Ben Stiller received hugs and support for talking about his prostate cancer. The actor spoke about how he had his prostate removed two years ago after taking a blood test that screens for the cancer. “ “Taking the PSA test saved my life. Literally. That’s why I am writing this now” wrote Stiller last week. While wishing him well and continued good health, it’s important to note that Stiller is making false and misleading assertions about prostate cancer.
And it is Hollywood melodrama on his part to suggest that the PSA test saved his life.
Stiller first spoke about his cancer on the Howard Stern radio show earlier this month - not exactly the most medically rigorous forum out there - and then wrote an essay about it for the Medium website. Because of his celebrity wattage, what he wrote was widely read and disseminated. Prostate cancer terrifies the life out of men of a certain age. You have to be careful in the words you chose to use about cancer. Stiller’s essay is based on a false assumption.
The PSA blood test Stiller took is a highly controversial way of screening for prostate cancer. So much so that a few years ago the United States Preventive Services Task Force, a team of experts selected by the US government, strongly recommended that no man should take the PSA test.
One of the man problems with the PSA test is it can return “false positives” and find a whole lot of prostate cancers that will never kill people. But the treatment given for those varying degrees of cancer could end up hurting patients more than the cancer itself say experts. The side effects of these aggressive treatments include incontinence and impotence.
Oncologist Vinay Prasad told the Health News Review that there were many flaws in Stiller’s logic. “His strong faith that the PSA test “saved his life” is incompatible with a true understanding of overdiagnosis; no person whose cancer was found by PSA screening can say “the test saved my life”” say Prasad.
Health News Review contributor, Dr Douglas Campos-Outcalt, says Stiller has “over a 95 per cent chance of being wrong” in his analysis of the PSA test. “Screening does more harm than good in these men, (there are people) who are killed by the treatment and a large number who are left impotent and incontinent”.
The point here is that you can find what you are looking for when searching for prostate cancer and the PSA test. In much the same way ,as Stiller himself did), you can be heartened by Googling “People who survived Prostate cancer” or dismayed by Googling “People who have died from Prostate cancer.”
As some indication of how complex and labyrinth like the debate about prostate cancer screening is (and being cancer this is a highly emotive issue) consider the statement released by Prostate Cancer UK last week. “We applaud Ben Stiller for his courage in talking openly about his personal experience. If you are over 50, black, or have a family history of prostate cancer, it’s important that you speak to your doctor about this disease”.
But Ben Stiller is white, was 48 when he had his prostate surgery and says he has no family history whatsoever of the disease.
Understandably, Stiller is evangelical about the PSA test - saying every man should get the test when they hit 40 years of age. But the medical world says the opposite.
We are where we are: either PSA screening is strongly advised against and may well be very harmful or it is a “life-saver”.
The “Stiller effect” now seems set to replace the “Jolie effect”. When, three years ago, Angelina Jolie wrote about why she elected to undergo a double mastectomy to reduce a very real genetic risk of developing fatal breast cancer, she did so in measured and insightful tones. There was no melodrama, just accurate and informative information about the benefits of genetic testing. Not once did she write “this saved my life”. The power of her story persuaded many women to get tested.
Stiller, like Jolie, had a powerful personal cancer story to tell. But he fluffed his lines. Arguably, more men have read more about prostate cancer and the PSA test over the last week than they have ever done before. At a very time when clarity is needed on a subject, there is now confusion and controversy.
Timothy Caulfield is a Professor and a Research Chair in Health Law and Policy at the University of Alberta. He wrote the best selling “Is Gwyneth Paltrow Wrong about Everything?: How the Famous Sell Us Elixirs of Health, Beauty & Happiness”.
Of the “Stiller effect” he says: “There is a large body of research showing that, like it or not, celebrities have an influence on health behaviours, including cancer screening. One way this happens is the power of the high-profile anecdote. Ben Stiller told a good story, one that will resonate with many man, even if the science doesn’t support his position. And it doesn’t. But research tells us that a good narrative will often overwhelm a mountain of good data”
Professor Caulfield has it that simply because “Stiller has such a massive cultural footprint” this plays to our cognitive biases - “if something is more readily accessible (as Stiller’s widely read essay on Medium is) it is more likely to be believed - even if the celebrity that is helping to spread the misinformation is not particularly trustworthy”.
When a high-profile celebrity details the narrative arc of an emotional story such as prostate cancer, the amount of hits on it tend to relegate other viewpoints in online search engines. “Ben Stiller’s PSA advice became a highly searchable item” says Caulfield. “For a few days, it was everywhere. It was discussed on social media. And it was in media outlets that don’t usually cover cancer screening, like celebrity blogs and magazines. There is a growing body of evidence that social media can play a significant role in shaping public discourse about health”.
Ben Stiller’s Medium essay on his prostate cancer diagnosis and treatment is well composed, thoughtful and moving.
But an anecdote is not the same thing as evidence.