Dr. Richard Goldberg: Preventive care and cancer screenings are critical to your health
The news of President Joe Biden's prostate cancer diagnosis came as a shock to the country. But preventive screening can protect you from having a similar shock of your own.
While we don't know all the details about the former president's personal medical decisions, what we do know is this: Preventive care is absolutely critical to our health. Everyone should get the screenings appropriate to their age and individual health profiles.
I have served as an oncologist for over four decades, helping thousands of cancer patients and their families navigate difficult diagnoses as well as helping thousands of other Americans catch a problem early when taking appropriate action can be curative. I have seen too many heartbreaking situations among my patients that could have led to better outcomes if a problem had been caught earlier.
I have also seen firsthand the startling rise in the incidence, in particular, of colorectal cancer among younger adults at a time when incidence rates in older Americans are falling. Colorectal cancer is now the second-deadliest cancer for men and the third-deadliest cancer for women. The rise in early-onset colorectal cancer has been so dramatic that the recommended age for regular colonoscopy in people with no special risk factors was lowered in 2021 from age 50 to age 45.
Some might think that moving up the screening age by five years is a small step, but it is not — certainly not in terms of outcomes. I have already witnessed examples where screening five years earlier has been consequential in identifying premalignant polyps and identifying early cancers before they metastasize when they are most likely to be cured. In many cases the polyps and even early cancers can simply be removed during a colonoscopy.
I cannot urge this message strongly enough: All Americans of average risk that are over 45, and especially those exhibiting symptoms, need to get tested. One alternative is to have a colonoscopy at least every 10 years or more often if there are abnormal findings. Alternatives include stool-based studies such as Cologuard or Hemoccult testing, which need to be done more often to be most effective. New technologies are unlocking the potential for blood-based screening tests as well.
The reason for this alarming increase in colorectal cancer incidence in younger adults is still being studied and the potential causes are debated in the scientific community. It is possible that there are several or even many different causes compounding the problem.
As someone who practices risk-reducing dietary and activity strategies to protect my own health, I commend President Donald Trump and Health and Human Services Secretary Robert Kennedy Jr. for their emphasis on disease prevention and identifying the causes of America's chronic illness epidemic and finding measures to prevent disease like colorectal cancer.
It is critical for all Americans to know what screenings are recommended at each stage in life. In general, everyone should get an annual physical, and see a dentist regularly — and everyone should receive the standard childhood vaccines.
The U.S. Preventive Services Task Force recommends women over 21 should get screened for cervical cancer and women over 40 to be screened for breast cancer. The task force recommends that smokers over 50 get checked for lung cancer. And men aged 55 to 69 are recommended to be screened for prostate cancer with a prostate specific antigen test. These and other screenings can help catch cancer or even precancerous growths as early as possible.
Unfortunately, surveys show that a large number of Americans don't get these tests done, including for reasons of cost. I understand why people might do this, but getting a checkup and talking to your health care provider about what screening tests are appropriate for you is the first step to taking action to improve our health and our lives.
Fortunately, there are also some positive trends in oncology to celebrate. Science continues to deliver great promise for the most vulnerable among us: the sick. In spite of some concerning short-term trends, cancer mortality has dropped by one-third since 1991, mainly because of a dramatic decrease in smoking. Life expectancy rose by almost a full year from 2022 to 2023.
In my field, recent studies have shown exciting potential for people with confirmed cancers that are called immuno-oncology approaches. These are cancer treatments that enable the immune system to kill cancer cells, rather than using the more traditional treatment methods including chemotherapy, radiation and radical surgery, which often have harrowing and sometimes lifelong side effects.
These approaches are changing the model in cancer care and particularly in my area of clinical practice and research, colorectal cancer. The benefits of these immune targeted therapies are changing treatments in many types of cancer.
However, only a small subset, about 5%, of colorectal cancers respond to this approach using currently approved therapeutic regimens. More research is needed on this treatment approach to determine how to best harness this powerful tool and get new drugs approved by the FDA to help the large majority of colorectal cancer patients.
But doctors, patients, and their loved ones can reasonably hope that the thousands of scientists around the world who are working to find better treatments and cures will change our current standards of care.
All of us should ensure that we receive the screenings and vaccines appropriate to our age — and that our kids do the same. An ounce of prevention is still worth at least a pound of cure.
