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"Too much medical information comes with its own harms." A doctor reflects on Joe Biden's recent diagnosis. Plus:

Dhruv Khullar

Khullar is a practicing physician and writes about medicine, health care, and politics for The New Yorker.

On Sunday, Joe Biden disclosed that he has an aggressive form of prostate cancer that has spread to the bone, which means that it can be managed but not cured. The news roughly coincided with the promotion of a book whose authors argue that his inner circle engaged in misdirection, if not obfuscation, about his mental acuity near the end of his term. Sympathy quickly gave way to speculation regarding what Biden had known about his cancer, and when he'd known it. Donald Trump said that he felt "very badly," but that "people should try and find out what happened" and that "somebody is not telling the facts."

Prostate cancer, which kills more men than almost any other cancer, can be diagnosed with a quick blood test for a biomarker called prostate-specific antigen. Many observers were perplexed that an eighty-two-year-old man with virtually unlimited access to medical care -- and about whose health there has been virtually unlimited conjecture -- could have gone undiagnosed until the cancer threatened his life. It's reasonable to wonder, Shouldn't every man get tested, just in case? "You have to be your best advocate," Ana Navarro, a political strategist who co-hosts ABC's "The View," told viewers in response to Biden's news. "If you are over seventy and they're telling you, 'No P.S.A. necessary' -- require a P.S.A. Make it a point."

But not all cancer tests are straightforward. Some men who develop prostate cancer take P.S.A. tests and have normal results. Many men with elevated levels don't have cancer, or they have a cancer so slow-growing that it's of little concern. (Roughly one in eight are diagnosed with prostate cancer; by some estimates, most men over the age of eighty have some cancerous cells in their prostate.) Too much medical information comes with its own harms. In a 2015 piece for this magazine, Atul Gawande wrote that the medical system too often performs tests, "unnecessarily, to reveal problems that aren't quite problems to then be fixed, unnecessarily, at great expense and no little risk."

For these reasons, some medical organizations, such as the United States Preventive Services Task Force, currently counsel against P.S.A. tests in men aged seventy or older, and advise younger men to talk to their doctors about potential harms of screening -- unnecessary biopsies, overdiagnosis, treatment complications including erectile dysfunction and urinary incontinence. (Once, while reporting a piece, I got a full-body MRI that unearthed an indeterminate spot in my prostate; a P.S.A. test and follow-up MRI later, it's still not clear what it is.) Of course, one can question whether such guidelines are sufficient for the leader of the free world. Trump, Barack Obama, and George W. Bush all shared P.S.A. results during their terms; on Tuesday, Biden's office said that his last test was in 2014, when he was seventy-one.

A bright spot for Biden, in a morass of difficult news, is that his cancer appears to be "hormone-sensitive." Drugs that suppress testosterone can be used to treat the condition. Partisans can disagree about which kinds of health records Presidents should release, and whether Biden should have been tested sooner. But one thing that's not in doubt is the role that medical research has played here. When Biden was first elected to the Senate, at twenty-nine, life expectancy for men with metastatic prostate cancer was dismal. Today, many patients live for years -- the product of half a century of scientific progress. The Trump Administration is currently carrying out drastic cuts to the types of federal research that help keep cancer patients alive. Biden has been given the same grave prognosis that many thousands of Americans receive each year. American science shouldn't be given one, too.

Amid the destruction of America's public-health systems, Trump's Surgeon General nominee, Casey Means, believes that your wellness is yours alone to defend. For long stretches of the book "Good Energy," which Means co-authored, the prescription seems to be fear: "fear of Smartfood popcorn and Ben & Jerry's ice cream. Fear of progestin pills and dryer sheets and unfiltered shower water. Fear of your glucose levels, or of not knowing what your glucose levels are at any given moment." Means does not have an active medical license. Jessica Winter reports "

P.S. Wedding season is upon us. Here's hoping you don't have a bride in your life requesting that her bridesmaids wear "the color of the feeling of when my mom made me peppermint waffles." 👰