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In Reply: Dr Singer and colleagues are correct in their assessment of the current understanding of the value of PSA screening. In an ideal world, physicians would take the time to discuss the potential benefits and known harms and limitations of PSA testing. Unfortunately, for many physicians economic pressures are forcing them to see an increasing number of patients each hour. There is limited time available to discuss all of the appropriate preventive health measures such as smoking cessation, weight reduction, cholesterol management, and colon cancer screening. Furthermore, failure to detect cancer (including failure to order a PSA test) has been a source of malpractice litigation.¹

Unfortunately, medical practice is driven not only by medical evidence but by powerful economic forces. If this society wants more rational medical practice, it must align appropriate practice patterns with positive economic incentives.

Financial Disclosures: None reported.

Peter C. Albertsen, MD, MS
albertsen@nso.uchc.edu
Division of Urology
University of Connecticut Health Center
Farmington

1. Merenstein D. Winners and losers [A Piece of My Mind]. JAMA. 2004;291:15-16. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297:949-950.

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