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Atlantic
35 minutes ago
- Atlantic
‘We're Just Becoming a Weapon of the State'
Since winning President Donald Trump's nomination to serve as the director of the National Institutes of Health, Jay Bhattacharya—a health economist and prominent COVID contrarian who advocated for reopening society in the early months of the pandemic—has pledged himself to a culture of dissent. 'Dissent is the very essence of science,' Bhattacharya said at his confirmation hearing in March. 'I'll foster a culture where NIH leadership will actively encourage different perspectives and create an environment where scientists, including early-career scientists and scientists that disagree with me, can express disagreement, respectfully.' Two months into his tenure at the agency, hundreds of NIH officials are taking Bhattacharya at his word. More than 300 officials, from across all of the NIH's 27 institutes and centers, have signed and sent a letter to Bhattacharya that condemns the changes that have thrown the agency into chaos in recent months—and calls on their director to reverse some of the most damaging shifts. Since January, the agency has been forced by Trump officials to fire thousands of its workers and rescind or withhold funding from thousands of research projects. Tomorrow, Bhattacharya is set to appear before a Senate appropriations subcommittee to discuss a proposed $18 billion slash to the NIH budget—about 40 percent of the agency's current allocation. The letter, titled the Bethesda Declaration (a reference to the NIH's location in Bethesda, Maryland), is modeled after the Great Barrington Declaration, an open letter published by Bhattacharya and two of his colleagues in October 2020 that criticized 'the prevailing COVID-19 policies' and argued that it was safe—even beneficial—for most people to resume life as normal. The approach that the Great Barrington Declaration laid out was, at the time, widely denounced by public-health experts, including the World Health Organization and then–NIH director Francis Collins, as dangerous and scientifically unsound. The allusion in the NIH letter, officials told me, isn't meant glibly: 'We hoped he might see himself in us as we were putting those concerns forward,' Jenna Norton, a program director at the National Institute of Diabetes and Digestive and Kidney Diseases, and one of the letter's organizers, told me. None of the NIH officials I spoke with for this story could recall another time in their agency's history when staff have spoken out so publicly against a director. But none of them could recall, either, ever seeing the NIH so aggressively jolted away from its core mission. 'It was time enough for us to speak out,' Sarah Kobrin, a branch chief at the National Cancer Institute, who has signed her name to the letter, told me. To preserve American research, government scientists—typically focused on scrutinizing and funding the projects most likely to advance the public's health—are now instead trying to persuade their agency's director to help them win a political fight with the White House. Bhattacharya, the NIH, and the Department of Health and Human Services did not respond immediately to a request for comment. The agency spends most of its nearly $48 billion budget powering science: It is the world's single-largest public funder of biomedical research. But since January, the NIH has canceled thousands of grants —originally awarded on the basis of merit—for political reasons: supporting DEI programming, having ties to universities that the administration has accused of anti-Semitism, sending resources to research initiatives in other countries, advancing scientific fields that Trump officials have deemed wasteful. Prior to 2025, grant cancellations were virtually unheard-of. But one official at the agency, who asked to remain anonymous out of fear of professional repercussions, told me that staff there now spend nearly as much time terminating grants as awarding them. And the few prominent projects that the agency has since been directed to fund appear either to be geared toward confirming the administration's biases on specific health conditions, or to benefit NIH leaders. 'We're just becoming a weapon of the state,' another official, who signed their name anonymously to the letter, told me. 'They're using grants as a lever to punish institutions and academia, and to censor and stifle science.' NIH officials have tried to voice their concerns in other ways. At internal meetings, leaders of the agency's institutes and centers have questioned major grant-making policy shifts. Some prominent officials have resigned. Current and former NIH staffers have been holding weekly vigils in Bethesda, commemorating, in the words of the organizers, ' the lives and knowledge lost through NIH cuts.' (Attendees are encouraged to wear black.) But these efforts have done little to slow the torrent of changes at the agency. Ian Morgan, a postdoctoral fellow at the NIH and one of the letter's signers, told me that the NIH fellows union, which he is part of, has sent Bhattacharya repeated requests to engage in discussion since his first week at the NIH. 