Warren Buffett was recently diagnosed with prostate cancer. The 81 year old investor released the following
statement about his disease:

To the Shareholders of Berkshire Hathaway:

This is to let you know that I have been diagnosed with stage I prostate cancer. The good news is that I’ve been told by my doctors that my condition is not remotely life-threatening or even debilitating in any meaningful way. I received my diagnosis last Wednesday. I then had a CAT scan and a bone scan on Thursday, followed by an MRI today. These tests showed no incidence of cancer elsewhere in my body.

My doctors and I have decided on a two-month treatment of daily radiation to begin in mid-July. This regimen will restrict my travel during that period, but will not otherwise change my daily routine.

I feel great — as if I were in my normal excellent health — and my energy level is 100 percent. I discovered the cancer because my PSA level (an indicator my doctors had regularly checked for many years) recently jumped beyond its normal elevation and a biopsy seemed warranted.

I will let shareholders know immediately should my health situation change. Eventually, of course, it will; but I believe that day is a long way off.

Warren E. Buffett

As Mr Buffett’s condition is a matter of public record, it serves a useful didactic purpose. First, it shows that when it comes to his own health Buffett does not exhibit the same analytical skill that has made him one of the most successful investors ever. He says he was told that his condition was “not remotely life-threatening,” which is true. But if such is the case why did he opt for two months of daily radiation therapy? Such treatment is not typically offered to patients who have a non life-threatening disease. He says he feels great. It’s uncertain that he will feel this way after two months of radiation therapy which has a significant incidence of radiation colitis. Every medical student is repeatedly admonished to remember that you can’t make an asymptomatic patient feel better.

An 81 year old man with “stage I” prostate cancer will almost certainly die from something other than prostate cancer. Why did Buffett have a CT scan, an MRI, and a bone scan for an innocuous medical condition which should never have been diagnosed to begin with? The US Preventative Services Task Force has long advised against PSA screening in men older than 75. More recently the Task Force advised against routine PSA screening in men of any age. The most obvious answer is that Mr Buffett left the decision about his diagnosis and treatment mainly to his doctors and doctors notoriously are either unaware of the latest data about procedures they have used for years or are so wedded to routine that flexibility is impossible. While Buffett can afford any thing he wants, Medicare likely footed the bill for all this unnecessary diagnostic overkill as it does for thousands of other men in the US. When the final bill is totaled, as much as $100,000 will have been spent for no good reason. Here’s one of the reasons Medicare is bankrupting the country.

If Buffett had done a simple Google search on prostate cancer he would have discovered that there has been controversy about PSA screening for years. To make this case even more instructive is the recent report to the American Urological Association of the PIVOT study which showed no benefit from radical prostatectomy in low risk early stage prostate cancer. In other words, patients with prostate cancer similar to the type that Buffett has did just as well with no treatment as they did with surgery. There’s no reason to think that radiation therapy for this disease is superior to surgery; in fact, it’s likely less effective.

There are several lessons from this case. One is that human intelligence and reason is compartmentalized. One can be brilliant in one area of intellectual pursuit and inept in another. And when it comes to medicine reason and rigorous analysis are often casualties of sloth and unfocused desire to do good. Come to think of it, medicine is not an isolated example of this kind of reasoning.