Some people are promoting prostate screening as a means of putting men's cancers up the agenda.” Dr Gray added that Canada took a similar approach to that in the United Kingdom, where men requesting a test were only given one after being told of the risks and benefits. (See “Prostate debate” in Reviews at bmj.com)