By Evan Falchuk

The American Cancer Society says that men over 50 need to seriously consider whether they really ought to get screened for prostate cancer.  According to them, the risks of getting tested may outweigh the benefits of detecting the cancer, especially for younger men.  They say it’s a “complex issue,” but they understate how complicated it really is.

Like the recent controversy over breast cancer screening, the new recommendations add to the swirling morass of conflicting messages and priorities around health care in America.

Here’s what I mean.

In recent years there has been a big public effort to get men to educate themselves and get tested for prostate cancer.  For example, Major League Baseball has turned Father’s Day into its own prostate cancer awareness day.  Their central message: the disease is treatable if caught early, so talk to your doctor, and get tested.

To show how important it is to get started with this at the right age, a key spokesperson is 51-year old baseball legend Ozzie Smith.  Ozzie says men as young as 40 need to start thinking about it, and to “take the plunge” by the time they are 50.

Ozzie says men as young as 40 need to start thinking about it, and to “take the plunge” by the time they are 50.  Star slugger Jim Thome, 39, has also been recognized by the player’s union for his work on prostate cancer.  Even President Obama is doing his part.  The 48-year old had a PSA test as part of his physical exam.

Now the American Cancer Society says that most men don’t need to start even talking to their doctor about this until they are 50.  It’s all very confusing.  And when you listen to people like Warren Buffet saying we need to declare a “national emergency” to control health care spending, you might start to wonder other things.  Like, if these screenings cost money, and may not be all that necessary, is someone going to use recommendations like these as an excuse to just stop paying for screenings?  After all, aggressive screening saves only about 6 men out of every 1,000.  What’s six lives in 1,000 when there’s money at stake?

Still, I respect that there is a real medical issue here, and so does the American Cancer Society.  They say that doctors need to spend the time to educate their patients about the risks and benefits of testing and to help their patients make the right decisions for themselves.  This is good, but there’s a bigger problem: time.

According to CNN, Dr. Herbert Lepor, chairman of urology at NYU Langone Medical Center in New York, put it well:

[I]t is impractical to suggest that a primary care physician who has 15 to 20 minutes to spend with a patient fully explain all the pros and cons of screening in the course of an annual physical.”How do you present this to a patient? You can’t possibly spend an hour discussing this,” Lepor said.

During the same 15- or 20-minute physical, the physician also has to discuss issues like blood pressure, diabetes, exercise and diet.

So we come back to the same old problem.  Medicine should be about a doctor and a patient working together to get the best outcome.  They need time with each other to do that.  But our system has different priorities.  It says, health care should be about trying to stop doctors and patients from spending too much money.

It’s a mistake.  And what it means is that all the well-intentioned efforts by people like Ozzie Smith, Jim Thome, President Obama and the American Cancer Society to help people get things right end up lost.

UPDATE: Advocacy groups complain that complex new guidelines are confusing men about prostate cancer screening.