'All of those have been ignored,' Morgan said. By formalizing their objections and signing their names to them, officials told me, they hope that Bhattacharya will finally feel compelled to respond. (To add to the public pressure, Jeremy Berg, who led the NIH's National Institute of General Medical Sciences until 2011, is also organizing a public letter of support for the Bethesda Declaration, in partnership with Stand Up for Science, which has organized rallies in support of research.) Scientists elsewhere at HHS, which oversees the NIH, have become unusually public in defying political leadership, too. Last month, after Health Secretary Robert F. Kennedy Jr.—in a bizarre departure from precedent—announced on social media that he was sidestepping his own agency, the CDC, and purging COVID shots from the childhood-immunization schedule, CDC officials chose to retain the vaccines in their recommendations, under the condition of shared decision making with a health-care provider. Many signers of the Bethesda letter are hopeful that Bhattacharya, 'as a scientist, has some of the same values as us,' Benjamin Feldman, a staff scientist at the National Institute of Child Health and Human Development, told me. Perhaps, with his academic credentials and commitment to evidence, he'll be willing to aid in the pushback against the administration's overall attacks on science, and defend the agency's ability to power research. But other officials I spoke with weren't so optimistic. Many at the NIH now feel they work in a 'culture of fear,' Norton said. Since January, NIH officials have told me that they have been screamed at and bullied by HHS personnel pushing for policy changes; some of the NIH leaders who have been most outspoken against leadership have also been forcibly reassigned to irrelevant positions. At one point, Norton said, after she fought for a program focused on researcher diversity, some members of NIH leadership came to her office and cautioned her that they didn't want to see her on the next list of mass firings. (In conversations with me, all of the named officials I spoke with emphasized that they were speaking in their personal capacity, and not for the NIH.) Bhattacharya, who took over only two months ago, hasn't been the Trump appointee driving most of the decisions affecting the NIH—and therefore might not have the power to reverse or overrule them. HHS officials have pressured agency leadership to defy court orders, as I've reported; mass cullings of grants have been overseen by DOGE. And as much as Bhattacharya might welcome dissent, he so far seems unmoved by it. In early May, Berg emailed Bhattacharya to express alarm over the NIH's severe slowdown in grant making, and to remind him of his responsibilities as director to responsibly shepherd the funds Congress had appropriated to the agency. The next morning, according to the exchange shared with me by Berg, Bhattacharya replied saying that, 'contrary to the assertion you make in the letter,' his job was to ensure that the NIH's money would be spent on projects that advance American health, rather than 'on ideological boondoggles and on dangerous research.' And at a recent NIH town hall, Bhattacharya dismissed one staffer's concerns that the Trump administration was purging the identifying variable of gender from scientific research. (Years of evidence back its use.) He echoed, instead, the Trump talking point that 'sex is a very cleanly defined variable,' and argued that gender shouldn't be included as 'a routine question in order to make an ideological point.' The officials I spoke with had few clear plans for what to do if their letter goes unheeded by leadership. Inside the agency, most see few levers left to pull. At the town hall, Bhattacharya also endorsed the highly contentious notion that human research started the pandemic—and noted that NIH-funded science, specifically, might have been to blame. When dozens of staffers stood and left the auditorium in protest, prompting applause that interrupted Bhattacharya, he simply smiled
36 minutes ago
NIH scientists publish declaration criticizing Trump's deep cuts in public health research
WASHINGTON -- In his confirmation hearings to lead the National Institutes of Health, Jay Bhattacharya pledged his openness to views that might conflict with his own. 'Dissent," he said, 'is the very essence of science.' That commitment is being put to the test. On Monday, scores of scientists at the agency sent their Trump-appointed leader a letter titled the Bethesda Declaration, a frontal challenge to 'policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe.' It says: "We dissent." In a capital where insiders often insist on anonymity to say such things publicly, more than 90 NIH researchers, program directors, branch chiefs and scientific review officers put their signatures on the letter — and their careers on the line. They went public in the face of a 'culture of fear and suppression' they say President Donald Trump's administration has spread through the federal civil service. 'We are compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources,' the declaration says. Named for the agency's headquarters location in Maryland, the Bethesda Declaration details upheaval in the world's premier public health research institution over the course of mere months. It addresses the abrupt termination of 2,100 research grants valued at more than $12 billion and some of the human costs that have resulted, such as cutting off medication regimens to participants in clinical trials or leaving them with unmonitored device implants. In one case, an NIH-supported study of multi-drug-resistant tuberculosis in Haiti had to be stopped, ceasing antibiotic treatment mid-course for patients. In a number of cases, trials that were mostly completed were rendered useless without the money to finish and analyze the work, the letter says. 