The worst thing I’ve read all year: @Slate piece on prostate cancer

cancer mythI’ve read a lot of bad writing in the past year including on prostate cancer. Lucky me, right? It’s probably true for most of us.

However, a new piece in Slate on prostate cancer and the Movember movement (an effort that raises awareness and funds for prostate cancer research) takes the cake as the absolute worst thing that I’ve read in all of 2015.

As many of you are aware, I’m a prostate cancer survivor. I was diagnosed with a serious form of the disease almost exactly 6 years ago at the age of 42. You can read more on my experiences here.

I’m doing OK now so far, but for hundreds of thousands of patients prostate cancer is a devastatingly tough illness. The cancer as well as the treatment were together the most difficult thing I’ve ever had to deal with in my life. So admittedly I’m probably more sensitive to discussions of prostate cancer than the average person, but the Slate piece is an utter train wreck by any account.

Authors Jacob Brogan and Christina Cauterucci did the piece as a chatty conversation between the two. It comes off like a transcript of an idiotic YouTube video.

The authors seem obsessively focused on the sexual and gender implications of Movember, again a movement primarily focused on raising awareness about prostate cancer and funds for research. In fact, the authors themselves hypersexualize the issue in how they discuss it. I’m not here to defend everything associated with Movember and there may well be legitimate issues here, but this Slate piece is an epic fail. The authors didn’t do their homework on prostate cancer. They showed an extreme disregard for prostate cancer patients and their families too.

The Slate piece goes from bad to disaster as one reads myths presented as fact and witnesses persistent trivialization of prostate cancer. Take this passage:

Jacob: What’s more, while prostate cancer is the second leading cause of death by cancer in men, Siddhartha Mukherjee writes in The Emperor of All Maladies that more elderly men die with it than die of it. I wouldn’t want to minimize the damage—both emotional and physical—that prostate cancer can cause, but I also think it’s important not to scare people by overstating their risks. And that’s exactly what I think is happening here.

Okay, so according to Slate supposedly while prostate cancer is the 2nd leading cause of cancer death for men, since most men who die of it (or with it) are “old” let’s not make a fuss about it? Let’s not “scare” people through increased awareness via educational outreach?

That’s illogical to put it kindly. Seems like a massive case of ageism too. The authors further missed an opportunity to discuss the real, key issue of PSA testing and how that should be reformed to hopefully do more good than harm.

Then Christina comes in with a real humdinger of her own, “and besides, everybody already knows about prostate cancer.”

That’s actually a harmful myth.

Prostate cancer is not on the radar screens of people the way that other cancers are and there is a huge need for further education and awareness. While campaigns for awareness and research funding for other cancers have done a very effective job, the same sadly cannot be said about prostate cancer by any stretch of the imagination. In short, Movember for all its potential imperfections has done and continues to do valuable, unique things.

Next Jacob chimes in by criticizing Movember for raising awareness about mental health issues related to prostate cancer. What the heck? How could that possibly be a bad thing?

He then astonishingly goes on to question whether prostate cancer research even merits funding. Apparently, it’s just not quite bad enough and after all it is a “manly” disease:

Jacob: And it’s not entirely clear how meaningful that charity has been. Over the years, the Movember Foundation has raised a lot of money, and that’s great. But because of its focus on ostensibly masculine afflictions, those funds aren’t always going where they’re needed most. They’ve dedicated tens of millions of dollars to prostate cancer research, and though charity isn’t a zero-sum game, it’s hard not to wonder whether those funds might have done more good if they’d gone toward a less manly but more deadly ailment—like lung cancer.

So Jacob turns raising millions of dollars for prostate cancer research into a bad thing because, heck, that money would be better served studying some other cancer like lung cancer?

I wonder: what does whether something is “manly” have to do with cancer research funding decisions?

No campaign is perfect and I’m sure Movember has its own share of flaws, but these authors do such a profoundly lame job on this Slate article.

Note that I have no affiliation with Movember and have never even participated in it myself.

The icing on the cake is that these authors act all annoyed because Movember apparently takes place in their birth month of November, saying “And why did they have to corrupt our birthday month?”

Is this supposed to be some kind of pathetic attempt at humor? And talk about an astounding level of self-centeredness by these authors.

We are talking about a disease that in the US alone is newly diagnosed in almost a quarter of a million men each year and claims the lives of about 30,000 annually. There are huge negative impacts and suffering for decades for millions of American men living with the disease and their families, who also suffer collateral damage from the disease in many cases.

There’s a staggering level of ignorance and childishness here by the Slate authors overall.

