medicine doesn’t include guarantees

conflicting medical advice

Earlier this week, the news broke about Joe Biden's advanced prostate cancer. That announcement motivated my column, proposing that we use magical thinking to elect more aged officials of any party or gender. I don't know the perfect age when humans should stop running for office as humans are diverse, but each of us, as voters, has a different risk tolerance for what we expect from those we elect.

If the Biden administration officials knew of any adverse medical condition, they were unequivocally wrong to withhold this information. I feel this strongly, as you likely do, but note that it's a general criticism of any administration. Trust, in such short supply these days, remains the bedrock of a functioning society, which is why many fear we are teetering.

I write today, however, about medical advice on detecting prostate cancer rather than defending Biden's history. For the sake of this analysis, I accept the premise that Biden did not receive a PSA (prostate-specific antigen) test over the last several years.

What if we focus on the current medical advice for men in Biden's and Trump's age cohort: conflicting advice exists on testing for this condition. While you or I may well question the decision not to test the president of the United States for all diseases, the Biden prostate saga is a cautionary tale in medicine.

The PSA test for blood assesses protein and malignant prostate gland cell levels. As far back as 2008, the medical community retreated from the notion that all men should receive this test regularly, regardless of age. Thirty years ago, all men who had routine physicals that included blood work received an assessment of their PSA levels.

Beginning in 2012, guidance started changing, with men over 75 told they no longer should take the test. Six years later, the age dropped to 70, so men of Biden's and Trump's stopped routine testing. The reason was that statistically, the frequently slow-growing cancer is less likely to be a cause of death than some other cause. This week's report from National Public Radio noted that medical advice on this subject is evolving.

Biden's medical team followed that advice, last testing the former president in 2014 at 72. Biden's decision not to test again accorded with national recommendations, although Biden was slightly younger than the noted age of 75. Reports indicate he did not have elevated PSA levels at that time.

Medical recommendations on any disease, developed by national experts in any particular specialty, are the collective wisdom of professionals working off blind, peer-reviewed, replicable studies to answer a question. That is how experts specialize in a topic rather than basing their recommendations on a single or dozen experiences here or there. Scientists hypothesize on many questions before developing collective wisdom to recommend to the public.

Almost invariably, advice changes as the expertise develops with more hypotheses, data, and assessments. Thirty years ago, advice on prostate cancer recommended that men with a high PSA result have an immediate biopsy. Today, the acknowledgment of the cancer's relatively slow growth in the majority of cases means that weighing this risk versus others is part of an overall approach to men's health as they age. Prostate issues are far from the only health challenge where this occurs.

Several aspects of this story leap off the page. Medical advice from accredited professionals (I confess to utter frustration with this concept of "influencers" and anecdotal assessments of health) can and do often conflict. Medicine is far from perfect in its diagnoses. That is reality. Even the best research hospitals in the world get things wrong. We had a friend with an inexplicable health issue twenty-five years ago who spent months in a bed at a world-renowned research hospital. No matter what they thought, doctors could not diagnose her problem. Despite this care, she died of a fairly common disease that the doctors had not identified. Medicine is yet one further human activity. Therefore, we should never guarantee perfection—as painful as that may be.

Additionally, one must wonder what the effects will be of the current Department of Health & Human Services trend to disestablish the government's role in so many health questions. We are disestablishing so many monitoring systems, not merely those related to vaccines, that one has to worry about government-issued guidance. Doctors are members of their fraternity, whether the American College of Surgeons or a gynecological society. However, the federal government has played a prominent role in issuing national guidance in conjunction with those other bodies for generations.

The incoming Surgeon General Casey Means, M.D., eschews "traditional medicine" for a more commercially driven approach to determining what causes illness in line with the Make America Healthy Again (MAHA) movement, a pursuit that has many doctors dubious. Perhaps MAHA will be proven correct, but no rigorous analyses support that approach now. Many professionals worry that the movement relies on commercial interests and the unproven promises of abandoning the regulation of health interests.

Finally, what about the men who aren't getting the most intense medical scrutiny in the world—everyone who isn't president, in other words? These men get medical care from physicians following the guidelines the medical community publishes as best practices, which is optimal care. However, many of those individuals won't have access, for cost or time-off-work reasons, to regular checkups, thus increasing their chances of missing the cancer's early indicators. With decreased funding under the new tax bill for Medicaid and Medicare, how often will these men track PSA numbers? Some, like Biden, with world-class care, will develop aggressive, stage 4 prostate cancer.

If I understand this dilemma, most men develop prostate cancer if they reach an advanced enough age. Still, the level, speed of development, and other aspects are individualized rather than entirely predictable. Many different illnesses follow a similar pattern of unpredictability.

Humans prefer guarantees, yet they are rarely available. Risk is at the heart of the human condition every day of our lives. We can minimize some of those risks but never all of them. It is incumbent on physicians to continue testing and retesting hypotheses about our health in the most rigorous manner.

On this Memorial Day weekend, savor the lives we have and thank those who sacrificed on our behalf. For all of our conspiracy theories, divisions, and anxieties, this is the United States of America for 340 million of us experiencing it together.

Every single day is a gift.

Thank you for your time today or any day you read Actions Create Consequences. I value your thoughts on this or any other column. I welcome dialogue to expand our knowledge, as I don't have all the answers.

I thank those who contribute as paid subscribers as your commitment offers me options to pursue additional resources in addressing these questions.

It was a spectacular sunrise. Your U.S. Naval Academy graduation will be under cloudy skies today as Annapolis bids adieu to these young officers commencing on their careers. What is it like where you live this weekend?

Be well and be safe. FIN

Ronnie Cohen, “The pros and cons of PSA tests for prostate cancer for midlife and older men”, NPR.org, 21 May 2025, https://www.npr.org/sections/shots-health-news/2025/05/21/nx-s1-5405613/prostate-cancer-psa-test-age

Gabriella Coleman and Eric Reinhart, “Opinion: How MAHA is Helping to Poison Americans while Claiming to Save Them”, politico.com, 2 April 2025, retrieved at https://www.politico.com/news/magazine/2025/04/02/rfk-jr-s-maha-movement-has-a-fatal-flaw-00263926

Mark Hagland, “House Passes Budget Bill, with Huge Medicaid cuts and Potential Medicare Fallout”, hcinnovationgroup.com, 22 May 2025, retrieved at https://www.hcinnovationgroup.com/policy-value-based-care/article/55292192/house-passes-budget-bill-with-huge-medicaid-cuts-and-potential-medicare-fallout

Alexander Tin and Joe Walsh, “Dr. Casey Means, Trump’s new surgeon general nominee, is RFK Jr. ally and MAHA advocate”, CBSNews.com, 8 May 2025, retrieved at https://www.cbsnews.com/news/trump-casey-means-surgeon-general-nominee/