On the Viagra Dole, What the Former Senator Doesn't Say in Those Ads
Bob Dole is speaking out about prostate
cancer and erectile dysfunction. (AP
Photo Sephan Savoia)
By Nicholas Regush
ABCNEWS.com
My, my. What do we have here?
Bob Dole in a Pfizer commercial?
Yes, there he is on the tube, looking soft,
caring and thoughtful. The crusty Kansas
Republican who ran for president in '96 even emotes like a
bleeding-heart liberal.
According to Pfizer, his benefactor, Dole will participate
in public service activities, essentially becoming a health
spokesperson. The goal? To get doctors and patients,
especially men, speaking openly about issues like impotence
and prostate cancer.
And what could possibly be wrong with that?
A Vote for Viagra Is a Vote for …
Plenty. It's not just the ads that are at issue here. In the
United States, doing TV commercials has become the
ladder to Real Recognition, Real Influence and Real
Success. Who could deny Bob Dole this great opportunity?
Clearly, he feels deeply about the issues. He had
surgery for prostate cancer in 1991 and became impotent
as a result. He participated in Pfizer's clinical trials for
Viagra and the drug worked for him, a fact he and his wife,
Elizabeth, now a presidential hopeful, spoke happily about
on Larry King Live.
That appearance led to Dole's relationship with Pfizer
and the TV ad. In it, he mentions his prostate cancer
experience, but no, he doesn't mention Viagra. The Pfizer
logo appears very discreetly, in the corner of your TV
screen. Let's not kid ourselves about that, though. Use the
words “impotence” and “Pfizer” together these days and
we all know what it means.
Medical Minefield
But what really concerns me about Dole's activities as a
health spokesperson for Pfizer is that he will help spread a
misconception about prostate cancer. Not only is what he
says in the commercial medically controversial, it may
inevitably — and unnecessarily — cause a lot of men to
suffer needless pain and stress.
It seems reasonable that Dole would want to advocate
for early detection — until you consider that there's no
proof that detecting prostate cancer early lowers death
rates or has much effect on the speed with which the
cancer spreads. This includes such techniques as routine
digital rectal exams and testing for blood PSA levels (a
marker for prostate cancer cells).
These tests are far from perfect, and can result in false
positives and negatives. And there have been no good
studies investigating the effect of screening and early
treatment on prostate cancer death rates.
What's Wrong With Waiting?
An illness that afflicts mainly men over 50 (most in their
60s), prostate cancer grows slowly and might never spread.
But with early detection, many men are subjected to the
indelicate emotional and physical impact of biopsies and
jump-the-gun surgery when it would have been OK simply
to wait and watch for developments.
It's prostate surgery, by the way, that leads to impotence
and incontinence in many men. And that would make them
good candidates for Viagra prescriptions, right? And
screening and early detection might be leading doctors to
suggest aggressive but unnecessary surgical treatment,
which then results in impotence. So if a more conservative
approach to screening and treatment prevailed, doctors
might not have to write so many Viagra prescriptions, right?
If, for example, doctors screened only those men who
had a strong family history of prostate cancer, and were
between 60 and 69 years old, how might this affect Viagra
sales in the years to come?
When in Doubt, Cut It Out
Furthermore, when treatment for prostate cancer is
indicated, there is an unfortunate, almost blind devotion in
this country to surgery, rather than to alternative
approaches. For early prostate cancer, for example,
radioactive implants (tiny pellets placed in the prostate
gland) seem to be as effective as surgery and more
effective than external beam radiation at keeping the
cancer at bay over a 10-year follow-up period.
And research shows that implants cause impotence in
only about 25 percent of patients, a smaller number than for
surgery; another plus is that the procedure is done on an
outpatient basis and patients can go back to work in about
three days. In contrast, surgery usually means cutting out
the prostate and surrounding tissue, and often involves
severing nerves crucial to having an erection. (There are
experimental efforts under way to provide surgeons with a
mapping device that might help them avoid snipping these
nerves.)
Prostate cancer treatment is a hotbed of points and
counterpoints. Some argue strongly for early detection on
the grounds that the disease kills at least 40,000 American
men each year. In some, the disease grows quickly, the
early detection advocates say, and screening would catch
these cases.
The Pfizer Professor?
But the bottom line is that medicine needs to move forward
not on the basis of assumptions, but of evidence. And
doctors must impart that evidence to their patients, not
guesswork or politically correct phrases in the guise of
knowledge.
In the Pfizer commercial Bob Dole speaks about the
need for men to visit their doctors because so many don't.
What he doesn't say is that doctors have climbed on the
early detection bandwagon and are testing away in huge
numbers.
What men really need is an educated doctor who'll
apprise them of the risks and benefits of screening, what
we know about prostate cancer and what we don't, and
which treatments are available for different stages of the
disease. Once educated, the patient can decide which route
to take.
Fulfilling this educational requirement will not be easy
because prostate cancer care is already a battleground. But
one thing is certain: educating doctors and patients about
the disease is not a job for the likes of Bob Dole and Pfizer.
Nicholas Regush produces medical
features for ABCNEWS. In his weekly
column, published Wednesdays, he looks
at medical trouble spots, heralds
innovative achievements and analyzes
health trends that may greatly influence
our lives. His latest book is The Breaking
Point: Understanding Your Potential For
Violence.
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