Biden’s prostate cancer diagnosis: Why should we care?
Patient confidentiality is a high ethical responsibility for doctors these days. Strict HIPAA provisions enjoin health practitioners from releasing confidential information about their patients. Many Biden defenders are calling for respecting the privacy of the beleaguered ex-President now that he’s facing yet another challenging diagnosis.
There’s also the informal “Goldwater Rule” that dates back to the 1964 presidential election, when partisan psychiatrists were labeling the hawkish Conservative candidate a dangerous paranoid schizophrenic from afar; the American Psychiatric Association ruled it unethical for doctors to render a diagnosis on individuals not directly under their care. That rule emboldened White House officials and their media enablers to slam critics of Biden’s mental status.
But Biden’s new predicament is different. The sudden revelation that he has advanced prostate cancer raises serious questions about the medical care he received as a candidate and while in office. Moreover, in light of the obvious concealment of his cognitive problems, ultimately the undoing of his 2024 candidacy, it raises questions about who knew what, and when, about a cancer that’s notorious for its slow, sometimes decades-long progression.
Moreover, Biden’s medical condition is a matter of national security. While entitled to privacy, public officials have a higher responsibility to be candid about ailments that could limit their capacity to serve.
And finally, even if we were to accept the disavowals of concealment of Biden’s cancer, the failure to timely diagnose a potentially curable condition that afflicts millions of men needs to be highlighted as a teachable moment for the American public, worthy of analysis and discussion.
Not that secrecy about politicians’ medical problems isn’t a long-standing tradition in America. Examples include Grover Cleveland’s cancer; Woodrow Wilson’s incapacitating stroke; Franklin Roosevelt’s paralysis; Senator Diane Feinstein’s progressive dementia; and more recently, the death of Texas Representative Gerry Connolly from esophageal cancer—mere months after he defeated Alexandria Ocasio Cortez for the chairmanship of the influential House Oversight and Accountability Committee.
Some medical reporters are highlighting the fact that a considerable proportion of prostate cancers, like Biden’s, are undetected until they present in advanced stages. But that represents just 8% of diagnoses. The rest are found earlier, more amenable to cure. And that statistic may reflect the woeful fact that poorer Americans, without adequate coverage or poor medical literacy, are less likely to get appropriate screening and care. Certainly, Presidents, surrounded by top doctors, afforded the most advanced methods of detection, and subject to routine checkups, do not qualify as “medically underserved”.
In a July 2024 press conference, presidential spokesperson Karine Jean-Pierre averred:
“[The President] has something that most majority of Americans — all Americans — I would probably argue — don’t have, which is a full medical unit that is with him at all times and he gets a full, full, full physical, annual physical we share with all of you and that is very different — a very different than an everyday American who, sometimes, they’re lucky if they can go get a physical.”
It’s also been suggested, by way of justification for the apparent oversight, that sometimes even advanced cancers develop “under the radar”—with no foreshadowing by elevated PSAs. But only 1% of advanced cancers present that way. By the time bone metastases develop, PSAs are generally in the high double-digits, or even in the hundreds. Why weren’t these detected, months or even years before Biden’s complaint of urinary problems led to an investigation?
This highlights an anomaly in Biden’s medical care: He is said to have had his last PSA in 2014, when he turned 72. His subsequent presidential physical exams disclose that he was, as is common for men in their 70s and 80s, suffering from BPH, prostate enlargement that necessitated a urinary medication called Flomax. Why wasn’t closer attention paid to his prostate health? Previous Presidents, including Bush, Obama, and now President Trump, undertook routine PSA screening and disclosed their (normal) results.
Biden’s presidential physical exam disclosures reveal input from a raft of specialists—cardiologists, orthopedists, podiatrists, dermatologists, even neurologists (although conspicuously missing are results of a mental status exam), but NO urologist! Why the omission?
The most charitable explanation is this reflects a tendency to downplay the importance of PSA screening in older men. It’s been argued, especially in the wake of a controversial US Public Services Task Force recommendation that, in men of over 70, screening PSAs not be routinely performed because they don’t ultimately save lives.
The fatalistic rationale is that prostate cancer is mostly slow-growing in older men, whose longevity is already constrained by other health problems; aggressive treatment of a non-life-threatening early prostate cancer is not entirely benign, and side effects might compromise quality of life in men’s few remaining years, when they’d die of something else anyway.
But obviously, that dictum needs to be selectively applied. It doesn’t excuse a 10-year lapse in PSA testing for a President with acknowledged urinary problems. These days, not every man with a questionable PSA is immediately referred for an invasive prostate biopsy; subtler methods like other blood and urine tests and MRIs can reveal the presence of aggressive cancers. Treatments of prostate cancer are now more individualized and restrained, sometimes even foregoing surgery or radiation in lieu of “Active Surveillance”. Since otherwise healthy men frequently can live into their eighties and beyond, there’s enough time for early discovery and treatment of a small prostate cancer in an older man to make a difference.