'Ending a $5 million research study when it is 80% complete does not save $1 million,' it says, 'it wastes $4 million.' The four-page letter, addressed to Bhattacharya but also sent to Health Secretary Robert F. Kennedy Jr. and members of Congress who oversee the NIH, was endorsed by 250 anonymous employees of the agency besides the 92 who signed. Jenna Norton, who oversees health disparity research at the agency's National Institute of Diabetes and Digestive and Kidney Diseases, recently appeared at a forum by Sen. Angela Alsobrooks, D-Md., to talk about what's happening at the NIH. At the event, she masked to conceal her identity. Now the mask is off. She was a lead organizer of the declaration. 'I want people to know how bad things are at NIH," Norton told The Associated Press. The signers said they modeled their indictment after Bhattacharya's own Great Barrington Declaration of October 2020, when he was a professor at Stanford University Medical School. His declaration drew together likeminded infectious disease epidemiologists and public health scientists who dissented from what they saw as excessive COVID-19 lockdown policies and felt ostracized by the larger public health community that pushed those policies, including the NIH. 'He is proud of his statement, and we are proud of ours," said Sarah Kobrin, a branch chief at the NIH's National Cancer Institute who signed the Bethesda Declaration. As chief of the Health Systems and Interventions Research Branch, Kobrin provides scientific oversight of researchers across the country who've been funded by the cancer institute or want to be. But sudden cuts in personnel and money have shifted her work from improving cancer care research to what she sees as minimizing its destruction. "So much of it is gone — my work,' she said. The 21-year NIH veteran said she signed because 'I don't want to be a collaborator' in the political manipulation of biomedical science. Ian Morgan, a postdoctoral fellow with the National Institute of General Medical Sciences, also signed the declaration. 'We have a saying in basic science,' he said. 'You go and become a physician if you want to treat thousands of patients. You go and become a researcher if you want to save billions of patients. 'We are doing the research that is going to go and create the cures of the future,' he added. But that won't happen, he said, if Trump's Republican administration prevails with its searing cuts to grants. The NIH employees interviewed by the AP emphasized they were speaking for themselves and not for their institutes or the NIH. Employees from all 27 NIH institutes and centers gave their support to the declaration. Most who signed are intimately involved with evaluating and overseeing extramural research grants. The letter asserts that 'NIH trials are being halted without regard to participant safety' and that the agency is shirking commitments to trial participants who 'braved personal risk to give the incredible gift of biological samples, understanding that their generosity would fuel scientific discovery and improve health.' The Trump administration has gone at public health research on several fronts, both directly, as part of its broad effort to root out diversity, equity and inclusion values throughout the bureaucracy, and as part of its drive to starve some universities of federal money. This has forced 'indiscriminate grant terminations, payment freezes for ongoing research, and blanket holds on awards regardless of the quality, progress, or impact of the science,' the declaration says. Some NIH employees have previously come forward in televised protests to air grievances, and many walked out of Bhattacharya's town hall with staff. The declaration is the first cohesive effort to register agency-wide dismay with the NIH's direction. A Signal group became the place for participants to sort through NIH chatter on Reddit, discern rumor from reality and offer mutual support. The declaration took shape in that group and as word spread neighbor to neighbor in NIH offices. The dissenters remind Bhattacharya in their letter of his oft-stated ethic that academic freedom must be a lynchpin in science. With that in place, he said in a statement in April, 'NIH scientists can be certain they are afforded the ability to engage in open, academic discourse as part of their official duties and in their personal capacities without risk of official interference, professional disadvantage or workplace retaliation." Now it will be seen whether that's enough to protect those NIH employees challenging the Trump administration and him. 'There's a book I read to my kids, and it talks about how you can't be brave if you're not scared,' said Norton, who has three young children. "I am so scared about doing this, but I am trying to be brave for my kids because it's only going to get harder to speak up. 'Maybe I'm putting my kids at risk by doing this," she added. "And I'm doing it anyway because I couldn't live with myself otherwise.'
Washington Post
44 minutes ago
- Washington Post
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