Pandora's Lab: Seven Stories of Science Gone Wrong

by Paul A. Offit

Screening for prostate cancer has also come under closer scrutiny. In 1970, Richard Ablin, a professor of pathology at the University of Arizona, discovered the PSA test, which stands for prostate-specific antigen. PSA is an enzyme made by cells in the prostate gland. The purpose of PSA is to break up cervical mucus so that sperm can enter the uterus. Criminologists were the first to recognize the value of PSA, which offered proof for the existence of semen in rape cases, even when the rapist had had a vasectomy or couldn’t make sperm. Doctors were the next to realize the potential value of PSAs, using the test to determine whether prostate cancers had relapsed. Then physicians took a step they are now starting to regret—PSA tests were used to predict whether someone had prostate cancer. If the level of PSA in the blood was high, then urologists recommended a prostate biopsy. If the biopsy showed prostate cancer, then men either had a total removal of the prostate (prostatectomy) or they had radiation therapy to the prostate. More than 90 percent of men in the United States who have been diagnosed with prostate cancer have had one therapy or the other. Because of the PSA test, prostate cancer is now the most commonly diagnosed non-skin cancer in the United States. So, what’s happened to the incidence of death from the disease? Nothing. The risk of dying from prostate cancer hasn’t changed in the last ten years. Indeed, about 50 percent of men more than 60 years old have be...

Mammography screening for breast cancer is also being reevaluated. Although it is clear that mammography, which was first introduced into the United States in the mid-1970s, saves lives; the question is how many and at what cost. In 2012, Archie Bleyer and Gilbert Welch published a study in the New England Journal of Medicine titled “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence.” They found that, with the advent of screening mammographies, the incidence of breast cancer in the United States had doubled. For every 100,000 women screened, the number of women diagnosed with breast cancer had increased from 112 to 234. In other words, every year 122 more women (per 100,000) were being diagnosed with breast cancer. At the same time, the number of women presenting with late-stage breast cancer (the kind that often results in death), decreased from 102 to 94 (per 100,000). This meant that only 8 women among 122 appeared to benefit from the screening. Eight. The others were treated with mastectomy, radiation therapy, and chemotherapy without benefit. The authors concluded that, although the incidence of death from breast cancer had clearly decreased during the era of screening mammography, most of that decrease was due to better treatment, not better screening. They also estimated that during the three decades of mammography, about 1.3 million women had been diagnosed with a cancer that would never have killed them. The authors concluded that, “scree...

If Andrew Wakefield and Linus Pauling’s hypotheses were right, then subsequent studies would have shown that they were right. When well-designed studies refuted their claims, they chose to attack those who had found them to be wrong. They did what any good lawyer would do; they argued conspiracy. (The legal aphorism is that when the law is on your side, argue the law; when the facts are on your side, argue the facts; when neither is on your side, attack the witness.) The minute that you hear researchers claim conspiracy, you should suspect that their hypotheses are built on sand. And although their this-is-what-happens-when-you-speak-truth-to-power lament is appealing, it doesn’t mean that it’s right. As Norman Levitt, a mathematician and debunker of pseudoscience, famously said, “While Galileo was a rebel, not all rebels are Galileo”—no matter how hard they try to convince you that they are.