11 thoughts on “The worst thing I’ve read all year: @Slate piece on prostate cancer”

  1. Yes, i think about this a lot – though don’t have any simple answers. There’s no doubt that some people don’t like Movember, but i daresay that Movember is big enough and tough enough to withstand some whingeing from hacks wishing to boost their website traffic.

    I’m grateful that my day job is marginally more virtuous than writing clickbait 🙂

  2. Jacob and Christina dismiss Movember because lung cancer is more “deadly” and it’s a mans disease.

    Well, it’s true that about 3 times as many people die from lung cancer as prostate cancer (based on UK statistics). On the other hand, I would point out that prostate cancer is 3 times more likely to strike black men as it is to strike Asians and Pacific Islanders.

    I guess that Jacob and Christina are not much concerned with the plight of black men?

    I say, everyone matters.

    This brings me to a much bigger issue: the notion that concerns of those who cannot gather in the largest numbers should be dismissed. This is, of course, the convenient thing about the democratic process — a process which condemned Socrates, by the way. Democratic society can only work in so much as it also takes great care to tread lightly and build consensus.

    I would say that Jacob and Christina are just another manifestation of some very nasty trends that we see in politics and escalating aggressive behaviour within nations and between nations…

  3. Thanks for you elegant deconstruction of the Slate hackery.

    Disclaimer; i’m an academic scientist, part funded by Movember – doing basic research.

    PSA testing; i’m not an expert in this, but i would make the observation that it is largely accepted that there is a lot of overtreatment in this disease – because some forms of it are indolent/non-progressive. Problem is, we’re not able to reliably differentiate this type. Yet. 5 year survival is 95%; so if you are ‘old’ there is certainly a reasonable chance that the grim reaper will get you before your tumour does… This is where the 2 out of 3 men will die with it rather than of it comes from.

    I would also point out that the NNT (number needed to treat) is estimated at 30:1 down to 8:1 (this latter example came from incidental diagnoses, so is unduly ‘good’ – the unscreened population will be higher). So, an estimate would be that to save one life somewhere between 8 to 30 (15 might be a reasonable guess…) need to be removed to save one life. This is not stratified for age – it would seem logical to think that comparing young versus old might produce better numbers. Perhaps i’m a risk taker – but these sort of numbers would not have me rushing to treatment – unless the side effect profile improves a lot.

    Further disclaimer; i’m not a statisitician or clinician, and would heartily agree that in the younger patient there may be a preponderance of more aggressive disease that needs urgent intervention.

    1. @Axel,
      Your comment reflects some serious thought and research on this, things largely absent from the Slate piece. As mentioned in an earlier comment, it may well be that the Slate authors were only seeking generate a lot of controversy and clicks, rather than any kind of serious discussion.

  4. The problem with Movember is not the cause it supports, but the incredibly hackneyed way in which it goes about it.

    Prostate cancer deserves recognition and funding, but not through the method of using lame, vaguely misogynist, racist, and otherwise divisive tactics.

    1. @Katharine,
      I can see your points, but the Slate article is itself destructive and misleading about prostate cancer itself.

  5. I stopped reading at “microaggression”. Enough said right there. It’s simply not a serious article, and it must not be taken seriously. (That aside, Slate hasn’t been relevant in years. They’re on the “Gawker” business model now: Clickbait, hyperbole and sensationalism, wholly low-brow content….)

    1. @Erebus,
      You are right. They are just after traffic. In hindsight today I wonder if some of their statements in their article are things they don’t even believe but they just said them to get their article more attention.

  6. Michael Finfer, MD

    The numbers you quote day it all: 250,000 cases of prostate cancer diagnosed in the U.S. every year and 30,000 deaths per year. We have an enormous problem in this country with over diagnosis and over treatment of prostate cancer. The tough nut to crack here is how do we separate the men who go on to die of prostate cancer from the very large numbers of men who have prostate cancer and die of something else?

    Right now, that answer is not apparent.

    In cases like yours (and mine, a T3, Gleason grade 9 diagnosed at age 49), treatment is basically a no brainer, but in older men who have so-called ordinary prostate cancers, it is not. I have seen several cases recently of older men who had radical prostatectomies and recurred more than 20 years later. This makes me wonder whether the treatments that are available have any effect at all on the natural history of the disease, and if they do not, why are we continuing to push PSA screening, surgery and, mostly, at least in my area, radiation on these older men?

    I tend to agree with the current recommendation for no screening for men of ordinary risk, simply because I do not think that the risk to benefit ratio is acceptable. I think we need to find a biological marker that is more specific to prostate cancer. PSA is a prostate marker, not a prostate cancer marker.

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