Bob Dole, Pitchman for Erectile Dysfunction

Healthfacts, March, 1999 by Maryann Napoli

Bob Dole is hawking Viagra. The ad, sponsored by the drugs manufacturer, Pfizer, seems to be everywhere in the print and broadcast media. Words like "courage" and "worthwhile" leap from the ad, as the former senator urges men to speak to their doctors about erectile dysfunction, the new term for impotence. In keeping with the current trend in prescription drug advertising, Viagra isnt mentioned in the ad. Instead, Pfizer is selling the illness of erectile dysfunction, or E.D., as it is referred to throughout the ad.

Of the common causes of E.D., such as high blood pressure, alcohol abuse, and diabetes, prostate surgery figures prominently in the ad and is offered as the reason for Mr. Doles presence. Nowhere does it say that he personally experienced E.D. On the contrary, he was simply worried about E.D. as a postoperative side effect once he was diagnosed with prostate cancer. Heres the irony. For years, Bob Dole has been speaking out about the importance of a prostate cancer screening test for all middle-aged and older men. His well-intended efforts were misguided and may very well have generated more cases of E.D. The test appears to have inflicted more harm than good, causing many men to suffer the complications of treatment without reducing their odds of dying of prostate cancer.Prostatectomy, surgical removal of the prostate gland, is the most common treatment, and E.D. is a frequent result.

Since the mid-1980s, when the use of the prostate-specific antigen (PSA) screening test began to increase dramatically, the incidence of prostate cancer showed a concurrent steep rise. If early detection of prostate cancer truly saves lives, there should be a corresponding drop in the prostate cancer death rate. It hasnt happened. The prostate cancer death rate in the U.S. has not changed in 30 years. The vast majority of men with prostate cancer do not die of the disease because they have the slow-growing type that would never become lethal. Even if doctors could determine which cases of early-stage prostate cancer will be fatal (about 10-15%), there is no evidence that early detection will alter the outcome. About 2% who undergo prostatectomy die within 30 days of the operation.

The PSA blood test, originally intended only to monitor men after treatment for prostate cancer, should never have been promoted as a screening tool for men without symptoms. It has a high rate of false alarms (two out of every three) and misses cancer 25% of the time. Its dangers are so well recognized that no medical organization recommends PSA screening. Yet the test became popular because of prostate awareness campaigns funded by the pharmaceutical and medical device industries. The latter produces the biopsy guns which are in demand thanks to mass screening.

PSA Has No Endorsement

PSA testing got a major lift from an endorsement by the American Cancer Society which has a history of overselling the value of early detection and advising the public to seek tests before their safety and efficacy has been established. Medical organizations like the American College of Physicians and the U.S. Preventive Services Task Force that carefully search the scientific evidence before making screening recommendations have refused to endorse the PSA test. By the time the American Cancer Society tempered its endorsement in 1997, the test had already worked its way into standard medical practice, and one survey showed that half the men over age 65 reported having had a PSA. Not many men, even if fully informed, can walk away from a cancer diagnosis and choose the watchful waiting option that should be offered. Worse, some men dont even know theyve had a PSA. It is often thrown in with usual blood work during a routine physical.

The most disturbing aspect of Bob Doles ad campaign is its sub-text. In effect, he is telling men not to worry about the prospect of surgery because now theres a drug that will solve E.D., should that be their fate. He would have better served his fellow men by encouraging them to think twice before allowing any doctor to order a PSA test.