And, with all that poking and prodding administered by multiple specialists every year, why was it that no intrepid doctor had the temerity to stick his gloved finger up the POTUS’ hindquarters for a routine digital rectal exam that might have revealed the culprit nodule that was said to be only belatedly discovered this month?
This begs the question of whether or not Biden, were he just an ordinary citizen, could have a case for medical malpractice under the familiar legal rationale of negligence due to “failure to diagnose”?
Last week, I had a long-ranging discussion with Dr. Geo Espinosa, America’s foremost integrative urologist and author of Thrive Don’t Only Survive: Dr. Geo’s Guide to Living Your Best Life Before & After Prostate
Trained as a naturopathic doctor, he’s now an associate professor in NYU Langone’s Department of Urology. He explained the controversies over PSA testing, the implications of Biden’s advanced diagnosis, and also the range of medical options for this stage of prostate cancer.
Not surprisingly, Dr. Geo frequently sees patients in Biden’s predicament. Despite a challenging diagnosis, some patients, especially younger men with Stage Four prostate cancer, can enjoy long intervals of quality life, despite statistics indicating only one third of men with advanced cancer survive five years.
One problem, Dr. Geo stated, is that the very treatments that slow the progression of advanced prostate cancer curtail longevity via their serious side effects. Hormone blockers are deployed to shrink bone metastases, but the “chemical castration” they initiate causes instantaneous male menopause.
Worse than the gradual decline of testosterone that occurs with age, this results in rapid replacement of muscle with fat, deterioration of blood sugar control, adverse lipid profiles, and hence higher mortality from heart disease and stroke. There’s also acceleration of osteoporosis, which can heighten the likelihood of hip fracture, a calamity that portends as high as a 50% risk of subsequent death in senior men. Moreover, there’s clear evidence that hormone blockade for prostate cancer hastens cognitive decline, already an issue for Biden.
To offset these side effects, Dr. Geo envisions a role for low-carb diets, with plenty of polyphenol-rich fruits and vegetables, and an emphasis on adequate protein for muscle retention. The role of dairy in the causation or acceleration of prostate cancer remains controversial; some studies suggest an association, while others dispute it.
Importantly, Dr. Geo, personally a devotee of resistance exercise, envisions a role for regular weight training to forestall muscle and bone decline in his patients taking hormone blockers.
As to supplementation, Dr. Geo recommends ample vitamin D, whose sufficiency has been shown to affect cancer prognosis, as well as offset osteoporosis. Other favored supplements include curcumin, Boswellin, EGCG and broccoli extracts for their anticancer effects; ashwagandha as an adaptogen, and Lion’s Mane mushroom extract for cognitive preservation.
Of interest is that some resourceful patients with advanced prostate cancer are resorting to alternative remedies. While on a cruise last month, I met a retired pharmaceutical executive who revealed that he was treating his stage four prostate cancer with the usual cocktail of blockers, but with the addition of ivermectin, an anti-parasitic medication. Championed by some as an alternative therapy for Covid, ivermectin was maligned by health authorities as “horse dewormer” and its availability restricted. Now cancer sufferers are embracing it, sometimes accompanied by another anti-parasitic medication, fenbendazole.
We all know that cancer is NOT a parasitic disease, but there’s some evidence that ivermectin delivers some “off target” effects that might make it a promising adjunct to conventional therapies for certain cancers, including prostate, although definitive human trials are as yet lacking.
A final challenge for Biden will be the pain associated with bone metastases, a scourge recently alluded to by cartoonist Scott Adams, of Dilbert fame. He recently posted a YouTube revealing his diagnosis of terminal metastatic prostate cancer, predicting he’s not likely to survive the summer. According to NPR, Adams called his condition “intolerable,” saying he’s been using a walker for months and is “always in pain” that moves to different parts of his body.
Pain of that type was the initial impetus for the development of Fentanyl, which can be delivered orally or as a sustained-release patch. But as with hormone treatments, it too can hike the risk of mental confusion.
On a personal level, we wish Biden and his family Godspeed as a new challenging chapter unfolds. But let’s keep in mind that, had Biden’s 2024 candidacy succeeded, his incapacitating illnesses might have propelled us into a resignation or unprecedented deployment of the 25th Amendment.
Which underscores why the American public deserves full transparency about officials’ medical conditions that may affect their ability to effectively carry out the duties of their offices. We need answers.